• Title/Summary/Keyword: 성문보존

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Treatment of Early Laryngeal Cancer - Indication and Technique of Conservative Partial Laryngectomy - (초기 후두암의 치료 - 보존적 후두절제술의 적용범위와 방법 -)

  • 서장수;송시연
    • Korean Journal of Bronchoesophagology
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    • v.3 no.1
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    • pp.27-36
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    • 1997
  • 초기후두암에 있어서 보존적 술식의 장점은 후두 전적출술시와 같은 국소치료효과를 얻을 수 있으면서도 후두의 생리적 기능을 최대한 보존하는데 있다. 성공적인 후두부분절제술을 위해서는 후두내에서 종양의 발생위치 및 그 확산에 대한 연부조직들의 해부학적 역할에 대한 이해가 필요하다. 과거에는 초기후두암환자에서 정상적인 목소리를 보존할 수 있다는 이점 때문에 방사선 치료가 일차적 치료요법으로 많이 시행되어 왔다. Wang 과 Wong은 성대 막양부에 국한된 병변에서 방사선치료에 대한 5년간 조절율(5-year control rate)이 92%, 전연합부를 침범한 경우가 81%, 그리고 후방으로 전파된 경우 76%로 감소된다고 보고하였다. Olofsson 등은 전연합부를 침범한 57례의 환자에서 방사선 치료를 시행하여 85.7%의 5년 생존율을 얻었으나, 57례중 15례에서 재발하여 구제수술(salvage surgery)을 시행하였고, Jesse 등$^{13)}$ 은 전연합부를 침범한 91례의 T1, T2 성문암을 방사선 치료를 시행하여 8.8%의 실패율을 보였으나 22례의 환자에서 재발하여 후에 salvage surgery를 시행하였다. 그러나 Ogura 등은 피열 연골을 침범한 79례의 환자에서 보존적 수술을 시행한 결과 6례의 환자에서 재발하여 90%의 3-years control rate를 얻을 수 있었다고 보고하였다. 이처럼 병변이 전연합부, 피열연골 혹은 후방성문하부로의 침범이 있는 경우는 방사선 치료 효과가 떨어지고, 따라서 방사선 치료에 실패할 가능성이 보다 높기 때문에 비록 방사선 치료 후 실패한 경우에서 구제 수술을 시행할 수는 있지만 후두기능을 보존하려는 궁극적인 목표를 생각할 때 보존적 수술을 우선적으로 시행하는 것이 바람직하다고 할 수 있다. Biller 등은 방사선 요법에서 실패한 성문부 종양에서는 대부분 전적출술을 시행하지만 일부는 보존적 수술을 시행할 수 있다고 보고하였다. 이들은 반대측 성문부에 종양의 침범이 없어야 하고, 전연 합으로의 파급은 있어도 가능하며 성대돌기를 제외한 피열연골이 정상이어야 하고, 종양의 성문하부로의 파급이 5mm 이내라야 하며, 연골에 침범이 없어야 하고, 성대고정이 없어야 하며, 재발 병소가 방사선요법 전의 원발병소와 상관관계가 있어야 하며, 원발병소가 후두부분적출술에 합당할 경우 보존적 술식을 시행할 수 있다고 하였다. 최근에는 다양한 후두 재건술의 발달로 보다 진행된 후두암에 대한 보존적 후두절제술들이 소개되고 있다. 단측 T3,T4 후두암 혹은 경성문암, 이상와에 위치한 암의 경우 음성만을 재건하는 후두근적출술 (near total laryngectomy)을 시행하기도 한다. 본원 이비인후과에서 1986년부터 초기성문암 51례 중 24례(47.1%)와 초기성문상암 17례 중 12례 (70.6%)에 대하여 보존적 술식을 시행하였다. 초기 성문암의 보존적 술식을 시행한 24례중, 2례(8.3%)에서 경부재발, 1례(4.2%)에서 경부재발과 동반된 폐의 원격전이가 있었으나 원발부위의 재발은 관찰되지 않았고, 술후 합병증으로 1례(4.2%)에서 후두협착, 3례(12.5%)에서 수술부위의 육아종형성, 그리고 1례(4.2%)에서 기관지염이 발생하였으나 오연으로 인한 폐렴은 발생하지 않았다. 초기성문 상암의 보존적 술식을 시행한 12례 중 1례(8.3%)에서 원발병소의 재발, 2례(16.7%)에서 경부재발이 있었으며, 술후 합병증으로 3례(16.7%)에서 오연으로 인한 폐렴의 발생이 있었지만 다른 합병증은 발생하지 않았다. 초기성문암 24례 중 재발이 나타난 3례의 환자를 제외한 21례(97.5%)와 초기성문상암 12례 중 재발이 나타난 3례의 환자를 제외한 9례 (75%)에서는 현재까지 재발소견을 보이지 않고 있다. 이러한 결과는 다른 보고자들과 유사한 결과를 보이고 있지만 아직까지 증례가 많지 않기 때문에 생존율을 얻기에는 미흡한 점이 있으며, 향후 지속적인 추적관찰이 필요할 것으로 사료된다.

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The Role of Primary Radiotherapy for Squamous Cell Carcinoma of the Suprag1ottic Larynx (성문상부 상피세포암에서의 근치적 방사선치료의 역할)

  • Kim, Won-Taek;Kim, Dong-Won;Kwon, Byung-Hyun;Nam, Ji-Ho;Hur, Won-Joo
    • Radiation Oncology Journal
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    • v.18 no.4
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    • pp.233-243
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    • 2000
  • Purpose : First of all, this study was performed to assess the result of curative radiotherapy and to evaluate different possible prognostic factors for squamous cell carcinoma of the supraglottic larynx treated at the Pusan National University Hospital. The second goal of this study was by comparing our data with those of other study groups, to determine the better treatment policy of supraglottic cancer in future. Methods and Material : Thirty-two patients with squamous cell carcinoma of the supraglottic larynx were treated with radiotherapy at Pusan National University Hospital, from August 1985 to December 1996. Minimum follow-up period was 29 months, Twenty-seven patients (84.4$\%$) were followed up over 5 years. Radiotherapy was delivered with 6 MV photons to the primary laryngeal tumor and regional iymphatics with shrinking field technique. Ail patients received radiotherapy under conventional fractionated schedule (once a day). Median total tumor dose was 70.2 Gy (range, 55.8 to 75.6 Gy) on primary or gross tumor lesion. Thirteen patients had Induction chemotherapy with cisplatln and 5-fluorouracil (1-3 cycles). Patient distribution, according to the different stages, were as follows: stage I, 5/32 (15.6$\%$): stage II, 10/32 (31.3$\%$); stage III, 8/32 (25$\%$): stage IV, 9/32 (28.1$\%$). Results :The 5-year overall survival rate of the whole series (32 patients) was 51.7$\%$. The overall survival rate at 5-years was 80$\%$ in stage I, 66.7$\%$ in stage II, 42.9$\%$ in stage III, 25$\%$ in stage IV (p=0.0958). The S-year local control rates after radiotherapy were as fellows: stage I, 100$\%$; stage II, 60$\%$ stage III, 62.5$\%$; stage IV, 44.4$\%$ (p=0.233). Overall vocal preservation rates was 65.6$\%$, 100% In stage I, 70% in stage II, 62.5$\%$ In stage III, 44.4$\%$ in stage IV (p=0.210). There was no statistical significance in survival and local control rate between neoadjuvant chemotherapy followed by radiotherapy group and radiotherapy alone group. Severe laryngeal edema was found in 2 cases after radiotllerapy, emergent tracheostomy was done. Four patients were died from distant metastsis, . three in lung, one in brain. Double primary tumor was found in 2 cases, one in lung (metachronous), another in thyroid (synchronous). Ulcerative lesions were revealed as unfavorable prognostic factor ( p=0.0215), and radiation dose (more or less than 70.2 Gy) was an important factor on survival (p=0.002). Conclusion : The role of radiotherapy treatment of supraglottic carcinoma is to important factor on survival and to preserve the laryngeal function. Based on our data and other studies, early and moderately advanced supragiottic carcinomas could be successfully treated with either consewative surgery or radiotherapy alone. Both modalities showed similar results in survival and vocal preservation. For the advanced cases, radiotherapy alone is Inadequate for curative aim and surgery combined with radiotherapy should be done in operable patients. When patients refuse operation or want to preserve vocal function, or for the patients with inoperable medical conditions, combined chemoradiotherapy (concurrent) or altered fractionated radiotherapy with or without radiosensitizer should be taken into consideration in future.

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김치의 보존성 증진 방안

  • 김순동;오영애;김미경
    • Food Industry And Nutrition
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    • v.1 no.1
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    • pp.71-80
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    • 1996
  • 김치의 보존성을 높여 가식기간을 연장시키고져 하는 연구는 김치의 숙성원리 측면에서 접근하는 것이 바람직하며, 이러한 접근에 있어서도 저온관리는 가장 기본적인 요소이다. 현재까지 이루어진 연구들은 주로 김치의 미생물 생육을 제어함으로서 보존성을 증진코져하는 시도가 많았다. 김치의 숙성에 영향을 줄 수 있는 요소들은 매우 다양하고 복잡함에도 일부 측면에 한정하여 보존성을 다룸으로서 지금까지 얻어진 효과가 미흡하지 않았나 판단된다. 김치 보존성을 증진시키기 위하여 중점을 두어야 할 몇가지 항목들은 (1)재료의 청정화 (2)소금절임에 대한 과학화 (3)효소저해제 개발 (4)호모형 젖산균의 선택적 저해 (5)완충제 및 중화제의 개발 (6)신맛의 완화 및 억제 물질 개발 (7)철저한 저온관리 등이다. 따라서 김치의 보존성에 영향을 줄 수 있는 다양한 측면에서 그리고 이들을 종합적으로 활용함으로서 보존성문제에 대한 해결이 가능할 것으로 판단된다.

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Long Term Results of Radiation Therapy in Early Glottic Cancer (초기 성문암의 방사선치료: 장기 추적결과)

  • Kim, Jin-Hee;Byun, Sang-Jun
    • Radiation Oncology Journal
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    • v.27 no.1
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    • pp.29-34
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    • 2009
  • Purpose: This study was designed to evaluate long-term results in terms of failure, survival and voice preservation after radiation therapy for early glottic cancer. Materials and Methods: From February 1988 to December 2003, 70 patients with early glottic cancer were treated with radiation therapy at Keimyung University Dongsan Medical Center. Patient age distribution was from 39 to 79 years, with a median age of 62 years. All patients had squamous cell carcinoma. According to the TNM stage, 58 patients had stage I disease, 12 patients had stage II disease; 67 patients were male. The laryngeal area was irradiated with the use of bilateral opposing fields with/without a wedge filter with 6 MV photons at a total dose of $54{\sim}70.2$ Gy in $1.8{\sim}2.2$ Gy fractions over $6{\sim}8$ weeks. We delivered a median radiation dose of 60 Gy for stage I patients and a median radiation dose of 66 Gy for stage II patients. Salvage surgery was performed in patients with local recurrence. The voice preservation rate was analyzed after all treatments including salvage surgery. Follow-up periods were from 13 to 180 months, with a median follow-up period of 77.5 months. The survival rate was analyzed by the use of the Kaplan Meier method and log rank test. A comparison of two groups was performed with the use of the chi-squared test. Results: The local control rate was 98.5% (69/70). The five-year-overall survival rate was 93.9%. The five-year disease free survival rate (5YDFS) was 84.1% and the 5YDFS after radiation and salvage surgery was 92.8%. According to stage, the 5YDFS was 93.1% and 91.7% for stage I and stage II respectively. Thirteen patients (18.5%) had local failure with 24 months of median time to local failure and nine patients received salvage surgery; however, four patients were lost to follow-up after a diagnosis of recurrence. Only two patients died due to a distant metastasis at 33 months and 71 months after radiation therapy, respectively. Nine patients died due to other diseases with a median time of 73 months. There were no severe acute or chronic complications after radiation therapy. Voice preservation was ultimately achieved in 88.5% (62/70) of patients. Conclusion: We considered that radiation therapy was effective and we achieved excellent survival and voice preservation in early laryngeal cancer. The use of radiation therapy should be the first choice for the treatment of early glottic cancer.

PIV에 의한 유동장 계측

  • 이영호
    • Bulletin of the Society of Naval Architects of Korea
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    • v.31 no.2
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    • pp.43-46
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    • 1994
  • VIP는 유동장을 영상기록매체에 기록하여 보존 및 재생이 가능함으로서 유동장의 재현성문제를 쉽게 해결할 수 있는 장점을 아울러 가지고 있다. 따라서, VIP는 비정상, 동시다점 계측 및 유 동장의 재현성확보가 원리적으로 가능함으로서 CFD에 필적할 수 있는 유일한 실험기법으로 평 가되고 있다. 본 해설에서는 이에 관한 내용을 개설적으로 정리하고자 하며, 상세한 것은 참고 문헌을 인용하기로 한다.

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Radiation Therapy for T2N0 Glottic Cancer (T2N0 병기 성문암의 방사선치료)

  • Kim, Jae-Chul
    • Radiation Oncology Journal
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    • v.24 no.4
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    • pp.217-222
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    • 2006
  • $\underline{Purpose}$: This study evaluated the results of definitive radiation therapy and the prognostic factors that affect survival rates for T2N0 glottic cancer patients. $\underline{Materials\;and\;Methods}$: Thirty patients with T2N0 glottic cancer who were treated with definitive radiation therapy at our institution between September 1986 and June 2004 were retrospectively reviewed. All patients were pathologically confirmed as having squamous cell carcinoma and were staged as AJCC T2N0. The age of the patients ranged from 39 to 79 (median 62) years and all were male. A total dose of $66{\sim}70\;Gy$ (median 66 Gy) was delivered with a 6-MV linear accelerator in $6.5{\sim}7$ weeks. The median follow-up period was 63 months. $\underline{Results}$: The actuarial disease-free survival rate for the entire group of the patients was 79% at 5 years. The five-year disease-free survival rates for patients without and with subglottic extension were 90% and 56%, respectively (p=0.03). However, anterior commissure involvement, supraglottic extension, and impaired cord mobility were not statistically significant prognostic factors. The five-year disease-free survival rates for patients with and without concurrent chemotherapy were 86% and 69%, respectively (p=0.47). $\underline{Conclusion}$: Subglottic extension can be considered a poor prognostic factor for T2N0 glottic cancer.

Quantitative Analysis of Voice Quality after Radiation Therapy for Stage T1a Glottic Carcinoma (T1a 병기 성문암의 방사선 치료 후 음성에 관한 연구)

  • Lee Joon-Kyoo;Chung Woong-Gi
    • Radiation Oncology Journal
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    • v.23 no.1
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    • pp.17-21
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    • 2005
  • Purpose : To evaluate the voices of irradiated patients with early glottic carcinoma and to compare these with the voices of healthy volunteers. Materials and Methods : The voice samples (sustained vowel) of seventeen male patients who had been irradiated for T1a glottic squamous carcinoma at least 1 year prior to the study were analyzed with objective voice analyzer (acoustic voice analysis, aerodynamic test, and videostroboscopic analysis) and compared with those of a normal group of twenty age- and sex-matched volunteers. Average fundamental frequency, jitter, shimmer, and noise-to-harmonic ratio were obtained for acoustic voice analysis. Maximal phonation time, mean flow rate, intensity, subglottic pressure, glottal resistance, glottal efficiency, and glottal power were obtained for aerodynamic test. Results : The irradiated group presented higher values of shimmer in acoustic voice analysis. There was no significant difference between two groups in other parameters. Conclusion : In this study all the objective voice parameters except shimmer were no4 significantly different between the irradiated group and the control group. These results suggest that the voice quality is minimally affected by radiation therapy for 71 a glottic carcinoma.

On a Pitch Point Detection by Preserving the Phase Component of the Autocorrelation Function (자기상관함수에서 위상 성분의 보존에 의한 피치 시점 검출에 관한 연구)

  • 함명규;최성영;박종철;배명진
    • Proceedings of the IEEK Conference
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    • 2000.09a
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    • pp.799-802
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    • 2000
  • 음성신호처리 분야에서 음성신호의 기본 주파수를 정확히 검출 할 수 있다면 음성인식을 할 때 화자에 따른 영향을 줄일 수 있으므로 인식의 정확도를 높일 수 있고, 음성합성을 할 때 자연성과 개성을 쉽게 변경하거나 유지할 수 있다. 또한 분석을 할 때 피치에 동기시켜 분석하면 성문의 영향이 제거된 정확한 성도 파라미터를 얻을 수 있다. 위와 같은 피치검출의 중요성 때문에 피치검출에 대하여 다양한 방법 이 제안되었다〔1〕. 본 논문에서는 음성신호의 분석 시 불안정한 구간에 대해 피치 시점을 검출하는 방법을 연구하였다. 음성신호의 분석에 있어서 기존의 자기상관함수법(Autocorrelation Function)은 주기성을 강조할 수 있다는 장점을 가지고 있다. 그러나 자기상관함수는 위상성분을 보존하지 못한다는 단점을 가지고 있다. 따라서, 자기상관함수를 사용하면서 위상성분을 보존할 수 있는 알고리즘을 제안하고자 한다. 실험결과 피치시점을 수동으로 찾은 경우와 비교하였을 때 약 98% 정도의 정확도를 얻을 수 있었다. 위의 결과와 같이 위상 성분이 보존된 자기상관함수를 사용할 경우 음성합성, 코딩, 인식에서 유용하게 쓰일 수 있다.

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Squamous Cell Carcinoma of the Supraglottic Larynx Treated with Radiation Therapy (성문상부암의 근치적 방사선 치료)

  • Park, Charn-Il;Kim, Kwang-Hyun
    • Radiation Oncology Journal
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    • v.7 no.1
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    • pp.37-43
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    • 1989
  • Sixty-six patients with squamous cell carcinoma of the supraglottic larynx received irradiation with curative intent between 1979 and 1985 were retrospectively analysed. All patients had a minimum follow-up of 4 years. Of the entire group consisting of $73\%$T3 and T4 lesions and $58\%$ lymph node metastases, a 5-year acturial survival rate was $31.3\%$. A 5-year acturial survival rates for stage II, III and IV were $60.7\%,\;45.7\%\;and\;13.5\%$ respectively (p<0.05). Patients without lymphnode metastases had better survival rate than those with postive lymphnode metastases $(54.8\%\;vs\;12.2\%)$ (p<0.005). Surgical salvage rate w8s 4/7 $(57\%)$. Three patients developed distant metastases. Major complications requiring surgery were seen in $11\%$, Radiation therapy alone with surgical salvage was an effective, voice preserving treatment for stage I, II and selected III carcinoma of the supraglottic carcinoma, however planned combined treatment with surgery and radiation therapy is advised for stage III and IV carcinoma of the supraglottic larynx with resectable neck disease.

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Radiotherapy Results of Stage I Glottic Cancer (조기 성문암의 방사선 치료 결과)

  • Kim, Jae-Chul;Park, In-Kyu
    • Radiation Oncology Journal
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    • v.16 no.3
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    • pp.245-250
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    • 1998
  • Purpose : This study was to evaluate survival, failure patterns, and prognostic factors of stage I squamous cell carcinoma of the glottic larynx after curative radiation therapy. Materials and Methods : A retrospective analysis was done for 57 patients with glottic cancer who were treated with curative radiation therapy from June 1985 to November 1992. There were 55 male and two female patients. Patients' age ranged from 17 to 71 years(median 39 years). Radiation therapy was delivered five times a week, 2 Gy daily, total 66 Gy using 6 MV X-ray. Results : Complete response(CR) was noted in 51 out of 57 patients (89.5%) and persistent disease (PER) in six out of 57 patients(10.5%). The disease-free survival rates at 3 and 5 years were 72.9% and 63.8%, respectively. Seven failures were observed among 51 CR patients during follow-up. Salvage total laryngectomy for six recurred patients and partial laryngectomy for one recurred patient were done with successful results, i.e., all of them were actually salvaged. Among six PER patients, salvage total laryngectomy for two patients and partial laryngectomy for two patients were done and two patients refused operation. Following salvage surgery for the four PER patients, three were salvaged and one failed locoregionally. Among the 13 failures 10(76.9%) were salvaged with surgery. The ultimate local control rate at 5 years was 92.3% and overall 47 out of 57 (82.5%) patients were able to preserve their larynx. The 5-year disease-free survival rates were 85.5% for posterior lesions, and 61.6% for anterior lesions(P<0.05). Cord mobility, involvement of anterior commissure, field size, and T stage did not impact on disease-free survival. Conclusion : Considering the high percentage of voice preservation with initial radiotherapy, radiotherapy should be the first choice in the treatment of stage 1 glottic carcinoma.

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