• Journal of Chest Surgery
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• 제24권10호
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• pp.1039-1043
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• 1991

The bullectomy, or sedge resection of the lung including bullae is the treatment of choice for the recurrent spontaneous pneumothorax, and but results in pleuropulmonary fistulae in postoperative periods in some emphysematous lungs. There are many methods to close the air leakages with T-M, Talc powders. Or the closure of air leakage sites can be closed c resuture, wedge resection or lobectomy through re-explothoracotomy. Tisseel, a in thoracic surgical areas in recents. We have sealed the post-operative air leakage sites after bullectomy or segmental resection for 4 recurrent spontaneous pneumothorax with the spray of Tisseel & throbin through thoracoscope without re-explothoracotomy. The post-operative courses are uneventful to now.

• Journal of Chest Surgery
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• 제32권3호
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• pp.326-329
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• 1999

폐림프관평활근종증은 드물게 발생하는 질환으로 거의 대부분 가임기의 여성에서 발생하며 매우 빠르게 호흡부전이 발생하여 평균 10년이내에 사망하게 되는 질환이다. 이 질환은 폐의 림프관, 혈관, 그리고 기도에 비정형적인 평활근이 점진적으로 증식하여 유발되며 결국 원위부의 낭성 변화를 초래하여 자주 재발성 기흉을 일으키게 된다. 저자들은 양측의 재발성 기흉의 병력을 가진 30세 여자환자에서 폐림프관평활근종증을 치험하였다. 환자는 우측 개흉술을 통해 폐생검을 시행하였으며 폐림프관평활근종증으로 진단되었다. 이에 문헌고찰과 함께 보고하는 바이다

• Journal of Chest Surgery
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• 제21권2호
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• pp.299-306
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• 1988

We have reviewed 330 cases of spontaneous pneumothorax from Jan. 1980 to Jul. 1987 at the department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University. The ratio of male to female was 8.4:1, predominant in male. The incidence according to the age group was highest as 32% in the adolescence between 21 and 30 years old. The site of pneumothorax was right in 48%, left in 45% and bilateral in 7%. The initial symptoms were frequently dyspnea in 85%, chest pain in 63%. The etiologic factors were as follows; bleb origin in 31%, tuberculous origin in 30%, COPD in 3.3%, lung cancer in 1.5%, unknown in 29%. There was no significant difference in seasonal incidence irrespective of tuberculous or sex. The employed managements were as follows; bed rest with oxygen inhalation in 4 cases, closed thoracostomy in 326 cases, open thoracotomy in 122 cases, median sternotomy in 23 cases. The operative procedures at thoracotomy were as follows; simple pleurodesis in 5 cases, bleb excision or wedge resection in 113 cases, segmentectomy or lobectomy in 17 cases, decortication in 42 cases. Recurrence rate of each treatment was as follow; 50% in conservative treatment, 19% in closed thoracostomy, 2% in open thoracotomy, 4% in median sternotomy. Therefore overall recurrence rate was 12%. Open thoracotomy was the most effective procedure in recurrent pneumothorax, previous contralateral pneumothorax, bilateral simultaneous pneumothorax, visible bleb or bullae on the chest x-ray and persistent air leakage. 23 cases of unilateral spontaneous pneumothorax was examined whether or not underlying pathology of pneumothorax at opposite lung. 18 cases[78%] were positive findings. Therefore, bilateral thoracotomy by median sternotomy was a good operative method preventing contralateral pneumothorax.

• Journal of Chest Surgery
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• 제52권2호
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• pp.85-90
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• 2019

Background: Variation exists in the initial treatment for the first episode of primary spontaneous pneumothorax (PSP), and no definitive consensus exists due to a lack of high-quality evidence. This study examined the outcomes of needle aspiration and closed thoracostomy in first episodes of PSP requiring intervention. Methods: This study was a randomized, prospective, single-center trial conducted between December 2015 and August 2016. Patients of all ages with a documented first episode of PSP who were unilaterally affected, hemodynamically stable, and had a pneumothorax measuring over 25% in size were included. Patients with underlying lung disease, severe comorbidities, bilateral pneumothorax, tension pneumothorax, recurrent pneumothorax, traumatic pneumothorax, and pregnancy were excluded. Patients were randomly assigned to the needle aspiration or closed thoracostomy group using a random number table. Results: Forty patients with a first episode of PSP were recruited, and 21 and 19 patients were included in the needle aspiration group and the closed thoracostomy group, respectively. The hospital stay of each group was $2.1{\pm}1.8days$ and $5.4{\pm}3.6days$, respectively (p<0.01). However, no significant differences were found in the success rate of initial treatment or the 1-month and 1-year recurrence rates. Conclusion: Needle aspiration is a favorable initial treatment in patients experiencing a first episode of PSP.

• Journal of Chest Surgery
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• 제28권2호
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• pp.166-169
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• 1995

Pneumothorax, a frequently encountered disease in the clinic, has been interesting to surgeons for it`s high recurrence rate. 52 patients with a second attack of pneumothorax at our hospital in a 24 month period were evaluated especially for the risk factors of recurrence. The results were as follows:1. Patients after operative treatment[21 cases There were no postoperative complications and recurrence.2. Patients with tube drainage or conservative treatment [31 cases [i Overall recurrence rate was 45.2 %. [ii Suggestive risk factors for the recurrence were: age above 30 years, short period of thoracostomy less than six days. And other factors such as male, right lung, higher level of lung collapse were thought to be followed further more.

• Journal of Chest Surgery
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• 제27권3호
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• pp.221-225
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• 1994

Video-assisted thoracic surgery[VATS] has recently evolved as an alternative to thoracotomy for several thoracic disorders. Between March 1993 and September 1993, 42 patients underwent VATS at Gil General Hospital. They were diagnosed as spontaneous pneumothorax in 34[81.0%], mediastinal mass in 5, congenital lobar emphysema in 1, traumatic hemothorax in 1, and sarcoidosis in 1. For pneumothorax, wedge resection of bullae or blebs was done in 18 patients, wedge resection and limited parietal pleulectomy in 13, and only pleulectomy in 2. And excision for mediastinal mass in 5, hematoma evacuation for chronic hemothorax in 1, biopsies of mediastinal lymph node and lung for confirming sarcoidosis in 1, and lobectomy of left upper lobe for congenital lobar emphysema in the child of 12 years. The period of chest tube drainage and postoperative hospitalization averaged 3.8 days [range, 1 to 11 days] and 5.9 days [range, 2 to 18 days]. Three complications occurred in 3 patients with pneumothorax [7.1%, 2 recurrent pneumothorax and 1 postoperative bleeding], and the conversion to open thoracotomy was done in 1 due to massive air leak. The causes of postoperative air leak were speculated and the techniques for saving expensive Endo-GIA staplers are described in this paper. VATS is safe and offers the benefits of reduced postoperative pain and rapid recovery. Our experience indicates a markedly expanded role for VATS in the diagnosis and treatment of various thoracic diseases.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1502-1507
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• 1992

Between February and July 1992, videothoracoscopic bullectomy was performed in nineteen patients with primary spontaneous pneumothorax. The indications of this surgery are recurrent in 12, persistent airleakage in 4 and previous contralateral pneumothorax in 3 patients. For the good operative field, we used double lumen endotracheal tube and put the CO2 gas into the thoracic cavity to make the lung collapse. We usually apply the endoGIA or electric cauterization for handling the bleb or bullae and there were 9 cases with of endoGIA only, 4 electric cauterization only and 6 both procedures. To evaluate the advantage of the Videothoracoscopic surgery, we compared surgical results with that of the tho-racotomy group[19 patients]. There were significant differences in operative time[93.8$\pm$41.9 min and 17.1$\pm$53.9 min, p< 0.01] and postoperative airleakage duration[35.6$\pm$113.3 hours and 117.9$\pm$214.4 hours, p<0.05] between the Videothoracoscopy and thoracotomy group. Tube indwelling time was shortened in Videothoracoscopy group[p<0.05]. The hospital stay was very short[p<0.01] and the patients needed analgesic injection less frequentley in videthoracoscopic group[p<0.05] In conclusion, we prefer the Videothoracoscopic procedure to the thoracotomy in uncomplicateed patients with pneumothorax because of simple procedure and good results.

• Journal of Chest Surgery
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• 제24권5호
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• pp.451-458
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• 1991

We have observed 101 cases of recurrent spontaneous pneumothorax from Sep. 1979 to Dec. 1989 at the Department of Thoracic & Cardiovascular Surgery, College of Medicine, Inje University, Pusan Paik Hospital and the result obtained as follows. 1] Age range of patients was the first decade to seventh decade. Males outnumbered females by 6.7: l. One or two episodes of recurrent attack were noted in majority cases. 2] In distribution of the lesion sites, right side was 55 cases[55.4%], left 42 cases[41.9%], and bilateral 4 cases[3.0%]. 3] In clinical manifestations, abrupt onset of dyspnea was 78 cases[77.2%], chest pain 48 cases[47.5%], cough 9 cases[8.9%] and chest discomfort 8 cases[7.9%]. 4] Of 101 cases, 48 cases were associated with pulmonary tuberculosis and other cases were associated with subpleural bullae and blebs[26 cases], emphysema[7 cases], bronchiectasis[2 cases], lung cancer[1 case], and silicosis[1 case], 5] In 88 cases[87.2%] of patients, the magnitude of collapse was above 50% in plain chest film. 6] The interval of recurrence after last attack was frequently within 1 year. 7] In the management, closed thoracostomy with underwater-sealed drainage was applied in first recurrent 53 cases but 2nd recurrence was developed in 16 cases. In 52 cases, surgical management was applied. The pleurodesis with chemical agent[tetracycline] via chest tube was applied in 2 cases. Among 51 cases subjected to the open thoracotomy, pleural abrasion was performed in 3 cases, excision of bullae & blebs in 12 cases, wedge resection in 28 cases, lobectomy in 6 cases and wedge resection combined with lobectomy in 2 cases. In one case subjected to the median sternotomy, wedge resection on both lung apex was performed. 8] Postoperative complications were developed in 8 cases but not serious.

• Journal of Chest Surgery
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• 제9권1호
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• pp.98-101
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• 1976

Clinical observations were made on a total 104 cases of spontaneous pneumothorax during the period of 5 years from MAR. 1971 to MAR. 1976 at the Dept. of Chest Surgery, Korea University Medical College. The ratio of male to female cases was 7.4 : 1 in male predominance, and age distribution was 73% of the total cases within the 15-40 age range. There were 56 patients (53.8%) of right sided pneumothorax and 44 patients (42.3%) of left sided pneumothorax, 8 patients presented bilateral spontaneous pneumothorax. The etiologic factors were tuberculous origin in 42.3%, rupture of bullae or blebs in 15.4%, acute pulmonary infection in 3.8%, pulmonary paragonimiasis in 2.9%, cysticercosis 1%, Marfan's syndrome in 1.9%, unknown causes in 32.7%. In all 104 cases, closed chest tube thoracostomy were performed for reexpansion of collapsed lung. In 50 cases of 104 cases, intrapleural instillation of Quinacrine HCl (Atabrine, Winthrop Laboratories, New York, N.Y.) thru the chest tube was used to control of recurrent pneumothorax, and compared observation with 54 cases control group of closed chest tube thoracostomy only. In both groups, 1) cure rates were 63% in control group and 88% in Atabrine group. 2) average duration of inserted chest tube were 5.6 days in control group and 5.7 days in Atabrine group.

• Journal of Chest Surgery
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• 제32권4호
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• pp.383-387
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• 1999

배경: 일차성 자연기흉은 대개 기포가 터져서 발생하며 상당수에서 재발이 되는 것으로 알려져 있다. 그러나 단순 흉부촬영에서 기포의 발견률은 높지 않다. 이에 저자들은 고해상CT를 이용하여 치료방향 설정과 수술적 치료시 지침을 제공하고, 단순촬영에서 찾을 수 없으나 재발의 원인이 될 수 있는 숨겨진 기포를 숙지하기위해 이 연구를 시행하였다. 대상 및 방법: 외상성 기흉을 제외한 70명의 자연기흉 환자들을 대상으로 고해상 CT를 시행하여 병변측 및 반대측의 기포의 유무, 개수, 동반된 폐질환, 그리고 치료의 종류와 빈도를 후향적으로 분석하였다. 결과: 70명의 대상군중 45명은 원인질환이 분명하지 않은 일차성이었고 25명은 폐결핵에 의한 이차성으로 모두 이전에 앓은 후유증의 소견들을 보였으며 활동성 폐결핵의 소견을 보인 경우는 없었다. 일차성과 이차성 기흉의 평균 연령은 각각 25.9세와 44.1세로 일차성에서 더 젊었다. 단순촬영에서는 30.2%에서 기포를 찾을 수 있었다. 고해상 CT에서는 75.7%에서 기포를 찾을 수 있었고(병변측에 68.6%, 반대측에 55.7%) 48.6%에서는 양쪽폐에서 관찰되었다. 기포의 개수가 10개이상으로 다발성인 경우는 이차성 기흉에서 일차성 기흉에서보다 더 흔히 관찰되었다. 대부분의 환자을 흉강삽관술(36명)이나 기포제거술(27명)로 치료하였다. 결론: 자연기흉환자들에서 고해상 CT가 단순촬영보다 동반된 기포를 찾는데 훨씬 더 우수하였고 동반 질환의 평가에도 유용하였다. 따라서 고해상CT가 재발의 고위험군등에서 재발을 막는 예방적 치료를 결정하는등 치료방법의 선택에 도움을 줄 수 있고, 수술적 치료시 수술의 지침을 제공할 수도 있으며 나아가 재발의 원인이 될 수 있는 잠복된 기포를 환자에 주지시킬 수 있다는 점에서 큰 도움이 될 것으로 생각한다.