• 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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• 제31권11호
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• pp.1106-1109
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• 1998

식도의 원발성 악성 흑색종은 매우 드문 종양성 질환으로 전세계적으로 약 200례가 보고되어 있다. 저자들은 식도 악성 흑색종의 외과적 치험 1례를 문헌고찰과 함께 보고하였다. 종양은 호두알 크기의 타원형으로 중부 식도에 위치하고 있었으며, 식도-위 경계부위에 2개의 위성병변이 있었다. 종양은 조직학적 검사와 면역조직학적 검사에 의하여 식도원발의 악성 흑색종으로 확진되었다. 개흉적 식도아전절제와 2영역 림프절적출로 근치적 수술을 하였으나, 수술 7개월후 원격전이 재발이 확인되었으며 면역요법에 뚜렷한 효과를 보이지 않고 있다.

• Journal of Chest Surgery
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• 제17권4호
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• pp.819-828
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• 1984

Between September 1973 and December 1983, 61 patients with carcinoma of the esophagus were treated surgically at the Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital. Among 61 patients, male patients were 51 cases, female 10 cases and the age ranged from 21 years old to 72 years old with the average of 54.6 years old. Min symptoms of esophageal cancer were dysphagia (91.5%), weight loss (40.4%), pain(27.6%), and the average symptom duration was 3.85 months. The anatomical locations of esophageal cancer in preoperative esophagogram revealed 41.7% in middle 1/3, 8.3% in esophagograstic junction or cardia. Among 61 cases, 9 cases were managed by feeding gastrostomy due to inoperability, 8 cases by exploratory thoracotomy or lapatotomy only without curative or palliative resection, and 44 cases by curative or palliative resection with reconstruction. Among 52 cases of exploration, 44 cases were managed with curative or palliative resection of cancer and the resectability revealed 84.6% in operated cases. Among palliative or curative resected group, the esophagogastrostomy was performed in 40 cases (90.9%), esophagojejunostomy in 3 cases(6.8%), esophagectomy only in 1 case(2.3%). Postoperative complications were noticed in 12 cases, such as anastomotic leakage in 7 cases(15.6%), empyema in 2 cases (4.4%), respiratory failure in 2 cases (4.4%), anastomotic stricture in 1 case (2.2%). among 7 postoperative anastomotic leakage, 2 patients died as a result of that complication and the operative mortality revealed 4.3%. During follow-up work, the mean survival period was 19.3 months in patients who discharged hospital alive, and the 2 year survival rate was 34.6%.

• 대한기관식도과학회지
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• 제9권1호
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• pp.87-91
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• 2003

Currently gastrointestinal mesenchymal tumors are divided into three major categories: myogenic tumors(leiomyoma, leiomyosarcoma), neurogenic tumors (schwannomas) and neoplasms that belong to neither group, which are known by GIST(gastrointestinal stromal tumors). The stromal tumors are hetrogenous, so that they may show myogenic or neurogenic differentiation or both, or no differentiation at all in some patients. The best defining feature for GIST is their expression of KIT-protein(CD117). Leiomyomas are the most common mesenchymal tumor in esophagus. Esophageal GISTS are very rare in comparision to those of the stomach and intestine. Recently we experieneced one case of the esophageal GIST, so that we describe an esophageal GIST on immunohistochemical analysis. A 70 years old woman complained of dysphagia and nausea for 3 days. FGS showed a huge elevated lesion in lower esophagus 33cm distal to incisor, which was covered with normal mucosa. CT and UGI showed the intramural tumor of lower third of the esophagus. The distal esophagectomy and esophago-gastrostomy were performed. The tumor was located in lower third of esophagus and measured as $6{\times}3.7$cm in size. Immunohistochemically, it showed weakly positive CD117 and diffusely positive S-100. SMA, desmin, NES and chromogranin showed negative immune-reaction. The patient was followed for 15 month after operation. There was no recurrence.

• Journal of Chest Surgery
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• 제45권1호
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• pp.53-55
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• 2012

We report a very rare case of surgery on gastric conduit cancer. A 67-year-old male patient underwent esophagectomy and intrathoracic esophagogastrostomy for squamous cell carcinoma of the lower thoracic esophagus 27 months ago. Upon follow-up, a gastric carcinoma at the intra-abdominal part of the gastric conduit was found on an esophagogastroduodenoscopy. We performed total gastrectomy and esophagocolonojejunostomy in the manner of Roux-en-Y anastomosis. The postoperative course was not eventful and an esophagogram on the 10th postoperative day showed no leakage or stenosis of the passage. The patient was discharged on the 17th day with no complications.

• Journal of Chest Surgery
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• 제23권4호
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• pp.825-830
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• 1990

Esophageal cancer is relatively uncommon except in isolated endemic areas, but it generally devastating to the patient. Usually, by the time the disease becomes clinically evident, it is incurable. The aim of treatment is then relegated to attempting to palliate the symptoms in the best possible manner with the least morbidity and mortality. Squamous cell carcinoma in by far the commonest type of malignancy involving the body of the esophagus, accounting for more than 95 percent of all esophageal malignancies. Because the tumor’s microscopic spread is much greater than its macroscopic extent, it is necessary to resect a sufficiently long segment of the esophagus. And second tumors may occur either in the esophagus as a manifestation of a field change or in other organs. Recently we had experienced a case with in situ carcinoma away from the invasive squamous cell carcinoma of the esophagus. A 58 year-old male was admitted with the chief complaint of swallowing difficulty for a month prior to admission. While we studied the esophagogram and chest CT, we found that the mass was protruded to the lumen of esophagus at the level of the 7th-9th thoracic vertebral columns. We performed esophagectomy with lymph node dissection and esophagogastrostomy by thoracic and abdominal approaches. The pathologic result showed separation of another in situ carcinoma away from the invasive squamous cell carcinoma of esophagus at the level of esophagogastric junctions. Postoperative course was uneventful. Now he is taking the postoperative irradiation at out patient department.

• 한국가시화정보학회지
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• 제7권2호
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• pp.22-27
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• 2010

The delayed gastric emptying flows have been visualized in this study when a gastric graft replaced an esophagus after esophagectomy. To construct visualization models for gastric grafts, the path data of gastric graft were extracted from the CT images for real patients and then the experimental models were made from silicone tube by considering elasticity of real stomach. During experiments, 200 ml of water or glycerin was poured into the gastric graft model and the gastric emptying time for total volume of fluid to pass pylorus was measured from the successive images captured by a high speed CCD. The gastric emptying time was compared according to the change of diameter and path (front or rear path) of gastric graft, and pyloroplasty or not. In case that the pyloroplasty was not conducted, the smaller was the diameter of gastric graft, the shorter was the gastric emptying time. However, if the pyloroplasty was conducted, the larger diameter of gastric graft was better for the gastric emptying. Although the rear path gave rise to longer gastric emptying time than the front path, it did not matter, if the pyloroplasty was conducted.

• Journal of Chest Surgery
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• 제26권10호
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• pp.769-774
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• 1993

Thoracic empyema is defined as purulent pleural effusion or effusion with positive bacteriology. Recently, the empyema has markedly decreased by developement of antibiotics, but empyemas following thoracotomy were occasionaly reported. During the period of January, 1985 to May,1991, 18 patients with postthoracotomy empyema have been treated in the Department of Thoracic and Cardiovascular Surgery of Chonbuk National University Hospital.There were 17 males and 1 female ranged from 18 years to 67 years of age. The underlying diseases of empyema were tuberculosis [50%], lung cancer [33.3%], esophageal cancer [11.1%],and aspergillosis with tuberculosis[5.6%]. In surgical procedures causing the empyema, there were lobectomy[38.9%], pneumonectomy[22.2%], decortication[16.7%], decortication & lobectomy[11.1%], and esophagectomy [11.1%]. Etiologic organisms in the pleural fluid were Pseudomonas [27.7%], S.aureus [16.7%], mixed infection [16.7%], K.pneumonia [5.6%], M.tuberculosis [5.6%], and no isolation [27.7%]. In 6 cases with BPF, completion pneumonectomy was performed in 1 case, and open thoracostomy in 5 cases. In 12 cases without BPF, closed thoracostomy was performed in 1 case, decortication in 2 cases, decortication & open thoracostomy in 2 cases, and open thoracostomy in 7 cases. In 6 cases with BPF, the fistulas were closed in 4 cases at follow up, the other 2 cases died from pulmonary insufficiency after completion pneumonectomy and open thoracostomy,respectively. In 12 cases without BPF, the empyema cavities were filled with expanded lungs and granulation tissues, except 1 case died from sepsis.

• Journal of Chest Surgery
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• 제29권5호
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• pp.536-541
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• 1996

Between June 1988 and June 1994, twenty five patients with locAlly advanced esophageal carcinoma received preoperative chemotherapy (Cisplatln, 5-Fluorouracil with or without Etoposide) and followed by resection. All patients had clinical evidence of airway involvement or distant Iymphnode involve- ment (M 1 Iymphnode) on bronchoscopy or computed tomographic scans. The major response rate to chemotherapy decided by the postoperative stage was 48% (12125). The resection rate was 92% (23/25) with overall complete resection rate of 72% (18125). Two patients had exploratory laparotomy (thorn- cotomy) only. Thirteen patients had esophagogastrostomy with a combined abdominl and Rt. thoracic approach (Ivor Lewis operation), slx pAtients had transhiatal esophagectomy, four patients had esophagogastrostomy with a combined Rt. thoracotonly & abdominal, cervical approach. There were three postoperative deaths (12%). Follow-up duration was between 3.3 months to 65 months. Median survival ime of resected patients except hospital death was 14.8 months. Actuarial survival at 12, 24 months was 72.9%, 26.2%. Signifi- cant better survival was associated with responder group (postoperative stage less than lIB) (P=0.029). These results demonstrate that 1) Preoperative Cisplatin based combined chemotherapy Produce high response rate, 2) High complete resection rate with acceptable mortality rate occur after preoperative chemotherapy, 3) Better surviL dl can be anticipated if complete resection performed after major re- sponse to preoperative chemotherapy.

• Journal of Chest Surgery
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• 제40권3호
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• pp.244-246
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• 2007

식도암 수술 시 종격동 림프절 절제는 식도암의 재발과 관련하여 환자의 장기 생존율을 높이는 하나의 방법이다. 하지만 좌측 종격동 림프절 절제는 수술 시야의 제한으로 인해 절제가 거의 불가능하다. 이에 본원에서는 식도암 최소 침습 수술 시 경부 절개창을 통하여 흉강경을 이용한 좌측 종격동 림프절 절제를 시행하였기에 보고하는 바이다.