• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.943-945
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• 2006

An 11-month old girl with a feeding difficulty and recurrent aspiration pneumonia received surgical correction of complete vascular ring, which was formed by right aortic arch, aberrant left subclavian artery(LSCA) originating from Kommerell's diverticulum(KD) and ligamentum arteriosum. Through left posterolateral thoracotomy, the ligamentum arteriosum was divided to relieve the tracheo-esophageal bundle. KD was separated from the right descending aorta, and the left subclavian artery was severed from KD at its origin and trasfered to the side wall of left common carotid artery. Postoperative course was uneventful, and the patient has been followed up with a clinical improvement.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1991.06a
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• pp.22-22
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• 1991

구개열 및 구개근의 기능부전 등에 의한 인두문(velopharyngeal valve)의 폐쇄부전으로 인하여 발생하는 구개범인두부전증(velopharyngeal insufficiency)은 흔히 과비성으로 알려진 구음장애를 나타내는 병적현상으로 Von Langenbeck(1861)이 구개 외측 점막성 골막편을, Smith(1895) 와 Ganzer(1920)는 각각 구개 4-판 및 3-판 점막성 골막편을 이용한 수술적 치료법을 통하여 구음장애를 해결하여 주려하였고, 그외 인두후벽의 증대 및 언어보조기 등을 이용한 방법으로 구음장애를 해결하여 주려는 연구가 최근까지 활발하게 이루어지고 있으나 만족할 만한 성적을 거두지 못하고 있는 실정에 있다. 이에 저자들은 구개범인두부전증에 대한 수술적 치료후 증상의 호전정도를 관찰하고, 술후에도 증상의 호전을 보이지 않는 환자의 음성재활에 대한 향후 방향제시에 도움을 주고자 1987년 1월부터 1991년 1월까지 과비성을 주소로 본원 이비인후과에 내원하여 구개성형술을 시행받고 3개월 이상 추적 관찰이 가능하였던 14례의 환자를 분석한 결과 구개범인두부전에 대하여 1차 수술을 시행받은 14례중 5례(36%)에서 정상적인 구음이 가능하였으며 실패한 9례중 5례에 대하여는 재 수술을 시행하였으나 만족할 만한 음성회복을 거두지 못하여 그 원인과 저자들의 술식을 분석 검토함으로써 구개범인두부전증의 치료에 대한 보다 효율적인 방법을 모색하고자 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.356-363
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• 2004

Esophageal cancer is an aggressive disease with a poor prognosis. Recently, every effort has been made to improve the long term survival, but the general prognosis for patients with this disease remains poor. In this study, we reviewed 8 years of experiences with esophageal cancer patients managed in our department at Dong-A University Hospital and evaluated the effectiveness of cervical lymph node dissection performed selectively. Material and Method: From January 1995 to August 2003, 70 patients underwent esophagectomy for esophageal cancer in our department. Among them, 51 patients who underwent curative resection, had no double primary tumors and no neoadjuvant therapy were analyzed retrospectively. In most patients, intrathoracic esophagectomy and cervical esophago-gastrostomy was performed. Since 1997, 3-field lymph node dissection was performed selectively. Result: There were 46 men and 15 women. The median age was 60 years. The tumor was located in the upper third part in 10 patients (19%), middle third in 21 (41%), and lower third in 20 (40%). Majority of the patients (90%) had squamous cell carcinoma. Cervical anastomosis was made in 41 patients, and intrathoracic anastomosis in 10. 2-field lymph node dissection was done in 40 patients, and 3-field lymph node dissection in 11. The pathologic staging were as follows: stage I in 9 patients (17.6%), IIA in 20 (39.2%), IIIB in 7 (13.7%), III in 11 (21.6%), IVA in 2 (3.9%), and IVB in 2 (3.9%). The in-hospital mortality was 3.9% (2 patients) and complications occurred in 24 patients (47%). Overall actuarial 1, 3, and 5-year survival rates were 74.4%, 48.4%, and 48.4% including operative mortality. The 4-year survival rate did not differ significantly between 3-field lymph node dissection group (50.5%) and 2-field lymph node dissection group (48.9%). In 3-field lymph node dissection group, the respiratory complications were more frequent and operative time was significantly longer. Conclusion: We think that curative resection for esophageal cancer can be performed with acceptable mortality, and aggressive surgical approach may improve the long term survival. even for advanced stages. Effectiveness of 3-field lymph node dissection needs further investigations.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.589-593
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• 2005

Esophageal schwannoma is very rare and almost of all cases are diagnosed as esophageal submucosal tumor preoperatively. Final diagnosis is made by postoperative immunohistochemical (IHC) staining of the surgical specimen. We experienced two cases of esophageal submucosal tumor, one was 63 year old female suffering from three months of dysphagia and another was 39 year old female complaining of two months of intermittent dysphagia. Two esophageal tumors were completely removed by esophagectomy and enucleation through right thoracotomy respectively. Postoperative IHC staining demonstrated S-100 positive without mitotic figures and confirmative diagnosed was made as benign esopphageal schwannoma.

• Journal of Chest Surgery
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• v.29 no.4
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• pp.466-471
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• 1996

Esophageal atresia with tracheoesophageal fistula is a common form of congenital malformation of the esophagus, which was usually overlooked during the physical examination after delivery. The first report of esophageal atresia with tracheoesophageal fistula was done by Thomas-Gibson in 1696. We have performed primary repair by extrapleural approach through the right 4th intercostal space in 4 cases of congenital esophageal atresia with distal racheoesophageal fistula. End to end anastomosis was performed by Haight method in all cases. Postoperatively, two patients showed severe stenosis and one patient showed mild stenosis at the anastomotic site. Ballots dilatation was performed two cases with severe anastomotic stenosis.

• Korean Journal of Bronchoesophagology
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• v.2 no.2
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• pp.182-193
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• 1996

식도내 이물은 종종 어린이나 식도질환을 가진 환자, 죄수들, 정신박약자 및 정신질환자등의 위험성이 높은 성인에서 흔히 발생한다. 그러나 대부분의 이물은 저절로 위장관을 통과하나 날카롭고 뾰족하며 긴 이물은 위장관의 천공이나 혈관과 누공형성 및 다른 합병증을 초래할 수도 있다. 이물의 섭취는 대개 환자나 다른 목격자에 의하여 복용한 병력으로 진단할 수 있다. 그러나 어린이나 정신박약자는 병력을 얻을 수 없기 때문에 우선 의심하는 것이 중요한 진단방법이 될 수밖에 없다. 연하곤란과 연하통은 식도이물의 통상적인 증상이다. 주변기도의 압박으로 인한 호흡기 증상은 어린이에 흔하며 종종 성인에서도 관찰된다. 식도내 이물을 제거하는데 많이 사용되는 방법은 굴곡형내시경을 사용하여 제거하는 것이다. 이방법은 성인이나 어린이에서 전신마취없이 기존의 진정제 투여방법으로 시술할 수 있다. 이물제거에 사용되는 파지겸자와 올가미는 내시경이물제거술을 가능하게 하였고 굴곡형내시경에 사용되는 overtube는 기존의 강직 형내시경의 장점을 얻을 수 있어 뽀족하거나 날카로운 이물을 제거하는데 사용하게 되었다. 이런 내시경적이물제거 원칙을 잘 지키고 적절한 준비가 된다면 합병증이 거의 없이 98% 정도의 이물을 제거할 수 있다. 내시경을 사용하지 않는 여러 가지 방법은 천공의 위험성이 높고 흡인성폐렴을 유발할 수 있기 때문에 사용하지 않는 것이 낫다. 수술적인 처치는 천공이 되었거나 다른 이물로 인한 합병증이 있는 경우에만 드물게 적용된다.

• Korean Journal of Bronchoesophagology
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• v.11 no.2 s.22
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• pp.5-9
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• 2005

종격동내의 림프계는 해부학적으로 크게 3구역 즉, anterior compartment, visceral compartment, 그리고 paravertebral sulci 로 나눌 수 있으며, 이 중 식도와 폐로부터 유입되는 visceral compartment가 종양외과학적으로 중요한 의미를 가지고 있다. 두경부 암종에서도 경부의 림프계를 거쳐 종격동의 visceral compartment의 림프계로 전이가 일어날 수 있는데, 본 연제에서는 종격동의 visceral compartment와 관련이 깊은 식도 림프계의 해부학적인 특성과 종격 림프계의 해부, 그리고 두경부 암종의 수술에서 종격 림프절 적출에 대하여 기술하였다. 선천성과 악성 질환에 의한 경우는 비악성 질환에 의한 경우와 치료방침에 많은 차이가 있어 비악성 질환에 의한 기관식도루에 초점을 두고 논하고자 한다.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1977.06a
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• pp.8.4-8
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• 1977

Coin is the most common foreign body in foreign bodies of food passage in ENT field. Most of the coin canbe removed with ease by means of endos copy but in rare cases operative measures are necessary. The authors have recently experienced a case of foreign body in mediastinum near bifurcation of trachea, between trachea and esophagus which was removed by lateral neck exploration under general anesthesia, and this is the report of this case along with literature survey.

• Journal of Chest Surgery
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• v.37 no.8
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• pp.665-671
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• 2004

Background: Lymph node metastasis is commonly reported in thoracic esophageal cancer, even in the early esophageal cancer which may be localized only in the mucosa or within the submucosal layer. Although lymph node metastasis greatly influence long-term outcome and cure of the disease, endoscopic mucosal resection or photodynamic therapy without lymph node dissection is widely attempted. The investigation of the pattern of lymph node metastasis and results of surgical resection of superficial esophageal cancer is needed. Material and Method: Pattern of lymph node metastsis and depth of tumor invasion were studied retrospectively from 44 patients with early esophageal cancer who underwent radical resection of the tumor from December, 1995 to August, 2001. Result: Lymph node metastasis was found in 10 patients (22.7%) out of total of 44 patients. Lymph node metastasis was found in 0% (0 of 3), 0% (0 of 4), 50% (2 of 4), and 24.24% (8 of 33) of tumors that invaded the intraepitherium, lamina propria, muscularis mucosa, and submucosa respectively. Anatomically distant lymph node metastases were found more frequently in recurrent laryngeal nerve node(5 cases of 10 patients) and in intraperitoneal node (8 cases of 10). than intrathoracic node (3 cases of 10). There was no operative mortality, however, there were 1 hospital death in patient with lamina propria cancer, 1 late death in patient with submucosal cancer. Three-year survival rates (except hospital death) were 100% in mucosal cancer and 97.0% in submucosal cancer (p>0.05), and 100% in the node negative group and 90.0% in the node positive group (p>0.05). Conclusion: The survival rate of superficial esophageal cancer patient who was recieved operative resection was excellent. But, lymph node metastasis were found in superficial esophageal cancer, even in esophageal cancer limited to the muscularis mucosa. Systemic lymph node dissection which includes recurrent laryngeal nerve nodes and intraperitoneal nodes was recommended for favorable outcome in superficial esophageal cancer.

• Journal of Gastric Cancer
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• v.5 no.1
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• pp.1-9
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• 2005

Purpose: The debate is still on-going as to whether a transthoracic esophagectomy (TTE) or a transhiatal esophagectomy(THE) is the proper treatment for patients with cardia and esophageal cancers. This study tries to demonstrate and assess the efficacy and the validity of both surgeries. Materials and Methods: In a retrospective study, data from 52 cases of patients with esophageal and/or cardia cancer who received a surgical operation during the last decade were analyzed. Results: A TTE was done in 20 cases and a THE in 32 cases. The average times for the operations were 558.0 min for a TTE and 451.7 min for a THE (P>0.05). The estimated blood loss was 1,825.0 ml in a TTE and 1459.4 ml in a THE (P>0.05). The amounts of transfusion during the operations were 3.9 units in a TTE and 2.6 units in a THE (P<0.05). Post-operative complications occurred in 15 cases of TTE and 23 cases of THE. The average length of stay in the hospital was 25.6 days for a TTE and 20.6 days for a THE. The 5-year survival rate was $10\%$ for TTE patients and $28\%$ for THE patients (P>0.05). Conclusion: For most factors, including morbidity and mortality, there was no statistically significant difference between a TTE and a THE. However, a THE is expected to be more convenient, leading to a shorter operative duration, a shorter post-operative hospitalization and lesser amounts of hemorrhage and transfusion. Hence, the THE may be a more valid or efficient surgical method for those patients with cardia and esophagus cancer who require a resection of the esophagus. (J Korean Gastric Cancer Assoc 2005;5:1-9)