• Journal of Chest Surgery
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• 제31권5호
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• pp.540-543
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• 1998

본 례는 65세 남자 환자에서 전폐절제술후에 발생한 기관지 늑막루 및 농흉의 치험례로 일차적으로 만성화하게한 다음 정중흉골절개하 심낭절개로 좌 주기관지를 노출후 자동봉합기(TA 4.8-30)로 좌 주기관지를 이중 결찰 봉합하여 좌측 늑막강내의 염증을 일으키는 원인인 기관지 늑막루를 차단한 다음, 늑막강내의 농흉을 치료함에 있어 흉강경을 이용하여 변형된 Clagett술식으로 내면을 깨끗하게 세척한 후 민감한 항생제를 이용하여 늑막강을 채우고 흉강삽관을 뽑고 그 부위를 봉합하는 방법을 시행하여 잔존 농흉강을 폐쇄하였다.

• Tuberculosis and Respiratory Diseases
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• 제40권6호
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• pp.638-645
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• 1993

연구목적 : 폐절제술 후 폐환기능은 절제될 폐와 절제술 후 잔여 폐의 기능, 또한 잔여 폐의 잠재적인 대상능력에 의존한다. 최근에는 폐암 환자에서 광범위한 폐절제술이 행하여지는 추세이며 종종 만성폐질환으로 인하여 폐환기능이 상당히 손상된 환자에서도 이러한 수술이 행해지고 있는데 이들에서 절제술 후 폐기능의 회복정도를 예측함은 매우 중요하다. 본 연구의 목적은 폐절제술 후 폐기능의 변화를 장기간 관찰하여 기간에 따른 폐기능의 변화양상을 파악하여 폐절제술이 폐기능에 미치는 영향을 분석함에 있다. 방법 : 폐암 및 양성폐질환으로 전폐절제술 및 폐엽절제술을 시행받은 환자중 수술 후 특기할 만한 합병증이 없고, 18개월 이상 정기적으로 추적관찰이 가능하였던 16예를 대상으로 수술 전과 수술 후 5년동안 3개월 간격으로 폐환기능검사를 실시하여 폐기능의 변화양상을 분석하였다. 결과: 1) 수술 1주 후 폐기능은 폐엽절제군과 전폐절제군 각 군에서 수술전 측정치의 FVC 59.8%, 52.2%, FEV1 63.1%, 50.5%로서 예측치에 비하여 유의하게 낮았으며(p<0.05), 두군 사이에 유의한 차이는 없었고, 1-3개월 후 예측치와 유사하게 회복되었다. 2) FVC는 폐엽절제군은 6-24개월에는 예측치보다 높았고, 그 이후에는 예측치와 유사하게 유지되었으며, 전폐절제군에서는 6-36개월에는 예측치와 유사하게 유지되다가 수술 3년 6개월 이후에는 호전되어 예측치보다 약간 높게 유지되었다. 3) FEV1은 폐엽절제군과 전폐절제군 각각 6개월-5년동안 뚜렷한 변화없이 예측치와 유사하게 유지되었다. 4) FEV1/FVC는 두군 모두에서 수술 전후 전기간동안 통계학적으로 유의한 변화가 없었다. 5) FEF25-75%는 폐엽절제군에서는 6개월-5년동안 유의한 변화없이 예측치보다 높게 유지되었고, 전폐절제군에서는 수술 1년 이후 감소하여 예측치보다 낮게 유지되었다. 6) MVV는 폐엽절제군의 경우 2년까지는 예측치와 유사하게 유지되다가 그 후 약간 감소하는 경향을 나타내었고, 전폐절제군의 경우는 전 추적기간 동안 예측치와 유사하게 유지되었다. 7) 전폐절제군이 폐엽절제군에 벼해 수술 후 6개월의 FVC, FEV1, FEF 25-75%, MVV가 통계학적으로 유의하게 낮았으며(p<0.05), 수술 2년 이후에는 전폐절제군이 폐엽절제군보다 FVC, FEV1, FEF 25-75%가 낮은 경향을 보였으나 통계학적으로 유의하지는 않았다. 결론 : 폐환기능은 수술 직후에는 수술 전보다 현저히 감소하였다가 수술 1-3개월 후 회복되어 예측치와 유사해지고 6개월에 최고에 이르고, 2년 이후 약간 감소하여 5년까지 뚜렷한 변화없이 예측치와 유사하게 유지되었다. 폐엽절제군과 전폐절제군 사이의 폐환기능의 차이가 가장 뚜렷한 시기는 수술 6개월-1년 사이였고, 수술 2년 이후에는 두군 사이의 차이가 감소하였다.

• Journal of Chest Surgery
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• 제29권3호
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• pp.315-321
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• 1996

폐암 환자에서 기관지성형술은 전폐절제술을 받기에 폐기능이 충분치 않은 환자에서 사용되었으나 최근에는 일부 환자에서 전폐절제술을대신할만큼 발달되었다 1992년 1월부터 1995년 7월까지 15례의 폐암 환자에서 기관지성형술을 시행하였다. 연령 분포는 46세에서 70세까지였으며 60대가 8례로 가장 많았다. 남자 13례 여자 2례 였다. 소매우상엽절제술이 7례로 가장 많았고 소매우하엽절제술 2례, 소매좌 상엽절제술 5례, 소매전폐절제술이 1례였다. 수술 병기는제 1병기 3례, 제 2병기 8례,제 3병기가 1례였고 T4N2MO가 1례 였다. 술후 합병증을 보면 국소적 재발이 3례로 가장 많았고 그외 문합부위 육아조직 형성이 1례, 창상감염이 1례였다. 패혈증에 의한 수술사망이 1례 있었으며 만기사망이 2례 발생하여 전 체 환자의 3년 생존율이 80%였다. 술전 폐기능검사를 이용하여 술후 예상 FEVI을 구하여 술후 실측 FE'Vl과 비교해 본 결과 상관계수 0.71로 상관관계가 있는 것으로 나타나 문합부위 이하의 폐기능이 잘 보존 된 것으로 사료되 었다. 결론적으로 폐암 환자의 일부에서 수술이 원만히 이루어지고 술후 적절한 환자관리가 된다면 기관지 성형술이 幌瓚卉┝杏릿\ulcorner향상된 폐기능을 유지하면서 높은 생존율을 보일 것으로 사료된다.

• Journal of Chest Surgery
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• 제22권2호
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• pp.321-324
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• 1989

The Swyer-James syndrome is rare abnormality that may be encountered on routine chest X * ray examination and frequently presents a diagnostic problem. Recently, we experienced a case of Swyer-James syndrome which was accompanied with ipsilateral uncontrolled pneumothorax. We performed exploratory thoracotomy because of failure of re-expansion of the lung. Right pneumonectomy was performed and postoperative course was uneventful.

• Journal of Chest Surgery
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• 제25권7호
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• pp.732-735
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• 1992

We experienced a case of application of Gianturco Self-Expendable Metal vascular stent for S V.C. syndrome at the postoperative stae of pneumonectomy for Lung cancer[Squamous cell carcinoma, stage IIIa] Placement was performed under fluoroscopic guidance. Clinical problem for patient was resolved satisfactorily Long-term follow-up is required to determine restenosis, complication, and recurrence of cancer, etc.

• Journal of Chest Surgery
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• 제28권11호
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• pp.1007-1013
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• 1995

We managed 80 patients of bronchiectasis from Jan.1983 to Dec.1992 admitted to the department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital. We evaluated clinically these patients and summarized as follows. Alpha-hemolytic streptococcus was the most commonly found bacterial strain in microbial study. For the conservative treatment, first generation cefalosporins, aminoglycosides and ampicillin were used as antibiotic therapy in this order of frequency. The preoperative final diagnosis was made by bronchography and HRCT. In the image study saccular type bronchiectasis was 47.1%, cylindrical 27.5%, mixed 17.6% and varicose 7.8%. Anatomically left side involvement was more frequent than the right as 61.2% to 38.8% and the most commonly invading lobar area was left lower. Reversibility after conservative treatment for all the types of bronchiectasis was 66%. Surgical treatment were done in 50 cases, among these left lower lobectomy was 38.0%, left lower lobectomy with ligular segmentectomy 22.0%, right middle and lower bilobectomy 16.0%, right lower lobectomy 10.0%, left pneumonectomy 10.0%, right pneumonectomy 4.0%. In 10 cases, there remained some lesion in the other sites of lung parenchyme after first attempt surgical resection because the distribution of lesion is too broad to resect out in single thoracotomy hoping improvement by medical management.

• Journal of Chest Surgery
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• 제26권8호
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• pp.613-619
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• 1993

As developing surgical techniques and postoperative cares, a pneumonectomy is a relatively popular surgical method in disease which is not treated completely with other type of pulmonary resection, but a postpneumonectomy complication is a life-threatening serious problem if it occurred. We performed one hundred twenty-five cases of pneumonectomy for treatment of various causes of pulmonary diseases in Kosin Medical College during about ten years, and we experienced 41 cases of postoperative complications in 29 patients, so we analyzed them. The most common complication is an empyema thoracis in 13 cases[10.4%], of which one case combined with bronchopleural fistula died on early postoperative day. Of them except one case, the early postoperative empyema thoracis[within 30 days] were 6 cases, and the late postoperative empyema thoracis[above 30 days] were 6 cases. The main etiologic pathogens were a staphylococcus in early postoperative empyema and a streptococcus in late postoperative empyema, but the most cases were mixed infections with pseudomonas, klebsiella, acinectobacter, and candida. The treatment of postoperative empyema thoracis were that 4 cases were treated with open drainage using chest tube, 7 cases with Clagett`s operation, and 1 case with thoracoplasty. The next common complication was a postoperative serious respiratory insufficiency in 7 cases. And the other complications were massive postoperative bleeding in 5 cases, of which 2 cases advanced to occurrence of postoperative empyema thoracis, and wound disruption in 4 cases, cardiac arrhythmia in 3 cases, contralateral pneumothorax and pneumonia in each of 2 cases, esophagopleural fistula in 1 case. The postoperative deaths were 9 cases[7.2%] of 125 cases, the causes of death were respiratory insufficiency in 6 cases, sepsis in 2 cases, and cardiac arrhythmia in 1 case.

• Journal of Chest Surgery
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• 제24권8호
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• pp.782-791
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• 1991

In Pusan Paik Hospital, Inje University, we experienced 174 cases of pulmonary resections for pulmonary tuberculosis from Jun. 1979 to Feb. 1990. In all of them automatic stapling devices were used for division of lung parenchyme and /or bronchial closure. The results were as follows; l. In 174 cases[male 100, female 74], third and fourth decades were 116 cases [66.7%]. 2. Indications for lung resection in the radiographic findings were destroyed lung 47 cases[27.0%], destroyed lobe 42 cases[24.1%], cavitary lesions 42 cases[24.1%], tuberculoma 22 cases[12.7%], and bronchial lesions 21 cases[12.1%]. 3. The mean of staplers used in the operations was 1.6, and possible stapler-associated complications were only 2 cases of bronchopleural fistula after pneumonectomy. 4. Twenty-seven of 36 patients with bilateral lesions and 52 of unilateral ones on chest X-ray films were AFB positive on preoperative sputum smears. Twenty-three[85.2%] of bilateral lesions and 51[98.1%] of unilateral ones were AFB negative at 6 months after operations. 5. Main complications of resections were operative death 1[0.6%], empyema 4[2.3%], respiratory insufficiency 3[1.7%], pleural dead space 5[2.9%], and bronchial spreading of tuberculosis 2[1.1%]. Bronchopleural fistula were only 2 cases after pneumonectomy and none after lobectomy or segmentectomy. 6. One hundred and forty two patients[92.8%] of 153 with available follow-up data were in the state of good quality of life.

• Journal of Chest Surgery
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• 제23권4호
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• pp.750-757
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• 1990

Empyema with bronchopleural fistula is an uncommon, but serious problem. Early diagnosis and adequate drainage of the empyema cavity are well established principles for the initial management of this condition and will enable patient to recover from the toxic effects of loculated pus. 37 patients of empyema with bronchopleural fistula were treated at the department of the chonbuk National University Hospital between 1981 and 1988. The age group of fifty and sixty decades occupied 64.8%. Bacteriologic cultures of the pus were postive in 56.8%. The most common organism of the culture was staphylococci(42.9%). And the others were Pseudomonas(19%). Klebsiella(14.3%), and E. doli. No growth of pathologic organism was reported 43.2%. 24 patients of empyema with bronchopleural fistula were nonoperative causes : There were 10 pulmonary tuberculosis, 3 abscess, 9 ascending infection, one bronchiectasis and one tumor, respectively. The remaining 13 were occurred as postoperative complications ; pneumonectomy in 6, lobectomy in 4, decortication in 2, and lobectomy with segmentectomy in 1. When used as the initial mode of drainage, closed thoracostomy was performed to almost all of the patients, but 4 patients were died during this treatment. Main operations were performed except 4 died patients ; open thoracostomy in 21, open thoracostomy with myoplasty in 3, decortication in 5, decortication with resection in 3, and completion pneumonectomy in 1. Open thoracostomy was performed in 21 patients which results were favorable except one death. Permanent open thoracostomy is an old but still useful minor operation in patients with empyema with bronchopleural fistula. The overall mortality rate was 15% (6 patients) and the causes of the death were respiratory insufficiency or sepsis, or both.

• Journal of Chest Surgery
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• 제53권3호
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• pp.140-143
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• 2020

Primary cardiac sarcoma is rare, and intimal sarcoma is an extremely rare and highly lethal disease. We report a case of a 62-year-old woman who was incidentally diagnosed with a primary cardiac sarcoma originating from the left atrial appendage and extending to the left superior pulmonary vein. The location of the tumor was very complicated, posing a major challenge for complete resection. We successfully performed complete resection of the cardiac sarcoma via cardiac autotransplantation with left pneumonectomy. The patient recovered uneventfully, without any adjuvant therapy as of 6 months postoperatively. Autotransplantation of the heart may be suggested as a reasonable surgical option for extensive left atrial tumors.