untitled
|
|
|
- 소미 공
- 5 years ago
- Views:
Transcription
1 J Korean Surg Soc 2011;80: DOI: /jkss 원 저 혈관내치료시대에복부대동맥류의수술적치료의적응과단기치료성적 성균관대학교의과대학삼성서울병원외과학교실혈관외과, 1 영상의학교실, 2 순환기내과학교실 노영남ㆍ박양진ㆍ김동익ㆍ박광보 1 ㆍ도영수 1 ㆍ최승혁 2 ㆍ김덕경 2 ㆍ김영욱 Indications and Short-term Results of Open Surgical Repair of Abdominal Aortic Aneurysm in an Endovascular Era Young-Nam Roh, M.D., Yang Jin Park, M.D., Dong-Ik Kim, M.D., Kwang-Bo Park, M.D. 1, Young-Soo Do, M.D. 1, Seung Hyuk Choi, M.D. 2, Duk-Kyung Kim, M.D. 2, Young-Wook Kim, M.D. Division of Vascular Surgery, Department of Surgery, Departments of 1 Radiology, 2 Cardiology, Samsung Medical Center (SMC), Sungkyunkwan University School of Medicine, Seoul, Korea Purpose: To assess the role of OR in treatment of AAA patients, we reviewed the indications and our current results of OR of AAA. Methods: We retrospectively investigated the database of 366 patients (mean age, 68.3±8.7 years, male 86%) who underwent open surgical (n=291, 80%) or endovascular treatments (n=75, 20%) of AAA in a tertiary referral center between Sep to Aug Treatment-related morbidities and mortality rates within 30 days were investigated according to the indications for treatment, clinical features, anatomic location, and underlying causes of AAA. Results: According to the location of AAA, we treated 343 (94%) infrarenal, 17 (5%) juxtarenal and 6 (2%) suprarenal AAAs. Underlying causes of AAA were degenerative (90%), infected (3%), inflammatory (3%), Marfan s syndrome (2%), and vasculitis (0.5%). Clinically, 338 (92%) were non-ruptured and 28 (8%) were ruptured AAAs. 75% of patients were treated with OR after the inception of reimbursement of aortic device while 25% of patients were treated with EVARs. The operative mortality rates of OR was 0.4% in patients with non-ruptured infrarenal AAA, 0% in patients with non-ruptured juxta- and suprarenal AAA and 21.4% in ruptured AAA patients. Conclusion: In an era of endovascular treatment of AAA, we have experienced excellent surgical results after OR in patients with non-ruptured AAA with various clinical features. Though EVAR is rapidly replacing OR in treatment of infrarenal AAAs, OR has its own role in treatment of AAA patients with unfavorable conditions for EVAR. The role of OR should not be underestimated. (J Korean Surg Soc 2011;80: ) Key Words: Abdominal aortic aneurysm, Surgical repair, Outcomes 중심단어 : 복부대동맥류, 수술적치료, 결과 서 론 책임저자 : 김영욱, 서울시강남구일원동 50 번지 , 성균관대학교삼성서울병원혈관외과 Tel: , Fax: E -mail: ywkim@skku.edu 접수일 :2010 년 11 월 1 일, 게재승인일 :2011 년 2 월 8 일 복부대동맥류에대한치료는 1950년대수술적방법이처음도입된이후수술기구, 대용혈관, 수술기법, 수술전후처치등이많은발전을해왔지만아직도파열되지않 212
2 Young-Nam Roh, et al:indications and Short-term Results of Open Surgical Repair of Abdominal Aortic Aneurysm in an Endovascular Era 213 은복부대동맥류에대한계획수술후수술사망률은 % 로비교적높게보고되고있다.(1-3) 특히복부대동맥류치료목적으로혈관내동맥류치료 (EndoVascular Aneurysm Repair, EVAR) 가도입된이후수술적치료 (Open repair) 의대상환자들은수술에도불리한해부학적조건을가지고있는경우가더빈번해짐으로써복부대동맥류의수술적치료후수술사망률은 2000년대이후에는오히려증가하고있다는보고도있다.(4) EVAR의도입은전체복부대동맥류환자의치료후사망률을낮추는것으로이미잘알려져있으며,(5) 최근 EVAR가널리행해짐에따라일부에서는수술적치료의중요성이저평가되는경향이있다. 2006년미국의통계에따르면전체복부대동맥류환자의약 30% 는수술적방법으로치료되고있으며,(6) 수술적치료는복부대동맥류의치료에서여전히중요한부분을차지하고있다고볼수있다. 저자등은 EVAR 시행이증가하는현시점에서복부대동맥류환자에서수술적치료의적응증과동맥류의원인및위치에따른최근 7년간의수술후조기성적을알아보고자하였다. 방법 2003년 9월부터 2010년 8월까지 7년동안한 3차의료기관에서복부대동맥류로진단된환자 556명중치료를받은 366명의 data base와의무기록을후향적으로조사하였다. 2005년 8월건강보험심사평가원 (Health Insurance Review & Fig. 1. Treatment algorithm for patients with abdominal aortic aneurysm (AAA). Fig. 2. Result of preoperative cardiac evaluation before elective treatment of abdominal aortic aneurysm (AAA) (N= 341). *Percutaneous coronary intervention; Coronary artery bypass grafting.
3 214 J Korean Surg Soc. Vol. 80, No. 3 Assessment Service, HIRA) 에서신동맥하부의, 직경 5 cm 이상의복부대동맥류환자에대한 EVAR 시술에대해보험급여를시행한이후, 본원에서는복부대동맥류환자에서가능하면 EVAR first policy 를채택하여환자를치료하였다. 본원의복부대동맥류치료방침은 Fig. 1과같았다. EVAR 시행의해부학적적합성기준은 Zenith R Aortic Stent Graft (Cook Company, Bloomington, IL, U.S.A) 의 physician reference manual (2003년) 을따랐다. 치료전심장질환에대한위험도평가를위해계획수술을시행한전례의환자에서심초음파검사와동위원소를이용한심근스캔을시행하였고, 2009년 9월이후에는심초음파검사와관상동맥 CT 조영술 (Coronary CT Angiography, Somatom Definition Flash, Siemens R, Germany) 을시행하였 Table 1. Procedural details of open repair of abdominal aortic aneurysm (AAA) (n=291) Procedures Non-ruptured (n=263) Ruptured (n=28) Status Elective 246 (94%) Emergent 17 (6%) 28 (100%) Approach Transperitoneal 237 (90%) 28 (100%) Retroperitoneal 26 (10%) Aortic clamping Infra-renal 240 (91%) 23 (82%) Supra-renal 18 (7%) 1 (4%) Supra-celiac 5 (2%) 1 (4%) None 3* (11%) Graft material Prosthetic graft 255 (97%) 25 (89%) Cryopreserved aortic allograft 7 (3%) Autogenous arterial patch 1 (0.4%) Bifurcated 200 (76%) 19 (68%) Tube graft 60 (23%) 5 (18%) Axillo-bifem. 1 (0.4%) 1 (4%) Patch 2 (1%) Adjuvant procedure Cholecystectomy 15 (6%) Hypogastric artery reconstruction 22 (8%) Renal artery reconstruction 10 (4%) 1 (4%) Omental wrapping 11 (4%) 1 (4%) Left renal vein division 6 (2%) Closure of enteric fistula 2 (1%) Removal of aortic stent graft 1 (0.4%) 3 (11%) *Intraoperative death before aortic clamping; Autogenous arterial patch of aneurysmal neck for saccular aortic aneurysms due to mycotic origin with hypogastric artery and one PTFE patch. 다. 수술전급성관상동맥증후군의경우와, 안정형협심증이라도관상동맥에 3혈관질환 (3-vessel disease) 이의심될경우, 심근스캔상가역적인큰관류결손 (large reversible perfusion defect) 이발견될경우관상동맥조영술을시행하였다. 수술전심장질환에대한위험평가를시행한결과는 Fig. 2와같았다. 비파열성복부대동맥류환자중위와같은소견으로인해대동맥수술전관상동맥조영술을요했던환자는 15명 (4.4%) 이었고, 이들중 5명에서는복부대동맥류치료전에관상동맥재건술 ( 경피적관상동맥성형술 4예, 관상동맥우회술 1예 ) 을시행하였으며, 1명에서는복부대동맥류수술과관상동맥우회술을동시에시행하였다. 복부대동맥류에대한수술적치료는모든환자들에서전신마취하에시행되었고, 정중절개를통한개복혹은좌측후복막을통한접근을이용해시행하였다. 대동맥재건수술에대한세부사항은 Table 1에기술하였다. 치료후사망은치료후 1개월이내사망한경우로정의하였다. 결과 556명의복부대동맥류환자중치료를받지않은 187명 (34%) 은직경 5 cm 미만의크기가작은복부대동맥류환자 168명, 치료의적응은되었으나환자측이치료를거부한환자 15명, 말기암동반환자 2명, 중증폐결핵환자 1명, 말기간경화환자 1명이있었다. 이들을제외한 369명 (66%) 의환자가복부대동맥류치료를시행받았으며, 이연구에서는동기간중흉복부대동맥류 (Thoraco-abdominal aneurysm) 로수술을시행받은 3명은복부대동맥류에서제외하였다 (Fig. 3). 치료를거부한환자 15명중심폐기능상복부대동맥류수술의고위험군으로판단된환자는 5예였으며그중 2예는본연구기간이후에수술적치료와 EVAR를각각시행받았고, 나머지 3명의환자들은아직치료를받지않은상태이다. 연구에포함된 366명환자의임상적특징은 Table 2, 동맥류병변의특징은 Table 3과같았다. 치료방법으로 291명 (80%) 에서는수술적치료 (Open repair) 가시행되었고, 75명 (20%) 에서는 EVAR가시행되었다. 1명의환자는 EVAR 시행중동맥류파열로수술적치료로전환되었다 (Fig. 4). 국내에서 EVAR의보험급여가이루어진 2005년 8월이후에는 221예 (75%) 의수술적치료와 75예 (25%) 의 EVAR가시행되었다. 221예의수술적치료환자에서 EVAR가시행되지
4 Young-Nam Roh, et al:indications and Short-term Results of Open Surgical Repair of Abdominal Aortic Aneurysm in an Endovascular Era 215 Fig. 3. Indications for AAA treatment (Sep Aug. 2010). *Thoracoabdominal aortic aneurysm. 못한이유들은 Table 4와같았다. EVAR는급여시행이후신동맥하부의비파열성복부대동맥류에대한치료의 29% (75/263) 로증가하였다. 1) 수술적치료의성적복부대동맥류의평균직경은 6.1±1.5 cm였고, 수술후재원기간의중간값은비파열성의경우 9.0±12.0일, 파열성동맥류의경우 17.0±22.4일이었다. 파열되지않은복부대동맥류의수술후심근경색, 급성신부전, 급성호흡부전증후군, 다발성장기부전, 그리고좌측대장허혈증은각각 5.3%, 3.8%, 4.6%, 1.9%, 1.5% 에서발생하였다. 수술적치료후수술사망률은비파열성복부대동맥류와파열성복부대동맥류에서각각 0.4% ( 신동맥하부대동맥류 0.4%, 신동맥근접혹은신동맥상부대동맥류 0%) 그리고파열성복부대동맥류수술후 21.4% 였다. 비파열성복부대동맥류의수술적치료후수술사망 1예는급성심근경색증에의해좌심실파열이발생한경우였다. 수술적치료의성적은 Table 5에요약되어있다. 고찰 복부대동맥류수술에많은발전이있었음에도불구하고, 비파열성복부대동맥류에서수술적치료의사망률은 % 로비교적높게보고되고있고, 파열성복부대동맥류의경우에는수술적치료후사망률이 40 60% 에이르는것으로보고되고있다.(1-3,7,8) 복부대동맥류환자의치료에대해국내학회에서빈번한구연발표가있었지만, 실제저자등이근자에발표된논문중수술성적에관한보고는예상외로적었는데, Kim 등 (9) 은계획수술후 6.5%, 응급수술후 26.7% 의수술사망률을보고하였고, Park 등 (10) 은비파열성복부대동맥류의경우 4.4%, 파열성복부대동맥류의경우 35.7% 로보고하였다. 국내에서 EVAR의보험급여인정은다른나라와비교하여비교적늦은시기인 2005년 8월에야이루어졌고그결과임상에서 EVAR의적극적인시술은서구나다른나라에비해상대적으로늦었다고볼수있다. Giles 등 (5) 은 1993년부터 2005년까지의미국에서 Nationwide Inpatient Sample (NIS) 의자료를대상으로한연구에서 EVAR의도입이후수술적치료의사망률은 4.5% 이고, EVAR 후수술사망률은 1.3% 로 EVAR후상대적으로낮은수술사망률을보고하였다. 또한그들은 EVAR의도입이전체복부대동맥류의치료에따른사망률을의미있게감소시켰다고결론지었다 (4.7% vs 3.1%, P<.0001).(5) EVAR와수술적치료를비교한전향적다기관무작위비교연구들은 EVAR의사망률이수술적치료보다의미있게낮다 (1 2% vs. 4 5%) 는사실을통해 EVAR의효과를입
5 216 J Korean Surg Soc. Vol. 80, No. 3 Table 2. Dermographic and clinical characteristics of 366 patients who underwent open surgical or endovascular repair of abdominal aortic aneurysm (AAA) Characteristics Non-ruptured (n=263) Open repair (N=291) Ruptured (n=28) EVAR (N=75) Total (N=366) Mean age, yr (range) 67.6±9.3 (31 86) 70.3±8.6 (45 81) 70.2±5.9 (59 84) 68.3±8.7 (31 86) Male (%) 218 (83%) 24 (86%) 71 (95%) 313 (86%) Clinical presentation of AAA Asymptomatic pulsating mass 190 (72%) 75 (100%) 265 (72%) Abdominal or back pain 65 (25%) 22 (79%) 87 (24%) Hemorrhagic shock 5 (18%) 5 (1%) Aortic occlusion 2 (0.7%) 2 (0.5%) Infected aneurysm 11 (4%) 1 (4%) 2 (3%) Aorto-enteric fistula 2 (0.7%) 2 (0.5%) Distal artery embolization 2 (0.7%) 2 (0.5%) Comorbidities Hypertension 173 (66%) 19 (68%) 54 (72%) 246 (67%) Coronary artery disease 87 (33%) 7 (25%) 23 (31%) 117 (32%) Prior CABG* 23 (9%) 1 (4%) 4 (5%) 28 (8%) Remote (>6 mo) 14 (5%) 3 (4%) 17 (5%) Recent (<6 mo) incidental 7 (3%) 1 (4%) 1 (1%) 9 (2%) Planned preliminary 2 (0.8%) 2 (0.5%) Prior PCI 32 (12%) 3 (11%) 9 (12%) 44 (12%) Remote (>6 mo) 23 (9%) 3 (11%) 8 (11%) 34 (9%) Recent (<6 mo) incidental 5 (2%) 1 (1%) 6 (2%) Planned preliminary 4 (1.5%) 4 (1%) Medical treatment 35 (13%) 3 (11%) 8 (11%) 46 (13%) Diabetes mellitus 51 (19%) 4 (14%) 14 (19%) 69 (19%) Chronic renal insufficiency 10 (4%) 4 (14%) 1 (1%) 15 (4%) S Cr 2 3 mg/dl 7 (3%) 3 (11%) 10 (3%) S Cr >3 mg/dl 2 (0.7%) 1 (4%) 3 (1%) Dialysis-dependent 1 (0.4%) 1 (1%) 2 (0.5%) COPD >Moderate 20 (8%) 7 (9%) 27 (7%) Symptomatic CVD 24 (9%) 1 (4%) 8 (11%) 33 (9%) Malignant tumor 29 (11%) 4 (14%) 13 (17%) 46 (13%) *Coronary artery bypass grafting; Percutaneous coronary intervention; Chronic obstructive pulmonary disease; Post-bronchodilator FEV 1/FVC<70% and FEV 1<80% predicted; Cerebrovascular disease; Stomach cancer, 17; Colon cancer, 7; Lung cancer, 4; Prostate cancer, 5; Renal cell cancer, 4; Bladder cancer, 3; Liver cancer, 2; Head & Neck cancer, 2; Breast cancer, 2. 증하고자하였다. The Dutch Randomized Endovascular Aneurysm Management (DREAM) trial은수술사망률 (<30 일 ) 보고에서 EVAR 1.2%, 수술적치료 4.6% 로보고하였고 (P=.10),(11) EVAR trial 1도수술사망률비교에서 EVAR 1.7%, 수술적치료 4.7% 로보고하였다 (P=.009).(12) 이들다기관전향적연구중 EVAR trial 1에서는 60세이하환자를, DREAM trial에서는염증성복부대동맥류, 결체조직질환등의환자들을제외하였으며, 두연구모두해부학적으로 EVAR가가능하다고판단되는환자만을대상으로한치료의결과였다. 지금까지의두치료방법의비교연구결과수술적치료와비교하여 EVAR는단기생존율, 중증합병증발생률측면에서더우수한성적을보였고, 고령환자에서지속적인생존율증가를보인다는관찰결과에근거하여 EVAR의역할은더커졌다고볼수있으며이와함께수술적치료의역할은축소된것은사실이다.(13) 그리고 EVAR의경우계속적인기기의발달과함께그치료성적이향상된것이사실이지만수술적치료방법은기술적으로이미완성된치료법으로오랫동안지속되어왔다. 본연구결과에따르면 2005년 8월이후저자등이경험
6 Young-Nam Roh, et al:indications and Short-term Results of Open Surgical Repair of Abdominal Aortic Aneurysm in an Endovascular Era 217 Table 3. Lesion characteristics of 366 patients who underwent open surgical or endovascular treatment of abdominal aortic aneurysm (AAA) Characteristics Intact (n=263) Open repair (n=291) Ruptured (n=28) EVAR (n=75) Total (N=366) Etiology Degenerative 233 (89%) 23 (82%) 75 (100%) 331 (90%) Inflammatory 10 (4%) 2 (7%) 12 (3%) Infected 10 (4%) 2 (7%) 12 (3%) Marfan s syndrome 9 (3%) 9 (2%) Takayasu s arteritis 1 (0.4%) 1 (0.3%) Behcet disease 1 (4%) 1 (0.3%) Anatomic location Infrarenal 241 (92%) 27 (96%) 75 (100%) 343 (94%) Juxtarenal 16 (6%) 1 (4%) 17 (5%) Suprarenal 6 (2%) 6 (2%) Fig. 4. A patient who required open conversion during EVAR. (A) Completion angiogram during EVAR shows extravasation of contrast agent after deployment of the aortic stent graft with suprarenal fixing device. (B) An operative finding of ruptured abdominal aortic aneurysm (AAA) showing aortic stent graft. (C) Excised aortic stent graft device (Zenith R ): suprarenal stents were removed during the operation. (D) Follow-up CT angiogram shows abdominal aortic and the left renal artery reconstructions. 한전체복부대동맥류치료환자 296명중해부학적원인 (164예, 55%), 환자나이 <60세 (17예, 6%), 파열성대동맥류 (17예, 6%), 세균감염성대동맥류 (5예, 2%), Marfan 증후군 (7예, 2%), 신기능저하환자 (3예, 1%) 등의원인으로 EVAR의적응증에서제외된환자의수는 221명으로전체의 75% 를차지하였음을경험하였다. 최근 EVAR 기기의점차적인개선에힘입어 EVAR 시술의해부학적적응증이확장되었고분지형 (Branched) 또는 Fenestrated stent graft, Iliac Branched Device (IBD) 등이개발되어있고, 최근에는 stent graft의직경도더다양하게개발되었지만, 국내에서는아직도이같은모든제품의사용이허가되어있지는않은실정에있다. 특히분지형또는 Fenestrated stent graft, Iliac Branched Device (IBD) 등새로운기기의장기성적에대해서는아직규명되어야할부분이남아있다고생각된다. 복부대동맥류에대한일차치료로서 EVAR가합리화된
7 218 J Korean Surg Soc. Vol. 80, No. 3 Table 4. Reasons for infeasibility of EVAR in AAA patients (N=221*) Reasons No (%) Anatomical reason Proximal neck Angulation>60 o 32 (11%) Length<15 mm 32 (11%) Diameter<18 mm or >28 mm 13 (4%) Distal aortic diameter<17 mm 7 (2%) Iliac artery Unavailable to preserve 1 hypogastric artery 34 (11%) due to iliac artery aneurysms Small diameter (<7.5 mm) or occlusion 18 (6%) Common iliac artery length<10 mm 10 (3%) Juxtarenal or suprarenal AAA 16 (5%) Thrombotic occlusion of AAA 2 (1%) Physiologic or clinical reason Age<60 years 17 (6%) Ruptured AAA 17 (6%) Infected aneurysm 5 (2%) Marfan s syndrome 7 (2%) Contrast allergy or scr>2.5 mg/dl 3 (1%) Symptomatic AAA due to impending rupture 5 (2%) Combined with type B thoracic aortic dissection 2 (1%) Patient refuse 1 (0.3%) *Patients number after inception of reimbursement for aortic stent graft. 것은무작위비교연구에서수술적치료의사망률이 EVAR 에비해의미있게높았다는사실에근거하고있다. 그러나이들다기관무작위전향적비교연구에서의복부대동맥류의수술적치료후수술사망률은단일기관연구들이보고한 % 에비해상대적으로높게보고되었으며,(1,14-16) 여러연구에서신동맥하부의비파열성복부대동맥류의수술적치료후 1% 내외의사망률을보고한사실에비추어볼때,(14,15) 다기관연구보고의수술적치료후사망률이높게나타난사실은우리가주목할만한점이다. 본연구에서도비특이성 ( 퇴행성 ) 원인에의한신동맥하부복부대동맥류환자의계획수술후수술사망률은 0.4% (1/241) 로낮았음을경험하였다. 복부대동맥류의수술사망률은술자의경험과병원의복부대동맥수술환자수와상관관계가있음이보고되어있다.(17-21) 이는수술적치료뿐만아니라 EVAR의경우도마찬가지였다.(21) 경험이많은센터에서는수술시불필요한박리와출혈량, 수술시간, 기술적인결함을줄일수있다고생각되며, 수술중마취과의사그리고수술후심장 Table 5. Postoperative morbidity and mortality after open abdominal aortic aneurysm (AAA) repairs (n=291) Complications Non-ruptured (n=263) Ruptured (n=28) Acute myocardiac infarction* 14 (5.3%) 4 (14.2%) Acute renal failure 10 (3.8%) 9 (32.1%) Acute respiratory distress 12 (4.6%) 13 (46.4%) syndrome Multi-organ failure 5 (1.9%) 10 (35.7%) Leg artery embolism 2 (0.8%) 1 (3.6%) Ureteral injury 2 (0.8%) Left colon ischemia 4 (1.5%) 3 (10.7%) Bleeding required reoperation 6 (2.3%) Thoracic spinal cord ischemia 1 (0.4%) 1 (3.6%) Operative mortality 1/263 (0.4%) 6/28 (21.4%) Infrarenal AAA 1/241 (0.4%) 6/27 (22.2%) Juxtarenal & suprarenal AAA 0/22 (0%) 0/1 (0%) Infected AAA 0/10 (%) 1/2 (50%) Inflammatory AAA 0/10 1/2 (50%) Marfan s syndrome 0/9 Aorto-enteric fistula 0/2 (0%) *According to WHO diagnostic criteria; Serum Cr level elevatio n>50% of preoperative level; Ventilator care for>3 days after surgery; Except mortality cases. 혹은신장내과와의긴밀한협조가수술사망률을줄일수있는요인이라생각된다. 본원에서는수술전모든복부대동맥류환자에서순환기내과전문의가수술에대한환자의심장합병증위험도평가를하고있으며, 고위험군환자 (n=15) 에서관상동맥조영술을대동맥류치료전먼저시행하였고이들중 6예에서는관상동맥병변에대한치료를시행하였다. 과거의보고들에서안정성관상동맥질환은복부대동맥수술전예방적관상동맥재관류술을시행하여도환자생존율향상이나심근경색의발생빈도를감소시키지않았음이이미보고되어있었다.(22-24) 그러나복부대동맥류계획수술을요하는환자에서불안정성관상동맥질환이나좌심실기능이현저히떨어진환자에서는복부대동맥류수술전관상동맥재건술이먼저고려될수있다.(23) 본연구에서수술전심장질환에대한검사를통해고위험군환자에서는복부대동맥류수술을연기하고관상동맥재건술을먼저시행한것도복부대동맥류수술후수술사망률을낮추는데기여하였을것으로추측된다.
8 Young-Nam Roh, et al:indications and Short-term Results of Open Surgical Repair of Abdominal Aortic Aneurysm in an Endovascular Era 219 결 EVAR First Policy 에도불구하고본원에서복부대동맥류에대한치료로서수술적치료가여전히많이시행되었다. 그리고비파열성복부대동맥류에대한수술적치료의사망률은 1% 이하로낮았음을경험하였다. EVAR가각광받고점점널리행해지고있는현시점에서 EVAR의기술, 기기발전, 교육이중요한것은당연하다. 복부대동맥류의수술적치료는 EVAR와는다른적응과역할을가지므로 EVAR의그늘에서저평가되어서는안된다고생각된다. 따라서복부대동맥류의수술적치료에대한교육이등한시되지않고 EVAR와함께지속적인발전을해야한다고생각된다. 론 감사의글 이논문의 data 정리를도와주신우영간호사께감사드립니다. REFERENCES 1) Lloyd WE, Paty PS, Darling RC, 3rd, Chang BB, Fitzgerald KM, Leather RP, et al. Results of 1000 consecutive elective abdominal aortic aneurysm repairs. Cardiovasc Surg 1996;4: ) Aune S. Risk factors and operative results of patients aged less than 66 years operated on for asymptomatic abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2001;22: ) Starr JE, Hertzer NR, Mascha EJ, O'Hara PJ, Krajewski LP, Sullivan TM, et al. Influence of gender on cardiac risk and survival in patients with infrarenal aortic aneurysms. J Vasc Surg 1996;23: ) Nowygrod R, Egorova N, Greco G, Anderson P, Gelijns A, Moskowitz A, et al. Trends, complications, and mortality in peripheral vascular surgery. J Vasc Surg 2006;43: ) Giles KA, Pomposelli F, Hamdan A, Wyers M, Jhaveri A, Schermerhorn ML. Decrease in total aneurysm-related deaths in the era of endovascular aneurysm repair. J Vasc Surg 2009;49:543-50; discussion ) Schwarze ML, Shen Y, Hemmerich J, Dale W. Age-related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysm in the United States, J Vasc Surg 2009;50:722-9 e2. 7) Lawrence PF, Gazak C, Bhirangi L, Jones B, Bhirangi K, Oderich G, et al. The epidemiology of surgically repaired aneurysms in the United States. J Vasc Surg 1999;30: ) Mureebe L, Egorova N, Giacovelli JK, Gelijns A, Kent KC, McKinsey JF. National trends in the repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2008;48: ) Kim YC, Yun IJ, Ha JW, Yang HK, Ahn H, Kim SJ. 10 year experiences of surgically treated abdominal aortic aneurysm patients. J Korean Surg Soc 1996;12: ) Park YJ, Lee JH, Ha J, Chung JW, Park JH, Kim SJ. 118 cases of abdominal aortic aneurysm (AAA) repair. J Korean Surg Soc 2003;65: ) Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004;351: ) Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004;364: ) Schermerhorn ML, O'Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 2008;358: ) Hertzer NR, Mascha EJ, Karafa MT, O'Hara PJ, Krajewski LP, Beven EG. Open infrarenal abdominal aortic aneurysm repair: the Cleveland Clinic experience from 1989 to J Vasc Surg 2002;35: ) Menard MT, Chew DK, Chan RK, Conte MS, Donaldson MC, Mannick JA, et al. Outcome in patients at high risk after open surgical repair of abdominal aortic aneurysm. J Vasc Surg 2003;37: ) Sicard GA, Reilly JM, Rubin BG, Thompson RW, Allen BT, Flye MW, et al. Transabdominal versus retroperitoneal incision for abdominal aortic surgery: report of a prospective randomized trial. J Vasc Surg 1995;21:174-81; discussion ) Hannan EL, Kilburn H Jr, O'Donnell JF, Bernard HR, Shields EP, Lindsey ML, et al. A longitudinal analysis of the relationship between in-hospital mortality in New York State and the volume of abdominal aortic aneurysm surgeries performed. Health Serv Res 1992;27: ) Dardik A, Lin JW, Gordon TA, Williams GM, Perler BA. Results of elective abdominal aortic aneurysm repair in the 1990s: A population-based analysis of 2335 cases. J Vasc Surg 1999;30: ) Katz DJ, Stanley JC, Zelenock GB. Operative mortality rates for intact and ruptured abdominal aortic aneurysms in Michigan: an eleven-year statewide experience. J Vasc Surg 1994;19:804-15; discussion ) Kazmers A, Jacobs L, Perkins A, Lindenauer SM, Bates E. Abdominal aortic aneurysm repair in Veterans Affairs medical centers. J Vasc Surg 1996;23:
9 220 J Korean Surg Soc. Vol. 80, No. 3 21) Dimick JB, Upchurch GR Jr. Endovascular technology, hospital volume, and mortality with abdominal aortic aneurysm surgery. J Vasc Surg 2008;47: ) Hosokawa Y, Takano H, Aoki A, Inami T, Ogano M, Kobayashi N, et al. Management of coronary artery disease in patients undergoing elective abdominal aortic aneurysm open repair. Clin Cardiol 2008;31: ) Tiefenbacher CP. Abdominal aortic aneurysm repair in cardiac high risk patients--medication, surgery or stent? Clin Res Cardiol 2008;97: ) Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter- Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol 2006;47:
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
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
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
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 :
김범수
Analysis of Outcomes after Resection of Sarcomatous Hepatocellular Carcinoma Purpose: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis
637
Peripheral Arterial Disease Yong Bok Koh, M.D. Department of General Surgery The Catholic University of Korea, College of Medicine, Kangnam St. Mary s Hospital E mail : ybkoh@catholic.ac.kr Abstract Peripheral
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
The 1 st Seoul Aorta Symposium, 2019 공동조직위원장 : 삼성서울병원최승혁, 서울아산병원주석중 주최 : 삼성서울병원심장뇌혈관병원혈관센터, 서울아산병원심장병원대동맥센터 후원 : 대한혈관외과학회 일시 : ( 토 ) 장소 : 그
The 1 st Seoul Aorta Symposium, 2019 공동조직위원장 : 삼성서울병원최승혁, 서울아산병원주석중 주최 : 삼성서울병원심장뇌혈관병원혈관센터, 서울아산병원심장병원대동맥센터 후원 : 대한혈관외과학회 일시 : 2019-05-11 ( 토 ) 장소 : 그랜드워커힐서울, B1 그랜드홀 07:50-07:55 Greetings and Introduction
( )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
(
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,
untitled
J Korean Surg Soc 2009;77:429-433 DOI: 10.4174/jkss.2009.77.6.429 증 례 파열된복부대동맥류의혈관내치료치험 인하대학교의학전문대학원외과학교실, 1 영상의학교실 김장용ㆍ박근명ㆍ전용선 1 ㆍ조순구 1 ㆍ홍기천 Successful Endovascular Aneurysm Repair for a Ruptured Abdominal
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
12.ÀÇÇа�ÁÂc10«±âõ-42~552
Endovascular Aneurysm Repair Kee Chun Hong, M.D. Jang Yong Kim, M.D. Yong Sun Jeon M.D. Department of Surgery Radiology* Inha University College of Medicine & Hospital E mail : keechong@inha.ac.kr Abstract
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
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
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
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
Original Articles Korean Circulation J 1999;29 9 : Bifurcated Stent-Graft Vanguard 를이용한 복부대동맥류의경관적치료 심원흠 1 최동훈 1 윤영섭 1 이도연 2 장병철 3 Bifurcated S
Original Articles Korean Circulation J 1999;299:907-912 Bifurcated Stent-GraftVanguard 를이용한 복부대동맥류의경관적치료 심원흠 1 최동훈 1 윤영섭 1 이도연 2 장병철 3 Bifurcated Stent-GraftVanguard for the Endovascular Treatment of Abdominal
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)
May 10~ Hotel Inter-Burgo Exco, Daegu Plenary lectures From metabolic syndrome to diabetes Meta-inflammation responsible for the progression fr
May 10~12 2012 Hotel Inter-Burgo Exco, Daegu Plenary lectures From metabolic syndrome to diabetes Meta-inflammation responsible for the progression from obesity to metabolic syndrome originates in the
untitled
J Korean Surg Soc 2011;80:125-130 DOI: 10.4174/jkss.2011.80.2.125 원 저 국내복부대동맥류환자치료의실태조사 성균관대학교의과대학삼성서울병원외과학교실, 1 심장혈관센터 박양진ㆍ김나리 1 ㆍ김영욱 Investigation of Current Trend of AAA Treatment in Korea Yang Jin
저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할
저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할수없습니다. 변경금지. 귀하는이저작물을개작, 변형또는가공할수없습니다. 귀하는, 이저작물의재이용이나배포의경우,
untitled
Korean J Vasc Endovasc Surg 2012;28(1):19-23 http://dx.doi.org/10.5758/kjves.2012.28.1.19 일자형이식편을이용한복부대동맥류수술후총장골동맥의변화양상 경북대학교의학전문대학원외과학교실 1, 대구가톨릭대학교병원혈관외과 2, 포항성모병원외과 3 우인택 1 ㆍ윤우성 2 ㆍ조자윤 1 ㆍ이경근 3 ㆍ김형기
untitled
Case Report : Asan Medical Center Cardiac Rehabilitation AACVPR (http://www.aacvpr.org/) KACVPR (http://www.kacvpr.com/) Backgrounds PCI 2,395 consecutive patients in Minnesota (Mayo Clinic) Between1994
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
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
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
<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
한국성인에서초기황반변성질환과 연관된위험요인연구
한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -
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
- 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
03-ÀÌÁ¦Çö
25 3 (2004 9 ) J Korean Oriental Med 2004;25(3):20-31 1), 2), 3) 1) 2) 3) Grope for a Summary Program about Intellectual Property Protection of Traditional Knowledge (TK)etc. Discussed in WIPO Hwan-Soo
A Study on Married Female Immigrants Life Style and Marriage Satisfaction in Terms of Preparing Their Old Age in Chungcheongnam-do Department of Gerontology, Hoseo University Doctoral Student : Hi Ran
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,
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
DBPIA-NURIMEDIA
27(2), 2007, 96-121 S ij k i POP j a i SEXR j i AGER j i BEDDAT j ij i j S ij S ij POP j SEXR j AGER j BEDDAT j k i a i i i L ij = S ij - S ij ---------- S ij S ij = k i POP j a i SEXR j i AGER j i BEDDAT
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.
(Microsoft PowerPoint - S13-3_\261\350\273\363\307\366 [\310\243\310\257 \270\360\265\345])
![(Microsoft PowerPoint - S13-3_\261\350\273\363\307\366 [\310\243\310\257 \270\360\265\345])](/thumbs/100/144769741.jpg "(Microsoft PowerPoint - S13-3_\261\350\273\363\307\366 [\310\243\310\257 \270\360\265\345])")
Cardiovascular Disease in Metabolic Syndrome 김상현 보라매병원내과 서울대학교의과대학내과학교실 Contents Metabolic syndrome and Cardiovascular system CVD Mortality Coronary artery disease Heart failure Atrial fibrillation Management
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
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
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
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
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
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
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,
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
부속
04 Definitions of terminology in neonatal, infant, and perinatal epidemiology.,. (perinatal period),,,, (morbidity) (mortality).,,,.,,,.,., 2. (World Health Organization, WHO) International Statistical
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
전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II)
전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II) 전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II) - i - - ii - - iii - - iv - - v - - vi - - vii - - viii - - ix - -
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
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
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
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
<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
untitled
Korean J Vasc Endovasc Surg 2013;29(4):142-146 http://dx.doi.org/10.5758/kjves.2013.29.4.142 복부대동맥류의스텐트결합인조혈관시술후발생한파열을동반한지연성 Ib 형속누출 1 예 서울대학교의과대학외과학교실 1, 영상의학교실 2 박대도 1 ㆍ민상일 1 ㆍ제환준 2 ㆍ정진욱 2 ㆍ김서민 2 ㆍ민승기
l l l l l l l l l Lee, Geon Kook None This project was designed to establish the Tumor Bank of National Cancer Center in 2000. From the first tumor sample in 2000, the total of tumor and tumor-related
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
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,
- 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 -
페링야간뇨소책자-내지-16
야간뇨의진단과치료 - 실제적접근 - Reference 1. Choo MS, Ku JH, Park CH et al. Prevalence of Nocturia in a Korean Population Aged 40 to 89 Years. Neurourol Urodyn 2008; 27:60-64. 2. Weiss JP. Prevalence
<4D F736F F F696E74202D20BFA1C4DA5FC0D3BBF3C3CAC0BDC6C42E BC8A3C8AF20B8F0B5E55D>
심장 (Heart) 심초음파 서울대병원내과 김용진 심장은평생몇번이나뛸까요? 1) 3 백만번 2) 3 천만번 3) 3 억번 4) 30 억번 30 억박동, 2 억리터의혈액 Cause 심장질환 6.2 12.4 11.1 16.2 뇌졸중 4.3 8.5 7.7 11.3 기타심혈관질환 2.6 5.1 6.0 8.8 심혈관질환 13.1 26.0 24.8 36.3 총사망 50.4
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)
( )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
untitled
Korean J Vasc Endovasc Surg 2012;28(4):202-206 http://dx.doi.org/10.5758/kjves.2012.28.4.202 우리나라 환자의 투석을 위한 혈관접근로 조성에서는 수술 전 일률적 초음파검사가 필요치 않다 계명대학교 동산병원 외과 현슬기ㆍ김형태ㆍ박의준ㆍ조원현 Careful Physical Examination
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
서론
- i - - ii - - iii - - iv - - v - - vi - - 1 - - 2 - - 3 - - 4 - - 5 - - 6 - - 7 - - 8 - - 9 - - 10 - - 11 - - 12 - - 13 - - 14 - - 15 - - 16 - - 17 - - 18 - - 19 - - 20 - - 21 - - 22 - - 23 - - 24 - -
A Study on the Relationships between Self-Differentiation and Adaptability Factors for Senior Dementia Patients Care Givers Department of Social Welfare, Seoul Welfare Graduate University Full-time Lecturer
(49-54)Kjhps004.hwp
Biliary Cystadenoma and Cystadenocarcinoma of the Liver Jae Hoon Lee, M.D., Dong Ho Choi, M.D. 1, Kyeong Geun Lee, M.D., Hwon Kyum Park M.D. and Kwang Soo Lee, M.D. Department of Surgery, College of Medicine,
( )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,
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
심장2.PDF
(Treatment of Hypertension with Associated Diseases) 1.. (140/90 mmhg). 80 mmhg. ( ). (atenolol ), (amlodipine ) 1. -1 nitrate. ACE diltiazem, verapamil. ACE. ( )., ACE diltiazem,, diltiazem, verapamil.
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
DBPIA-NURIMEDIA
The e-business Studies Volume 17, Number 6, December, 30, 2016:275~289 Received: 2016/12/02, Accepted: 2016/12/22 Revised: 2016/12/20, Published: 2016/12/30 [ABSTRACT] SNS is used in various fields. Although
untitled
대한혈관외과학회지 : 제 26 권제 1 호 Vol. 26, No. 1, May 2010 내장동맥분리재건술을이용한흉복부대동맥류재건술 3 예 포항성모병원외과 1, 경북대학교의학전문대학원외과학교실 2, 흉부외과학교실 3 최향희 1 ㆍ김형기 2 ㆍ김근직 3 ㆍ이종태 3 ㆍ허승 2 Separate Visceral Revascularization in Thoracoabdominal
Fluoroscopic anatomy for supraventricular tachycardia ablation Hui-Nam Pak, MD, PhD Division of Cardiology, Yonsei Cariovascular Center and Cardiovascular Research Institute, Yonsei University College
Àå¾Ö¿Í°í¿ë ³»Áö
Disability & Employment 55 Disability & Employment 56 57 Disability & Employment 58 59 Disability & Employment 60 61 Disability & Employment 62 63 Disability & Employment 64 65 Disability & Employment
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.,
untitled
대한마취과학회지 2008; 55: 190~6 Korean J Anesthesiol Vol. 55, No. 2, August, 2008 임상연구 대한민국의 마취통증의학 임상실습 현황 연세대학교 의과대학 마취통증의학교실 및 마취통증의학연구소 장동진ㆍ안소운ㆍ안지원ㆍ김종훈 The current status of anesthesiology clerkship in Korea
untitled
Korean J Vasc Endovasc Surg 2012;28(3):109-114 http://dx.doi.org/10.5758/kjves.2012.28.3.109 복부대동맥류치료의최신지견 : 혈관내치료를중심으로 경북대학교의학전문대학원외과학교실 허 승 Current Endovascular Treatment of Abdominal Aortic Aneurysm
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
2009;21(1): (1777) 49 (1800 ),.,,.,, ( ) ( ) 1782., ( ). ( ) 1,... 2,3,4,5.,,, ( ), ( ),. 6,,, ( ), ( ),....,.. (, ) (, )
Abstract Kim Dal-Rae, Kim Sun-Hyung* Dept. of Sasang Constitutional Medicine, College of Oriental Medicine, Kyung-Hee Univ. *Dept. of Sasang Constitutional Medicine, East-West Neo Medical Center, Kyung-Hee
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
16(1)-3(국문)(p.40-45).fm
w wz 16«1y Kor. J. Clin. Pharm., Vol. 16, No. 1. 2006 x w$btf3fqpsu'psn û w m w Department of Statistics, Chonnam National University Eunsik Park College of Natural Sciences, Chonnam National University
untitled
Korean J Vasc Endovasc Surg 2011;27(4):184-189 http://dx.doi.org/10.5758/kjves.2011.27.4.184 복부대동맥류의혈관내치료후발생한제 1 형 Endoleak 치료경험 인하대학교의학전문대학원외과학교실 1, 영상의학교실 2 이주형 1 ㆍ전용선 2 ㆍ조순구 2 ㆍ최선근 1 ㆍ신우영 1 ㆍ김장용 1 ㆍ홍기천
1. Korea Centers for Disease Control and Prevention. The fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1) 2010. Cheongwon: Korea Centers for Disease Control and Prevention; 2012.
388 The Korean Journal of Hepatology : Vol. 6. No COMMENT 1. (dysplastic nodule) (adenomatous hyperplasia, AH), (macroregenerative nodule, MR
6 3 2000 ; 387-392 (3) Dysplastic Nodule Young Nyun Park, M.D., Chanil Park, M.D. Department of Pathology, Yonsei University College of Medicine BRIEF HISTORY 56. AST/ALT 72/73 IU/L, total bilirubin 0.7
....(....).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,
¼Û±âÇõ
223 Table 1. Results of FEV 1.0, Methacholine Challenge Test, and Exercise Provocation Test in Eight Patients Who Performed PFT Pts Tests 1 2 3 4 5 6 7 8 FEV 1.0 (%pred) 66.6 88.8 120 101 90.5 95.4 91.6
슬라이드 1
Proposed Korean guideline for the diagnosis of BPH Hyun Woo Kim The Catholic University of Korea BPH Guideline AHCPR guideline on BPH (1994) AUA guideline on BPH (2003) EAU guideline on BPH (2004) International
¾ç½ÂºÎ
229 A B C D Fig. 1. Intramural type uterine myoma in a 32-year-old woman presented with hypermenorrhea and vaginal bleeding. A. Left uterine artery angiogram shows collateral vessel(arrow) to the the left
Journal of Educational Innovation Research 2017, Vol. 27, No. 1, pp DOI: * The
Journal of Educational Innovation Research 2017, Vol. 27, No. 1, pp.243-268 DOI: http://dx.doi.org/10.21024/pnuedi.27.1.201703.243 * - 2001 2015 - The Research Trends on Peer Counseling in Elementary and
(Microsoft PowerPoint - CXBTUEOAPVQY.ppt [\310\243\310\257 \270\360\265\345])
![(Microsoft PowerPoint - CXBTUEOAPVQY.ppt [\310\243\310\257 \270\360\265\345])](/thumbs/102/154983535.jpg "(Microsoft PowerPoint - CXBTUEOAPVQY.ppt [\310\243\310\257 \270\360\265\345])")
당뇨병환자에서항혈소판제사용 - 아스피린일차예방을중심으로 - 경희대학교강동경희대병원 황유철 말씀드릴내용 당뇨병및심혈관질환의역학 아스피린의심혈관질환 1차, 2차예방효과 아스피린부작용및용량에따른효과차이 당뇨병환자에서아스피린사용의적응증 사망원인순위, 2010 년 25.6% 통계청 심혈관질환에의한의료비추세 6 조 1400 억 국민건강보험공단, 2002-2009 Multidisciplinary
untitled
J Korean Surg Soc 2010;78:225-230 DOI: 10.4174/jkss.2010.78.4.225 원 저 복강경 충수절제술시 함께 시행된 만성 담낭 병변의 동시절제 이화여자대학교 의과대학 목동병원 외과학교실, 1 한솔병원 외과, 2 성균관대학교 의과대학 강북삼성병원 외과학교실, 3 한양대학교 의과대학 구리병원 외과학교실 이안복ㆍ이정은 1
Microsoft Word - 순8-4.doc
Original ORIGINAL Article ARTICLE Korean Circulation J 005;35:583-590 ISSN 1738-550 c 005, The Korean Society of Circulation 복부대동맥류에서인조혈관스텐트 (Stent-Graft) 를이용한경관적치료의단기및중기임상결과 연세대학교의과대학심장혈관병원심장내과학교실, 1
........-55..9.30
MYONGJI ST. MARY S HOSPITAL EXCELLENT STROKE TREATMENT CENTER The president of Myongji St. Mary s Hospital M.D. HUH, CHOON WOONG Graduated from Seoul Catholic Medical College. Achived M.D. in Neurosurgeon.
DBPIA-NURIMEDIA
The e-business Studies Volume 17, Number 6, December, 30, 2016:237~251 Received: 2016/11/20, Accepted: 2016/12/24 Revised: 2016/12/21, Published: 2016/12/30 [ABSTRACT] Recently, there is an increasing
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
노인정신의학회보14-1호
제14권 1호 통권 제23호 www.kagp.or.kr 발행인 : 정인과 / 편집인 : 이동우 / 발행처 : 정인과 (152-703) 서울특별시 구로구 구로동 80번지 고려대학교 구로병원 정신과 / TEL : 02-818-6608 / FAX : 02-852-1937 발행일 : 2008년 4월 30일 / 제 작 : (주)엠엘커뮤니케이션 140-846 서울특별시
03이경미(237~248)ok
The recent (2001-2010) changes on temperature and precipitation related to normals (1971-2000) in Korea* Kyoungmi Lee** Hee-Jeong Baek*** ChunHo Cho**** Won-Tae Kwon*****. 61 (1971~2000) 10 (2001~2010).
ÀÇÇа�ÁÂc00Ì»óÀÏ˘
Common Allergic Diseases in Children Sang - Il Lee, M.D. Department of pediatrics Sungkyunkwan University School of Medicine, Samsung Medical Center E - mail : silee@smc.samsung.co.kr Abstract Allergy