• Journal of Chest Surgery
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• 제30권2호
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• pp.219-225
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• 1997

비록 대부분의 기관지내 결핵 환자들이 약간의 기관지 협착을동반하지만,항결핵제요법과스테로이 드 치료에 잘 반응하지 않는 환자들에서 기관 및 기관지내 개방성을 유지하기 위해서는 더욱 적극적인 치료가 필요하다. 저자가 치험한 첫 번째 경우에는, 기관지내 결핵에 의한 협착이 있는 42세 여자 환자 에게 Modified Gianturco스텐트를 삽입후 육아조직의 증식으로 재협착이 생겨 6cm의 기관절제 및 단단문합술을 시행하였고, 결핵에 의한 좌측 주기관지 협착 증세를 보이는 31세 남자에게 Strecker스텐트 삽입후 스텐트의 이동과 육아조직의 형성으로 재혐착된 예에서는 좌측 주기관지 전체와 하엽을 절제하고 주기관지와 상엽 기관지를 연결하여 주었다.

• Tuberculosis and Respiratory Diseases
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• 제61권5호
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• pp.484-489
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• 2006

원발성 기관지내 평활근육종은 폐에 원발하는 매우 드문 악성 종양으로 통상적인 생검방법으로는 육종의 진단이 쉽지 않고 수술적 폐생검이 필요한 경우가 많으며 치료는 근치적 절제술로 완치를 기대할 수 있다. 저자들은 대량객혈을 주소로 내원한 21세 남자에서 좌폐하엽 기관지에서 발생한 원발성 기관지내 평활근육종을 진단하고 좌하엽 수상절제술을 시행하였으나 3개월 후에 국소 재발하였다. 1차 수술 후 4개월 째 좌측 전폐절제술을 시행하였으나 2차 수술 후 11개월 째 다시 국소재발과 기관지흉막루가 발생하였고 이와 관련된 농흉과 패혈증으로 사망하였던 환자를 경험하여 이를 보고하는 바이다.

• Journal of Chest Surgery
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• 제27권11호
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• pp.922-929
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• 1994

This research represents an attempt to study the postoperative results among 32 patients who underwent complete resections of primary lung and involved mediastinal lymph nodes between January 1988 and June 1993. Ages ranged from 34 to 73 years with a mean age of 51.31 $\pm$ 8.17 years. There were 29 male patients[90.6%]. Left lung cancers were more frequent than right lung cancers. There were 19 cases of left lung cancers accounting for 59.4% of the total lung cancers. The difference, however, was insignificant. There was no T1 lesion. T2 and T3 lesions were 21[65.6%] and 11 cases[34.4%], respectively. As for cell type, squamous cell carcinomas were reported in 25 cases making up 78.1% of the cell types. Pneumonectomy was conducted on 20[62.5%] cases. Lobectomy and sleeve lobectomy were conducted on 12[37.5%] cases respectively. Mediastinal lymph node involvemednts were most frequent in subcarinal lymph node[9/13] among right lung cancers, while subaortic lymph noce[12/19] was most frequent among left lung cancers. Postoperative complications were reported in 18.9% of the total cases, including 2 cases each of paralysis of the recurrent laryngeal nerve and 1 case each of chylothorax and pyothorax. They were more frequent among patients who underwent pneumonectomy. The operative mortality stood at 3.1% with 1 patient who underwent pneumonectomy dying of pulmonary edema. The 1-year and 5-year survival rates were 50.8% and 30.1%, respectively. Patients treated with squamous cell carcinoma, involvement of single level mediastinal lymph node and lobectomy showed a higher level of survival. These fidings suggest that a long-term survival can be expected of a considerable number of N2 non-small cell lung cancer patients with a selective complete surgical resection of primary lung cancers involved mediastinal lymph nodes.

• Journal of Chest Surgery
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• 제39권3호
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• pp.240-243
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• 2006

폐실질 내 과오종은 흔히 볼 수 있는 양성 폐종양이나, 기관지 내 과오종은 드문 종양 중 하나이다. 치료로는 기관지내시경을 이용한 제거나 기관절개 또는 정상적인 폐실질을 보존하기 위해 소매절제를 통한 종양의 제거가 보편적이다. 그러나 만성적인 기관지 폐쇄로 인해 폐실질이 파괴되어 보존이 어려운 경우에는 폐절제술이 필요할 수 있다. 저자는 기관지 내 과오종에 의해 좌상엽의 경화가 진행되어 좌상엽절제술이 필요했던 환자를 보고하는 바이다. 42세 여자가 3주일 전부터 발생한 기침과 좌측 흥통을 주소로 내원하였다. 기관지내시경 소견상 좌상엽기관지의 입구를 완전히 막고 있는 엽성 종괴가 관찰되었고, 생검을 시도하였으나 출혈로 실패하였다. 수술 소견상 만성적인 기관지 폐쇄에 의해 좌상엽의 경화가 심하여 좌상엽절제술을 시행하였다. 환자는 술 후 14일째 퇴원하였다.

• Journal of Chest Surgery
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• 제31권2호
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• pp.182-185
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• 1998

최근 교통사고와 산업재해로 인한 기관지파열상이 증가하고 있는 추세이다. 일단 기관지 파열상이 발생한 경우는 매우 심각한 증상을 유발하여 생명의 위협을 초래하고, 많은 합병증을 야기하기 때문에 조기 진단과 조기 치료가 원칙이다. 본 저자들은 승용차 전복사고로 흉부둔상을 받아 좌주기관지가 완전 절단된 21세 여자 환자에서 수상후 14일이 경과된 후, 기관지내시경과 흉부 단층 촬영으로 확진하고 , 기관지 성형술과 단단문합술을 시행하였으며 술후 2일간의 호기말양압을 이용한 인공호흡기 적용, 기관지내시경을 이용한 분비액 흡인, 지속적인 물리치료와 체위 배액요법을 시행하여 좌폐기능이 완전 정상화되었음을 추적 검사하에 확인하였다.

• Journal of Chest Surgery
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• 제28권1호
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• pp.42-46
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• 1995

Vertical axillary muscle sparing thoracotomy is newly appeared and excellent alternative method of standard posterolateral thoracotomy.It has many advantages compared to standard posterolateral thoracotomy , less postoperative pain, well preserved thoracic muscle strength, full range of motion of the shoulder girdle and attractive cosmetic results. We performed vertical axillary muscle sparing thoracotomy in 36 patients from November 1993 to July 1994. The ages of the patients ranged from 6 months to 71 years[mean 45.1 years , and the patients consisted of 20 males and 16 females.The preoperative diagnosis were as follows : lung cancer in 17 patients, tbc destroyed lung in 7, bronchiectasis in 3, bullous emphysema in 3 and the others are mediastinal tumor, bronchogenic cyst, lung abscess, empyema, esophageal diverticulum, and CCAM [congenital cystic adenomatoid malformation . The operative procedures were as follows : lobectomy and bilobectomy in 16 patients, segmentectomy in 4, wedge resection in 3, penumonectomy in 7, and the others were open biopsy, lobectomy with diaphragm excision, sleeve right upper lobectomy, decortication, mediastinal mass excision, and esophageal diverticulectomy. We had 6 complications : postoperative bleeding in 2 cases, operative wound infection, arrrhythmia[atrial fibrillation , Horner`s syndrome, hoarseness. The subcutaneous seroma occurred in 4 cases but did not require drainage and relieved within 4 weeks spontaneously. We concluded that vertical axillary muscle sparing thoracotomy could be done in most of all thoracic surgery with safety. Comparing to standard posterolateral thoracotomy vertical axillary muscle sparing thoracotomy has many advantages such as less postoperative pain, well preserved muscle strengths and good cosmetic results.

• Journal of Chest Surgery
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• 제31권2호
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• pp.134-141
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• 1998

최근 원발성 폐암의 유병률이 점점 증가하고 있으며, 비소세포폐암의 완치 목적의 치료로 외과적 폐절제술이 가장 좋은 방법으로 알려져있다. 저자들은 1992년 1월부터 1995년 7월까지 경북대학교병원 흉부외과에서 원발성 비소세포폐암으로 폐 절제술을 받은 환자중 100례의 임상기록을 분석하여 다음과 같은 결과를 얻었다. 남자가 86례, 여자가 14례로 남녀비는 6 : 1이었고, 60대가 43%로 환자의 대부분을 차지하였고 최소 34세 및 최고 81세였다. 수술수기는 단엽절제술 55례(55%), 전폐절제술 22(22%), 쌍엽절제술 15례(15%), 구역절제술 2례(2%) 및 기관지성형술이 필요했던 수상엽절제술, 수상전폐절제술 및 쐐기전폐절제술이 각각 4례, 1례 및 1례였다. 수술후 조직학적 분류는 편평상피세포암 67례(67%), 선암 26례(26%), 거대세포암 6례(6%) 및 선평편상피세포암 1례(1%)였다. 종격림프절로 전이가 있었던 예는 총 18례(18%)였으며, 편평상피세포암이 8/67(11.9%)례, 선암이 9/26(34.6%)례, 거대세포암이 1/6(16.7%)례였다. 술후 병리학적 병기는 1병기 45례(45%), 2병기 13례(13%), 3a병기 36례(36%), 3b병기 5례(5%) 및 4병기 1례(1%)였다. 전체 환자에서의 12개월, 24개월, 36개월 및 43개월의 생명표법에의한 생존률은 각각 77.5%, 56.1%, 43.7% 및 43.7%였으며, 병기별 43개월의 생존률은 1병기에서 81.3%, 2병기에서 20.8%, 3a병기에서 27.9%, 3b병기에서 25.0%였다. 수술후 병원사망은 패혈증 2례, 호흡부전 1례 및 급성 심경색에 의한 급사가 1례로 총 4례(4%)였다. 원발성폐암의 절제술후 생존률을 향상시키기 위해서는 조기 발견 및 수술적응 환자의 적극적인 수술이 필요한 것으로 판단되었다.Hg로 감소하였고 폐동맥압의 평균은 수술전에 11.4$\pm$5.68 mmHg에서 25.94$\pm$11.53, 29.67$\pm$9.31 mmHg로 증가 하였으나 모두 통계적 의의는 없었다(p>0.05). 양측 폐이식수술에서인 폐동정맥문합부위의 파열, 협착, 뒤틀림 등의 수술수기상의 문제점을 예방하면서 우측폐를 먼저 이식하면서, 폐수술시야를 충분히 확보하고, 재관류손상을 방지하는 경우 cystic fibrosis, pulmonary hypertention, emphysema와 같은 심한 호흡부전증 환자의 치료방법으로 적합하리라 사료된다.에서 선택수술 (elective coronary artery bypass graft)에 비하여 특별한 위험 요소의 증가 관상 동맥 우회술을 적용하여 좋은 결과를 얻을 수 있었으며 이들에 대한 장기 추적이 릴요할 된다.착군에 비하여 의미있게 작았는데 이는 아마도수술 당시 협 착 부위의 완전제거가 이루어지지 않은 것이 원인이라고 사료되었다. 본 분석에서는 어린 연령(3개월 이하), 3개월이하에 시행한 쇄골하동맥편 교약성형술이 의미있는 재협착의 위험요소로 밝혀졌다. 결론 적으로 저자등은 본연구를 통하여 대동맥협부지수, 횡대동맥 지수 등이 개개 대동맥교약 환아의 해부학 적, 임상적 특징을 파악하는데 도움이 되는 도구라는 사실을 발견하였고 아울러 교약의 해부학적 특성, 동반 심기 형, 연령, 수술방법 등이 수술사망 및 재협착에 영향한다는 사실을 입증하였다.t was resulted from increase of weight of single cocoon. "Manta"2.5ppm produced 22.2kg of cocoon. It is equal to 9% increase in index, as compared to that of control. In case

• Journal of Trauma and Injury
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• 제29권1호
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• pp.1-7
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• 2016

Purpose: Tracheobronchial injuries caused by trauma are rare, but can be life threatening. The objective of this study was to evaluate the surgical outcome for patients with tracheobronchial injuries and to determine the difference, if any, between the outcomes for patients with penetrating trauma and those for patients with blunt trauma. Methods: From January 2010 to June 2015, 40 patients underwent tracheobronchial repair surgery due to trauma. We excluded 14 patients with iatrogenic injuries, and divided the remaining 26 into two groups. Results: In the blunt trauma group, injury mechanisms were motor vehicle accident (9 cases), free falls (3 cases), flat falls (1 case) and mechanical injury (1 case). In the penetrating trauma group, injury mechanisms were stab wounds (10 cases), a gunshot wound (1 case) and a stab wound caused by metal pieces (1 case). The mean RTS (Revised Trauma Score) was $6.89{\pm}1.59$ (range: 2.40-7.84) and the mean ISS (Injury Severity Score) was $24.36{\pm}7.16$ (range: 11-34) in the blunt group; the mean RTS was $7.56{\pm}0.41$ (range: 7.11-7.84), and the mean ISS was $13{\pm}5.26$ (range: 9-25) in the penetrating trauma group. In the blunt trauma group, 9 primary repairs, 1 resection with end-end anastomosis, 2 lobectomies, 1 sleeve bronchial resection and 1 pneumonectomy were performed. In the penetrating trauma group, 10 primary repairs and 2 resections with end-end anastomosis were performed. Complications associated with surgery were found in one patient in the blunt trauma group, and one patient in the penetrating trauma group. No mortalities occurred in either groups. Conclusion: Surgical management of a traumatic tracheobronchial injury is a safe procedure for both patients with a penetrating trauma and those with a blunt trauma.

• Journal of Chest Surgery
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• 제25권3호
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• pp.247-257
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• 1992

Bronchial adenoma, firstly described by Muller[1882] had been reported on the subject stressed their benign nature prior to 1940`s, but these tumors including carcinoid tumor, mucoepidermoid carcinoma, adenoid cystic carcinoma, pleomorphic adenoma are now known to possess the various degree of malignant natures from benign course, low grade malignant potential to distant lymphatic or hematogenous metastasis or combination. Although histologically diffeerent, four varieties except carcinoid tumor which is a spectrum of neu-roendocrine tumor originating Kulchitsky cell of the bronchial epithelium and form the part of the APUD tumor spectrum, are morphologically and in many respects clinically similar to the corresponding tumor of the salivary gland is a specific varient of adenocarcinoma that occurs most commonly in the major and minor salivary gland and less frequently tra-cheobronchial tree, esophagus etc. To better understand the clinical characteristics and assess more precisely the malignat nature of bronchial adenoma, we studied 17 cases of bronchial adenoma, which had been experienced at the Department of Thoracic and Cardiovascular surgery of Catholic University Medical College from April 1977 to september 1991. Seventeen cases of bronchial adenoma consist of 2 carcinoid tumors, 6 adenoid cystic carcinomas, 8 mucoepidermoid carcinomas and one pleomorphic adenoma. There is a slight predominace of male patients[10/17] and the age of pt studied varied with a higher incidence occurring between the ages of 40 years and 60 years[mean age, 46.5 years]; the youngest being 15 years and oldest 69 years. Their leading complaints were hemoptysis[4], exertional dyspnea[8], fever & chilness [4], and symptoms mimicking the bronchial asthma[4]. Diagnosis was aided by the radiologic studies such as chest X-ray, polytomography, CT scan, brochography and bronchoscopy. The preferred locations of fumor were in the trachea[4], main stem bronchus[3], bronchus intermedius[3], bronchus of RUL[2], LUL[1], RLL[1], LLL[3] with no peripheral location. Modalities of treatments were single or combination of surgical resection, radiation therapy, chemotherapy. Complete resections were permitted in 12 cases with late recurrences of 4 cases ranging from 6 months to 10 years: pneumonectomy[4], lobectomy[4], bil-obectomy[2], sleeve resection[2]. Gross findings of resected specimens in 14 cases showed that 4 cases were polyp-like pedunculated mass[entirely intraluminal mass] with intact mucosa, 8 cases were broad-bas-ed sessile mass[predominatly intraluminal] and the main portions were located below the mucosa similar to tip of iceburg[predominantly extraluminal] in 2 cases. Follow-up information was availble in all 17 cases ; eight were alive without evidence of disese ranging from 1 month to 13 years. But seven cases died of the causes related to tumor[6 cases within 12 months, one case 10 years after pneumonectomy]. We concluded that 8 cases[47%] of 17 cases were metastasizing bronchial adenoma and precise survival rate cannot be answered by the scanty materials available for study.

• Journal of Chest Surgery
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• 제28권5호
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• pp.499-503
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• 1995

Since the insertion of self expandable metalic stent[SEMS has became popular method for hollow organ stenosis, many attempts for further apply the stent to airway stenosis as an simple procedure has been made, but intrabronchial migration of stent or occurrence of inflammatory granuloma around stent develop occasionally and sometimes it worsen bronchial stenosis further more. This report describes 2 case of surgically treated bronchial restenosis in whom intrabronchial stent were applied for release of bronchial stenosis. Our surgical option was pneumonectomy and bronchoplasty with sleeve right middle and upper lobectomy respectively. During the operation we found the SEMSs were tightly impacted in restenotic bronchial lumen with overgrowth of granulation tissues. The bronchial obstructions occupied more than 90% of lumens in both cases, and needed much complicated procedure to be relieved. Therefore, even though the insertion of SEMS remains as a prcedure determined by the physician`s preference, it has to be considered prudently that the use of SEMS can cause severe restenosis and the surgeon has more difficulties in performing segmental resection of restenotic bronchus in patient with SEMS previously inserted. Throughout these experiences we can conclude that the insertion of SEMS must be performed only in very selected cases of bronchial stenosis.