Minimally invasive surgery for maximally invasive tumors: pelvic exenterations for rectal cancers

Mufaddal Kazi,Ashwin Desouza,Chaitali Nashikkar,Avanish Saklani 대한내시경로봇외과학회 2022 Journal of Minimally Invasive Surgery Vol.25 No.4

Purpose: Trials comparing minimally invasive rectal surgery have uniformly excluded T4 tumors. The present study aimed to determine the safety of minimally invasive surgery (MIS) for locally-advanced rectal cancers requiring pelvic exenterations based on benchmarked outcomes from the international PelvEx database. Methods: Consecutive patients of T4 rectal cancers with urogenital organ invasion that underwent MIS exenterations between November 2015 and June 2022 were analyzed from a single center. A safety threshold was set at 20% for R1 resections and 40% for major complications (≥grade IIIA) for the upper limit of the 95% confidence interval (CI). Results: The study included 124 MIS exenterations. A majority had a total pelvic exenteration (74 patients, 59.7%). Laparoscopic surgery was performed in 95 (76.6%) and 29 (23.4%) had the robotic operation. Major complications were observed in 35 patients (28.2%; 95% CI, 20.5%–37.0%). R1 resections were found pathologically in nine patients (7.3%; 95% CI, 3.4%–13.4%). The set safety thresholds were not crossed. At a median follow-up of 15 months, 44 patients (35.5%) recurred with 8.1% local recurrence rate. The 2-year overall and disease-free survivals were 85.2% and 53.7%, respectively. Conclusion: MIS exenterations for locally-advanced rectal cancers demonstrated acceptable morbidity and safety in term of R0 resections at experienced centers. Longer follow-up is required to demonstrate cancer survival outcomes.

Is it Possible to Successfully Treat Locally Advanced Colon Cancer Using Pre-Operative Chemoradiotherapy?

Ji Hun Choi,김재현,Won Moon,Seung Hun Lee,Sung Uhn Baek,Byung Kwon Ahn,Jung Gu Park,박선자 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.2

Pre-operative chemoradiotherapy (CRT) is a preferable treatment option for patients with locally advanced rectal cancer. However, fewdata are available regarding pre-operative CRT for locally advanced colon cancer. Here, we describe two cases of successful treatmentwith pre-operative CRT and establish evidence supporting this treatment option in patients with locally advanced colon cancer. In thefirst case, a 65-year-old woman was diagnosed with ascending colon cancer with duodenal invasion. In the second case, a 63-year-oldman was diagnosed with a colonic-duodenal fistula due to transverse colon cancer invasion. These case reports will help to establish atreatment consensus for pre-operative CRT in patients with locally advanced colon cancer.

고려시대 경남지역의 군현 편제와 지역문화

김광철 한국중세사학회 2012 한국중세사연구 Vol.0 No.34

There were 9 main Eups(邑) where chiefs were dispatched and under their control 45 subsidiary Eups affiliated to main Eups in Geongnam area in the Goryeo dynasty. Among them Jinjumok, Hapju, Geumju, and Milseong-gun made their influence felt. They had already held the same status in the reorganization of Gun-Hyeon system in the King Gyeongdeok’s regime of the Shilla dynasty and they still maintained their position or got stronger power in the Goryeo dynasty. On the contrary 8 regions such as Dongrae, Changyeong, Euian, Hadong, Gangseong, Haman, Geochang, and Hamyang had been main in the Shilla dynasty, and were reorganized into subsidiary Eups in the Goryeo dynasty. This was caused by the adoption of the wide area system in the Goryeo Gun-Hyeon organization, and also by the difference of ways how each region coped with in the social fluctuation in the late Shilla and the early Goryeo dynasty. Meanwhile there were about 133 Bugoks(部曲) affiliated to 54 Guns and Hyeons in the Gyeongnam area of the Goryeo dynasty. In particular, 16 Bugoks belonged to Goseong-Hyeon, and even though it was main Eup, it had only Bugoks without any subsidiary Eups. In general many Bugoks were in the main Eups, but it was remarkable that Haman-Gun and Gonmyeong-Hyeon had many Bugoks even though both were subsidiary Eups. Changes appeared in the Gun-Hyeon organizing system due to the internal and external reasons of social fluctuation in the Gyeongnam area of the Goryeo dynasty. There was a change that Guns and Hyeons of Geoje-Hyeon and Namhae-Hyeon were moved into another regions due to Sambyeolcho’s resistance and the Japanese invasion, and the status of Milseong-Gun was degraded into a lower rank, Bugok for a short while. In the meantime Gammus were dispatched to half of subsidiary Eups until the end of the Goryeo dynasty, which later formed the basis of independent administrative unit. Among them 6 Guns and Hyeonssuchas Euian-Hyeon, Happo-Hyeon, Haman-Hyeon, Cheongdo- Hyeon, and Chogye-Hyeon including Dongrae-Hyeon were raised to the status of main Eups. Their upgrade was indebted to those who performed meritorious military services for the subjugation of Japanese soldiers or those who played an active role in their native place as in Euian-Gun. Cultural properties related to Buddhism exceed others among cultural heritage in the Gyeongnam area of the Goryeo dynasty in number. This proves that the Buddhist culture was leading the local culture of Gyeongnam. As for fortifications, the percentage of cultural properties related to castle walls and beacons was high. Mountain fortress walls including castle walls functioning as the seat of a provincial office existed in the Gyeongnam area of the Goryeo dynasty. In particular the region well-equipped with all kinds of defensive facilities including castle walls showed their true characteristics of the local culture as the Gyeongnam coastal area became an important strategic point as national defence line from the Japanese invasion in the end of the Goryeo dynasty. The Gyeongnam local culture has formed and developed in the natural environment in harmony with mountains, rivers, fields, isles and seas accumulating the historical experience for a long time. The Gyeongnam area was not only the fore-front in wartime but also a passage into the outside world. In addition the area showed its independent and active posture to overcome the social conflicts when they got more deeply involved. Therefore, it is believed that hereafter the excavation and investigation of the local properties should be conducted based upon the identification of the Gyeongnam area after due consideration for the regional culture of the Gyeongnam area vividly reflects its local characteristics. There were 9 main Eups(邑) where chiefs were dispatched and under their control 45 subsidiary Eups affiliated to main Eups in Geongnam area in the Goryeo dynasty. Among them Jinjumok, Hapju, Geumju, and Milseong-gun made their influence felt. They had already held the same status in the reorganization of Gun-Hyeon system in the King Gyeongdeok’s regime of the Shilla dynasty and they still maintained their position or got stronger power in the Goryeo dynasty. On the contrary 8 regions such as Dongrae, Changyeong, Euian, Hadong, Gangseong, Haman, Geochang, and Hamyang had been main in the Shilla dynasty, and were reorganized into subsidiary Eups in the Goryeo dynasty. This was caused by the adoption of the wide area system in the Goryeo Gun-Hyeon organization, and also by the difference of ways how each region coped with in the social fluctuation in the late Shilla and the early Goryeo dynasty. Meanwhile there were about 133 Bugoks(部曲) affiliated to 54 Guns and Hyeons in the Gyeongnam area of the Goryeo dynasty. In particular, 16 Bugoks belonged to Goseong-Hyeon, and even though it was main Eup, it had only Bugoks without any subsidiary Eups. In general many Bugoks were in the main Eups, but it was remarkable that Haman-Gun and Gonmyeong-Hyeon had many Bugoks even though both were subsidiary Eups. Changes appeared in the Gun-Hyeon organizing system due to the internal and external reasons of social fluctuation in the Gyeongnam area of the Goryeo dynasty. There was a change that Guns and Hyeons of Geoje-Hyeon and Namhae-Hyeon were moved into another regions due to Sambyeolcho’s resistance and the Japanese invasion, and the status of Milseong-Gun was degraded into a lower rank, Bugok for a short while. In the meantime Gammus were dispatched to half of subsidiary Eups until the end of the Goryeo dynasty, which later formed the basis of independent administrative unit. Among them 6 Guns and Hyeonssuchas Euian-Hyeon, Happo-Hyeon, Haman-Hyeon, Cheongdo- Hyeon, and Chogye-Hyeon including Dongrae-Hyeon were raised to the status of main Eups. Their upgrade was indebted to those who performed meritorious military services for the subjugation of Japanese soldiers or those who played an active role in their native place as in Euian-Gun. Cultural properties related to Buddhism exceed others among cultural heritage in the Gyeongnam area of the Goryeo dynasty in number. This proves that the Buddhist culture was leading the local culture of Gyeongnam. As for fortifications, the percentage of cultural properties related to castle walls and beacons was high. Mountain fortress walls including castle walls functioning as the seat of a provincial office existed in the Gyeongnam area of the Goryeo dynasty. In particular the region well-equipped with all kinds of defensive facilities including castle walls showed their true characteristics of the local culture as the Gyeongnam coastal area became an important strategic point as national defence line from the Japanese invasion in the end of the Goryeo dynasty. The Gyeongnam local culture has formed and developed in the natural environment in harmony with mountains, rivers, fields, isles and seas accumulating the historical experience for a long time. The Gyeongnam area was not only the fore-front in wartime but also a passage into the outside world. In addition the area showed its independent and active posture to overcome the social conflicts when they got more deeply involved. Therefore, it is believed that hereafter the excavation and investigation of the local properties should be conducted based upon the identification of the Gyeongnam area after due consideration for the regional culture of the Gyeongnam area vividly reflects its local characteristics.

고려 현종대 거란과의 전쟁과 지배체제 개편

이정훈 한국중세사학회 2010 한국중세사연구 Vol.0 No.29

본 논문은 고려의 정치․사회체제 수립이 거의 일단락되었던 현종대에 진행된 지배체제 개편을 대외적 상황, 특히 거란의 2차 전쟁과 관련하여 살펴본 것이다. 고려가 건국될 당시 동아시아 국제질서는 중국을 통일한 송이 압도적인 힘을 발휘하지 못하는 가운데 거란과 여진이 흥기하였다. 그 결과 동아시아 국제질서는 거란과 여진의 성장과 쇠퇴에 따라 많은 변화가 있었고, 이는 고려사회에 커다란 영향을 미쳤다. 특히 거란의 2차 침입은 성종대에 수립된 지배체제를 붕괴시켰으며, 거란의 침입을 피해 南行했던 현종에게는 국정운영의 최고 책임자로서의 위치마저 위태롭게 하는 등 심각한 문제를 초래하였다. 이런 상황에서 고려 국가의 존립을 위해서도, 국왕이라는 지위를 유지하기 위해서도 현종은 지배체제를 재정비하고 정치운영을 정상화해야만 하였다. 이에 현종은 사신을 정기적으로 파견하는 가운데 거란과의 마찰을 최대한 줄이면서 지배체제 개편을 단행하였다. 현종은 中樞院을 復置하고, 자신의 즉위를 도왔던 관료들을 주축으로 지배체제 개편을 단행하였다. 현종은 정치적 기반을 확보․강화하기 위한 방안으로서 宰臣들과의 혼인을 추진하였고, 태자와 종실에 대한 정책을 실시하여 국왕권을 강화했으며, 음서를 확대하여 이미 정계에 진출한 지방세력 출신 자제들이 入仕할 수 있는 기회를 확대함으로써 지방세력 출신들의 기득권을 인정해 주었다. 3省 分立의 원칙을 유지하는 가운데 재신의 숫자를 증원하여, 재신의 권력을 분산시켰다. 6부의 권한과 기능을 축소시키는 한편 각사의 기능을 확대하고 동시에 6부와 각사가 직접 국왕에게 업무를 보고하고 국왕의 명령이 직접 하달되는 행정운영방식을 취하였다. 또한 두 차례에 걸쳐 지방제도를 개편함으로써 지방관 파견을 확대하고, 鄕吏의 公服 제정 등을 통해 향리층을 관료체제의 일원으로 편입함으로써 중앙정부의 지방지배를 확대해 나갔다. 그러면서도 유교사상 이외에 전통사상과 佛敎까지도 국가의 사상적 기반으로 인정하여, 지방세력들의 지방사회에서의 기득권을 부분적으로 인정해 주었다. 송악성의 중수, 거란과의 접경 지역에 성곽을 신축하거나 수축하는 등 거란의 침입에 효과적으로 대응하기 위한 군비 증강도 꾸준히 진행하였다. 또한 거란의 침입으로 소실되었던 많은 서적과 문적들을 복구하였고, 문덕전과 연영전 등 궁궐의 전각에 국왕에 대한 교육과 서적의 편찬․주해․교정을 담당하는 학사를 설치하는 등 文風을 진작시키기 위한 여러 정책도 시행하였다. 이러한 지배체제 개편 작업이 본궤도에 올라감에 따라 고려사회는 안정을 찾아갔고 거듭되는 거란의 침공을 잘 막아낼 수 있었다. 특히 현종 9년 거란의 3차 침입을 격퇴함에 따라 고려에 대한 거란의 군사적 행동을 좌절시켰다. 그 결과 고려, 송, 거란을 주축으로 한 동아시아 국제질서는 고려와 거란간의 군사적 대립을 통해 다시 균형을 이루게 되었다. 거란의 3차 침입을 효과적으로 막아낸 고려는 지배체제 재정비에 박차를 가할 수 있었다. 이를 통해 고려의 실정에 맞는 지배체제를 구축할 수 있었다. This thesis is to consider the reorganization of ruling system in Goryeo Dynasty during the reign of Hyeonjong, who almost finished the construction of Goryeo’s political/ social system, in the light of international situation, especially the second war with Kitans. When Goryeo was established, the international situation of East Asia was rather unstable. While the Song Dynasty who reunited China could not exert the absolute power over there, Kitan and Jutchen were still in power. As a result, the international order of East Asia including Goryeo was greatly influenced by ups and downs of Kitan and Jutchen. Especially, the second invasion of Kitans collapsed the ruling system which was established during the reign of Seongjong and caused the serious problem to Hyeonjong who fled to the southern region, facing the risk of dethronement. Under this situation, to secure the survival of Goryeo Dynasty and to maintain his royal position, Hyeonjong had to reorganize the ruling system and normalize the political operation. So, while dispatching the delegates to Kitan periodically to minimize the conflict with Kitan, Hyeonjong started to reform the ruling system. Restoring the Jungchuwon, Hyeonjong reorganized the ruling system along with the vassals who had helped his enthronement. To secure and strengthen his political foundation, Hyeonjong promoted the marriage with the vassals and promulgated the policy for the crown prince and the royal family to reinforce the royal power. He also extended the eumseo(special employment of officials) system to facilitate the employment of children of local powerful vassals who had already taken the position in the royal court. It was to acknowledge the vested right of local powers. While maintaining the separation of three ‘seongs’(prime offices), he increased the number of high ministers to disperse the power of the high ministers. He reduced the authorities of 6 departments, and expanded the functions of each suboffice. He let the 6 departments and their suboffices report to the king and receive the order from the king directly. Furthermore, he reorganized the local governing system twice, expanding the dispatching the local governors. He incorporated the local magnates to the members of local government by enacting the laws for local officials to expand the rule of central government for the local regions. Meanwhile, he recognized the traditional ideas and even Buddhism along with Confucianism as national ideological bases, securing the vested rights of local powers partially in the local regions. He rebuilt the city of Songak and other walls around the border with Kitans and continuously increased the armament to respond another invasion of Kitan effectively. He also practiced several cultural policies to revive the academic atmosphere. He restored many books and documents burnt by the invasion of Kitans and installed the academic institutions such as Mundeokjeon and Yeonyeongjeon in the palace that educated the king and made/commented/corrected the books. When this reformation of ruling system got on the right track, Goryeo society became stable and could fight against Kitans who invaded Goryeo repeatedly. Especially, in 9th year of Hyeonjong, the 3rd invasion of Kitans was failed and the military action of Kitans against Goryeo was totally frustrated. As a result, the East Asian order led by Goryeo, Song and Kitan came to be balanced again through the military confrontation between Goryeo and Kitan. Goryeo who protected itself effectively from Kitan's third invasion could accelerate the rearrangement of ruling system and establish the proper regime for its own.

임진왜란기 경상좌도 지역 청도군수의 임용실태와 전쟁대응

이선희 국민대학교 한국학연구소 2018 한국학논총 Vol.49 No.-

The purpose of this research is trace real condition of bureaucracy in Joseon Dynasty during the Japanese invasion of Korea by analyzing appointment situations, war task, and the process of local governor selection and detailed task of the local governor in Cheongdo. Through this research, how Joseon Dynasty’s state management was carried out during 7 years of Japanese Invasion of Korea Until today, circumstances of the war in locals were researched primarily through analyzing local battle between Joseon army and Japanese army, and civilian army activity. The contribution that civilian army achieved was more than enough to cover the shame of those who ran away from front-line including the king, local governors. However, the distinction between the government army and civilian army was not clear in premodern era. According to the daily records, Cheongdo civilian army called themselves as government army and came under Cheongdo governor, which shows that civilian army and government army was not a dichotomy. Meanwhile, local governors who are classified as fled included those who left their governing area and joined their superiors or died in battle. According to the record of a deceased Bea Yeung-Keang's life, who was Cheongdog governor at the time of the outbreak of the war, he has left his governing area due to his duty of chasing deserters. Later, the Office of Border Defense classified Bea Yeung-Keang as granted amnesty while they were handling local governors who fled. Unlike the Office of Border Defense in the premodern era which had several cases for local governors who left their governing area, today’s researchers only have one case; “ran away to keep their lives.” There were 5 Cheongdo governors during the time of war who were selected without any administration gap. Average incumbency during the war was 1.5 years long, which is not quite different from normal incumbency of 2 years. Out of Cheongdo governor during the war, three of them were from the military service examination and others form a civil servant but with a talent commander. Tasks that were carried out by Cheongdo governor varied from the war situation of the area. The tasks can be divided into supporting a civilian army and Ming army and building mountain fortresses. Building mountain fortresses were not limited to Cheongdo O-Rea mountain fortress, but supporting Changnyeong building Huea-Yang mountain fortress which was adjacent to Cheongdo. The citizens of Cheongdo had to work on building Huea-Yang mountain fortress and its defense after completion of it. The general war situation and situations that each region’s local governments and citizens were facing was different. The difference between regions is the reason for the need of case studies, and accumulation of data about the difference to understand the life of citizens who underwent the war is expected. 이 논문은 임진왜란기 수령의 활동상황을 추적하고자 청도군수의 재임상황과 전쟁업무를 살핀 것이다. 전란 초기 수령이 임지에 있었는지부터 확인해야 할 만큼 전란기 수령의 부재와 도망은 이 시기를 특징짓는 부정적 이미지를 구축하였다. 그러나 최근 연구를 통한 임란기 수령과 관군에 대한 새로운 접근은 수령의 활동을 구체적으로 살필 필요와 호응하고 있다. 이에 청도군수가 국가 전란 시기 어떤 기준으로 선발되었으며, 어떤 역할을 담당하였는지를 살폈다. 관료제로 운영되고 행정체계가 작동하였던 조선시대에 7년간 겪은 전란의 혼란기에 정부의 통치력은 어느 정도 작동하였는지를 고찰할 수 있는 일단이 되고자 하였다. 한편 도망으로 분류된 수령 중에는 전란 중 비록 순찰사나 조방장의 진에 합류하여 임지를 이탈한 경우나 전투 중 사망으로 연락이 두절된 경우도 포함되어 있었다. 임란 발발 당시 청도군수였던 배응경도 그의 행장에 따르면 포망장으로 임지를 떠났던 것으로 기록되어 있다. 이후 비변사에서 도망친 수령에 대해 처리할 때 배응경은 사면대상자로 분류되었다. 이처럼 당대에는 도망한 수령을 여러 경우로 분류한 반면, 오늘날에는 도망친 수령이란 개인의 목숨을 부지하기 위한 한 가지 경우로 일괄되고 있는 점은 재고가 필요해 보인다. 전란기에 재임한 청도군수는 5명으로, 전란 중에도 행정적 공백 없이 선발되었으며 평균 재임기간은 1.5년으로 평상시 재임기간인 2년과 크게 차이나지 않았다. 이 당시 선발된 수령 5명 중 3명은 무과 출신이고 1명은 장수의 재능이 있는 문신으로 평가되어 차출되었다는 점이 주목되는 특징이다. 청도군수가 전란기 수행한 업무는 이 지역의 전쟁 상황에 따라 변화하였다. 전란시 청도군수의 역할은 의병지원, 명군지원, 산성축성 등으로 나뉜다. 특히 산성축성은 청도 오례산성뿐만 아니라 인접 고을인 창녕의 화왕산성에 대한 축성 지원 활동이 계속되었다. 청도 백성들은 화왕산성의 축성 지원뿐만 아니라 수비도 함께 분담해야 하였다. 임진왜란의 대체적 추세와 각 고을 수령과 백성들이 처한 구체적 상황은 차이가 있을 수밖에 없다. 지역별 상이함은 여전히 사례연구가 요구되는 까닭이며, 전란을 겪은 백성의 삶을 이해하기 위한 바탕으로 지속적인 축적을 고대하는 이유이다.

국소침범한 갑상선암의 임상적 고찰

김영민(Young Min Kim),이창윤(Chang Yun Lee),양경헌(Kyung Hun Yang),노영수(Young Soo Rho),박영민(Young Minn Park),임현준(Hyun Jun Lim) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.2

1991년부터 1997년월까지 7년간 한림대학교 이비인후과학교실에서 국소침범한 갑상선암으로 치료를 받은 10명의 환자들을 후향적으로 검토하여 다음과 같은 결과를 얻었다. 1) 성별 분포는 남녀비는 1:2.3이었으며 연령별 분포는 60대 이상이 7명으로 노인에 호발함을 알 수 있었다. 2) 임상승상은 애성이 5례(50%)로 가장 많았으며 무증상이면서 경부종괴로 온 경우가 3례 그외에 연하곤란, 호흡곤란 객혈 등이었다. 3) 침범된 구조는 기관 7례, 반회후두신경과 종격동임파절이 각각 5례, 경부식도 3례, 경동맥 3례, 기관주위임파절 3례, 하인두 1례, 미주신경 1례 순이었다. 4) 침범된 구조물들에 대한 수술로는 기관 수상절제술 및 단단문합술이 1례. 기관 수상절제와 윤상기관성형술 1례, 기관 창절제술 및 일차봉합술 1례. 기관 창절제술 및 흉쇄유돌근-근막피판재건술 1례, 기관 면도식절제술 1례, 식도 부분절제술 2례, 식도 면도식절제술 1례, 편측 윤상후두절제술 1례, 윤상연골 부분절제술 및 흉쇄유돌근-근골막피판재건술 1례, 갑상연골 면도식절제술 1례, 반회후두신경절제술이 2례, 미주신경절제술 1례, 경동맥절제술 및 Gortex?潁? 이용한 재건술 2례, 경동맥 면도식절제술 1례 등이었다. 이상에서 국소침범한 갑상선암은 대부분의 경우 가능한 완전절제를 시도하였으나 광범위 절제 후 재건술의 어려움이 있었으며 또한 대부분이 노인 환자로서 전신상태에 따른 예후가 불량한 경우가 있었다. 따라서 각 환자의 나이와 침범 정도에 따른 개별적인 술식으로 치료방법을 선택하는 것이 중요할 것으로 사료된다. Objectives: Local invasion of the thyroid cancer that is invasion of the upper aerodigestive tract, neurovascular structures of the neck and superior mediastinum, is infrequent and comprises of 1-16% of well-differentiated thyroid cancer. However the proximity of the thyroid gland to these structures provides the means for an invasive cancer to gain ready access into theses structures and when invasion occurs, it is the source of significant morbidity and mortality. So locally invasive thyroid cancer should be removed as much as possible, but still much debates have been exist whether the surgical method should be radical or conservative. This study was desinged to evaluate the clinical characteristics and the surgical treatment of the locally invasive thyroid cancer. Material and Methods: At the department of otorhinolaryngology of Hallym university, 10 patients diagnosed as locally invasive thyroid cancer among the 81 patients treated for thyroid cancer between 1991 to 1997 were retrospectively evaluated. Results: Of the 10 patients, 3 patients had histories of previous surgical treatment with or without radiation or radioactive iodine therapy. The site of invasion of thyroid cancer were trachea(7 cases), recurrent laryngeal nerve(5 cases), mediastinal node(5 cases), esophagus(3cases), larynx(3cases), carotid artery(3 cases), pharynx(l case), and other sites(4 cases). The operation techniques included 1 partial laryngectomy and 1 partial cricoid resection, 2 shavings and 3 window resections of the trachea, 1 sleeve resection of the trachea with end-to-end anastomosis and 1 cricotracheoplasty for tracheal invasion, 2 shavings and 1 partial esophagectomies for esophageal invasion, and 1 wall shaving and 2 partial resections with Gortex?? tube reconstruction for carotid artery invasion, and so on. Conclusions: These data and review of literature suggest that the surgical method should be perfomed on the basis of individual condition and complete removal of all gross tumor with preservation of vital structures whenever possible will offer a good result.

일반논문 : 『고대일록』을 통해본 함양 사족층의 동향

원창애 ( Chang Ae Won ) 경상대학교 남명학연구소 2012 남명학연구 Vol.33 No.-

임진왜란이 발발해서부터 광해군 초기까지 함양 사족의 일상을 기록한 『고대일록』을 통해서 당시 조선 사회의 모습을 재구성해 보았다. 함양은 일찍부터 사림파 군수인 김종직을 통하여 성리학을 접하게 되었고, 그 학풍을 계승한 곳이다. 성리학풍을 바탕으로 함양으로 이주한 성관에서 문과 급제를 통한 관원이나 생원진사시 입격자들이 배출되면서 함양의 재지사족으로 성장하였다. 사림파의 성리학풍을 계승한 함양 사족은 남명학파와도 맥이 닿았다. 의리지학을 배우고 그것을 실천하는 것을 최고의 목적으로 하는 남명학파 인물들이 함양 사족으로 활동할 당시 임진왜란이 발발하였다. 함양 사족들은 그들의 배운 바를 실천할 수 있는 기회를 놓치지 않고 적극적으로 의병활동에 참여하였다. 그들은 의병을 모집하고, 무기를 제작하였으며, 군자를 마련하였다. 이러한 일련의 활동이 임진왜란 초기에만 국한된 것은 아니었다. 정유재란 당시 함양 역시 왜적의 피해를 입었으나, 의병 지원 활동이 계속되었다. 이것은 함양 사족이 엘리트로서 향촌 사회에 대하여 가졌던 책임의식을 여실히 보여준 것이다. 전란 속에서도 사족들은 자신들의 사회적 지위를 유지시켜 주는 경제 기반인 토지와 노비에 대한 강한 애착을 드러냈으며, 위기 상황에서 명분보다는 실리를 위해서 상행위까지 마다하지 않는 당시 선비의 유연성까지도 가지고 있었다. 사족의 사회적 지위는 경제 기반만으로는 해결될 수 없었다. 중종대 규정된 사족은 경제적 부로 측정된 것이 아니라, 문·무과 출신의 자제, 생원·진사, 내외 사조 내의 顯官이 있는 자로 규정되어 있다. 즉 생원진사시 혹은 문·무과의 급제 여부, 과거를 통한 관료 진출 여부가 핵심이었다. 그러므로 전란 속에서도 사족들이 과거에 매달릴 수밖에 없었다. 또한 선조 대에는 지방 유생의 상소가 공론으로 인정되는 사회였다. 중요한 사안이 있을 때 유생들은 상소를 통해 의견을 개진하였다. 일부 함양 사족은 정인홍이 주도하는 대북 계통의 유생이었기 때문에 사회 폐단의 해결책을 제시하는 상소 이외에도 서인과의 공론 대결이 치열하게 전개되었다. 정경운은 정인홍의 제자로 정치색이 뚜렷한 인물이기 때문에 일기 곳곳에서 서인에 대한 평가를 볼 수 있다. 이러한 모습 속에서 당시 지방 사족들이 정쟁에 가담하는 모습이 생생하게 드러내고 있다. 전란 이후 향촌 사회의 복구에 앞장선 사족들은 향촌을 교화하고, 원악향리의 처벌을 강화하고, 사족들에 대해서도 儒罰을 내림으로써 그들 중심의 향촌 질서를 유지하였다. 이 시기 함양 내에 유력 사족 간의 갈등이 서원의 위차 문제로 표출되었다. 유력 사족의 이러한 갈등은 17세기 이후 서로 다른 정치 노선을 갖게 하는 단초가 되었다. Ko­dae Diaries,`` written by Kyeong­wun Jeong, began in 1592 when Japanese army invaded Choseon and ended in the early Kwang­hae reign. This contains detailed daily activities around the author himself as well as the pertinent persons and events. It allows us to reconstruct what the situations at the war time were like. Ham­yang region where he lived had been influenced earlier than any other places by the neo­confucianism through their county magistrate, Jong­jik Kim, who was a leader of the outside government or Sa­rim faction. The local literatus class in that region grew up from migrated families after their offsprings had begun to pass civil and military service examinations and accordingly assumed official positions in the government. They also communicated closely with the scholars of Nam­myong School. Neo­confucianism emphasized actual practices rather than mere theoretical debates. This ideology enabled them actively to take part in the Anti-Japanese Righteous Volunteer Fighters, when Japanese army invaded firstly in from 1592 to 1598 and secondly in from 1597 to 1598. Their reaction clearly reflected what they felt their responsibilities about their land as the local elite class. The diary also shows that the local literatus class concerned deeply about their economic basis such as cultivation land and slavery. Moreover, they were even involved in commercial activities, too, which belonged at that time mostly to merchant class. In the reign of King Jung­jong, literati were defined not by their economic wealth but by family members who were at least a public officer, a passer of local examinations, or a high officer within great­great grand father nodes including matrilineal line. This regulation explained the reason why they were strongly engaged in taking civil and military service examinations to maintain their status. In the reign of King Seon­jo, local confucian scholars were allowed to send their written opinions to king as a public opinion. Almost of all the literatus class in this area belonged to the Splinter Group of the Easterner (or Dae­Book) Faction, they tended to oppose to Westerners Faction (or Seo­in). The author, who was a disciple of In­hong Jeong, was so political that he often blamed the opposite people so many times in his diary. We can observe a positive function of local literati, on one hand, to recover their society and enlighten local people. They, however, began to confront each other, on the other hand, with such issues as setting up a tablet order in the shrine of local confucian schools which facilitated, at last, to divide into a different political faction after 17th century.

임진왜란기 지방 이서의 전쟁 경험과 정리 작업 : -이탁영의 『정만록』을 중심으로-

박인호(PARK, In-Ho) 한국사학사학회 2016 韓國史學史學報 Vol.0 No.34

[征蠻錄]은 의성 출신의 향리인 李擢英(1541-1610)이 겪었던 임진왜란의 전쟁 경험을 정리한 것이다. 저자는 임진왜란시 營吏로서 경상 감사를 곁에서 수행하였던 인물이다. 이 논문에서는 중인의 신분적 위치에 있던이가 바라 본 임진왜란이라는 관점에 착목하여 [정만록]의 사료적 가치와 사학사적 의의를 살펴보았다. 임진왜란 참전을 통해 지방 사족들은 지역에서 우월적 지위의 지속적인 창출을 도모하게 되었으며, 이에 따라 참전 가문에서는 출신 인물들의 전공이나 역할을 강조하는 倡義錄이나 日記기록들을 확대 재생산하여 왔다. 이로 인해 오늘날 임진왜란을 보는 시각에서는 사족들의 倡義논리가 적지않게 작동하고 있다. 임진왜란을 겪었던 관료들도 자신들의 역할에 대해 정당화하려는 각종 기록을 남기고 있다. 그런데 이탁영은 경상 監營의 營吏역임자이다. 이에 따라 [정만록]은 지방 吏胥의 시선에서 임진왜란을 기술하였다는 특징이 있다. 내용에서는 이탁영의 근거 지역이 경상도 의성이며, 모셨던 상관이 金睟와 金誠一등남인 출신이었다는 점에서 대체로 남인에게 우호적인 시선을 보내고 있다.당시 경상 감사였던 김수의 활동과 김수 집안 인물들의 비극적인 피해 상황을 자세히 적고 있다. 사족들의 일기나 실기와는 달리 이탁영은 지역에서 올라오는 전황과 피해 상황을 자세하게 기술하였으며, 개인적 단상과 가족에 대한 그리움이 내용의 상당 부분을 차지하고 있다. 요컨대 [정만록]은 경상도에 거주하였던 영리가 남인 상관을 모신 정치적 입장과 중인이라는 신분적 입장에서 바라보는 임진왜란의 모습이라는점에 일정한 의의가 있다. The Jeongmannok is a summary of war experiences written by a local functionary (hyangli) named Yi Takyeong (1541-1610) during the Japanese Invasions of Korea (1592-1598). Yi Takyeong assisted the Governor of Gyeongsang Province in his capacity as a petty officer (yeongli) attached to the headquarters of the provincial governor (gamyeong) during the Japanese Invasions of Korea. This study analyzes the historical values and implications of the Jeongmannok, paying specific attention to the perceptions of the Japanese Invasions of Korea viewed of a person who belonged to the bureaucratic middle class (jungin). The local gentry (sajok) saw the Japanese Invasions of Korea as an opportunity to maintain their superior status by participating in local righteous army (uibyeong) activities. As such, the families of those who participated in righteous army activities continuously expanded and reproduced records such as the Changuirok and diaries or daily records (ilgi) emphasizing the achievements and great roles played by their ancestors. To this end, the notion of initiative righteousness possessed by the local gentry has been reflected in the modern perception of the Japanese Invasions of Korea. The bureaucrats who went through the Japanese Invasions of Korea left behind various records to justify their roles during the war time. Yi Takyeong was a petty officer attached to the headquarters of the provincial governor in Gyeongsang Province. In this regard, the Jeongmannok describes the Japanese Invasions of Korea from the viewpoint of a local clerk (iseo). Yi lived in the Uiseong area of Gyeongsang Province. Yi maintained a favorable opinion of the Southerners (namin) faction, a group to which immediate superiors such as Kim Su and Kim Seongil belonged. Yi Takyeong described in great detail the activities of the Governor of Gyeongsang Province Kim Su and the tragic situation which befell Kim Su’s family. Contrary to the diaries and daily records written by the members of the local gentry, Yi described the actual war situation and reported on the damage in different areas. However, the majority of the Jeongmannok is reserved for personal thoughts and longing for family. Considering these aspects, the significance of the Jeongmannok can be said to stem from the fact that it sheds light as to how a local functionary residing in Gyeongsang Province came to view the Japanese Invasions of Korea from the standpoint of assisting his superiors from the Southerner faction as well as from his vantage point as a member of the middle class (jungin).

간세포암 국소 소작술의 발전

임현철 대한의사협회 2013 대한의사협회지 Vol.56 No.11

Local ablation has been accepted in many treatment guidelines as a good alternative to curative resection or transplantation for patients with unresectable hepatocellular carcinoma (HCC). The main advantage of local ablative therapy is minimal invasiveness, guaranteeing low morbidity even for the patient with poor hepatic reserve. Furthermore, the therapeutic efficacy of local ablation, especially radiofrequency ablation (RFA), has been shown to be as effective as surgical resection for early-stage (smaller than 3 cm, less than 4 in number) HCC. The long-term outcome after radiofrequency ablation for HCC reported in large series studies were overall survival of 50% to 60% at 5 years and 27 to 32% at 10 years. Major complication rates are 0%to 2.4%. However, controversy remains regarding whether local ablation can replace surgical resection because many retrospective comparative studies have produced conflicting results. Only a well-designed randomized study will be able to clearly answer this long-standing question. During the past decade, many technical advancements in local ablation have been reported,including novel electrodes, thermal protection (i.e., artificial ascites), fusion image guidance,Sonazoid-enhanced ultrasound guidance, and emerging energy sources (i.e., microwaves,High internsity focused ultrasound, Irreversible electroporation). Local ablation is still an evolving technique in the era of minimally invasive treatment for HCC. Many more technical advances are ongoing to enhance the therapeutic efficacy of local ablation. In summary, local ablation will remain a mainstay of non-surgical treatment early stage HCC and play an important role in multidisciplinary approach for HCC management.

임진왜란 초기 경상도 수령의 동향과 의병 지원 활동

정해은 조선시대사학회 2014 朝鮮時代史學報 Vol.70 No.-

This study aims to achieve a new understanding of the Suryeong (local governors) by investigating the movements of the Suryeong in Gyeongsang Province and reviewing righteous militia support activities at the beginning of Japanese Invasion of Korea in 1592. Hanseong, Joseon’s capital, fell in to the Japanese army around 20 days after the outbreak of war. This clearly shows the fact that Joseon army’s initial reaction to the attack was poor. During that time, many Gwanchalsa (provincial governors), Jeoldosa(military governors) and Suryeong(local governors) fled or evacuated. As a result, the evaluation of the Suryeong at that time was summarized as cowardice and incompetence. The focus of this study, however, was raised with the question:did most Suryeong’s really flee at the beginning of the war? The reason why the existence of the Suryeong’s during the Japanese Invasion of Korea is due to the fact that it was impossible to recruit soldiers or to pursue military activities without the participation of the Suryeongs, who were in charge of public administration in the front line. Upon the investigation on the traces of 67 Suryeongs in Gyeongsang Province, 33 persons (49.3%) were incumbent, 3 persons (4.5%) were killed in battle, 2 persons (3%) were executed by beheading (after the execution, their heads were put on a display to alert other’s attention), 1 person was dismissed (1.5%) and 1 person was taken captive (1.5%). On the other hand, 25 persons (37.3%) fled. The important fact is that half of the Suryeong’s who fled or evacuated returned to duty or continued on with government affairs and military activities while fleeing. The Suryeongs who fled first emerged from the inchoate mess, and started to reorganize the military between May and July in 1592. The most impressive part is that the Suryeongs played essential roles in forming righteous militias and aggressively handled the war pressing on with joint operations with righteous militias while procuring provisions and weapons for the militias. The role of the Suryeong is no less important than righteous militias. Therefore, in order to grasp the logic of the situation at the beginning of Japanese Invasion of Korea, it is critical to pay attention to the roles of the Suryeong. 이 논고는 임진왜란 발발 초기 경상도 수령의 동향을 조사하고, 의병 지원 활동을 검토해 임진왜란기 수령에 대한 새로운 이해를 시도한 글이다. 조선은 전쟁 발발 20 여 일 만에 일본군에게 수도 한성을 함락을 당했다. 이 사실은 조선 군대가 초기 대응을 제대로 하지 못한 사실을 잘 보여준다. 여기에는 지역 방어를 책임진 관찰사와 절도사 그리고 수령의 대처가 미숙했던 것이 큰 요인이었다. 이 과정에서 관찰사․절도사나 수령들의 도망이나 피신이 발생했고, 그 결과 수령들에 대한 평가는 도망과 무능으로 집약되었다. 이 논문의 문제의식은 단순해보일 수도 있지만, 과연 전쟁 초기 경상도 수령들이 대부분 도망갔을까 하는 질문에서 출발하였다. 임진왜란기 수령의 존재가 중요한 이유는 대민 행정의 최전선이라 할 수 있는 수령이 참여하지 않고서는 군사 모집이나 군사 활동이 현실적으로 가능하지 않았기 때문이다. 임진왜란 초기 경상도 수령 67인의 행적을 추적해 存否 여부를 조사한 결과, 재직 33인(49.3%), 전사 3인(4.5%), 효시 2인(3%), 파직 1인(1.5%), 포로 1인(1.5%)이어서 총 40인(59.7%)이 직무를 수행하였다. 이에 비해 도망한 수령은 25인(37.3%)이었다. 중요한 사실은 도망이나 피신한 수령의 절반 정도가 다시 복귀하거나, 피신 중인 상태에서 공무나 군사 활동을 수행했다는 점이다. 1592년 7월 이후로 도망 수령들은 초창기 혼란에서 벗어나 차차 전열을 정비하였다. 무엇보다도 인상적인 사항은 수령들이 전쟁 초기 의병 결성에 크고 작은 역할을 수행하면서, 의병 부대에 군량과 무기를 지원하고 함께 연합작전을 펼쳐 전쟁에 대처해 나간 점이다. 이 점은 그동안 임진왜란기 경상도 수령에 대한 평가나 인식과 차이를 보이는 것으로서, 향후 임진왜란기 수령들의 역할과 평가에서 반드시 숙고해야 할 측면이다.