• Journal of Chest Surgery
• /
• 제48권6호
• /
• pp.393-397
• /
• 2015

Background: The management of contralateral bullae incidentally found in radiological studies is controversial, largely due to the unpredictability of the natural course of incidentally found contralateral bullae. This study aimed to identify the factors associated with the contralateral occurrence of primary spontaneous pneumothorax (PSP), and to characterize the outcomes of contralateral bullae incidentally found in radiological studies. Methods: From January 2005 to December 2008, 285 patients were admitted to our institution for PSP, and the patients underwent follow-up until August 2012. The relationships between the following variables and contralateral pneumothorax occurrence were evaluated: age, sex, smoking history, body mass index, ipsilateral recurrence, ipsilateral bullae size, the number of ipsilateral bullae, contralateral bullae size, and the number of contralateral bullae. Results: The study group consisted of 233 males and 29 females. The mean age and mean body index of the patients were $23.85{\pm}9.50years$ and $19.63{\pm}2.50kg/m^2$. Contralateral PSP occurred in 26 patients. The five-year contralateral PSP occurrence-free survival rate was 64.3% in patients in whom contralateral bullae were found. Conclusion: The occurrence of contralateral PSP was associated with younger age, ipsilateral recurrence, and the presence of contralateral bullae. Contralateral PSP occurrence was more common in young patients and patients with recurrent PSP. Single-stage bilateral surgery should be considered if an operation is needed in young patients, patients with recurrent pneumothorax, and patients with contralateral bullae.

• Tuberculosis and Respiratory Diseases
• /
• 제69권6호
• /
• pp.465-468
• /
• 2010

Spontaneous pneumothorax (SPTx) associated with primary lung cancer is quite rare, but has been reported as the initial presentation or a complication of disease progression. Moreover, chemotherapy-related SPTx in primary lung cancer occurs at a very low frequency, accounting for less than 0.05% of all cases. Here, we report the first case of erlotinib-related SPTx in a patient with advanced lung adenocarcinoma in Korea. After 3 cycles of cisplatin-based chemotherapy as first-line therapy, erlotinib was administered as second-line treatment. Asymptomatic SPTx accompanied by a significant decrease in tumor size was observed in the left lung 7 weeks later. The patient received continuous administration of erlotinib, without additional treatment. This case showed that SPTx can occur in patients with primary lung cancer receiving erlotinib, and asymptomatic chemotherapy-related SPTx in primary lung cancer may not require therapeutic intervention.

• Journal of Chest Surgery
• /
• 제27권12호
• /
• pp.1002-1007
• /
• 1994

The spontaneous pneumothorax occurs subsequent to a disruption in the continuity of the visceral pleura with escape of free air into the pleural space included primary & secondary pneumothorax that is unrelated to identifiable etiologies such as trauma. In. the 33 year period 1960 to 1993, the 230 cases of open thoracotomy were carried out for definitive treatment of spontaneous pneumothorax, at the Dept. of Thoracic & Cardiovascular Surgery, National Medical Center, Seoul, Korea. There were 193 men & 37 women. They ranged in age from 15 years old to 72 years old. The lesion site was on the right side in 117 and on the left in 97, the 16 cases were in bilateral lesions.Surgical indications included recurrence in 98 cases, persistent air leak in 68 cases, nonexpansion of the lung 37 cases, roentgenologically apparent bullae & blebs in 23 cases, bilateral lesions in 16 cases,combined hemothorax & prevent for recurrence in each 2 cases. The types of operation were bullectomy in 207 cases, wedge resection in 13 cases, decortication & B.P.F. closure in 6 cases,lobectomy in 2 cases, pneumonectomy, plication in each I case. The post operative complication developed in 18 cases[7.8 %], there was I case of death due to sepsis. We believed that open thoracotomy with resection or obliteration of blebs & pleurodes is provided the best protection against recurrence.

• Tuberculosis and Respiratory Diseases
• /
• 제44권5호
• /
• pp.1094-1104
• /
• 1997

연구배경 : 자연 기흉은 기저 질환이 없는 건강한 사람에서 발생하는 원발성 자연 기흉과, 결핵이나 만성폐쇄성 폐질환에서 발생하는 속발성 자연기흉으로 나뉘어지며, 자연 기흉에 대한 치료는 다양하지만 흔히 흉관 삽입을 우선적으로 고려하고 있다. 흉관삽입법은 특별한 술식과 삽입시 통증, 피하기종, 감염 등의 합병증이 문제되는 바 본 저자들은 흉관에 비해 직경이 훨씬 작은 8 French 도관을 자연 기흉의 치료에 적용했을 때 단기적인 치료 효과가 있음을 이전 연구에서 확인한 바 있다. 본 연구는 의인성 기흉의 치료에 이용되어져 왔던 작은 직경의 도관을 자연 기흉의 치료에 적용하였을 때, 치료 성공후 추적관찰을 통하여 재발율을 조사하여 장기적인 치료적 효과를 살펴보고자 하였다. 방법 : 1990년 1월부터 1996년 1월까지 중앙대학교 부속병원 내과와 흉부외과에서 8 French 도관 또는 흉관 삽입법으로 치료받은 원발성 또는 속발성 자연 기흉 환자 62명을 대상으로 하였으며 이들은 기흉의 크기가 가 25% 이상, 기흉의 크기에 관계없이 호흡곤란이나 흉통이 발생하였을 때, 기흉의 크기가 증가할 때, 다시 재발한 자연 기흉 환자를 대상으로 하였다. 긴장성 기흉, 혈흉, 화학적 흉막유착술이나 흉강경하 기포절제술을 한 경우는 대상에서 제외되었다. 임상특성(성별, 연령별, 과거 기흉의 유무, 기흉의 크기, 기저 질환의 유무)을 조사하고 합병증, 유치기간, 의무기록이나 개인적 접촉을 통하여 관찰 후 재발율을 비교 분석 하였다. 결과 : 8 French 삽입군과 흉관 삽입군의 추적 관찰기간의 중앙값은 각각 28개월, 22개월로 양군간에 유의한 차이를 보이고 있지 않았다. 8 French 도관 삽입군과 흉관 삽입군의 대상환자들의 임상적 특성-성별, 연령별, 기저 질환의 유무, 기흉의 크기의 분포에는 유의한 차이가 없었다. 원발성 및 속발성을 포함한 자연 기흉을 대상으로 비교한 결과, 도관 또는 흉관의 유치기간은 8 French 도관 삽입군이 $6.2{\pm}3.8$일로 흉관삽입군의 $9.1{\pm}7.5$일에 비해 유의하게 짧았다(p=0.047). 원발성 자연 기흉을 대상으로 두군을 비교하여, 8 French 도관 삽입군의 치료와 관련된 합병증은 6.25%로 흉관삽입군의 23.8%에 비해 더 적은 경향을 관찰할 수 있었다(0.041 ; one-tailed, p=0.053, two-tailed). 8 French 도관 삽입군과 흉관 삽입군에서 재발율에 있어서는 유의한 차이를 나타내지 않았다. 결론 : 이상의 결과로 원발성 또는 속발성 자연 기흉에 대한 치료로 지금까지의 흉관삽입법에 대하여 더 작은 직경의 도관을 삽입하여 치료에 의한 합병증의 빈도를 줄이면서, 치료기간을 줄이고 장기적인 재발을 예방할 수 있을 것으로 기대되며, 더 많은 환자를 대상으로하여 전향적인 연구가 앞으로 필요할 것으로 사료된다.

• Journal of Chest Surgery
• /
• 제52권2호
• /
• pp.91-99
• /
• 2019

Background: The relationship between the size of bullae and pneumothorax recurrence is controversial. The aim of this study was to retrospectively evaluate the role of blebs or bullae in predicting ipsilateral recurrence in young patients experiencing their first episode of primary spontaneous pneumothorax (PSP) who underwent conservative treatment. Methods: A total of 299 cases of first-episode PSP were analyzed. The status of blebs or bullae was reviewed on high-resolution computed tomography (HRCT). The dystrophic severity score (DSS; range, 0 to 6 points) was calculated based on HRCT. Results: The 5-year recurrence rate was 38.2%. In univariate analysis, age (<20 years), body mass index (<$20kg/m^2$), a unilateral lesion, and intermediate risk (DSS 4 and 5) were associated with recurrence. Sex; smoking history; and the presence, number, and maximal size of blebs or bullae were not related to recurrence. In Cox regression, age and intermediate risk were independent risk factors for recurrence. High risk (DDS 6) was not an independent risk factor. Conclusion: The presence, number, and size of blebs or bullae did not affect ipsilateral recurrence. DSS failed to show a positive correlation between severity and recurrence. The decision to perform surgery in patients experiencing their first episode of PSP should not be determined by the severity of blebs and bullae.

• Journal of Chest Surgery
• /
• 제55권1호
• /
• pp.44-48
• /
• 2022

Background: Although classical multi-port video-assisted thoracic surgery has been widely performed, single-incision thoracoscopic surgery (SITS) is a popular surgical technique for the treatment of primary spontaneous pneumothorax (PSP). However, the inconvenient alignment of instruments and the limited field of view occasionally make surgeons convert from SITS to multi-port surgery or extend the incision. This study aimed to present an easy and safe SITS technique for PSP using a spinal needle. Methods: In total, 139 patients underwent SITS between May 2011 and December 2017. We used a spinal needle to hook the bulla or bleb, and wedge resection was performed through a small incision. Patients' medical records were reviewed retrospectively, and a telephone survey was conducted to investigate the recurrence rate. Results: The mean age of the 139 patients was 23.62±9.60 years. The mean operative time was 36.69±14.64 minutes, and multi-port conversion was not performed. The mean postoperative hospital stay was 3.00±0.78 days, and the mean indwelling chest tube duration was 1.97±0.77 days. No complications were observed. In the mean follow-up period of 86.75±23.20 months, recurrence of pneumothorax was found in 3 patients. Conclusion: We suggest that SITS for PSP with the aid of a spinal needle to replace a grasper is a safe and easy technique that only requires a small incision.

• Journal of Chest Surgery
• /
• 제41권6호
• /
• pp.729-735
• /
• 2008

배경: 이 연구는 일차성 자연 기흉 환자의 흉강경 수술 시, 부가적으로 시행한 경구용 tetracycline 흉막 유착술의 안전성과 효용을 평가하기 위해 시행되었다. 대상 및 방법: 2004년 3월부터 2007년 12월까지 본원 심장 센터에서 일차성 자연 기흉으로 비디오 흉강경 수술을 시행한 91예를 대상으로 하였다. 모든 환자에서 흉강경을 통해 폐 기포를 제거하고 벽측 흉막을 문질러 기계적 흉막 유착술을 시행하였다. 27예에서는 절개를 봉합하기 전에 트로카를 통하여 20 mg/kg의 경구용 tetracycline을 흉강 내로 주입하였다(Tetracycline군, 1군). 같은 기간 동안 tetracycline을 주입하지 않고 흉강경 수술만 시행한 나머지 64예를 대조군(2군)으로 하였다. 결과: 인구통계학적 데이터, 수술 소견, 수술 시간 등에서 두 군 사이에 유의한 차이는 없었다. 정주용 진통제가 필요했던 환자의 수와 기간은 두 군 사이에 비슷했으며, 공기 누출 기간과 합병증 발생률에서도 유의한 차이가 없었다. 술 후 평균 16개월($1{\sim}47$개월)의 추적 관찰 기간 동안 총 91예 중 7예(7.7%)에서 동측에 재발이 있었다. 재발은 모두 2군에서 발생하여 재발 예가 없는 1군에 비해 재발율이 높았으나 통계적 유의성은 없었다(0% vs 10.9%, p=0.099). 같은 기간 동안 재발 회피율 역시 1군에서 높은 경향을 보였으나 통계적 유의성에는 미치지 못하였다(p=0.077). 반면 2군에 비해 1군에서 술 후 흉관 거치 기간(4.2일 vs 3.5일, p=0.03)과 재원 일수(5.0일 vs 4.0일, p=0.006)가 유의하게 길었다. 결론: 이 연구에서 일차성 자연 기흉 환자의 흉강경 수술 시 부가적으로 시행한 경구용 tetracycline 흉막 유착술은 흉관 거치 기간과 재원 일수의 연장을 초래하였으나, 특별한 합병증 없이 안전하게 시행될 수 있음을 확인하였다. 또한 통계적 유의성에는 미치지 못하였지만, 술 후 재발율을 감소시키는 뚜렷한 경향을 보여 추가 연구의 필요성이 있다.

• Tuberculosis and Respiratory Diseases
• /
• 제67권1호
• /
• pp.27-31
• /
• 2009

연구 배경: 공기가슴증 치료 시 사용되는 흉관삽입술은 통증이 심하고, 흉터가 남으며, 흔하지 않지만 삽관 주위 조직에 손상을 입히기도 하여 그에 따라 입원 기간도 연장된다. 본 연구에서는 성인의 자연 공기가슴증 치료로 기존의 흉관삽입술과 소구경 도관을 삽입한 경우에 치료 결과를 비교하고자 하였다. 방 법: 원발성 공기가슴증 진단을 받고 흉관삽입술 치료나 직경 1.2 mm 길이 10 cm의 소구경 도관 삽입 치료를 받은 환자 99명을 대상으로 합병증, 재원일수, 치료성공률 그리고 12개월간 재발률을 비교하고 통계학적으로 분석하였다. 결 과: 흉관삽입군의 재원 일수는 10.8$\pm$3.6일(n=68), 소구경 도관 삽입군의 재원 일수는 4.5$\pm$1.3일(n=31)로 재원 일수를 감소시켰으며(p<0.05), 치료 성공률과 재발률에는 차이가 없음을 확인하였다. 결 론: 성인에서 자연 공기가슴증 발생 시 흉관 삽입보다 덜 침습적이어서 시술이 용이하고, 재원 일수를 감소시킬 수 있는 장점을 가진 소구경 도관 삽입을 초 치료 방법으로 고려할 수 있겠다.

• Journal of Chest Surgery
• /
• 제28권5호
• /
• pp.471-474
• /
• 1995

A total of 20 patients underwent bullectomy in the spontaneous pneumothorax between October 1993 and August 1994. The patients were divided into two groups: Control group; the patients who received with mid-axillary approach[n=10 , Experimental group; the patients who received with video-assisted thoracic surgery [n = 10 . The results were as follows; 1. The total sex distribution was male predominence [M :F=6:1 . Mean age of control group was 31.6$\pm$ 10.1 age and experimental group was 24.3$\pm$ 5.5 age. 2. The operative times were 117.0 $\pm$ 32.6min in control group and 102.5$\pm$ 38.4min in experimental group [not significant . 3. The indwelling period of postoperative chest tube and hospital stay were 4.5$\pm$ 2.6 days and 8.3 $\pm$ 1.8 days in control group, $1.5\pm$ 0.5 days and 3.1 $\pm$ 0.3 days in experimental group[p=0.0018, < 0.0001 . 4. In control group, injection times of pain-killer were 1.7$\pm$ 0.7 times/day at operative day and 0.4$\pm$ 0.6times/day at postoperative 1 day. In experimental group, there were 0.3$\pm$ 0.7times/day at operative day and 0.1 $\pm$ 0.3times/day at postoperative 1 day[p=O.O002 at operative day, not significant at postoperative 1 day .

• Journal of Chest Surgery
• /
• 제47권4호
• /
• pp.384-388
• /
• 2014

Background: Recently, single-port video-assisted thoracic surgery (VATS) has been proposed as an alternative to the conventional three-port VATS for primary spontaneous pneumothorax (PSP). The aim of this study is to evaluate the early outcomes of the single-port VATS for PSP. Methods: VATS was performed for PSP in 52 patients from March 2012 to March 2013. We reviewed the medical records of these 52 patients, retrospectively. Nineteen patients underwent the conventional three-port VATS (three-port group) and 33 patients underwent the single-port VATS (single-port group). Both groups were compared according to the operation time, number of wedge resections, amount of chest tube drainage during the first 24 hours after surgery, length of chest tube drainage, length of hospital stay, postoperative pain score, and postoperative paresthesia. Results: There was no difference in patient characteristics between the two groups. There was no difference in the number of wedge resections, operation time, or amount of drainage between the two groups. The mean lengths of chest tube drainage and hospital stay were shorter in the single-port group than in the three-port group. Further, there was less postoperative pain and paresthesia in the single-port group than in the three-port group. These differences were statistically significant. The mean size of the surgical wound was 2.10 cm (range, 1.6 to 3.0 cm) in the single-port group. Conclusion: Single-port VATS for PSP had many advantages in terms of the lengths of chest tube drainage and hospital stay, postoperative pain, and paresthesia. Single-port VATS is a feasible technique for PSP as an alternative to the conventional three-port VATS in well-selected patients.