Microsoft Word - ¸ñÂ÷-1.doc

Size: px

Start display at page:

Download "Microsoft Word - ¸ñÂ÷-1.doc"

원준 노
5 years ago
Views:

1 일시 :2006 년 9 월 30 일 ( 토 ) 오후 2 시 50 분 장소 : 전북대학교병원 GSK 홀 증례발표및토의 자유연제 I 자유연제 II - 2 -

2 목차 의대 05 의대 07 의대 08 의대 의대 12 의대 의대 의대 20 의대

3 Laser Excision of Hypopharynx Cancer Followed by Radiotherapy 단국대학교의과대학이비인후 - 두경부외과학교실 정필상 * 이상준 Case IF/38 C.C.foreign body sensation, throat onset 4MA C.C.known hypopharynx mass onset 40DA P.I. 4 local clinic PMHx.Anemia 10, PMHx.Total gastrectomy2001 huge leiomyoma GS op. P.E.hypophaynxwhitish round mass, Lt. pyriform sinus P.E. larynxv.c. mobility- good P.E. neckno palpable mass G-lab.Hb./Hct. 5.5/22.3 Neck MRLt. pyriform sinus mass, suspicious invasion of lt. vocal cord Neck MRLN enlargement, both int. jugular chain about 0.7 cm Imp.R/O pyriform sinus cancer Progress note Op. finding Suspension exam & frozen Bx.SCC transoral laser excision of pyriform sinus cancer CO 2 laser, 4.0W, continuous POD#4d discharge RTx.70 Gy, 39 POD#6m PET CTno evidence of mets. POD#10m NED Case IIM/62 C.C.foreign body sensation, throat onset 1MA P.I. local clinic pyriform sinus cancer PMHx.DM, Mallory-Weiss syndrome Social Hx.alcohol /day, smoking34 pack/day P.E.hypophaynxwhitish fungating mass, lt. pyriform sinus P.E. larynxv.c. mobility-good P.E. neckno palpable mass Neck MRHypopharynx ca., post. hypopharyneal wall, pyriform sinus Neck MRsuspicious invasion of post. false vocal cord Neck MRLN enlargement, both level I, II and III about 1 cm - 5 -

4 Imp.R/O pyriform sinus cancer Progress note Op. finding Suspension exam & frozen Bx.SCC transoral laser excision of pyriform sinus cancer CO 2 laser, 2.0W, super-pulse POD#2d discharge RTx. 70 Gy, ChemoTx.#3 5-FU, cisplatin POD#12m f/u MRno evidence of recurrence LMS Rt. false V.C.hypertrophic lesion Bx.ulceration with atypical squamous epithelium, favor reactive POD#2yr 9m f/u MRno evidence of recurrence POD#4yr 4m NED - 6 -

5 Pre-RT Neck Dissection in Organ Preservation Protocol 서울대학교의과대학이비인후과학교실 김광현 * - 7 -

6 인두이물감을주소로내원한 59 세남자환자 한림대학교의과대학이비인후과학교실 노영수 박일석 * 주형로 안회영 - 8 -

7 부분후두인두절제술을이용한하인두암치료의양상및결과 울산대학교의과대학서울아산병원이비인후과학교실 김상윤 남순열 최승호 * 노종렬 배경및목적 대 결 결 상 과 론 - 9 -

8 Larynx Preserving Wide Vertical Hemipharyngolaryngectomy 가톨릭대학교의과대학이비인후 - 두경부외과학교실 김민식 주영훈 * M/60 C/C Lt. Palpable neck mass for 4 months P/I local Neck CT : R/O pyriform sinus ca. further evaluation Lt neck mass FNAB SCC tonsil chr. Inflammation panendoscope BxSCC pyrifom sinus Lt. lat wall OP Cancer study NECK CT & MRI LAPs involving the Lt level I, level II, level III and level IV, with the largest one measuring less than 6 cm Lt posterolateral aspect of the hypopharynxabout 2 cm soft tissue Esophagogram N-S PET CT Most likely, left pyriform sinus cancer with LN metastases in left upper & middle internal jugular chain. Possibly, early marrow metastasis in left proximal femur. DDx. Benign bone tumor or focal marrow hyperplasia. Thigh MRI Prominent red marrow in the L proximal femoral shaft without definite evidence of metastasis. OP WVHPL. Lt ERND, Rt. SND II-IV reconstruction c Rt. ALTF. Pathology paraglottic space invasionpresent lymph node metastasispresent 1/76 Right II0/16, III0/8, IV0/4 Left Ia0/2, Ib0/4, III0/6, IV0/15, V0/14, II, III & IV1/1 pericapsular invasionpresent, size cm superiorresected margin1.5 cm inferior resected margin2.6 cm paraglottic space resected margin0.7 cm posterior cricoid midline margin0.6 cm lateral resected margin0.1 cm

9 Hospital course Hopital course POD #5 pathology report POD #12dry swallowing training silver # 6 downing sizing POD #15MBS 30% aspiration siver #5 dowin sizing POD#16 oral diet start pluging POD#34 SD decaulation POD#38 dischage CCRTx

10 Salvage Pharyngolaryngectomy with Jejunal Free Flap Reconstruction after Concurrent Chemo-Radiation Therapy 성균관대학교의과대학이비인후 - 두경부외과학교실 백정환 정만기 강제형 * 복권효 박기남 Case 1 M/64 C/CDysphagia onset 3 months ago P/I 8MA Odynophagia Hypopharynx cancer Squamous cell carcinoma Dx in outside hospital Chemotherapy & Radiation till 2 months ago 1MA PET-CTR/O Recur SMC OPD visit PMHxN-S P/ExHypopharynx & Larynx Right VCP, Pharyngeal wall diffuse swelling & sclerotic mucosa, patent airway CTrecurrent tumor manifestating as bilateral cervical lymph node metastasis AssessmentHypopharynx cancer rt3n2bm0 TreatmentTotal laryngopharyngectomy, partial cervical esophagectomy, Bilateral MRND, Left retrophayngeal neck dissection, Jejunal free flap reconstruction Pathologic staget4an2bm0 Progress POD#11 Esophagographyleakage Oral feeding POD#20 Liquid food leakage on stomadistal anastomosis site POD#27 Wound debridement and fistula repair POD#35 Wound repair with PMMC flap and pharyngocutaneous fistula repair POD#48 Wound debridement and repair with artificial skin POD#2 months Discharge POD#3 months F/U neck CT checked Case 2 M/54 C/CThroat discomfort onset 3 months ago P/I3MA Larynx mass BxSquamous cell carcinoma, poorly differentiated. PMHxN-S P/ExLarynx Mass on laryngeal surface of epiglottis, mobile vocal cord CTSupraglottic cancer involving the aryepiglottic fold and pharyngoepiglottic fold with suspected focal invasion of the suprahyoid epiglottis, right, with interdeterminate cervical lymphadenopathy

11 PET-CTHypermetabolic mass in the epiglottis and the supraglottic area, c/w malignant tissue. PET-CTIncreased FDG uptake in the right level III LN, malignant lymphadenopathy can t be excluded. AssessmentSupraglottic cancer ct2n1m0 TreatmentLaser supraglottic partial laryngectomy and staged right neck dissection Pathologic stagesupraglottic cancer pt2n2bm0 Progress POD#12 months Postoperative radiotherapy POD#6 months NED POD#8 months Aspiration and throat painrecurred cancer Dx extension to hypopharyx POD#9 months Total laryngopharyngectomy with Jejunal free flap reconstruction POD#10 months EsophagographyNo leakage

12 하인두암환자의수술적치료후재건시이용된위간치술의유용성 부산대학교의과대학이비인후과학교실 이진춘 * 이병주 왕수건 목적 방법 결과 결론

13 Flap Dehiscence After Total Laryngopharyngectomy and Neopharyneal Reconstruction with PMMC Flap 인제대학교의과대학부산백병원이비인후과학교실 엄재욱 * 김진수 C.C.horseness, dysphagia for 2 months P.I LMC PHxHBs Ag, DM/HTN/Tbc ROSodynophagia, Dyspnea, Right Otalgia, FB sensation in the neck P/E1 neck11 cm sized non-tender, movable, soft LN in the level III FNABno cancer metastasis P/E2 larynx and hypopharynxright vocal cord fixation, huge fungating mass on the right aryepiglottic fold which extended to the posterior and lateral wall of the hypopharynx. No visible apex of the right pyriform sinus. Hospital Course EUA c Bx papillomatous fungation mass on the right aryepiglottic fold extending to the right false vocal cord, laryngeal surface of the epiglottis, and lateral and posterior wall of the pyriform sinus Pathology reportscc meta workupno metastasis admission for chemotherapy 5-FU cysplantin Total laryngopharyngectomy, right hemithyroidectomy, right MRND type I, reconstruction of neopharynx with the PMMC flap Pathology reportscc with no metastasis in the neck nodes Pathology reportno involvement with esophageal inlet telescopy right side of the flapwound dehiscence right stoma wound dehiscence saliva leakage repair of wound dehiscence upper and lower marine of the PMMC flap dehiscence repair scopolamine 1.5 mg patch telescopy wound dehiscence right side of the flap telescopy wound dehiscence anterior side of the flap POD #62 NPO, dry mouth

14 인후두부분절제술후재건한요골전완부피판에발생한괴사 1 예 전북대학교의과대학이비인후 - 두경부외과학교실 홍기환 양윤수 *

15 하인두암에서후두전적출술및부분인두절제술후 Deep Inferior Epigastric Perforator(DIEP) Flap 을이용한재건 이화여자대학교의과대학이비인후과학교실 정성민 김한수 *

16 Pharyngeal-Esophageal Stenosis after Reconstruction with Forearm Free Flap of Total Laryngopharyngectomy 순천향대학교의과대학이비인후과학교실 고윤우 * 이승원 장혁순 M/68 C.Cdysphagia D.several months PHx.DM, HiBP PHx NECK CT, GFS, FNAB for cervical LNs PHxPharyngeal mass biopsy of GFSSCC PHxFNAB for cervical LNSCC ROS.mild dysphagia & dyspnea Reflux symptom ROSVoice change odynophagia aspiration ROSReferred otalgia PEx.70 telescopic exam Posterior hypopjaryngeal wallfungating mass PEx.70 telescopic exam Vocal cord movementwnl PEx.70 telescopic exam NeckRt. Level II- round, hard, movable, and non-tender LAP ImpressionHypopharynx cancer Iposterior pharyngeal wall ct2n2bmx Progress 1 General lab 2 WBBS, Abdominal USG, Chest CT 3 Neck MRI Treatment plansurgery with postop. RTx Operation Total laryngopharyectomy, cervical esophagectomy Rt. MRND level II, III, IV, V Lt. SND level II, III, IV Reconstruction with jejunal free flap Progress 1 POD # 6 days- Flap necrosis & failure emergency operation 2 nd free flap reconstruction with Forearm tubing 2 POD #7 days/pod # 1 day- Postop. bleeding bleeder ligation 3POD # 22 days/pod # 16 days- Pharyngocutaneous fistula repair under L/A 4 POD # 59 days- GFS Esophageal stricture 5 POD # 63 days/pod # 57 days- Endoscopic esophageal bouginage 6 POD # 71 days/pod # 65 days- Postop. RTx start. 7 Discahrgereadmission due to dysphagia- GI dept. Endoscopic bouginage Esophageal stricture

17 Discussion point 1 Why did esophageal stenosis develop 2 How could we prevent esophageal stenosis 3 How can we treat this patient s esophageal stenosis

18 하인두암의보존적수술과경부재발의술중방사선치료치험 1 예 고려대학교의과대학이비인후 - 두경부외과학교실 백승국 * 정광윤 Age/Sex56/M C.C.Foreign body sense in throat duration3 months P.I.3 P/Hx.HTN/DM/Tbc/Hepatitis S/Hx.Alcohol/Smoking ROS.Aspiration, Dyspnea, Hoarseness, Dysphagia, Weight loss P/Ex.Vocal cord palsy, Medial pyriform sinus 23 cm mass, Midline cross Work up Neck CT Biopsy Pyriform sinusscc in situ Pharynx MRI PET CT FNA Neck mass LMetastatic neck node SCC Neck CT PET CT Hospital course Exploration under LMS Hemipharyngolaryngectomy L c RND L, FFFR, Hemithyroidectomy L Postoperative RTx 5,220 cgy Bilateral neck FNA Supraclavicular area mass LSCC Extended salvage neck dissection L & IORT 1,500 cgy No evidence of disease

19 Surgical Treatment of Hypopharyngeal Cancer: A Review of 11 Cases 경상대학교의과대학이비인후과학교실 박정제 * 김진평 전시영 조한규 권오진 배경및목적 대상및방법 결 결 과 론

20 대한두경부외과학회회원가입신청서 신ᄏ청 ᄏ자 추천정회원 추천정회원

21 대한두경부외과학회 ,

제 20 회대한두경부외과연구회증례토론회 일시 :2006 년 5 월 27 일 ( 토 ) 오후 2 시 50 분 장소 : 강원도사북강원랜드 증례발표및토의 자유연제 I 자유연제 II - 2 -

제 20 회대한두경부외과연구회증례토론회 일시 :2006 년 5 월 27 일 ( 토 ) 오후 2 시 50 분 장소 : 강원도사북강원랜드 증례발표및토의 자유연제 I 자유연제 II - 2 - 일시 :2006 년 5 월 27 일 ( 토 ) 오후 2 시 50 분 장소 : 강원도사북강원랜드 증례발표및토의 자유연제 I 자유연제 II - 2 - 목차 의대 5 의대 6 의대 7 의대 8 9 의대 10 의대 11 의대 13 의대 14 15 의대 16 의대 17 의대 18 의대 20-3 - Myxoid Liposarcoma of Epiglottis 가천대학교의과대학이비인후과학교실