• Tuberculosis and Respiratory Diseases
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• 제45권3호
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• pp.630-635
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• 1998

저자들은 심한 폐기종 환자에 대해 양측성 폐용적감축술을 시행하여 증상의 호전과 폐기능의 호전을 경험하였기에 문헌고찰과 함께 보고한 바이다.

• Journal of Chest Surgery
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• 제30권8호
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• pp.827-832
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• 1997

폐용적 감축술(Lung volume reduction surgery : Lns)은 최근들어 활동이 어려운 심한 폐기종 환자에서 폐이식의 대체요법이나 폐이식의 전단계 시술로 추천되고 있다. 이 시술은 폐기종 환자의 호흡곤란을 감소 시키고 일상생활의 수행을 개선시키기 위한 고식적인 치료방법이다. 범발성 폐기종 환자에 대한 폐용적 감축술(LVRS)의 개념은 병변이 심한 기능이 없는 폐를 절제함으로써 남아있는 병변이 적은 폐의 기능을 개선 시킨다는 것이다. 폐용적 감축술UnS)의 성공에 결정적인 영향을 미치는 요소들로는 철저한 환자의 선택 (patient selection), 정확한 수술부위의 위치선정, 신중한 마취 및 수술기법, 그리고 집중적인 술후 처치 등이 있다. 본 병원에서는 심한 폐기종으로 입원한 59세 남자환자에서 철저한 선택과정patient selection)과 호흡기재활 (pulmonary rehabilitation)을 거쳐 흉강내시경을 이용하여 폐용적 감축술InnS)을 시행하였으며 술후 경과 양 호하녀 퇴원 후 현재 외래 추적관찰 중이다.

• Journal of Chest Surgery
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• 제32권6호
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• pp.543-548
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• 1999

배경: 폐용적 감축술은 말기 폐기종환자의 치료에 폐장이식의 대치술 혹은 전단계 시술로 최근 이용되고 있는 술식이다. 또한 심한 폐기종환자에서 종양이 동반되는 경우, 종양절제술과 동반하여 사용될 수 있을 것으로 생각된다. 저자들은 폐종양 절제술을 동시 시행한 2례를 포함하여 7례의 폐용적 감축술후 평균 21개월간의 추적 관찰 결과를 보고한다. 대상 및 방법: 가톨릭대학교 흉부외과에서는 1996년 7월부터 1997년6월까지 수술당시 폐 종양이 의심되었던 환자 2례를 포함하여 만성폐기종환자 7명에서 폐용적 감축술을 시행하였다. 술후 검사는 3개월, 6개월, 1년, 2년에 각각 시행하였으며 현재까지 평균 21개월의 추적관찰을 시행하였다. 결과: 술후 사망은 술후 13개월에 뇌 전이를 동반한 평편상피암이 좌상엽에서 발견된 환자 1례에서 있었다. 나머지 6례의 환자는 평균 21개월의 추적관찰 중으로 현재까지 양호한 경과를 보이고 있다. 결론: 폐용적 감축술은 심한 폐기종환자의 치료에 유용하며 앞으로 적절한 적응증이 확인되고 장기성적이 보고되는 등의 계속적인 연구 결과가 필요한 것으로 생각된다. 또 폐 기능의 여유가 없는 폐기종환자의 초기 폐종양치료에 술후 폐 기능의 개선을 위하여 종양절제술과 동시에 폐용적 감축술을 시행할 수 있을 것으로 생각된다.

• 대한흉부심장혈관외과학회:학술대회논문집
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• 대한흉부외과학회 1996년도 제12차 춘계학술대회 초록집
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• pp.20-23
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• 1996

• Journal of Yeungnam Medical Science
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• 제14권1호
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• pp.21-32
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• 1997

• Journal of Chest Surgery
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• 제39권4호
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• pp.323-327
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• 2006

호흡부전을 동반한 말기 폐림프관 평활근종증은 가임기 여성에서 발병하는 매우 드문 질환으로서 폐이식이 유일한 치료법으로 알려져 있다. 이런 환자에서 폐이식을 시행하는 경우 단측 폐이식이 추천되고 있으나 이식한 폐의 기능부전이나 이식하지 않은 폐에서 원발질환의 악화가 문제점으로 제시되고 있다. 본원에서는 폐림프관 평활근종증을 앓고 있던 말기 호흡부전의 36세 여자 환자에게 우측 단일 폐이식술을 시행한 이후 이식폐의 폐허탈로 인한 기능부전으로 인하여 내과적 또는 외과적 치료에도 불구하고 호전이 없어 반대쪽의 단측폐 재이식수술을 시행한 후 좋은 결과를 얻었기에 이를 보고하는 바이다.

• Journal of Chest Surgery
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• 제24권10호
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• pp.1005-1011
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• 1991

Eighty-four patients with pulmonary metastases from gestational choriocarcinoma were treated at the Catholic Medical Center between August, 1985 and August, 1991. Among these 13 patients underwent thoracotomy with resection of pulmonary lesions and the results obtained were follows. 1] The ages of the patients ranged from 26 to 47 years, with a mean age of 31 years. 2] The frequency of chemotherapy before operation ranged from zero to 46, with a mean frequency of 13.6. 3] Four patients were operated upon for a solitary metastasis of the lung; 6 patients, for unilateral multiple metastases and 3 patients, for bilateral pulmonary metastases. 4] Eight patients underwent wedge resection; 1 patient, segmentectomy; 2 patients, lobectomy; 3 patients, open lung biopsy. The lung lesions of eleven patients showed hemorrhagic necrosis[among these, 2 patients combined with pulmonary tuberculosis]; one was non-necrotic choriocarcinoma; another one was metastatic lung carcinoma from endocrine cancer of unknown origin. 5] Among twelve patients who had managed with chemotherapy before thoracotomy three patients were in remission; among 13 patients who had undergone thoracotomy 6 patients were in remission. 6] The median survival time of these patients was 25.8 months with 3 postoperative deaths. Subsequently, in the patients with pulmonary metastases from choriocarcinoma, if the primary tumor is under control, there are no other metastases, and the patients should be able to tolerate the planned operation, it is necessary to undergo aggressive thoracotomy for diagnostic purposes; for therapeutic purposes only when the pulmonary lesion is the only remaining source of increased hCG excretion; for reduction of tumor volume to shorten hospitalization or to reduce the quantity of drugs.

• Journal of Chest Surgery
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• 제53권4호
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• pp.184-190
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• 2020

Radiation therapy (RT) has improved patient outcomes, but treatment-related complication rates remain high. In the conventional 2-dimensional and 3-dimensional conformal RT (3D-CRT) era, there was little room for toxicity reduction because of the need to balance the estimated toxicity to organs at risk (OARs), derived from dose-volume histogram data for organs including the lung, heart, spinal cord, and liver, with the planning target volume (PTV) dose. Intensity-modulated RT (IMRT) is an advanced form of conformal RT that utilizes computer-controlled linear accelerators to deliver precise radiation doses to the PTV. The dosimetric advantages of IMRT enable better sparing of normal tissues and OARs than is possible with 3D-CRT. A major breakthrough in the treatment of esophageal cancer (EC), whether early or locally advanced, is the use of proton beam therapy (PBT). Protons deposit their highest dose of radiation at the tumor, while leaving none behind; the resulting effective dose reduction to healthy tissues and OARs considerably reduces acute and delayed RT-related toxicity. In recent studies, PBT has been found to alleviate severe lymphopenia resulting from combined chemo-radiation, opening up the possibility of reducing immune suppression, which might be associated with a poor prognosis in cases of locally advanced EC.

• Journal of Chest Surgery
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• 제16권4호
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• pp.539-546
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• 1983

Maximal expiratory flow-volume [MEFV] curves were studied in 22 patients who underwent pneumonectomy with various pulmonary lesions, such as lung cancer, bronchiectasis and tuberculosis etc, at the preoperative stage and 3 week, 4 month and 12 month after pneumonectomy for the analysis of the reduction and progressive improvement of postoperative ventilatory function. And the factors affecting them like as age difference and the site of pneumonectomy were also analyzed. From these curves peak flow rate [PF R], maximal expiratory flows at 25% and 50% of expired forced vital capacity [V25, V50] and forced vital capacity [FVC] were obtained. In addition, partial pressure of oxygen and carbon dioxide in arterial blood were measured. The results were as follows; 1. The mixed type, especially obstructive type of ventilatory impairment was observed at 3 week after operation. For 1 year of postpneumonectomy FVC was increased by 12.3% of predicted compared to 2.6% of predicted V50. 2. The improvement of FVC during 1 year of postpneumonectomy showed decreasing tendency with the increase of age but the changes of V25 and V50 were unremarkable. 3. The differences of immediate postoperative reduction and progressive improvement of ventilatory capacity after right and left pneumonectomy were analyzed. The reduction of V50, V25 and FVC at 3 week of postoperation were greater in patients with right pneumonectomy [20.9%, 18.2% and 26.2% of predicted] than in patients with left pneumonectomy 16.5%, 18.2% and 18.1%]. But there was no significant difference of these values at 12 month after pneumonectomy. 4. The partial pressure of oxygen in arterial blood [$PaO_2$] was decreased by 13.6 mmHg at 3 week after pneumonectomy compared to the preoperative stage but returned to the normal range within 4 month after pneumonectomy. However, TEX>$PaCO_2$ was within the normal range during 1 year of postoperation.

• Asian Pacific Journal of Cancer Prevention
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• 제16권8호
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• pp.3257-3265
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• 2015

Background: Radiotherapy is an important treatment of choice for breast cancer patients after breast-conserving surgery, and we compare the feasibility of using dual arc volumetric modulated arc therapy (VMAT2), single arc volumetric modulated arc therapy (VMAT1) and Multi-beam Intensity Modulated Radiotherapy (M-IMRT) on patients after breast-conserving surgery. Materials and Methods: Thirty patients with breast cancer (half right-sided and half left-sided) treated by conservative lumpectomy and requiring whole breast radiotherapy with tumor bed boost were planned with three different radiotherapy techniques: 1) VMAT1; 2) VMAT2; 3) M-IMRT. The distributions for the planning target volume (PTV) and organs at risk (OARs) were compared. Dosimetries for all the techniques were compared. Results: All three techniques satisfied the dose constraint well. VMAT2 showed no obvious difference in the homogeneity index (HI) and conformity index (CI) of the PTV with respect to M-IMRT and VMAT1. VMAT2 clearly improved the treatment efficiency and can also decrease the mean dose and V5Gy of the contralateral lung. The mean dose and maximum dose of the spinal cord and contralateral breast were lower for VMAT2 than the other two techniques. The very low dose distribution (V1Gy) of the contralateral breast also showed great reduction in VMAT2 compared with the other two techniques. For the ipsilateral lung of right-sided breast cancer, the mean dose was decreased significantly in VMAT2 compared with VMAT1 and M-IMRT. The V20Gy and V30Gy of the ipsilateral lung of the left-sided breast cancer for VMAT2 showed obvious reduction compared with the other two techniques. The heart statistics of VMAT2 also decreased considerably compared to VMAT1 and M-IMRT. Conclusions: Compared to the other two techniques, the dual arc volumetric modulated arc therapy technique reduced radiation dose exposure to the organs at risk and maintained a reasonable target dose distribution.