• Journal of Chest Surgery
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• 제16권4호
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• pp.584-593
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• 1983

Esophageal reconstruction was performed in 344 patients with irreversible stricture of the esophagus resulting from caustic burns at National Medical Center from 1959 to 1982.There were 113 males and 231 females, and ranging from 2.5 to 58 years of age, and mean age was 26.5 years, and 25 cases were less than 10 years old. Caustic materials were 286 [83.2%] alkali and 50[14.5%] acid. The most frequent stricture site was upper thoracic esophagus as 56.7%, and the next was cervical as 31.4%, and lower, 11.9%. The stomach was involved in 10.8% totally, and hypopharyngeal stricture was also noticed in 3.2%, and in 3 cases, hypopharyngeal reconstruction was needed due to extensive scar change. In 329 of total 344 cases, colon interposition was performed without resection of the strictured esophagus except 4 cases which were complicated T-E fistula or perforation, and most of them, about 10-15 cm of terminal ileum with right half of the colon was used as the graft. The left colon with anti-peristalsis was used as graft only in 30 cases. The most common postoperative complication was anastomotic leak as 16.7% of total cases, and it was 12.5% from neck, 3.3% from ileocolostoma and 0.9% from cologastrostoma. Next common complication was neck stenosis [8.8%], aspiration pneumonia [6.4%], and graft necrosis [3.9%] in order. Overall operative mortality was 5.5% [14/329], and main causes of death were graft necrosis, sepsis due to anastomotic leak, gastric bleeding, and intestinal obstruction. Besides of colon interposition, according to shape or level of the stricture, plastic repair or segmental resection and direct anastomosis was done in 9, and 1 of them were complicated stenosis at the anastomotic site. In lower stricture, esophagogastrostomy was done in 10 cases, and 1 case expired due to hepatitis, and anastomotic stenosis was occurred in 2 cases at 1.5 months and 2.4 years later. During follow-up of 298 cases colon interposition from 6 months to 22 years, 82.6% was excellent, and 2.9% was complained of mild discomfort, and 4 cases were dead laterly, but 3 of them were not related to reconstruction.

• Clinical Endoscopy
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• 제56권6호
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• pp.735-737
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• 2023

• Clinical Endoscopy
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• 제55권4호
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• pp.516-517
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• 2022

• Journal of Chest Surgery
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• 제38권6호
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• pp.445-449
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• 2005

부식성 식도협착의 재건수술시 대장의 혈액순환이 나쁜 경우 또는 대장치환술 후 허혈성 부전이 나타난 경우 가장 적합한 재건장기로는 유리공장이식편을 들 수 있다. 복잡하게 합병된 부식성식도협착 환자에서 유리공장이식편을 이용하여 식도재건술을 시행한 4예를 보고하고자 한다. 일차식도재건술로서 4예 중 3예는 대장치환술을, 1예는 장천공에 의한 복막염으로 Whipple's 술식 및 공장루설치술을 받았다. 1예는 인두대장문합부의에 유리공장첩포 이식을, 2예는 대장이식편 부전 부위에 유리공장이식편 치환을 받았다. 1예는 대장의 일부와 유리공장이식편을 이용하여 인두공장대장공장문합술을 시행하였다. 수술 후 문합부위 누출로 인한 재수술이 1예 있었다. 장기추적 관찰상 모두 연하곤란이 없었다. 여러 가지 원인으로 인하여 합병된 식도재건술이 필요하여 유리공장이식편을 사용했던 경우 만족할 술 후 이환율과 연하기능을 보였다.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2006년도 춘계학술대회
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• pp.173-173
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• 2006

• Journal of Chest Surgery
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• 제33권7호
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• pp.601-604
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• 2000

방선균증은 혐기성 그람 양성균인 Actinomyces israelii의 감염에 의한 만성 육야종성 질환으로 안면부, 폐, 목부에 주로 발생하며 농양, 누공 두터운 반흔의 형성을 특징으로 한다. 식도 방선균증은 매우 드물어 전세계적으로 단지 몇례 보고되어 있으며, 그 대부분이 후천성 면역결핍증 환자에서의 발병이다. 염산의 오연으로 인한 식도협착이 발생한 58세의 여자에서 식도 스텐트 삽입후 흉통, 연하장애, 연하통이 발생하였고 이에 대한 식도절제술후 병리조직학적으로 식도 방선균증으로 확진된 증례를 보고한다.

• Journal of Chest Surgery
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• 제2권2호
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• pp.147-154
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• 1969

This is a report on a total of 11 cases of esophageal perforation in the department of thoracic surgery, Chonnam University Hospital during the period of 8 years from 1962 to 1969. They occurred by the following agents, that is,lye solution[7 cases], fish bone[2 cases]. compress air [one case], strong acid [one case]. The perforated portions of esophagus were cervical esophagus in 2 cases, upper third of esophagus in 5 cases, middle third of esophagus in 3 cases and lower third of esophagus [abdominal esophagus] in one case. 4 cases out of cases of esophageal perforation after ingestion of Lye solution were due to Bougination to improve esophageal stenosis: 2 cases occurred 2 months after ingestion of Lye solution and the remaining 2 cases, 2 to 3 weeks after Lye solution ingestion. Therefore, It is realized that Bougination for esephageal stricture by Lye solution is particularly dangerous. The complication after esophageal perforation were mediastinitis,[10 cases], right pyothorax with mediastinitis [8 cases], peritonitis [4 cases], esophago-bronchial fistula[one case]. Owing to the various complications above mentioned, surgical approach to esophageal perforation is accordingly complicated and a combination of more than two of the following different procedures were properly used case by case, that is. gastrostomy or jejunostomy for feeding and esophageal rest,thoracotomy and chest drainage, lung decortication for pyothorax, primary closure of compress air perforation and esophago-bronchial fistula, mediastinostomy, retrosternal esophagoplasty using right colon to Lye stricture etc. 5 cases[45. 5%] of 11 cases were expired and the rest of 6 cases[54.5%]were survived with complete accomplishment of surgical procedures and satisfactory healing in 4 cases and interruption of follow up in 2 cases because of poor economical condition of the patients.

• Clinical and Experimental Pediatrics
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• 제63권11호
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• pp.447-450
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• 2020

Background: Esophageal stricture (ES) is an uncommon clinic entity in pediatrics that may be congenital or acquired in childhood. Acquired noncaustic ES is very rare, and clinical features of affected patients are unknown. Purpose: We aimed to evaluate the clinical findings, and outcomes of patients with acquired noncaustic ES to aid physicians in the early referral of patients to gastroenterologists. Methods: The medical data of patients with acquired noncaustic ES who were followed in our gastroenterology clinic between January 2009 and December 2019 were reviewed. Results: Acquired noncaustic ES was found in 12 of the 4,950 patients (0.24%) who underwent endoscopy during the study period. The main symptoms were dysphagia (58.3%), vomiting (33.3%), and chronic anemia (8.3%). Chronic malnutrition and underweight were found in 66.6% of the patients. The most common etiological factors were radiotherapy, peptic reflux, and achalasia (16.6%, each), while chemotherapy, squamous-cell carcinoma (SC) of the esophagus, eosinophilic esophagitis (EoE), esophageal web, epidermolysis bullosa, and esophageal diverticulum (8.2%, each) were the other etiological factors. Patients with EoE underwent endoscopic bougie dilation in addition to steroid use and elimination diet. Patients with epidermolysis bullosa and esophageal web underwent bougie dilation. Patients with peptic reflux-related ES were initially put on antireflux therapy, but during follow-up, one patient required esophageal replacement with colonic interposition. Patients with radiotherapy-related ES recovered with medical therapy. The patient with initially underwent surgical gastrostomy and tumoral mass excision. The patient then received chemotherapy and radiotherapy and underwent jejunal interposition. Patients with achalasia underwent surgical esophagomyotomy. Conclusion: The presence of solid dysphagia, malnutrition, and an associated disease may alert physicians to the presence of ES.

• Journal of Chest Surgery
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• 제15권2호
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• pp.188-193
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• 1982

Between 1967 and 1980, a total of 99 patients with a benign stricture of esophagus, resulting from a chemical burn, underwent a reconstructive procedure in which various segments of colon were used to bridge the gap between the cervical esophagus and the stomach. There were 42 males and 57 females and most were in their twenties and thirties. The most frequent site of the stricture was upper 1/3 of the thoracic esophagus [48.5%] and the next most common site was the low cervical esophagus [23.2%]. In 89 cases, the right colon with or without the terminal ileum was used as the conduit in an isoperistaltic manner and in 10, the left colon was used in an antiperistaltic position, because the right colon was not suitable as the conduit. There was a higher incidence of regurgitation [90% vs 0%], leakage at cervical anastomosis [80% vs 27%] and stenosis at anastomotic site [70% vs 15%] in an antiperistaltic left colon anastomosis, as compared to isoperistaltic right colon anastomosis. This was felt to be due to the orad peristaltic motion of the transplanted colon which acted as a functional obstruction distal to the esophagocolic suture line, resulting in breakdown of the anastomosis, leakage and eventual stenosis at the site of anastomosis. In conclusion, colon is useful and effective conduit as an esophageal substitute. Either the right or the left colon can be used for this purpose, provided that it is placed in an isoperistaltic position to minimize some of the complications listed above.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1979년도 제13차 학술대회 연제순서 및 초록
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• pp.10.4-10
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• 1979

대부분의 식도암의 원인은 아직 불명이나 암의 발생과 관련이 있는 식도의 기존질환으로서 부식성 물질에 의한 식도협착, 식도무이완증, plummer-vinson증후군과 식이의 습성 등이 보고되고 있다. 저자들은 20년전(1959년) 양잿물의 오연에 의한 부식성 식도염으로 본원에서 입원치료한 환자에서 최근 연하장애를 주소로 재입원하여 식도 X-선검사 및 식도경에 의한 조직검사 결과 식도암으로 진단된 환자를 경험하였다. 부식성 식도염은 흔히 사고나 자해의 목적으로 부식성 물질을 오연함으로서 환자의 정신 및 신체에 주는 고통이 클뿐아니라 영구적 불구를 막고 생명을 구하기 위해서는 응급을 요하는 경우가 대부분이다. 또한 당시의 치료로서 끝나지 아니하고 식도협착이나 드물게는 15∼20년이 경과후 식도암을 유발하는 경우를 볼 때 꾸준한 추적 관찰이 실로 요청되는 바이다.