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이민로,이민주,김종훈,황용 대한대장항문학회 2006 Annals of Coloproctolgy Vol.22 No.5
Purpose: A barium enema is frequently performed to check for healing prior to ileostomy closure, but there have been reports that ileostomy closure without a contrast study is safe in selected patients. The aim of this study was to assess the necessity of a routine barium enema prior to ileostomy closure. Methods: Between January 1994 and June 2005, 51 patients with a temporary loop ileostomy who had a barium enema prior to ileostomy closure at Chonbuk National University Hospital were retrospectively reviewed. These patients were divided into 2 groups, the protective ileostomy group and the ileostomy-after-leakage group. To examine the necessity of a routine barium enema prior to ileostomy closure, we assessed whether the barium enema results changed management and whether there were pelvic sepsis and obstructive symptoms following ileostomy closure. Results: In the protective ileostomy group (n=39), the barium enema was performed after a mean of 59 days (range: 27~151 days). There were no abnormal findings at the barium enema, no schedule changes, no pelvic sepsis, and no obstructive symptoms following ileostomy closure. In the ileostomy-after-leakage group (n=12), the barium enema was performed after a mean of 54 days (range: 30~82 days). In 2 patients, with barium enemas at 33 days and 36 days, an anastomotic leakage was found, and ileostomy closure was delayed. Conclusions: In patients with a protective ileostomy, a barium enema prior to ileostomy closure is unnecessary, but in patients with an ileostomy after leakage, barium enema should be considered.
절제된 치핵의 조직검사 소견: 치핵조직에 대한 병리학적 검사는 필요한가?
이민로,홍창원,윤상남,박규주 대한대장항문학회 2005 Annals of Coloproctolgy Vol.21 No.3
Purpose: The aim of this study was to determine the necessity for routine pathologic evaluation of hemorrhoidectomy specimens. Methods: Between March 1998 and February 2001, 280 patients (185 males, 95 females) underwent a hemorrhoidectomy at Seoul National University Hospital. All patients had grade III~IV hemorrhoids, and the mean age of the patients was 51 years (range: 21~74 years). All hemorrhoidectomy specimens were examined with a hematoxylin and eosin stain of one representative section by a pathologist. We performed a retrospective analysis regarding the pathologic results for the hemorrhoidectomy specimens. Results: Two hundred sixty-seven specimens (267, 95.4%) had typical hemorrhoids reported as external and internal hemorrhoids, external hemorrhoids, hemorrhoidal varices, and thrombi. Ten patients (10, 3.2%) had additional benign pathologes such as fibroepithelial polyps (6 cases), a flat condyloma (1 case), hypertrophied papillae with a condyloma, like papillomatosis and keratosis (1 case), dyskeratotic squamous cells with koilocytotic atypia (1 case), and an inflammatory polyp (1 case). Interestingly, three patients (3, 1.1%) had carcinomas in the hemorrhoidectomy specimens. Two patients had squamous- cell carcinomas; one suffered from delayed wound healing after a previous hemorrhoidectomy, and the other had indurated lesions on the hemorrhoids. One patients who had under gone a low anterior resection due to stage-C rectal cancer 7 months before had a adenocarcinoma. Conclusions: Because of the possibility of unsuspected anal cancer, we recommend pathologic examination of hemorrhoidectomy specimens, especially in cases of suspected indurated lesions within the hemorrhoids, delayed wound healing after a previous hemorrhoidectomy, or previous history of colon cancer.
황홍필,이민로,김종훈 대한대장항문학회 2007 Annals of Coloproctolgy Vol.23 No.6
Purpose: Pelvic actinomycosis is a rare infection which presents difficulty in establishing a correct preoperative diagnosis. The aim of this study is to find diagnostic clues for pelvic actinomycosis preoperatively. Methods: A retrospective analysis performed at Chonbuk National University Hospital identified 9 patients with a diagnosis of pelvic actinomycosis from 1998 to 2006. Results: All patients were women with a history of intrauterine device (IUD) use. Abdominal pain (7 cases), palpable mass (3 cases), defecation difficulty (3 cases) and leucorrhea (2 cases) were the main presenting complaints. The median duration of presenting symptoms was 78 days (range: 10∼365 days). The median duration of using an IUD unchanged was 11 years (range: 4∼30 years). A correct diagnosis was made in 3 patients (33%) without exploration. All patients were treated with antibiotics after pathologic diagnosis. There was no recurrence. Conclusions: It is very difficult to diagnose pelvic actinomycosis preoperatively. Howere, if a mass or a pelvic abscess is found in women with an IUD that has been unchanged for a long time, pelvic actinomycosis should be suspected to avoid unnecessary exploration.
폐쇄성 좌측 대장암의 일차치료로서 스텐트와 응급수술의 임상성적 비교
박지원,이민로,홍창원,윤상남,박형철,김세형,한준구,박규주,박재갑 대한대장항문학회 2006 Annals of Coloproctolgy Vol.22 No.1
Purpose: Emergency surgery has been a conventional treatment for malignant large-bowel obstruction, but is associated with high morbidity and mortality. Recently, self-expanding metallic stents (SEMS) have provided a new modality as palliation or bridge therapy for patients with obstructing colorectal cancers. The purpose of the present study is to evaluate whether SEMS is useful in patients with malignant large bowel obstruction. Methods: Between January 1999 and June 2004, 63 patients were treated for primary obstructing left-side colorectal cancer at the Department of Surgery, Seoul National University Hospital. 32 patients were managed firstly with SEMS (stent group), and 31 patients underwent an emergency operation (emergency surgery group). Clinical data were retrospectively reviewed. The results, including perioperative outcome and survival, were compared between the two groups. Results: Clinicopathological parameters, including age, gender, ASA grade, tumor location and stage, were similar between the two groups. The rate of one-stage operations was significantly higher in the stent group (52% vs 13%; P=0.004). The stent group was associated with a lower rate of stoma formation (48% vs 87%; P=0.004), a shorter length of hospital stay (19 days vs 26 days; P=0.048), and fewer complications (7% vs 30%; P= 0.035). The overall and the disease-free survival rates were similar between the two groups (P=0.973, 0.126). The stent group was associated with fewer surgeries needed, shorter length of hospital stay, and fewer complications. Conclusions: Stenting with SEMS is useful in managing malignant large-bowel cancer with obstruction and may be better than traditional open surgery.