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이경원,박찬흔,박용래,현기훈,윤지섭,Kyung-Won Lee,Chan-Heun Park,Yong-Lai Park,Ki-Hun Hyun,Ji-Sup Yoon 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.4
Purpose: Gasless transaxillary approach to endoscopic thyroidectomy is a widely performed procedure for benign or malignant thyroid neoplasms. However, it requires wide dissection for approaching the target area. The intravenous patient-controlled analgesia (IV PCA) is an effective method for postoperative pain control and patients can use it according to their requirement. However, patients suffer from nausea, vomiting, sleep disturbance, etc. due to opioids. Pain pump ON-Q<sup>Ⓡ</sup> PainBuster<sup>Ⓡ</sup> (pain buster) has been used widely in various surgeries for control of postoperative localizing and wide area pain without side effects of opioid analgesia because it consists of Ropivacaine. Methods: From Aug. 2008 to Jan. 2013, Gasless transaxillary endoscopic thyroidectomy was performed in 90 patients in a single institution, who were divided into three groups, including the IV PCA, pain buster, and null groups. We compared postoperative outcomes, pain severity between groups. We recorded scores immediately, 6, 12, 24, and 48 hours after surgery following visual analog pain score (VAS), and investigated hospital stay and occurrence of events of nausea, vomiting, and complications. Results: In the IV PCA group, it was discontinued due to nausea in 36.7% of patients. No significant difference in pain severity following VAS score was observed among the three groups. However, smaller numbers of analgesia injections were required in the Pain buster group than in the other groups, and fewer patients suffered from constipation, compared with the PCA group. Conclusion: Pain buster showed even effects compared to IV PCA, with few side effects and less discomfort of patients, compared with the other groups. Therefore, pain buster was thought to be the proper method for pain control after dissection of the anterior chest wall, cervical area in order to secure an operative view for transaxillary endoscopic thyroi-dectomy.
침윤성 유방암과 주변 정상 관상피세포에서의 COX-2 발현의 의의
김준호(Jun Ho Kim),박용래(Yong Lai Park) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.3
Purpose: Cyclooxygenase-2 (Cox-2) is an inducible enzyme that converts arachidonic acid to prostaglandins. Aberrant expression of Cox-2 and prostaglandins has been observed in many cancers, including colon and breast cancers, and 40% of human breast cancers show overexpression of Cox-2. The aim of this study was to analyze the role of Cox-2 expression in breast cancers. Methods: The expression of Cox-2 and HER2 was examined in 56 breast tissue samples including microscopically normal epithelium and invasive ductal carcinomas (IDC) using immunohistochemical (IHC) methods. Frozen breast cancers and adjacent non-cancerous tissue (ANCT) pairs (n=30) were analyzed for Cox-2 and HER2 mRNA expression by RT-PCR. The results were compared with the prognostic parameters of breast cancer including tumor grade, growth pattern, lymph node metastasis, estrogen receptor status and Ki-67 labeling index. Results: Cytoplasmic Cox-2 expression was detected in 39 of 56 (69.6%) IDC and the Cox-2 expression in IDC was closely associated with HER2 expression (P=0.023). However, the expression of Cox-2 was not associated with other prognostic parameters of breast cancer (P>0.05). The Cox-2 mRNA showed high expression levels in IDC (25/30, 83.3%) as well as ANCT (22/25, 88%). Conclusion: The association between the expression of Cox-2 and HER2 suggests that Her2/neu gene induces the Cox-2 expression in breast cancer and overexpression of Cox-2 is involved in breast cancer development. Though the cells of ANCT are normal in morphology, their molecular alteration (overexpression of Cox-2) suggests that these cells have transformed already.
백진희(Jin Hee Paik),박용래(Yong Lai Park),손병호(Byung Ho Son) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.5
Purpose: The aims of this study were to evaluate the efficacy of laparoscopic totally extraperitoneal (TEP) repair of femoral hernia. Methods: Eight patients who underwent laparoscopic TEP repair for femoral hernia between 2008 and 2010 were reviewed retrospectively. In total, 256 adult patients underwent inguinal or femoral hernia repair; TEP was performed in 224 patients. The preoperative diagnosis, clinical symptom, operative finding, postoperative complications, chronic pain, and recurrence were analyzed. Results: The incidence of femoral hernia was 8 (3.1%) in the present study. The female to male ratio was 3:1 (6 females and 2 males). Seven patients were preoperatively misdiagnosed with inguinal hernia using ultrasonography. Computed tomography (CT) was performed in three patients, and femoral hernia was diagnosed in two patients. Two patients had synchronous femoral hernia with direct or indirect inguinal hernia. One patient has previously undergone ipsilateral inguinal hernia repair. In all patients, the hernia sac was irreducible by gas insufflation. Seven patients had lipoma-like soft tissue in hernia sac. Peritoneal tears developed in three patients. There was one postoperative complication: chronic discomfort due to seroma. There was no recurrence during median 6.5 months (range 2∼26). Conclusion: Laparoscopic TEP repair is safe and effective therapeutic option for repair of femoral hernia. CT images are the most valuable type for the evaluation of the femoral hernia.
내시경하 갑상선절제술에 있어 CO₂ 가스주입은 안전한가?
최원범(Won Beom Choi),박용래(Yong Lai Park),최준호(Jun Ho Choe),김흥대(Hung Dai Kim),배원길(Won Gil Bae) 대한외과학회 2007 Annals of Surgical Treatment and Research Vol.73 No.4
Purpose: Endoscopic thyroidectomy has recently been widely used in clinical practice. The operative method can be classified into CO₂gas insufflation and the gasless technique. This study assessed the safety of low pressure CO₂gas insufflation (up to 6 mmHg) by performing continuous measurement of the end-tidal CO₂ (ETCO₂) pressure. Methods: From March 2003 to October 2006, 95 patients (90 hemithyroidectomies and 5 total thyroidectomies) underwent endoscopic thyroidectomy. The low pressure CO₂gas insufflation technique was applied in all cases. The ETCO₂ pressure of the patients was measured by capnometry at the time of a pre-CO₂gas insufflation status (0 minutes) and at the time of post-CO₂gas insufflation (30 minutes) and then it was measured every 30 minutes with also performing capnograms. We analyzed the ETCO₂ pressure at the time of the pre-CO₂gas insufflation status (0 min) and we compared this with that of each status by using paired T-test. Results: For all 95 cases, the mean patient age was 36.2±9.1 (range: 21∼57 years), the mean tumor size was 1.7±1.1 (range: 0.1∼4.5 ㎝) and the mean operative time was 135.0±46.1 (range: 50∼340 min). The mean ETCO₂ pressure (mmHg) was 33.0±3.9 at the time of pre-CO₂gas insufflation status (0 min); the mean ETCO₂ pressure was 31.1±3.7 at 30 min (n=95), 33.5±3.7 at 60 min (n=95), 35.2±3.6 at 90 min (n=95), 34.9±3.7 at 120 min (n=90), 34.6±3.8 at 150 min (n=70), 34.1±3.4 at 180 min (n=40), 34.3±5.2 at 210 min (n=15) and 34.0±4.2 at 240 min (n=9). There was a significant difference the early post-CO₂gas insufflation status (P<0.05 at 30 min, 90 min, 120 min), but there was no significant difference in the late post-CO₂gas insufflation status (P>0.05; at 60 min, 150 min, 180 min, 210 min, 240 min). At each time point, the ETCO₂ pressures were all within the normal range. Conclusion: We successfully performed endoscopic thyroidectomy with using the low pressure CO₂gas insufflation technique and there were no significant complications. We think that performing endoscopic thyroidectomy with using the low pressure CO₂gas insufflation technique is a safe procedure.