( ) Jksvs023.hwp

Size: px
Start display at page:

Download "( ) Jksvs023.hwp"

Transcription

1 대한혈관외과학회지 : 제 23 권제 2 호 Vol. 23, No. 2, November, 2007 소복재정맥하지정맥류에서고위결찰술을동반한정맥내레이저열응고요법 서울대학교보라매병원외과, 1 서울대학교의과대학외과학교실 민승기 1 ㆍ정인목ㆍ민상일 1 ㆍ허승철ㆍ안영준ㆍ황기태ㆍ박양진 1 ㆍ이태승 1 ㆍ하종원 1 ㆍ김상준 1 ㆍ정중기 Endovenous Laser Treatment (EVLT) with High Ligation of Small Saphenous Vein Varicosities Seung-Kee Min, M.D. 1, In Mok Jung, M.D., Sang Il Min, M.D. 1, Seung Chul Heo, M.D., Young Joon Ahn, M.D., Ki-Tae Hwang, M.D., Yang Jin Park, M.D. 1, Taeseung Lee, M.D. 1, Jongwon Ha, M.D. 1, Sang Joon Kim, M.D. 1 and Jung Kee Chung, M.D. Department of Surgery, Seoul National University Boramae Hospital, 1 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea Purpose: Endovenous laser treatment (EVLT) of great saphenous vein (GSV) varicosities is a widely accepted procedure. However, EVLT of small saphenous vein (SSV) varicosities is not so popular due to concern about sural nerve damage and popliteal thrombosis. In addition, higher rates of recanalization and recurrence of tributaries make clinicians reluctant to use EVLT for SSV incompetence. The purpose of this study is to assess the safety and efficacy of SSV EVLT and the advantage of a combined high ligation and EVLT to reduce the complications and recurrence. Method: Between November 2003 and March 2006, 47 patients (55 limbs) with SSV incompetence and enlarged truncal varicosities, documented by duplex ultrasound, were included in the study. All patients were treated with an EVLT combined with ambulatory phlebectomy (AP) of the residual varicosities. High ligation of the sapheno-popliteal junction (SPJ) was performed in 26 limbs (47.3%, HL group); the EVLT without high ligation was performed in another 29 limbs (52.7%, NHL group). The patients were followed by clinical examinations at 1 week, 4 weeks and 12 weeks and with duplex ultrasound at 12 weeks after the operation. Symptomatic improvement, complications, recanalization of the SSV and recurrence of tributaries were recorded and compared between the two groups. Result: Mean follow-up was for 5.0 months. Most of the patients (95.4%) showed symptomatic improvement at 12 weeks with better venous clinical severity scores (VCSS). The overall complication rate was 27.3% (15 limbs), most of them were minor problems including 4 cases of transient sural nerve numbness (7.3%). The duplex US-confirmed saphenous vein recanalization rate and recurrence rate of tributaries at 3 months were 5.4% and 9.1%, respectively. There were no differences in the rate of symptomatic improvement and complications between the HL and NHL groups. However, the HL group showed a lower tendency for recanalization and recurrence compared to the NHL group. Conclusion: EVLT combined with AP might be an effective minimally invasive treatment modality for SSV varicosities with an acceptable complication rate and low recanalization rate of the saphenous veins. The simultaneous high ligation of the SPJ decreased the rates of recanalization and recurrence. Long-term data from large randomized prospective trials with more objective measure of the outcomes are needed to confirm the effectiveness and durability of this operative procedure. Key Words: Endovenous laser treatment (EVLT), High ligation, Small saphenous vein, Varicose vein 중심단어 : 정맥내레이저열응고요법, 고위결찰술, 소복재정맥, 하지정맥류 책임저자 : 정인목, 서울시동작구신대방 2 동 425, 우 , 서울대학교보라매병원외과 Tel: , Fax: , imjung@brm.co.kr 본연구는 2007 년서울대학교보라매병원임상연구비지원에의해이루어진것임. 첫두저자는논문완성에같은기여도로기여함 ( 공동제 1 저자 ). 174

2 민승기외 : 소복재정맥하지정맥류에서고위결찰술을동반한정맥내레이저열응고요법 175 서론소복재정맥하지정맥류는전통적인고위결찰술및발거술 (High ligation and stripping) 을시행하면불완전한소복재- 오금정맥문합부의결찰로약 50% 정도의높은재발률과빈번한장딴지신경저린감 (Sural nerve numbness) 등의수술후합병증이문제가되어왔다 (1). 최근최소침습수술이확대되면서혈관내조작기법 (Endovascular technique) 을통한복재정맥의폐쇄를시도하려는수술법이개발되어활발히시행되고있다. 이중하나인정맥내레이저열응고요법 (Endovenous laser treatment, EVLT) 은정맥내로레이저카테터를삽입하여혈액구성요소 (blood components) 와혈관내막동시를가열하여증기수포 (steam bubbles) 를발생시켜균일하게내강을폐쇄시키는기전으로 2002년도미국식품의약국 (Food and Drug Administration, FDA) 에서대복재정맥하지정맥류의치료로공인된후현재전세계적으로보편화된수술방법이다. 소복재정맥에서의 EVLT는발거술에비해정맥내로레이저카테터를삽입하는최소침습적인수술로수술후통증, 감염및장딴지정맥저린감을줄일수있고초음파유도하에정확한소복재-오금정맥문합부를찾아정확한치료할수있다는이점으로인하여최근전통적인수술을대신하여이용이증가하는추세이다 (2-5). 하지만소복재정맥의해부학적특성인소복재-오금정맥문합부의분지정맥의결여빈도가높아대복재정맥에비하여상대적으로심부정맥혈전증의발생이많고장딴지신경이소복재정맥과근접되어있다는이유로저림감이많이발생하여대복재정맥에서보다는널리이용되고있지는않다 (4). 저자들은소복재정맥 EVLT의안정성과효용성을판단하고심부정맥혈전증등의합병증및재발률을줄이기위한방법으로최근에소복재정맥 EVLT시동시에고위결찰술을시행하여단기결과와함께고위결찰술을시행하지않은군과의비교를통해이수술의의의를규명하고자본연구를시행하였다. 대상과방법 1) 대상환자본병원외과에서 2003년 11월처음으로소복재정맥하지정맥류치료에 EVLT를시행한이후 2007년 3월까지총 47명의환자에서 55예소복재정맥 EVLT가시행되었다. 대상환자들은육안적으로 CEAP 분류법에의거하여분지정맥류를동반한 C2이상의병변이있으며도플러초음파에서소복재-오금동맥문합부위에역류가관찰된경우를포함하였다. 평균연령은 49.5세였고남녀비는 1:2.6으로여자가더많았다. 가족력이있는경우가 42.6% 였으며소복재정맥 으로역류가있는양측성환자가 11명 (23.4%) 에서있었다. 수술시행부위는우측 13명 (27.7%), 좌측 26명 (55.3%), 양측 8명 (17.0%) 이었고소복재정맥만시행한경우가 33명 (70.2%), 14명 (29.8%) 은역류가동반된대복재정맥과동시에시행되었다. 전환자에서분지정맥류의치료를위해보행성정맥절제술 (Ambulatory phlebectomy, AP) 을시행하였고부가적인수술로혈관경화요법이 5예 (10.6%), Giacomini 정맥절제술이 1예 (2.1%) 에서시행되었다. 47명환자들의임상적인특성은 Table 1과같다. 총 47명의환자중대상기간후기에서심부정맥혈전증등의합병증및재발률을줄이기위한목적으로 21명 (44.7%), 26예의소복재정맥에서초음파유도하최소절개를통한고위결찰술이동시에시행되었다. 2) 수술전검사 대상환자전부에서시진, Trendelenberg 검사법등이학적검사및수술전도플러초음파검사를시행하여소복재 -오금정맥문합부와소복재정맥의역류여부, 심부정맥의폐색여부및관통정맥기능부전여부를관찰하였다. 3) 수술방법 수술전외래혹은수술장에서마취전환자를세운상태에서환자의정맥류를지워지지않는유성펜으로초음파를보면서환자의정맥류를표시하였다. 소복재-오금정맥 Table 1. Demographic and clinical data for 47 patients (55 limbs) treated with small saphenous vein EVLT combined with ambulatory phlebectomy Variable Data Mean age, y (range) 49.5 (18 73) Sex (M:F) 1 : 2.6 Family history 20 (42.6%) Bilateral (SSV reflux (+)) 11 (23.4%) Clinical presentation (CEAP) C2 43 (91.5%) C3, 4 4 (8.5%) Site of operation Right 13 (27.7%) Left 26 (55.3%) Both 8 (17.0%) Sahenous vein of operation SSV only 33 (70.2%) SSV +GSV 14 (29.8%) Ancillary procedures (except AP*) Sclerotherapy 5 (10.6%) Giacomini v. excision 1 (2.1%) *AP = ambulatory phlebectomy

3 176 대한혈관외과학회지 : 제 23 권제 2 호 2007 문합부와소복재정맥과파생된분지정맥및관통정맥의위치를파악하여표시하였고소복재정맥은장딴지하부 2/3까지추적하여표시하였다. 수술은대부분척추마취나종창성국소마취하에수술을시행하였고사용된종창성국소마취제는 250 ml 생리식염수에 1% lidocaine 60 ml와 8.4% sodium bicarbonate 6 ml를혼합하여준비하였다 (6). (1) 고위결찰술을동반하지않은경우 : 환자를배와위자세로눕힌후초음파로주행이표시된발목뒤외측장딴지하부 2/3부위에미세횡절개와 Varady 혹은 Müller hook을이용하여정맥을들어낸후소복재정맥-오금정맥합류부위까지 J-tip 유도철사-도관순으로삽입후 600μm 굵기의레이저관을삽입하여위치시켰다. 합류부위는수술전초음파로위치를확인하여표시하였으며안내선, 레이저관을위치시킨후문합부위 1 2 cm 원위부부터최초삽입부위 2 cm 상방까지레이저를혈관굵기및깊이에따라 8 12 W, cm/sec의속도의연속파행 (continuous mode) 으로총 1,200 1,500 Joule의에너지를방열하였고절개정맥을결찰하였다. 분지정맥류의치료는표시된주행을따라 2 3 mm의절개창을통해복재정맥재개통 hook을이용하여 AP를시행하였고절개창의개수는환자의상태에따라달리하였으나가능한한최소로 5 6개를넘지않도록시행하였다. 절개창의봉합은시행하지않거나필요한경우 4-0 Vicryl로봉합하고접합테이프를이용하였다. 절개창위에종이반창고를붙이고압박붕대를감고수술을종료하였다. (2) 고위결찰술을동반한경우 : 환자를배와위자세로눕힌후초음파로소복재정맥주행을표시하였다. 초음파로확인된소복재-오금정맥문합부 1 2 cm 하방에서초음파유도하에 3 4 mm의최소절개후 Varady 혹은 Müller hook 을이용하여소복재정맥을들어내어분할 (division) 후근위부고위결찰술을시행하였다. 분할후원위부소복재정맥을따라레이저카테터를발목뒤외측장딴지하부 2/3부위까지위치시킨후위와같은방법으로혈관굵기및깊이에따라 8 12 W, cm/sec의속도의연속파행 (continuous mode) 으로위로천천히당기면서총 1,200 1,500 Joule의에너지를방열하였고절개정맥원위부를결찰하였다. 분지정맥류의치료및절개창의봉합은고위결찰술을시행하지않은경우와동일하게시행하였다. 4) 수술후관리및추적방법수술직후고압력탄력스타킹 (class II) 을착용시키고적극적인보행을권장하였다. 수술 1주일, 1개월, 3개월, 6개월후외래통원관찰을통해증상호전및지속여부, Venous clinical severity score (VCSS) 및합병증발생을확인하였다 (7). 또한동기간별로복재정맥재개통여부와분지정맥류재출현등재발여부를검사하였다. 또한, 고위결찰술을시행하였던군과시행하지않았던군을대상으로임상 적특성및결과를비교분석하였다. 수술 3개월후도플러초음파검사를권장하였으며합병증이나재발이의심될경우에는시기에관계없이반드시시행하여심부정맥혈전증과복재정맥혈류의재개통여부등을감시하였다. 5) 통계적분석 두군간의임상적특성및임상적호전지표의결과분석은 Student t-test, paired t-test 등을이용하여분석하였고 P 값이 0.05 미만인경우의미있는것으로판정하였다. Table 2. Clinical outcome in symptomatic small saphenous vein varicosities following EVLT combined with AP (N=43) Outcome 결 1) 전체환자의수술결과 소복재정맥하지정맥류에 EVLT를시행하였던전체환자의수술후평균추적기간은 5.0개월이었으며전예에서 3개월이상의추적이가능하였다. 환자들대부분이수술다음날부터일상생활이가능하였고 1주일이내에직장복귀가가능하였다. 수술후 1주일이내증상호전은국제적보고기준 (8) 에의거한임상증상개선정도로분석해보면수술전정맥류로인한역류성증상이있던 43예중증상소실 21예 (+3, 48.8%), 중등도개선 14예 (+2, 32.6%), 경도개선 8예 (+1, 18.6%) 로분석되어전예에서수술전증상의호전이있었다. 수술 3개월후결과는증상소실 19예 (+3, 44.2%), 중등도개선 16예 (+2, 37.2%), 경도개선 6예 (+1, 14.0%), 증상이호전이없거나재발하여이전증상과비교하여변화가없었던경우가 2예 (4.6%) 였다 (Table 2). VCSS는수술전 4.65±1.54에서수술 3개월후 0.54±0.38 로분석되어육안적인정맥류의감소와증상의호전이확인되었다. 수술과관계된합병증으로총 15 하지 (27.3%) 에서 17예가발생하였다. 반상출혈 (ecchymosis) 7예, 통증 4예, 장딴 Within one week Cases (%) Postop. 3 months +3, asymptomatic 21 (48.8) 19 (44.2) +2, moderate improvement 14 (32.6) 16 (37.2) +1, mild improvement 8 (18.6) 6 (14.0) 0, unchanged 0 (0) 2 (4.6) Total 43 (100.0) 43 (100.0) No cases of worsening symptoms ( 1, 2, 3) following EVLT combined with AP. AP = ambulatory phlebectomy. 과

4 민승기외 : 소복재정맥하지정맥류에서고위결찰술을동반한정맥내레이저열응고요법 177 Table 3. Complications following small saphenous vein EVLT combined with AP (n=55 limbs) Complications Events (%) Ecchymosis 7 (12.8) Pain 4 (7.3) Sural nerve numbness 4 (7.3) Phlebitis 1 (1.8) Foot drop (peroneal nerve palsy) 1 (1.8) Total 17 events (30.9)/15 limbs (27.3) 지신경저림감 4예, 정맥염 1예등미미한경우가대부분이었으며정맥염한예에서경구용항생제를 1주일투여한것을제외하고는특별한치료없이외래관찰기간동안소실되거나현저히호전되었다. 혈전의상행진행으로인한심부정맥혈전증이나폐색전증은발생하지않았다. 중등도이상의합병증은한예에서있었다. 이는양측소복재정맥 EVLT와광범위한 AP 시행후후자로인해발생된근육내혈종으로구획증후군이유발되어비골신경압박에의한족하수 (foot drop) 가발생된경우였으며 2개월간의물리치료로호전되어현재는정상생활을영위하고있다 (Table 3). 수술 3개월후소복재정맥재개통율은 3예 (3/55, 5.4%) 로분석되었으며전예에서도플러초음파로확인되었다. 수술 3개월후분지정맥류재출현율은 5예 (5/55, 9.1%) 였으며, 대부분추가치료가필요없을정도로경미하였으며그중 1예 (20.0%) 에서만추가적으로경화요법을외래에서시행하였다. 2) 고위결찰술을시행한군과시행하지않은군의비교 (Table 4) 고위결찰술은 21명환자의 26예소복재정맥 EVLT 수술시동반되어시행되었고 ( 고위결찰술군 ) 26명의 29예의수술시에는시행되지않았다 ( 비고위결찰술군 ). 양군간의임상적특성은남녀비를제외하고통계적으로유의한차이없이비슷하였다. 수술 3개월후경도이상의증상호전이있었던비율은고위결찰술군 20/21 (95.2%), 비고위결찰술군및 25/26 (96.2%) 로두군간의차이가없었다. 동기간후 VCSS도고위결찰술군에서 0.52±0.41, 비고위결찰술군에서 0.55±0.38 로분석되어두군간에차이가없었다. 장딴지신경저림증을포함한합병증의빈도는두군간에각각 7.7%, 6.9% 로비슷하였다. 수술 3개월후재개통율및분지정맥재출현율은고위결찰술및비고위결찰술군에서각각 3.8%, 7.7% 로비고위결찰술군의 6.9%, 10.3% 보다낮은경향을보였으나비교대상예가적어통계적인유의성을구할수는없었다. Table 4. Comparison clinical data and results of high ligation group (HL group, n=21) versus no-high ligation group (NHL group, n=26) Variable HL group* NHL group Mean age, year Sex (M : F) 2:19 11:15 Family history 9 (42.9%) 11 (42.3%) Site of operation Right 6 (28.6%) 7 (26.9%) Left 11 (52.4%) 15 (57.7%) Both 4 (19.0%) 4 (15.4%) Clinical improvement 20/21 (95.2%) 25/26 (96.2%) (> +1, mild improvement) VCSS 0.52± ±0.38 Post-EVLT sural 2/26 (7.7%) 2/29 (6.9%) nerve numbness Saphenous vein 1/26 (3.8%) 2/29 (6.9%) recanalization rate Recurrence rate of 2/26 (7.7%) 3/29 (10.3%) tributaries VCSS = venous clinical severity score. *HL group; 21 patients, 26 small saphenous veins, NHL group; 26 patients, 29 small saphenous veins, P<0.05 고 소복재정맥역류를동반한하지정맥류의성공적인치료에는소복재-오금정맥문합부및소복재정맥역류를효과적으로제거하는것이필수적이다. 과거에시행되었던전통적인고위결찰술및발거술은한정된창상으로오금정맥으로의이행부위나분지정맥을정확히확인하기힘들뿐아니라문합부위의해부학적다양성으로재발률이높았고장딴지신경저림증등의합병증의빈발한빈도가문제가되어왔다. 이러한단점을보완하기위해서혈관내로열전달기구를삽입하여표재성하지정맥부전증에대한치료를도모하는수술방법이개발되어현재널리시행되고있다. 여기에는레이저를이용한 EVLT와고주파열응고요법 (Radiofrequency ablation) 의방법이있으며두수술간의복재정맥폐색률은비슷하게보고되었으나 (6,9-11) 수술의간편성과수술시간의단축등의장점으로본원에서는 EVLT 를선호하여 2003년부터시행하고있다. EVLT는 2002년대복재정맥하지정맥류의치료로 FDA 에서허가된후적응증이 2004년말에는소복재정맥등다른하지정맥류의치료로확대인정되었다. 그러나대복재정맥과는달리소복재정맥에서 EVLT 수술은널리이용되고있지않다. 그이유는첫째, 소복재정맥의해부학적특성인소복재-오금정맥문합부의분지정맥의결여빈도가높 찰

5 178 대한혈관외과학회지 : 제 23 권제 2 호 2007 아상대적으로심부정맥혈전증의발생이많다는것이며, 둘째는장딴지신경이소복재정맥과근접되어있어수술후저린감의호소가빈번하다는것이다 (4). 여러보고에의하면심부정맥혈전증은대복재정맥수술시에는 0 3% (9), 소복재정맥수술시 0 5.7% 로소복재정맥에서약간높게보고되고있다 (2,4,5). Gibson 등은 EVLT 시행전초음파검사에서소복재-오금정맥문합부의해부학적양상을분류하여 43% 에서소복재정맥과오금정맥이행부위에분지정맥이존재하지않았다고보고하면서이경우에는대복재정맥수술시같이레이저카테터끝을아래배벽정맥 (inferior epigastric vein) 원위부에위치시켜심부정맥으로의혈류를유지시킴으로서혈전의심부정맥으로의이행을방지하는효과를기대하기어렵기때문에심부정맥혈전증의빈도가높을수있다는이론적근거를제시하였다 (4). 신경저림증은대복재정맥 1 7% 에비해 (9) 소복재정맥수술시에는 % 로보고되었으며 (2,4,5) 이는소복재정맥과장딴지신경의근접성에기인한다. 위에언급한제한점과장기결과가없으나최근소복재정맥 EVLT 시행후향상된결과가보고되고있어 (2-5) 이용이보편화되고있는실정이며저자들도과거에높은소복재정맥폐색율과낮은합병증의결과를얻어효과적이고안정성이높음을보고한바있다 (12,13). 본연구의대상환자는전부소복재정맥으로의역류와더불어육안적으로명확한분지정맥류가존재하였던경우였으며이의치료로는 AP를동시에시행하였다 (14,15). 그이유는첫째, 복재정맥폐색술후정맥성고혈압의원인을제거함으로써분지정맥류치료필요성을감소시킬수있어도 (6,16) 증상과더불어가장많이호소하는육안적인분지정맥류의소멸을동시에기대하는대부분의환자의욕구를충족시키기위함이었고, 둘째는환자의추가치료가능성을감소시킴으로써경제적측면을고려하였고, 셋째로색소침착이나경결등의합병증의발생빈도가상당히존재하는경화요법보다 AP를통한치료가오히려더만족도가높다고생각했기때문이었다. 저자들은소복재정맥 EVLT의치료효과를높이고합병증빈도및조기재개통 (early recanalization) 을방지하기위해서다음과같은방법을시도하였다. 첫째, 수술시발목부위를높이는자세로적절히정맥내혈액을감소시켜 (adequate venous emptying) 레이저효과를높였고, 둘째, 소복재정맥주위로종창성용액을충분히주입하여주위조직에의온도를 45 o C 이하로낮추어비가역적인장딴지신경손상을방지하려하였다. 셋째, 초음파를이용하여수술전이나수술시소복재-오금정맥문합부를정확히찾아고위결찰술을시행하거나고위결찰술을시행하지않을경우에는레이저관끝의위치를문합부위 1 2 cm 하방에올바르게위치시켜효과를극대화시켰고, 마지막으로술후압박붕대나탄력스타킹을수술직후에착용함으로써 조기재개통을방지하려고시도하였다 (13,17,18). 이런방법을통해서후유증이남는주합병증이나장딴지신경저림증같은특이적인합병증발생을줄일수있었고외국보고들과 (2,4,5,19) 비슷한 5.4% 의소복재정맥재개통율을얻을수있었다. 본연구에서수술후합병증으로심부정맥혈전증의발생이전무한이유는물론, 환자선택에서복재정맥굵기에따라굵은경우혈전증을염려하여발거술을우선적으로고려한경우도있었으나무엇보다도초음파유도하에소복재-오금정맥합류부에서 1 2 cm 원위부에서근위부압박하에레이저방열을시작하여생성된혈전이심부정맥까지영향이미치는것을방지하려는저자들의시도가도움이되었을것으로사료된다. 동반된 AP에의한합병증은거의없었으나관통정맥부전증과동반된분지정맥류의광범위한절제술후근육내출혈과근육부종으로인한비골신경압박으로인한족하수 (foot drop) 가발생된한예가있었으며 2개월간의물리치료로호전되어정상생활로복귀가가능하였다. 그러나경미하더라도분지정맥류재출현율, 즉재발의빈도가다른보고 (14) 에비해높았고앞서언급한해부학적근거로인한심부정맥혈전증에대한염려를이유로저자들은대상기간후기에는전예에서소복재정맥고위결찰술을시행하였다. 이는초음파유도하에정확히소복재-오금정맥문합부와근접된분지정맥을 3 4 mm의최소절개를통해박리, 결찰하는방법이다. 저자들은고위결찰술에대한추가비용은받지않았으며시행시초음파유도하에최소절개를통해숙련도를갖추고시행하였으므로수술시간증가등비효율성은없었다. 무엇보다도기존의 EVLT 방법에비해반흔이남는다는것과오금부위박리를통한장딴지신경손상가능성이있다는것이문제이지만본연구에서는 1예를제외하고는수술후오금부위의반흔에대한미용적인불편함을호소하지않았으며장딴지신경저림증비도각각 7.7%, 6.9% 로고위결찰술군과비고위결찰술군간의큰차이는없었다. 수술 3개월후 VCSS를포함한임상적호전지표도두군간의차이는없었으나재개통율은고위결찰술군 3.8%, 비고위결찰술군 6.9% 로분석되었고분지정맥류재출현율도각각 7.7%, 10.3% 로고위결찰술군에서낮게분석되었다. 포함된대상예가적고무작위적전향적연구가아니므로결론을제시할수는없었지만고위결찰술을시행하여재발률을낮추려는저자들의시도에합당한단기결과를얻을수있었다. 물론분지정맥류재출현이복재정맥이폐쇄되지않고재개통되거나분지정맥을결찰하지못해발생하는것외에관통정맥부전이나다른구획에서생긴잔존분지정맥류가포함될수있기때문에정확한지표로서의가치가떨어져일부의보고에서만재발률을이수술의효용성지표로언

6 민승기외 : 소복재정맥하지정맥류에서고위결찰술을동반한정맥내레이저열응고요법 179 급하고있다 (14,15). 하지만저자들은고위결찰술을전자의가능성을최소화시키려는목적으로시행하였고관통정맥부전이나다른구획의분지정맥류는수술시 AP나혈관경화요법으로제거함을원칙으로하여분지정맥류재출현율을객관화된지표로삼고자노력하였다. 소복재-오금정맥고위결찰술의수술의의가확립되려면안정성과효용성이뒷받침되어야한다. 즉, 장딴지신경저림증과미용적인불편감등이비고위결찰술군과차이가없이안정성이입증되고중장기소복재정맥재개통율과재발률이비고위결찰술군과비교하여적어야할것이다. 본연구에서이에합당한경향을보이는단기결과는얻었지만통계적인유의성을포함한수술로서의가치가입증되려면보다많은환자에서장기추적검사를통한무작위적전향적연구가시행되어야하며임상질지표를포함한이수술의효용성을담보할보다객관화된지표의개발이동반되어야할것이다. 결 저자들은분지정맥류를동반한소복재정맥하지정맥류환자에서 EVLT를시행하여낮은합병증발생및조기일상생활복귀등이가능하였고높은환자의만족도와비교적낮은복재정맥재개통율과재발률등의결과를얻어수술의안정성과효용성을확인할수있었다. 그러나본연구에서는경미하더라도분지정맥류재출현율, 즉재발의빈도가높고심부정맥혈전증에대한염려를이유로일부의예에서소복재정맥고위결찰술을시행하여시행하지않은군과단기결과를비교하였다. 두군간의임상적호전지표와합병증발생률은비슷하였고단기간분지정맥류재출현율및복재정맥재개통률은고위결찰술군에서낮은경향을보여저자들의목적에부합하는결과를보였다. 소복재-오금정맥고위결찰술이긍정적인단기결과는얻었지만안정성과효용성을지닌수술로서의가치가입증되려면향후보다많은환자에서장기추적검사를통한무작위적전향적연구가필수적이며임상질지표를포함한이수술의효용성을담보할보다객관화된지표의개발이보완되어야할것이다. 론 REFERENCES 1) Van Rij AM, Jiang P, Solomon C, Christie RA, Hill GB. Recurrence after varicose vein surgery: a prospective longterm clinical study with duplex ultrasound scanning and air plethysmography. J Vasc Surg 2003;38: ) Proebstle TM, Gul D, Kargl A, Knop J. Endovenous laser treatment of the lesser saphenous vein with a 940-nm diode laser: early results. Dermatol Surg 2003;29: ) Ravi R, Rodriguez-Lopez JA, Traylor EA, Barrett DA, Ramaiah V, Diethrich EB. Endovenous ablation of incompetent saphenous veins: a large single-center experience. J Endovasc Ther 2006;13: ) Gibson KD, Ferris BL, Polissar N, Neradilek B, Pepper D. Endovenous laser treatment of the short saphenous vein: efficacy and complications. J Vasc Surg 2007;45: ) Theivacumar NS, Beale RJ, Mavor AI, Gough MJ. Initial experience in endovenous laser ablation (EVLA) of varicose veins due to small saphenous vein reflux. Eur J Vasc Endovasc Surg 2007;33: ) Welch HJ. Endovenous ablation of the great saphenous vein may avert phlebectomy for branch varicose veins. J Vasc Surg 2006;44: ) Rutherford RB, Palberg FT, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. Venous severity scoring: an adjunct to venous clinical assessment. J Vasc Surg 2000;31: ) Porter JP, Moneta GM, and International Consensus Committee on Chronic Venous Disease. Reporting standards in venous disease: an update. J Vasc Surg 1995;21: )Mundy L, Merlin TL, Fitridge RA, Hiller JE. Systematic review of endovenous laser treatment for varicose veins. Br J Surg 2005;92: ) Min RJ, Khilnani NM. Endovenous laser ablation of varicose veins. J Cardiovsc Surg 2005;46: ) Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg 2002;35: ) 정중기, 정인목, 김영철, 허승철, 안영준, 이태승등. 소복재정맥류에서경정맥레이저치료의임상적경험. 대한혈관외과학회지 2004;20: ) 정인목, 정중기, 채영준, 허승철, 안영준, 황기태등. 정맥내레이저열응고요법과동시에시행한국소정맥류절제술을이용한하지정맥류의치료. 대한외과학회지 2006;71: ) Sadick NS, Wasser S. Combined endovascular laser plus ambulatory phlebectomy for the treatment of superficial venous incompetence: a 4-year perspective. J Cosmet Laser Ther 2007; 9: ) Mekako A, Hatfield J, Bryce J, Heng M, Lee D, McCollum P, et al. Combined endovenous laser therapy and ambulatory phlebectomy: refinement of a new technique. Eur J Vasc Endovasc Surg 2006;32: ) Monahan DL. Can phlebectomy be deferred in the treatment of varicose veins? J Vasc Surg 2005;42: ) Puggioni A, Kalra M, Carmo M, Mozes G, Gloviczki P. Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications. J Vasc Surg 2005;42: ) Huang Y, Jiang M, Li W, Lu X, Huang X, Lu M. Endovenous

7 180 대한혈관외과학회지 : 제 23 권제 2 호 2007 laser treatment combined with a surgical strategy for treatment of venous insufficiency in lower extremity: a report of 208 cases. J Vasc Surg 2005;42: ) Perkowski P, Ravi R, Gowda RCN, Olsen D, Ramaiah V, Rodriguez-Lopez JA, et al. Endovenous laser ablation of the saphenous vein for treatment of venous insufficiency and varicose veins: early results from a large single-center experience. J Endovasc Ther 2004;11:

untitled

untitled 대한혈관외과학회지 : 제 26 권제 1 호 Vol. 26, No. 1, May 2010 하지정맥류환자에서정맥내레이저치료법과전통적인수술방법의수술후합병증비교 서울대학교보라매병원외과 1, 서울대학교의과대학외과학교실 2 정인목 1,2 ㆍ오은미 1,2 ㆍ정중기 1,2 Comparative Study of Postoperative Complications of High

More information

untitled

untitled 대한혈관외과학회지 : 제 26 권제 2 호 Vol. 26, No. 2, August 2010 하지정맥류치료에있어서고위결찰술을함께실시한 Endovenous Laser Treatment 의임상고찰 광주기독병원외과 윤성필ㆍ박범석ㆍ문덕진 Clinical Analysis of Endovenous Laser Treatment Combined with High Ligation

More information

untitled

untitled 대한혈관외과학회지 : 제 25 권제 1 호 Vol. 25, No. 1, May 2009 복재정맥역류를동반한하지정맥류환자에서다른레이저파장을이용한정맥내레이저치료법의결과비교 서울대학교보라매병원외과 1, 영상의학과 2, 병리과 3 김서민 1, * ㆍ정인목 1, * ㆍ허승철 1 ㆍ안영준 1 ㆍ황기태 1 ㆍ최영호 2 ㆍ장미수 3 ㆍ정중기 1 Comparative Study

More information

Jksvs019(8-15).hwp

Jksvs019(8-15).hwp Grade I Grade II Grade III 12 대한혈관외과학회지 : 제 20 권 제 1 호 2004 Control Group A Group B Fig. 4. Microscopic findings of vein wall in control, group A and group B on the day of 7 after venous occlusion. The

More information

untitled

untitled REVIEW ARTICLE J Surg Ultrasound 2015;2:16-21 JSU Journal of Surgical Ultrasound 복재정맥열절제술을위한초음파검사 계명대학교동산의료원외과 박의준 Duplex Ultrasound for Thermal Ablation of Saphenous Vein Ui Jun Park Department of Surgery,

More information

황지웅

황지웅 Comparison of Laparoscopy and Exploration in the Distal Pancreatectomy BACKGROUND: To determine the benefits of laparoscopic surgery compared with exploration, the clinical outcomes of open and laparoscopic

More information

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar

More information

Lumbar spine

Lumbar spine Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical

More information

untitled

untitled 대한혈관외과학회지 : 제 26 권제 3 호 Vol. 26, No. 3, November 2010 소복재정맥역류와무관한오금부위정맥류 서을대학교의과대학외과학교실 1, 영상의학교실 2 신용찬 1 ㆍ민승기 1 ㆍ박은아 2 ㆍ이활 2 ㆍ정진욱 2 ㆍ하종원 1 ㆍ김상준 1 Atypical Varicose Veins in the Popliteal Fossa Unrelated

More information

untitled

untitled 대한혈관외과학회지 : 제 25 권제 1 호 Vol. 25, No. 1, May 2009 하지정맥류의정맥내레이저열응고요법 (EVLT) 후대복재 - 대퇴정맥접합부의관찰 을지대학교의과대학외과학교실 서승은ㆍ조병선ㆍ이민구ㆍ박성혜ㆍ최영진ㆍ김창남ㆍ강윤중ㆍ박주승 The Evaluation of the Saphenofemoral Junction after Endovenous

More information

untitled

untitled 대한혈관외과학회지 : 제 25 권제 2 호 Vol. 25, No. 2, November 2009 최신 VNUS ClosureFAST System 을이용한정맥내고주파열제거술과평면고위결찰술을병행한하지정맥류의조기결과 대구보훈병원흉부외과 1, 안동병원흉부외과 2 공준혁 1 ㆍ허진 2 The Early Results of Endovenous Radiofrequency

More information

( ) Jksvs022.hwp

( ) Jksvs022.hwp 대한혈관외과학회지 : 제 23 권제 2 호 Vol. 23, No. 2, November, 2007 하지정맥류수술방법의비교분석 예수병원외과 양석정ㆍ박영삼ㆍ김철승 Comparison of the Operative Methods for Varicose Veins in the Lower Extremities Seok Jeong Yang, M.D., Young Sam

More information

untitled

untitled 대흉외지 2010;43:635-641 DOI:10.5090/kjtcs.2010.43.6.635 임상연구 하지정맥류치료를위한 2 세대고주파열폐쇄술 ( Closure fast) 과기존의고주파열폐쇄술 ( Closure plus) 의임상치험비교분석 김우식 * ㆍ이정상 ** ㆍ정성철 * ㆍ신용철 * Clinical Experience of Closure fast in

More information

원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현

원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현 원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현 원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현 원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 지도김석원교수 이논문을석사학위논문으로제출함

More information

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770>

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770> 대한안과학회지 제 49 권 제 5 호 2008 J Korean Ophthalmol Soc 49(5):727-731, 2008 DOI : 10.3341/jkos.2008.49.5.727 다초점 소프트콘택트렌즈의 노안의 시력보정에 대한 유용성 평가 김현경 1 김효명 2 정성근 1 가톨릭대학교 의과대학 성모병원 안과학교실 1, 고려대학교 의과대학 안암병원 안과학교실

More information

( )Jkstro011.hwp

( )Jkstro011.hwp 비인강암의방사선치료결과및생존율에관한예후인자분석 2005 2 1 2005 3 28. :, Tel: 053)250-7665, Fax: 053)250-7984 E-mail: jhkim@dsmc.or.kr 정영연외 2 인 : 비인강암의예후인자분석 정영연외 2 인 : 비인강암의예후인자분석 Carcinoma of the nasopharynx treated by radiotherapy

More information

기관고유연구사업결과보고

기관고유연구사업결과보고 기관고유연구사업결과보고 작성요령 2001 ~ 2004 2005 ~ 2007 2008 ~ 2010 2001 ~ 2004 2005 ~ 2007 2008 ~ 2010 1 2/3 2 1 0 2 3 52 0 31 83 12 6 3 21 593 404 304 1,301 4 3 1 8 159 191 116 466 6 11 (`1: (1: 16 33 44 106

More information

(01) hwp

(01) hwp Journal of Life Science 2013 Vol. 23. No. 2. 157~166 ISSN (Print) 1225-9918 ISSN (Online) 2287-3406 DOI : http://dx.doi.org/10.5352/jls.2013.23.2.157 α μ δ κ 158 생명과학회지 2013, Vol. 23. No. 2 Journal of

More information

( )Kju269.hwp

( )Kju269.hwp 만성세균성전립선염모델흰쥐에서 의항염효과 Anti-inflammatory Effect of Lycopene on Chronic Bacterial Prostatitis Rat Model Cho Hwan Yang, Dong Wan Sohn, Yong-Hyun Cho From the Department of Urology, The Catholic University

More information

A 617

A 617 Special Issue Diabetic Retinopathy Won Ki Lee, M.D. Department of Ophthalmology The Catholic University of Korea College of Medicine Kangnam St. Mary s Hospital E mail : wklee@catholic.ac.kr Abstract R

More information

노영남

노영남 Purpose: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding

More information

³ëº´¼®

³ëº´¼® 121 A B C Fig. 1. Deep vein thrombosis of left lower extremity in 48-years-old female. A. After removal of iliofemoral vein thrombus, Initial venography shows impacted thrombus with obstruction in the

More information

제5회 가톨릭대학교 의과대학 마취통증의학교실 심포지엄 Program 1 ANESTHESIA (Room 2층 대강당) >> Session 4 Updates on PNB Techniques PNB Techniques for shoulder surgery: continuou

제5회 가톨릭대학교 의과대학 마취통증의학교실 심포지엄 Program 1 ANESTHESIA (Room 2층 대강당) >> Session 4 Updates on PNB Techniques PNB Techniques for shoulder surgery: continuou 제5회 가톨릭대학교 의과대학 마취통증의학교실 심포지엄 (Room 2층 대강당) >> Session 4 Updates on PNB Techniques PNB Techniques for shoulder surgery: continuous vs single injection, interscalene vs supraclavicular approach 의정부성모병원

More information

Jkbcs030(10)( ).hwp

Jkbcs030(10)( ).hwp Treatment of Breast Fibroadenoma with Interstitial Laser Photocoagulation Doo Min Sohn, Hyo Won Lee, Tae Yun Kim, Dan Song, Sung Yong Kim, Chul Wan Lim and Min Hyuk Lee Department of Surgery, College of

More information

2009¿©¸§È£ÃÖÁ¾

2009¿©¸§È£ÃÖÁ¾ 2009 여름호 / 통권 04 www.kuh.co.kr 포커스 충청해바라기 아동센터 개설 건국대학교충주병원은 여성부와 2009년 5월 15일 성폭력으로 부터 아동을 보호하고 치료할 수 있는 전문 의료기관으 로 협약체결 하였다. 이번에 설립하는 충청해바라기 아동센터에서는 최고의 인프라구축을 통한 One-stop서비스를 제공하며, 충청남북도 아 동들의 성학대 예방

More information

Kbcs002.hwp

Kbcs002.hwp Does Real-time Compound Imaging Improve Evaluation of reast Cancer Compared to Conventional Sonography? o Kyoung Seo, M.D., Yu Whan Oh, M.D., Kyu Ran Cho, M.D., Young Hen Lee, M.D., Hyung Joon Noh, M.D.,

More information

김범수

김범수 Analysis of Outcomes after Resection of Sarcomatous Hepatocellular Carcinoma Purpose: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis

More information

001-학회지소개(영)

001-학회지소개(영) Review Article Randomization, What is the Proper Method? Jin Ho Hong, M.D., Jae Chul Yoo, M.D. Shoulder & Sports medicine, Department of Orthopedic Surgery, Samsung Medical Center Purpose: Among the numerous

More information

Abstract Background : Most hospitalized children will experience physical pain as well as psychological distress. Painful procedure can increase anxie

Abstract Background : Most hospitalized children will experience physical pain as well as psychological distress. Painful procedure can increase anxie Volume 12, Number 1, 92~102, An Intervention Study of Pain Reduction during IV Therapy in Hospitalized Children Myo-Jin Kim 1), Joung-Hae Bak 1), Won-Seok Seo 2) Mi-Young Kim 3), Sun-Kyoung Park 3), Jai-Soung

More information

untitled

untitled 하지동맥검사 1. 적응증하지동맥초음파검사의적응증은다음과같은임상증상이나질환이의심될때시행되어야하며, 진료현장에서검사가필요하다고판단된경우아래적응에국한되지않고시행할수있다. 1) 임상증상 - 하지의간헐적파행증 - 하지의휴식기통증 - 동맥성하지궤양및괴사 2) 의심질환 - 말초동맥질환 ( 협착및폐색, 동맥류 ) - 하지동맥색전증 - 하지동정맥루 - 하지가성동맥류 - 외상

More information

歯1.PDF

歯1.PDF 200176 .,.,.,. 5... 1/2. /. / 2. . 293.33 (54.32%), 65.54(12.13%), / 53.80(9.96%), 25.60(4.74%), 5.22(0.97%). / 3 S (1997)14.59% (1971) 10%, (1977).5%~11.5%, (1986)

More information

( )Kjhps043.hwp

( )Kjhps043.hwp Difference of Fistula Maturation Degree and Physical Property by the Types of Tube Material: An Experimental Study Sang Koo Kang, M.D. 1, Hee Chul Yu, M.D. 1,4, Woo Sung Moon, M.D. 2,4, Ju Hyoung Lee,

More information

Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp DOI: : Researc

Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp DOI:   : Researc Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp.251-273 DOI: http://dx.doi.org/10.21024/pnuedi.27.2.201706.251 : 1997 2005 Research Trend Analysis on the Korean Alternative Education

More information

12이문규

12이문규 Review on Conservative Treatment of Spinal Scoliosis Moon-kyu Lee, O.M.D., Gil-jae Lee, O.M.D., Yun-kyung Song, O.M.D., Hyung-ho Lim, O.M.D. Dept. of Oriental Rehabilitation Medicine College of Oriental

More information

04조남훈

04조남훈 Received : 2011. 11. 16 Reviewed : 2011. 11. 25 Accpeted : 2011. 12. 5 A Case Report of Prescribing Yanghyeolgeopung-tang(yangxuequfeng-tang) to Two Patients with Cervical Disc Herniation and Headache

More information

Minimally invasive parathyroidectomy

Minimally invasive parathyroidectomy 2013. 2. 2 대한간암연구학회 7차 심포지움 및 학술대회 Indication and Clinical Outcomes of Metachronous HCC Metastasectomy Shin Hwang Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan

More information

- i - - ii - - iii - - iv - - v - - 1 - - 2 - - 3 - - 4 - - 5 - - 6 - - 7 - - 8 - - 9 - - 10 - - 11 - - 12 - - 13 - - 14 - - 15 - - 16 - - 17 - - 18 - - 19 - α α - 20 - α α α α α α - 21 - - 22 - - 23 -

More information

<342EBEC8BCBABFAD2CB9DAC7E2C1D82E687770>

<342EBEC8BCBABFAD2CB9DAC7E2C1D82E687770> 大 韓 癩 學 會 誌 : 第 41 卷, 第 1 號 2008 Korean Leprosy Bulletin, Vol. 41, No. 1, June, 2008 마비성 하안검 외반증에 대한 lateral tarsal strip의 재조명 안성열 성형외과의원 1), 제일병원 피부과 2) 안성열 1), 박향준 2) - Abstract - Reappraisal of the

More information

Trd022.hwp

Trd022.hwp 김신태, 이선녕, 이석정, 정필문, 박홍준, 신명상, 김종환, 이부길, 김상하, 리원연, 신계철, 용석중 Shin-Tae Kim, M.D., Shun Nyung Lee, M.D., Seok Jeong Lee, M.D., Pil Moon Jung, M.D., Hong Jun Park, M.D., Myung Sang Shin, M.D., Chong Whan Kim,

More information

[ 영어영문학 ] 제 55 권 4 호 (2010) ( ) ( ) ( ) 1) Kyuchul Yoon, Ji-Yeon Oh & Sang-Cheol Ahn. Teaching English prosody through English poems with clon

[ 영어영문학 ] 제 55 권 4 호 (2010) ( ) ( ) ( ) 1) Kyuchul Yoon, Ji-Yeon Oh & Sang-Cheol Ahn. Teaching English prosody through English poems with clon [ 영어영문학 ] 제 55 권 4 호 (2010) 775-794 ( ) ( ) ( ) 1) Kyuchul Yoon, Ji-Yeon Oh & Sang-Cheol Ahn. Teaching English prosody through English poems with cloned native intonation. The purpose of this work is to

More information

Jkbcs012( ).hwp

Jkbcs012( ).hwp Complications and Reasons for Dissatisfaction in Augmentation Mammoplasty - Analysis of 42 Cases of Re-operation - Sangdal Lee M.D. Clinic Purpose: Breast augmentation has recently become a common plastic

More information

Microsoft PowerPoint - 발표자료(KSSiS 2016)

Microsoft PowerPoint - 발표자료(KSSiS 2016) Sang Jun Kim, MD, PhD Application of 3D Printing in the Orthotic Fields Hallux Valgus, Charcot Marie Tooth, ADL Kit, Foot Insole, Wrist Pain, Foot Drop Development of Automated Program for Ankle Foot Orthosis

More information

1..

1.. Volume 12, Number 1, 6~16, Factors influencing consultation time and waiting time of ambulatory patients in a tertiary teaching hospital Jee-In Hwang College of Nursing Science, Kyung Hee University :

More information

Kjhps016( ).hwp

Kjhps016( ).hwp Surgical Extent and Types in Pancreatic Cancer Song Cheol Kim, M.D. Department of Surgery, Ulsan University College of Medicine & Asan Medical Center, Seoul, Korea Pancreatic cancer continues to pose a

More information

Abstract Musculoskeletal Symptoms and Related Factors for Nurses and Radiological Technologists Wearing a Lead Apron for Radiation Pro t e c t i o n Jung-Im Yoo, Jung-Wan Koo 1 ) Angio Unit, Team of Radiology,

More information

005송영일

005송영일 Received : 2015. 12. 09 Reviewed : 2015. 12. 16 Accepted : 2015. 12. 16 Sternal Fracture occurred after Thai Massage : A Case Report Young-Il Song, K.M.D. 1, Dong-Eun Kim, K.M.D. 1 1 Department of Rehabilitation

More information

Journal of Educational Innovation Research 2017, Vol. 27, No. 3, pp DOI: (NCS) Method of Con

Journal of Educational Innovation Research 2017, Vol. 27, No. 3, pp DOI:   (NCS) Method of Con Journal of Educational Innovation Research 2017, Vol. 27, No. 3, pp.181-212 DOI: http://dx.doi.org/10.21024/pnuedi.27.3.201709.181 (NCS) Method of Constructing and Using the Differentiated National Competency

More information

Jkbcs016(92-97).hwp

Jkbcs016(92-97).hwp Expression of bcl-2 and Apoptosis and Its Relationship to Clinicopathological Prognostic Factors in Breast Cancer - A Study with Long Term Follow-up correlated with the survival rate.(journal of Korean

More information

자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 A B Fig. 1. High-contrast spatial resolution in phantom test. A. Slice 1 with three sets of hole arr

자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 A B Fig. 1. High-contrast spatial resolution in phantom test. A. Slice 1 with three sets of hole arr Original Article pissn 1738-2637 J Korean Soc Radiol 2012;67(2):129-134 The Survey of Magnetic Resonance Imaging Quality according to in Korea 1 자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 1 Hyun-Hae

More information

Kaes025.hwp

Kaes025.hwp 고위험군유두상갑상선암환자에대한방사성옥소최대허용선량측정법및치료법의검증 Verification of Measurement Methods and Therapeutic Efficacy of Maximum Permissible Dose of I-131 in High Risk Patients with Differentiated Papillary Thyroid Cancer

More information

Can032.hwp

Can032.hwp Chromosomal Alterations in Hepatocellular Carcinoma Cell Lines Detected by Comparative Genomic Hybridization Sang Jin Park 1, Mahn Joon Ha, Ph.D. 1, Hugh Chul Kim, M.D. 2 and Hyon Ju Kim, M.D. 1 1 Laboratory

More information

<B0E6C8F1B4EBB3BBB0FAC0D3BBF3B0ADC1C E687770>

<B0E6C8F1B4EBB3BBB0FAC0D3BBF3B0ADC1C E687770> 개원의와함께하는임상강좌 2011 역류성식도질환제대로이해하기 Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea Jae-Young Jang, M.D., PhD. 개원의와함께하는임상강좌 2011 109 최신치료

More information

K O R E A C E N T E R S F O R D I S E A S E C O N T R O L & P R E V E N T I O N PHWR Vol. 5 No. 41 www.cdc.go.kr/phwr 2012 10 12 5 41 ISSN:2005-811X Comparison of drug-susceptibility test to the anti-tuberculosis

More information

Journal of Educational Innovation Research 2018, Vol. 28, No. 4, pp DOI: * A Research Trend

Journal of Educational Innovation Research 2018, Vol. 28, No. 4, pp DOI:   * A Research Trend Journal of Educational Innovation Research 2018, Vol. 28, No. 4, pp.295-318 DOI: http://dx.doi.org/10.21024/pnuedi.28.4.201812.295 * A Research Trend on the Studies related to Parents of Adults with Disabilities

More information

untitled

untitled 대한수혈학회지:제권 제호, 0 한 대학병원의 혈액 폐기 분석 김병철ㆍ서영익ㆍ채금란ㆍ신정원ㆍ최태윤 = Abstract = 순천향대학교 의과대학 서울병원 진단검사의학교실 Analysis of Discarded Blood Components at a University Hospital in Korea Byung Chul Kim, Young Ik Seo, Gum Ran

More information

현대패션의 로맨틱 이미지에 관한 연구

현대패션의 로맨틱 이미지에 관한 연구 한지닥섬유제품의인체생리반응및쾌적성평가 임순 Evaluation of Thermal Physiological Responses and Comfort in Dox Fabric Soon Im Professor, Dept. of Fashion Industry, Incheon National University This study performed the evaluation

More information

- iii - - i - - ii - - iii - 국문요약 종합병원남자간호사가지각하는조직공정성 사회정체성과 조직시민행동과의관계 - iv - - v - - 1 - - 2 - - 3 - - 4 - - 5 - - 6 - - 7 - - 8 - - 9 - - 10 - - 11 - - 12 - - 13 - - 14 - α α α α - 15 - α α α α α α

More information

Treatment and Role of Hormaonal Replaement Therapy

Treatment and Role of Hormaonal Replaement Therapy Treatment and Role of Hormone Replacement Therapy Chung-Ang University Hospital Chee Jeong Kim 7.2 5.3 6.4 5.6 7.3 5.5 1 1 2 3 4 10 11 7 34 49 122 123 1.0 - - 10. 2001 1998 1998 Improvement of postmenopausal

More information

(

( 317 318 319 320 1 3 5 5 5 5 2 321 : 1.,,,,, 06 2. X-ray beam penetration (density) (contrast) 03 3. patch coating, precipitation, flaking 03 4. centering 03 5. Esophagus, cardia, fundus, body, angle, antrum,

More information

ECG & EP CASES Young-Keun On, MD, PhD Division of Cardiology, Department of Medicine Cardiac & Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea A case of

More information

Analysis of objective and error source of ski technical championship Jin Su Seok 1, Seoung ki Kang 1 *, Jae Hyung Lee 1, & Won Il Son 2 1 yong in Univ

Analysis of objective and error source of ski technical championship Jin Su Seok 1, Seoung ki Kang 1 *, Jae Hyung Lee 1, & Won Il Son 2 1 yong in Univ Analysis of objective and error source of ski technical championship Jin Su Seok 1, Seoung ki Kang 1 *, Jae Hyung Lee 1, & Won Il Son 2 1 yong in University & 2 Kang Won University [Purpose] [Methods]

More information

Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ

Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee University College of Medicine & Hospital E mail : ycell2@yahoo.co.kr Abstract

More information

달생산이 초산모 분만시간에 미치는 영향 Ⅰ. 서 론 Ⅱ. 연구대상 및 방법 達 은 23) 의 丹 溪 에 최초로 기 재된 처방으로, 에 복용하면 한 다하여 난산의 예방과 및, 등에 널리 활용되어 왔다. 達 은 이 毒 하고 는 甘 苦 하여 氣, 氣 寬,, 結 의 효능이 있

달생산이 초산모 분만시간에 미치는 영향 Ⅰ. 서 론 Ⅱ. 연구대상 및 방법 達 은 23) 의 丹 溪 에 최초로 기 재된 처방으로, 에 복용하면 한 다하여 난산의 예방과 및, 등에 널리 활용되어 왔다. 達 은 이 毒 하고 는 甘 苦 하여 氣, 氣 寬,, 結 의 효능이 있 대한한방부인과학회지 THE JOURNAL OF ORIENTAL OBSTETRICS & GYNECOLOGY VOL.17, NO.2 : 115-122 (2004) 달생산이 초산모 분만시간에 미치는 영향 * 북경한의원, ** 윤산부인과의원, *** 최은림산부인과의원, 상지대학교 한의과대학 부인과학교실 ****, 경희대학교 동서의학대학원 김성준 *****, 윤왕준

More information

[ 하지정맥류 _ 양방 ] 약사가알아야할하지정맥류의개요와치료 저자송영천소속삼육대학교약학과약학정보원학술자문위원 개요 정맥류 [ 靜脈瘤, varix (varices) 는정맥내강이압박, 폐쇄등에의해혈류에지장을받아비정상적으로확장된상태를말하며, 정맥류성정맥은피부아래로볼수있는,

[ 하지정맥류 _ 양방 ] 약사가알아야할하지정맥류의개요와치료 저자송영천소속삼육대학교약학과약학정보원학술자문위원 개요 정맥류 [ 靜脈瘤, varix (varices) 는정맥내강이압박, 폐쇄등에의해혈류에지장을받아비정상적으로확장된상태를말하며, 정맥류성정맥은피부아래로볼수있는, [ 하지정맥류 _ 양방 ] 약사가알아야할하지정맥류의개요와치료 저자송영천소속삼육대학교약학과약학정보원학술자문위원 개요 정맥류 [ 靜脈瘤, varix (varices) 는정맥내강이압박, 폐쇄등에의해혈류에지장을받아비정상적으로확장된상태를말하며, 정맥류성정맥은피부아래로볼수있는, 부풀어오르고구불구불꼬아진상태의정맥을지칭한다. 대개는하지정맥에서발생하지만다른신체부위에서도형성될수있다.

More information

590호(01-11)

590호(01-11) T H E K O R E A N D O C T O R S W E E K L Y www.docdocdoc.co.kr I N S I D E 38 3 5 6 7 10 13 28 29 30 31 38 41 42 2 Advertisement Government & Medicine 3 Government & Medicine 4 Government & Medicine Government

More information

IL-1β, IL-1RN, IL-8, MUC, NAT, GST 등 ) IL-1β, IL-1RN, IL-8, MUC, NAT, GST 등 ) IL-1β, IL-1RN, IL-8, MUC, NAT, GST 등 ) l l l α β α β β α β β α β 목적 (Background/Aims): 위암의가족력과 Helicobacter pylori 감염은각각위암발생의위험인자로알려져있으나,

More information

00약제부봄호c03逞풚

00약제부봄호c03逞풚 경희대학교 동서신의학병원 약품 정보지 2 0 0 7. S P R I N G. V O L. 0 1 신약 소개 02 Journal Review 03 Special Subject 04 복약 지도 06 의약품 안전성 정보 07 약제부 알림 07 약제부 업무 소개 08 E A S T - W E S T N E O M E D I C A L C E N T E R 본 약품

More information

<35BFCFBCBA2E687770>

<35BFCFBCBA2E687770> 주요개념 : 컴퓨터음란물 접촉자, 성지식, 성태도 남자중학생의 컴퓨터음란물 접촉자와 비접촉자간의 성지식과 태도의 차이 김 영 혜* 이 화 자** 정 향 미*** 1. 연구의 필요성 한국은 I. 서 론 1960 년대 이후부터 시작된 돌진적 산업화 ( 한 상진, 1996) 로 인하여 경제적 부흥을 이루어 집집마다 TV 수상기를 가질 수 있게 되었고 최근에는 PC보급율

More information

386-390.hwp

386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon

More information

139~144 ¿À°ø¾àħ

139~144 ¿À°ø¾àħ 2 139 DOI : 10.3831/KPI.2010.13.2.139 2 Received : 10. 04. 08 Revised : 10. 04. 26 Two Case Report on Wrist Ganglion Treated with Scolopendrid Pharmacopuncture Accepted : 10. 05. 04 Key Words: Wrist Ganglion,

More information

- i - - ii - - iii - - iv - - v - - vi - - 1 - - 2 - - 3 - 1) 통계청고시제 2010-150 호 (2010.7.6 개정, 2011.1.1 시행 ) - 4 - 요양급여의적용기준및방법에관한세부사항에따른골밀도검사기준 (2007 년 11 월 1 일시행 ) - 5 - - 6 - - 7 - - 8 - - 9 - - 10 -

More information

( )Kju225.hwp

( )Kju225.hwp 비임균성비뇨생식기감염에서 의진단적효용성 Usefulness of the Mycofast Test (MYCOFAST Evolution 2) for the Diagnosis of Nongonococcal Genitourinary Infections Hang Ro Park, Yang Hyun Kim, Ho Jae Lee, Jea Sang Oh, Hyoung Jin

More information

°Ç°�°úÁúº´6-2È£

°Ç°�°úÁúº´6-2È£ K O R E A C E N T E R S F O R D I S E A S E C O N T R O L & P R E V E N T I O N PHWR Vol. 6 No. 2 www.cdc.go.kr 2013 1 11 6 2 ISSN:2005-811X Flavivirus surveillance in mosquitoes collected from the quarantine

More information

서론 34 2

서론 34 2 34 2 Journal of the Korean Society of Health Information and Health Statistics Volume 34, Number 2, 2009, pp. 165 176 165 진은희 A Study on Health related Action Rates of Dietary Guidelines and Pattern of

More information

04-07도현수

04-07도현수 대 한 외 상 학 회 지 Vol. 19, No. 2, December, 2006 원 저 임상실습과정 의과대학생을 대상으로 카데바 모델을 이용한 단순 봉합술 교육의 효율성 충남대학교 의과대학 응급의학교실 Abstract 도현수 민진홍 홍승우 한상균 김인수 유@ 승 이진웅 김승환 유인술 Evaluation of the Educational Efficacy of

More information

Crt114( ).hwp

Crt114( ).hwp cdna Microarray Experiment: Design Issues in Early Stage and the Need of Normalization Byung Soo Kim, Ph.D. 1, Sunho Lee, Ph.D. 2, Sun Young Rha, M.D., Ph.D. 3,4 and Hyun Cheol Chung, M.D., Ph.D. 3,4 1

More information

석사논문.PDF

석사논문.PDF ABO Rh A study on the importance of ABO and Rh blood groups information in Public Health 2000 2 1 ABO Rh A study on the importance of ABO and Rh blood groups information in Public Health 2000 2 2 ABO Rh

More information

54 한국교육문제연구제 27 권 2 호, I. 1.,,,,,,, (, 1998). 14.2% 16.2% (, ), OECD (, ) % (, )., 2, 3. 3

54 한국교육문제연구제 27 권 2 호, I. 1.,,,,,,, (, 1998). 14.2% 16.2% (, ), OECD (, ) % (, )., 2, 3. 3 27 2, 53-70, 2009. (Nursing Home) * ** (Nursing Home). 5 50 5 2 1,,,,, SPSS t.,,,,,,,. :,, : 2009/08/27 : 2009/09/24 : 2009/09/30 * ** (: hjkim@daelim.ac.kr) 54 한국교육문제연구제 27 권 2 호, 2009. I. 1.,,,,,,, (,

More information

Journal of Educational Innovation Research 2019, Vol. 29, No. 2, pp DOI: 3 * Effects of 9th

Journal of Educational Innovation Research 2019, Vol. 29, No. 2, pp DOI:   3 * Effects of 9th Journal of Educational Innovation Research 2019, Vol. 29, No. 2, pp.357-378 DOI: http://dx.doi.org/10.21024/pnuedi.29.2.201906.357 3 * Effects of 9th Grade Students Participation in Career Curriculum Cluster

More information

<B0E6C8F1B4EBB3BBB0FA20C0D3BBF3B0ADC1C E687770>

<B0E6C8F1B4EBB3BBB0FA20C0D3BBF3B0ADC1C E687770> 심전도연수강좌 : 처음시작하는사람들을위한심전도 연세대학교원주의과대학순환기내과학교실 안민수 Cardiac Electrophysiology I : Automaticity : 60-100 회 /min, His bundle : 40-60 회 /min Bundle branch : 20-40 회 /min Purkinje fiber : 20 회 /min Cardiac Electrophysiology

More information

16_이주용_155~163.hwp

16_이주용_155~163.hwp 사상체질의학회지 2008;20(2):155-163 J of Sasang Constitutional Medicine Vol. 20, No. 2, 2008:155-163 http://www.esasang.com 腦 梗 塞 으로 발생한 少 陽 人 半 身 舞 蹈 病 患 者 치험 1례 이주용 이한얼 한경수 안택원 Abstract 대전대학교 한의과대학 사상체질과 A Soyangin

More information

....-42.(11+12.).pdf

....-42.(11+12.).pdf www.himchanhospital.com 2011:11+12 www.himchanhospital.com Himchan People CONTENTS 2011 11+12 HIMCHAN PEOPLE 02 04 07 08 10 12 13 14 16 HIMCHAN NETWORK 18 19 22 04+05 Himchan People 06+07 Himchan People

More information

Table 1. Distribution by site and stage of laryngeal cancer Supraglottic Glottic Transglottic Total Stage Total 20

Table 1. Distribution by site and stage of laryngeal cancer Supraglottic Glottic Transglottic Total Stage Total 20 KISEP Head and Neck Korean J Otolaryngol 1999;42:1284-9 후두암수술환자에대한치료성적 송달원 김희준 정현수 김영한 안재현 이복수 박선호 Treatment Result in Laryngeal Cancer Patients Submitted to Surgical Treatment Dal Won Song, MD, Hee Jun

More information

Jkcs022(89-113).hwp

Jkcs022(89-113).hwp 대한배뇨장애 및 요실금 학회지 J. Korean Continence Society 2004;8:89-113 Bristol Female Lower Urinary Tract Symptom 설문지의 한국어 번역 및 번역본의 언어 타당도 Seung-June Oh*, Hyung Geun Park*, Sung Hyun Paick, Won Hee Park and Myung-Soo

More information

Jkafm093.hwp

Jkafm093.hwp 가정의학회지 2004;25:721-739 비만은 심혈관 질환, 고혈압 및 당뇨병에 각각 위험요인이고 다양한 내과적, 심리적 장애와 연관이 있는 질병이다. 체중감소는 비만한 사람들에 있어 이런 위험을 감소시키고 이들 병발 질환을 호전시킨다고 알려져 있고 일반적으로 많은 사람들에게 건강을 호전시킬 것이라는 믿음이 있어 왔다. 그러나 이런 믿음을 지지하는 연구들은

More information

20, 41..,..,.,.,....,.,, (relevant).,.,..??.,

20, 41..,..,.,.,....,.,, (relevant).,.,..??., , 41 (2007 12 ) * 1) *** ***,. IMF..,,,.,,,,.. I.. 1999 (,.),,. 2010 *. ** *** 19 20, 41..,..,.,.,....,.,, (relevant).,.,..??., 21.....,. II. 1967 G. G. Muller International Accounting. 1960. 1970... 1966,,,.

More information

레이아웃 1

레이아웃 1 대한위장관기질종양연구회 01 GIST 06 02 11 03 Imatinib 14 04 05 06 07 Sunitinib 32 40 44 48 GIST 6 01 7 GIST Guide book GIST 8 01 9 GIST Guide book GIST (CT) MRI FDG-PET 10 02 11 GIST Guide book 12 02 (Imatinib)

More information

36-2A.hwp

36-2A.hwp 박 정 준* 홍 장 미* 김 용 진* 이 정 렬* 노 준 량* =Abstract= Surgical Treatment of Complications after Fontan Operation Jeong-Jun Park, M.D.*, Jang Mee Hong, M.D.*, Yong Jin Kim, M.D.* Jeong Ryul Lee, M.D.*, Joon Ryang

More information

충북의대학술지 Chungbuk Med. J. Vol. 27. No. 1. 1~ Charcot-Marie-Tooth Disease 환자의마취 : 증례보고 신일동 1, 이진희 1, 박상희 1,2 * 책임저자 : 박상희, 충북청주시서원구충대로 1 번지, 충북대학교

충북의대학술지 Chungbuk Med. J. Vol. 27. No. 1. 1~ Charcot-Marie-Tooth Disease 환자의마취 : 증례보고 신일동 1, 이진희 1, 박상희 1,2 * 책임저자 : 박상희, 충북청주시서원구충대로 1 번지, 충북대학교 충북의대학술지 Chungbuk Med. J. Vol. 27. No. 1. 1~5 2017 Charcot-Marie-Tooth Disease 환자의마취 : 증례보고 신일동 1, 이진희 1, 박상희 1,2 * 책임저자 : 박상희, 충북청주시서원구충대로 1 번지, 충북대학교의과대학마취통증의학교실, 의학연구소 (28644), happycat19@hanmail.net

More information

....(....).hwp

....(....).hwp 김 학 제* 조 원 민* 류 세 민* 황 재 준* 손 영 상* 최 영 호* = Abstract = Clinical Analysis of Palliative Treatments in Occlusive Vascular Disease Hark Jei Kim, M.D.*, Won Min Jo, M.D.*, Se Min Rhu, M.D.*, Jae Joon Hwang,

More information

γ

γ 경락경혈학회지 Vol.27, No.1, pp.87 106, 2010 Journal of Meridian & Acupoint Dept. of 1 Meridian & Acupoint, 3 Acupuncture & Moxibustion, College of Oriental Medicine, Daejeon University 2 Division of Clinical

More information

433대지05박창용

433대지05박창용 Recent Changes in Summer Precipitation Characteristics over South Korea Changyong Park* JaYeon Moon** Eun-Jeong Cha*** Won-Tae Yun**** Youngeun Choi***** 1958 2007 6 9 6 9 10 10 10 10 10 Abstract This

More information

( ) Jkra076.hwp

( ) Jkra076.hwp Vol. 11, No. 4, December, 2004 Objective: Ultrasonography (USG) of joints has a unique position for the diagnosis of joint diseases. Bone surface, cartilage, periarticular soft tissue and their pathologic

More information

( )Jksc057.hwp

( )Jksc057.hwp 직장암환자의전직장간막절제술의 예측인자분석 : 불완전절제와절제시간에영향을미치는인자에관한연구 Analysis of Factors Affecting the Degree of Difficulty in Total Mesorectal Excision for Rectal Cancer: Investigation of the Factors Affecting Incomplete

More information

(Exposure) Exposure (Exposure Assesment) EMF Unknown to mechanism Health Effect (Effect) Unknown to mechanism Behavior pattern (Micro- Environment) Re

(Exposure) Exposure (Exposure Assesment) EMF Unknown to mechanism Health Effect (Effect) Unknown to mechanism Behavior pattern (Micro- Environment) Re EMF Health Effect 2003 10 20 21-29 2-10 - - ( ) area spot measurement - - 1 (Exposure) Exposure (Exposure Assesment) EMF Unknown to mechanism Health Effect (Effect) Unknown to mechanism Behavior pattern

More information

Jkss hwp

Jkss hwp 급성복증을보이는감염성요막관기형 Infected Urachal Remnants with Symtoms of the Acute Abdomen: The Differential Diagnosis & Proper Management Jan Dy Lee, M.D., Chee Young Lim, M.D. 1, Hyoung Il Kim, M.D. 1, Chul Woon Chung,

More information

YI Ggodme : The Lives and Diseases of Females during the Latter Half of the Joseon Dynasty as Reconstructed with Cases in Yeoksi Manpil (Stray Notes w

YI Ggodme : The Lives and Diseases of Females during the Latter Half of the Joseon Dynasty as Reconstructed with Cases in Yeoksi Manpil (Stray Notes w 497 의사학 제24권 제2호(통권 제50호) 2015년 8월 Korean J Med Hist 24 ː497-532 Aug 2015 c대한의사학회 http://dx.doi.org/10.13081/kjmh.2015.24.497 pissn 1225-505X, eissn 2093-5609 역시만필( 歷 試 漫 筆 ) 의 사례로 재구성한 조선후기 여성의 삶과 질병

More information

..........5-45..

..........5-45.. K O R E A C E N T E R S F O R D I S E A S E C O N T R O L & P R E V E N T I O N PHWR Vol. 5 No. 45 www.cdc.go.kr 2012 11 9 5 45 ISSN:2005-811X Monitoring of antimicrobial resistance on non-tertiary hospitals

More information

Kaes017.hwp

Kaes017.hwp 갑상선의 Poorly Differentiated (Insular) Carcinoma Insular Carcinoma: An Aggressive Subtype of Differentiated Thyroid Neoplasms Seok-Jin Nam, M.D., Sang-Dal Lee, M.D., Hal-lin Park, M.D., Young-Ryun Oh, M.D.

More information

Fluoroscopic anatomy for supraventricular tachycardia ablation Hui-Nam Pak, MD, PhD Division of Cardiology, Yonsei Cariovascular Center and Cardiovascular Research Institute, Yonsei University College

More information