• 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.

• Journal of Trauma and Injury
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• 제25권2호
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• pp.37-43
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• 2012

Purpose: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. Methods: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. Results: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. Conclusion: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons.

• Journal of Chest Surgery
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• 제54권5호
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• pp.404-407
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• 2021

We present a case study of necrotizing fasciitis (NF), a very rare but dangerous complication of chest tube management. A 69-year-old man with shortness of breath underwent thoracostomy for chest tube placement and drainage with antibiotic treatment, followed by a computed tomography scan. He was diagnosed with thoracic empyema. Initially, a non-cardiovascular and thoracic surgeon managed the drainage, but the management was inappropriate. The patient developed NF at the tube site on the chest wall, requiring emergency fasciotomy and extensive surgical debridement. He was discharged without any complications after successful control of NF. A thoracic surgeon can perform both tube thoracostomy and tube management directly to avoid complications, as delayed drainage might result in severe complications.

• Journal of Chest Surgery
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• 제44권6호
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• pp.418-422
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• 2011

Background: It has recently become most general to use the small bore catheter to perform closed thoracostomy in treating iatrogenic pneumothorax. This study was performed for analysis of the efficacy of treatment methods by using small bore catheter such as 7 F (French) central venous catheter, 10 F trocar catheter, 12 F pigtail catheter and for analysis of the appropriateness of each procedure. Materials and Methods: From March 2007 to February 2010, Retrospective review of 105 patients with iatrogenic pneumothorax, who underwent closed thoracostomy by using small bore catheter, was performed. We analyzed the total success rate for all procedures as well as the individual success rate for each procedure, and analyzed the cause of failure, additional treatment method for failure, influential factors of treatment outcome, and complications. Results: The most common causes of iatrogenic pneumothorax were presented as percutaneous needle aspiration(PCNA) in 48 cases (45.7%), and central venous catheterization in 26 cases (24.8%). The mean interval to thoracostomy after the procedure was measured as 5.2 hours (1~34 hours). Total success rate of thoracostomy was 78.1%. The success rate was not significantly difference by tube type, with 7 F central venous catheter as 80%, 10 F trocar catheter as 81.6%, and 12 F pigtail catheter as 71%. Twenty one out of 23 patients that had failed with small bore catheter treatment added large bore conventional thoracostomy, and another 2 patients received surgery. The causes for treatment failure were presented as continuous air leakage in 12 cases (52.2%) and tube malfunction in 7 cases (30%). The causes for failure did not present significant differences by tube type. Statistically significant factors affecting treatment performance were not discovered. Conclusion: Closed thoracostomy with small bore catheter proved to be effective for iatrogenic pneumothorax. The success rate was not difference for each type. However, it is important to select the appropriate catheter by considering the patient status, pneumothorax aspect, and medical personnel in the cardiothoracic surgery department of the relevant hospital.

• Journal of Chest Surgery
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• 제20권1호
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• pp.39-47
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• 1987

The records of 268 patients, who were diagnosed as spontaneous pneumothorax during the period 1975 to 1984, treated at the department of thoracic and cardiovascular surgery, Hanyang University Hospital, were reviewed retrospectively to evaluate the effect of surgical intervention on each indications. Of these,.61 patients [22.8%] were taken operation to treat the pneumothorax after closed thoracostomy. We have classified the 61 patients to evaluate the therapeutic effect on each indications. And the therapeutic effect is based on the chest tube indwelling days. The results were as follows: 1. The chest tube indwelling days of the group who were taken closed thoracostomy only was average 14.13*9.17 days [range 5-66 days], and that of the group who were finally taken the thoracotomy after closed thoracostomy was 21.85*12.30 days [range 5-55 days]. 2. The indications of thoractomy were thoracoscopic findings, recurrence and continuous air leakage. 3. The chest tube indwelling day of the group who was taken thoracotomy by thoracoscopic findings was average 11.67*6.51 day, that was relatively short compared to those of the other groups. 4. The continuous air leakage group after closed thoracostomy was subdivided into three subgroups, continuous air leakage in 1st attack, thoracoscopic findings in 1st attack, and recurrence. 5. Of these, the chest tube indwelling day of the subgroup, who was taken operation by thoracoscopic findings, was 21.33e8.26, that was relatively short compared with those of the other subgroups. We use the thoracoscope as excellent diagnostic tool to detect the operation indication in the spontaneous pneumothorax patients. And we gain the benefits to shorten the chest tube indwelling days and admission days, and also to protect the recurrence.

• Tuberculosis and Respiratory Diseases
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• 제72권1호
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• pp.59-62
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• 2012

Tube thoracostomy is known to cause complications such as bleeding or infection, but the incidence of chylothorax secondary to tube thoracostomy is under-reported, and therefore, we report this case. A patient was diagnosed as systemic lupus erythematosus with pleural and pericardial involvement. During repeated therapeutic thoracentesis, which were performed because of poor response to steroids and cylophosphamide, hemothorax developed and we therefore inserted a chest tube. The pleural effusion changed from red to milky color in several hours and we diagnosed the pleural effusion as chylothorax. Total parenteral nutrition based on medium-chain triglycerides was supplied to this patient and chylothorax was improved after 4 days.

• Journal of Trauma and Injury
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• 제37권1호
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• pp.37-47
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• 2024

Purpose: This study aimed at developing a novel tube thoracostomy technique using the sternum, a fixed anatomical structure, as an indicator to reduce the possibility of incorrect chest tube positioning and complications in patients with chest trauma. Methods: This retrospective study analyzed the data of 184 patients with chest trauma who were aged ≥18 years, visited a single regional trauma center in Korea between April and June 2022, and underwent chest computed tomography (CT) with their arms down. The conventional gold standard, 5th intercostal space (ICS) method, was compared to the lower 1/2, 1/3, and 1/4 of the sternum method by analyzing CT images. Results: When virtual tube thoracostomy routes were drawn at the mid-axillary line at the 5th ICS level, 150 patients (81.5%) on the right side and 179 patients (97.3%) on the left did not pass the diaphragm. However, at the lower 1/2 of the sternum level, 171 patients (92.9%, P<0.001) on the right and 182 patients (98.9%, P= 0.250) on the left did not pass the diaphragm. At the 5th ICS level, 129 patients (70.1%) on the right and 156 patients (84.8%) on the left were located in the safety zone and did not pass the diaphragm. Alternatively, at the lower 1/2, 1/3, and 1/4 of the sternum level, 139 (75.5%, P=0.185), 49 (26.6%, P<0.001), and 10 (5.4%, P<0.001), respectively, on the right, and 146 (79.3%, P=0.041), 69 (37.5%, P<0.001), and 16 (8.7%, P<0.001) on the left were located in the safety zone and did not pass the diaphragm. Compared to the conventional 5th ICS method, the sternum 1/2 method had a safety zone prediction sensitivity of 90.0% to 90.7%, and 97.3% to 100% sensitivity for not passing the diaphragm. Conclusions: Using the sternum length as a tube thoracostomy indicator might be feasible.

• Journal of Chest Surgery
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• 제37권12호
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• pp.983-986
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• 2004

배경: 원발성 자연기흉의 흉관삽입술의 적응증에 대해서는 잘 알려져 있지만, 어떤 크기의 흉관을 삽입할 것인가에 대해서는 특별한 지침이 없는 것으로 생각된다. 한편 최근에는 여러 가지 수술 수기에 대한 보다 최소한의 침습적인 치료방법들이 다양하게 소개되고 연구되는 경향이 있다. 본 교실에서는 이러한 추세에 따라 원발성 자연기흉의 흉관삽입슬에 있어서 기존의 24 Fr. 흉관을 12 Fr. 흉관으로 대신해 새로운 치료 지침에 따른 효용성을 확인하고자 한다. 대상 및 방법: 본원에서 원발성 자연기흉으로 진단 받고 흉관삽입술을 시행한 30세 이하의 환자를 대상으로, 2003년 1월부터 2003년 5월까지 24 Fr.흥관삽입술을 시행받은 환자 19예는 A군, 2003년 11월부터 2004년 4월까지 12 Fr.흉관삽입술을 시행받은 환자 20예는 B군으로 각각 분류하여 흉관삽입 시술시간, 흉관 거치기간, 재원일수, 합병증, 수술여부, 재발여부를 후향적인 방법으로 비교 조사하였다. 결과: 두 군 간의 남녀 비는 A군은 16 : 3, B군은 18 : 2였고, 나이는 A군은 21.7$\pm$4.0세, B군은 20.0$\pm$3.7세 였다. 흉관삽입 시술시간은 A군은 21.6$\pm$2.9분, B군은 10.8$\pm$1.9분으로 유의한 차이를 보였다(p<0.05). 흉관 거치기간은 A군은 3.8$\pm$1.7일, B군은 4.3$\pm$2.2일이었으며, 재원일수는 A군은 5.6$\pm$9일, B군은 5.2$\pm$1.5일이었다. 흉관 삽입술에 따른 합병증은 두 군에서 모두 없었으며, 기흉의 재발과 지속적인 공기 누출로 수술을 시행 받은 환자는 A군은 6예(35%), B군은 5예(25%)였다. 결과적으로 흉관삽입 시술 시간을 제외하고는 통계학적으로 유의한 차이가 없었다. 결론: 원발성 자연기흉의 흉관삽입술시 12 Fr. 흉관으로도 24 Fr. 흉관과 비교하여 효용성에 차이가 없다는 점과, 보다 시술이 쉽고 용이하여 시술 시간을 단축할 수 있는 장점이 있다고 생각된다.

• Journal of Medicine and Life Science
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• 제17권1호
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• pp.25-28
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• 2020

The prevalence of pulmonary pargonimiasis in Korea has been steadily decreasing due to develop of the public health, and there have been few clinical cases of paragonimiasis infections, especially in pneumothorax. A 22-year-old man referred to emergency department for dyspnea and chest pain. The right lung was totally collapsed on a chest X-ray. We emergently performed a closed thoracostomy with a 28-Fr chest tube. However, the air leak from the chest tube persisted for three days after the closed thoracostomy. A chest computed tomography showed multiple subpleural consolidative nodular lesions and mixed ground-glass attenuation nodules. We potentially suspected a secondary pneumothorax resulting from pulmonary paragonimiasis infection because the patient was a Chinese man who was working at a Korean restaurant. We decided to perform a medical treatment instead of pulmonary wedge resections. The air leak was discontinued three days after the prescription of praziquantel. The patient was discharged nine days after the admission. We suggest that anti-parasitic drugs are very effective in the secondary pneumothorax resulting from paragonimiasis.

• Journal of Chest Surgery
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• 제26권7호
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• pp.532-537
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• 1993

To assess the therapy of spontaneous pneumothorax in the aged patients, the treatment methods and results in 60 patients 50 years of age or older were retrospectively reviewed. Most of the patients were male [56 of 60 patients] and the major underlying lung diseases associated with spontaneous pneumothorax were tuberculosis [32 patients] and chronic obstructive lung disease [20 patients]. The recurrence rate of thoracostomy tube drainage with or without chemical pleurodesis using tetracycline was 39.6% [21 of 53 patients], but there was no recurrence in the patients treated with open thoracotomy, pleural abrasion, and chemical pleurodesis using talcum powder[Asbestosis free]. In the patients treated with open thoracotomy, the bullous or bleb lesions were placed in the various sites of both lungs. We concluded that even though thoracostomy tube drainage is the first choice of therapy for spontaneous pneumothorax in the aged patients, the recurrence rate is high, especially in the patients with persistent air leakage for more than 2 days, and the open thoracotomy with pleural abrasion and chemical pleurodesis using talcum powder can prevent the recurrence in the selected patients.