• 한국간담췌외과학회지
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• 제27권4호
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• pp.366-371
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• 2023

Backgrounds/Aims: Biliary surgery in patients with extrahepatic portal vein obstruction with portal cavernoma (PC) is technically challenging, and associated with the risk of bleeding. Therefore, prior portal vein decompression is usually recommended before definitive biliary surgery. Only a few studies have so far reported the safety of isolated laparoscopic cholecystectomy. We aimed to evaluate our experience of laparoscopic cholecystectomy in patients with PC without prior portal decompression. Methods: Prospectively maintained data for patients with PC who underwent laparoscopic cholecystectomy for symptomatic gallstone disease without portal decompression were analyzed. Clinical features, imaging, intraoperative factors, conversion rate, complications of surgery, and long-term outcomes were assessed. Results: Sixteen patients underwent cholecystectomy without portal decompression from 2012 to 2021, of which interventions 14 were laparoscopic cholecystectomies. One patient required conversion (7.1%) to open surgery. Jaundice was present in 5 patients (35.7%), and underwent endoscopic stone clearance before surgery. Median intraoperative blood loss, operative time, and hospital stay were 100 mL (20-400 mL), 105 min (60-220 min), and 2 days (1-7 days), respectively. Blood transfusion was required in two patients (14.2%). Prior endoscopic or percutaneous intervention was associated with significant blood loss and prolonged intraoperative time. Conclusions: In centers with experience, prior portal decompression can be avoided in patients with PC requiring isolated cholecystectomy to treat gallstones or their complications. Laparoscopic surgery is safe and feasible for these patients, and gives excellent outcomes in the selected group.

• Journal of Chest Surgery
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• 제5권2호
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• pp.107-112
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• 1972

Recently we experienced a case of the portal hypertension, extrahepatlc origin in the National Medical Center, Seoul. The case was a male aged 19 who was undergone the elective splenorenal shunt with splenectomy 9 years ago and emergency ligation of the coronary vein because of recurred variceal rupture 6 years later and had recurring esophageal varices with bleeding this time.At the age of 10 he had been occasionally suffering from nasal bleeding and visited to our Pediatric department, when there was encountered for the first time the splenomegaly, esophageal varices in the lower third esophagus on the esophagogram, and stenosis and kinking of the portal vein with rich collateral circulation on the splenoportography without hepatic functional impairment.The elective splenorenal shunt with splenectomy was undergone under the diagnosis of portal hypertension due to congenital anomaly of the portal vein and postoperatlvely no troubles had been obtained until postoperative 1st attack of massive hematemesis due to esophagenl variceal rupture recurred about 6 years later which was confirmed by control esophagogram and it was resulted by stenosis of previous anastomotic site of the splenorenal shunt.Then emergency ligation of the coronary vein was only made for bleeding control and no episodes of hematemesis had been encountered thereafter until April 1972 about 3 years after the 2nd operation, when hematemesis recurred again. In this time, recurring esophageal varices were noted in the lower third esophagus on the control esophagogram and he was employed side to end mesocaval shunt as the final step of portal decompression,and following results were obtained. 1] No postoperatlve troubles as leg edema or pain: Postoperatively leg elevation and elastic bandage on the both legs were employed until discharge. 2] During operation the portal pressure was 300 mm $H_2O$ and immediately lowered to 170 mm $H_2O$ after shunt.

• 대한관절경학회지
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• 제13권2호
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• pp.174-178
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• 2009

목적: 상완 골두 골괴사증에서의 관절경하 핵심 갑압술을 소개하고자 한다. 수술 술기: 후방 및 전방 삽입구를 이용하여 진단적 관절경을 시행하고 견봉 외측 연의 전방 1/3 부위의 3 cm 하방에 2cm의 천공술을 위한 삽입구를 만든 후, 유도핀 삽입시 주위 연부 조직 손상을 막기 위해 짧게 만든 회색 도관를 위치시킨다. C-형 투시 장치를 견관절의 전후방에 정확히 위치시키고, 관절경을 통해 상완 골두의 관절면을 관찰하면서 3~4개의 유도핀을 괴사 부위에 삽입한 후 7.0 mm 확공기를 이용하여 천공술을 시행한다. 결론: 본 술기는 기존의 삼각흉근 도달법을 이용한 개방적 핵심 감압술에 비해 합병증을 감소시킬 수 있으며, 견관절내 병변의 진단 및 치료를 동시에 할 수 있을 뿐 아니라 술후 통증 및 재활에 유리하여 초기 상완 골두 골괴사증의 치료로 활용할 수 있는 효과적인 술식으로 생각된다.

• 대한영상의학회지
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• 제79권5호
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• pp.264-270
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• 2018

목적: 간기능이 보존된 간세포암 환자에서 간문맥 고혈압이 고주파열치료 후 종양 재발에 미치는 영향을 평가한다. 대상과 방법: 2010년 1월에서 2017년 3월 사이에 Milan criteria 및 Child-Pugh class A를 가진 신규 간세포암 환자 중 본원에서 고주파열치료를 시행한 환자가 본 연구에 포함되었다. 종양 재발에 대한 예측인자를 찾기 위해 Cox proportional hazard model을 이용한 단변량 및 다변량 분석을 수행하였다. 결과: 모두 178명의 환자가 본 연구에 포함되었다. 추적 관찰 기간의 중앙값은 42.8개월이었다. 국소 재발률은 문맥고혈압 여부에 따라 뚜렷한 차이를 유발하지 않았다(p = 0.195). 3년 및 5년 원위부 간내 종양 재발률은 문맥고혈압이 없는 환자의 경우 각각 29.5%와 53.7%, 그리고 문맥고혈압이 있는 환자의 경우 51.9%와 63.6%였으며 두 군 사이의 차이는 통계적으로 유의하였다(p = 0.011). 단변량 및 다변량 분석에서 문맥압항진은 원위부 간내 종양 재발에 대한 독립적인 예측 인자이었다(p = 0.008). 결론: Child-Pugh class A를 가진 간세포암 환자의 경우, 문맥고혈압은 종양 재발에 불량 예후인자로 작용하였다.

• Clinics in Orthopedic Surgery
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• 제10권4호
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• pp.439-447
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• 2018

Background: Since open Wiltse approach allows limited visualization for foraminal stenosis leading to an incomplete decompression, we report the short-term clinical and radiological results of unilateral biportal endoscopic foraminal decompression using $0^{\circ}$ or $30^{\circ}$ endoscopy with better visualization. Methods: We examined 31 patients that underwent surgery for neurological symptoms due to lumbar foraminal stenosis which was refractory to 6 weeks of conservative treatment. All 31 patients underwent unilateral biportal endoscopic far-lateral decompression (UBEFLD). One portal was used for viewing purpose, and the other was for surgical instruments. Unilateral foraminotomy was performed under guidance of $0^{\circ}$ or $30^{\circ}$ endoscopy. Clinical outcomes were analyzed using the modified Macnab criteria, Oswestry disability index, and visual analogue scale. Plain radiographs obtained preoperatively and 1 year postoperatively were compared to analyze the intervertebral angle (IVA), dynamic IVA, percentage of slip, dynamic percentage of slip (gap between the percentage of slip on flexion and extension views), slip angle, disc height index (DHI), and foraminal height index (FHI). Results: The IVA significantly increased from $6.24^{\circ}{\pm}4.27^{\circ}$ to $6.96^{\circ}{\pm}3.58^{\circ}$ at 1 year postoperatively (p = 0.306). The dynamic IVA slightly decreased from $6.27^{\circ}{\pm}3.12^{\circ}$ to $6.04^{\circ}{\pm}2.41^{\circ}$, but the difference was not statistically significant (p = 0.375). The percentage of slip was $3.41%{\pm}5.24%$ preoperatively and $6.01%{\pm}1.43%$ at 1-year follow-up (p = 0.227), showing no significant difference. The preoperative dynamic percentage of slip was $2.90%{\pm}3.37%$; at 1 year postoperatively, it was $3.13%{\pm}4.11%$ (p = 0.720), showing no significant difference. The DHI changed from $34.78%{\pm}9.54%$ preoperatively to $35.05%{\pm}8.83%$ postoperatively, which was not statistically significant (p = 0.837). In addition, the FHI slightly decreased from $55.15%{\pm}9.45%$ preoperatively to $54.56%{\pm}9.86%$ postoperatively, but the results were not statistically significant (p = 0.705). Conclusions: UBEFLD using endoscopy showed a satisfactory clinical outcome after 1-year follow-up and did not induce postoperative segmental spinal instability. It could be a feasible alternative to conventional open decompression or fusion surgery for lumbar foraminal stenosis.

• 대한정형외과 초음파학회지
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• 제5권1호
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• pp.41-45
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• 2012

견갑 상 신경의 압박을 초래할 수 있는 많은 질환중에서, 견갑 상 낭종에 의한 압박은 흔치 않으며, 많은 수에서 간과되거나 오진되기도 한다. 저자들은 견갑 상 신경 압박 증상을 초래하고 있는 낭종을 자기공명영상 및 초음파로 확진하였다. 환자의 증상은 견갑 상 신경 중, 하극 신경에만 국한되어 있었다. Neviaser portal과 같은 위치에서 초음파 유도하에 경피적 흡인을 시행하였다. 시술 8주 후 경과에서 재발 소견은 없었으며, 객관적인 기능 평가에서도 호전된 소견을 보였다. 견갑 상 신경의 압박이 의심되는 증상이 있으면, 우선적으로 초음파로 병변을 찾는 것에 주력해야 한다. 낭종의 압박에 의한 증상은 낭종의 단순 제거 혹은 축소로도 증상은 호전되기 때문이다. 하지만, 동반하고 있는 질환 혹은 원인 질환 등이 강력하게 의심될 경우, 추가적인 진단 후에 침습적인 치료를 요할 수도 있다.

• 대한관절경학회지
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• 제9권2호
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• pp.232-237
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• 2005

목적: 슬와낭종의 치료에 있어서 70도 관절경과 후내측 도달법을 이용한 직접적 제거술 및 관절낭 주름 제거술 술기의 유용성을 알아보고자 한다. 대상 및 방법: 2003년 1월부터 2004년 1월까지 관절경을 이용한 슬와낭종의 직접적 감압술의 방법으로 치료받은 21명, 23예를 대상으로 하였다. 연령 분포는 35세에서 78세로 평균 54세 였으며, 남자 5명, 여자 16명이었고, 우측 슬관절이 8예,좌측 슬관절이 11예,양측에 발생한 예가 4예 있었다. 수술전 슬관절내 동반 병변의 유무 파악을 위해 전예에서 MRI를 시행하였고, 술후 6개월과 1년째에 초음파 검사를 시행하여 낭종의 재발 여부를 관찰하였으며, 슬관절 통증과 낭종의 촉지 유무를 관찰하였고, 임상 평가를 위해 Rauschning and Lindgren criteria를 사용하였다. 결과: 23예중 전예에서 1년이상의 최종 추시시 방종이 촉지되지 않았으며, 초음파 검사에서 낭종이 재발한 예는 없었다. 통증 및 보행장애는 없었으며, 합병증은 1예에서 전동절삭기에 의한 후내측 구획부위의 피부손상이 있었다. 수술 후 전예에서 Rauschning and Lindgren criteria는 Grade 1 이상이었다. 결론: 70도 관절경과 후내측 도달법을 이용한 치료방법은 낭종재발의 원인이 될 것으로 사료되는 check valve 형태의 낭주름 제거가 용이하며, 슬관절 후면의 피부절개가 없어 미용상 보기 좋으며 그로 인한 합병증을 줄일 수 있으므로 슬와 낭종 치료에 효과적인 방법으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.390-394
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• 2014

Objective : In most patients with carpal tunnel syndrome (CTS), pain and/or paresthesia disappeared or decreased in a month after endoscopic carpal tunnel release (ECTR). However, subpopulation of patients showed delayed improvement following ECTR. We analyzed the delayed improvement hands to investigate the characteristics of those patients and to determine the predictable factors of delayed improvement. Methods : Single-portal ECTRs were performed in 1194 hands of 793 CTS patients from 2002 to 2011. Five-hundred seventy hands with minimal 1-year postoperative follow-up were included. We divided the 545 satisfied hands into early (group A) and delayed (group B) groups according to improvement period of 1 month. Demographic data, clinical severity and electrodiagnostic abnormality were compared between groups. Results : Group A included 510 hands and group B included 35 hands. In group B, 11 hands improved in 2 months, 15 hands in 3 months and 9 hands in 6 months, respectively. In group A/B, according to clinical severity, 60/1 hands were graded to I, 345/24 hands to II, 105/10 hands to III. In group A/B, based on electrodiagnostic abnormality, 57/3 hands were classified to mild, 221/11 hands to moderate and 222/21 hands to severe group. Statistical analysis between groups did not reach significance but electrodiagnostic or clinical severity had a tendency to affect the delayed response. Conclusion : It is difficult to predict the factors contributing to postoperatively-delayed response in subpopulation of CTS patients. However, we recommend that postoperative observation for at least 6 months is necessary in patients without symptomatic improvement.