• Journal of Chest Surgery
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• 제29권10호
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• pp.1148-1151
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• 1996

순천향대학 천안병 원은 1984년 2월부터 1994년 2월까지 종격동 종양 51례를 수술하였다. 연령은 11개월에서 75세까지고 평균연령 39.4$\pm$18.8세였고 성비는 1:1.4였다. 임상증상은 무증상이 21.6%로 가장 많았고 종격동 종양의 60.6%가 전상부에 위치해 있었다. 조직학적 병명의 빈도는흉선종 (3).3%), 신경성종양(25.5%), 배아세포종(19.6%), 종격동낭종(9.8%) 및 간염종양(5.9%) 순이었다. 양성 종양 46례는 완전절제였고 악성종양 5례중 2례는 완전절제, 1례는 불완전절제, 2례는 조직생검만 시행한 후 방사선치료하였다. 술후 합병증은 5례(9.8%)에서 창상파열 2례, 기흉 1례, 성대마비 1례 및 지속적 인공호흡요구 1례 등이었다.

• 대한두경부종양학회지
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• 제12권2호
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• pp.201-205
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• 1996

이상의 성적에서 레이저 성대 절제술은 초기 성문암종에 대한 일차 치료법으로 유용하다고 생각되었으며, 일차 절제가 가장 중요하고 그후 성대를 포함한 전체 후두점막에 대하여 주기적으로 현수후두경하에 수술현미경을 이용한 추적관찰과 원격전이 및 이차암의 발생 유무에 대하여 적극적인 추적검사가 필요할 것으로 사료된다.

• Journal of Chest Surgery
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• 제33권7호
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• pp.565-569
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• 2000

배경; 기관 협착의 가장 흔한 원인은 기관 삽관에 따른 합병증이다. 기관 협착에 대한 치료 방침은 병변의 범위에 따라 달라진다. 전막부분의 국소적인 병변의 경우에는 레이저 절제요법을 적용할 수 있지만, 기관의 전층에 병변이 있는 경우는 기관 절제 후 단단 문합 수술을 시행하여야 좋은 치료 결과를 얻을 수 있다. 대상 및 방법; 경상대학교병원 흉부외과에서는 1998년 4월부터 1999년 5월까지 기관 삽관의 합병증으로 발생한 기관협착증 환자 12명에게 기관협착부위를 절제하고 단단 문합 수술을 시행하였다. 결과; 수술 후 사망자는 없었고, 조기 합병증으로 일시적인 성대마비가 5명, 창상 감염이 1명에서 발생하였다. 수술 후 평균 18개월간 추적하는 동안 재협착은 발견되지 않았다. 결론; 기관 삽관 후 발생한 기관협착증에 대한 외과적 치료로서 절제 및 단단 문합술은 비교적 우수한 치료버빙라 할 수 있다.

• 성인간호학회지
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• 제22권1호
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• pp.1-10
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• 2010

Purpose: The purpose of this study was to determine the effects of surgery information service on one-day surgery patients' anxiety and satisfaction with nursing care. Methods: The study used the nonequivalent control group time difference design. Sampling and measurement of the control group participants (n=30) was completed first. Later, participants in the experimental group (n=30) were sampled, intervened, and measured. The experimental group participants received the surgery information services twice: before and after the surgery, 20~30 minutes for each of the sessions. The anxiety was measured with the State-Trait Anxiety Inventory developed by Spielberger (1975), and modified by Kim & Shin (1978). The patient satisfaction with nursing care was measured with the Patient Satisfaction with Nursing Care Scale developed by La Monica and colleagues (1986), and modified by Shin (1999). The data was collected between February 1 and May 30, 2006. Results: The results were as follows: 1) The level of anxiety in the experimental group was not significantly different from that in the control group. 2) The level of patient satisfaction with nursing care in the experimental group was significantly higher than in the control group (t=-4.53, p=.00). Conclusion: These findings suggested that the one-day vocal cord surgery information service could be a useful nursing intervention to improve patient satisfaction with nursing care, but not for controlling the anxiety of one-day surgery patients.

• Journal of Chest Surgery
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• 제33권9호
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• pp.738-743
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• 2000

Background: Video-assisted thoracic surgery(VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. Material and Method: Group I (n=18) underwent video-assisted thoracic surgery, and group II(n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. Result: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I(155.6$\pm$77.8cc) than in group II(572.8$\pm$280.1cc)(p<0.05). Conclusion: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.

• Journal of Chest Surgery
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• 제19권4호
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• pp.744-749
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• 1986

Even in the hands of the expert endoscopists, an occasional instrumental perforation of the esophagus occurs. But instrumental perforation of the esophagus should not be difficult to diagnose if the possibility is borne in mind. Occasionally patient with esophageal perforations show little reaction at first, but usually they develop systemic manifestation if surgical management is delayed. Early surgical drainage of esophageal perforation is very important & effective therapeutic method. The delayed surgical treatment of esophageal perforation would have increased the morbidity & mortality by allowing mediastinitis & empyema thoracis. We have experienced 6 cases of delayed surgical management of instrumental perforation of esophagus from May 1974 to April 1986 in the department of thoracic and cardiovascular surgery, Yonsei University, college of the medicine. The ages ranged from 4 years to 57 years. The underlying esophageal diseases consisted of esophageal stricture in 3 cases, foreign bodies in the esophagus in 2 cases and esophageal ca. in one case. Most clinical manifestations on admission were high fever, chest discomfort, chest pain, dysphagia and subcutaneous emphysema. Most complications due to esophageal rupture were acute mediastinitis with or without empyema thoracis. Failure to diagnose promptly and failure to promptly institute adequate treatment undoubtedly were largely responsible for this patients death. All 6 patients had been taken delayed surgical drainage more than 24 hours following esophageal perforation. One patient had been in the open drainage state for long time and the another patient has been in the tracheostomy with postintubation vocal cord ulceration. The third patient died due to respiratory failure and sepsis due to fulminant mediastinitis & empyema thoracis. Even if the patients with esophageal perforation have been taken delayed surgical management, the patients should be survived with aggressive & effective surgical drainage with intensive post-operative care.

• Journal of Chest Surgery
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• 제36권2호
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• pp.113-117
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• 2003

특발성 종격동 섬유증은 매우 드문 질환으로 특별한 원인 없이 종격동에 섬유화가 진행되는 질환이다. 본 증례는 요통을 주소로 내원한 41세 남자환자와 쉰 목소리를 주소로 내원한 65세 남자환자에서 종격동에 종괴가 관찰되었고 진단적 목적의 흉강경을 이용한 조직 생검을 시행하여 조직 소견상 특발성 종격동 섬유증으로 진단된 2 례를 보고하였다. 수술 소견은 2 례 모두에서 종괴가 매우 단단하였고 주위조직과 단단히 유착되어 있었으며 주위조직과 명확한 경계가 없이 섬유화가 심하였다. 현미경 소견에서 염증세포의 침윤과 함께 다량의 교원질 및 섬유 아세포를 관찰할 수 있었나. 수술 후 약물치료는 시행하지 않았고 5개월과 7개월 추적관찰 중에 합병증은 없었으며 종격동 섬유화의 진행도 보이지 않았다.

• 대한두경부종양학회지
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• 제33권1호
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• pp.47-52
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• 2017

Anaplastic thyroid cancer is a rare disease entity consist 2% of whole thyroid cancer but once diagnosed, it is too fatal to survive. Airway obstruction is a leading cause of death in anaplastic thyroid cancer, which may be caused by both vocal cord palsy, mass effect of the cancer or direct invasion of the cancer itself to the tracheal lumen. Tracheal stent insertion can be a solution for airway compromised cases where surgical excision cannot be performed. The advantage is that the airway problem can be solved without invasive procedure. In this case, we tried expandable tracheal stent insertion for 66 years-old man with anaplastic cancer who visited ER for small amount of hemoptysis and dyspnea. There was severe tracheal narrowing and deviation due to the anaplastic thyroid cancer, ECMO (Extra Corporal Membrane Oxygenation) was used instead of a tracheal intubation for general anesthesia.

• 대한후두음성언어의학회지
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• 제23권1호
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• pp.52-55
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• 2012

Background and Objectives : Based on histological findings, intracordal cysts are divided in two subtypes : retention cysts and epidermoid cysts. They are typically located in the superficial layer of the lamina propria and appeared as opaque ovoid buldging masses underlying the epithelium. They are characterized by unilateral diminished mucosal wave on stroboscopy. In this article, we report some cases of patients with an oval shaped-yellowish flat cyst. Materials and Method : At the clinic of the department of otorhinolaryngology in Gangnam Severance Hospital, with 3 female complained of hoarseness as subjects, using the stroboscopy we checked preoperative and postoperative vocal cord and operative findings. Surgery was performed under general anesthesia by the senior authors. All patients noted subjectively that their performing voice was improved. Results : During surgery, an oval shaped-yellowish flat cystic lesion was distinguished from normal epithelium. On palpation of this area with microforceps and cottons, the yellowish discharge was noted to move out from the opening of the cyst. In one case, the cyst was ruptured but remove the capsule completely. In other cases, sulcus was noted at the oppsite site. Conclusion : Because of the opening, the cyst was not easy to dissect and remove completely. After the debris was move out, fibrosis around the opening and invaginated epithelium extending into the deeper layers to the fold. The cyst was must removed carefully and completely for improvement of voice quality before evolving into a sulcus vocalis.

• Archives of Plastic Surgery
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• 제44권6호
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• pp.550-553
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• 2017

Esophageal perforation is a rare but potentially fatal complication of robot-assisted thyroidectomy (RAT). Herein, we report the long-term outcome of an esophageal reconstruction with a jejunal free flap for esophageal rupture after RAT. A 33-year-old woman developed subcutaneous emphysema and hoarseness on postoperative day1 following RAT. Esophageal rupture was diagnosed by computed tomography and endoscopy, and immediate surgical exploration confirmed esophageal rupture, as well as recurrent laryngeal nerve injury. We performed a jejunal free flap repair of the 8-cm defect in the esophagus. End-to-side microvascular anastomoses were created between the right external carotid artery and the jejunal branches of the superior mesenteric artery, and end-to-end anastomosis was performed between the external jugular vein and the jejunal vein. The right recurrent laryngeal nerve injury was repaired with a 4-cm nerve graft from the right ansa cervicalis. Esophagography at 1 year after surgery confirmed that there were no leaks or structures, endoscopy at 1 year confirmed the resolution of vocal cord paralysis, and there were no residual problems with swallowing or speech at a 5-year follow-up examination. RAT requires experienced surgeons with a thorough knowledge of anatomy, as well as adequate resources to quickly and competently address potentially severe complications such as esophageal rupture.