유리공장을 이용한 인두 및 경부식도 재건술

오경균(Kyung Kyoon Oh),심윤상(Youn Sang Shim),이용식(Yong Sik Lee),박혁동(Hyuk Dong Park),김기환(Gi Hwan Kim),심영목(Young Mog Shim),조재일(Jae Ill Zo) 대한두경부종양학회 1991 대한두경부 종양학회지 Vol.7 No.2

Reconstruction of the pharynx and cervical esophagus presents a tremendous surgical challenge to the Head and Neck Surgeon. Because life expectancy of patients with advanced carcinoma of the hypopharynx, and cervical esophagus is limited, treatment must be aimed at palliation. A variety of techiques have been proposed over the years with none proving entirely satisfactory. These techiques include prosthesis; skin graft; cervical flaps; tubed cutaneous and myocutaneous chest flaps; visceral reconstruction with stomach, colon. and jejunum; and jejunal free autografts. Many factors dictate the best method of reconstruction in any given clinical situation. The goal of the surgery is a one-stage reconstruction of swallowing function with minimal morbidity to allow as short a hospital stay as posible. Nine patients underwent the free jejunal autograft reconstruction of the pharyngoesophagus after the ablative surgery for the advanced hypopharyngeal cancer. Postoperative complications included one perioperative death, two abdominal wound dehiscences, two neck hematomas, one carotid rupture, one funtional dysphagia, one late strictures. There were no graft failure, no immediate stenosis and no fistula. An oral diet was started between days 8 and 16, with an average of 9 days and median of 8 days. Patients left the hospital between days 9 and days 38, with an average of 23.4 days and median of 23 days. This method of reconstruction is advocated as reliable palliative procedure with short-term follow-up. In conclusion, we at Korea Cancer Center Hospital are of the opinion that the free jejunal autograft offers an excellent, safe and relative easy method of the pharyngeal and cervical esophageal reconstruction with significant advantages over other techiques.

하인두암종에서 전후두인두절제술 후 유리피판 재건술의 비교 연구

최의제,이동원,지용배,송창면,김정태,안희창,태경 대한이비인후과학회 2013 대한이비인후과학회지 두경부외과학 Vol.56 No.9

Background and Objectives Recently, both jejunal and fasciocutaneous free flap reconstruction are widely used after total laryngopharyngetomy for the treatment of hypopharyngeal cancer. The aim of this study is to evaluate and compare the functional outcomes between jejunal and fasciocutaneous free flap in the reconstruction of hypopharynx after total laryngopharyngectomy. Subjects and Method The medical records of 27 patients with hypopharyngeal cancer who underwent total laryngopharyngectomy and free flap reconstruction were reviewed retrospectively. Of 27 patients, 18 (66.7%) were reconstructed with jejunal free flap and 9 (33.3%) with fasciocutaneous free flap. We compared complications, flap success rates, functional outcomes such as swallowing, respiration and quality of life (QOL) between two reconstruction groups. The swallowing function was evaluated by Functional Outcome of Swallowing Scale (FOSS), and QOL was evaluated by EORTC QOL-C30, HN35. Results Twenty-seven patients consisted of 26 males and 1 female. The mean age of 69±9.1. There were 4, 13, and 10 cases for T2, T3, and T4, respectively. Also, there were 8, 5, 7, and 7 for N0, N1, N2 and N3 cases. The success rate of free flap was 96.3%. The complication rate, operative time, the period of hospital stay did not differ between the two groups. The average score of FOSS was 0.92 in the jejunal group and 1.00 in the fasciocutaneous group. Quality of life was satisfactory in both groups. Conclusion Both jejunal and fasciocutaneous free flap are very effective reconstructive methods after total laryngopharyngectomy for hypopharyngeal cancer. The choice of free flap can be determined based on the individual status of patient and preference of surgeon.

Surgical Outcomes of Cervical Esophageal Cancer: A Single-Center Experience

Lee Yoonseo,Yun Jeonghee,Jeon Yeong Jeong,이정희,박성용,조종호,김홍관,최용수,심영목 대한심장혈관흉부외과학회 2024 Journal of Chest Surgery (J Chest Surg) Vol.57 No.1

Background: Cervical esophageal cancer is a rare malignancy that requires specialized care. While definitive chemoradiation is the standard treatment approach, surgery remains a valuable option for certain patients. This study examined the surgical outcomes of patients with cervical esophageal cancer. Methods: The study involved a retrospective review and analysis of 24 patients with cervical esophageal cancer. These patients underwent surgical resection between September 1994 and December 2018. Results: The mean age of the patients was 61.0±10.2 years, and 22 (91.7%) of them were male. Furthermore, 21 patients (87.5%) had T3 or T4 tumors, and 11 (45.8%) exhibited lymph node metastasis. Gastric pull-up with esophagectomy was performed for 19 patients (79.2%), while 5 (20.8%) underwent free jejunal graft with cervical esophagectomy. The 30-day operative mortality rate was 8.3%. During the follow-up period, complications included leakage at the anastomotic site in 9 cases (37.5%) and graft necrosis of the gastric conduit in 1 case. Progression to oral feeding was achieved in 20 patients (83.3%). Fifteen patients (62.5%) displayed tumor recurrence. The median time from surgery to recurrence was 10.5 months, and the 1-year recurrence rate was 73.3%. The 1-year and 3-year survival rates were 75% and 33.3%, respectively, with a median survival period of 17 months. Conclusion: Patients with cervical esophageal cancer who underwent surgical resection faced unfavorable outcomes and relatively poor survival. The selection of cases and decision to proceed with surgery should be made cautiously, considering the risk of severe complications.

장막 침윤이 없는 위암에서 하부 식도 조임근 보존 전체위절제술 후 공장낭 간치술

김동진(Dong Jin Kim),허훈(Hoon Hur),전해명(Hae Myung Jeon),김욱(Wook Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.5

Purpose: Conventional total gastrectomy with Roux-en-Y esophagojejunostomy has certain limitations such as insufficient food reservoir and malabsorption of nutrients. Therefore, we performed reconstruction of the jejunal pouch interposition (JPI) after near-total gastrectomy preserving the lower esophageal sphincter (LES). We compared the technical feasibility, safety, and surgical outcome of this operation with conventional total gastrectomy accompanying with Roux-en-Y esophagojejunostomy. Methods: From April 2003 to October 2005, 15 LES-preserving, near-total gastrectomies with JPI (LES-JPI group) were performed. The clinical features and surgical outcomes were retrospectively compared with 17 cases of conventional R-Y esophagojejunostomy. Statistical analysis was performed using Fisher’s exact test for categorical data and an unpaired t-test for continuous data. Results: Clinicopathological features of the LES-JPI and R-Y groups did not show differences excepting patient age (50.8±5.8 years vs. 62.8±12.4, respectively; P=0.002) and the depth of tumor invasion (T1-T2; 11∼4 vs. 5∼12; P=0.032). The operative outcomes for the two groups significantly differed in terms of operation time (676 vs. 484 min; P=0.008) and blood loss (424 vs. 336 ㎖; P=0.006). Postoperative gastrofiberscopic examination of all LES-JPI patients showed no esophageal reflux or strictures and intact LES. In addition, the LES-JPI group did not experience swallowing difficulty or stricture. Conclusion: LES-preserving total gastrectomy with JPI is a feasible and safe procedure for patients with upper gastric cancer.

가족성 용종성 대장암 환자에서 발생한 공장암을 포함한 소화기계의 이시성 원발성 삼중암

최문선 ( Mun Sun Choi ),정현채 ( Hyun Chae Jung ) 대한장연구학회 2011 Intestinal Research Vol.9 No.2

Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant inherited disease characterized by onset at a relatively early age, an excess of synchronous and metachronous tumors, and a variety of extracolorectal malignancies. Small bowel carcinoma reported, is included in the tumor spectrum of HNPCC, but the frequency of occurrence of this tumor in HNPCC patients is comparatively rare. In Korea, several cases of multiple primary cancers in patients with HNPCC have been reported, however, primary jejunal adenocarcinoma in conjunction with multiple primary cancers in the digestive tract has rarely been reported. Recently, we evaluated a 61-year-old male diagnosed with metachronous triple primary cancers of the jejunum, stomach, and colon. We report this rare case of primary jejunal adenocarcinoma as a part of metachronous triple cancers along with a review of the relevant literature. (Intest Res 2011;9:158-161)

하인두암에서 후두인두 및 경부 식도 전 적출술 후 유리 공장 이식술의 합병증에 대한 후향적 분석

민현진(Hyun Jin Min),현동우(Dong Woo Hyun),김영호(Young Ho Kim),최은창(Eun Chang Choi),김광문(Kwang Moon Kim),김세헌(Se Heon Kim) 대한두경부종양학회 2008 대한두경부 종양학회지 Vol.24 No.1

Hypophayngeal cancers are usually diagnosed in advanced stages and in many cases, they need total pharyngo-cervical esophagectomy and surgical reconstruction. Among many surgical reconstructive methods, jejunal free flap has anatomical and functional advantages such as tubed nature, peristaltic activity, excellent blood supply. In this study we analysed the surgical procedure and complications of jejunal free flap after total pharyngo-cervical esophagectomy. 20 cases performed jejunal free flap from 1995 to 2007 at Severance Hospital were reviewed. According to time of onset, early and late complications were reviewed. Surgical procedure was reviewed with operation record. Oral diet tolerance was reviewed on the basis of pharyngogram and subjective symptoms. The most common complication was stricture, and it occurred in 40% of cases and 63% of them were managed with conservative care. As early complication, fistula formation was all managed with conservative care. Oral feeding tolerance after jejunal free flap was 65% and 7 patients were tolerable to general diet. In our study, stricture was the most common complication and its management is important in post op oral diet tolerance.

2-1 ; The Effect of Jejunal Interposition on Iron Deficiency in Patients of Radical Subtotal Gastrectomy

( Dong Baek Kang ),( Bo Ram Hong ),( Ken Young Kim ),( Won Cheol Park ),( Jeon Kyun Lee ) 한국정맥경장영양학회 2012 한국정맥경장영양학회 학술대회집 Vol.2012 No.-

Objective: Decreased gastric acid and reflux gastritis after radical subtotal gastrectomy (RSG) and duodenal bypass after gastrojejunostomy may increase the frequency and severity of iron deficiency and anemia. The objective of this study was to investigate changes of serum iron level after RSG with jejunal interposition by comparing various reconstruction methods. Methods: 293 patients were evaluated who received RSG for gastric cancer with gastroduodenostomy (BI, 144cases), gastrojejunostomy (BII, 76), and jejunal interposition (JI, 73) from April 2007 to June 2010. We investigated blood hemoglobin, MCV, MCHC, iron, TIBC, and ferritin before, 6weeks after, 6months after, and 1 year after RSG. Statistical analyses were carried out with SPSS software. Differences were analyzed by paired samples test and ANOVA test. Results: Mean age was 60.1 years, sex ration 1.38:1, BMI>25 117cases, stage Ia 174, Ib 34, IIa 20, IIb 23, IIIa 18, IIIb 9, IIIc 15cases. Percentages of patients with Hb level lower than normal were 35.4, 65.2, 53.4, 39.8 % in BI, 39.5, 62.1, 60.9, 58.1% in BII, and 41.1, 80.8, 63.2, 56.1% in JI. Percentages of patients with serum iron lower than normal were 40.7, 40.5, 19.8, 21.7% in BI, 45.8, 40.0, 44.0, 34.3% in BII, and 40.6, 46.6, 23.0, 16.7% in JI. Conclusion: Percentage of patients with normal Hb level was high in BI 6weeks and 1year after RSG, and percentage of patients with normal iron level in JI 1year after RSG. Iron deficiency was improved in the patients with jejunal interposition.

젊은 환자에서 이중풍선소장내시경으로 진단한 소장암 1예

최윤지 ( Yoon Ji Choi ),정성우 ( Sung Woo Jung ),엄준원 ( Jun Won Um ),이응석 ( Eung Seok Lee ),구자설 ( Ja Seol Koo ),임형준 ( Hyung Joon Yim ),이상우 ( Sang Woo Lee ),최재현 ( Jai Hyun Choi ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.4

A 17-year old female presented with a chief complaint of melena and epigastric pain. She had a family history of colon cancer, her mother having been diagnosed with hereditary nonpolyposis colorectal carcinoma (HNPCC). After close examination including double-balloon enteroscopy, the patient was diagnosed with small bowel carcinoma, in spite of her young age. Here we report this rare case of small bowel carcinoma in a young patient with a family history of HNPCC. (Korean J Gastroenterol 2011;58:217-220)