복강경 대장 절제술의 초기 시행 시 고려점(대장내시경 문신술의 가치와 전직장간막 절제술의 완전성 평가를 중심으로)

오유진,임영철,최대화,차희정 대한내시경복강경외과학회 2009 Journal of Minimally Invasive Surgery Vol.12 No.1

Purpose: Laparoscopic colectomy is technically demanding. Here we share of experience with laparoscopic procedures with focusing on (1) preoperative localization by a colonoscopic tattoo and (2) comparing the laparoscopic total mesorectal excision (lapaTME) with the conventional TME (openTME) according to microscopic examination. Methods: We retrospectively collected 112 cases of laparoscopic colectomy that was performed for treating colorectal cancer during the past 6 years. Preoperative colonoscopic tattoo was done by using india ink. The tattoo cases were compared with the non-tattoo cases. Comparison between 13 cases of lapaTME and 15 cases of openTME was assessed by both gross and microscopic examination in the 28 cases for 9 months. The lapaTME and openTME were applied to mid-rectal cancer and mid & low rectal cancer, respectively. Results: Tattoo was carried out for the Tis (100%), T1 (92%), T2 (72%), T3 (36%) cases. Of the significant cases, T3 lesion was not identified at laparoscopic colectomy. LapaTME grossly showed a greater incidence of defect than that of openTME, but there was no difference microscopically between lapaTME and openTME. Conclusion: A tattoo was useful for early lesion and it should be considered for advanced lesion. LapaTME for mid-rectal cancer can be done without compromising the principles of TME.

폐쇄성 좌측 대장암에서 스텐트 삽입 후 단단계 복강경 대장 절제술의 단기 예후: 비폐쇄성 좌측 대장암의 복강경 대장 절제술군과의 비교

김현실,김성근,안창혁,강원경,이윤석,이인규,김형진,이상철,조현민,박종경,오승택,김준기 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.6

Purpose: Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative bowel decompression and bowel preparation. The aim of this study is to evaluate the safety and the feasibility of a one-stage laparoscopic resection for obstructive left-sided colon cancer after stent insertion by comparing the results to those for nonobstructive left-sided colon cancer. Methods: Between May 2006 and January 2009, a laparoscopic colorectal operation was performed on 18 consecutive patients with obstructive left-sided colon cancer after placement of a self-expandable stent by one colorectal surgeon, and the results were compared retrospectively to those for 43 patients with non-obstructive left-sided colon cancer who had undergone a laparoscopic procedure with the same surgeon. The collected data were the clinicopathologic characteristics, the perioperative complications, the oncologic outcomes, the postoperative recovery results, and the survival rate. Results: The obstructive left-sided colon cancer group had significant benefits in retrieved lymph nodes (18.8±5.3 vs. 14.0± 8.7, P=0.036), and distal resection margin (5.5±3.0 cm vs. 3.6±2.4 cm, P=0.011). There were no significant differences in other clinicopathological characteristics and oncologic outcomes, including the overall 3-yr survival rate, between the two groups. Conclusion: Preoperative stent decompression followed by a laparoscopic colorectal resection is a safe and feasible option for treating obstructive left-sided colon cancer. A further large-scale prospective study should be performed to evaluate the long-term outcome of a one-stage laparoscopic resection using stent insertion in cases of obstructive left-sided colon cancer. Purpose: Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative bowel decompression and bowel preparation. The aim of this study is to evaluate the safety and the feasibility of a one-stage laparoscopic resection for obstructive left-sided colon cancer after stent insertion by comparing the results to those for nonobstructive left-sided colon cancer. Methods: Between May 2006 and January 2009, a laparoscopic colorectal operation was performed on 18 consecutive patients with obstructive left-sided colon cancer after placement of a self-expandable stent by one colorectal surgeon, and the results were compared retrospectively to those for 43 patients with non-obstructive left-sided colon cancer who had undergone a laparoscopic procedure with the same surgeon. The collected data were the clinicopathologic characteristics, the perioperative complications, the oncologic outcomes, the postoperative recovery results, and the survival rate. Results: The obstructive left-sided colon cancer group had significant benefits in retrieved lymph nodes (18.8±5.3 vs. 14.0± 8.7, P=0.036), and distal resection margin (5.5±3.0 cm vs. 3.6±2.4 cm, P=0.011). There were no significant differences in other clinicopathological characteristics and oncologic outcomes, including the overall 3-yr survival rate, between the two groups. Conclusion: Preoperative stent decompression followed by a laparoscopic colorectal resection is a safe and feasible option for treating obstructive left-sided colon cancer. A further large-scale prospective study should be performed to evaluate the long-term outcome of a one-stage laparoscopic resection using stent insertion in cases of obstructive left-sided colon cancer.

복강경 대장절제술의 초기 결과; 개복술과의 후향적 비교 연구

최성일,우종국,장내성,이우용,전호경 대한대장항문학회 2003 Annals of Coloproctolgy Vol.19 No.4

대장 내시경으로 진단하여 복강경 절제로 치료한충수돌기 출혈 1예

강동백,이정균,양빛나,김승호,오정택,박원철,김기훈,조은영 대한소화기내시경학회 2008 Clinical Endoscopy Vol.37 No.4

하부 위장관 출혈부위를 찾기 위해 대장 내시경 등의 여러 진단 방법들이 시행 되고 했으나 정확한 출혈 부위를 찾아내지 못하는 경우가 있어 종종 진단 및 치료에 어려움이 있다. 하부위장관 출혈이 충수돌기에서 발생되는 경우는 드물게 보고 되고 있으며, 원인으로는 충수돌기염, 게실, 중첩증, 혈관이형성증, 크론씨병 등에 의해 다양한 급, 만성 염증 반응으로 충수돌기 점막하층의 혈관이 노출되면 출혈이 일어날 수 있다. 저자들은 하부위장관 출혈로 내원한 48세 여자에서 대장내시경으로 진단된 충수돌기 출혈에 대하여 복강경 충수돌기절제술로 치료한 1예를 문헌고찰과 함께 보고한다.

폐쇄성 대장암에서 스텐트 삽입 후 시행한 대장 절제술

장연수(Yeon Soo Chang),이길연(Kil Yeon Lee),이석환(Suk-Hwan Lee),윤충(Choong Yoon) 대한외과학회 2006 Annals of Surgical Treatment and Research(ASRT) Vol.70 No.4

직장암 환자에서 수부보조 복강경 수술과 개복술의 비교

김창종(Chang Jong Kim),오보영(Bo-Young Oh),홍경숙(Kyoung Sook Hong),이령아(Ryung-Ah Lee),정순섭(Soon Sup Chung),김광호(Kwang Ho Kim) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.1

고령 환자에게 시행된 복강경 대장직장절제술

김민권(Min-Ghwon Kim),이호석(Ho-Suk Lee),박창균(Chang-Kyun Park),조유진(Yoo-Jin Cho),황덕원(Duk Won Hwang),노상익(Sang-Ik Noh) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.5

Purpose: The purpose of this study is to assess the periopertive morbidity and mortality rates in relation to the principal variables in aged patients who undergo laparoscopic colorectal resection. Methods: From March 2001 to March 2006, the prospective laparoscopic colorectal resection database was used to identify 233 patients. Among them, 132 were 70 years of age or older and they were classified as the aged group. 101 were younger than 70 years of age and they were classified as the younger group. Results: Comorbidity was more common in the aged group than in the younger group (67.4% and 53.5%, respectively) (P=0.030). There were higher ASA scores in the aged group (Ⅰ: 2.3% Ⅱ: 68.2% Ⅲ: 29.5%) than in the younger group (Ⅰ: 27.7% II: 56.4% Ⅲ: 15.8%) (P<0.0001). There was a higher postoperative complication rate for the aged group than for the younger group (25.0% and 8.9%, respectively) (P=0.002). Only one case of mortality (0.8%) was found in the aged group. The period of the postoperative hospital stay was longer for the aged group than that for the younger group (21.9±3/416.3 days and 16.3±3/48.1days, respectively) (P=0.002). For the aged group, univariate analysis revealed that the operative procedure, disease, the T stage and the operation time were significant variables for the postoperative complications, and multivariate analysis identified the operation time as an independent variable faor the postoperative complications. Conclusion: More prudent care is needed to prevent postoperative complications for the aged patients who undergo laparoscopic colorectal resection, and particularly for those who can be expected to have a longer operation time.