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식도정맥류 출혈의 치료에 대한 비용 대비 효과 - Modified Sugiura Procedure와 내시경적 치료의 비교 -
배병노 ( Byung Noe Bae ),양근호 ( Keun Ho Yang ),김홍용 ( Hong Yong Kim ),김기환 ( Ki Hwan Kim ),한세환 ( Se Hwan Han ),김홍주 ( Hong Joo Kim ),김영덕 ( Young Duck Kim ),신원창 ( Won Chang Shin ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.4
Background/Aims: According to current studies, the patients treated with modified Sugiura procedure show lower rebleeding rates compared with endoscopic therapy. The aim of this case-control study was to compare modified Sugiura procedure (transabdominal esophageal transection plus esophagogastric devascularization plus splenectomy) with endoscopic therapy for the prevention of recurrent variceal bleeding. Methods: Twenty patients were treated with surgery and 22 patients were treated with endoscopic therapy. We compared their outcomes. Measured main outcomes were mortality, variceal rebleeding, post-interventional changes of liver function, total hospital days, and total hospital charges. Results: Overall mortality in this series was not different. Bleeding related mortality and encephalopathy in the endoscopic therapy group were slightly higher than those in the surgery therapy group. However, these differences were not statistically significant. In patients treated with the modified Sugiura procedure, the liver function was remarkably improved after the operation. Rates of rebleeding (p<0.001), requiring additional endoscopy (p=0.016) and rehospitlalizations (p=0.008) were higher in endoscopic therapy group. In spite of initial lower cost, the overall costs of endoscopic therapy were higher than those of surgery if the costs for the prevention of variceal rebleeding was included. Conclusions: These results indicate that modified Sugiura procedure for esophageal variceal bleeding could improve therapeutic efficiency and quality of life of the patient, especially in the patients with good liver reservoir function. (Korean J Gastroenterol 2003;41:302-308)
이유진,배병노 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.S
Mesh erosion or migration is a rare and late complication after hernia repair. Its incidence is increasing as the utilization of prosthetic mesh gains popularity for abdominal hernia repair. However, mesh migration is exceedingly rare and its clinical presentation is atypical and diverse. Therefore, the management of mesh migration should be individualized to each patient. This research reports the case of a 94-year-old man with transmural migration of Prolene mesh (Ethicon) from the abdominal wall to the rectum 14 years after incisional hernia repair. He presented with only chronic abdominal pain and constipation. Migration of the mesh and a fistula between the right abdominal wall and transverse colon was observed on computed tomography. The mesh was evacuated manually from the anus without any sequelae. These findings made this case atypical, since complete transluminal migration of mesh is exceedingly rare and mesh erosion or migration requires surgical treatment in many cases.
림프절 전이가 없는 결직장암에서 p27kip1 의 예후인자로서의 역할
송상현,배병노,이우용,양근호,김기환,한세환,김홍주,김영덕,김홍용,김정연 대한대장항문학회 2007 Annals of Coloproctolgy Vol.23 No.1
Purpose: Dukes’ A & B colorectal cancer patients are often excluded from adjuvant chemotherapy following potentially curative surgery because they are expected to have good long-term survival. However, actually 20~30% of these patients suffer from recurrent disease, so it would be helpful for these patients of recurrent disease to be able to select a high risk group. Methods: In 78 Dukes’ A & B colorectal cancers, we investigated by immunohistochemistry the role of molecular markers, such as p27kip1, p53, Ki-67, and Skp2, in identifying high-risk patients. Results: Patients with low p27kip1 expression showed poor overall survival compared to those with high p27kip1 expressions (55.3 versus 66.7 months, P=0.018). The only significant factor associated with p27kip1 expression was p53 expression. The low p27kip1 expression and positive p53 expression group had poor overall survival (54.3 months, P=0.036). Conclusions: In a node-negative colorectal carcinoma, the molecular marker p27kip1 does not play an independent prognostic role, but it may have prognostic significance in correlation with other markers such as p53, Ki-67, and Skp2. The assessment of molecular alterations may be useful to node-negative colorectal patients in identifying the high risk group that may benefit from adjuvant chemotherapy.
천간호,배병노,안훈,정현석,조현진,곽금희,양근호,김기환,김홍주,김영덕 대한대장항문학회 2014 Annals of Coloproctolgy Vol.30 No.6
Purpose: Many studies have shown that the completion of adjuvant chemotherapy improves the survival rate. Recently, laparoscopic surgery has been used to treat patients with colon cancer. We analyzed the relationship between the completion of adjuvant chemotherapy and the operation method. Methods: We retrospectively analyzed the medical records of 147 patients diagnosed with colon cancer from January 1, 2009, to May 31, 2012. The numbers of patients who underwent laparoscopic and open surgery were 91 and 56, respectively. We analyzed the relationship between the operation method and various factors such as the completion rate of chemotherapy, the patient’s age, gender, and physical activity, the postoperative hospital stay, the start time of chemotherapy, and the patient’s body mass index (BMI), TNM stage, and type of health insurance. Results: In the laparoscopic surgery group, the postoperative hospital stay (13.5 ± 14.82 days vs. 19.6 ± 11.38 days, P = 0.001) and start time of chemotherapy (17.7 ± 17.48 days vs. 23.0 ± 15.00 days, P = 0.044) were shorter, but the percent complete of chemotherapy (71/91 [78.0%] vs. 38/56 [67.8%], P = 0.121), and survival rate (88/91 [96.7%], 47/56 [83.9%], P = 0.007) were higher than they were in the open surgery group. Patients who were elderly, had a low BMI, and a high American Society of Anesthesiologists score were less likely to complete adjuvant chemotherapy than other patients were. Conclusion: Laparoscopic surgery shows a shorter postoperative hospital stay, a shorter start time of chemotherapy, and a higher survival rate. Laparoscopic surgery may be expected to increase compliance of chemotherapy and to improve survival rate.
Risk Factors of a Pulmonary Thromboembolism After Colorectal Surgery
김준엽,배병노,정현석,박인석,조현진,곽금희,김기환,김홍주,김영덕 대한대장항문학회 2015 Annals of Coloproctolgy Vol.31 No.5
Purpose: Previous studies have revealed that predictors and risk factors of pulmonary thromboembolism (PTE) are malignancy, immobilization, diabetes, and obesity in the postoperative patients. However, in patients undergoing colorectal cancer, studies of PTE have not been enough. Thus, we investigated the risk factors of PTE related to colorectal surgery. Methods: From January 2009 to October 2014, 312 patients received colorectal surgery without other organ resection. The postoperative patients with PTE were 14 (4.5%), and they were classified by sex, age, and stage as a 1:3 paired match to the control group. A multiple logistic regression was performed to identify which factors were associated with PTE. Results: One patient was in stage I, 3 in stage II, 9 in stage III, and 1 in stage IV. In the binary logistic regression analysis, history of diabetes mellitus (odds ratio, 6.498; P = 0.031) and being overweight (odds ratio, 10.018; P = 0.014) were independent risk factors for PTE in patients undergoing colorectal cancer. Conclusion: A history of diabetes mellitus and being overweight were independent risk factors of PTE after colorectal cancer.
강정우,배병노,Geumhee Gwak,Inseok Park,Hyunjin Cho,Keun Ho Yang,김기환,한세환,Hong-Joo Kim,김영덕 대한대장항문학회 2012 Annals of Coloproctolgy Vol.28 No.6
Purpose: For the treatment of acute appendicitis, a conventional laparoscopic appendectomy (LA) has been widely performed. Recently, the use of single incision laparoscopic surgery (SILS) is increasing because it is believed to have advantages over conventional laparoscopic surgery. In this study, we compared SILS and a conventional LA. Methods: We analyzed the 217 patients who received laparoscopy-assisted appendectomies between August 2010 and April 2012 at Inje University Sanggye Paik Hospital. One hundred-twelve patients underwent SILS, and 105 patients underwent LA. For the two groups, we compared the operation times, postoperative laboratory results, postoperative pain,hospital stay, and postoperative complications. Results: The patients’ demographics, including body mass index, were not significantly different between the two groups. There were 6 perforated appendicitis cases in the SILS group and 5 cases in the LA group. The mean operative time in the SILS group was 65.88 ± 22.74 minutes whereas that in the LA group was 61.70 ± 22.27 minutes (P = 0.276). There were no significant differences in the mean hospital stays, use of nonsteroidal antiinflammatory drugs, and wound infections between the two groups. Conclusion: Postoperative pain, complications and hospital stay showed no statistically significant differences between the SILS and the LA groups. However, our SILS method uses a single trocar and two latex tubes, so cost savings and reduced interference during surgery are expected.