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췌십이지장절제술 후 췌공장문합부 누출과 관련된 인자에 대한 연구
안승익 한국간담췌외과학회 2007 한국간담췌외과학회지 Vol.11 No.3
Purpose: Pancreacticoduodenectomy is the procedure of choice for managing periampullary malignancy. But pancreatojejunostomy site leakage is a very critical complication because it is hard to prevent leakage. The aim of this study is to analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy. Methods: We retrospectively reviewed 172 consecutive patients who had received pancreaticoduodenectomy at Inha University Hospital between Apr. 1996 and Mar. 2006. We analyzed the pancreatic leakage rates according to the clinical characteristics, the pathologic and laboratory findings and the anastomosis methods. Results: There were differences in the mean age and pathologic findings between the two groups. There were 115 (66.9%) patients older than 60 years, while the other 57 patients (33.1%) were younger than 60 years. The incidence of developing pancreatic fistula in patients older than 60 years was 21.7% (25/115) while this was 8.8% (5/57) for the younger patients, and the difference was significant (p=0.03). The patients with a dilated pancreatic duct showed a lower rate of esser post-operative pancreatic fistula than the patients with a non-dilated duct (p=0.001). Other factors, including the anastomosis method and the pathologic diagnosis, didn’t show any statistical difference. According to the pathologic diagnosis, the patients with pancreatitis and stomach cancer revealed pancreatic fistula to a smaller extent; there were 6 cases (3.5%) of pancreatitis and 22 (12.8%) of stomach cancer. Among the case with pancreatic fistula, there were 0 cases of pancreatitis and 2 cases (6,7%) of stomach cancer, but the difference was not statistically significant. Conclusion: Our study demonstrated that pancreatic fistula is related to age and a dilated pancreatic duct. Surgeon must take these risk factors into consideration when performing pancreaticoduodenectomy. We recommend surgeons to use skillful technique to prevent pancreatic fistula. Purpose: Pancreacticoduodenectomy is the procedure of choice for managing periampullary malignancy. But pancreatojejunostomy site leakage is a very critical complication because it is hard to prevent leakage. The aim of this study is to analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy. Methods: We retrospectively reviewed 172 consecutive patients who had received pancreaticoduodenectomy at Inha University Hospital between Apr. 1996 and Mar. 2006. We analyzed the pancreatic leakage rates according to the clinical characteristics, the pathologic and laboratory findings and the anastomosis methods. Results: There were differences in the mean age and pathologic findings between the two groups. There were 115 (66.9%) patients older than 60 years, while the other 57 patients (33.1%) were younger than 60 years. The incidence of developing pancreatic fistula in patients older than 60 years was 21.7% (25/115) while this was 8.8% (5/57) for the younger patients, and the difference was significant (p=0.03). The patients with a dilated pancreatic duct showed a lower rate of esser post-operative pancreatic fistula than the patients with a non-dilated duct (p=0.001). Other factors, including the anastomosis method and the pathologic diagnosis, didn’t show any statistical difference. According to the pathologic diagnosis, the patients with pancreatitis and stomach cancer revealed pancreatic fistula to a smaller extent; there were 6 cases (3.5%) of pancreatitis and 22 (12.8%) of stomach cancer. Among the case with pancreatic fistula, there were 0 cases of pancreatitis and 2 cases (6,7%) of stomach cancer, but the difference was not statistically significant. Conclusion: Our study demonstrated that pancreatic fistula is related to age and a dilated pancreatic duct. Surgeon must take these risk factors into consideration when performing pancreaticoduodenectomy. We recommend surgeons to use skillful technique to prevent pancreatic fistula.
Yersinia pseudotuberculosis 5b에 의한 장간막 임파선염 1예
안승익,구명숙,유병욱 대한감염학회 1993 감염 Vol.25 No.3
We report one case of acute mesenteric lymphadenitis due to Yersinia pseudotuberculosis 5b in a 11-year old girl, had triphasic fever and scarlatiniform rash and localized pain on right lower abdomen, mimicking acute appendicitis and scarlet fever initially. She had histories of intermittent drinking of untreated water and close contact with two pet cats. At operation, appendix in retrocecal position was normal except three palpable fecaliths, but there were multiple enlarged mesenteric lymph nodes, showing variable size and darkish yellow colors. Y. pseudotuberculosis was isolated from the mesenteric lymph nodes but not from stool, appendix, blood or drinking water. Agglutinating serum antibody against the serotype 5b strain of Y. pseudotuberculosis was detected with titers of 1:160 in her serum. The isolate was facultative anaerobic Gram-negative coccobacillus that was colorless on (Mac ConKey and salmonella-shigella media, pink on) Cefsulodin-Irgasan-Novobiocin(CIN) media, K/A on TSI, and motile at 22℃ but not at 37℃. In biochemical reaction, oxidase, indole, VP and citrate were negative, but catalase, nitrate reduction to nitrite, urease, methyl red and β-galactosidase were positive. It was nonlactose fermenting, but produced acid without gas from arabinose, esculin, glucose, maltose, mannitol, mannose, rhamnose, salicin and xylose. The result of antimicrobial susceptibility test was sensitive to amikacin, ampicillin, carbenicillin, cephalothin, cephotaxime, chloramphenicol, ciprofloxacin, gentamycin, kanamycin, nalidixic acid, neomycin, norfloxacin, oxacillin, penicillin, polymyxin B, streptomycin, tetracycline, tobramycin, sulfamethoxazole with trimethoprim, and vancomycin except resistant to erythromycin. In conclusion, although Y. pseudotuberculosis infection may not common in Korea, effort to isolate the organism from the clinical specimens and further epidemic study of healthy carrier animals should be necessary.