• Journal of Chest Surgery
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• 제29권7호
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• pp.747-752
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• 1996

최근 비디오흥강경의 발달로 인하여 많은 수의 외과의사들에 의하여 자연기흥에 대하여 비디오흥강 경을 이용한 기포절제술이 적절한 치료법으로 제시되고 있지만 지금까지 이 수술 후의 추적관찰 결과 등에 대하여는 크게 보고된 바가 없다. 저자는 1994년 6월부터 1995년 12월까지 38회의 비디오흥강경을 이용한 기포절제술을 시행받은 자연기흥 환자 34례(1군)를 대상으로 그 수술결과와 조기 추적관찰 결과 를분석하였으며 동시에 이 결과를 같은 기간에 액와절개술을통해 기포절제술을시행받은환자 14례(2 군)의 결과와 비교하였다. 성별, 나이, 기흥의 위치와 정도, 수술적응증, 그리고 수술후 합병증 발생률은 두군에서 유의한 차이 를 보이지 않았다. 그러나 2군에서 1군에 비해 기포의 숫자와 위치가 다발성인 경향이 있었으며 1군에 서 기포절제술시 사용한 자동봉합기의 숫자는 2개에서 4개 사이로 평균 2.6개를 차지하고 있었다. 흥관제거시까지의 기간은 두군에서 차이가 없었으나(3.7일, 3.9일)퇴원시까지의 기간은 1군(5.6일)에 서 2군(8.9일)에 비해 유의하게 짧았다. 수술후2개월에서 21개월까지 평균 12개월의 추적관찰기간중 1 군에서는 3례(7. %)의 기흥재발이 있었으나 2군에서는 기흥의 재발례가 없었다. 이상의 결과로 기흥에 대한 비디오홍강경수술이 액와절개술에 의한 수술보다 덜 침습적 이고 재원기 간이 팎아지는등의 장점이 있으나 수술후 기흥의 재발률이 높은 것으로 관찰되어 이의 적용에는 신중을 기해야 할 것으로 판단된다.

• Journal of Chest Surgery
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• 제25권10호
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• pp.1020-1024
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• 1992

Thirty-four patients underwent 39 subaxillary minithoracotomies for the treatment of primary spontaneous pneumothorax from June 1987 to April 1992. The age of patients ranged from 17 to 32 years. The ratio of male to female was 8.8: 1 with male predominance. The associated pulmonary lesions and pleural adhesion were not seen on the chest X-rays in all cases. Average operative time was 83 minutes[30~130 min]. Postoperative average duration of air leakage was 2.4 days, the chest tube indwelling was 5.1 days, and postoperative hospital stay was 8 days, Analgegics were not given for pain control postoperatively In conclusion, the subaxillary minithoracotomy has the following advantages: reducing the operative time, postoperative pain, morbidity, hospital stay, shoulder problems, and excellent cosmetic result.

• Journal of Chest Surgery
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• 제1권1호
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• pp.25-30
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• 1968

Fifty-two cases of spontaneous pneumothorax encountered in Seoul National University Hospital during the period from 1961 to 1968 were reviewed. The incidence was highest in the adult between 21 and 40 years of age, showing 50%. Four cases of bilateral spontaneous pneumothorax [7.7%] were noted. Pulmonary tuberculosis was the most common cause, 50% of the cases. Non-tuberculous group was 26 cases [50%], of which 15 cases were idiopathic, 5 emphysematous bullae or blebs, 5 inflammatory lung disease, mostly pneumonia, and one pulmonary paragonimiasis. Among 52 cases, the lung expanded completely with absolute bed rest in 7 cases, 3 out of 9 with needle aspiration and bed rest, 34 out of 41 with closed thoracotomy and underwater seal Stedman suction, and 7 cases were treated with open thoracotomy with resection of the lesions without complication. Among these cases treated with closed thoracotomy it took about 3 days in non-tuberculous group to expand the collapsed lung and more than 2 weeks in tuberculous group.

• Journal of Chest Surgery
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• 제48권6호
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• pp.387-392
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• 2015

Background: The aim of this study was to evaluate the feasibility of single-port video-assisted thoracic surgery (VATS) in the treatment of secondary spontaneous pneumothorax (SSP). Methods: Twenty-four patients who were scheduled to undergo single-port VATS for SSP were studied. The medical records of the patients were retrospectively reviewed. The mean follow-up duration was $26.1{\pm}19.8$ months. In order to evaluate the feasibility of single-port VATS for SSP, the postoperative results of single-port VATS (n=15) in patients with emphysema were compared with those of emphysematous patients who underwent three-port VATS (n=15) during the study period. Results: Single-port VATS was feasible in 19 of 24 patients (79.2%), while an additional port was needed in five patients. In the single-port VATS patients, the median operation time, duration of chest tube drainage, and hospital stay were 84.0 minutes, one day, and two days, respectively. Postoperative complications included prolonged chest tube drainage for more than five days (n=1), wound infection (n=1), and vocal fold palsy (n=1). No recurrence of pneumothorax was observed during the follow-up period. The median operation time, duration of chest tube drainage, and hospital stay of the emphysematous patients who underwent single-port VATS were shorter than those who underwent three-port VATS group (p<0.05 for all parameters). Conclusion: Single-port VATS proved to be a feasible procedure in the treatment of patients with secondary spontaneous pneumothorax.

• Journal of Chest Surgery
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• 제44권3호
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• pp.225-228
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• 2011

Background: Conventional treatment (i.e. chest tube insertion and chemical pleurodesis) still remains standard for patients with secondary spontaneous pneumothorax because the risk of surgical bullectomy is deemed high in this subset. However, it has been suggested that surgical treatment using thoracoscopy may expedite postoperative recovery and, thus, may reduce hospital stay. Materials and Methods: Retrospective review of 61 patients with secondary spontaneous pneumothorax, who underwent conventional treatment (n=39) or video-assisted thoracoscopic surgery (VATS) (n=22) between January 2007 and December 2009, was performed. Talc was used for chemical pleurodesis in both groups. Results: Hospital stay of conventional treatment group and VATS group was $14.2{\pm}14.2$ days (4~58 days) and $10.6{\pm}5.8$ days (5~32 days), respectively, with statistically significant difference (p=0.033). Recurrence rate of conventional treatment group was also significantly higher (12/39, 30%) compared to VATS group (1/22, 4.5%) (p=0.016). Conclusion: In selected patients with secondary spontaneous pneumothorax with continuous air leak or inadequate lung expansion, thoracoscopic surgery with chemical pleurodesis using talc results in shorter hospital stay and lower recurrence rate compared to conventional approach.

• Journal of Chest Surgery
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• 제24권9호
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• pp.890-894
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• 1991

We have performed a prospective study to assess the efficacy of suction drainage in 45 patients with primary spontaneous pneumothorax and 15 patients with secondary spontaneous pneumothorax, treated by closed chest tube drainage with underwater seal during the period Jan. 1990 to Dec. 1990 at the Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital. The patients were divided randomly into two groups, 28 cases receiving suction and the other 32 cases no suction. The success rate was 82.1% for the former and 87.5% for the latter with the overall success rate of 85.0% and there was no significant difference in success rate between the two groups According to the causes and the extent of pneumothorax, the difference between the success rates of the two groups was also not significant statistically. But according to the duration of air leakage, suction group under 2 days showed a high success rate[46.4%] and the same group with 3-4 days, a relatively low success rate[21.4%] compared with that of the former. We conclude that the suction treatment is somewhat valuable in shortening the tubing time in patients with small amounts of air leakage, but it doesn`t seem to increase the success rate in all patients.

• Journal of Chest Surgery
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• 제43권6호
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• pp.824-828
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• 2010

일차성 자발성 기흉(primary spontaneous pneumothorax, PSP)의 원인은 명확하지 않다. 최근, FLCN 유전자의 돌연변이가 PSP의 한 원인인자으로 소개되고 있다. 반복적인 PSP를 주소로 한 47세 남성에서 고해상도 컴퓨터 단층 촬영 소견상 많은 폐기포와 다수의 큰 낭종과 함께 FLCN c.468_470 delTTC 돌연변이를 발견하여 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제43권4호
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• pp.447-449
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• 2010

랑거한스 세포 조직구 증식증이 2개 이상의 장기를 침범하게 되면 다체계 병변이라고 한다. 폐와 갑성선을 침범한 다체계 랑거한스 조직구 증식증을 진단 받은 41세 여자 환자에서 기흉의 형태로 발현 되어진 다체계 랑거한스 조직구 증식증의 치료 경험을 보고 하는 바이다.

• Journal of Chest Surgery
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• 제53권2호
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• pp.49-52
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• 2020

Background: Primary spontaneous pneumothorax is commonly treated with chest tube insertion, which requires hospitalization. In this study, we evaluated the efficacy, costs, and benefits of a portable small-bore chest tube (Thoracic Egg; Sumitomo Bakelite Co. Ltd., Tokyo, Japan) compared with a conventional chest tube. Methods: We retrospectively analyzed all primary spontaneous pneumothorax patients who underwent treatment at Gangnam Severance Hospital between August 2014 and May 2018. Results: A total of 279 patients were divided into 2 groups: the conventional group (n=236) and the Thoracic Egg group (n=43). Of the 236 patients in the conventional group, 100 were excluded because they underwent surgery during the study period. The efficacy and cost were compared between the 2 groups. There was no statistically significant difference between the groups regarding recurrence (conventional group, 36 patients [26.5%]; Thoracic Egg group, 15 patients [29.4%]; p=0.287). However, the Egg group had statistically significantly lower mean medical expenses than the conventional group (433,413 Korean won and 522,146 Korean won, respectively; p<0.001). Conclusion: Although portable small-bore chest tubes may not be significantly more efficacious than conventional chest tubes, their use is significantly less expensive. We believe that the Thoracic Egg catheter could be a less costly alternative to conventional chest tube insertion.

• Journal of Chest Surgery
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• 제31권7호
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• pp.692-696
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• 1998

원인 질환이 동반된 속발성 자연기흉에 대한 개흉술은 수술 전후로 높은 위험율을 동반하나, 비디오 흉강경은 최소의 침습적 수술방법으로 치료 효과를 기대할 수 있다. 저자들은 비디오 흉강경술을 이용한 속발성 자연기흉에 대한 36 예(남 33 예, 여 3 예)의 환자에서 임상적 결과로서 유용성을 알고자 하였다. 대상의 평균 나이는 56.3세(범위, 31∼80세)였으며, 21 예에서 폐기종, 20 예에서 폐결핵을 동반하였다. 술전 폐기능 검사상 FEV1은 예상치의 59.3%, FVC는 예상치의 64.0%를 보였다. 19 예의 환자에서 술전 3일 이상의 지속적 공기유출을 보였고, 15 예의 환자에서는 한 번 이상의 재발 기왕력을 보였다. 36 예의 전 환자에서 기계적 흉막유착술을 시행하였으며 33예의 환자에서는 폐기포절제술(bullectomy) 및 폐기포배제술(bullous exclusion technique)을 시행하였다. 평균 수술시간은 97분이었다. 7 예에서 심한 유착을 보였으며, 10 예의 환자에서 폐상엽에 경미한 흉막유착을 보였다. 술후 지속적인 공기유출로 개흉술이 필요한 경우는 없었으나 1 예에서 술후 지속된 공기유출과 호흡부전으로 인하여 사망하였다. 술후 평균 입원기간은 7일(범위, 2∼17일)이었다. 술후 평균 15.8개월(범위, 5∼45개월)의 추적기간동안 기흉의 재발은 없었다. 저자들이 시행한 112 예의 원발성 자연기흉에 대한 비디오 흉강경술에 비하여 수술시간 및 치료 실패율에 있어서 통계적 유의한 차이를 보이지 않았으나 술후 흉강삽관기간 및 입원기간은 더 길었다. 개흉술을 시행하기에 위험한 비교적 고령의 속발성 자연기흉의 환자에서 비디오 흉강경술은 효과적이고 비교적 안전한 수술방법이라 사료된다.