대한토목학회 학생지회 Student Chapters

서형일(Hyung-Il Seo) 대한토목학회 2005 대한토목학회지 Vol.53 No.5

단순 담낭 절제술 후 확인된 담낭암에 대한 임상적 고찰

서형일(Hyung-Il Seo),김성훈(Seong Hoon Kim),박상재(Sang-Jae Park),이우진(Woo Jin Lee),안민,박홍석(Hong Suk Park),김영일(Yung Il Kim),신정아,박경우,이순애(Soon-Ae Lee),홍은경(Eun Kyung Hong),박중원(Joong-Won Park),김창민(Chang-Min Kim) 한국간담췌외과학회 2006 Annals of hepato-biliary-pancreatic surgery Vol.10 No.2

Purpose: Gallbladder carcinoma (GBC) is a rare neoplasm with poor prognosis. With the introduction and the wide acceptance of laparoscopic surgery, the diagnostic rate of incidental GBC has increased. We report our experience with the reoperated GBC diagnosed after simple cholecystectomy.Methods: From March 2001 to July 2005, 17 patients with a postoperative diagnosis of GBC after prior simple cholecystectomy were referred to our center for curative reoperation. The types of simple cholecystectomy were open cholecystectomy in 5 cases, and laparoscopic cholecystectomy in 12 cases. The types of reoperation were hepatic wedge resection with lymph node dissection (HWR /c LND, n=9), HWR with LND and bile duct resection (HWR /c LND and BDR, n=4), right hepatectomy (RH) with LND and BDR (n=1), extended RH with LND, BDR and caudate lobectomy (n=1) and extended left hepatectomy with LND and BDR (n=1). Residual tumor is defined as the tumor tissue detected on reoperation; bile duct, liver, lymph node, lymphatics, vessels and nerves.Results: There is no operative mortality. The median hospital stay was 18.5days (range, 8 - 44 days). The median interval between 1st and 2nd operation was 23.5 days (range, 6 - 44 days). The median operative time was 379 minutes (range, 240-726). Five complications occurred in 4 patients. One patient received intraoperative transfusion. The depth of tumor invasion in 17 patients was T2 in 15, T3 in 1, and T4 in 1. There was no residual tumor in 8 out of 17 patients. In the other 9 patients, the residual tumor was identified after reoperation: liver in 2, lymph node in 7, bile duct in 3, lymphatics in 6, vessels in 3, and nerves in 3. Three patients of 17 patients recurred and 2 patients of them died. In curative reoperation after simple cholecystectomy, the median follow-up length was 14.7 months (1-53 months). One- and two-year survival rates were 90.9%, 79.6%, respectively. Vascular, lymphatic, and neural invasions were the significant risk factors for recurrence by the log-rank test.Conclusion: Reoperation of GBC diagnosed after simple cholecystectomy is safe and may be effective. Lymphatic, vascular, and neural invasion may have a dismal effect on the disease-free survival.

간세포암종에 대한 연속된 간절제술 200예 예후인자 분석

서형일(Hyung-Il Seo),박상재(Sang-Jae Park),김성훈(Seong Hoon Kim),이우진(Woo Jin Lee),안민(Min Ahn),박홍석(Hong Suk Park),김영일(Yung Il Kim),신정아(Jung-A Shin),박경우(Kyung Woo Park),이순애(Soon-Ae Lee),홍은경(Eun Kyung Hong),박중원( 한국간담췌외과학회 2006 Annals of hepato-biliary-pancreatic surgery Vol.10 No.1

Purpose: The long-term outcome after liver resection for hepatocellular carcinoma (HCC) is somewhat disappointing because of tumor recurrence. The purposes of this study were to evaluate the prognostic factors and to suggest the data to improve the long-term outcome of hepatic resection for HCC.Methods: A retrospective survey was carried out in 200 patients undergoing hepatic resection for HCC from April 2001 to June 2004. The various clinicopathologic factors were analysed for the overall survival (OS) and the disease-free survival (DFS) rates by the univariate test (log rank test) and multivariate test (Cox regression model).Results: There were one hospital mortality and 23% morbidity after partial hepatectomy. Intraoperative transfusion was given to 20 patients (10%). Mean follow-up period was 19 months (range, 2-43). The 1-, 2- and 3-year OS rates after hepatic resection for HCC were 90.5%, 86.8% and 76.2% and the 1-, 2- and 3-year DFS rates were 65.5%, 54.3% and 49.4%, respectively. By the univariate analysis for OS, aspartate aminotransferase (AST), Child-Pugh classification, Edmondson-Steiner histologic grade, microvascular invasion, major vessel invasion, alpha-fetoprotein (AFP), TNM stage, transfusion, surgical margin involvement and presence of complication were significant for survival. By the multivariate analysis, Child-Pugh classification, Edmondson-Steiner histologic grade, major vessel invasion and complication were independent risk factors for OS.Whereas viral marker, Child-Pugh classification, microvascular invasion, major vessel invasion, AFP, TNM stage, surgical margin involvement and presence of complication were the significant risk factors for DFS by the univariate analysis, viral marker, microvascular invasion, major vessel invasion, surgical margin involvement and presence of complication were the independent predictive factors of the DFS.Conclusion: Hepatic resection for HCC has become safe. To improve the long-term outcome of hepatic resection for HCC, the patients with poor liver function or major vessel invasion should be precluded in hepatic resection, if possible, and adequate surgical margin and avoidance of complication are mandatory.

진행성 간세포암종의 성공적 외과적 절제술 및 장기 생존 예 진행성 간세포암종의 성공적 외과 절제예

서형일 ( Hyung Il Seo ),박상재 ( Sang Jae Park ),홍성화 ( Sung Wha Hong ),김성훈 ( Seong Hoon Kim ),이순애 ( Soon Ae Lee ),최준일 ( Joon Il Choi ),김현범 ( Hyun Bum Kim ),홍은경 ( Eun Kyung Hong ),박중원 ( Joong Won Park ),김창민 대한간암학회 2006 대한간암학회지 Vol.6 No.-

Collision Tumor of the Liver

Hyung Il Seo(서형일) 한국간담췌외과학회 2009 Annals of hepato-biliary-pancreatic surgery Vol.13 No.2

Collision tumors represent the coexistence of two adjacent but histologically distinct tumors in an organ. Collision tumors have been identified in various organs, but they are rare in liver. We present a rare case of a 57-year-old man, who was hospitalized for the removal of a liver mass (S5/6 segmentectomy), that was probably a hepatocellular carcinoma. The eventual pathology examination revealed a collision tumor composed of a hepatocellular carcinoma and an undifferentiated sarcoma. Because the tumor recurred 2 months after the operation, reoperation (right hemicolectomy and tumorectomy) was performed. In the 2nd month following the second operation we found multiple liver metastases, chest metastasis and abdominal cavity metastasis. To our knowledge this is the first case of a hepatic collision tumor that was composed of a hepatocellular carcinoma and an undifferentiated sarcoma. Herein, we report the case of a hepatic collision tumor and briefly review the literature.

절제된 간내 담관암 50예의 예후 인자 분석

서형일(Hyung-Il Seo),박상재(Sang-Jae Park),김성훈(Seong Hoon Kim),이우진(Woo Jin Lee),최준일(Joon Il Choi),김현범(Hyun Beom Kim),김태현(Tae-Hyun Kim),이순애(Soon-Ae Lee),홍은경(Eun Kyung Hong),박중원(Joong Won Park),김창민(Chang-Min 한국간담췌외과학회 2006 Annals of hepato-biliary-pancreatic surgery Vol.10 No.3

Purpose: Intrahepatic cholangiocarcinoma (CCC) is the second most common primary liver cancer and constitutes 10% of primary liver malignancies. The prognosis of hepatic resection for CCC and the specific factors influencing survival remain unclear. The aims of this study were to analyze the survival outcome and the prognostic factors in patients with CCC who underwent hepatic resection and suggest relevant prognostic factors.Methods: Between April 2001 and February 2006, 50 patients with CCC underwent hepatic resection. Patients with hilar cholangiocarcinoma and gallbladder carcinoma were excluded. All patients were considered resectable based on dynamic CT or MRI findings. Patients with R1 resection or nodal invasion received adjuvant chemotherapy or radiation. Twenty-four clinicopathological factors were divided into three into categories and analyzed to evaluate their influence on the outcomes.Results: There were 2 operative death (mortality; 4%). Postoperative complications occurred in 12 of the 50 (24%) patients. The 1-, 2- and 3-year overall survival rates were 69.8%, 53.6% and 46.9% respectively. The following variables were significant prognostic factors in univariate analysis. Age, presence of hepatitis or liver cirrhosis in patient-related factors, lymph node metastasis, TNM stage according to 6th AJCC in tumor-related factors and intraoperative transfusion in treatment-related factors. Multivariate analysis identified only lymph node metastasis is an independent prognostic factor for poor prognosis.Conclusion: Hepatic resection remains the most effective therapeutic option for CCC. Lymph node metastasis was the single worst prognostic factor for CCC resection. Further study for the benefit of resection for the lymph node positive CCC is needed.

생체 부분간이식이 시행된 Hepatic Epithelioid Hemangioendothelioma 증례

서형일(Hyung-Il Seo),박상재(Sang-Jae Park),김성훈(Seong Hoon Kim),서경석(Kyung-Suk Suh),이남준(Nam-Joon Yi),이우진(Woo Jin Lee),최준일(Joon Il Choi),이순애(Soon-Ae Lee),홍은경(Eun Kyung Hong),박중원(Joong-Won Park),김창민(Chang-Min K 한국간담췌외과학회 2006 Annals of hepato-biliary-pancreatic surgery Vol.10 No.3

Hepatic epithelioid hemangioendothelioma (HEHE) is a rare a low-grade malignant tumor of endothelial origin. The natural history of this tumor is unpredictable and it is difficult to differentiate from cholangiocarcinoma or metastatic liver tumor on imaging study. A case of HEHE treated by living donor liver transplantation (LDLT) is presented. A 52-year-old man was admitted because of multiple bilobar liver masses. The histological appearances of the preoperative biopsy showed positive immunostaining for factor VIII and CD34 antigens. So it was dagrored as HEHE The tumor was unresectable because of multiple involvement of both lobes of the liver. The tumor was enlarged after 3months, which prompted the decision to perform LDLT. The right liver of the donor was transplanted to the recipient. The intraoperative & postoperative courses were uneventful. At the time of writing, the patient had survived for 13 months without any complications.

돼지에 있어 인공혈관으로 대정맥 재건을 통한 자가 부분 간이식 동물 실험 모델

서형일(Hyung-Il Seo),심문섭(Mun Sup Sim),김동헌(Dong-Heon Kim),전태용(Tae Yong Jeon),조홍재(Hong-Jae Jo),권재영(Jae Young Kwon),김해규(Hae Kyu Kim),김해영(Hae Young Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.4

Purpose: Experimental animal models are useful training methods for liver transplantation, despite of ethical issues. The aims of this study are to examine the technical feasibility of living donor liver transplantation in pigs and to address the ethical problems. Methods: Eight pigs were used in this experiment. The pig liver was divided via a left hemi-hepatectomy without inflow occlusion. The GORE-TEX<SUP>R</SUP> Vascular Graft was used as a replacement for the inferior vena cava during the graft. After the bench technique, the remnant right lobe of the pig was removed. During the anhepatic phase, an abdominal aortic clamp in combination with general hypothermia was applied, instead of using a conventional bypass procedure. Results: Anhepatic time was 41.3±7.0 min and cold ischemic time was 200.3±29.4 min. The 1<SUP>st</SUP>, 4<SUP>th</SUP>, and 8<SUP>th</SUP> pig died because of declamping shock and arrhythmia on releasing the abdominal aortic clamp. Three pigs had five postoperative complications: pneumonia, gastrointestinal bleeding, IVC thrombosis, portal vein thrombosis, and bile duct stricture. The 6th pig received a hepaticojejunostomy due to stricture of the anastomosis site at 37 days after transplantation. Conclusion: Pigs are economically and ethically more convenient compared to primate models. For auto-liver transplantation, no immunotherapy was needed. The pigs lived relatively long, allowing operative faults to be detected and studied. This experimental model will be useful training for living donor liver transplantation.

유방 사분역절제술 후 즉각적인 광배근 피판술에서 장액종 형성 예방에 있어 누빔 봉합술(Quilting)의 효과

이석원(Seok-Won Lee),서형일(Hyung-Il Seo),배영태(Young-Tae Bae) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.3

Purpose: Latissimus dorsi myocutaneous flap (LDMCF) is a commonly used technique for breast reconstruction following breast-conserving surgery. However, this technique has a high incidence of donor site seroma. The aim of this study is to evaluate the effect of donor-site quilting on seroma formation. Methods: A retrospective review of 95 patients who underwent immediate breast reconstruction with LDMCF from May of 2006 through February of 2007 was performed. Patients were divided into Group A, in which only a closed suction drain was used, and Group B, in which quilting and a closed suction drain were used. The outcome measures were age, body mass index (BMI), mastectomy volume, duration of drain, total volume of postoperative seroma, length of hospital stay, and incidence of postoperative aspiration. Results: In Group B, the total amount of seroma, duration of drain, and length of hospital stay were significantly reduced (P<0.05). However, the incidence of postoperative aspiration was not different between Group A and Group B (P=0.06). Conclusion: The quilting technique reduces the volume of postoperative seroma and may help prevent of seroma after LDMCF.

담낭암 T2 병기에서 단순 담낭절제술의 유용성

이지연(Jee-Yeon Lee),서형일(Hyung-Il Seo),심문섭(Mun-Sup Sim) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.5

Purpose: Stage-related treatment has been recommended for gallbladder cancer (GBC). When patients with T2 tumors undergo an extended cholecystectomy, the 5?year survival rates have been reported to be 64∼100%. But when patients with T2 tumors undergo simple cholecystectomy, the 5?year survival rates have been reported to be only 20∼40%. The question may rise as to which patients benefit from simple cholecystectomy among patients with T2 GBC. We investigated the survivals and the facts leading to death or recurrence after simple cholecystectomy for T2 GBC. Methods: Between Mar. 2001 and Dec. 2007, 13 patients had refused second radical operation for T2 GBC incidentally discovered after simple cholecystectomy. Survival analyses were evaluated by clinopathological factors. Results: The 1?, 3? and 4?year overall survival rates were 84.6%, 76.2% and 38.1% and 1? and 3?year disease-free survival rates were 69.2%, 51.3%. The factors affected survival rates were low serum albumin titer and R1 resection (Lymph node metastasis or cystic duct involvement in microscopic finding) (P<0.05). Conclusion: Simple cholecystectomy is not a curative method of T2 GBC, because it reveals lower 5?year survival rates compared to those of extended cholecystectomy or radical surgery. But in the case when the patient refuses reoperation or it is difficult to undergo reoperation because of severe underlying disease, simple cholecystectomy with normal albumin titer or the absence of lymph node metastasis and absence of cystic duct involvement in microscopic findings may help the long-term survivals after simple cholecystectomy.