• 대한기관식도과학회지
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• 제8권1호
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• pp.50-56
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• 2002

Advanced or recurrent thyroid cancer, and metastatic paratracheal lymph nodes may directly invade the trachea and lead to tracheal stenosis. In these cases the stenosis is not circumferential and it would be possible to reconstruct the trachea after partial resection of the stenotic trachea. We experienced five cases of tracheal reconstruction after partial resection of the tracheal wall in four Patients of advanced thyroid cancer, and in one Patient of malignant paratracheal lymphadenopathy.

• 대한기관식도과학회지
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• 제3권1호
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• pp.61-69
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• 1997

A total of 55 patients underwent surgical managements for postintubation tracheal stenosis from July 1975 through March 1997. All but 8 had received ventilatory assistance. The patients had S cuff lesions, 17 stoma lesions, 7 at both levels, 5 at subglottic lesions. Thirty two patients underwent the sleeve tracheal resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Twenty two patients received the Montgomery T-tube for relief of airway obstruction. Simple excision of granulation tissue was done in 7 patients. Rethi procedures(anterior division of cricoid cartilage, partial wedge resection of lower thyroid cartilage and T-tube molding) were performed in 2 subglottic stenosis patients. And the other subglottic patient was received permanent tracheal fenestration at 1975. The tracheoesophageal fistula patient was done sleeve tracheal resection and end-to-end anastomosis with interrupted double layer closure of esophageal fistula site. Cervical approach was used in 49 cases, cervicomediastinal in 13 cases and median stemotomy In 6 cases. Techniques for obtaining tension-free anastomosis included a cervical neck flexion(15-30$^{\circ}$) in all sleeve resection patients and laryngeal release in one. The length of resection was 1.5 to 5.0 on A total of 41 patients(74.5%) had good(24 patients) or satisfactory(17 patients) results. But in ten cases, the restenosis of anastomosis site which is the most common complication was developed Two of them underwent a second reconstruction and 8 patients required T-tube insertion for airway maintenance. Three patients(5.4%) died. The causes of death were tracheo-innominate artery fistula(2) and sudden obstruction of airway(1).

• 대한두경부종양학회지
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• 제37권1호
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• pp.63-66
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• 2021

Supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) involves the removal of the whole thyroid cartilage, both true and false vocal cords, the ventricles, and the paraglottic spaces, sparing the cricoid cartilage, hyoid bone, and at least one functional and mobile cricoarytenoid unit. Reconstruction is performed by suturing of the cricoid cartilage up tightly to the hyoid bone, so trachea-releasing procedures are needed to prevent leakage at anastomosis site. In case of advanced tranglottic cancer invading tracheal tracheal wall, we need to perform additional circumferentrial circumferential tracheal wall resection. However, when we perform SCPL, circumferential resection of tracheal wall is limited because SCPL procedure itself needs releasing of tracheal length. We report a case of advanced transglottic cancer involving tracheal wall treated with induction chemotherapy and SCPL including tracheal wall resection with reconstruction of tracheal defect by sternocleidomastoid muscle flap covered with skin graft.

• Journal of Chest Surgery
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• 제18권4호
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• pp.792-799
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• 1985

Primary neoplasms of the trachea are rare, but are a very serious critical life-threatening disease. Nearly all the lesions of the trachea are presented as obstructive lesions. Bronchoscopic examination including chest C-T, tomogram and air tracheogram are essential for the further definition of these lesions. The need for removal of tracheal tumors whether complete or incomplete, is clear enough regardless of the histology of the tumor. We have experienced 9 cases from Jan. 1965 to June, 1985. One patient with tracheal hamartoma was cured with complete resection through rigid bronchoscopy and another patient with fibrous histiocytoma was treated with re-excision and laser evaporation through superior mediastinotomy due to recurrence, 1 year later. The remaining patients were treated with mass excision or segmental resection and end-to-end anastomosis through collar incision and superior mediastinal sternotomy. The remaining two patients were operated with and segmental resection and end-to-end anastomosis of trachea using partial cardiopulmonary bypass. The histologic diagnosis were adenoid cystic Ca[5], fibrous histiocytoma[1], mucoepidermoid Ca[1]. hamartoma[1], anaplastic Ca.[1]. Three patients were treated post-operatively with radiation; with adenoid cystic Ca.[2] and anaplastic Ca.[1]. Their post-operative courses were uneventful during the follow-up from 2 months to 7 years.

• Journal of Chest Surgery
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• 제28권3호
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• pp.328-331
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• 1995

A 42-year-old Marfan female had a chronic dissection of the descending aorta[Type B and the aneurysmal expansion of the descending aorta caused compression of the trachea resulting in respiratory distress which mimicked bronchial asthma. The patient has been successfully managed by resection and replacement of the aneurysm in the descending aorta. The operation could be done without the aid of the partial cardiopumonary bypass. As the patient had been prepared by unilateral axillo-bifemoral by-pass using prosthetic graft 8mm in diameter 10days prior to the main operation.

• 대한기관식도과학회지
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• 제10권2호
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• pp.17-21
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• 2004

Background Insertion of tracheal stent in the treatment of benign tracheal & bronchial disease has increased since the introduction of expandable metallic stent. Material & Methods : Between Jan, 1995 and Feb. 2004, eight patients who had benign tracheo-bronchial disease underwent insertion of expandable metallic tracheal stent. We retrospectively analyzed stent insertion indications, complications, and following the result. Results : Surgical indications were post-intubation tracheal stenosis (1 case), tracheal stenosis following tracheal surgery (2 cases), tracheo-esophageal fistula (2 cases), broncho-pleural fistula(1 case), left main bronchus stenosis following bronchoplasty (1 case), and left main bronchus stenosis due to mediastinal repositioning (1 case). Expandable metallic tracheal stent was inserted in five patients to resolve dyspnea caused by airway obstruction, and to prevent recurrent pneumonia in three patients. The complication developed in 6 patients $75\%$; 3 cases of distal stenosis due to growth of granulation tissue, and one case each of tearing of posterior membrane, aggravation of tracheo-esophageal fistula, and airway partial obstruction due to stent migration. The stent was removed in 5 patients and tracheal surgery (tracheal resection and end to end anastomosis with primary repair of esophagus, pericardial patch tracheo-bronchoplasty, tracheal repair and omental wrapping) was performed in 3 patients. Conclusion Insertion of self expandable metallic stent in benign tracheo-bronchial disease is an effective means of relieving dyspnea for only a short period, and it did not increase the long term survival. Better means of treatment of benign tracheo-bronchial stenosis in necessary.

• Journal of Chest Surgery
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• 제31권2호
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• pp.194-197
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• 1998

근상피종은 방추형, 형질세포양, 상피세포양, 투명세포들의 다양한 비율로 구성되는 양성종양으로 기관내 발생빈도가 극히 희귀하여 현재까지 전세계적으로 1례가 보고 되었으며 국내에서는 아직 보고례가 없었다. 본 증례는 우측 경부 종괴를 주소로 내원한 38세 여자 환자로 갑상선 종양및 기관종괴 진단하에 절제문합술을 시행하였다. 절제된 종괴는 주위와 잘 경계지워지는 충실성 조직으로 이루워져 있으며 주로 방추형 혹은 상피양 세포로 구성되고 간간히 세포질의 투명변성이 보였다. 이들 세포는 S-100 단백과 평활근 액틴에 양성이었고 전자현미경 검색상 세포질내에 다량의 소섬유와 기저막 물질이 세포질외에서 관찰되어 양성 근상피종에 합당한 소견을 보였다. 환자는 술후 8개월째 합병증없이 정상생활을 영위하고 있다.

• Journal of Chest Surgery
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• 제38권11호
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• pp.795-798
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• 2005

기관 삽관 후에 발생한 기관 협착에 대한 근본적 치료는 기관 부분 절제 및 단단 문합이다. 기관 협착에 대한 성공적이지 못한 교정으로 인해 발생하는 기관의 재협착에 대한 수술 치료는 쉽지 않다. 재수술이 실패할 경우 환자는 평생 기관절개 상태 및 목소리 소실을 안고 살아야 한다. 첫 번째 수술이 실패했을 경우 염증반응, 부종, 섬유화가 해소될 때까지 약 $4\~6$개월을 기다린 후 재수술을 시행해야 한다 환자의 상태에 대한 정확한 평가가 필요하며 일단 재수술의 후보자로 선정되면 재수술의 성공률은 $90\%$ 이상이다. 저자들은 기관 삽관으로 인해 발생한 기관 협착에 대해 성공적이지 못한 교정 후 발생한 기관의 재협착 2예에 대한 치험을 문헌 고찰과 함께 보고하는 바이다.

• 대한두경부종양학회지
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• 제14권2호
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• pp.236-243
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• 1998

1991년부터 1997년월까지 7년간 한림대학교 이비인후과학교실에서 국소침범한 갑상선암으로 치료를 받은 10명의 환자들을 후향적으로 검토하여 다음과 같은 결과를 얻었다. 1) 성별 분포는 남녀비는 1:2.3이었으며 연령별 분포는 60대 이상이 7명으로 노인에 호발함을 알 수 있었다. 2) 임상승상은 애성이 5례(50%)로 가장 많았으며 무증상이면서 경부종괴로 온 경우가 3례 그외에 연하곤란, 호흡곤란 객혈 등이었다. 3) 침범된 구조는 기관 7례, 반회후두신경과 종격동임파절이 각각 5례, 경부식도 3례, 경동맥 3례, 기관주위임파절 3례, 하인두 1례, 미주신경 1례 순이었다. 4) 침범된 구조물들에 대한 수술로는 기관 수상절제술 및 단단문합술이 1례. 기관 수상절제와 윤상기관성형술 1례, 기관 창절제술 및 일차봉합술 1례. 기관 창절제술 및 흉쇄유돌근-근막피판재건술 1례, 기관 면도식절제술 1례, 식도 부분절제술 2례, 식도 면도식절제술 1례, 편측 윤상후두절제술 1례, 윤상연골 부분절제술 및 흉쇄유돌근-근골막피판재건술 1례, 갑상연골 면도식절제술 1례, 반회후두신경절제술이 2례, 미주신경절제술 1례, 경동맥절제술 및 $Gortex^{\circledR}$를 이용한 재건술 2례, 경동맥 면도식절제술 1례 등이었다. 이상에서 국소침범한 갑상선암은 대부분의 경우 가능한 완전절제를 시도하였으나 광범위 절제 후 재건술의 어려움이 있었으며 또한 대부분이 노인 환자로서 전신상태에 따른 예후가 불량한 경우가 있었다. 따라서 각 환자의 나이와 침범 정도에 따른 개별적인 술식으로 치료방법을 선택하는 것이 중요할 것으로 사료된다.하다고 생각된다. 6) 횡문근육종과 골육종의 경우 3례중 2례에서 광범위한 수술적 제거후 방사선치료를 병행하였으며, 현재 무병생존 중이고, 1례는 화학요법과 방사선치료의 병합요법을 시행하였으나 실패하였다. 육종의 경우 광범위한 수술적 절제가 가장 좋은 치료로 사료되며, 미세잔존암이 남아있는 경우는 방사선 치료의 병합이 필요하리라 생각된다.\beta$4-tyrosine phosphorylation site (Clone M)을 얻었다. 암 세포의 부착 및 침투 능력의 기능적 연구로 모노 클로날 항체와 fibronectin, laminin, Matrigel을 단백질 기질로 사용하였으며 결과 비교를 위하여 pRc/CMV 벡터만 주입시켰던 클로운과 방광암 세포주를 $\beta$4 integrin 음성 대조군으로 또한 이 Integrin의 높은 발현을 보이는 두경부 편평상피암 세포주를 양성 대조군으로 이용하였다. 결과 : 세포부착능력에 있어서 온전한 $\beta$4 cytoplasmic domain이 존재하는 클로운이 laminin에 강한 부착능력을 보였으나 fibronectin의 부착정도는 $\beta$4 integrin의 표현정도와 관계없이 모든 클로운에서 비슷하였다. Matrigel을 투과하는 암세포 침윤 능력에서는 $\beta$4 integrin의 표현이 존재하는 클로운들이 투과 능력이 높았으나 세포외 리간드가 없는 control membrane을 사용하였을 때와 비교하여 투과능력의 차이를 보이지 않았다. 결론 : 유전자 주입(transfection) 방법으로

• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4529-4532
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• 2013

Background: Acute normovolemic hemodilution (ANH) has been widely used to prevent the massive blood loss during hepatic carcinoma. The influences of ANH on coagulation function are still controversy, especially in elderly patients. The study observed ANH effects on coagulation function and fibrinolysis in elderly patients undergoing the disease. Materials and Methods: Thirty elderly patients (aged 60-70 yr) with liver cancer (ASA I or II) taken hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group (n=15) and control group (n=15). After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch (130/0.4) and Ringer's solution, respectively. Blood samples were drawn from patients in both groups at five different time points: before anesthesia induction (T1), 30 min after ANH (T2), 1 h after start of operation (T3), immediately after operation (T4), and 24 h after operation (T5). Then coagulation function, soluble fibrin monomer complex (SFMC), prothrombin fragment (F1+2), and platelet membrane glycoprotein (CD62P and activated GP IIb/GP IIIa) were measured. Results: The perioperative blood loss and allogeneic blood transfusion were recorded during the surgery. The perioperative blood loss was not significantly different between two groups (p>0.05), but the volume of allogeneic blood transfusion in ANH group was significantly less than in control group ($350.0{\pm}70.7$) mL vs. ($457.0{\pm}181.3$) mL (p<0.01). Compared with the data of T1, the prothrombin time (PT) and activated partial thromboplastin time (APTT) measured after T3 were significantly longer (p<0.05) in both groups, but within normal range. There were no significant changes of thrombin time (TT) and D-dimer between two groups at different time points (p>0.05). SFMC and F1+2 increased in both groups, but were not statistically significant. PAC-1-positive cells and CD62P expressions in patients of ANH group were significantly lower than those at T1 (p<0.05) and T2-T5 (p>0.05). Conclusions: ANH has no obvious impact on fibrinolysis and coagulation function in elderly patients undergoing resection of liver cancer. The study suggested that ANH is safe to use in elderly patients and it could reduce allogeneic blood transfusion.