• Title/Summary/Keyword: 개복수술

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계측 및 제어 기술을 이용하는 최소절개수술에 관한 연구 동향

  • Jo, So-Hyeong
    • Journal of the KSME
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    • v.54 no.3
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    • pp.42-46
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    • 2014
  • 전통적인 개복수술에 비해서 경감된 수술 후 회복기간 등 여러 가지 장점이 있는 최소절개수술은 수술자들에게는 훨씬 복잡하고 배우기 어려운 기법으로 알려져 있다. 이 글은 최소절개수술의 기법을 향상시키는 데 도움이 되는 다양한 계측 및 제어 기술을 검토하고 새로운 디바이스를 소개하는 데 초점을 둔다.

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Short-term Surgical Outcomes after Laparoscopic D2 Lymphadenectomy in Patients with Distal Gastric Cancer (원위부 위암에서 복강경 D2 림프절 절제술의 수술 성적)

  • Cheong, Oh;Park, Young Kyu;Yook, Jeong Hwan;Kim, Byung Sik
    • Journal of Gastric Cancer
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    • v.8 no.2
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    • pp.79-84
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    • 2008
  • Purpose: With advancements in laparoscopic surgery, there have been efforts to expand the indication for laparoscopic surgery up to advanced gastric cancer. However, scant data are available regarding the feasibility and advantages of laparoscopy-assisted distal gastrectomy (LADG) with standard radical D2 lymph node dissection. Materials and Methods: Twenty-two patients who were preoperatively diagnosed with cT1N0M0 gastric cancer underwent LADG with standard D2 lymphadenectomy between February and August 2007. They were compared with patients who underwent conventional open D2 lymphadenectomy with respect to clinicopathologic features, surgical outcomes, and postoperative course. Results: The mean operative time was significantly longer in the LADG group than in the open group ($160{\pm}25min$ vs. $135{\pm}21min$, P<0.001). However, surgical outcomes, such as surgical margin and number of retrieved lymph nodes ($25.7{\pm}11.1$ vs. $26.9{\pm}9.2$, P=ns) were comparable between the groups. The LADG group exhibited quicker postoperative recovery, and both groups exhibited similar postoperative morbidity and mortality. Conclusion: LADG with D2 lymphadenectomy is feasible and safe, with short-term surgical outcomes comparable to those seen in open D2 lymphadenectomy. Further prospective clinical investigation will be needed to better evaluate the advantages of LADG with D2 lymphadenectomy.

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The Effects of Gum-Chewing on the Recovery of Bowel Movement and Oral Cavity Discomfort after Abdominal Surgery (껌씹기가 개복수술 환자의 장운동 회복과 구강불편감에 미치는 효과)

  • Bang, Sul Yeong;Jung, Gum Ja;Jung, Hye Yeon;An, So Hyeon
    • Journal of Korean Clinical Nursing Research
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    • v.14 no.3
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    • pp.15-25
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    • 2008
  • Purpose: This study was aimed to investigate the effects of gum-chewing on the recovery of bowel movement and oral cavity discomfort after abdominal surgery. Method: The nonequivalent control group, non-syncronized repeated treatment design was used. A total of 99 patients were participated in the study. The 44 patients were in the experimental group and the rest in the control group. The experimental group chewed gum three times a day until they passed gas. As the patient reported gas-passing, bowel movement time, subjective symptoms of oral cavity, and oral status were recorded precisely. The frequency, percentage, $x^2$-test and t-test were analyzed by SPSS PC 12.0. Results: There were significant differences in bowel movement, gas passing, oral cavity symptoms, and oral status scores between the experimental and the control group. Conclusion: The findings of the study demonstrated the fact that gum-chewing helps early recovery from post-operative ileus and thirst. It is because gum chewing stimulates bowel mobility and secretion of saliva. Thus gum-chewing seems to be an effective nursing intervention in reducing post-operative side effects for patients with abdominal surgery.

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Comparative Analysis of Laparoscopy-assisted Gastrectomy versus Open Gastrectomy (복강경 보조 위절제술과 개복 위절제술의 비교 분석)

  • Lim, Jung Taek;Kim, Byung Sik;Jeong, Oh;Kim, Ji Hoon;Yook, Jeong Hwan;Oh, Sung Tae;Park, Kun Choon
    • Journal of Gastric Cancer
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    • v.7 no.1
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    • pp.1-8
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    • 2007
  • Purpose: There has been increased the number of early gastric cancer and laparoscopy-assisted gastrectomy (LAG), due to early detection through mass screening program. We started the LAG in April 2004 and performed 119 cases of gastric cancer in 2005, so we report a surgical outcome compared with that of open gastrectomy (OG). Materials and Methods: 119 patients underwent LAG in 2005, and for open group, 126 patiens of early gastric cancer were selected sequentially from January 2005 to March 2005. We compared clinicopathologic characteristics, postoperative courses and complications between two groups. Results: There was no significant difference between age, a length of hospital stay, distal resection margin and a number of retrived lymph nodes. The operation time was longer in LAG group (239.2 vs 123.3 mins, P<0.001) and a diet progression was faster in LAG group (first flatus: 3.05 vs 3.70 days, SOW: 2.86 vs 3.22 days, liquid diet: 3.87 vs 4.19 days, soft diet: 4.84 vs 5.26 days, P<0.001). But there was no difference statistically in postoperative discharge date (7.73 vs 8.25 days, P=0.229). The additional requirement of analgesic injection was less frequent in LAG group (2.97 vs 4.92 times, P<0.001). The harvested lymph nodes were similar in both groups (23.9 vs 23.1, P=0.563). A complication rate was lower in LAG group (4.9% vs 9.5%), but there was no statistical significance (P=0.179). There was no mortality in both groups and no conversion to open gastrectomy in the LAG group. Conclusion: LAG can be performed safely and accepted in view of curative procedure in treatment of early gastric cancer. But we need the follow up of long-term period to evaluate the survival rate and recurrence, and a prospective randomized controlled study should be done to establish that LAG will be a standard operation for early gastric cancer.

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Transpleural Retroperitoneal Approach for the Coarctation of the Abdominal Aorta (경흉막 후복막 접근에 의한 복부대동맥 축착 수술)

  • Lee, Chul-Burm;Song, Dong-Sub;Kim, Hyuk;Kim, Young-Hak;Kang, Jung-Ho;Lee, Jae-Ung;Kim, Sun-Gil
    • Journal of Chest Surgery
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    • v.34 no.3
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    • pp.270-273
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    • 2001
  • 신동맥 사이 또는 신동맥 상부에 위치하는 대부분의 복부대동맥 축착은 흉복부절개의 접근으로 수술한다. 우리는 경흉막 후복막 접근으로 개복을 하지 않고 단측단측 흉복부대동맥의우회술을 시행한 1례의 수술을 소개하고자 한다. 경흉막 후복막 접근은 흉복부대동맥의 시야가 매우 좋으며 개복을 할 때보다 더 쉽게 흉복부대동맥의 우회술을 할 수 있고 복강내 장기를 노출하지 않는 장점이 있다.

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The Surgical Outcome for Gastric Submucosal Tumors: Laparoscopy vs. Open Surgery (위 점막하 종양에 대한 개복 및 복강경 위 절제술의 비교)

  • Lim, Chai-Sun;Lee, Sang-Lim;Park, Jong-Min;Jin, Sung-Ho;Jung, In-Ho;Cho, Young-Kwan;Han, Sang-Uk
    • Journal of Gastric Cancer
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    • v.8 no.4
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    • pp.225-231
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    • 2008
  • Purpose: Laparoscopic gastric resection (LGR) is increasingly being used instead of open gastric resection (OGR) as the standard surgical treatment for gastric submucosal tumors. Yet there are few reports on which technique shows better postoperative outcomes. This study was performed to compare these two treatment modalities for gastric submucosal tumors by evaluating the postoperative outcomes. We also provide an analysis of the learning curve for LGR. Materials and Methods: Between 2003.4 and 2008.8, 103 patients with a gastric submucosal tumor underwent either LGR (N=78) or OGR (n=25). A retrospective review was performed on a prospectively obtained database of 103 patients. We reviewed the data with regard to the operative time, the blood loss during the operation, the time to the first soft diet, the postoperative hospital stay, the tumor size and the tumor location. Results: The clinicopatholgic and tumor characteristics of the patients were similar for both groups. There was no open conversion in the LGR group. The mean operation time and the bleeding loss were not different between the LGR group and the OWR group. The time to first soft diet (3.27 vs. 6.16 days, P<0.001) and the length of the postoperative hospital stay (7.37 vs. 8.88 days, P=0.002) were shorter in the LGR group compared to the OGR group. The tumor size was bigger in the OGR group than that in the LGR group (6.44 vs. 3.65 cm, P<0.001). When performing laparoscopic gastric resection of gastric SMT, the surgeon was able to decrease the operation time and bleeding loss with gaining more experience. We separated the total cases into 3 periods to compare the operation time, the bleeding losses and the complications. The third period showed the shortest operation time, the least bleeding loss and the fewest complications. Conclusion: LGR for treating a gastric submucosal tumor was superior to OGR in terms of the postoperative outcomes. An operator needs some experience to perform a complete laparoscopic gastric resection. Laparoscopic resection could be considered the first-line treatment for gastric submucosal tumors.

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Esophagectomy with Operating Mediastinoscope (종격동경을 이용한 식도절제수술 -1례-)

  • 윤용한;이두연;이성수
    • Journal of Chest Surgery
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    • v.31 no.11
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    • pp.1110-1115
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    • 1998
  • Esophagectomy has a high morbidity rate, mainly related to pulmonary complications. The respiratory morbidity of open esophagectomy is high, ranging from 6% to 10%. This high morbidity is partially responsible for the 6∼15% mortality rate of esophagectomy. Many techniques of esophagectomy without thoracotomy have been described since the initial report of Orringer and Sloan. Endoscopic microsurgical dissection of the esophagus was clinically introduced in 1989. Endoscopic microsurgical dissection of the esophagus was developed as a minimally invasive procedure that avoids thoracotomy and provides precise vision during the operation in order to reduce mediastinal trauma and to improve the peri- and post-operative situation. A 20 year-old women who accidentally swallowed about 150 cc of glacial acetic acid underwent an esophagectomy using the operating mediastinoscopy, cervical esophagogastric anastomosis, pyloromyotomy, and feeding jejunostomy tube placement for esophageal stricture. The postoperative course was uneventful and the patient was discharged on the 17th postoperative day. Our clinical experience shows that endoscopic microsurgical dissection of esophagus is a safe and feasible method because it offers excellent optical control and enables the surgeon to operate in a minimally invasive manner.

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