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위 전절제술에서 췌장보존 비장적출술의 합병증 및 보완술식
이문수,강길호,조규석,김용진,김성용,백무준,김창호,조무식,Lee, Moon Soo,Kang, Gil Ho,Cho, Gyu Seok,Kim, Yong Jin,Kim, Sung Yong,Baek, Moo Jun,Kim, Chang Ho,Cho, Moo Sik 대한위암학회 2007 대한위암학회지 Vol.7 No.1
목적: 위 전절제술 시 췌장의 합병 절제로 인한 술 후 합병증의 감소를 위해 췌장보존 비장적출술이 소개되었으나, 이 술식을 적용했던 몇몇 보고에서 여전히 합병증에 대한 문제점이 제기되었고 이에 따른 보완술식의 필요성과 해부학적 검토가 요구되어 본원에서 시행한 술식의 결과를 통해 그 보완점을 제시하고자 하였다. 대상 및 방법: 1997년 1월부터 2004년 12월까지 위암으로 위 전절제술 시 췌장보존 비장적출술을 시행 받은 환자 141명을 대상으로 하였으며, 기존의 전통적인 술식을 시행한 38예(A군)와 췌장 미부의 괴사에 대해 보완 개발된 술식을 시행한 103예(B군)를 각각 두 군으로 구분하여 술 후 합병증을 비교 분석하였다. 결과: A군과 B군 두 군 간 술 후 합병증 비교에서는 췌장루가 각각 4예와 0예, 복강내 농양이 1예와 0예였고 췌미부 괴사는 2예와 0예에서 수술 중 발생되었으며 2예 모두 췌미부 절제술을 시행하였다. 그 외로 경미한 췌즙누출이 각각 2예씩 발생하였으나, 보존적 치료로 호전되었다. 두 군 간 합병증 발생률은 통계적으로 유의한 차이를 보였다(P=0.0001). 결론: 위 전절제술에서 췌장보존 비장적출술의 합병증에 대한 보완을 위해 혈관 겸자를 이용해 임시적으로 비동맥의 혈류를 차단하여 췌 미부의 허혈성 변화를 관찰한 후 비동맥을 절단하는 술식을 적용한 보완된 췌장 보존 비장 적출술은 간편하면서도 술후 합병증을 예방할 수 있는 유용한 술식으로 생각된다. Purpose: A pancreas-preserving total gastrectomy (PPTG) was introduced to decrease the postoperative complications due to pancreatic resection. However, some complications, such as leakage of pancreatic juice, are still reported. Thus, the purpose of this study was to propose a supplementary procedure based on the results of treatment for gastric cancer at our hospital. Materials and Methods: From Jan. 1997 to Dec. 2004, the cases of 141 patients who underwent a PPTG for gastric cancer were reviewed retrospectively. The patients were divided into Group A (38 cases), patients who were treated using a conventional PPTG, and Group B (103 cases), patients who were treated using a new and improved PPTG. Their postoperative complications were compared. Results: No statistically significant differences in clinicopathologic data were noted between the two groups. The comparison of complications showed for groups A and B, respectively, 4 and 0 cases of pancreatic fistula, 1 and 0 cases of intraabdominal abscess, 2 and 0 cases of intraoperative pancreatic necrosis, and 2 and 2 cases of minor leakage. The difference in the prevalence of complications between the two groups was statistically significant (P=0.0001). Conclusion: In order to reduce the risk of PPTG-related complications, we used vascular clamps to observe the necrosis of the pancreatic tail before dividing the splenic artery, and this method resulted in a significant decrease in postoperative complications. Thus, we conclude that our use of vascular clamps in a PPTG is a simple and useful method for preventing postoperative complications.
원위부 위아전절제술 후 원형문합기를 이용한 위십이지장 문합술 - 문합부 합병증과 예방책 -
이문수,강길호,조규석,김용진,김형수,이화수,김성용,백무준,김창호,조무식,Lee, Moon-Soo,Kang, Gil-Ho,Cho, Gyu-Seok,Kim, Yong-Jin,Kim, Hyung-Soo,Lee, Hwa-Soo,Kim, Sung-Yong,Baek, Moo-Jun,Kim, Chang-Ho,Cho, Moo-Sik 대한위암학회 2006 대한위암학회지 Vol.6 No.2
목적: 원위부 위아전절제술 후 원형문합기를 이용한 위십이지장 문합술은 안정성과 간편함, 신속성 등 여러 장점으로 인해 점점 그 선호도가 증가되고 있다. 이에 기계문합술 후 발생할 수 있는 합병증의 고찰을 통해 이 술식의 안전성을 위해 보완해야 될 점을 알아보고자 하였다. 대상 및 방법: 1998년 1월부터 2004년 12월까지 위암으로 근치적 원위부 위아전절제술 후 원형문합기를 이용하여 위십이지장 문합술을 시행한 594명을 대상으로 하였다. 문합부위의 출혈유무를 육안으로 확인하기 시작하였던 2001년 1월을 기점으로 그 이전을 제1군(n=219), 그 이후를 제2군(n=375)으로 분류하여 각 군 간의 임상적 특징과 문합부와 관련된 술후 합병증을 비교하였다. 결과: 두 군 간 합병증 비교에서, 문합부의 누출은 제1군이 4예(1.8%), 제2군이 3예(0.8%) 발생하였고(P=0.196), 문합부 협착은 두 군 모두 발생하지 않아 두 군 간 차이는 없었다. 출혈은 제1군이 43예(19,6%), 제2군이 2예(0.5%)로 제1군에서 많게 나타났다(P=0.019). 결론: 위암 환자의 원위부 위아전절제술 후 원형문합기를 이용한 위십이지장 문합술은 이 술식이 갖는 여러가지 장점으로 권장되는 술식이나, 문합부 출혈이 중요한 문제점으로 지적될 수 있어 술 중 문합부 출혈 유무를 육안적으로 확인하는 것이 기계문합법의 안전성을 향상시킬 수 있으리라 생각한다. Purpose: The circular stapled Billroth I gastrectomy has been gradually popularized because of several advantages. Thus, this study aims to identify what to be supplemented for the safety of this technique by examining the potential complication after the circular stapled Billroth I gastrectomy. Materials and Methods: This study selected 594 patients who underwent the circular stapled Billroth I gastrectomy because of the gastric cancer in our department of surgery from Jan. 1998 to Dec. 2004 as the subjects. As of Jan. 2001 when the bleeding on the anastomosis site was visually checked through the small incision at the opposite curvature to the lesion of the stomach to be resected and so the operation was completed, the patients were divided into the Group I (n=219) and Group II (n=375), which were the patients before and after Jan. 2001, respectively. Then, the clinical characteristics and postoperative anastomotic complications of both groups were compared. Results: For the comparison of complications between two groups, the anastomotic leakage was found in four cases in Group I and three cases in Group II (p=0.196). The stenosis on the anastomosis region was not observed in both groups. The bleeding on the anastomosis region illustrates the statistically significant difference between Group I and Group II, with 43 cases and 2 cases, respectively (P=0.0019). Conclusion: The circular stapled Billroth I gastrectomy is recommended because of several advantages of this technique. However, the bleeding on the anastomosis site may be indicated as the critical issue. Accordingly, the visual check on the bleeding on the anastomosis site during the operation will improve the safety of circular stapler.
이문수,김태윤,조규석,채만규,김성용,백무준,이상한,박경규,김창호,송옥평,조무식,Lee, Moon-Soo,Kim, Tae-Yun,Cho, Gyu-Seok,Chae-Man-Kyu,Kim, Sung-Yong,Baek-Moo-Jun,Lee, Sang-Han,Park, Kyung-Kyu,Kim, Chang-Ho,Song-Ok-Pyung,Cho, Moo-Sik 대한위암학회 2003 대한위암학회지 Vol.3 No.1
Purpose: Genomic alterations and abnormal expression of the fragile histidine triad (FHIT) gene in gastric cancer were examined to determine whether the FHIT gene is actually a frequent target for alteration during gastric carcinogenesis. Materials and Methods: To correlate DNA and RNA lesions of the FHIT gene with the effect on FHIT protein expression, in 40 gastric cancers, we investigated the FHIT gene for loss of heterozygisity (LOH), aberrant transcripts, and protein expression. Results: Allelic loss at D3S1300 was detected in 7 of 38 ($19\%$) informative cases. Aberrant transcripts were observed in 20 of 40 ($50\%$) cases. Significant reduction of FHIT protein expression was observed in 22 of 40 ($55\%$) cases. Aberrant FHIT transcription was shown to be associated with loss of FHIT protein expression. However, aberrent FHIT transcripts themselves were not associated with any clinicopathological parameters, such as age, sex, tumor site, or clinical stage. Moreover, there was no association between the presence of LOH at D3S1300 and the expression of aberrant FHIT transcripts. Conclusion: The high frequency of aberrant FHIT transcripts, the significant rate of LOH at D3S1300, and the altered expression of the FHIT protein indicate that alterations of the FHIT gene can play an important role in gastric carcinogenesis.
이문수,김성용,오상현,채만규,정일권,백무준,박경규,김창호,조무식,Lee Moon Soo,Kim Sung Yong,Oh Sang Hyun,hCae Man Kyu,Chung Il Kwon,Baek Moo Jun,Park Kyung Kyu,Kim Chang Ho,Cho Moo Sik 대한위암학회 2001 대한위암학회지 Vol.1 No.1
An exceedingly rare case of perforated early gastric cancer is reported. A 68-year-old man developed peritonitis due to perforation of early gastric cancer. An emergency radical operation was performed and was followed by an uneventful recovery. Histologic examination of the surgical specimen showed type III early gastric cancer composed of a signet ring cell carcinoma. Five years after surgery, the patients was alive with no evidence of tumor recurrence. The rarity of this complication in early gastric cancer is discussed, and a review of the literature is presented.
간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 담관낭종의 15예에 대한 임상적 고찰
김선주(Sun Joo Kim),정재삼(Jae Sam Chung),조무식(Moo Sik Cho),조주영(Joo Young Cho),김대수(Dae Soo Kim),황성규(Seong Gyu Hwang),이문호(Moon Ho Lee),임건일(Gune Il Lim),구영무(Young Moo Koo),김창호(Chang Ho Kim),송옥평(Ok Pyeong Song) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.1
N/A Congenital diatation of the common bile duct is an uncommon condition. More than 190 cases have been reported in the Korean literature up to date including the present series. We reviewed 15 cases of choledochal cyst treated surgically at the Chun-an Hospital, Soonchunhyang University, between January 1984 and July 1990. The results were as follows. 1) Age ranged from 1 year to 64 years and 7 of 15 cases were above 30 years. The ratio of men to women was 1: 6.5. 2) The durations of symtoms varied widely from 3 days to 13 years. 3) The frequency of the triad of symptoms and signs were in order of abdominal pain 14 cases (93%), jaundice 8 cases (53%) and abdominal mass 7 cases (47%), The classical triad of mass, pain and jaundice was present in 6 cases (40%). 4) Ultrasonography was useful as the initial diagnostic tool in all cases As next diagnostic studies, abdominal CT was performed in 6 cases, ERCP in 4 cases and PTC in 3 cases. 5) According to the classification of Todani, 13 cases (87%) were type I and two cases (13%) were type II. 6) The associated disease were cholecystitis in 8 cases, stone in common bile duct in 4 cases, cancers in 2 cases, GB empyema in 1 case and bile peritonitis in 1 case 7) Preoperative diagnosis was made in 13 (87%) of 15 cases 8) Surgical procedure used were principally choledochocystoduodenostomy in 3 cases, choledo-chocystojejunostomy in 8 cases, cyst excision in 2 cases, T tube choledochostomy in 1 case, and T tube choledochostomy with delayed cyst excision in 1 case.
이문수,채만규,김태윤,조규석,김성용,백무준,정일권,박경규,김창호,송옥평,조무식,Lee, Moon-Soo,Chae, Man-Kyu,Kim, Tae-Yun,Cho, Gyu-Seok,Kim, Sung-Yong,Baek-Moo-Jun,Chung-Il-Kwon,Park, Kyung-Kyu,Kim, Chang-Ho,Song-Ok-Pyung,Cho, Moo-Sik 대한위암학회 2002 대한위암학회지 Vol.2 No.2
Purpose: Perforated gastric cancer (PGC) is rare and occurs in $1\∼4\%$ of all gastric cancers. Possible dissemination of tumor cells at the time of perforation of the gastric carcinoma has been a matter of concern. The intraoperative determination of what kind of operation should be done and how extensive the lymphnode dissection should be still remains controversial. The purpose of this study is to evaluate the factors influencing the survival and to determine the optimal treatment for PGC. Materials and Methods: A total of 42 patients were operated on for a perforated gastric carcinoma at Soonchunhyang University Chunan Hospital from 1983 to 2000. the age and the sexes of the patients, the location of perforation, the diameter of perforation, the histologic type of the tumor, the depth of wall invasion, the absence or presence of lymph node metastasis / distant metastasis, the stage of disease, the type of operation, and the outcomes were examined. Statistically significant differences were analyzed by using Fisher's exact test. Results: The stage distributions according to the UICC classification were 1 case of stage I, 6 cases of stage II, 17 cases of stage III, and 11 cases of stage IV. An emergency gastrectomy was done in 26 patients ($61.9\%$), with a 5-yr survival rate of $44\%$. The survival of patients was significantly influenced by the depth of wall invasion, the lymphnode metastasis, distant metastasis, the stage of disease, and the type of operation. Conclusions: an emergency gastrectomy is the treatment of choice for most patients with resectable PGC. Choosing more a optimistic surgical approach for potentially curative cases of PGC should be one way to increase the patient's survival rate.
김명환(Myung Hwan Kim),김선주(Sun Joo Kim),우종욱(Chong Wook Woo),정재삼(Jae Sam Jung),조무식(Moo Sik Cho) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.2
N/A Enteritis necroticans, or pig-bel, a rare type of food poisoning seen primarily in Papua New Guinea, is probably caused by clostridium welchii type C producing beta toxin. The appearance of small intestine, and in particular the jejunum, was consistent with gangrenous enteritis of patchy distribu- tion. We report a case of necrotizing jejunitis probably caused by ingestion of infected food.