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간세포암의 간이식 적응증: Barcelona Clinical Liver Cancer 가이드라인을 벗어난 치료 적응증
이남준 ( Nam Joon Yi ),이광웅 ( Kwang Woong Lee ),서경석 ( Kyoung Suk Suh ) 대한간암학회 2015 대한간암학회지 Vol.15 No.1
The management of hepatocellular carcinoma (HCC) is decided according to the evidence base recommendations generated by international societies especially by Barcelona clinical liver cancer (BCLC) guideline. However, the BCLC guideline based on studies of the Western countries, has not been well matched to real life cohort in Korea. In Western countries, a deceased donor liver transplantation has been well allocated to the HCC patients with preserved liver function. Patients with mild to moderate portal hypertension and certain BCLC B patients could be eligible for hepatic resection if a chance for 50% survival rate at 5 years is perceived. If liver transplantation (LT) is back up for liver resection in those patients as a salvage therapy, widening indication of liver resection could be much easily acceptable. On the other hands, new selection criteria of HCC beyond Milan criteria considering tumor biology, has been provided in the field of LT resulting in more than 50% survival rate at 5 years. Herein, surgical perspectives beyond the BCLC recommendation for LT for HCC would be reviewed in the respect of Korean surgeon’s view in this article. (Journal of Liver Cancer 2015;15:4-10)
이남준(Nam-Joon Yi),권준혁(Choon Hyuck David Kwon),김건국(Keon Kuk Kim),김봉완(Bong-Wan Kim),유영경(Young Kyoung You),최진섭(Jin Sub Choi),하태용(Tae-Yong Ha),한영석(Young Seok Han),이광웅(Kwang-Woong Lee) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.4
Purpose: Despite refinements in the surgical techniques for adult-to-adult living donor liver transplantation (ALDLT), biliary complications still remain the Achilles’ heel of ALDLT. Moreover, there is no consensus for the ideal technique of biliary reconstruction to reduce the rate of complications to an acceptable range. We strove to collate the available data of the current surgical techniques for biliary reconstruction in ALDLT in Korea. Methods: A questionnaire concerning the surgical techniques for biliary reconstruction was sent to 9 surgeons who performed biliary anastomosis in the major LDLT centers of Korea (the response rate was 100%). Results: MR cholangiography (n=7) and/or intra-operative cholangiography (n=5) were routinely performed to evaluate the donor biliary anatomy. All the participants (n=9) preferred duct-to-duct anastomosis to hepatico-jejunostomy. Anastomosis was usually made on the whole layer (n=7 epithelium, n=2) of recipient’s common hepatic duct under loupe magnification (n=8); only one center reconstructed the anastomosis on the 2nd order hepatic duct under view of a surgical microscope. There were various techniques for biliary reconstruction as follows: suture material (absorbable: n=5, non-absorbable: n=4), suture method (continuous: n=4, interrupted: n=3, mixed: n=3) and the use of a biliary stent (routine: n=3, sometimes: n=5, rare: n=1). Ductoplasty was performed on the back table (n=7) for the cases with a very close distance (<5 mm) between the bile ducts’ openings, but each duct was separately anastomosed to the recipients’ bile duct (n=8) or a roux-en-Y limb (n=1) was done in cases with a distance more than 10 mm. Conclusion: In 9 LDLT centers of Koreas, duct-to-duct was preferred; however, there was no unique consensus, among the major centers, for the biliary reconstruction techniques that might reduce complications.
Unilateral Hydrocephalus in Congenital Atresia of the Foramen of Monro
김종현,정용구,이남준,김세훈,이훈갑,이기찬,서중근,Kim, Jong Hyun,Chung, Yong Gu,Lee, Nam Joon,Kim, Se Hoon,Lee, Hoon Kap,Lee, Ki Chan,Suh, Jung Keun The Korean Neurosurgical Society 2000 Journal of Korean neurosurgical society Vol.29 No.3
일측성 수두증은 여러가지 원인에 의해 발생될 수 있으나 주로 종양이나 감염등에 의한 후천적인 몬로공 폐쇄의 경우가 대부분이고 선천성 몬로공 폐쇄에 의한 일측성 수두증은 그 예가 많지 않다. 산전초음파 검사로 태아의 선천성 일측성 수두증을 진단했고 출산 후 수술적 방법을 통해 치료한 예는 국내에 아직 보고된 바가 없어 이를 문헌고찰과 함께 보고한다. Unilateral hydrocephalus is an uncommon disease which may result from obstruction of the foramen of Monro. Congenital or acquired lesions obstructing this foramen have been reported. We present a case of prenatally diagnosed fetal unilateral hydrocephalus. Ventriculoperitoneal shunt operation was performed and following the procedure, ventricular size was decreased and patients neurological status was improved.
간 이식 소아에서 발생한 이식 후 림프 증식 질환: 단일 기관에서의 21년 경험
이정화,고재성,서정기,이남준,서경석,이건욱,강경훈,Lee, Jung-Hwa,Ko, Jae-Sung,Seo, Jeong-Kee,Yi, Nam-Joon,Suh, Kyung-Suk,Lee, Kuhn-Uk,Kang, Gyeong-Hoon 대한소아소화기영양학회 2009 Pediatric gastroenterology, hepatology & nutrition Vol.12 No.2
Purpose: To analyze the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) after liver transplantation in children. Methods: From January 1988 to June 2009, we retrospectively reviewed the medical records of 8 PTLD cases among 148 pediatric patients underwent liver transplantation. The age at transplantation, time of presentation after transplantation, clinical manifestations, histologic diagnosis, results of EBV (Epstein-Barr virus) assessments, managements and outcomes of PTLD were investigated. Results: The prevalence of PTLD in liver transplant pediatric recipients was 5.4% (8 of 148). The mean age of patients was 25.4${\pm}$21.3 months (range 10 to 67 months). Seven of 8 patients (87.5%) underwent liver transplantation before 1 year of age. The common clinical presentations were persistent fever (8 of 8, 100%) and bloody diarrhea (6 of 8, 75%). PTLD was diagnosed with gastrointestinal endoscopic biopsies in five patients and surgical biopsies in three. Histologic findings showed early lesion in three patients, polymorphic in two, and monomorphic in three. Burkitt lymphoma and lymphoblastic lymphoma were found in two of 3 monomorphic patients. Seven of 8 patients were found with EBV-positive. Eight patients were treated with dose reduction of immunosuppressants and infusion of ganciclovir. Rituximab was added to four patients. PTLD were successfully managed in all patients except one who died of sepsis during chemotherapy. Conclusion: Major risk factor of PTLD was to undergo liver transplantation before 1 year of age. Continuous monitoring for EBV viral load and gastrointestinal endoscopic biopsy may be useful to early detection of PTLD. 목 적: 간 이식 소아에서 발생한 PTLD의 경험을 통해 발현 양상, 발병 위험 인자, 진단 방법, 치료 및 예후에 영향을 줄 수 있는 요인들을 알아보았다. 방 법: 1988년 1월부터 2009년 6월까지 서울대학교 어린이병원에서 간 이식을 받은 소아 148명 중 PTLD로 진단된 8명의 환아들을 대상으로 후향적 분석을 하였다. 이식당시 나이, 이식 후 PTLD 증상이 나타날 때 까지의 기간, 임상적 증상, 조직학적 소견, EBV 검사 결과, 치료 및 경과에 대해 조사하였다. 결 과: 간 이식 후 PTLD의 유병률은 5.4%였고, 발생시기는 조기 PTLD가 6명(75%), 후기 PTLD가 2명(25%)이었다. 대상 환아의 간 이식 당시 나이는 평균8.1${\pm}$4.4개월로, 12개월 미만이 7명(87.5%), 12개월 이후가 1명(12.5%)이었다. PTLD 진단 시 주증상은 발열, 설사, 혈변이었고 모두 장이나 장간막 림프절 침범이 있었다. 3명은 개복 수술로 5명은 상부 위장관 내시경이나 대장 내시경을 통한 조직 검사로 진단되었다. 조직학적 진단은 early lesion이 3명, polymorphic PTLD 2명, monomorphic PTLD 1명, Burkitt 림프종 1명, B 세포 림프종이 1명이었다. EBV는 7명에서 양성을 보였다. 치료는 전례에서 1차 치료로 면역억제제를 중지하고 항바이러스제(ganciclovir)를 투여 하였다. 4명의 환아들에서 rituximab을 추가하였고 Burkitt 림프종과 B 세포림프종으로 진단된 환아들은 각각 항암 치료를 병행하였다. B 세포 림프종으로 진단되어 치료 중에 패혈증으로 1명이 사망하였으며 나머지 7명은 호전되었다. 결 론: 1세 미만에 간 이식을 받은 경우가 PTLD 발생의 주요한 위험 인자였으며, EBV viral load의 지속적인 감시와 위장관 내시경을 통한 조직 검사가 PTLD 조기진단에 유용할 것으로 생각한다.