• Journal of Chest Surgery
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• 제33권2호
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• pp.179-182
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• 2000

Background: A pleural effusion is not a disease entity but a clincial sign of systemic or pleural disease. Although the diagnosis of pleural effusion can often be done by toracentesis and pleural needle biopsy the yeild of positive diagnosis is low.

• Journal of Chest Surgery
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• 제35권5호
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• pp.392-396
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• 2002

배경: 폐암환자의 정확한 병기 판단을 위한 비디오흉강경수술은 흉강내를 직시하며 병변의 의심이 있는 부위의 생김을 실시할 수 있으므로 기존의 방법에 덧붙여 절재술 여부를 결정하는데 중요한 역할을 할 것으로 생각된다. 본 조사의 목적은 폐절제술 전 비디오흉강경수술의 역할을 평가하기 위하여 실시하였다. 대상 및 방법: 흉부전산화단층촬영술등과 종격동경으로 평가를 실시하여 절제술을 하려는 폐암환자에서 개흉전 비디오흉강경술을 실시하였다. 총 37예에서 흉강경수술을 실시하였으며 흉강경수술전 병기는 TNM병기로 1병기 18예, II병기 7예, III병기가 12예였다. 결과: 37예 중 15예는 흉강내 유착, 횡격막 또는 흉벽의 종양침범과 폐문부 종괴의 거대로 인하여 종격동에 접근이 어려워 흉강경수술이 용이치 않아 실시할 수 없었으며 이들 예에서는 전제술 후 병리조직학적으로 6예에서 종격동림프절에 암 전이가 확인되었다. 흉강경수술을 실시한 22예 중 2예는 흉강경수술 전 병기평가에선 N0이었으나 N2로 확인되어 개흉하지 않았고 20예에서는 흉강경수술상 종격동림프절에 천이가 확인되지 않아 절제를 실시하였다. 그러나 이중 5예에서 절제술 후 병리조직학적으로 N2로 확인되었다. 결론: 이상의 결과를 보아 흉막강내의 유착, 흉벽과 횡격막에 종양침범이나 거대종괴등으로 인하여 흉강경을 통한 흉강내 관찰이 어려워 흉강경술을 진행할 수 없는 예들이 많이 있으므로 비디오흉강경술의 적용에 신중을 기하여 할 것이나, 흉강경을 통한 관찰과 생검으로 적은 예들에서지만 불필요한 개흉을 피하는데 도움이 되었다.

• Journal of Chest Surgery
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• 제26권3호
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• pp.236-240
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• 1993

Video thoracoscopic surgery is a new modality that gains acceptance rapidly from thoracic surgeons. We have experienced two left lower lobectomies, one left upper lobectomy & one right upper lobectomy with using video thoracoscopy for the four patients with lung parenchymal disease from July 1992 to February 1993. The post-operative courses were uneventful. The final pathologic diagnosis were sclerosing hemangioma, adenocarcinoma, bronchiectasis, leiomyoma & the post-operative courses were short. These patients needed less analgesics because postoperative pain was reduced markedly, and hospitalization was shortened due to rapid recovery. We would like to prefer video thoracoscopic lobectomy to the lobectomy through standard thoracotomy in uncomplicated patients with simple pulmonary parenchymal diseases.

• Journal of Chest Surgery
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• 제17권3호
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• pp.522-530
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• 1984

During a 12-month period, 31 patients underwent diagnostic and therapeutic thoracoscopy for previously undiagnosed thoracic diseases. In all patient, the diagnosis had been unobtainable by the usual diagnostic modalities of thoracentesis, closed pleural biopsy, bronchoscopy, or mediastinoscopy. The patients ranged from 4 years to 84 years old. One procedure was performed for mediastinal mass, 8 for parenchymal lesions, 21 for pleural diseases, and 1 for diaphragmatic disease. A correct diagnosis was obtained by thoracoscopy in 31 procedures for a 90% overall accuracy rate. There was no clinically significant morbidity in this series and no procedure-related mortality. Thoracoscopy, performed under intercostal nerve block and regional anesthesia, has proved to be a very attractive method of the diagnosis of thoracic disease.

• Journal of Chest Surgery
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• 제8권1호
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• pp.19-28
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• 1975

The thoracoscopic study was reported on 21 cases of spontaneous pneumothorax requiring surgical management, and clinical values of thoracoscopic examination on spontaneous pneumothorax were also discussed. patients were treated in the Department of .Thoracic Surgery, Hanyang University Hospital for the period of two Years from May 1972 to April 1974. For exact detection of etiologic factors on spontaneous pneumothorax, the thoracoscopic examination in the intrapleural space was performed in parallel with X-ray study. this study, the difference of diagnostic and therapeutic significance between radiological and thoracoscopic findings were observed and compared simultaneously. The results are summerized as follows: Patients age was distributed between 3 and 70 years old with highest incidence in the age group of sixty decade [33. 3%], and sex ratio of male to female was 5:2. The tuberculous processes which developed superficial subpleural layer in the lung parenchyme, on the pulmonary surface could be observed by thoracoscopic examination in a characteristic picture. detection ratio of pulmonary tuberculosis by the radiologic study to that by thoracoscopy was 8:2. The adhesion between the visceral and the parietal pleura which could possibly make a rupture of the alveola and the visceral pleura was found to be localized in a small area of the lung surface. The other part of the lung surface was free of the adhesion and, therefore, the movement of the lung took place completely without any difficulty. The ruptured orifice of the pleura and pathological changes surrounding the orifice can be detected by thoracoscopy, but not by other means such as radiologic examination. A single tuberculous bleb and multiple emphysematous blebs were found on 6 cases out of 21 cases of spontaneous pneumothorax. Among these cases, radiologic Study revealed the bleb only in one patient. On the other hand, the blebs were found in all the six patients by means of thoracoscopic examination. It gives the detection ratio of bleb by radiologic study to that by thoracoscopy was 1:6. By thoracoscopy, the rupture on the lung surface were visualized on the 10 patients out of a total of 21 patients [10 patients of visual rupture]. However, the rupture of the pleura was not observed on the rest of 11 patients even by thoracoscopic examination [11 patients of non visual rupture]. Five patients [50%] out of ten who had the visual rupture on the lung surface was required a surgical operation to remove pneumothorax. For the patients who were detected to have the visual rupture of the pleura by thoracoscopy, be considered in the early stage of closed thoracostomy. of 21 patients, 16 patients [11 patients of non visual rupture of the pleura and 5 patients of visual rupture of the pleura] who received no surgical management, were treated with closed thoracostomy with continuous suction, and the` pneumothorax was healed completely up in each cases. Therapeutic measures for the remaining 5 patients of visual rupture of the pleura who were subjected to surgical approach for radical treatment of spontaneous pneumothorax were accordingly complicated, and the following different procedures were properly indicated case by case, that is, rib resection thoracostomy, simple closure of ruptured visceral pleura, wedged resection of the lung, and lobectomy.

• Journal of Animal Science and Technology
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• 제59권3호
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• pp.5.1-5.10
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• 2017

Background: Bovine respiratory disease (BRD) is one of the leading causes of economic losses in the beef and dairy industry. Reliable antemortem tools for diagnosing BRD would improve the efficacy of treatment and reduce costs. Here we examined whether the relatively simple technique of thoracoscopy can support BRD diagnosis under field conditions. We also compared various equipment set-ups in order to optimize the safety and efficacy of the procedure. A total of 24 thoracoscopic procedures were performed in 17 calves diagnosed with BRD and in 2 healthy control calves. Rigid and flexible endoscopes and industrial videoscopes were tested using various insertion approaches. The suitability of the technique was assessed in terms of duration, volume of air extracted, visualization score, and image quality. Safety was assessed in terms of rectal temperature, body weight, breaths/min, presence of fibrinogen, pain score, recovery time, intraoperative complications and risk of laceration or threatening collapse. Results: Insertion of a flexible endoscope via a right, dorso-caudal approach at the $5^{th}$ intercostal space allowed complete examination of the right lung in 15 min, as well as identification of main lung lesions and adherences in calves with BRD, without compromising calf welfare. While the dorso-caudal approach was optimal, it was associated with substantial discomfort when rigid endoscopes were used, minimal complications or mortality due to thoracoscopy were observed up to 28 days after the procedure. Videoscopes were as safe and easy to use as endoscopes, but endoscopes provided better image quality. Conclusion: This study provides the first field evidence that thoracoscopy can be safe to explore BRD-diseased calves. These results justify a larger study to rigorously assess the diagnostic performance of the technique.

• Tuberculosis and Respiratory Diseases
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• 제63권3호
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• pp.261-267
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• 2007

배경: 삼출성 흉수 환자의 적지 않은 빈도에서 원인이 불명확하다. 삼출성 흉수를 진단하기 위한 다양한 방법 중에서 내과적 흉강경은 국소마취 하에서 시행할 수 있으며 악성 종양이나 결핵에서 진단율이 높으며, 진정제와 국소마취상태에서 시행할 수 있다. 본 연구의 목적은 내과적 흉강경의 진단적 정확성과 안전성에 대해 알아보고자 하였다. 대상 및 방법: 2005년 10월부터 2006년 9월까지 25명의 원인을 알 수 없는 삼출성 흉수 환자를 대상으로 내과적 흉강경을 시행하였다. 성별, 연령 시술 전 폐기능, 흉부 측와위 사진에서 흉수의 두께(LDR) 등의 정보를 얻었다. 내과적 흉강경 시행도중 활력징후를 기록하였고 동맥혈 가스 분석을 5차례 시행하여 혈역학적 상태와 산-염기 균형 상태를 파악할 수 있도록 하였다. 결과: 환자의 평균 연령은 56.8(22-79)세였고, 흉부 측와위 사진에서 흉수의 두께는 27.49 mm이었다. 내과적 흉강경을 이용한 흉막 조직 생검으로 24명(96%)이 진단되었으며, 결핵성 흉막염이 9명(36%), 악성 흉수가 8명(32%), 부폐렴성 흉수가 7명(28%)이었다. 내과적 흉강경으로 흉수의 원인을 알아낼 수 없었던 1명(4%)은 추후에 심장막 조직 생검으로 결핵으로 진단되었다. 내과적 흉강경 중 혈압, 심박동수, 산-염기 상태의 변화는 보이지 않았다(p>0.05). 결론: 내과적 흉강경은 진단율이 높으면서도 안전한 시술이다.

• Journal of Chest Surgery
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• 제20권3호
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• pp.548-551
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• 1987

Thoracoscopy, mediastinoscopy and/or mediastinotomy and explo-thoracotomy were performed and confirmed diagnosis of the 26 cases of the mediastinal tumors, those were admitted and treated at the Department of Thoracic and Cardiovascular surgery, Chonbuk National University Hospital, from June,1976 to September, 1986. We experienced 7 thoracoscopies, 7 mediastinoscopies &/or mediastinotomies, and 12 explo-thoracotomies. The most common histologic type was teratoma and lymphoma [6 cases]. Of the 26 cases of the histologically confirmed mediastinal tumor, 19 were benign tumors and 7 were malignants. 19 cases of benign tumors were surgically resected with good result but one case of the surgically resected malignant thymoma was recurred 4 months later. 6 cases of malignant lymphoma and one case of recurred malignant thymoma were treated with chemo-and radiation therapy. Thoracoscopy and mediastinoscopy with tissue biopsy were simple in procedure and had a tissue diagnosis with obtaining the pathologic tissue in a acceptable complication rate and reduced exploratory thoracotomy.

• Journal of Chest Surgery
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• 제26권3호
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• pp.204-208
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• 1993

The review of 68 patients, who were diagnosed as spontaneous pneumothorax during the period from Dec, 1991. to Jul, 1992. were performed thoracoscopy of 70 cases under local anesthesia with 1% lidocaine at the department of thoracic & cardiovascular surgery, HanYang University Hospital. Clinical data on distribution of Age & Sex, Location, Frequency of Reccurrence and other aspects of pneumothorax were summerized.37 cases were treated by thoracoscopic management and closed thoracostomy. As thoracoscopic management, Electrocauterization of bullae or blebs[37 cases], Endo-clip application [2 cases], Removal of foreign body[1 case] were performed. 31 cases were cured by open thoracotomy. The thoracotomy indications under thoracoscopic finding were followed as: 1. Severe pulmonary adhesion and destroyed lung parenchyme 2. multiple bullae or blebs on several areas 3. finding of pulmonary tuberculous caseous lesion 4. persistant air leakage after 7 days from thoracoscopic management Excision, wedge resection of bullae or blebs was performed in most cases [22 cases], 2 cases by median sternotomy and Segmentectomy of 7 cases were carried out depending on the pathologic change of lung.There was no operative mortality and Follow-up for all patients were showed good results.

• Journal of Chest Surgery
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• 제38권5호
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• pp.371-376
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• 2005

배경: 저자는 원발성 자연 공기가슴증 환자에서 고식적인 비디오흉강경하 쐐기절제술이 흉강경을 이용한 변형된 소절개술식보다 우수한가를 결정할 목적으로 후향적으로 연구를 하였다. 대상 및 방법: 원발성 자연 공기가슴증을 보인 $14\~35$세 사이의 160명의 환자를 대상으로 하였다. 환자는 수술기법과 수술 접근법에 의해서 고식적인 흉강경하 쐐기절제술군(A군: 80예)과 흉강경을 이용한 변형된 소절개술식을 이용한 군(B군: 80예)으로 분류하였다. 모든 환자에서 술 후 늑막강 첨부의 찰과상과 탈크 도포를 수행하였다. 이 연구는 수술시간, 수술 후 사용한 진통제의 사용일수, 수술 첫날 공기누출이 없는 수, 흉관 삽관일과 병원 입원일, 그리고 술 후 합병증, 추적기간 동안의 만성 흉통과 일상생활로 복귀할 때까지의 기간 그리고 또한 추적기간 동안에 수술동측에서의 재발을 평가하였다. 결과: 양 군사이에서 연구한 평가요소 중 어느 것에서도 의의 있는 차이는 없었다. 결론: 고식적인 비디오 흉강경하 쐐기절제술과 흉강경을 이용한 변형된 소절개술식은 원발성 자연 공기가슴증 환자의 수술적 치료에 있어서 유사한 결과를 야기하였다. 합병증의 발생률도 낮고, 통각도 장기 추적동안에 받아들일 만 하였다. 따라서 흉강경을 이용한 변형된 소절개술식 또한 가치 있는 대체수술 기법으로 보인다.