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황순휘(Sun-Hwi Hwang),박도중(Do Joong Park),박영수(Young Soo Park),이경호(Kyoung Ho Lee),김영훈(Young Hoon Kim),이혜승(Hye Seung Lee),이혁준(Hyuk-Joon Lee),김형호(Hyung-Ho Kim),양한광(Han-Kwang Yang),이건욱(Kuhn Uk Lee) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.5
Liposarcoma is a mesenchymal malignant tumor which occurs most frequently in the limbs, retroperitoneum, and trunk: Although primary liposarcoma may occur anywhere adipose tissue is found, visceral locations are only rarely represented. Moreover, primary gastric liposarcoma is extremely rare. So, only a few cases of primary gastric liposarcoma have been reported in English literature. We describe the case of a 43-year-old woman presenting with melena, epigastric pain, general weakness. Esophagogastroduodenoscopy (EGD) showed a 6×4×3 ㎝ sized-mass which was located on the posterior gastric wall. By endoscopic ultrasonography and abdominal CT scan, we suspected gastric lipoma and performed the laparoscopic transgastric tumor resection by eversion method. Finally, it was confirmed as a gastric liposarcoma pathologically. Herein, we present a case of gastric liposarcoma which was resected by laparoscopic transgastric wedge resection.
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위암수술 환자에서의 cp 개발과 cp적용에 따른 질 향상 활동에 관한 연구
임은주,황순휘,박도중,하광일,배현주,김형호 한국의료QA학회 2006 한국의료질향상학회지 Vol.13 No.2
Background : In an era of increasing medical costs, safe reduction in postoperative stay has become a major focus to optimize utilization of healthcare resources. The authors aimed to evaluate the clinical significance of the critical pathway(CP) for gastrectomy patients by implementing standardized postoperative management and electronic medical records. Method : From August 2006 to April 2007, critical pathways were introduced to inpatients and outpatients with gastric cancer. 60 consecutive patients undergoing distal gastrectomy were randomly divided into two groups; 30 CP group(A) and 30 non-CP group(B). Simultaneously, we also retrospectively reviewed the records of 438 patients(C:control group) who were able to be enrolled in CP program. We compared group(A) with (B), (C) in terms of hospital stay, complication rate, use of antibiotics and hospital costs. Patient satisfaction was surveyed by questionnaires. Result : There was no significant demographic difference between group(A) and (B). Of 30 patients in group(A), 5 drop-outs and 14 variances occurred. The mean postoperative hospital stays(Laparoscopy-assisted distal gastrectomy: LADG/Open distal gastrectomy: ODG) were 7.6/10.5 days for the group(A), 8.9/12.7 days for the group(B) and 12.6/14.5 days for the group(C) (p=0.02 in LADG). The total hospital cost of group(A) had a tendency to be less than that of group(B) and the amount of hospital cost per day in group(A) was significantly higher than that in group(B). The usage rates of the first generation antibiotics were 73.33%, 63.33%, and 59.2% in group(A), (B), and (C), respectively. Patients’ satisfaction had a tendency to be higher in the CP group than non-CP group. Conclusion : The mean hospital stay in LADG patients was shortened meaningfully and hospital cost per day was enlarged after introduction of clinical pathway. It is necessary to apply a number of patients to the critical pathway and to make an effort to reduce the variation and drop-out rates.
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