소아 멕켈씨 게실의 합병증

전흥만,남소현,김대연,김성철,김인구,Jun, Heung-Man,Nam, So-Hyun,Kim, Dae-Yeon,Kim, Seong-Chul,Kim, In-Koo 대한소아외과학회 2007 소아외과 Vol.13 No.2

소아 멕켈씨 게실의 가장 흔한 합병증은 장출혈이었고, 장중첩, 장폐쇄, 장천공 등도 있었다. 멕켈씨 게실의 조직검사상 이소성위조직이 가장 많았고, 이소성 췌장조직도 있었다. 소아 급성 복증의 원인으로 멕켈씨 게실에 의한 합병증을 염두에 두어야겠으며, 진단이 불명확한 경우, 복강경을 통한 진단이 도움이 될 수 있을 것이다. 또한 멕켈씨 게실의 경우 복강경하 절제술로 복강경 수술의 장점을 충분히 살릴 수 있을 것으로 사료된다. Meckel's diverticulum is the most common congenital anomaly of gastrointestinal tract in children. The incidence of complicated Meckel's diverticulum is about 4 %. The major complications of Meckel's diverticulum are bleeding, intussusception, obstruction and perforation. The aim of this study was to investigate the clinical manifestations and the role of laparoscopic surgery in complicated Meckel's diverticulum in children. We retrospectively reviewed the medical records of 19 patients with complicated Meckel's diverticulum who underwent operation at Asan Medical Center between Jan. 1990 and Apr. 2007. Male to female ratio was 11:8, and median age was 1 year (1 day-13 years). The most frequent symptom was hematochezia (68%), followed by irritability or abdominal pain (16%), vomiting (11%), and abdominal distension (5%). Two operative procedures were performed; small bowel resection with anastomosis (68%) and diverticulectomy (32%). The operation proven complications of the Meckel's diverticulum were bleeding (68%), intussusception (16%), perforation (11%) and obstruction (5%). Ectopic tissues found by postoperative pathologic examination were gastric (84%) and pancreatic (11%). Hospital stay after laparoscopic operation for bleeding Meckel's was 5 days (median) and average first postoperative feeding was 1.5 days. On the contrary, hospital stay for open surgery was 7 days and first feed was 3 days. In summary, the most common compliation of Meckel's diverticulum in children was bleeding and ectopic gastric tissues were present in 84%. Laparoscopic procedure seemed to be useful for diagnosis as well as for definitive treatment.

내장동맥 폐색을 동반한 3형 흉복부 대동맥류의 하이브리드 치료

전흥만,조용필,고기영,주석중,권태원 대한혈관외과학회 2013 Vascular Specialist International Vol.29 No.2

As experiences with endovascular aortic devices increases over time, hybrid repair for the treatment of thoracoabdominal aortic aneurysms (TAAA) by using a combination of thoracoabdominal endovascular aneurysm repair and visceral revascularization has been reported with acceptable result. A 55-year-old man with type III TAAA involving visceral arteries has been treated successfully with tube stent-graft followed by right renal revascularization that was facilitated by a rare anatomic configuration. The authors present a type III TAAA patient with rare anatomic configuration of the visceral arteries successfully treated with hybrid endovascular-surgical TAAA repair.

하지정맥류의 1세대 치료법: 약물치료, 압박치료, 경화요법, 발거술

전흥만,윤상철 대한의사협회 2022 대한의사협회지 Vol.65 No.4

Background: Improving the understanding varicose veins (VV) is increasing due to life extension and concerns regarding quality of life. Recently, endovascular treatment has become more common, even in mild cases. Excessive procedures are often performed before conservative and non-surgical treatments. We aimed to explain the efficacy of medication, compression, sclerotherapy, and stripping of treatments and to consider the appropriate indications for many treatment methods, including endovascular procedures. Current Concepts: Venoactive drugs can be used as first-line agents for symptoms, such as edema, at all stages of varicose vein. These are effective adjuvant agents and can help achieve compression before and after procedures. Compression therapy is effective for skin change and ulcers and is excellent for the improvement of symptoms. Sclerotherapy has been widely used as an adjuvant treatment, but recently, its indications have been expanded for non-invasive causes. Traditional high ligation and stripping is still the recommended treatment option for recurrent or complicated varicose veins. Discussion and Conclusion: The patients’ symptoms should be evaluated more critically than assessing only the venous reflux using ultrasound. Additionally, objective evaluation of various causes of lower extremity discomfort should be considered. Treatment according to appropriate indications, such as medication, compression, sclerotherapy, stripping, and endovascular therapy, can improve the patients’ quality of life and prevent complications.

Diagnostic performance of multidetector computed tomography for symptomatic lymphoceles in kidney transplant recipients

전흥만,황성호 대한이식학회 2019 Korean Journal of Transplantation Vol.33 No.2

Background: To evaluate the size of a postoperative lymphocele in the coronal and axial reconstruction planes using multidetector computed tomography (MDCT) in kidney transplantation recipients. Methods: We evaluated 92 recipients who underwent MDCT of the abdominopelvis at 1 month after kidney transplantation. The axial short axis, axial surface area, coronal short axis, and coronal surface area of the lymphocele were measured using the reconstructed MDCT coronal and axial images. Depending on the clinical manifestations and radiologic findings of the recipients, all lymphoceles were classified into symptomatic and asymptomatic. We compared the suitability of the size measurement on coronal and axial planes of MDCT reconstruction for symptomatic lymphocele in kidney transplant recipients using Spearman's correlation analysis and comparisons of receiver operating characteristic (ROC) curves. Results: Areas under the ROC curves were 0.957 and 0.928 for the axial short axis and axial surface area and 0.968 and 0.966 for the coronal short axis and coronal surface area, respectively. In pairwise comparison of the ROC curve of the parameters of the symptomatic lymphoceles, the coronal measurement was significant in contrast to the axial measurement (short axis, P=0.357; surface area, P=0.047). Conclusions: For the prediction of symptomatic lymphoceles using MDCT, the coronal measurement of postoperative lymphoceles can significantly improve diagnostic performance over axial measurement in kidney transplant recipients.

Hand-assisted Laparoscopic Donor Surgery for Living Donor Pancreas and Kidney Transplantation: A Single Center Experience

김정섭,정철웅,전흥만,박관태 대한이식학회 2016 Korean Journal of Transplantation Vol.30 No.4

Background: In this era of donor shortage, use of organs from living donors has increased significantly. Nonetheless, less than 1% of pancreas transplantations involve living donors, despite the immunological benefits, reduced cold ischemic time, and decreased waiting time. One reason for the paucity of donors is the high morbidity after open surgery. Using hand-assisted laparoscopic donor surgery (HALDS) can be a favorable technique for living donors. Methods: Using HALDS, we performed three Simultaneous pancreas-kidney transplantations (SPKs) involving living donors. Two donors were women; one was a man. Results: Their mean age was 34.3±4.7 years, and their body mass index was 23.2±2.36 kg/m2. The mean operation time was 241±19.0 minutes and the mean cold-ischemic time of the kidney was 42.7±9.8 minutes, while that of the pancreas was 64.3±5.2 minutes. One donor developed a pancreatic fistula, which was controlled using conservative management. The donors’ pancreatic and renal functions were well preserved postoperatively. Conclusions: HALDS for SPKs can be performed without significant complications if the surgeon has sufficient skill.

Single-Incision, Two-Port Laparoscopic Appendectomy as an Alternative to Transumbilical Single-Port Laparoscopic Appendectomy

정한솔,정성민,이미리,신용찬,전흥만,김재일,최평화 대한내시경복강경외과학회 2019 Journal of Minimally Invasive Surgery Vol.22 No.1

Purpose: We designed a modified technique to perform an advanced procedure using conventional instruments and did not employ specialized single-incision laparoscopic surgery (SILS) port equipment. We compared postoperative results for transumbilical, single-port laparoscopic appendectomy (TUSPLA) and single-incision, 2-port laparoscopic appendectomy (SITPLA). Methods: This retrospective study enrolled 77 patients who underwent TUSPLA or SITPLA to provide more minimally invasive surgery between May 2017 and April 2018. TUSPLA was performed in 39 patients and 38 underwent SITPLA. In the SITPLA group, two 5-mm trocars were inserted through the umbilicus and an extra puncture site was used for a left-handed instrument. Demographic characteristics, operative data, and postoperative outcomes were collected and compared between the groups. Results: The mean total operative time in the SITPLA group was shorter than in the TUSPLA group (p=0.003). The mean laparoscopic instrumental time was also shorter (p<0.001) in the SITPLA. The number of postoperative analgesics in the SITPLA group was less than in the TUSPLA group (p=0.002). The length of hospital day after surgery was shorter in the SITPLA group than in the TUSPLA group (p=0.008). There were no other significant differences between the groups. Conclusion: SITPLA had a shorter operative time, required less pain management, and had a similar cosmetic outcome when compared with TUSPLA.

슬와동맥류의 임상양상과 수술 후 예후인자

이준호,권태원,조용필,김진우,신성,전흥만 대한혈관외과학회 2011 Vascular Specialist International Vol.27 No.4

Purpose: The present study investigated clinical features of popliteal artery aneurysm (PAA) and evaluated clinical factors which cause poor outcomes of surgical management. Methods: From January 2004 to January 2011, 17 patients underwent surgical treatment at Asan Medical Center. Patient medical records and radiographic findings were retrospectively reviewed. Results: Twenty one PAAs were treated in 17 patients, consisting 15 men (88.2%) and 2 women (11.8%)and were diagnosed at a median age of 59 years (range: 24-88). The mean PAA diameter was 2.73±1.88cm (range: 1.1-7.1 cm). Ten patients (58.8%) had bilateral PAAs. Four patients (19.0%) had abdominal aortic aneurysms, and 9 patients (42.9%) had other peripheral artery aneurysms. Acute limb ischemia was the initial presentation symptom in 9 patients (42.9%), and chronic limb ischemia was present in 9 patients (42.9%). One patient (4.8%) was asymptomatic. All patients received interposition or bypass surgery. The graft patency and limb salvage rate were 81.0% and 90.5%, respectively. Two of 3 cases (66.7%) of no distal run-off developed graft obstruction, while only 2 of 18 cases (11.1%) of patent distal run-off showed graft obstruction. However, no statistical significance was observed between graft obstruction and lack of distal run-off (P=0.080). The risk factor for amputation was no distal run-off (P=0.014). Conclusion: The patency of distal branches was a contributing factor for improving the outcome of surgical management.

양측 내경동맥 협착 환자에서 단기간 순차적 양측 경동맥 내막절제술

이동주,권태원,박호종,권순억,강동화,전흥만,조용필 대한혈관외과학회 2012 Vascular Specialist International Vol.28 No.3

Purpose: The purpose of this study was to evaluate the efficacy and safety of closely sequential carotid endarterectomies (CEAs) for bilateral internal carotid artery stenosis. Methods: From September 1995 to December 2011, 953 CEAs were performed for internal carotid artery occlusive disease in Asan Medical Center. Seven hundreds eighty-five patients received unilateral CEA, and 84 patients received bilateral CEAs. Of the 84 patients with bilateral CEAs, 15 who underwent closely sequential CEAs with an intersurgical period of 7 days were included in this study. Retrospectively, surgical outcomes were evaluated and compared, regarding CEA-related parameters, and early and late mortality and morbidity rates between patients with closely sequential bilateral CEAs and unilateral CEA. Results: With this strategy, initial CEA was performed for the symptomatic side in symptomatic patients, or for the higher-grade carotid stenosis in asymptomatic patients. All 15 patients received contralateral CEA 7 days after initial CEA, and sufficient revascularization was obtained in all procedures. With a mean follow-up of 11.7 months, there were no perioperative neurological complications or strokes. During the follow-up period, early and late complications, except for transient cranial nerve injury, occurred without statistically significant difference between unilateral CEA and closely sequential bilateral CEAs. Conclusion: Closely sequential bilateral CEAs showed excellent early and late clinical outcomes. Although the number of patients included in the study was few, our results demonstrated that closely sequential bilateral CEAs were safe and effective strategies for bilateral internal carotid artery stenosis. In addition, future clinical studies will be needed, with a greater number of patients.

입자유동시스템에 의한 스프링콜릿 버의 디버링 효과

김정두(Jeong-Du Kim),육인수(In-Soo Yook),양동희(Dong-Hee Yang),전흥일(Heung-Il Jun) 한국생산제조학회 1998 한국공작기계학회 추계학술대회논문집 Vol.1998 No.-

The Management of Retained Rectal Foreign Body

김주훈,엄은해,정성민,신용찬,정성원,김재일,허태길,이명수,전흥만,최평화 대한대장항문학회 2020 Annals of Coloproctolgy Vol.36 No.5

Purpose: Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience.Methods: We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes.Results: All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling.Conclusion: Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.