• Journal of Chest Surgery
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• 제33권1호
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• pp.38-44
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• 2000

Background: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. Material and Method : The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60$\pm$9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. Result: The mean number of grafts was 3.2$\pm$1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13$\pm$20 hours after the operation. Mean duration of stay in intensive care unit was 49$\pm$46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70$\pm$1.36 pack/patient. Conclusion: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.less cost.

• Clinics in Orthopedic Surgery
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• 제10권4호
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• pp.439-447
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• 2018

Background: Since open Wiltse approach allows limited visualization for foraminal stenosis leading to an incomplete decompression, we report the short-term clinical and radiological results of unilateral biportal endoscopic foraminal decompression using $0^{\circ}$ or $30^{\circ}$ endoscopy with better visualization. Methods: We examined 31 patients that underwent surgery for neurological symptoms due to lumbar foraminal stenosis which was refractory to 6 weeks of conservative treatment. All 31 patients underwent unilateral biportal endoscopic far-lateral decompression (UBEFLD). One portal was used for viewing purpose, and the other was for surgical instruments. Unilateral foraminotomy was performed under guidance of $0^{\circ}$ or $30^{\circ}$ endoscopy. Clinical outcomes were analyzed using the modified Macnab criteria, Oswestry disability index, and visual analogue scale. Plain radiographs obtained preoperatively and 1 year postoperatively were compared to analyze the intervertebral angle (IVA), dynamic IVA, percentage of slip, dynamic percentage of slip (gap between the percentage of slip on flexion and extension views), slip angle, disc height index (DHI), and foraminal height index (FHI). Results: The IVA significantly increased from $6.24^{\circ}{\pm}4.27^{\circ}$ to $6.96^{\circ}{\pm}3.58^{\circ}$ at 1 year postoperatively (p = 0.306). The dynamic IVA slightly decreased from $6.27^{\circ}{\pm}3.12^{\circ}$ to $6.04^{\circ}{\pm}2.41^{\circ}$, but the difference was not statistically significant (p = 0.375). The percentage of slip was $3.41%{\pm}5.24%$ preoperatively and $6.01%{\pm}1.43%$ at 1-year follow-up (p = 0.227), showing no significant difference. The preoperative dynamic percentage of slip was $2.90%{\pm}3.37%$; at 1 year postoperatively, it was $3.13%{\pm}4.11%$ (p = 0.720), showing no significant difference. The DHI changed from $34.78%{\pm}9.54%$ preoperatively to $35.05%{\pm}8.83%$ postoperatively, which was not statistically significant (p = 0.837). In addition, the FHI slightly decreased from $55.15%{\pm}9.45%$ preoperatively to $54.56%{\pm}9.86%$ postoperatively, but the results were not statistically significant (p = 0.705). Conclusions: UBEFLD using endoscopy showed a satisfactory clinical outcome after 1-year follow-up and did not induce postoperative segmental spinal instability. It could be a feasible alternative to conventional open decompression or fusion surgery for lumbar foraminal stenosis.

• Journal of Korean Neurosurgical Society
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• 제29권2호
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• pp.249-254
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• 2000

Objective : As a minimally invasive strategy, endoscopic technique was introduced for removal of the traumatic intracerebral hematoma. Material and Method : A 54-year-old man with three-day history of seizure and progressive mental deterioration after traffic accident was presented. Computerized Tomography(CT) of the brain showed a huge intracerebral hematoma on the right frontal lobe and ventricle. The operation was performed via right frontal superolateral keyhole with 2cm eyebrow skin incision. Using 0-degree and 30-degree angled lens 4mm rigid endoscopes, nearly all of the hematoma was evacuated under the direct endoscopic visualization and a ventricular catheter was exactly placed into the frontal horn of the right lateral ventricle at the end of procedure. Results : The seizure was discontinued and neurological status had been improved during postoperative periods. Postoperative CT demonstrated that most of the hematoma was removed and the ventricular drainge tube was exactly placed in the right foramen of Monro. Conclusion : With endoscopic technique, the authors successfully evacuated traumatic intracerebral hematoma and exactly placed the ventricular drainage catheter under direct visualization. This technique may be considered as an another option for removal of traumatic intracerebral hematoma.

• Journal of Korean Neurosurgical Society
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• 제52권5호
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• pp.491-494
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• 2012

We report a rare complication of iatrogenic spinal intradural following minimally invasive extradural endoscopic procedues in the lumbo-sacral spines. To our knowledge, intradural cyst following epiduroscopy has not been reported in the literature. A 65-year-old woman with back pain related with previous lumbar disc surgery underwent endoscopic epidural neuroplasty and nerve block, but her back pain much aggravated after this procedure. Postoperative magnetic resonance imaging revealed a large intradural cyst from S1-2 to L2-3 displacing the nerve roots anteriorly. On T1 and T2-weighted image, the signal within the cyst had the same intensity as cerebrospinal fluid. The patient underwent partial laminectomy of L5 and intradural exploration, and fenestration of the cystic wall was accomplished. During operation, the communication between the cyst and subarachnoid space was not identified, and the content of the cyst was the same as that of cerebrospinal fluid. Postoperatively, the pain attenuated immediately. Incidental durotomy which occurred during advancing the endoscope through epidural space may be the cause of formation of the intradural cyst. Intrdural cyst should be considered, if a patient complains of new symptoms such as aggravation of back pain after epiduroscopy. Surgical treatment, simple fenestration of the cyst may lead to improved outcome. All the procedures using epiduroscopy should be performed with caution.

• The Korean Journal of Pain
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• 제20권2호
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• pp.224-229
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• 2007

Vertebral compression fractures can occur due to trauma, a malignancy, or most commonly, osteoporosis. These fractures are frequently seen in elderly women; 30% of postmenopausal women are affected by vertebral compression fractures. These fragile fractures frequently result in both acute and chronic pain, but more importantly, are a source of increased morbidity and possibly, mortality. These injuries can be treated both conservatively and with surgery. The use of percutaneous vertebral augmentation offers a minimally invasive approach for the treatment of vertebral compression fractures. We experienced two cases of compression fractures diagnosed during the treatment of thoracic postherpetic neuralgia. Two patients suffering from postherpetic neuralgia with a sharp and stabbing pain in the thoracic dermatomes that was unresponsive to conservative treatment were transferred to our clinic. During the management of postherpetic neuralgia, we incidentally found thoracic compression fractures after obtaining fluoroscopic guided images. After a balloon kyphoplasty, the preoperative pain related to the postherpetic neuralgia was successfully relieved soon after the procedure, and there were no complications.

• 대한골관절종양학회지
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• 제10권2호
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• pp.88-95
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• 2004

목적: 통증을 동반한 유골 골종의 치료는 일반적으로 수술적 절제로 이루어졌으나, 그 침습성으로 인하여 술후 통증 및 일정 동안의 회복 시간이 필요하였다. 최소 침습적인 방법인 경피적 고주파 열치료를 이용한 유골 골종의 치료는 술 후 통증이 적고, 회복이 빠르며, 재발은 수술적 방법과 비슷한 것으로 보고되어 있다. 이에 저자들은 본원에서 시행한 경피적 고주파 열치료의 임상 결과를 보고하고자 한다. 대상 및 방법: 1999년 4월에서 2004년 5월 사이에 삼성서울병원에 내원하여 유골 골종으로 진단된 환자 22명, 22례를 전산화 단층 촬영 도움 하에 경피적 고주파 열치료를 시행하였다. 평균 연령은 26.5(7~55)세였고, 남자가 15명, 여자가 7명이었다. 이 중 2례는 외부에서 치료 받은 후 재발한 경우였다. 병변의 위치는 대퇴골 13, 경골 4, 비골 1, 상완골 1, 장골 1, 좌골 1, 천골 1례였다. 시술 전 3례에서 경피적 생검을 시행하여 확진 하였고, 나머지는 임상양상 및 방사선 소견으로 진단하였다. 전신 또는 척추 마취 하에 전산화 단층 촬영으로 병소의 위치를 확인한 후 고주파 전극을 병소의 중심부에 위치한 후, 섭씨 80에서 90도로 평균 6(3~8)분간 가열하였다. 외래 추시 및 전화 통화로 증상 호전 여부 및 일상 생활 정도를 추적 관찰하였으며, 평균 추시 기간은 30(4~62)개월 이었다. 결과: 추시 중 19례(86%)에서 통증이 소실되었고, 2례에서는 시술 후 각각 5개월, 12개월에 병변이 재발하였으며, 1례에서는 재발의 증거 없이 지속되는 통증이 있었다. 시술 후 4시간 정도 침상 안정 후 바로 보조기 없이 보행이 가능하였으며, 화상으로 인한 근육 손상이 발생한 1례를 제외한 21례 환자들은 합병증 없이 시술 후 평균 1.9일에 퇴원하였다. 재발이 확인된 2례는 다시 고주파 열치료를 시행하여 증상이 모두 소실되었다. 결론: 유골 골종의 치료에 있어서 전산화 단층 촬영 도움 하 경피적 고주파 열치료는 최소 침습적인 방법으로 술후 통증이 적으며, 회복이 빠르고, 안전하면서, 이제까지 보고된 수술적 절제의 결과와 비교할 만한 우수한 성적을 나타내었다.

• Journal of Chest Surgery
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• 제32권2호
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• pp.175-180
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• 1999

배경: 연세대학교 영동세브란스병원 흉부외과에서 1992년 다한증환자에서 흉곽내시경을 이용한 교감신경절제술을 시행한이래로 교감신경절제술은 원발성 다한증환자에서 간편하고 효과적인 치료방법이다. 수술직후의 만족도는 94∼98%로 보고되는 반면 6개월이 지난 장기 추적조사에서의 만족도는 약 66%로 보고되고 있고 만족도가 떨어지는 원인으로 보상성다한증에 의한 일상생활의 불편이 가장큰 요인이다. 대상 및 방법:연세대학교 영동세브란스 흉부외과에서 1992년부터 1998년 까지 783례의 다한증 수술환자중 T2 교감신경절단술 환자 89명(1군), T2 교감신경절제술 88명(2군), T2-4 교감신경절제술 138명(3군)을 대상으로 각각의 수술방법에 따라 보상상다한증의 발생 빈도와 정도을 비교하였다. 보상성다한증의 정도를 1, 없다(Absence); 2, 약간있다(Mild); 3, 눈으로 보일정도이나 생활에 지장이 없다(Embarrassing); 4, 생활에 불편할정도로 많으며 하루에 2-3번내의를 갈아입는다(Disabling)로 구분하였다. 결과: 모든 환자에서 증상이 소실되었으며 전체적인 보상성 다한증의 발생율은 1군이 64%, 2군이 73.8%, 3군이 87.8%였으며 Embarrassing 과 Disabling 의 경우 1군 15.7%, 2군 32.2%, 3군 58.0% 로 수술방법에 따른 보상성 다한증의 발생과 정도에 차이가 있었다(p<0.05) 결론: 이와 같은 결과로 보상성 다한증의 발생과 정도는 교감신경절제의 범위와 밀접한 연관이 있으며 보상성 다한증을 줄이고 장기 추적조사에서의 만족도를 증가 시키기 위해서는 T2 교감신경절제술 보다는 T2 교감신경절단술이 종 더 유용할 것으로 생각됩니다.

• Journal of Chest Surgery
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• 제31권5호
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• pp.519-524
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• 1998

고려대학교 안암병원 흉부외과에서는 1996년 1월1부터 1996년 12월말까지 1년동안 수술한 본태성 다한증 환자 137명을 대상으로 전향적으로 조사하였다. 대상 기간에 다한증으로 수술한 환자는 모두 137명이며, 남자가 83명, 여자가 54명이였다. 환자의 연령 분포는 최소 13세에서 63세까지였으며, 평균나이는 25세였으며, 이중 128명은 수부 다한증이었고 안면 다한증의 경우도 26명이었다. 수술시 교감 신경절 부위는 하부성상 교감 신경절 절제술 4례, 하부성상 교감 신경절과 흉부 2번 교감 신경절 절제술 18례, 흉부 제 2번 교감 신경절 절제술 86례, 흉부 2번, 3번 교감 신경절 절제술 10례였으며, 제 2번부터 4번까지 흉부 교감 신경절 절제술도 19례있었다. 평균수술시간은 59분 이였으며, 평균입원기간은 3.8일이었다. 흔한 합병증으로는 보상성 다한증(109례)과 통증(18례)이있었으며, 평균 8개월간 추적조사한 결과 97%에서 만족할만한 결과를 얻은 것으로 조사되었다. 본태성 다한증에서 비디오 흉강경을 이용한 흉부 교감 신경절 절제술의 적용은 효과면 에서 만족할만하며, 안전한 수술이다.

• Journal of Chest Surgery
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• 제31권4호
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• pp.374-379
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• 1998

1985년 3월부터 1997년 6월까지 강북삼성병원 흉부외과에서 치료한 자연기흉451례를 후향적으로 임상분석하였다. 대부분이 남자환자 였으며(8.2:1), 원발성 자연기흉환자의 평균연령은 26.8세, 속발성 자연기흉은 53.1세였다.속발성 자연기흉의 원인으로는 결핵이 87례(73%)로 가장 많았고, 만성 폐쇄성 폐질환이 19.2%, 그외 기관지 천식, 폐암, 진폐증, 폐렴 등이었다. 환자의 치료로는 안정 및 산소요법이 42례, 흉강 삽관술로 치료한것이 208례, 개흉하에 폐기포 절제술이나 폐엽절제술을 시행한경우가 156례, 그리고 45례에서는 비디오 흉강경수술을 시행하였다. 평균술후흉관보유기간은 개흉술이 8.3일, 비디오흉강경 수술의 경우는 4.7일이었고 흉강삽관술로만 치료한경우 평균흉관보유기간은 11.2일이었다. 본원의 경우, 최근 3년동안 비디오 흉강경 수술이 외과적 수술의 적응이 되는 자연기흉의 치료에 개흉술보다 더 흔히 적용되는 술식이 되었다(1994 33%, 1996 78%). 향후 비침습적 수술방법이 더욱더 발전함에 따라 비디오 흉강경 수술은 자연기흉의 일차적인 치료방법이 될 수 있을 것으로 생각되며, 이의 적절성을 평가 하기위한 다자간의 공동연구가 요구된다.

• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.933-943
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• 2021

Objective : Percutaneous pedicle screw (PPS) fixation is a needle based procedure that requires fluoroscopic image guidance. Consequently, radiation exposure is inevitable for patients, surgeons, and operation room staff. We hypothesize that reducing the production of radiation emission will result in reduced radiation exposure for everyone in the operation room. Research was performed to evaluate reduction of radiation exposure by modifying imaging manner and mode of radiation source. Methods : A total of 170 patients (680 screws) who underwent fusion surgery with PPS fixation from September 2019 to March 2020 were analyzed in this study. Personal dosimeters (Polimaster Ltd.) were worn at the collar outside a lead apron to measure radiation exposure. Patients were assigned to four groups based on imaging manner of fluoroscopy and radiation modification (pulse mode with reduced dose) : continuous use without radiation modification (group 1, n=34), intermittent use without radiation modification (group 2, n=54), continuous use with radiation modification (group 3, n=26), and intermittent use with radiation modification (group 4, n=56). Post hoc Tukey Honest significant difference test was used for individual comparisons of radiation exposure/screw and fluoroscopic time/screw. Results : The average radiation exposure/screw was 71.45±45.75 µSv/screw for group 1, 18.77±11.51 µSv/screw for group 2, 19.58±7.00 µSv/screw for group 3, and 4.26±2.89 µSv/screw for group 4. By changing imaging manner from continuous multiple shot to intermittent single shot, 73.7% radiation reduction was achieved in the no radiation modification groups (groups 1, 2), and 78.2% radiation reduction was achieved in the radiation modification groups (groups 3, 4). Radiation source modification from continuous mode with standard dose to pulse mode with reduced dose resulted in 72.6% radiation reduction in continuous imaging groups (groups 1, 3) and 77.3% radiation reduction in intermittent imaging groups (groups 2, 4). The average radiation exposure/screw was reduced 94.1% by changing imaging manner and modifying radiation source from continuous imaging with standard fluoroscopy setting (group 1) to intermittent imaging with modified fluoroscopy setting (group 4). A total of 680 screws were reviewed postoperatively, and 99.3% (675) were evaluated as pedicle breach grade 0 (<2 mm). Conclusion : The average radiation exposure/screw for a spinal surgeon can be reduced 94.1% by changing imaging manner and modifying radiation source from real-time imaging with standard dose to intermittent imaging with modified dose. These modifications can be instantly applied to any procedure using fluoroscopic guidance and may reduce the overall radiation exposure of spine surgeons.