http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
분지췌관형 췌관내 유두상 점액종양의 악성도 예측 지표 수립
황대욱(Dae Wook Hwang),장진영(Jin-Young Jang),이승은(Seung Eun Lee),임창섭(Chang Sup Lim),이건욱(Kuhn Uk Lee),김선회(Sun-Whe Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.3
Purpose: Branch duct type intraductal papillary mucinous neoplasms (Br-IPMN) have better prognosis and lower malignancy rate than do main duct type IPMNs (M-IPMN). However, surgical resection is necessary when malignancy is suspected, and radical resection should be performed in cases of invasive IPMN. The objectives of this study were to investigate the characteristics of Br-IPMN and related predictive malignancy/invasiveness factors and to present a standardized scoring system for predicting pathologic results. Methods: We conducted a retrospective review of 91 patients diagnosed with Br-IPMNs between 1998 and 2007. Mean patient age was 62.5±9.0 years. Eighty (87.9%) patients had benign IPMNs (17 adenoma, 63 borderline malignancy), and 11 (12.1%) patients had malignant IPMNs (4 carcinoma in situ, 7 invasive carcinoma). Eighty-four (92.3%) patients had noninvasive IPMN, and 7 (7.7%) patients had invasive IPMN. Results: The size of the cystic mass and the presence and size of the mural nodule were found by univariate analysis to be significantly different between the benign and malignant groups. History of DM, size of the cystic mass, size of the mural nodule, and thickness of the cystic wall were significantly different between the noninvasive and invasive IPMN groups on univariate analysis. The regression coefficients for the size of the cystic mass and for the size and presence of the mural nodule were calculated using multivariate analysis, and the scores predicting malignant and invasive IPMN determined (P=0.001, P=0.000, respectively). Conclusion: There are no universally held guidelines for surgical management of Br-IPMN patients. Hence, many clinicians have difficulty deciding the specific character of the resection they will pursue. By using malignancyand invasiveness-predicting scores, we expect that much of this difficulty can be avoided in the future.
이승은(Seung Eun Lee),황대욱(Dae Wook Hwang),임창섭(Chang Sup Lim),장진영(Jin-Young Jang),김선회(Sun-Whe Kim) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.4
Pancreas-sparing total duodenectomy (PSTD), which allows preservation of the pancreas in its entirety is a promising procedure for benign or premalignant lesions at duodenum without invading the pancreas. We report two cases of tubular adenoma of Ampulla of Vater and a GIST of duodenum, which were resected by PSTD. The proximal duodenum was transected at 2 cm distal of pylorus and the distal end was cut in the distal portion of the Treitz ligament. The proximal jejunal limb was used for biliary-pancreatic duct systems reconstruction with end-to-side anastomosis and distal jejunum was anastomosed to duodenal bulb with an end-to-side anastomosis. Although a pancreatic fistula occurred in one patient, it was improved by conservative management. PSTD is a challenging surgical technique and requires excellent knowledge of anatomy. If performed for appropriate indications, PSTD is a useful alternative to formal pancreatoduodenecotmy and can be done safely with gastrointestinal function maintained.
권유진(Yujin kwon),이승은(Seung Eun Lee),황대욱(Dae Wook Hwang),임창섭(Chang Sup Lim),장진영(Jin-Young Jang),김선회(Sun-Whe Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4
Malignant peripheral nerve sheath tumor (MPNST) is rare, soft tissue, spindle cell sarcoma of an ectomesenchymal origin. MPNSTs frequently occur in the extremities and trunk, whereas there has been only one previous report of MPNST originated from the pancreas. A 55-yr-old previously healthy man was admitted for a pancreas head mass, which was detected during a routine health inspection. Fine needle aspiration biopsy showed atypical cells that were suspicious for malignancy. On open exploration, a 2.6cm sized hypervascular well capsulated mass was seen between the duodenal first portion and the pancreas head, and so enucleation was performed. The tumor was composed with spindle cells without a typical storiform pattern and the cells were positive for mesenchymal antigen, S-100 and vimentin, whereas they were negative for epithelial membrane antigen and cytokeratin. It was concluded that the tumor was a MPNST with perineural cell differentiation. Primary MPNST of the pancreas is extremely rare and performing immunohistochemical staining is necessary for making its diagnosis.
중간부 담도암 환자에서 담도분절절제와 췌두십이지장절제에 따른 예후 비교
서석인(Seok-In Seo),황신(Shin Hwang),이영주(Young-Joo Lee),김기훈(Ki-Hun Kim),안철수(Chul-Soo Ahn),문덕복(Deok-Bog Moon),하태용(Tae-Yong Ha),송기원(Gi-Won Song),정동환(Dong-Hwan Jung),박광민(Kwang-Min Park),황대욱(Dae-Wook Hwang),이승 한국간담췌외과학회 2011 한국간담췌외과학회지 Vol.15 No.1
Purpose: This study was designed to analyze the prognosis following segmental bile duct resection (BDR) versus pancreatoduodenectomy (PD) for mid bile duct (mBD) cancer. Methods: During the 4 years between 2003 and 2006, 55 patients underwent surgical resection for mBD cancer in our institution. Medical records were reviewed retrospectively. They were divided into two groups, a BDR group (n=24) and a PD group (n=31) according to the extent of resection. Results: Median follow-up was 43 months. Overall 3- and 5-year survival rates were 56.0% and 33.8%, respectively. The BDR group had lower tumor stages than the PD group (p=0.011). R0 resection was achieved in 17 (70.8%) of the BDR group and 30 (96.8%) of the PD group. Median survival periods were 43 and 34 months after R0 and R1 resections, respectively (p=0.715). Recurrence occurred in 41 patients after a mean period of 18 months. Three- and 5-year survival rates were 62.5% and 27.2% after BDR, respectively, and 51.5% and 34% after PD, respectively (p=0.715). No significant risk factors for shorter patient survival times was identified. Aggressive treatment of recurrence did not appear to prolong patient survival. Conclusion: The extent of resection for mBD cancer did not affect the survival outcome when R0 resection was achieved. Considering the operative risk in patients with older ages or co-morbidities, PD should be considered only after obtainment of simultaneous tumor-free radial and proximal longitudinal resection margins.
강미주(Mee Joo Kang),이승은(Seung Eun Lee),황대욱(Dae Wook Hwang),임창섭(Chagn-Sup Lim),장진영(Jin-Young Jang),이건욱(Kuhn Uk Lee),김선회(Sun-Whe Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.3
Purpose: The pancreatic uncinate process is defined as the portion of the pancreatic head that lies behind the SMV and SMA. In spite of its peculiar anatomical characteristics, there are few reports addressing the clinicopathologic features of uncinate process carcinoma (UPCa). The purpose of this study was to explore the clinical characteristics of UPCa and to compare them with the characteristics of carcinomas located in other parts of the pancreatic head (non-UPCa). Methods: We retrospectively reviewed the medical records of 380 patients (127 UPCa and 253 non-UPCa) treated for pancreatic head cancer at Seoul National University Hospital between January 2002 and December 2007. The patient demographics, clinical presentation, radiologic details, surgical data, and long-term survival rates were evaluated. The clinical characteristics were analyzed according to tumor location. Results: Jaundice was less common in UPCa (56/127, 44.1% vs. 150/253, 59.3%; p=0.006). Duodenal obstruction (12/127, 9.4% vs. 11/253, 4.3%; p =0.049) and SMA invasion (56/127, 44.1% vs. 58/253, 23.0%; p<0.001) were more frequent in UPCa. Resectability (38/127, 30.0% vs. 117/253, 46.2%; p=0.002) and curative resection rate (29/127, 22.8% vs. 90/253, 35.6%; p=0.001) were significantly lower in UPCa. The overall 3-year survival rate (7.7% vs. 17.9%; p=0.019) and 3-year survival rate after curative resection (0% vs. 35.9%; p=0.012) were lower in UPCa. Conclusion: UPCa less frequently caused jaundice, but more frequently caused duodenal obstruction. Frequent invasion into the SMA led to lower resectability and curative resection rates. Even in cases of R0 resection, long-term survival in the setting of UPCa was lower than that seen in the setting of non-UPCa, which suggests other unknown prognostic factors.
췌관내유두상점액종과 췌장 점액성낭종의 감별을 위한 분자생물학적 지표의 탐색
장진영(Jin-Young Jang),이승은(Seung Eun Lee),황대욱(Dae Wook Hwang),김우호(Woo Ho Kim),안영준(Young-Joon Ahn),윤유석(Yoo-Seok Yoon),한호성(Ho-Seong Han),김선회(Sun-Whe Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.2
Purpose: Although intraductal papillary mucinous tumor (IPMT) and mucionus cystic tumor (MCT) share many common features, they are 2 clinically different disease entities. The aims of this study were to compare the clinicopathological characteristics of IPMT and MCT and to find molecular markers for making the differential diagnosis between IPMT and MCT Methods: Forty-one patients with IPMT and 29 MCT patients who all underwent resection between 1994 and 2003 were enrolled in this study. After one gastrointestinal pathologist reviewed the pathological slides, we compared the clinico-pathological features of the two diseases. Immunohistochemical staining with using 17 biological markers was performed to find useful molecular markers for making the differential diagnosis. Results: Besides the clinical features like gender, the tumor size and location, the patient’s age and the radiological images, we found differences of the expressions of PR(p<0.001), ER(p<0.001), MUC2(p=0.038) and MUC5A(p=0.001) between IPMT and MCT. Conclusion: PR, ER, MUC2 and MUC5A can be useful in making the final differential diagnosis between IPMT and MCT. Considering the different gene expressions, further studies are needed to clarify the different pathogenesis of these two diseases entities.