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간좌엽 및 췌전절제 수술이 필요했던 간내담관 및 췌장관 내에 발생한 동시성 유두모양 점액선암
문덕복 ( Deok Bog Moon ),이승규 ( Sung Gyu Lee ),정동환 ( Dong Hwan Jung ),박길춘 ( Gil Chun Park ),박요한 ( Yo Han Park ),박형우 ( Hyung Woo Park ),김명환 ( Myung Hwan Kim ),이성구 ( Sung Koo Lee ),유은실 ( Eun Sil Yu ),김지훈 ( 대한소화기학회 2014 대한소화기학회지 Vol.63 No.2
Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) and intraductal papillary mucinous neoplasm of the pancreas (IPMN-P) have striking similarities and are recognized as counterparts. However, simultaneous occurrence of IPMN-B and IPMN-P is extremely rare. A 66 year-old female presented with recurrent epigastric pain and fever. During the past 9 years, she had three clinical episodes related to intrahepatic duct stones and IPMN-P in the pancreas head and was managed by medical treatment. Laboratory test results at admission revealed leukocytosis (12,600/mm3) and elevated CA 19-9 level (1,200 U/mL). Imaging study demonstrated liver abscess in the Couinaud`s segment 4, IPMN-B in the left lobe, and IPMN-P in the whole pancreas with suspicious malignant change. Liver abscess was drained preoperatively, followed by left lobectomy with bile duct resection and total pancreatectomy with splenectomy. On histologic examination, non-invasive intraductal papillary mucinous carcinoma arising from various degree of dysplastic mucosa of the liver and pancreas could be observed. However, there was no continuity between the hepatic and pancreatic lesions. This finding in our case supports the theory that double primary lesions are more likely explained by a diffuse IPMN leading to synchronous tumors arising from both biliary and pancreatic ducts rather than by a metastatic process. Herein we present a case of simultaneous IPMN of the bile duct and pancreas which was successfully treated by surgical management. (Korean J Gastroenterol 2014;63:129-133)
비장동맥 차단술이 생체간이식 수술 수혜자의 전혈구 수치 변화에 미치는 영향
김완준(Wan-Joon Kim),문덕복(Deok-Bog Moon),박정익(Jeong-Ik Park),황신(Shin Hwang),김기훈(Ki-Hun Kim),안철수(Chul-Soo Ahn),하태용(Tae-Yong Ha),송기원(Gi-Won Song),정동환(Dong-Hwan Jung),김관우(Kwan-Woo Kim),최남규(Nam-Kyu Choi),박길춘(G 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.4
Purpose: Splenectomy during living donor liver transplantation (LDLT) in a hepatitis C virus (HCV)-related cirrhotic recipient was performed by a Tokyo group to enhance the patient’s tolerability to post-operative anti-viral treatment by improving complete blood count (CBC) profiles. At our institution, interruption of the splenic artery (SPA) by ligation or embolization in lieu of splenectomy, has been performed in LDLT to modulate portal blood flow in small-for-size graft LDLT or to prevent rupture of SPA aneurysms in recipients. We aimed to determine if interruption of the SPA can serve as an alternative management to splenectomy in LDLT recipients based on our data. Methods: Patients were classified into the splenic artery ligation group (SAL; n=26) and splenic artery embolization group (SAE; n=19), respectively. Among the recipients without SPA interruption, age-, gender-, and severity of cirrhosis-matched 25 recipients were selected as a control group. Post-operative CBC profiles and spleen size were reviewed retrospectively and compared between the groups. Results: After SAL, platelet and neutrophil counts were significantly increased at 3 and 6 months, and at 1 week and 1 month, respectively (p<0.05). After SAE, platelet and neutrophil counts were significantly increased at 3 and 6 months, and at 1 week and 3 months, respectively. There were no significant complications related to interruption of the SPA. Conclusion: Interruption of the SPA may have a role in improving neutrophil and platelet counts in LDLT recipients with severe pancytopenia or in whom antiviral treatment for HCV in anticipated.