• Journal of Chest Surgery
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• 제7권2호
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• pp.139-144
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• 1974

Clinical observations were made on 513 cases of pulmonary resection for tuberculosis, those were treated at the Department of Thoracic Surgery in National Medical Center from January 1964 to December 1973. 1. The ratio of male to female cases of operation was 2.8:1 in male predominence and age from 21 to 30 occurred 74.3% of the total cases. 2. The extent of disease showed 59.3% moderately advanced, 38.4% far advanced and 2.3% minimal cases. Duration of chemotherapy before surgery was more than one year in 92.7% and only 7.3% was treated less than one year. Preoperative sputum examination for AFB was persistent negative in 8.6,% of cases. 3. Different operative procedures were performed in 513 cases, lobectomy in 230, pneumonectomy and Pleuropneumonectomy in 172, segmentectomy in 63, lobectomy and supplemental segmentectomy with conventional thoracoplasty in 32 cases. 4. The postoperative complications occurred in 67 cases [13.0%]. Of these complications, bleeding in 4.6% , dead space problem in 2.5% and empyema with or without bronchopleural fistula occurred in 2.3% of cases. 5. Overall mortality within 5 months postoperative period was 1.5,0/0 and the most common causes of death were due to shock and empyema with bronchopleural fistula. 6. In all our 867 cases of report I and II, complications occurred in 13.9% and mortality rate was 1.8%.

• Journal of Chest Surgery
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• 제33권3호
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• pp.245-251
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• 2000

Backround: Pulmonary aspergilloma is a potential life-threatening disease resulting from massive hemoptysis. Pulmonary aspergilloma has been treated surgically for many years, however, it has also had higher risk of mortality and complication rate. The purpose of this study is to analyze the operative methods and the types of complications. Material and Method: Sixty patients who underwent surgical resection for pulmonary their medical reconrds. Result: The mean age was 46.3$\pm$13.4 years(range 20 to 76 years). The most common clinical presentation was hemoptysis which occurred in 48 patients(80%). Pulmonary tuberculosis was the most common pre-existing disease, occurri9ng in 28 patients(46.7%). The other associated lung diseases were bronchiectasis(n=11), silicosis(n=2), and chronic pnumonia(n=1). Operative proceudres wer lobectomy in 35 patients, pneumonectomy in 6, segmentectomy in 5, lobectomy and thoracoplasty in 3, segmentectomy and thoracopasty in 1, and cavernostomy in 10. The operative mortality was 6%(n=3) in lung resection patients but 0% in cavernostomy patients. The most common complications were prolonged air leakage, wound infection and postoperative bleeding. Conclusion: In most cases of pulmonary aspergilloma surgical resectin remains the only effective therapy. However, cavernostomy may be more effective for pulmonary aspergilloma patients with decreased pulmonary functions and for patients with high risk for lung resection.

• Journal of Chest Surgery
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• 제21권1호
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• pp.109-115
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• 1988

With the decreasing incidence of new cases and the highly effective results with antituberculous drug therapy, there is a marked decline in the need for surgery which was formerly such an important part in the successful program of management of this disease. During the period of two years and a half from Jun. 1984 to Dec. 1986, this study represents an analysis of 163 cases of several surgical management for eventual control of pulmonary tuberculosis at National Kon-ju tuberculosis Hospital. 1. Mode of surgical treatment was: Resection; 123 cases [Pneumonectomy: 83, lobectomy: 35, lobectomy plus segmentectomy; 4 segmentectomy: 1], thoracoplasty: 20 and others: 20. 2. Age distribution ranged 16and 68 with average of 34 years. Male and female ratio was 1.2: 1. 3. Surgical indications were: totally destroyed lung; 64, Destroyed lobe of segment; 13, cavity positive sputum; 10, cavity c negative Sputum; 6, Bronchostenosis c atelectasis; 2, empyema c or s BPF; 46, Aspergilloma; 8, Questions of Associated tumor; 4 and other 5. 4. Incidence of Complications was 10.4% and the mortality was 5.5 percent. The cause of mortality were analyzed. The main causes of death were respiratory insufficiency; 4, fulminant hepatitis; 1, hemorrhage; 1 and unknown; 1 in pneumonectomy, and asphyxia; 1 in lobectomy and sepsis; 1 in other procedure. 5. Conversion rare of positive sputum to negative state related to resectional surgery was 91.5%. In pneumonectomy, drug resistant group preoperatively showed 88.1% conversion rate postoperatively and drug sensitive group showed that 100% conversion rate. In lobectomy, both drug resistant and sensitive groups showed that 100% conversion rate postoperatively.

• Journal of Chest Surgery
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• 제2권1호
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• pp.41-49
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• 1969

The authors made a clinical study of 80 cases of empyema who were diagnosed and treated at department of chest surgery, St. Mary`s Hospital, Chatholic Medical College, during the period of May.l964 through April.1969 and compared the empyema of infant and children with that of adults. 1. In age and sex ditribution, infant was 6 cases, childhood 22 cases and adult 52 cases. The ratio of male to female was 2.2:1. There`s a little difference in infant-childhood but prominence of males over females in adults was being 3. 3:1, in its ratio. 2. The cardinal symptoms were cough [61.3%], fever [60.0%] and dyspnea [52.8%]. The leukocytosis were observed in 83.7% of all cases, 96.2% of infant-childhood and 76.9% of adults. The hemoglobin level showed subnormal in 82.1% of infant-childhood and in 55.8% of adults. 3. Most frequent lesion to predisposing factor of empyema was pneumonia [43.7%],being prominent in infants children [64.3%] to that of adult 4. The Pathogenic organism by culture in 75 cases of empyema were staphylococuss [48%], streptococuss[9.3%], Gram[-] bacilli [9.3%], Klebsiella[2.7%], pneumococcus[4.0%], E. coli [5.4%] and no growth 21.3% in over all. Among the cases of empyema. staphlocal origin was 62.9% in infant-childfood and 39.6% adults. 5. Staphylococci were most susceptible to erythromycin [86. 1%], Kanamycin [75.0%], albamycin [61.7%] and neomycin [52.8%] but most resistant to penicillin, Chtoramphenicol and terramycin. 6. In the treatment of empyema, of 53 cases were closed thoracotomy drainage and the remainder of cases by open thoracotomy, decortication, thoracoplasty and pleuropneumonectomy. we could attain favourable results by only the closed thoracotomy in infant-childhood, 28 cases. 7. The mortality rate was 6.3% in over all; adult 3 cases, infant and children 2 cases. 3 cases of these, were due to staphylococcal infection.

• Journal of Chest Surgery
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• 제25권1호
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• pp.79-85
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• 1992

We have analyzed 1559 operated cases during the 32 year period, from October, 1958 to December, 1990. Annual incidence of the surgical treatment decreased from 101[1960] to 25[1990]. The ratio between male and female was 2.1: 1 and the age of peak incidence was in the 3rd and 4th decades. Recently, patients below the age of 20 years were decreased, but above 50 years were much increased. The patients were consisted of far-advanced case in 71.8% and moderately-advanced case in 22.0% in 1990, as compared with 44% and 54% correspondingly in 1960. Preoperative sputum positivity decreased from 91%[1958~1963] to 38%[1982~1990]. Preoperative antituberculous chemotherapy for more than 3 years increased from 16% [1958~1963] to 56.5% [1982~1990]. From the view of surgical indication, totally destroyed lung and destroyed lobe or segment has been main indication. Recently empyema with parenchymal lesion was increased, and so more extensive surgical resection such as pleuropneumonectomy was performed more frequently. The trends in the mode of surgical treatment revealed that thoracoplasty has virtually disappeared and operations required for residuals of pleural disease have increased. Postoperative mortality increased from 1.6-2.0% to 3.6% recently as well as morbidity. On the basis of our study, far-advanced and drug-resistant patients increased in number recently, whose pulmonary function was poor. So postoperative mortality and morbidity was increased despite improved anesthetic and surgical techniques. Proper surgical intervention should be considered before the appearance of resistance for all chemotherapeutic drugs.

• Journal of Chest Surgery
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• 제18권4호
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• pp.822-834
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• 1985

Reexpansion of the lung is the most desirable method of filling the pleural space whether it`s contents may be, and closed thoracotomy connected to a water-seal drainage remains the basic therapeutic modality in the treatment of the problems of the pleural space. We usually used rubber mushroom tubes, size No. from 16 to 34 Fr., and performed closed thoracotomy after preliminary thoracentesis to determine the exact depending position. Author reviewed 576 cases of closed thoracotomy which were performed in the Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, since Jan., 1980 to June, 1984. The results were as follows: 1. The age distribution was 10 days to 76 years old and mean age of the patients was 36.6 year, and the most prevalent age group was twenties, and sex predisposition was male dominant, 86.9%. 2. The most common etiologic disease group was pneumothorax and the most common etiologic disease was traumatic hemothorax. 3. Sites of tubing were predominantly at posterior axillary line, 7th intercostal space and midclavicular line, 2nd intercostal space even though frequent presence of free pleural space. The two sides, right and left difference of occurrence rate was more frequent at right side, 51.2%. 4. Usually the durations of tubing was less than 10 days, 52.6%, and the number of tubes used to the same patient concomitantly was one, 73.9%, and the time of tubing to the same patient was 1st, 83.6%. 5. The common symptom and sign were dyspnea, 50.0%, chest pain, 30.7%, cough, 10.7%, fever, 6.5%. Especially, fever and cough was the most common symptom and sign in pyogenic empyema, 59.3%. 6. The common etiologic lesions of pneumothorax were blebs and bullae, 73.3%, and of pyogenic empyema was pneumonia, 69.0%. 7. The complication rate of closed thoracotomy was 26.0%. Among these complications, infection was 44.7%, and intercostal neuralgia was 25.3%. 8. 70.9% of all patients recovered with only closed thoracotomy and the rest of patient needed additional some necessary managements such as open thoracotomy [Blebectomy, Resection, Pleurodesis, Decortication, Bleeding control], open drainage, thoracoplasty and so on to have successful results.

• Journal of Chest Surgery
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• 제22권5호
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• pp.839-844
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• 1989

There appears to be significant problems remained in the treatment of tuberculous empyema with BPF in spite of several surgical methods: decortication, thoracoplasty, and pleuropneumonectomy. We presented one case of tuberculous empyema with BPF. The patient was 42-year-old male and his chief complaint was hemoptysis. In past history, he was treated with left closed thoracostomy and antituberculous medication for two months, 16 years ago. Chest X-ray, tomogram and C. T, revealed a huge mass with central necrosis in the lower 2/3 of left thoracic cavity and shifting of the mediastinal structure to the right. Needle aspiration cytology was undifferentiated large cell carcinoma. Left thoracotomy was made under the impression of lung cancer and pleuropneumonectomy was done. Operative findings; thick walled empyema sac filled with hematoma and BPF, the mediastinum was fixated due to fibrosis and calcification of the pleura and the mediastinum. Postoperative biopsy was consistent with tuberculosis. In the postoperative course, there was massive hemorrhage and so reoperation was done. But there was no active bleeding focuses in the thoracic cavity at the time of reoperation. Massive transfusion, coagulant therapy and intermittent clamping and declamping of the chest tube were carried out. Especially, serum calcium level was chronically decreased and so large amount of calcium gluconate was infused for the calcium level to be normal. Total transfused blood; whole blood was 33 pints, packed cell was 63 pints and fresh frozen plasma was 70 pints. At the postoperative[reop] 45th day, intrathoracic hemorrhage was stopped and the chest tube was removed. In conclusion, this suggest that uncontrollable bleeding after pleuropneumonectomy of the tuberculous empyema with BPF could be treated without reoperation in case of the mediastinal fixation due to fibrosis and calcification of the pleura and the mediastinum.

• Journal of Chest Surgery
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• 제36권3호
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• pp.175-181
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• 2003

원발성 흉벽종양은 흉부의 연조직이나 뼈 또는 연골에서 다양하게 발생할 수 있는 종양으로서 전체 원발성 종양의 약 l∼2%를 차지한다. 수술적 절제술은 만성 궤양이나 심한 통증이 있는 환자에서 효과적인 치료법이며 조직학적 진단 및 수술방법에 따라서 장기생존이 가능할 수 있다. 대상 및 방법: 1976년 9월부터 2001년 3월까지 원발성 흉벽종양을 가진 125명(양성종양 86명, 악성종양 39명) 의 환자에서 수술적 절제술을 시행하여 수술결과와 예후에 영향을 미치는 요소들을 해석하고자 하였다. 결과: 양성종양은 수술적 치료로 재발 없이 완전 치료가 되었으며 악성종양은 대부분 광범위 절제술을 시행하였으며 환자에 따라 수술 후 보조요법을 병행하였다. 양성종양 중 신경초종이 가장 많았으며 악성종양은 악성섬유성조직구종이 가장 많은 빈도를 보였다. 악성종양의 경우 3년 생존율이 76.0%, 10년 생존율이 60.5%이었다. 수술과 관련된 사망은 없었으며 외래 추적 중 사망한 환자의 원인은 원격 전이에 의한 장기부전 이었으며 11명에서 재발하였다. 안전거리 절제면을 4 cm 이상과 미만으로 구분하였을 때 두 군간의 생존율에 차이가 없었다. 결론: 양성종양의 경우 수술적 치료로 재발 없이 완치가 가능하였으며 악성종양도 비교적 좋은 장기생존율을 나타내었다. 안전거리 4 cm는 예후에 미치는 영향은 발견할 수 없었으나 재발 시에는 예후가 좋지 않았다.

• Journal of Chest Surgery
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• 제32권8호
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• pp.732-738
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• 1999

배경: 비디오 기술의 발전과 내시경의 향상으로 비디오 흉강경수술은 기흉, 다한증 및 종격동 종양 같은 몇 몇 질환에서는 표준 수술로서 인정받고 있다. 이러한 비디오 흉강경수술은 전신마취하에 이중기도관에 의한 일측 폐환기가 필요하였다. 그러나 폐질환이 동반된 환자나 전신상태가 나쁜 고령의 환자와 같은 고위험군 의 경우는 일측 폐환기나 전신마취 자체에 대한 위험성이 높다. 대상 및 방법: 1997년 12월부터 1998년 7월 까지, 전신상태가 나빠서 전신마취가 위험한 8례의 환자를 대상으로(농흉 6례, 난치성 흉수 1례, 간질성 폐섬 유증 1례) 경막외마취하에 자가호흡을 유지한 상태에서 비디오 흉강경을 이용하여 흉강내 질환의 진단 및 치료를 시행하였다. 결과: 7례에서 성공적으로 비디오 흉강경수술이 시행되었다. 수술 도중 호흡기능이 저하 되어 전신마취로 전환한 경우가 1례 있었으나 개흉술로 전환한 경우는 없었다. 만성 농흉 환자 2례의 경우 에서, 1례는 재발하여 다시 비디오 흉강경 배농술을 시행하였으며 1례는 수술 후 7일째 흉곽성형술을 시행 하였다. 수술시간은 평균 31.8$\pm$15.2분이었으며 수술 후 호흡합병증이 발생한 경우는 없었다. 결론: 경막외마 취하에 비디오 흉강경을 통한 진단 및 치료는 고위험군에서 안전하게 시행될 수 있는 기법이라고 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제61권3호
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• pp.265-272
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• 2006

연구 배경: 척추후측만증, 흉곽성형술, 섬유흉 등과 같은 흉곽변형에 따른 질환들은 비슷한 환기장애의 형태로서 결과적으로 만성호흡부전에 이를 수 있으며, 경과 중 흔히 적인 급성호흡부전이 합병하게 되고 사망의 위험에 놓이게 된다. 저자들은 이러한 환자들에서 급성호흡부전의 빈도와 결과, 생리적 상태, 그리고 장기적 예후 등의 특성을 알아보고자 하였다. 대상 및 방법: 경북대학교병원에서 급성호흡부전으로 첫 환기보조를 받게 된 29명의 흉벽질환자를 대상으로 초기 사망률, 이후의 급성호흡부전의 재발빈도, 동맥혈가스검사 및 폐기능검사, 재택 산소 치료의 효과, 그리고 장기 생존율을 조사하였다. 결 과: 1) 첫 급성호흡부전시의 사망률은 24.1%였으며, 생존자 중 72.7%에서 급성호흡부전이 1회 이상 재발하였고 전체적인 급성호흡부전에 대한 이탈 성공률은 73.2%였다. 2) 첫 급성호흡부전으로부터 회복된 22명은 평균 FVC 및 TLC가 각각 추정 정상치의 37.2, 62.4%인 제한성 환기장애와 평균 $PaCO_{2}$가 57mmHg인 만성적 과탄산혈증 호흡부전소견을 보였으며, $PaCO_{2}$와 VC 및 FVC 사이에 유의한 연관성을 보였다. 3) 보존적 약물치료만 받은 군과 상대적으로 유의한 저산소혈증에 의해 보존적 치료와 재택 산소치료를 함께 받은 군의 비교 시에, 재 급성호흡부전 환자수와 생존율에서 두 군 간에 유의한 차이가 없었다. 4) 첫 급성호흡부전으로부터 생존한 22명의 경과에서 재택 NIV를 받은 2명을 제외한 20명의 1년, 3년, 5년 생존율은 각각 75%, 66%, 57%였으며, 사망자의 88%가 심폐부전으로 사망하였다. 결 론: 흉벽질환자의 급성호흡부전에 대해 적극적으로 환기보조치료가 시도될 만하나, 이들 만성적 호흡부전자에서 재택 산소 치료만으로는 그 효과가 미약하여 삶의 질 및 생존율의 향상을 위해서는 재택 NIV가 필요할 것으로 생각된다.