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이성철,목우균,서정민,정성은,박귀원,김우기,Lee, Seong-Cheol,Mok, Woo-Kyun,Seo, Jung-Min,Jung, Sung-Eun,Park, Kwi-Won,Kim, Woo-Ki 대한소아외과학회 1995 소아외과 Vol.1 No.1
The incidence of Meckel's diverticulum(MD) in general population has been assessed as 2 percent. The major complications of MD are bleeding, perforation, and intestinal obstruction. In spite that the complication rate of Meckel's diverticulum is relatively high(about 4.2% during a lifetime), the preoperative diagnostic rate of complicated MD is very low. Authors investigated the clinical characteristics of complicated MD to improve the diagnostic rate. 16 patients with complicated Meckel's diverticulum who were operated upon at the Department of Pediatric Surgery, Seoul National University Children's Hospital from June 1985 to December 1993 were reviewed. Among the 16 patients with complicated MD, 12 patients(75%) were under 2 year-old and male were predominant(88%). The most common complication was bleeding patients with bleeding MD (8 cases) were diagnosed preoperatively as MD. 8 patients with other complications(perforation : 4 cases, obstruction : 4 cases) could not be suspected as complicated MD except one patient who had previous history of melena. These patients were diagnosed after exploratory laparotomy under the various impression other than MD. Among 12 patients with ulcer related complications such as bleeding and perforation, heterotopic gastric mucosa was found in 11 patients. In conclusion, in any children with unexplained acute abdomen, especially under 2 years old, complicated MD must be included in differential diagnosis. In children with obscure lower gastrointestinal bleeding, $^{99m}Tc$-pertechnetate scintigraphy is a useful diagnostic tool to rule out bleeding MD.
소아 서혜부 탈장환자에서 반대측에 대한 복강경 검사의 의의
박일경,목우균,Park, Il-Kyung,Mok, Woo-Kyun 대한소아외과학회 2007 소아외과 Vol.13 No.2
저자들은 2000년 3월부터 2005년 9월까지, 건양대학교병원 외과에서 반대측에 대한 잔존 복막 초상돌기 개폐 여부를 복강경으로 확인한 환자 280명을 포함하여, 서혜부 탈장으로 고위 결찰술을 시행받은 만 15세 이하의 환자 601명을 대상으로 임상분석을 실시하여 다음과 같은 결과를 얻었다. 환자의 성비는 3.8:1로 남아에서 호발하였고, 진단 당시의 발생부위는 오른쪽이 57.7%, 좌측이 32.1%, 양측이 10.1%였으며, 복강경으로 반대측 잔존 복막 초상돌기를 확인한 군의 결과도 유사하였다. 복강경으로 복막 초상돌기의 개방을 확인한 결과, 1세 이하에서는 25%, 1세에서 5세 이하에서는 29%, 5세 이상에서는 18%로, 복막 초상돌기의 자연 폐쇄를 확인 할 수 없었다. 편측 서혜부 탈장 수술 후 반대측 탈장이 생긴 경우는 14명(2.5%)이었으며, 복강경으로 반대측 잔존 복강 초상돌기의 개폐 유무의 확인이 가능했던 2003년 3월 이후에는 발견되지 않았다. 추적 기간 중 반대측 탈장이 생긴 경우, 1세 이하에서 증상이 나타난 경우와, 첫 증상이 왼쪽에서 생겼을 때가 통계적으로 유의하였으며 이는 일반적인 반대측 탈장 발생의 고위험군과 일치하는 결과이다. It is known that pediatric inguinal hernia is caused by the incomplete closure of processus vaginalis (PV). In the case of unilateral hernia, possibile contralateral patent PV should be considered because of its delayed appearance as well as its risk of incarceration. Direct visualization of patent PV could be done by contralateral exploration or by indirect exploration through the ipsilateral opening site of the affected hernia assisted with laparoscope. A patient group (321 persons) to whom laparoscopy was not performed from March 2000 to March 2003 was analyzed and compared with a patient group (280 persons) to whom laparoscopy was performed from April 2003 to September 2005. With all 601 patients, the sex ratio (male/female) of patients was 3.8:1. The side distribution was 57.7% in the right, 32.1% in the left and 10.1% in bilateral. There was no difference of sex and side distribution between before and after laparosopy adoption. We did not find an age correlation in natural closure of the residual PV of the peritoneum. Contralateral hernia developed in 14 persons (2.5%) after the operation of unilateral inguinal hernia before laparoscope adoption. But no contralateral hernia developed after April 2003 with laparoscopy. We think that if we use laparoscopy, being a safe and accurate method, to check whether the contralateral residual PV is opened or closed, possible future contralateral operation can be avoided.
소아 난소 양성 낭기형종 환자의 복강경적 난소 보존 낭종절제술
박일경,목우균,Park, Il-Kyung,Mok, Woo-Kyun 대한소아외과학회 2006 소아외과 Vol.12 No.1
Mature cystic teratoma, commonly called dermoid cyst, is the most common benign germ cell tumor of the ovary in children. Malignant transformation is rare, approximately 2 %. As laparoscopic procedures are applied widely in pediatric surgery, a female chlid with a mature cystic teratoma may be an ideal candidate for laparoscopic surgery. Two children received laparoscopic operations successfuly for lower abdominal crises, twisted adnexa. There was no operative complication. Laparoscopic approach for ovarian lesions in infancy and childhood appears to be an effective and safe method for diagnosis as well as definitive therapy.
구태영,목우균,Koo, Tae-Young,Mok, Woo-Kyun 대한소아외과학회 2005 소아외과 Vol.11 No.1
Two cases of primary torsion of the greater omentum were described. The first patient was a 5-year-old boy who was admitted to the hospital because of severe abdominal pain for 1 day. The The clinical features were similar to perforated acute appendicitis. Laparotomy revealed a normal appendix and the greater omentum twisted around its pedicle. The second patient was a 7-year-old girl admitted to the hospital because of abdominal pain in right lower quadrant for 2 days. The clinical features? were that of acute appendicitis. Laparotomy revealed a normal appendix and primary torsion of greater omentum around its pedicle. In both cases, resection of twisted omentum and incidental appendectomy were done. The microscopic findings in two cases consisted of congestion and vascular hemorrhage. Both patients recovered uneventfully. Torsion of the greater omentum, therefore, may be added to the entities to consider in the differential diagnosis of acute appendicitis.
이성철(Seong cheol Lee),목우균(Woo Kyun Mok),전용순(Yong Soon Chun),김우기(Woo Ki Kim) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.2
Many theories have been proposed regarding the etiology of cho]edochal cyst. Anomalous chole- dochopancreatic ductal junction ray be one of the main contributive factors in the development of congenital choledocha] cyst. Congenital obstruction or stricture of the distal common bile duct (CBD) may also be of etiologic significance. Four cases of congenital choledocha] cyst diagnosed by antenatal ultrasonography have been reported in the literature. We report a congenital choledochal cyst detected antenatal]y and treated in the neonatal period. A 14-day old female neonate was referred to our hospita] because of jaundice and abdominal mass found antenatally. She was icteric and passed acholic stool. A 3.9'+2.0cm cystic abdominal mass was found by ultrasonography at 18 weeks gestation and it was 5.3 3.0 cm at 35 weeks gestation. At admission the bilirubin(tota.l/ direct) was 8.3/4.3 rng/dl and u]trasonography revealed a 5 X 5 cm choledocha] cyst. An exploratory ]aparotomy was performed on the l8th day of life. Operative cbo]angiograpy revea]ed no passage of contrast material into the distal CBD and duodenurn. The cyst was excised completely and a Roux-en-Y hepatic portoenterostoey was done. Postoperatively the baby was uneve.ntful and the liver function test done 3 v eeks after operation was within the normal range. (Korean J Gastroenterol 1996; 28: 272 275)