• Journal of Chest Surgery
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• 제24권11호
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• pp.1115-1124
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• 1991

Recently the thoracic injuries have been markedly increasing due to the vast increase of traffic accident, industrial disaster, and incidental accident as well as the frequent use of the murderous weapons including gun or rifle. Because the thoracic injuries could involve the heart, lung, and great vessels, and would influence the lives, prompt diagnosis and adequate treatment are essential. Most of thoracic injuries can be managed with the conservative treatment and simple surgical procedure such as closed thoracostomy, but certain cases require open thoracotomy to preserve lives and to return to their normal environment. The authors have analysed the result of 53 cases of open thoracotomy after thoracic injuries mainly according to the patient`s chart review. The mean age was 33.4 years old and male to female ratio was about 5: l. Injury mechanisms that elicited thoracic trauma indicated for open thoracotomy were penetrating[47%] and non-penetrating[53%] injuries. The Most common type of the thoracic lesion was hemothorax with or without pneumothorax and diaphragm rupture was the second. 58\ulcornero of thoracic injuries were accompanied by abdominal injuries and 47% by bone fractures. 34 patients were operated within 24 hours after injury and their average elapsed time was 13.6 hour. The remained patients were operated after 24 hours and their average elapsed time was 7.8 days. 71 cases of operative procedures containing some overlappings were performed: diaphragm repair[28], bleeding control[12], pulmonary and cardiac repair[4 cases] Postoperative complication rate was 32.1% and operative mortality rate was 9.4%[5/53].

• Journal of Chest Surgery
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• 제24권11호
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• pp.1068-1073
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• 1991

Bleeding after open heart surgery with cardiopulmonary bypass was a cause of concern. requiring reexploration of the chest in approximately 8 percent of patients who have had operations on the heart. From April., 1983 to October, 1991, 16 patients[2%] out of 777 patients who underwent open cardiac surgery had emergency reexploration with bleeding at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. In 12 cases[75%], reexploration was performed for continuous bleeding and the reminder[4 cases] were performed for suspected tamponade & hypotension. There were 9 cases[56%] of congenital heart disease and 7 cases of acquired heart disease. The mean blood loss were 997$\pm$472ml /sq. M in total cases and 1442$\pm$ 647ml /sq. M in cases repair of cyanotic heart disease. The mean interval till reoperation was 16.6hr [1hr~72hr] and 41 hr[12~72hr] in tamponade cases and 8.4hr[1hr~24hr] in continuous bleeding cases. The bleeding sites were identified in 7 cases: aortotomy site in 2 cases, ventriculotomy site, SVC, thymus, pleura and sternum wiring site in each other case. But no specific sites was found in the remaining 9 cases. The 8 cases had complications but all except 1 cases with hypoxic brain damage were recovered without sequale. We conclude that emergency thoractomy after open heart surgery may be lifesaving and-/or diminishing complications with bleeding if performed promptly with excessive bleeding, tamponade and unexpected hypotension.

• Journal of Chest Surgery
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• 제38권8호
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• pp.589-593
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• 2005

식도에 발생하는 신경초종은 매우 드문 질환으로 알려져 있으며, 술 전 대부분 식도 점막하종양으로 진단된다 확진은 술 후 시행되는 면역조직화학 검사에 의해 내려진다. 본원에서는 3개월 동안의 연하곤란을 주소로 내원한 63세 여자 환자와, 2개월간의 간헐적인 연하곤란을 주소로 내원한 39세의 여성에서 발생한 식도 점막하 종양을 우측개흉술을 통한 식도 절제술 및 종양 적출술을 각각 시행하여 제거하였다. 술 후 면역조직화학 검사 결과 2예 모두 S-100양성으로 나타나 식도의 양성 신경초종으로 확진되었다.

• Journal of Chest Surgery
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• 제36권3호
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• pp.215-218
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• 2003

65세 남자 환자가 우측 흉늑쇄골부위의 동통성 부종을 주소로 내원하였다. 환자는 과거력과 외상을 비롯한 특이 소견은 없었다. 입원 후 시행한 컴퓨터 단층촬영에서 우측경부의 농양과 우측 농흉소견이 나타났다. 개흉술로 우측 농흉제거술을 실시하였으며 우측 벽측 흉막과 우측 흉늑쇄골부위에 루가 발견되었다. 이어 경부절개를 통해 경부농양을 제거하였고 우측 흉늑쇄골부위에 골수염의 소견이 있어 우측쇄골일부, 제1번 늑연골, 흉골병 일부를 같이 제거하였다. 우측 흉늑쇄골부위의 골수염이 농흉으로 확대된 예는 드문 경우로서 저자들은 이를 치험 하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제38권10호
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• pp.714-716
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• 2005

우측심장이 매우 확장되어 있는 경우 정중흉골 재절개는 대량출혈의 위험성을 내포하고 있음을 고려해야 한다. 일차 수술에서 정중흉골절개를 통하여 수술했던 환자에서 우측개흉은 삼첨판막에 쉽고 안전하게 접근할 수 있는 방법이다.

• Journal of Chest Surgery
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• 제31권10호
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• pp.1014-1016
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• 1998

이중관 튜브(double-lumen tube)로 기관 삽관한 후 발생하는 기관지 파열은 극히 드문 합병증이다. 우리 는 기관 삽관후에 발생한 좌측 기관지 파열을 치험하였다. 58세 여자 환자로 수술전 검사상 우하엽에 병 기 IIB의 분화가 잘된 악성 선암으로 진단되었다. 환자는 우하엽절제술을 위하여 로버트쇼 튜브 (Robertshaw tube)로 기관 삽관하였고 수술중 종격동 기종과 환기 장애로 인하여 좌측 주기관지의 파열을 발견하였다. 즉시 좌측 개흉술을 시행하여 기관지 파열부위를 흡수성 봉합사(PDS)로 봉합하였으며 수술 후 별다른 문제없이 회복되었다.

• Journal of Chest Surgery
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• 제27권11호
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• pp.942-947
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• 1994

Post-thoracotomy pain is so severe that lead to postoperative pulmonary complications due to the patient`s inability to cough, deep breathing and chest wall motion. Many authors have been trying to reduce the post-thoracotomy pain, but there is no method of complete satisfaction. In 1990, we reported the result that the cryoanalgesia reduce the immediate postoperative pain significantly. We try to compare the effect of cyroanalgesia with the effect of Bupivacain intercostal nerve block for the post-thoracotomy pain control. Ninety patients, who undergoing thoracotomy in Korea University Medical Center Guro Hospital between the January 1993 and September 1993, were evaluated. The patients were divided into three groups : Group A, control, the patients without pain control procedure [N=30], Group B, the patients with Bupivacain intercostal nerve block [N=30], Group C, the patients with cryoanalgesia [N=30]. Postoperative analgesic effects were evaluated by the scoring system which made arbiturary by author. The results were that the Bupivacain intercostal nerve block markedly reduced the immediate postoperative pain compare with two other groups, the cryoanalgesia reduced the immediate postoperative pain significantly compare with control group, the pain reduction effect of the two groups- cryoanalgesia and Bupivacain intercostal nerve block- were not different at postoperative seventh day, probably due to the action time of Bupivacain and the result that there were no significant complications of the procedures.

• Archives of Plastic Surgery
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• 제32권4호
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• pp.421-427
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• 2005

Although the incidence of mediastinal wound infection in patient undergoing median sternotomy for cardiovascular surgery is relatively low(less than 1%), it is not only a devastating and potentially life-threatening complication but also associated morbidity, mortality and cost are unacceptably high. During the past few decades various methods had been applied for the treatment of postoperative mediastinitis. Currently, chest wall reconstruction by using muscle flaps-especially pectoralis major muscle and rectus abdominis muscle are commonly selected for the reconstruction after wide debridement has become widely accepted. We performed bilateral pectoralis major-rectus abdominis muscles in-continuity bipedicle flap to overcome the limit of each flap for reconstruction of sternal defects in 17 patients. We analyzed the results of the surgery. Recurrent infection developed in 17.6% of cases and abdominal herniation was observed in one patient. There was no postoperative hematoma or death. We conclude that this flap is very valuable in reconstruction of the anterior chest wall defect caused by post-sternotomy infection because it provides sufficient volume to fill the entire mediastinum, and the complication rate compares favorably to that of other methods.

• Journal of Chest Surgery
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• 제38권1호
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• pp.80-83
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• 2005

43세 남자 환자가 호흡곤란과 호흡시 나타나는 천명음을 주소로 내원하였다. 환자는 과거력상 1년전에 식도파열로 인하여 식도격리술과 식도위문합수술을 시행받았다. 흉부 컴퓨터 단층촬영상 기관을 압박하는 식도점액류가 마치 종격동 종양처럼 나타났다. 수술은 우측 개흉술을 통하여 식도를 절제하였다. 저자들은 이를 치험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제28권5호
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• pp.471-474
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• 1995

A total of 20 patients underwent bullectomy in the spontaneous pneumothorax between October 1993 and August 1994. The patients were divided into two groups: Control group; the patients who received with mid-axillary approach[n=10 , Experimental group; the patients who received with video-assisted thoracic surgery [n = 10 . The results were as follows; 1. The total sex distribution was male predominence [M :F=6:1 . Mean age of control group was 31.6$\pm$ 10.1 age and experimental group was 24.3$\pm$ 5.5 age. 2. The operative times were 117.0 $\pm$ 32.6min in control group and 102.5$\pm$ 38.4min in experimental group [not significant . 3. The indwelling period of postoperative chest tube and hospital stay were 4.5$\pm$ 2.6 days and 8.3 $\pm$ 1.8 days in control group, $1.5\pm$ 0.5 days and 3.1 $\pm$ 0.3 days in experimental group[p=0.0018, < 0.0001 . 4. In control group, injection times of pain-killer were 1.7$\pm$ 0.7 times/day at operative day and 0.4$\pm$ 0.6times/day at postoperative 1 day. In experimental group, there were 0.3$\pm$ 0.7times/day at operative day and 0.1 $\pm$ 0.3times/day at postoperative 1 day[p=O.O002 at operative day, not significant at postoperative 1 day .