• Title/Summary/Keyword: 외과적 우회술

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Surgical Treatment for Atherosclerosis of Aaortoiliac Artery (대동맥장골동맥의 죽상경화증에 대한 수술적치료)

  • 금동윤;정진악;신화균;이재원
    • Journal of Chest Surgery
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    • v.34 no.2
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    • pp.133-137
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    • 2001
  • 배경: 하지에 영향을 미치는 죽상경화증은 복부대동맥과 이에 중요분지인 총장골동맥을 침범할 수 있다. 또한 국소분절을 침범할 수 있으나 다중분절은 침범할 수도 있다. 대상 및 방법: 을지의과대학교 흉부외과학 교실에서는 1995년 1월부터 1999년 12월까지 대동맥총장골동맥의 죽상경화증을 주소로 우회술을 시행받은 23례의 환자들을 후향적으로 조사하였다. 결과: 모든 환자는 남자였고 평균연령은 60.15$\pm$8.7세였다. 전 예에서 흡연의 과거력이 있었으며 동반질환으로 당뇨병 8례, 고혈합 7례, 관상동맥질환 6례, 그리고 판막질환 1례였다. 대동맥장골동맥 죽상경화증에 대한 수술방법으로는 대동맥양측대퇴동맥 우회술(7례), 대동맥양측동맥 우회술 및 대퇴동맥슬와동맥 우회술(8례), 대동맥양측대퇴동맥 우회술(2례), 액와대퇴동맥 및 고고동맥 우회술(3례), 고고동맥 우회술(3례)였다. 훌후 합병증으로 후복막상 출혈 3례, 마비성 장폐색 3례, 폐렴3례, 뇌졸중 1례, 급성신부전 2례, 창상감염 2례였다. 해부학적 우회술을 받은 환자중 3례에서 수술 사망이 발생하였다. 결론: 해부학적 우회술은 대동맥장골동맥의 폐쇄성질환에 표준적인 수술방법이지만 또한 해부학적 우회술 역시 술후 유병률 및 사망률이 낮은 좋은 수술법으로 사료된다.

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Surgical Retrieval of Fractured Percutaneous Coronary Intervention Guidewire (경피적 관상동맥 중재술 시 골절된 가이드 와이어의 외과적 제거)

  • Lee Jun-Wan;Kim Sang-Pil
    • Journal of Chest Surgery
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    • v.39 no.8 s.265
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    • pp.640-642
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    • 2006
  • Entrapment and fracture of coronary angioplasty hardware are rare complications of percutaneous coronary intervention (PCI). Retained guidewire should be removed either percutaneously or surgically, because it could serve as a nidus for thrombus formation. We report on a successful surgical retrieval of entrapped PCI guidewire and subsequent bypass grafting of the affected coronary vessel.

Clinical Result of Surgical Treatment for Atherosclerosis Obliterans of Lower Extremity (하지의 폐쇄성 동맥경화증에 대한 외과적 치료의 성적)

  • Park Jeong-Ok;Seo Pil-Won;Ryu Jae-Wook
    • Journal of Chest Surgery
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    • v.39 no.4 s.261
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    • pp.298-303
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    • 2006
  • Background: This study was performed to investigate the outcomes of vascular operations that were done in patients with atheroscerosis obliterans (ASO) of lower limb. Material and Method: Forty patients underwent vascular operations from December 1996 to June 2004. The patient's records were analyzed retrospectively. Mean age was $66{\pm}8$ years (range, $47{\sim}81$ years). Gender ratio was 37:3 (male:female). Result: The operations were done on 50 lower limbs of 40 patients. The names of operations were femoropopliteal bypass in 12 patients (30%), femorofemoral bypass in 12 (30%), femorofemoral bypass and femoropopliteal bypass in five (12.5%), aorta-lower limb artery bypass in five (12.5%), axillofemoral bypass in two (5%), iliopopliteal bypass in two (5%), and endarterectomy in two (5%). All bypass surgeries were done with prosthetic conduits. Mean follow up period was $33.2{\pm}23.2$ months (range, $3.8{\sim}90.2$ months). The cumulative patency rates of 1 and 5 years were 75.5 and 58.7% respectively. In six patients, amputation of the lower limb was done. In eight patients, 12 complications occurred. After the first operation, 10 patients underwent reoperations. Conclusion: Our lower limb arterial bypass surgery revealed acceptable patency rate, but not a few patients required reoperations. An epochal treatment modality that can inhibit the progress of ASO and improve long term patency should be established.

Palliative Management of Gastric Cancer with Outlet Obstruction: Stent versus Bypass (위배출구 폐색을 동반한 위암환자의 치료)

  • Kim, Hyung-Ho
    • Journal of Gastric Cancer
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    • v.9 no.1
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    • pp.6-9
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    • 2009
  • Gastric cancer with gastric outlet obstruction has a high incidence of direct invasion into neighboring organs, with a low resection rate and a poor prognosis. Traditionally, open gastrojejunostomy has been the standard palliative treatment in these patients. Recently, endoscopic self-expanding metal stents have been used increasingly for the palliative treatment of malignant gastric outlet obstruction, but the choice of modality to treat the obstruction caused by gastric cancer is still controversial. Many studies have shown that endoscopic stenting is less invasive and offers not only a shorter time to oral intake and length of hospital stay, but also less frequent complications compared to open gastrojejunostomy. However, recurrent obstruction by tumor overgrowth and ingrowth occur more frequently and re-intervention for recurrent obstructive symptoms are more frequently performed after stent placement than after gastrojejunostomy. Thus, stent placement may be associated with more favorable results in patients with a relatively short life expectancy, while gastrojejunostomy is preferable in patients with a more prolonged prognosis. Also, open surgery affords a greater chance for curative surgery. However, most underlying diseases analyzed in previous studies were pancreaticobiliary malignancies, and there have been few prospective studies specific for patients with gastric cancer. Additional randomized controlled trials with larger sample sizes are expected to decide the treatment modality for unresectable gastric cancer with gastric outlet obstruction.

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Coronary Revascularization without Extracorporeal Circulation -Two Case Reports (체외순환을 사용하지 않은 관상동맥 우회술 -2례 보고-)

  • 홍종면;전용선
    • Journal of Chest Surgery
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    • v.30 no.11
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    • pp.1132-1135
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    • 1997
  • We have experienced two cases of coronary revascularization without extracorporeal circulation in a 63 year old female patient and a 75 year old male patient. The first patient had the lesion which was the nearly total occulusion of mid-LAD, about 90% luminal narrowing of second diagonal branch and less than 50% stenosis of proximal RCA. The other male patient had a single vessel disease involving about 95% stenosis of proximal LAD and 1st diagonal branch. PTCA failed in the irst patient because of relatively long sinus pause during procedure In both of the patients, the coronary revascularizations were done at distal LAD and diagonal branch using left internal mammary artery and saphenous vein graft under the beating state, respectively. The postoperative courses were uneventful and the patients were discharged without any complications.

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