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갑상선 수술의 해부학적 지표로서의 Zuckerkandl 결절의 중요성
윤지섭,정종주<SUP>1<,SUP>,이용상<SUP>1<,SUP>,남기현<SUP>1<,SUP>,정웅윤<SUP>1<,SUP>,장항석<SUP>1<,SUP>,박정수<SUP>1<,SUP>,Ji-Sup Yun,Jong Ju Jeong,<SUP>1<,SUP>,Yong Sang Lee,<SUP>1<,SUP>,Kee Hyun Nam,<SUP>1<,SUP>,Woong You 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.4
Purpose: Zuckerkandl's tubercle (ZT) of the thyroid gland is a well-documented anatomical structure. This study evaluated the anatomical relationship of the ZT in terms of the recurrent laryngeal nerve (RLN) and the superior parathyroid gland (SP). Methods: The study included 325 patients (ten patients with benign tumors and 315 patients with malignancies) who underwent thyroid surgery between February and June 2007. Tubercles were classified according to size: Grade 0 (unrecognizable), Grade I (≤ 5 mm), Grade II (6∼10 mm) and Grade III (>10 mm). The incidence and size of the ZT and its positional relationship to the RLN and SP were investigated during thyroid surgery. Results: ZTs were identified in most patients (right thyroid 89.3%, left thyroid 85.6%). The percentageof tubercles according to grade and location was as follows: Grade 0, right thyroid 10.7% and left thyroid 14.4%; Grade I, right thyroid 7.9% and left thyroid 11.1%; Grade II, right thyroid 43.5% and left thyroid 38.5%; Grade III, right thyroid 37.9% and left thyroid 35.9%. The most common RLN course was in a groove between the ZT and the main body of the thyroid. Most of the SPs are situated cranial to the ZTs and were located at the 1 or 2 o'clock position (96.1%) in the left thyroid and at the 10 or 11 o'clock position (95.2%) in the right thyroid. A greater distance between the ZT and the SP was seen with a decreasing size of the ZT. Conclusion: The ZT was identified during most thyroidectomies, and there was a constant relationship between the ZT and either the RLN or SP. Therefore, identification of the ZT and an understanding of the relationship between the ZT and either the RLN or SP are essential for the performance of safe thyroid surgery. (Korean J Endocrine Surg 2007;7:237-241)
윤지섭,이잔디,임치영,남기현,정웅윤,박정수,Ji-Sup Yun,M,D,Jandee Lee,M,D,Chi-Young Lim,M,D,Kee-Hyun Nam,M,D,Woung Youn Chung,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2006 The Koreran journal of Endocrine Surgery Vol.6 No.2
Purpose: Subacute thyroiditis (SAT) is an uncommon, self- lemiting inflammatory disorder. If clinicians cannot rule out thyroid cancer in SAT patients with a thyroid nodule, surgical management can be considered. This study was performed to review the clinical characteristics of patients who were treated surgically for SAT presenting with thyroid nodule. Methods: We retrospectively reviewed the clinical features of 14 cases who underwent an operation for SAT with a thyroid nodule between January 1986 and May 2006 at our institution. Results: There were 3 male and 11 female patients, with a mean age of 47 years. All patients underwent surgical management prior to 1998. Twelve patients had thyroidal pain, 6 had viral prodromal symptoms, and 5 had hyperthyroidisms. Preoperative erythrocyte sedimentation rates (ESRs) (n=4) were elevated in 3 patients. Decreased uptake of radioiodine was reported in all 6 patients for whom scans were performed (n=6). Fine needle aspiration biopsy (FNAB) was performed in 4. In this study, the operative indications were clinically indeterminate thyroid nodule (n=14); lobectomy in 8, lobectomy with partial thyroidectomy in 2, lobectomy with near total thyroidectomy in 2, and bilateral total thyroidectomy in 2. Hoarseness occurred in one patient. Conclusion: SAT is usually managed clinically, but patients presenting with an indeterminate thyroid nodule will require surgical management even though they may have more benign characteristics. Most surgeons have to wait for the results of frozen biopsy because limited resectioning can be performed if the results are benign. (Korean J Endocrine Surg 2006;6:83-86)
갑상선 유두암의 암성 혈전으로 인한 상공 정맥 증후군 1예
윤지섭(Ji-Sup Yun),이잔디(Jandee Lee),임치영(Chi-Young Lim),남기현(Kee-Hyun Nam),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.2
Papillary thyroid carcinoma is rarely associated with macroscopic vascular invasion or tumor thrombosis. Especially, superior vena cava syndrome(SVCS) resulted from tumor thrombosis of papillary thyroid car-cinoma is extremely rare. We present herein a case of SVCS caused by tumor thrombosis from papillary thyroid carcinoma which was successfully solved by intravascular placement of self-expandable stent in 74-year-old woman.
중앙 경부 재발 유두 갑상선암으로 수술한 환자의 재발 양상과 수술 합병증
윤지섭(Ji-Sup Yun),이용상(Yong Sang Lee),정종주(Jong Joo Jung),남기현(Kee-Hyun Nam),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.1
Purpose: Central compartment reoperation for recurrent thyroid carcinoma is challenging to surgeons due to the scar tissues and adhesions and the distortion of the normal anatomic relationships. This study was carried out to investigate the central neck recurrence patterns and the surgical morbidity of reoperation for patients with papillary thyroid carcinoma. Methods: The study population was comprised 68 papillary thyroid carcinoma patients (15 males and 53 females, median age: 50.8 years [range: 12∼78 years]) who underwent reoperation for recurrent tumors in the central compartment of the neck between January 1999 and June 2007. All of the patients had undergone prior total thyroidectomy. Results: Of the 68 patients, 21 recurrences occurred in the proper thyroid tissue of the thyroid bed, 43 in the central neck nodes and 4 in a combination of the central nodes and proper thyroid tissue. The common recurrent site from the proper thyroid tissue were at the berry ligaments and at the level of the upper one-third of the recurrent laryngeal nerves, while the common nodal recurrence sites were the lower-most portion of the paratracheal nodes and the right paraesophageal nodes (the lymph nodes posterior to the right recurrent laryngeal nerve). Eleven cases of transient hypocalcemia (17.5%, 11/63) and 3 cases of permanent hypocalcemia (4.3%, 3/63) were noted after reoperation. Recurrent laryngeal nerve injury occurred in 5 patients (8.1%, 5/62), but three of them were intentionally resected with the recurrent cancers. Conclusion: Reoperation for central neck recurrence of papillary thyroid carcinoma is associated with a higher complication rate. Meticulous surgical dissection of the central compartment based on the recurrent patterns is important to reduce injury to the recurrent laryngeal nerves and parathyroid glands.
갑상선암에 대한 로봇 보조 내시경적 갑상선 절제술; 100예에 대한 초기 경험
강상욱 ( Sang-wook Kang ),정종주 ( Jong Ju Jeong ),윤지섭 ( Ji-sup Yun ),성태연 ( Tae Yon Sung ),이승철 ( Seung Chul Lee ),이용상 ( Yong Sang Lee ),남기현 ( Kee-hyun Nam ),장항석 ( Hang Seok Chang ),정웅윤 ( Woong Youn Chung ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.2
Background and Objectives: Various surgical procedures have been performed using surgical robot in recent years and most reports proved that application of robotic technology for surgery is technically feasible and safe. The aim of this study is to introduce our technique of robot-assisted endoscopic thyroid surgery and demonstrate its utility in the surgical management of thyroid cancer. Materials and Methods: From October 4<sup>th</sup> 2007 through March 14<sup>th</sup> 2008, 100 patients with papillary thyroid cancer underwent robot-assisted endoscopic surgeries using a gasless trans-axillary approach. This novel robotic surgical approach allowed adequate endoscopic access for thyroid surgeries. All the procedures were completed successfully using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California, USA). We used four robotic arms with this system; a 12 mm telescope and three 5 mm instruments. The 3-dimensional magnified visualization obtained by the dual-channel endoscope and tremor-free instruments controlled by robot system helped surgeon do sharp and precise endoscopic dissection. Results: We performed 84 less-than total and 16 total thyroidectomies with ipsilateral central compartment node dissection. Mean operation times was 136.5 min. (range 79∼267 min.) in which the actual time for thyroidectomy with lymphadenectomy (console time) was 60.0 min. (range 25∼157 min). The average number of lymph nodes resected was 5.3 (range 1 to 28). There was no serious complication. Most patients could go home within 3 days after surgery. Conclusion: Our technique of robotic-assisted endoscopic thyroid surgery using a gasless trans-axillary approach is feasible, safe and promising for the selected patients with thyroid cancer. We suggest application of robotic technology for endsocopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.
측경부 림프절 청소술을 요하는 갑상선암 환자에서 척수부신경 상측 림프절 청소술이 필요한가?
성태연,윤지섭,정종주,이용상,남기현,정웅윤,장항석,박정수,Tae Yon Sung,M,D,Ji-Sup Yun,M,D,Jong Ju Jeong,M,D,Yong Sang Lee,M,D,Kee-Hyun Nam,M,D,Woong Youn Chung,M,D,Hang Seok Chang,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.2
Purpose: Controversy still exists concerning the extent of neck nodedissection in thyroid carcinoma patients. A modified neck dissection is usually performed for the treatment of thyroid carcinoma patients with positive lateral neck nodes. When performing a neck dissection, removal of the nodes superior to the spinal accessory nerve (level IIB) is difficult and time consuming. This study was performed to determine whether level IIB node dissection is always necessary in therapeutic neck dissection for metastatic papillary thyroid carcinoma. Methods: A total of 200 neck dissections were performed in 175 papillary thyroid carcinoma patients with positive lateral neck nodes between September 2005 and June 2007. The patterns of lateral neck metastasis were analyzed with respect to neck level, but the level IIB nodes were studied as separate specimens. Potential factors predicting level IIB node metastasis were also evaluated. Results: The most common site of metastasis was level III, showing 95.0% (190/200), followed by level IV 66.0% (132/200), level IIA 54.0% (108/200), and level V 15.5% (31/200). Level IIB metastases were seen in 12 necks (6.0%) and seen only in the necks with positive level IIA nodes. In 11 of the 12 necks, the primary tumors were located in the upper pole of the thyroid. Conclusion: Level IIB node dissection is not necessary when there is no level IIA metastasis. Even when there is level IIA metastasis, level IIB node dissection is not always necessary, unlessthe primary tumors are located in the upper pole of the thyroid. (Korean J Endocrine Surg 2007;7:88-93)
김국진,이잔디,윤지섭,임치영,남기현,장항석,정웅윤,박정수,Kuk-Jin Kim,M,D,Jandee Lee,M,D,Ji Sup Yun,M,D,Chi-Young Lim,M,D,Kee-Hyun Nam,M,D,Hang-Seok Chang,M,D,Woong Youn Chung,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2006 The Koreran journal of Endocrine Surgery Vol.6 No.1
Bone metastases as the first manifestation of thyroid carci- noma are extremely rare. Interestingly, evaluation at appropriate initials and proper treatment will lead to satisfactory long-term survival. We report here on two such cases; the patients presented with back pain and fine needle aspiration cytology of spine lesion revealed a metastatic carcinoma. A wide excision of the bone lesion was carried out and the histopathology was consistent with features of metastatic carcinoma of the thyroid. The management of thyroid carcinoma and the subsequent bone metastases is reviewed and the controversial points are highlighted. (Korean J Endocrine Surg 2006;6:46-49)