• Journal of Korean Neurosurgical Society
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• 제56권1호
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• pp.42-47
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• 2014

Objective : Helicopter ambulance transport (HAT) is a highly resource-intensive facility that is a well-established part of the trauma transport system in many developed countries. Here, we review the benefit of HAT for neurosurgical patients in Korea. Methods : This retrospective study followed neurotrauma patients who were transferred by HAT to a single emergency trauma center over a period of 2 years. The clinical benefits of HAT were measured according to the necessity of emergency surgical intervention and the differences in the time taken to transport patients by ground ambulance transport (GAT) and HAT. Results : Ninety-nine patients were transferred to a single university hospital using HAT, of whom 32 were taken to the neurosurgery department. Of these 32 patients, 10 (31.3%) needed neurosurgical intervention, 14 (43.8%) needed non-neurosurgical intervention, 3 (9.4%) required both, and 11 (34.4%) did not require any intervention. The transfer time was faster using HAT than the estimated time needed for GAT, although for a relatively close distance (<50 km) without ground obstacles (mountain or sea) HAT did not improve transfer time. The cost comparison showed that HAT was more expensive than GAT (3,292,000 vs. 84,000 KRW, p<0.001). Conclusion : In this Korean-based study, we found that HAT has a clinical benefit for neurotrauma cases involving a transfer from a distant site or an isolated area. A more precise triage for using HAT should be considered to prevent overuse of this expensive transport method.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.128-135
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• 2008

Purpose: As the care of surgical patients becomes increasingly complex and catheter-based techniques are more frequently applied, the pattern of iatrogenic vascular injuries may be increasing. Major vascular injuries can jeopardize a patient's life or limb survival. The purpose of this study was to examine the current etiology and prognosis for iatrogenic vascular injuries. Methods: We reviewed medical records of 29 cases of iatrogenic vascular injury that were treated Seoul National University Bundang Hospital between October 2003 and October 2008. We studied clinical variables including demographics, cause of injury, clinical presentations, management and prognosis. Results: The mean age was 60.8 years (range: 25-86), and the male to female ratio was 1.9 : 1. The causes of injuries were operation related complication in 18 cases (62.1%), endovascular intervention and diagnostic angiography in 11 cases (37.9%). The types of vascular injury were partial severance in 14 cases, pseudoaneurysm in 8, arteriovenous fistula (AVF) in 3, thrombosis in 2, complete severance in 2. Especially, device related complication including percutaneous closing device were occurred in 9 and the others came from inadvertent physician's procedure. Primary repair were done in 12 cases, end-to-end anastomosis in 5, interposition graft in 4, ligation in 2, patch angioplasty in 1, peudoaneurysm excision and arteriorrhaphy in 1, hematoma evacuation in 1, and endovascular repair in 3. There were 2 cases of mortality, one of them due to hemorrhagic shock and the other due to septic shock. Conclusion: Proper selection of treatment modalities should be important to have better outcome according to the type of injury as well as anatomical location. Each physician should be familiar to new device as well as patient's topographical feature. Immediate referral to vascular specialist is also essential to reduce morbidity.

• Journal of Chest Surgery
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• 제37권3호
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• pp.286-291
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• 2004

원발성 지방육종은 종격동에서 매우 드물게 발생하는 악성 종양으로 수술적 절제가 가장 효과적인 치료로 알려져 있다. 24세 남자 환자가 1개월 전부터 시작된 호흡곤란과 흉부 불편감으로 타 병원에서 좌측 혈흉을 의심하여 좌측 흉관삽관술을 시행받았다. 본원 입원 후 흉부 단순촬영에서 종격동 편위소견을 보였고 빈맥이 진행하였으며, 중심정맥압이 상승하는 양상보여 진단 및 혈괴제거를 위해 응급으로 좌측 개흉술을 시행하여 다량의 점액성의 혈성 흉수를 제거하였고, 조직검사 결과 골격계외 점액성 연골육종으로 진단되었다. 2주 후 좌측 개흉술로 횡격막 및 심낭의 일부를 포함하는 흉막외 좌측 전폐적출술과 함께 종격동 종양을 절제하였다. 조직검사에서 점액성/원형세포 지방육종으로 진단되었으며, 입원 54일만에 합병증 없이 퇴원하였다. 술 후 2개월째 1회의 항암화학요법(Ifosfamide+Adriamycin: IA) 후 종격동, 좌측 견갑골 부위 및 종격동 임파선에 재발하여, 약제를 바꾸어 (Etoposide+Ifosfamide+Cisplatin: VIP) 항암화학요법을 시행하였으나 복강전이로 술 후 10개월째 사망하였다. 종격동에 발생하는 원발성 지방육종은 매우 드문 질환으로 수술적 절제 및 항암요법 후 추적관찰한 1예를 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제37권12호
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• pp.987-991
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• 2004

배경: 외상성 혈흉에서 부적절한 배액은 농흉, 섬유흉 및 늑막석회화 등 합병증으로 입원 기간을 연장시킨다. 외상성 혈흉 80%에서는 단순 흉강삽관술로 치료가 되지만, 나머지 경우는 수술적 치료가 필요하다. 대상 및 방법: 2002년 3월부터 2003년 2월까지 흉강삽관술을 시행했던 123예 중 조기에 비디오 흉강경으로 저류된 응고된 혈흉을 제거하였던 10명(group I)과 국소적 혈흉 혹은 농흉으로 수술을 받았던 5명(group II)을 대상으로 하였다. 두 군에서 남자가 여자보다 많았으며, 평균 나이는 비슷하였다. 수상 원인은 교통사고가 가장 많았으며, 가장 흔히 동반된 병변은 복부였다. 결과: Group I에서 평균 수상일로부터 수술일까지 평균 기간, 수술 시간, 평균 흉관 유지 기간 및 재원기간은 group II보다 더 짧았다(p<0.05). Group I에서는 추적 관찰 기간(17.8$\pm$3.8개월) 중 재발되거나 수술과 관련된 합병증은 없었으나, group II(21.5$\pm$5.3 months)에서는 2예가 있었다. 결론: 외상성 혈흉에 남아 있는 국소적으로 응고된 혈흉을 비디오 흉강경으로 7일 이내에 제거한다면 안전하고 효과적이다.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.170-174
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• 2010

Purpose: As techniques and instruments for video-assisted thoracic surgery (VATS) have been evolving, attempts to perform VATS for chest trauma have been increasing. Several studies have demonstrated the feasibility and safety of VATS for thoracic trauma. We reviewed our experience to evaluate the clinical feasibility and safety of VATS for thoracic trauma. Methods: Fifty-two patients underwent thoracic surgery for chest trauma in Asan Medical Center from January 1990 to December 2009. VATS was performed in 21 patients who showed stable vital signs. We reviewed retrospectively the medical records of those patients to investigate the results of VATS for thoracic trauma. Results: Thoracic exploration for chest trauma was performed in 52 patients. There were 46 males (88.5%) and 6 females (11.5%). The median age was 46.0 years (range: 11~81 years). There were 39 blunt and 13 penetrating traumas. A standard posterolateral thoracotomy was performed in 31 patients, and VATS was tried in 21 patients. We performed successful VATS in 13 patients; 11 males (84.5%) and 2 females (15.5%) with a median age of 46.0 years (range: 24~75 years). The indication of VATS was persistent intrathoracic hemorrhage in 10 patients and clotted hemothorax in 3 patients. There were no complications, but there were two mortalities due to multiple organ failure after massive transfusion. In 8 patients, VATS was converted to a standard posterolateral thoracotomy for several reasons. The reason was inadequate visualization for bleeding control or evacuation of the hematoma in 5 patients. In 3 patients, VATS was performed to evaluate diaphragmatic injury. After the diaphragmatic injury had been confirmed, a standard posterolateral thoracotomy was performed to repair the diaphragm. Conclusion: VATS should be safe and efficient method for diagnostic evaluation and surgical management of stable patients with thoracic trauma.

• 한국임상수의학회지
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• 제29권5호
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• pp.368-371
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• 2012

본 연구는 개흉술을 실시한 11 마리 개에서 수술 후 흉강 내 음압 형성을 위한 흉강 튜브 삽입방법으로 넓은 등근 아래 흉강 튜브 삽입 방법의 효과를 평가하기 위해 실시 하였다. 흉강 튜브 삽입을 위해 수술 창 뒤쪽으로 다섯 번째 늑간 늑골 위 피부와 넓은 등근에 작은 절개창을 형성하였다. 지혈겸자를 장착한 흉강 튜브를 근육 아래 터널을 통과하여 흉강 내로 삽입하였으며 튜브 장착 후 절개창 주위에 매트리스 봉합법을 이용하여 봉합사를 설치하였다. 수술 후 흉강 내 음압을 형성한 다음 흉강 튜브를 제거하였다. 튜브 관련 부작용을 확인 하기 위해 튜브 삽입 시 튜브 꺽임 현상과 수술 후 신체 검사 및 방사선 검사를 통한 기흉, 피하 기종, 호흡곤란 여부를 확인 하였다. 튜브 삽입 시 튜브 꺽임 현상과 수술 후 기흉 및 호흡 곤란 증상이 11 마리 개 모두에서 확인 되지 않았다. 신체 검사에서 튜브 삽입 주위 피하 기종이 한 마리에서 관찰 되었으나 별다른 치료 없이 3일 후에 사라졌음을 확인 할 수 있었다. 음압 형성 후 평균 (${\pm}SD$) 추적 기간은 $19{\pm}10$ 개월 이었다. 결론적으로 넓은 등근 아래 흉강 튜브 삽입 방법은 튜브가 흉강 내 유지 될 때와 튜브 제거 후 남게 되는 터널을 통한 흉강 내 공기 유입 차단에 효과적이며 흉강 튜브 장착 시 우선적으로 고려 되야 할 방법으로 사료 된다.