수술장 투시영상을 통한 동맥경화증의 혈관 내 치료의 초기 결과

한언철,이태승 대한외과학회 2010 대한외과학회 학술대회 초록집 Vol.2010 No.11

[Free Paper] 만성 가성 장폐쇄에 대한 외과적 치료 성적

한언철,오홍권,하헌균,신루미,최은경,정승용,박규주 대한외과학회 2011 대한외과학회 학술대회 초록집 Vol.2011 No.11

Feasibility of Superficial Femoral Artery Intervention Using Mobile C-arms Compared to Fixed C-arms

한언철,박형섭,윤창진,강성권,이태승 대한혈관외과학회 2012 Vascular Specialist International Vol.28 No.4

Purpose: Endovascular therapy (ET) for peripheral arterial occlusive disease has increased dramatically in the past decade. ET is currently being performed by different specialists with available resources, with some of these resources being far superior to others, yet there have been no studies comparing the interventional outcomes according to the varying resources. The aim of this study was to analyze the outcomes of ET for superficial femoral artery (SFA) atherosclerosis using a mobile C-arm, in comparison to a historical control group. Methods: Between March 2009 and December 2010, ET for SFA atherosclerosis was performed in 54 limbs from 47 patients using a mobile C-arm in the operation theater (mobile group). In contrast, a historical group for comparison consisted of 60 patients, for whom ET for SFA atherosclerosis was performed in 76 limbs using a fixed C-arm in the angiographic suite, between July 2003 and May 2008 (fixed group). The outcomes of ET for both groups were retrospectively analyzed by a medical chart review. Results: There was no statistically significant difference in gender, age, risk factors, Trans-Atlantic Inter-Society Consensus (TASC) classification, intervention type, and postoperative blood creatinine levels between the two groups. However, procedural time was statistically higher in the mobile group. Patency rates at 1 year were 68.3% and 68.1% in the fixed and mobile group, respectively, which was not statistically significant. Subgroup analysis of 1 year patency rates for TASC A, B lesions and TASC C, D lesions were also similar. Conclusion: ET using the mobile C-arm in the operating theater is as effective as using the fixed C-arm,in the treatment of SFA atherosclerosis in terms of the technical success, patency, and early postoperative outcomes.

Gastrointestinal hemangioma in childhood: a rare cause of gastrointestinal bleeding

한언철,김수홍,김현영,정성은,박귀원 대한소아청소년과학회 2014 Clinical and Experimental Pediatrics (CEP) Vol.57 No.5

Gastrointestinal (GI) hemangiomas are relatively rare benign vascular tumors. The choice of anappropriate diagnostic method depends on patient age, anatomic location, and presenting symptoms. However, GI hemangiomas are not a common suspected cause of GI bleeding in children because oftheir rarity. Based on medical history, laboratory results, and imaging study findings, the patient couldbe treated with either medication or surgery. Herein, we report 3 cases of GI hemangioma found in thesmall bowel, rectum, and GI tract (multiple hemangiomas). Better knowledge and understanding of GIhemangioma could help reduce the delayed diagnosis rate and prevent inappropriate management. Although rare, GI hemangiomas should be considered in the differential diagnosis of GI bleeding.

Long-term Outcomes and Risk Factors for Reoperation After Surgical Treatment for Gastrointestinal Crohn Disease According to Anti-tumor Necrosis Factor-α Antibody Use: 35 Years of Experience at a Single Institute in Korea

이상목,한언철,유승범,오흥권,최은경,문상희,김주성,정현채,박규주 대한대장항문학회 2015 Annals of Coloproctolgy Vol.31 No.4

Purpose: Crohn disease is characterized by high rates of recurrence and reoperations. However, few studies have investigated long-term surgical outcomes in Asian populations. We investigated risk factors for reoperation, particularly those associated with anti-tumor necrosis factor-α (anti-TNF-α) antibody use, and long-term follow-up results. Methods: We reviewed the records of 148 patients (100 males and 48 females) who underwent surgery for gastrointestinal Crohn disease and retrospectively analyzed long-term outcomes and risk factors. Results: The mean age at diagnosis was 28.8 years. Thirty-eight patients (25.7%) received monoclonal antibody treatment before reoperation. A small bowel and colon resection was most commonly performed (83 patients, 56.1%). The median follow-up was 149 months, during which 47 patients underwent reoperation. The median interval between the primary and the secondary surgeries was 65 months, with accumulated reoperation rates of 16.5%, 31.8%, and 57.2% after 5, 10, and 15 years, respectively. Obstruction was the most common indication for reoperation (37 patients, 25.0%). In a multivariable analysis, age <17 years at diagnosis (A1) (odds ratio [OR], 2.20; P = 0.023), penetrating behavior (B3) (OR, 4.39; P < 0.001), and no azathioprine use (OR, 2.87; P = 0.003) were associated with reoperation. Anti-TNF-α antibody use did not affect the reoperation rate (P = 0.767). Conclusion: We showed a high reoperation rate regardless of treatment with anti-TNF-α antibody, which indicates that recurrent surgery is still needed to cure patients with gastrointestinal Crohn diseases. Younger age at primary operation, penetrating behavior, and no azathioprine use were significant factors associated with reoperation for gastrointestinal Crohn disease.

Rectourethral Fistula: Systemic Review of and Experiences With Various Surgical Treatment Methods

최지혜,전병건,최상지,한언철,하헌균,오흥권,최은경,문상희,유승범,박규주 대한대장항문학회 2014 Annals of Coloproctolgy Vol.30 No.1

Purpose: A rectourethral fistula (RUF) is an uncommon complication resulting from surgery, radiation or trauma. Although various surgical procedures for the treatment of an RUF have been described, none has gained acceptance as the procedure of choice. The aim of this study was to review our experience with surgical management of RUF. Methods: The outcomes of 6 male patients (mean age, 51 years) with an RUF who were operated on by a single surgeon between May 2005 and July 2012 were assessed. Results: The causes of the RUF were iatrogenic in four cases (two after radiation therapy for rectal cancer, one after brachytherapy for prostate cancer, and one after surgery for a bladder stone) and traumatic in two cases. Fecal diversion was the initial treatment in five patients. In one patient, fecal diversion was performed simultaneously with definitive repair. Four patients underwent staged repair after a mean of 12 months. Rectal advancement flaps were done for simple, small fistula (n = 2), and flap interpositions (gracilis muscle flap, n = 2; omental flap, n = 1) were done for complex or recurrent fistulae. Urinary strictures and incontinence were observed in patients after gracilis muscle flap interposition, but they were resolved with simple treatments. The mean follow-up period was 28 months, and closure of the fistula was achieved in all five patients (100%) who underwent definitive repairs. The fistula persisted in one patient who refused further definitive surgery after receiving only a fecal diversion. Conclusion: Depending on the severity and the recurrence status of RUF, a relatively simple rectal advancement flap repair or a more complex gracilis muscle or omental flap interposition can be used to achieve closure of the fistula.

Prognostic Impact of Changes in Adipose Tissue Areas after Colectomy in Colorectal Cancer Patients

최은경,박규주,유승범,문상휘,오흥권,한언철 대한의학회 2016 Journal of Korean medical science Vol.31 No.10

There have been few studies assessing the changes in the body components of patients after colectomy in colorectal cancer (CRC). The purpose of this study was to verify the trends in the adipose tissue areas of CRC patients before and after surgery and to determine their clinical relevance. Computed tomography (CT)-assessed subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) areas were recorded before and after curative resection in stage I to III CRC patients. Changes in the adipose tissue were assessed by calculating the difference in the adipose tissue area between preoperative CT and the most recent postoperative CT, which is disease-free state. Regarding obesity before surgery, there were no prognostic effect of body mass index (BMI), VAT and SAT, and 47.3% of patients had increases in VAT after colectomy. By multivariate analysis, adjusting sex, age, stage, differentiation, VAT change was the only obesity related factor to predict the prognosis, that patients who had increase in VAT after colectomy had better overall survival (HR, 0.557; 95% CI, 0.317-0.880) and disease-free survival (HR, 0.602; 95% CI, 0.391-0.927). BMI and SAT change had no significant association. In subgroup analysis of stage III CRC patients, VAT change had significance for prognosis only in patients who had adjuvant chemotherapy but not in those who did not receive postoperative chemotherapy. Increase in visceral adipose tissue after surgery is a favorable predictor of prognosis for CRC patients.

재발한 대장암에서 재발 후 생존율에 영향을 미치는 위험인자 분석

김유미(Yu Mi Kim),박병관(Byung Kwan Park),박지원(Ji Won Park),한언철(Eon Chul Han),유승범(Seung-Bum Ryoo),정승용(Seung-Yong Jeong),박규주(Kyu Joo Park) 대한종양외과학회 2014 Korean Journal of Clinical Oncology Vol.10 No.2

Purpose: Recently, survival after recurrence (SAR) has been one of the major concerns after recurrence of colorectal carcinoma. To identify the risk factors about SAR is important as much as to identify the risk factors about recurrence. It provides us useful information for treatment strategy to know which patient will be expected with long term survival after recurrence. This study was aimed to identify the risk factors about overall SAR in recurred colorectal carcinoma. Methods: Between January 2002 and December 2005, two hundred twenty one patients, who had recurrence of colorectal carcinoma after initial curative resection at Seoul National University Hospital, were included. Clinicopathologic characteristics and survival outcomes were retrospectively reviewed. Survival analysis was performed to identify the risk factors for SAR. Results: Median recurrence time after initial curative resection was 22.5 months (range, 0?93.0 month). Median follow-up time after recurrence was 34.8 months (range, 0?130.0 month). In univariate analysis, low body mass index, preoperative elevated carcinoembryonic antigen (CEA) level, high grade histology, metastatic disease and perineural invasion were significant associated with poor SAR. In multivariate analysis, preoperative elevated CEA (hazard ratio [HR], 1.517; 95% confidence interval [CI], 1.088?2.114; P=0.014), high grade histology (HR, 2.307; 95% CI, 1.343?3.961; P=0.002) and treatment after recurrence (HR, 2.755; 95% CI, 1.374?5.524; P=0.004) were significant associated with poor SAR. Conclusion: Preoperative elevated CEA, high grade histology and treatment after recurrence were independent risk factors for SAR.