이 책은 황성환 병원장이 30년간 환자들을 진료하고 치료하며 쌓아온 경험들을 토대로 변실금의 병태 생리와 치료에 대해 일목요연하게 정리하였습니다. 

고령화 사회에 접어들며 노인들에게는 물론 우리나라에도 꼭 필요했던 변실금에 대한 내용을 담았기에, 외과의들에게는 물론 변실금에 대한 정보가 필요했던 모든 분들에게 도움이 되어 삶의 질이 향상되리라 기대합니다. 

출판사 서평

우리나라에서는 유독 항문과 관련된 질병을 드러내기 꺼려하는 분위기가 짙게 깔려있고, 연령대가 높아질수록 질병을 더더욱 드러내기를 망설이는 분들이 많습니다. 그래서인지 요실금에 대해서는 비교적 많은 사람들이 인식하고 있지만, 변실금에 대해서는 잘 알지 못하고 적절한 치료법 또한 없었습니다.  

부산제2항운병원 황성환 병원장은 이런 실정을 파악하고 30년간 환자들을 가까이서 진료하고 치료하면서 쌓인 경험을 토대로 변실금에 대한 전반적인 내용을 알차게 담아냈습니다. 

이 책을 시발점으로 서구 의료현장만큼 우리나라에서도 활발한 연구와 다양한 치료법이 나오기를 기대하며, 많은 의료 현장에서 변실금에 대한 관심도 높아지기를 바랍니다. 

저자소개

황성환 병원장 

Head, Director of coloproctology 

Busan Hangun Hospital/ Hangun Hospital Bumcheon Campus 

● Graduate of Inje Medical School, 1986  

● Graduate of Inje Medical School, Postgraduate school Ph. D. 1998 

● Graduate school of Business, Busan National University MBA 2009  

● Residency training: Busan Paik Hospital, 1988~1991

● Professor, Busan Paik Hospital Inje University 1992~1993 

● Chief of Department of General Surgery ChoonHae Hospital  

● Started Coloproctology Clinic since 1994 in General Hospital  

● Established Hangun Hospital, 2000 

● Border of Trustees.  KSS 2018~ 

● Vice president. KSS (Korean Surgical Society) 2017~2018 

● Vice president. KSCP (Korean Society of Coloproctology) 2016~2017 

● Secretary general, Busan Hospital Society  2016~2020 

● Clinical Professor, Inje Univ Hospital,   

● Clinical Professor, Pusan National University Hospital, 

● Clinical Professor, Kosin Univ Hospital  

● Organizer of SERAF (South-East Recto-Anal Forum) 

● Chief, Medical Advisory Committee, Pusan East District Attorney 

● Secretary general, Advisory Committee, Busan Police Headquarters 

● Member, Viewers’ Steering Committee, Korean Broadcasting System (KBS) 

● Columnist, Kukje Sinmun, Pusan 

● Surgical carrier 

● More than 2000 cases of surgery every year for over 20 years  

● Expert in Benign Anorectal Surgery (90% of personal surgical career)  

● Expert in Laparoscopic Surgery  

●  (Laparoscopic colorectal cancer, TLG for gastric cancer, Hepatic Level I-II resection etc.) 

● Expert in Hepatobiliary Surgery.  

● Expert in General Surgery 

● Specialty in Endoscopy (Gastroscopy/ colonoscopy)  

Original paper 

1. Sung H. Hwang, Jinyong. Lee, Sanghyo Kim.  A Clinical Analysis of Breast Cancer. The Journal of Korean Surgical Society 1992; Vol 42 No.6: 776-86.  

2. Sung H. Hwang, Youngkil Choi, Sanghyo Kim, Nak Whan Paik. 120 Liver resections: A Four Year Experience.  The Journal of the Korean Surgical Society 1993; Vol 45, No.1: 38-46. 

3. Sung H. Hwang, Youngkil Choi, Sanghyo Kim. A Prelinimary Report of 111 Cases of Laparoscopic Cholecystectomy.  The Journal of the Korean Surgical Society 1993; Vol 45, No.5: 672-78. 

4. Keeok Park, Jung K. Shin, Sung H. Hwang, Joonhyun Kim. Laparoscopic Surgery in Sustected Appendicitis. The Journal of the Korean Surgical Society 1995; Vol 48, No4: 542-47. 

5. Sung H. Hwang. The Study of Hemodynamic Status after Reperfusion during Canine Orthotopic Liver Transplantation.  Graduation thesis. Master degree. Department of Medicine, Graduate School Inje University 1995 

6. Sung H. Hwang. The clinicopathologic and prognostic significance of mutation in the p53, DCC and nm23 genes in human gastric adenocarcinomas. Graduation thesis. Doctoral degree. Department of Medicine, Graduate School Inje University 1998 

7. Sung H. Hwang.  Hemorrhoidectomy using ultrasound shears. The Journal of the Busan Medical Association. 2000. Vol 36, No 3: 23-8. 

8. Sung H. Hwang. Perspectives on regional hospitals. Is it necessary for promotion?  Graduation thesis. AMP. School of Business Pusan National University 2003 

9. Sung H. Hwang.  MiJi Bang. Surgery for a Complex Anal Fistula. Journal of the Korean Society of Coloproctology 2008; 24: 77-82 

10. Sung H. Hwang.  Analysis of single or multiple factored CAPM(Capital Asset Pricing Model) 단일요인과 다요인 가격결정모형의 실증성과 분석. Graduation thesis.  MBA. School of Business Pusan National University 2009 

11. Hyeonseok Jeong, Sung H. Hwang, Kil O Ryu, Ji Y. Lim, Hyun T. Kim, Hye M. Yu, Ji H. Yoon, Ju Y. Lee, Hyong R. Kim, Young G. Choi. Early Experience with a Partial Stapled Hemorrhoidopexy for Treating Patients with Grades III-IV Prolapsing Hemorrhoids. Journal of the Korean Society of Coloproctology 2017; 33: 28-34 

12. Hyeonseok Jeong, Sung Hwan Hwang, Hyoung Rae Kim, Kil O Ryu, Jiyong Lim, Hye Mi Yu, Jihoon Yoon, Chee Young Kim, Kwang-Yong Jeong, Young Jae Jung, In Seob Jeong, and Young Gil Choi.  Effectiveness of Autologous Fat Graft in Treating Fecal Incontinence. Ann Coloproctol. 2019 Jun; 35(3): 144–151. 

Presentation 

● Sung H. Hwang.  Chan K. Hwang.  Management of complex anal fistula.  Annual meeting of the Korean Society of Coloproctology  Busan. April. 2003. 

● Sung H. Hwang. Jeongho. Kim. Hemorrhoidectomy Using Vessel Sealing Device(Plamakinetics) Annual meeting of the Korean Society of Coloproctology.  KyoungJu Apri. 2004. 

● Sung H. Hwang.  Surgery of the Complex Anal Fistula. Annual meeting of the Korean Society of Coloproctology.  Busan. April. 2005. 

● Sung H. Hwang. Types and Features of the Complex Anal Fistula Annual meeting of the Korean Society of Coloproctology.  Seoul. Nov. 2007   

● PPH – Significance in terms of treatment of benign anotectal disease. Annual meeting of the Korean Society of Coloproctology Apr. 2010  

● Sung H. Hwang.  Treatment experience of endoscopic colon perforation during colonoscopy.  AnnualmeetingoftheKoreanSocietyofColoproctology.  Muju. Apr. 2014   

● Sung H. Hwang. Trans-vaginal Total Pelvic Repair in the treatment of Idiopathic Female Fecal Incontinence.  Annual meeting of the Korean Society of Coloproctology.  Muju. Apr. 2014   

● Sung H. Hwang. What’s the conceptual difference (Conventional SH and Partial SH) Research Society of anorectal disease in Korean Society of Coloproctology.  Seoul. May. 2017   

● Sung H. Hwang. Is there a way to rebuild the Functional Anal Canal for patients of Fecal Incontinence?  Asia Pacific Federation of Colo-Proctology.  Seoul. Apr. 2017   

● Sung H. Hwang. Autologous Fat Graft in the treatment of Fecal Incontinence. (Early preliminary reports) Asia Pacific Federation of Colo-Proctology. Joint meeting of Asia Pacific Federation of Colo-Proctology.  & Annual meeting of the Korean Society of Coloproctology. Seoul. Apr. 2017   

● Sung H. Hwang. Partial stapled hemorrhoidopexy.  Asia Pacific Federation of Colo-Proctology. Joint meeting of Asia Pacific Federation of Colo-Proctology.  & Annual meeting of the Korean Society of Coloproctology. Seoul. Apr. 2017   

● Sung H. Hwang. Puborectal sling operation for fecal incontinence in male patient. Annual meeting of the Korean Society of Coloproctology. Seoul. Apr. 2018   

● SNS for Fecal Incontinence: Short-term follow up of my clinic. Annual meeting of the KSCP. Cheju Apr. 2019 

● Cell–Assisted Lipotransfer in the treatment of complex perianal sepsis including fistula. . Annual meeting of the KSCP. Cheju Apr. 2019 

Lecture

● PPH - Cons: Hemorrhoidectomy Using Circular Stapler - What is the problem.  Annual meeting of the Korean Society of Coloproctology.  Jeju.  April. 2002. 

● Anal stricture after treatment for Hemorrhoids. Official Training lecture.  Korean Society of Coloproctology.  Wonju. June. 2005.  

● Surgery of the Complex Anal Fistula.  The Busan Surgical Society May. 2006. 

● Treatment of Deep Anal Fistula. Official Training lecture.  Annual meeting of Korean Surgical Society.  Seoul. Nov. 2009  

● Conventional Hemorrhoidectomy. Official Training Lecture. Annual meeting of the Korean Society of Coloproctology June. 2016. 

● TST and SH – What is the conceptual difference? METC Brisbane, Australia Oct. 2016.  

● Is there a way to rebuild the Functional Anal Canal for patients of Fecal Incontinence? International meeting of CSCAIM Guangzhou China Nov. 2016.  

● Hemorrhoids Surgery “My Method” International Summit Forum. CSCAIM. Guangzhou China Nov. 2016 

● Alternative or complementary for the treatment of fecal incontinence? Autologous fat graft, PR sling, and SNM. Guangzhou Digestive Disease Week.  Guanzhou. Nov. 2017 

● Autologous Fat Graft in the treatment of Fecal Incontinence. The 1st Northwest Anorectal Academic conference and Seminar of new technique of integrated Chinese Western Thierapy. Xi`an Nov. 2017 

● Sung H. Hwang. “Why I became a surgeon.” Contirbution to regional society as a successful surgeon leading private hospital.  Annual meeting of Korean Surgical Society.  Busan. May. 2017  

● "Total Pelvic Repair " in the treatment of Senile Fecal Incontinence.  21 annual meeting of CSCAIM Taiyuan China Apr. 2018 

● “Perspectives in community surgical hospitals” Annual meeting of Korean Surgical Society. KyoungJu . May. 2018 

● Rectocele – Anal approach.  OfficialTrainingLecture.Annual meeting of the Korean Society of Coloproctology June. 2018. 

● Total Pelvic Repair – As a treatment option for fecal incontinence. Meeting of Busan Society of Coloproctology. July. 2018 

● Treatment Algorithm of Fecal Incontinence in my clinic. GDDW. Guangzhou. China. Nov. 2018 

● My methods and technical tips for TST (In Hemorrhoids Surgery) Annual symposium of specialty committee of anal and intestinal disease of WFCMS Shanghai. China. Dec. 2018.  

● How to drain abscess. SIPS (Songdo International Proctology Symposium) Seoul. Korea. Apr. 2019.  

● CAL (Cell Assisted Lipotransfer in the treatment of fecal incontinence. SERAF. Busan. Korea. May 2019 

● Optimization of the proctological and pelvic floor pathway organization. COPEC PISA. Italy June 2019 

● Surgical Option for Fecal Incontinence. International Colorectal Summit.  Seoul. Korea. Aug. 2019 

● Treatment Guidelines and the Surveillance of Colorectal Cancer in Korea. International Summit Forum for the diagnosis and treatment of early colorectal cancer CSCAIM. Guangzhou. China. Nov 2019 

● Surgical Perspectives in treating Fecal Incontinence. GDDW. Guangzhou. China. Nov 2019 

● Surgical Perspectives in treating Fecal Incontinence. APCC. Seoul. Korea. Sep. 2020 

● Laparoscopic Natural Tissue Repair for Rectal Prolapse. ISUCRS. Yokohama. Japan. Nov 2020 

 목   차  

PART 01
Chapter 01 개론
1. 개론
2. 변실금의 병태 생리
3. 변실금의 진단
4. 변실금의 치료

Chapter 02 변실금이란?

Chapter 03 변실금의 증상과 분류
1. 급박변
2. 변 누출
3. 변실금

Chapter 04 해부와 생리
1. 골반회음학
2. 항문
3. 항문거근과 주위 근육
4. 직장
5. 골반과 골반저
6. 항문 삼각과 비뇨생식 삼각
7. 내 음부동맥
8. 항문직장의 신경

Chapter 05 변실금의 원인(생리변화, 현상, 악화 요인)
1. 근육 손상
2. 음부신경 손상
3. 만성 변비
4. 변의 성상
5. 직장의 저장 능력
6. 치질과 항문 탈출
7. 항문 수술
8. 기타
9. 배변 자제

Chapter 06 변실금의 병태 생리
1. 변실금이 생기는 이유
2. 변실금의 위험요소


PART 02
Chapter 07 변실금의 진단
1. 항문직장 내압검사
2. 경항문 초음파
3. 배변조영술
4. 자기공명영상
5. 음부신경 말단 잠복검사
6. 대장내시경

Chapter 08 변실금의 보존적 치료
1. 지지요법
2. 약물요법
3. 바이오피드백과 괄약근 및 골반근육 강화 운동
4. 자기장 치료기
5. 가정 치료기

Chapter 09 변실금의 외과적 치료
1. 괄약근 복원수술
2. 괄약근 성혈술
3. 항문 후방복원술
4. 근육 치환술
5. 역동적 근육 치환술
6. 인공 항문 괄약근
7. 자기 항문 괄약근
8. 천수신경 조절술
9. 치골직장 슬링수술
10. 생체적합물질 주입
11. 삽입기구
12. 고주파에너지 치료
13. 줄기세포 치료 및 기타 조직 재생기법
14. 장루
15. 하행 자제 관장


PART 03
Chapter 10 노인성 변실금
1. 노인성 변실금의 진단
2. 노인성 변실금의 치료

Chapter 11 신경학적 변실금(Neurologic Fecal Incontinence)
1. 진단
2. 치료-보존요법
3. 치료-외과적 치료

Chapter 12 이중(복합)실금(Double Incontinence)

Chapter 13 직장 탈출증(Rectal Prolapse)

Chapter 14 항문직장 수술과 변실금
1. IPAA에서 변실금의 발생에 대한 요인
2. 직장 절제증후군
3. 치핵 수술 후 변실금
4. 치루 환자와 변실금
5. 치열 수술과 변실금
6. 포니에르 괴저