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허건웅,신동우,백소야,김일동,김기호,서병선,박진수,김상욱,Heo, Geon-Woong,Shin, Dong-Woo,Paik, So-Ya,Kim, Il-Dong,Kim, Ki-Ho,Suh, Byung-Sun,Park, Jin-Soo,Kim, Sang-Wook 대한위암학회 2007 대한위암학회지 Vol.7 No.4
목적: 위와 소장에 발생한 위장관 간질종양의 임상병리학적 특징을 비교하여 예후 인자 및 적절한 치료의 방침을 알아보고자 하였다. 대상 및 방법: 대진의료재단 분당제생병원에서 1998년 8월부터 2006년 5월까지 위장관 간질종양으로 진단된 38명의 환자 중 분석 및 추적 조사가 가능했던 29명의 환자에서 임상 양상을 조사하고, 면역조직화학적 염색을 시행하였으며, NIH 합의안에 따라 위험도를 분류하여 각각 위와 소장에서 발생한 위장관 간질종양을 비교하였다. 결과: 위와 소장에 발생한 위장관 간질종양의 임상병리학 적 차이 및 재발 양상의 차이는 없었으며, NIH 위험도 분류에 따라 나눈 고위험군과 저위험군 간에 재발의 차이는 있었다(P=0.030). 결론: 위장관 간질종양에서 원발 부위인 위와 소장간에 임상병리학적 양상이나 예후에 통계학적으로 유의한 차이는 없었으나, NIH 분류에 의한 고위험군에서는 재발 가능성이 높으므로 치료 지침에 따른 적절한 추적관찰이 필요하며, 앞으로 여러 기관의 예를 통합한 큰 모집단을 대상으로 지속적인 연구를 시행하여 국내 실정에 맞는 정확한 진단 기준 및 치료지침이 만들어져야 될 것으로 사료된다. Purpose: The purpose of this study is to compare the clinicopathological characteristics of stomach and small bowel gastrointestinal stromal tumors and to determine the risk factors and treatment guidelines. Materials and Methods: Among 38 patients who were diagnosed with a gastrointestinal stromal tumor from August 1998 to May 2006, 29 patients at the Pundang Jesaeng General Hospital, Daejin Medical Center were evaluated. The clinicopathological characteristics of gastrointestinal stromal tumors arising from stomach and small bowel were compared. Immunohistochemical staining for CD117, CD34, smooth muscle actin, desmin, and S-100 protein was performed and classified according to NIH criteria. Prognosis between groups was analyzed according to NIH criteria. Results: There was no significant difference in the clinicopathological characteristics and prognosis between gastrointestinal stromal tumors arising from the stomach and small bowel. Recurrence of the disease occurred in four (13.8%) patients. Classification of gastrointestinal stromal tumors according to NIH criteria was predictive of recurrence (P=0.030). Conclusion: NIH criteria were predictive of recurrence, but the location of the primary site was not predictive of recurrence. A further study involving multi center data and a long-term follow-up will be needed for formulating diagnostic and therapeutic guidelines.
위암 환자에서 da Vinci<SUP>®</SUP> Surgical System을 이용한 위절제술의 초기 경험
허건웅(Geon-Ung Heo),김민찬(Min-Chan Kim),정갑중(Ghap-Joong Jung),최석렬(Seok Reyol Choi) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.5
Purpose: To assess the feasibility of the da Vinci<SUP>®</SUP> surgical system in performing gastrectomies for gastric cancer. Methods: Between 31 December 2007 and 30 June 2008, twenty patients underwent robotic gastrectomies using the da Vinci<SUP>®</SUP> surgical system for gastric cancer. Retrospectively, clinicopathologic and postoperative surgical outcomes were retrieved from the Stomach Cancer Database at Dong-A University Medical Center. Results: Two patients with serosa invasion required conversion to laparotomy. Seventeen robotic distal gastrectomies and one robotic total gastrectomy were performed. Most patients underwent D1+β or D2 lymph node dissection. The average number of retrieved lymph nodes was 41. Mean operative time was 271 minutes. Estimated blood loss was 30 ml and mean postoperative hospital stay was 5.1 days. No postoperative complications were reported. Conclusion: While application of robotic technology for gastric cancer is technically feasible, problems of long operative times and extremely high costs remain. More randomized studies comparing long-term surgical outcomes between robotic, conventional open, and laparoscopic surgery are needed.
A Case of Endoscopic Resection of a Colonic Semipedunculated Leiomyoma
이승화,허건웅,정유석 대한대장항문학회 2011 Annals of Coloproctolgy Vol.27 No.4
During colonoscopic examination, epithelial lesions, such as adenomatous polyps, are frequently encountered, unlike sub- epithelial lesions, such as leiomyomas, which are uncommon. A colonic leiomyoma is a rare tumor, originating either from the mucularis mucosa or from the proper muscle, and accounts for only 3% of all gastrointestinal leiomyomas. Colonic leio- myomas are usually benign and asymptomatic. However, they can sometimes cause symptoms, ie, abdominal pain, intesti- nal obstruction, hemorrhage, and perforation. The traditional management option for a colonic leiomyoma is surgical re- section. Recently, with the development of endoscopy devices and techniques, the endoscopic resection has been consid- ered as an alternative treatment option. We experienced a patient with a leiomyoma that was diagnosed during colonoscopy. The leiomyoma was resected endoscopically without complication. We report this case with a review of the literature.