• 대한장애인치과학회지
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• 제10권1호
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• pp.38-42
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• 2014

본 증례에서는 특별한 주의가 필요한 장애인을 위한 효율적이고 전문적인 의료 전달을 위해 여러 과와의 협의를 통한 진료가 필요함을 알리고 있다. 특히 기관절개관을 가진 환자의 마취관리와 치과치료를 시행함에 있어서 전신상태 및 기관절개관에 대한 이해와 주의가 필요하다. 1. 충치치료를 주소로 내원한 22세 남환에서 기관내삽관의 활용을 통해 전신마취 하에서 치과치료를 성공적으로 전달하였다. 2. 환자는 발작의 위험성을 가지고 있었으며, 안전한 치과치료를 위해 전신마취를 행동조절의 방법으로 선택하였다. 3. 기관내삽관에는 여러 종류가 있으며, 그 중 전신마취 하에 호흡보조를 할 수 있는 종류는 커프를 가진, 이중내강의 형태로 된 관이다. 따라서, 기관내삽관을 가진 환자에서 전신마취 하 치과치료를 진행하기 위해서는 기관내삽관의 형태에 대한 적절한 평가 및 처치가 선행되어야 한다.

• Acute and Critical Care
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• 제33권4호
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• pp.252-259
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• 2018

Background: The aim of this study was to investigate the effects of using a systematic approach to tracheostomy care by a clinical nurse specialist and surgical intensivists for patients with a tracheostomy who were transferred from the surgical intensive care unit (SICU) to the general ward. Methods: In this retrospective study, subjects were limited to SICU patients with a tracheostomy who were transferred to the general ward. The study period was divided into a preintervention period (January 1, 2007 to December 31, 2010) and a postintervention period (January 1, 2011 to December 31, 2014), and electronic medical records were used to analyze and compare patient characteristics, clinical outcomes, and readmission to the SICU. Results: The analysis included 44 patients in the preintervention group and 96 patients in the postintervention group. Decannulation time ($26.7{\pm}25.1$ vs. $12.1{\pm}16.0days$, P=0.003), length of stay in the general ward ($70.6{\pm}89.1$ vs. $40.5{\pm}42.2days$, P=0.008), length of total hospital stay ($107.5{\pm}95.6$ vs. $74.7{\pm}51.2days$, P=0.009), and readmission rate of SICU decreased due to T-cannula occlusion (58.8% vs. 5.9%, P=0.010). Conclusions: Using a systematic approach to tracheostomy care in the general ward led to reduction in decannulation time through professional management, which resulted in a shorter hospital stay. It also lowered SICU readmission by solving problems related to direct T-cannula.

• 대한후두음성언어의학회지
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• 제33권2호
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• pp.97-102
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• 2022

Background and Objectives Tracheostomy is a relatively safe procedure, and the recent emergence of COVID-19 has raised the need to perform tracheostomy immediately in the bed of an intensive care unit (ICU) rather than an operating room. The purpose of this study was to determine the occurrence of complications related to surgical tracheotomy performed in the ICU by an ENT specialist. Materials and Method From March 2019 to January 2022, a total of 101 patients underwent tracheostomy in the ICU. Demographics and complications were classified according to postoperative period. Results Within 24 hours after the procedure, bleeding events were confirmed in 2 patients (2.0%) with mild bleeding. One case (1.0%) of ventricular fibrillation occurred shortly after the procedure. There were no complications from 24 hours to 1 week after procedure. After one week, 4 patients (4.5%) had a local infection, and 3 patients (3.4%) had a tube obstruction. During all follow-up periods, there were no serious side effects such as death, major vascular injury, pneumothroax. No complications were observed throughout the entire period in 6 COVID-19 patients. Conclusion The number of complications of surgical tracheotomy in the ICU performed by a specialist was lower than in previous studies, and there were no complications that delayed treatment or endangered life. The ENT training hospitals should provide sufficient training opportunities for residents to perform surgical tracheostomy and strive to minimize complications associated with the procedure and pre- and post-operative management under the detailed guidance and supervision of specialists.

• Journal of Chest Surgery
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• 제13권4호
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• pp.495-502
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• 1980

A 37 year old male patient was suffered from severe labored breathing caused by post tracheostomy stenosis, which was localized at the mediastinal trachea [cuffed tracheal stenosis] and ranged 1.5 cm in length and approximately 3 ram. in diameter on tracheogram. After dilation of tracheal stenosis with dilator, endotracheal intubation was tried for induction of anesthesia and control of respiration during operation. A tube was placed just beyond the tracheal stenosis without respiratory difficulty. Under the endotracheal anesthesia, circumferential resection of the mediastinal trachea containing the stenosis, approximately 2 cm in length [4 tracheal rings}, was carried out and primary direct end to end anastomosis was performed with interrupted submucosal sutures [3-0 Dexon] and mobilization of trachea Postoperative tracheostomy was not performed. The patient was completely relieved from dyspnea immediately after operation. Post-operative convalescence was entirely uneventful and at present, about 3 months after operation, he is now conducting a usual life. From the literature and our experience, the etiology and treatment of post-tracheostomy stenosis were discussed.

• Journal of Chest Surgery
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• 제39권5호
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• pp.415-418
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• 2006

악성 종양에 의한 기관침윤이나 양성 기관협착이 기관의 하부나 전면에 존재할 경우에는 통상의 기관절개술이나 기관 내 삽관이 곤란한 경우가 있으며, 이러한 상황에서는 기관의 측면이나 하부를 통한 기관절개술이 불가피할 것이다. 저자들은 2001년 5월부터 2005년 5월까지 기관의 하부 혹은 전면의 병변으로 유발된 기관협착증 환자 6예에서 기관의 측면이나 하부를 절개하는 변형된 기관절개술을 시행하여 만족스러운 결과를 얻었기에 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제59권sup1호
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• pp.76-79
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• 2016

Tracheoinnominate artery fistula is a rare, fatal complication of tracheostomy, and prompt diagnosis and management are imperative. We report the case of tracheoinnominate artery fistula after tracheostomy in a 14-year-old boy with a history of severe periventricular leukomalacia, hydrocephalus, cerebral palsy, and epilepsy. The tracheoinnominate artery fistula was successfully treated with a stent graft insertion via the right common femoral artery. Endovascular repair of the tracheoinnominate artery fistula via stent grafting is a safe, effective, and minimally invasive treatment for patients in poor clinical conditions and is an alternative to traditional open surgical treatment.

• Journal of Chest Surgery
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• 제29권5호
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• pp.589-592
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• 1996

기관 절개술을 시행받은 중증 근무력증 환자(Osserman's Group-ll-C-1) 2례에서 흥강내시경을 이용 하여 흉선 절제술을 시행하였다. 첫 환자는47세 남자로서 기관지 절개 부위로 기계적 보조호흡을받고 있는 상태였으며, 두번째 환자는 60세 남자로서 기계적 보조호흡치료에서 일단 회복되 였으나 다시 호흡 부전이 악화되는 상태였다. 두 예 모두 기관 절개술이 되어 있었으므로,정중흥골절골술등의 기존 방 식에 의한 수술의 경우 수술후 종격동염의 발생 가능성이 높을 것으로 예상되어 흥강내시경을 이용하 여 흉선 절제술을 시행하였다. 수술후 각각 16일째와 3일째에 기계적 보조호흡을 중단할수 있었고,종격동염의 발생없이 회복되었 다. 따라서 기관지 절개술을 시행받고 있는 중증 근무력증 환자에게 흥강내시경을 이용한 흉선 절제술 이 기존의 수술 방식을 대체할 수 있는 중요한 술식이라고 보고한다.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1976년도 제10차 학술대회연제 순서 및 초록
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• pp.87.3-87
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• 1976

병례 환자 : 강○종 4세 남자, 주소 : 기관 cannula 발거시의 호흡곤란, 병력 : 래원 2년전 소아과에서 기관절개술을 받았으며, 기관절개술 1개월후에 기관 cannula 발거곤란병으로 재수술을 받았음. 경과 : 양친에 의해 cannula corking 하에서 정상기도를 통한 호흡연습을 하여 1976년 3월 16일 본 교실에서 아무런 후유증 없이 기관 cannula를 발거하여 2일후 퇴원하였음. 2년간 기관 cannula의 발거가 곤란했던 5세 남아에서 기관 cannula 발거후 아무런 지장이 없었던 1례를 경험하였기에 보고한다. 정상기도를 통한 호흡곤란이 내외과적 수단을 가하지 않고 2년후에 기관 cannula의 발거가 가능했다는 사실은 1종의 자연치료현상으로 보아야 할 것이다. 물론 high tracheostomy로 인하여 cricoid cartilage의 손상, perichondritis, granulation 및 성문하종창의 동반이 있었다. 이러한 호흡곤란이 성장에 수반되는 기관성장이나 cannula corking 하에서 정상기도를 통한 꾸준한 호흡연습이 2년후에 기관 cannula의 발거를 가능케 했다고 볼 수도 있으나 암의 자연치료현상을 면역으로 설명하는 것과 같이 이러한 병례도 면역에 의한 자연치유나 unknown factor 등을 부가하여 생각할 수도 있겠다.

• 한국임상수의학회지
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• 제38권5호
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• pp.244-248
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• 2021

A 10-year-old Thoroughbred mare was referred to the Jeju National University Equine Hospital with roaring, dyspnea, and weight loss. On endoscopic examination, the horse was diagnosed with right arytenoid chondritis. Surgical treatment was selected due to the failure of a previous medical treatment. Permanent tracheostomy was performed in a standing position. The horse was restrained and tied in a proper position in the stock. The cranial parts of the 2nd to 5th tracheal cartilages were resected, as were the associated skin, mucosa, muscle, and cartilages. After the stoma was formed, external mucosa and skin were sutured using a simple interrupted method. The horse was hospitalized for 22 days receiving postoperative care including antibiotics, non-steroidal anti-inflammatory drugs, dressing as required, and was pregnant six months after the surgery. A permanent tracheostomy is thought to be effective in horses with diseases causing upper respiratory tract obstruction.

• 대한두경부종양학회지
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• 제34권2호
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• pp.77-80
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• 2018

Subglottic cysts have been reported as a relatively rare problem of pediatrics who have a history of premature birth and period of intubation. They may cause significant upper airway obstruction and many cases require tracheostomy to airway management. Endoscopic marsupialization by microinstruments or laser has been standard primary treatment but a high recurrence rate has been reported. A 19-month-old child presented with stridor who has history of ventilation via an endotracheal intubation in the newborn period for 7 days. Radiologic examinations were performed for aggravated dyspnea symptom and subglottic cystic mass was found, then it was marsupialized at operation room and tracheostomy was done at the same time. After decannulation of tracheostomy tube, there is no recurrence of cyst nor upper airway obstruction for 29 months. We report this case with a review of literature.