• 대한기관식도과학회지
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• 제14권2호
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• pp.43-47
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• 2008

Background : Anti-reflux procedures treat gastroesophageal reflux (GER) disease. It is known that gastroesophageal reflux is likelyrelated to the increased incidence of chronic rejection in lung transplantation recipients. Because experimental animal studies areto verify this, we have tried to make an animal model of GER in a rat. Material and Methods : Using the SD rats weighing 250-300 g, we surgically induced gastroesophageal reflux and measured the gastrostomy time under anesthesia. Of three groups, Group I was the control, Group II had lower esophageal and anterior myotomy, and Group III had lower esophageal and anterior myotomy plusdiaphragmatic crural myotomy.The animals were scarified, and lung biopsies and histological examinations were performed 1 week, 2 weeks, 4 weeks, 8 weeks and 3 months after gastroesophageal reflux surgery. Results : Baseline animals (n=5) had no GER after charcoal instillation through a gastrostomy tube in Group I. Charcoal-laden macrophages were observed in GroupsII and III. To determine evidence of GER evidence, charcoal was instillated through the gastrostomy tube in group III. In contrast, Group II demonstrated severe neurophil infiltration in the bronchioles and alveolar walls after procedure. After 12 weeks, we observed the disappearance of neurophil, lymphocyte and histiocyte infiltration, and also occasional focal bronchopneumonia and bronchitis. Group III demonstrated neurophil and basophil infiltration in the bronchioles and alveolar walls which was more severe than that in Group II. Interstitial fibrotic changes were observed in Group III.Conclusion : The purpose of our gastroesophageal reflux model was to find evidence of aspiration. There was more evidence of aspiration in Group II than in either of theother two groups.

• 대한기관식도과학회지
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• 제4권1호
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• pp.52-58
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• 1998

BACKGROUND： Aspiration is defined as the laryngeal penetration of secretions below the level of the true vocal cords. Aspiration can result in life-threatening complications, such as bronchospasm, airway obstruction, pneumonia, pulmonary abscess, sepsis, and death. The patient with high vagal palsy had significant aspiration and dysphagia OBJECTIVE： To formulate a step-by-step management paradign for the patients with high vagal palsy MATERIALS AND METHODS : The medical records of 23 patients who were diagnosed as high vagal palsy from September, 1995 to April, 1998 in Seoul National University Hospital were reviewed retrospectively. Eleven patients were managed conservatively and 12 patients were operated to treat chronic aspiration. RESULTS : The main etiologies of high vagal palsy were mass lesions of the skull base such as neurogenic tumor, pseudotumor, meningioma or nasopharyngeal carcinoma. Aspiration and dysphagia improved in 7 out of 11 patients who were managed conservatively after 2.2 months on the average. The patients who were refractory to the conservative management underwent surgery and showed improvement in 10 out of 12 patients. The employed surgical modalities were vocal cord medialization combined with cricopharyngeal myotomy in 7 patients, laryngotracheal separation in 3 patients and arytenoid adduction only in 2 patients. Two patients still had gastrostomy tube due to the persistent symptoms. Two patients had improved after surgery, but died of underlying disease. CONCLUSION : The patients with high vagal palsy are recommended to be managed conservatively for the first 2 months. If aspiration and dysphagia are persisting after conservative management, vocal cord medialization combined with or without cricopharyngeal myotomy should be considered. If failed, laryngotracheal separation or gastrostomy will be the next option based on the control of the oropharyngeal secretion.

• Clinical Endoscopy
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• 제57권5호
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• pp.610-619
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• 2024

Background/Aims: Achalasia is a rare esophageal motility disease, for which peroral endoscopic myotomy (POEM) has emerged as a promising treatment option; however, recurrence remains a challenge. Timed barium esophagography (TBE) is a useful diagnostic tool and potential outcome predictor of achalasia. This study aimed to determine predictive tools for recurrence after POEM. Methods: This retrospective study enrolled achalasia patients who underwent POEM between January 2015 and December 2021. Patients were categorized into two groups using the 1-month post-POEM Eckardt scores and TBE: the discordant group (Eckardt score improved >50%, TBE decreased <50%) and the concordant group (both Eckardt score and TBE improved >50%). Recurrence was defined as a reincrease in the Eckardt score to more than three during follow-up. Results: Complete medical records were available in 30 patients who underwent POEM. Seventeen patients (56.7%) were classified into the discordant group, while 13 patients (43.3%) were in the concordant group. The overall recurrence rate was 11.9% at 1-year, increasing to 23.8% during the extended follow-up. The discordant group had a 6.87 fold higher recurrence rate than the concordant group (52.9% vs. 7.7%, p=0.017). Conclusions: These results strongly suggest that combining the Eckardt score with TBE can effectively predict recurrent achalasia after POEM. Patients in the discordant group had an elevated risk.

• Journal of Chest Surgery
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• 제38권3호
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• pp.258-262
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• 2005

환자는 18세 여자로 6년 전부터 연하곤란 및 식사 후 빈번하게 구토가 발생하였으며, 최근 6개월 동안 15 kg의 체중 감소가 있었다. 식도 계측검사에서 식도이완불능증으로 진단되었다. 약물치료를 하였으나 증상이 호전되지 않아 복강경을 이용한 수술을 결정하였다. 복부에 5개의 트로카용 소절개를 시행하였고, 복강경을 이용하여 근절개술과 전방위저부주름술을 시행하였다. 수술 후 1일째 식도조영술을 시행하였다. 조영제가 누출 없이 원활하게 통과되었다. 수술 후 2일째 식이를 시행하였으며, 술 후 9일째 특별한 문제없이 퇴원하였다.

• Journal of Chest Surgery
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• 제31권12호
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• pp.1238-1242
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• 1998

심근교각을 해부학적인 정의을 하면 심외막의 관상동맥 주행중 국한된 부분의 관상동맥이 심근섬유에 의해 둘러싸여 있는 것을 말한다. 이질환은 주로 관상동맥 조영술에서 심근수축시 관상동맥이 좁아지거나 또는 압박효과을 나타내기 때문에 알게된다. 관상동맥중 좌전하행지의 중간부위에 가장 많이 발생 한다. 심근교각은 허혈 효과을 가지고 있어서 건강한 사람에서 협심증, 심근경색, 혹은 사망의 원인이 되기도 한다. 저자들은 좌전하행지 중간부분의 압박으로 협심증을 호소한 2례의 환자을 치험하고 보고 하고자 한다. 수술은 심폐 우회술하에 좌전하행지 동맥상부을 덮은 심근에 근절개술을 시행하였다. 수술후 협심증과 압박효과는 호전되었다.

• Journal of Chest Surgery
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• 제35권2호
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• pp.157-160
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• 2002

식도이완불능증 환자의 수술은 내시경을 이용한 최소 절개술로써 개복술에 상응하는 성적을 거두고 있다. 최근에는 복강경을 이용한 식도근절개술과 위저부성형술을 통해 기존에 시행되던 흉강경을 사용한 식도근 절개술보다 환자의 만족도에서 좋은 결과를 보이는 경우가 보고된 바 있다. 이 증례에서는 풍선확장술로써 치유되지 않는 식도이완불능증을 가지고 있는 15세의 남자 환자에서 5개의 작은 절개창을 통한 복부내시경을 이용하여 식도근절제술과 위저부성형술을 시행하여 증상을 현저히 개선하고 방사선적, 임상적 객관적 치료효과를 성공적으로 치험하였다.

• Journal of Chest Surgery
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• 제12권1호
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• pp.67-74
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• 1979

Esophagocardiomyotomy [modified Heller procedure] is a widely accepted operation for relief of dysphagia in patient with esophageal achalasia. But patients with advanced achalasia were more likely to get poorer results from a modified Heller myotomy because of the dependent pouch that creates an angulation at the junction of thick-walled dilated esophagus with the thin wailed aganglionic segment and hinders complete emptying. Thorbjarnarson[1975] proposed the method including truncal vagectomy and pyloroplasty. Vagectomy and pyloroplasty should lesson the severity of acid-peptic esophagitis, if reflux should occur postoperatively. Here we presented 4 cases esophageal achalasia treated by modified Heller operation of 3 cases and one case of Thorbjarnarson method. All postoperative results are good.

• Journal of Chest Surgery
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• 제21권5호
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• pp.924-928
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• 1988

Diffuse esophageal spasm[DES] is a rare disease, and its surgical management is controversial. We experienced one case of diffuse esophageal spasm with a large epiphrenic diverticulum. We resected the diverticulum with right side approach and underwent extended esophageal myotomy from the apex of the chest to 3 cm above the diaphragm. And then we preserved the LES without antireflux procedure.

• Journal of Chest Surgery
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• 제20권4호
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• pp.745-750
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• 1987

30 case of achalasia treated by modified Heller`s myotomy at the department of thoracic surgery of Seoul National University Hospital from 1965 to 1987 were analyzed. Preoperative Symptoms were alleviated completely or partially in 90% of the 30 patients who were available for follow up study [average: 3.6 years]. Excellent or good results were achieved in 83.3% of patients. Only two of the poor results were due to reflux esophagitis. It is concluded that an antireflux procedure is not routinely necessary to prevent postoperative reflux esophagitis if the technique of espohagomyotomy is used properly.

• Journal of Chest Surgery
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• 제20권2호
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• pp.379-383
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• 1987

Pharyngoesophageal diverticulum is a well-known disease entity but is seldomly reported in Korean literature. Recently the authors experienced two cases of pharyngoesophageal diverticulum. A 46 year old female and a 51 year old female patients were admitted due to foreign body sensation in esophagus and dysphagia. Preoperative esophagography and esophagoscopy confirmed the diagnosis of pharyngoesophageal diverticulum in each patient. The authors performed one-stage pharyngoesophageal diverticulectomy and myotomy. Postoperative esophagography revealed no diverticulum or stenosis and symptoms were markedly relieved.