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갑상선 전절제술 및 중앙경부 림프절 박리술 후 발생한 유미누출: 3예 증례보고
황승욱·,최향희·,김완욱·,박호용·,정진향,Seung Ook Hwang,Hyang Hee Choi,Wan Wook Kim,Ho Yong Park,Jin Hyang Jung 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.3
Chyle leakage is a rare complication of surgery for thyroid cancer that generally develops after lateral neck dissection. Here, we describe chyle leakages experienced after central neck dissection (CND). A total of 615 patients with thyroid cancer were treated by total thyroidectomy with CND between Jan 2012 and Dec 2012 at our facility, and three (0.49%) developed chyle leakages. The amounts of leakage were all less than 100 ml/day. One patient was resolved with conservative management, while the others were treated with conservative treatment and fibrin glue injection in chylous lymphocele. Chyle leakage after CND is very uncommon, and most cases involve minor leakage. Fibrin glue could be a treatment option for chyle leakage following CND.
관상피내암으로 최초 진단된 환자에서의 수술 후 잔존 침윤성 유방암의 예측인자 및 감시림프절 검사의 적용
이희재(Hee Jae Lee),황승욱(Seung Ook Hwang),정진향(Jin Hyang Jung),박호용(Ho Yong Park),박지영(Ji Young Park) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6
Purpose: The diagnostic methods for examining suspicious lesions in the breast are becoming less invasive, like core-needle biopsy. Yet, the risk of invasion has been reported to be up to 47% for patients with ductal carcinoma in situ (DCIS) initially diagnosed by core-needle biopsy. The value of sentinel lymph node biopsy (SLNB) for DCIS has not been clearly proved. We searched for the factors associated with invasiveness of preoperatively diagnosed DCIS, and we determined the indications for performing SLNB for patients with preoperatively diagnosed DCIS. Methods: Between October 1997 and December 2008, we retrospectively reviewed 135 patients with DCIS that was initially diagnosed by core-needle biopsy or other biopsy methods. We compared the invasive breast cancer group, which was finally diagnosed with the pure DCIS group in regards to clinical, radiological, and pathological factors. Results: 21.5% of the patients with initial diagnosis of DCIS were finally diagnosed with invasive breast cancer. On univariate analysis, the statistically meaningful factors for invasiveness were palpable lesion (P<0.0001), core-needle diagnosis (P=0.007), large tumor size (P=0.028), high nuclear grade (P=0.002), and negative estrogen receptor (P=0.005). On multivariate analysis, a palpable lesion was the only independent risk factor (odds ratio 3.9 (1.1 to 13.8); P=0.035). Axillar lymph node metastases were found in three patients in the invasive cancer group. There was no lymph node metastasis in the DCIS group. Conclusion: We recommend that SLNB be considered in initially diagnosed DCIS with palpable lesion or high nuclear grade due to the high risk of invasiveness.
부갑상선 점수가 갑상선 전절제술 후 저칼슘혈증을 예측할 수 있을까?
박진희(Jin Hee Park),박호용(Ho Yong Park),정진향(Jin Hyang Jung),황승욱(Seung Ook Hwang),이지연(Jee yeon Lee),권택주(Taek Ju Kwon),김완욱(Wan Wook Kim) 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.2
Purpose: The aims of this study were to investigate whether parathyroid score can predict hypocalcemia after total thyroidectomy with central lymph node dissection (CLND) and to determine clinical value of parathyroid score for treatment of hypocalcemia. Methods: A prospective review of 209 patients who underwent total thyroidectomy with CLND for papillary thyroid cancer from January to December 2012 was conducted. Parathyroid score was designed based on the number and color of parathyroid preservation (Save and intact color of a parathyroid was 2; Save but mild discoloration was 1.5; Not identification was 1.2; Autotransplantation was 1.0; Sacrifice was -1). Results: The mean numbers of parathyroid glands were as follows: save & intact color was 2.0; save & mild discoloration was 0.8; not identification was 0.8; autotransplantation was 0.4. The average parathyroid score was 6.54±0.69 (range 3.4∼8.0). The average PTH was 16.3 at the 1st POD. Transient and permanent hypocalcemia were 33.4% (70/209) and 0.9% (2/209), respectively. Parathyroid score was 6.78±0.54 in patients without transient hypocalcemia, 5.93±0.67 with hypocalcemia, parathyroid score was significantly lower in transient hypocalcemia, abnormal PTH at the 1st POD (P<0.001, P<0.001). Conclusion: Parathyroid score may predict patients at risk of developing transient hypocalcemia after total thyroidectomy with CLND.