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돼지에 있어 인공혈관으로 대정맥 재건을 통한 자가 부분 간이식 동물 실험 모델
서형일(Hyung-Il Seo),심문섭(Mun Sup Sim),김동헌(Dong-Heon Kim),전태용(Tae Yong Jeon),조홍재(Hong-Jae Jo),권재영(Jae Young Kwon),김해규(Hae Kyu Kim),김해영(Hae Young Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.4
Purpose: Experimental animal models are useful training methods for liver transplantation, despite of ethical issues. The aims of this study are to examine the technical feasibility of living donor liver transplantation in pigs and to address the ethical problems. Methods: Eight pigs were used in this experiment. The pig liver was divided via a left hemi-hepatectomy without inflow occlusion. The GORE-TEX<SUP>R</SUP> Vascular Graft was used as a replacement for the inferior vena cava during the graft. After the bench technique, the remnant right lobe of the pig was removed. During the anhepatic phase, an abdominal aortic clamp in combination with general hypothermia was applied, instead of using a conventional bypass procedure. Results: Anhepatic time was 41.3±7.0 min and cold ischemic time was 200.3±29.4 min. The 1<SUP>st</SUP>, 4<SUP>th</SUP>, and 8<SUP>th</SUP> pig died because of declamping shock and arrhythmia on releasing the abdominal aortic clamp. Three pigs had five postoperative complications: pneumonia, gastrointestinal bleeding, IVC thrombosis, portal vein thrombosis, and bile duct stricture. The 6th pig received a hepaticojejunostomy due to stricture of the anastomosis site at 37 days after transplantation. Conclusion: Pigs are economically and ethically more convenient compared to primate models. For auto-liver transplantation, no immunotherapy was needed. The pigs lived relatively long, allowing operative faults to be detected and studied. This experimental model will be useful training for living donor liver transplantation.
Hyung Il Seo(서형일) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.2
Collision tumors represent the coexistence of two adjacent but histologically distinct tumors in an organ. Collision tumors have been identified in various organs, but they are rare in liver. We present a rare case of a 57-year-old man, who was hospitalized for the removal of a liver mass (S5/6 segmentectomy), that was probably a hepatocellular carcinoma. The eventual pathology examination revealed a collision tumor composed of a hepatocellular carcinoma and an undifferentiated sarcoma. Because the tumor recurred 2 months after the operation, reoperation (right hemicolectomy and tumorectomy) was performed. In the 2nd month following the second operation we found multiple liver metastases, chest metastasis and abdominal cavity metastasis. To our knowledge this is the first case of a hepatic collision tumor that was composed of a hepatocellular carcinoma and an undifferentiated sarcoma. Herein, we report the case of a hepatic collision tumor and briefly review the literature.
이지연(Jee-Yeon Lee),서형일(Hyung-Il Seo),심문섭(Mun-Sup Sim) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.5
Purpose: Stage-related treatment has been recommended for gallbladder cancer (GBC). When patients with T2 tumors undergo an extended cholecystectomy, the 5?year survival rates have been reported to be 64∼100%. But when patients with T2 tumors undergo simple cholecystectomy, the 5?year survival rates have been reported to be only 20∼40%. The question may rise as to which patients benefit from simple cholecystectomy among patients with T2 GBC. We investigated the survivals and the facts leading to death or recurrence after simple cholecystectomy for T2 GBC. Methods: Between Mar. 2001 and Dec. 2007, 13 patients had refused second radical operation for T2 GBC incidentally discovered after simple cholecystectomy. Survival analyses were evaluated by clinopathological factors. Results: The 1?, 3? and 4?year overall survival rates were 84.6%, 76.2% and 38.1% and 1? and 3?year disease-free survival rates were 69.2%, 51.3%. The factors affected survival rates were low serum albumin titer and R1 resection (Lymph node metastasis or cystic duct involvement in microscopic finding) (P<0.05). Conclusion: Simple cholecystectomy is not a curative method of T2 GBC, because it reveals lower 5?year survival rates compared to those of extended cholecystectomy or radical surgery. But in the case when the patient refuses reoperation or it is difficult to undergo reoperation because of severe underlying disease, simple cholecystectomy with normal albumin titer or the absence of lymph node metastasis and absence of cystic duct involvement in microscopic findings may help the long-term survivals after simple cholecystectomy.
진행성 유방암에서 근치적 유방절제술 후 발생한 광범위 흉곽 결손의 외복사근 피판술을 이용한 유방재건술
이지연(Jee-Yeon Lee),서형일(Hyung-Il Seo),배영태(Young-Tae Bae) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.6
Purpose: Major chest wall reconstruction following radical excision of advanced breast cancer is remained a challenging treatment of oncoplastic surgeons. The aims of this study are to introduce a method of external oblique myocutaneous flap (EOMCF) and evaluate the effect of large chest wall reconstruction using external oblique myocutaneous flap. Methods: A retrospective review of 17 patients who underwent chest wall reconstruction with external oblique myocutaneous flap from January of 2007 through May of 2008 was performed. The upper edge of external oblique myocutaneous flap was lower margin of defect. The medial edge was mid-line of abdomen by umbilicus, vertically along the linea alba. The lower edge was a lateral transverse line at the level of umbilicus. The flap was rotated clockwise in the left side chest wall defects and counterclockwise in the right. Results: The mean chest wall defect was 360.8±137.8 ㎠ and the mean flap size was 591.1±136.2 ㎠. The mean reconstruction time was 41.5±7.9 min and patients were discharged on 8.8±1.2 postoperative day (mean). Three patients had superficial skin loss (<5%) and this lesions are healed with conservative therapy. Conclusion: We propose that the external oblique myocutaneous flap may be a safe and feasible method for reconstruction of large chest wall defects after radical mastectomy including all breast skin.