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S 469
－― S-237 ―
폐절제술로 완치한 림프절 전이가 의심된 비정형카르시노이드 종양 1례
삼성서울병원
*박소영, 박혜경, 전희정, 박맹열, 남해성, 함초롬, 심윤수, 전경만, 엄상원, 김호중
폐의 카르시노이드는 기관지 상피의 Kulchistky 세포에서 유래하는 종양으로 모든 폐 종양의 약 0.5-1%를 차지하는 드문 질환이다. WHO 에서는 폐의 카르시노이드를 정형 카르시노이드 종양과 비정형 카르시노이드 종양으로 분류하였고 정형 카르시노이드 종양과 비정형 카르 시노이드 종양은 조직학적 분화도, 임상적 경과, 예후 측면에서 서로 다른 특징을 보인다. 정형 카르시노이드 종양이 외과적 절제술 후 90%
이상의 5년 생존율을 보이는 반면 비정형 카르시노이드 종양의 경우에는 림프절 전이나 원격 전이를 동반하므로 5년 생존율이 40-60%로 정형 카르시노이드 종양에 비해 낮은 생존율을 보이며 이 경우, 외과적 수술 절제는 하지 않는 것으로 되어 있다. 그러나 저자들은 PET CT에서 중격동 림프절에 FDG섭취가 증가되어 있는 비정형 카르시노이드 종양 환자에서 중격동 내시경을 통한 조직검사와 우하엽 절제술 을 통해 완치한 증례를 보고함으로써 영상학적으로 림프절 전이가 의심되는 비정형 카르시노이드 종양 환자의 경우에서도 수술적 치료 가능 성 여부에 대한 적극적 평가가 이루어져야 함을 강조하는 바이다.
― ♣S-238 ―
Should the patients with small airway disease by spirometry have the preoperative consultations by pulmonologist?
1Inje University Busan Paik Hospital, 2Inje University Sanggye Paik Hospital, 3Inje University Seoul Paik Hospital,4Inje University Ilsan Paik Hospital, 5Inje University Dongrae Paik Hospital
*Koo Ho-Seok1, Lee Seung Heon1, Lee Young Min1, Lee Hyuk Pyo2, Yum Ho-Kee3, Choi Soo Jeon2, Park I-Nae3, Jung Hoon4, Choi Sang Bong2, Hur Jin Won4, Kim Hyun Kook, 5, Lee Hyun-Kyung1
Introduction: There are many studies for the prediction of the postoperative (post OP) pulmonary complications. But in those studies, they considered only COPD as one of risk factors. But there is no study about post OP risk of pulmonary complications in patients with small airway disease by spirometry. Therefore we studied about the risk of post OP pulmonary complications in patients with small airway disease group. And we also tried to classify the characteristics of these patients. Methods: From March to July 2008, we enrolled the patients who were referred to pulmonology department for the post OP risk evaluation. Among them we selected the patients with small airway disease. Post OP pneumonia index was used to stratify our patients. Results: We had 66 patients. The mean age of the patients is 69.The mean body weight is 58.21 Kilogram and the height is 159.47 centimeter, and BMI is 22.68.The number of Lower abdomen surgery is 23, upper abdomen surgery is 6, OBGY surgery is 4, ENT surgery is 11, Orothopedic surgery is 6, etc is 3.All operations were elective. All except 6 with spinal anesthesia, had undergone general anesthesia. 19 patients were current smokers. On physical examination, only 3 patients had wheezing. We stratified the patients with post OP pneumonia risk index. 39 patients are at risk class 3, 18 patients at risk class 2, and 5 patients at risk class 1, and 3 patients at risk class 4.Mean FVC is 2.88(96.8%), FEV1 is 1.89(92.5%), FVC/FEV1 is 66.26.After operation, there was no significant pulmonary complication. We searched what types of pulmonary diseases they have. 32(48%) patients were diagnosed as COPD, and 10(16%) asthma, 2(3%) bronchiectasis. Conclusion: This is the first study about risk of post OP pulmonary complications in small airway disease group. Because no pulmonary complication had occurred in our patient, routine pre OP pulmonary consultation may not be necessary. But large portion of patients were diagnosed pulmonary diseases such as COPD and asthma, careful history taking and physical examination in these patients are very important. If we have more large number of patients, we will come to know more about this group and more prepared for this kind of patients.
