• Journal of Chest Surgery
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• 제57권3호
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• pp.302-311
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• 2024

Background: Unexpected conversion to thoracotomy during planned video-assisted thoracoscopic surgery (VATS) can lead to poor outcomes and comparatively high morbidity. This study was conducted to assess preoperative risk factors associated with unexpected thoracotomy conversion and to develop a risk scoring model for preoperative use, aimed at identifying patients with an elevated risk of conversion. Methods: A retrospective analysis was conducted of 1,506 patients who underwent surgical resection for non-small cell lung cancer. To evaluate the risk factors, univariate analysis and logistic regression were performed. A risk scoring model was established to predict unexpected thoracotomy conversion during VATS of the lung, based on preoperative factors. To validate the model, an additional cohort of 878 patients was analyzed. Results: Among the potentially significant clinical variables, male sex, previous ipsilateral lung surgery, preoperative detection of calcified lymph nodes, and clinical T stage were identified as independent risk factors for unplanned conversion to thoracotomy. A 6-point risk scoring model was developed to predict conversion based on the assessed risk, with patients categorized into 4 groups. The results indicated an area under the receiver operating characteristic curve of 0.747, with a sensitivity of 80.5%, specificity of 56.4%, positive predictive value of 1.8%, and negative predictive value of 91.0%. When applied to the validation cohort, the model exhibited good predictive accuracy. Conclusion: We successfully developed and validated a risk scoring model for preoperative use that can predict the likelihood of unplanned conversion to thoracotomy during VATS of the lung.

• Journal of Chest Surgery
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• 제27권11호
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• pp.942-947
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• 1994

Post-thoracotomy pain is so severe that lead to postoperative pulmonary complications due to the patient`s inability to cough, deep breathing and chest wall motion. Many authors have been trying to reduce the post-thoracotomy pain, but there is no method of complete satisfaction. In 1990, we reported the result that the cryoanalgesia reduce the immediate postoperative pain significantly. We try to compare the effect of cyroanalgesia with the effect of Bupivacain intercostal nerve block for the post-thoracotomy pain control. Ninety patients, who undergoing thoracotomy in Korea University Medical Center Guro Hospital between the January 1993 and September 1993, were evaluated. The patients were divided into three groups : Group A, control, the patients without pain control procedure [N=30], Group B, the patients with Bupivacain intercostal nerve block [N=30], Group C, the patients with cryoanalgesia [N=30]. Postoperative analgesic effects were evaluated by the scoring system which made arbiturary by author. The results were that the Bupivacain intercostal nerve block markedly reduced the immediate postoperative pain compare with two other groups, the cryoanalgesia reduced the immediate postoperative pain significantly compare with control group, the pain reduction effect of the two groups- cryoanalgesia and Bupivacain intercostal nerve block- were not different at postoperative seventh day, probably due to the action time of Bupivacain and the result that there were no significant complications of the procedures.

• Journal of Chest Surgery
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• 제26권10호
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• pp.781-786
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• 1993

Effrctive analgesia after elective thoracotomy can be provided by continuous extrapleural intercostal nerve block.This study was designed to prove the effectiveness of continuous extrapleural intercostal nerve block. Twenty patients undergoing elective thoracotomy were randomized into two groups. Group I received lumbar epidural block[N=10] and group II received continuous extrapleural intercostal nerve block[N=10]. Postoperative pain relief was assessed on Numeric Rating Scale[NRS] and recovery of pulmonary function was assessed by coparison of preoperatrive and postoperative FVC[Forced Vital Capacity], FEV1[Forced expiratory Volume in 1 second], VC[Vital Capacity]. Arterial blood gas analysis[ABGA], vital signs and amount of additive analgesics were compared also. No significant difference was observed between the groups concerning these parameters mentioned above. Systemic complications, such as urinary retention[2/10] and weakness of lower extremity[2/10], occurred in group I but no complication occurred in group II. We conclude that continuous extrapleural intercostal nerve block is as effective as epidural block in pain relief and restoration of pulmonary mechanics with fewer comlications. Also because of it`s ease and safetiness, this must be considered as a substitute of epidural block in routine use for thoracotomy pain relief.

• Journal of Trauma and Injury
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• 제34권4호
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• pp.284-287
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• 2021

We report a case of delayed chest wall reconstruction after thoracotomy. A 53-yearold female, a victim of a motor vehicle accident, presented with bilateral multiple rib fractures with flail motion and multiple extrathoracic injuries. Whole-body computed tomography revealed multiple fractures of the bilateral ribs, clavicle, and scapula, and bilateral hemopneumothorax with severe lung contusions. Active hemorrhage was also found in the anterior pelvis, which was treated by angioembolization. The patient was transferred to the surgical intensive care unit for follow-up. We planned to perform surgical stabilization of rib fractures (SSRF) because her lung condition did not seem favorable for general anesthesia. Within a few hours, however, massive hemorrhage (presumably due to coagulopathy) drained through the thoracic drainage catheter. We performed an exploratory thoracotomy in the operating room. We initially planned to perform exploratory thoracotomy and "on the way out" SSRF. In the operating room, the hemorrhage was controlled; however, her condition deteriorated and SSRF could not be completed. SSRF was completed after about a month owing to other medical conditions, and the patient was weaned successfully.

• Journal of Chest Surgery
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• 제26권4호
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• pp.303-307
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• 1993

Postoperative pain relief and the side effects of epidurally injected morphine were investigated in 10 patients who received thoracotomy. Epidural morphine injection was given via an epidural catheter after thoracotomy. The pain score[VAS] and repiratory rate were decreased and the SaO2, tidal volume and vital capacity were increased significantly after epidural morphine injection. The analgesia of epidural morphine lasted for 13 hours with average. The side effects of epidural morphine were few and mild, but urinary retention was in 10%[1/10] of total patients.

• Journal of Chest Surgery
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• 제17권1호
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• pp.82-88
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• 1984

Total 310 cases of spontaneous pneumothorax in 281 patients were analyzed to review the results of surgical treatment for this condition. Clinical data on the age & sex distribution, recurrence, etiologic conditions and on the other aspects of spontaneous neumothorax were summarized. The results of surgical management of spontaneous pneumothorax are followings; 205 out of 310 cases[66.1%] were cured by closed thoracostomies. 82 cases[26.5%] were cured by thoracotomy. The indications of thoracotomy were 1] persistent air leakage, 2] history of recurrences, 3] blebs or bullae on thoracoscopy, 4] associated parenchymal lesion, 5] pneumothorax caused by paragonimiasis. Other reasons of thoracotomy were bilateral pneumothorax and inadequate expansion due to chronicity. Excision of blebs or wedge resection was performed in most cases with good result. Lobectomy [9 case] or pneumonectomy [3 cases] was carried out depending on the pathological involvement of the lung. There was no operative death and only one case showed recurrent pneumothorax during follow-up after thoracotomy.

• Journal of Chest Surgery
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• 제26권5호
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• pp.390-394
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• 1993

This study elvaluated clinically the surgical results of the thirty-eight patients who had exploratory thoracotomy for spontaneous pneumothorax between Jan. 1989 and Nov. 1992. Thirty three, or 86.8%, of the patients were male. The most frequent age of the spontaneous pneumothorax requiring thoracotomy was between fifteen years and twenty years. Sudden onset dyspnea and chest pain, which developed in thirty-five patients[89.5%], were the major chief complaints. Bleb and Bulla located in the both upper lobes were the most frequent causes of spontaneous pneumothorax for exploratory thoracotomy. There was no operative death. Postoperative morbidity included three cases of residual air space in the apical pleural space, tow cases of atrial fibrillation, and one each case of reoperation for bleeding, mediasitinitis, and sternal osteomyelitis. All postoperative complications were treated without any serious problems. This study suggests that early exploratory thoracotmy is desirable for patients with prolonged air-leak, massive air-leak, or multiple blebs and giant bullae on the computed tomography of the chest.

• Journal of Chest Surgery
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• 제24권3호
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• pp.261-264
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• 1991

The result of thoracotomy for recurrent and persistent pneumothorax is usually excellent. However the patients undergone thoracotomy suffer from postoperative chest pain and require long postoperative recovery period. Also the operative incision scar gives the patients cosmetic problems. Subpleural blebs are usually causes of pneumothorax. They can be reached through the thoracoscope without thoracotomy and can be ablated by electrical cautery through it. Six patients with recurrent and persistent pneumothorax were managed thoracoscopic-ally. Five patients were successful and one case was failed. The failed case was explored 21 days after thoracoscopy. Follow-up period was from one to eight months. Although the follow-up period was short, thoracoscopic management of recurrent and persistent pneumothorax is thought to be good for preventing thoracotomy.

• Journal of Chest Surgery
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• 제4권1호
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• pp.43-50
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• 1971

Three patients who sustained penetrating stab wound of the heart have been treated successfully by emergency thoracotomy in the Department of Thoracic Surgery, Chonnam University Hospital. There were two knife and one glass wound. The location of the injury were all on the right ventricle, but in one patient, it was penetrated to ventricular septum. All patients were in shock with a systolic pressure under 60 mmHg when admitted to the emergency room. In one of the three patients, blood pressure was not detectable and subsequently cardiac arrest. Two patients required immediate thoracotomy because of intrathoracic hemorrhage and increased pericardial tamponade and the other one required prompt thoracotomy because of sudden onset of cardiac arrest. There were no death postoperatively. Two patients are living without any complication in 4 years and 4 weeks after operation. One who had penetrating wound to ventricular septum, turned to cardiac decompensation, but he is living now in 4$\frac{1}{2}$ years after operation. Exploratory thoracotomy should be performed immediately in all the patients in whom a penetrating wound of the heart or pericardial tamponade following a penetrating wound of the chest wall is suspected.

• Journal of Chest Surgery
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• 제18권4호
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• pp.582-588
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• 1985

We have observed 165 cases of spontaneous pneumothorax from Aug. 1978 to May. 1985 at the department of Thoracic and Cardiovascular Surgery, School of Medicine, Keimyung University. The ratio of male to female cases were 8.2:1 in male predominance, and the incidence was highest in the adolescence between 21 to 30 year of age. There were 85 patients of primary spontaneous pneumothorax and 80 patients of secondary spontaneous pneumothorax. The etiologic factors of secondary spontaneous pneumothorax were tuberculous origin in 50 cases, chronic bronchitis with emphysematous bullae or blebs in 17 cases, asthma in 10 cases and lung cancer in 3 cases. Closed thoracotomy was performed for reexpansion of collapsed lung in 153 cases, bed rest in 3 cases, needle aspiration in 5 cases and open thoracotomy in 14 cases. Closed thoracotomy was the main therapeutic approach of choice in the great majority of spontaneous pneumothorax with recurrence rate of 21.6%. However, open thoracotomy was undertaken in patients with continuous air leakage, recurrent episodes, bilateral pneumothorax and large visible apical blebs or bullae.