• Journal of Chest Surgery
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• 제29권10호
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• pp.1138-1142
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• 1996

본 교실에서는 비디오흉강경을 이용하여 199)년 10월부터 1996년 5월까지 52례를 수술하였다. 성비 는 남자 40명(76.9%), 여자 12명(23.1%)으로 3.3 : 1로 남자가 많았으며 나이는 15세에서 68세까지 평균 31.47$\pm$13.59세였다. 수술적응증은 기흉이 40례(76.9%)로 가장 많았으며, 진단적 폐생검 6례(11.6%), 다한증 3례(5.8%), 흉막의 국소성 섬유성 종양 1례(1.9%), 결핵종 1례(1.9%) 및 aspergilloma 1례(1.9%) 였다. 수술방법은 40례 기층환자에서 36례는 폐부분절제와 늑막유착술을 동시에 시행하였으며(일측, 32례, 양측, 4례), 4례 에서는 폐기포가 발견되지않아 늑막유착술만 하였다. 진단적 폐생검 6례, 폐결핵종과 흉막의 국소성 섬유성 종양에서는 폐부분절제하였으며 좌상엽설구역에 있던 aspergilloma는 설구역절 제하였다. 다한증 3례에서는 양측의 흉부 교감신경절제하였다. 수술시간은 일측 폐수술이 105.38 $\pm$49. 82분(45~280분)이 었고, 양측 폐수술은 174.29$\pm$84.2)분(80~320분)이 었다. 술후 흉관거치기간은 2.00$\pm$ 1.32일(0~6일)이었으며 술후 재원기간은 3.55$\pm$1.45(1~8일)이었다. 술후 합병증은 경도의 흉막액 2명, 발열 1명 등 경미하였\ulcorner며 수술후 재발은 기층환자에서 1명(1.9%)있었다.

• Journal of Chest Surgery
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• 제29권10호
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• pp.1143-1147
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• 1996

최근들어 비디오 흉강경을 이용한 흉부수술은 다양한 흉부질환에 이용되고 있다. 전북대학교 의과대학 흉부외과학교실에서 1992년 8월부터 1995년 7훨까지 비디오 흉강경을 이용한 흉부수술을 46예 시행 하였다. 20명이 남자, 26명이 여자이었고 이들의 연령 분포는 14세에서 56세이었다. 대상질환은다한증 21예, 종격동 종양 12예, 기홍 10예, 식도의 평활근종 1예, 그리고 Raynaud's syndrome과 Burger's disease가 각각 1예씩이었다. 평균 수술시간은 89.7분이었고, 개흉술로 전환한 경우는 없었다. 사용한 트로카의 평균 숫자는 3개, 수술 후 흉관 거치 기간은 평균 1.8일, 그리고 수술 후 평균 입원 기간은 4.3일이 었다. 수술후 합병증은 5예(잔류기흉 1예, 횡격신경마비 1예, 지속적 공기 누출 2예, 대상성 과발한 1예)가 있었다. 지속적인 공기누출이 있었던 환자중 1예에서는 술후 3일째 개흉하여 폐부분절제술을 시행하였고 다른 1예에서는 술후 4일째 화학적 흉막유착술을 시행하여 공기 누출을 막을 수 있었다. 종격동 종양 절제술을 받은 환자중 1예에서는 조직검사상 흉선암으로 판명되어 6주간 5600cgy의 방사선 치료를 받 았다. 전체적으로 수술후 사망한 환자는 없었다. 흉강경을 이용한 흉부수술은 수술후 통증과 입원 기간을 감소시킬 수 있었고, 미용상의 이점이 있었다.

• Journal of Chest Surgery
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• 제39권6호
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• pp.475-478
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• 2006

배경: 동시에 발생한 양측성 자발성 기흉은 아주 드문 질환으로 일측성 기흉과는 달리 긴장성 기흉을 초래하지 않고도 심한 호흡곤란, 청색증, 흉통으로 사망에 이르게 할 수 있어 즉각적인 조치를 필요로 한다. 대상 및 방법: 한전의료재단 한일병원 흥부외과에서는 1994년 3월부터 2004년 2월까지 10년간 총 802명 자발성 기흉 환자 중 14명(1.7%)의 동시에 발생한 양측성 자발성 기흉을 발견하여 치험하였다. 결과: 총 14명 중 2명을 제외한 환자가 남자로 85.7%를 차지하였으며, 환자의 나이는 0세(1일)부터 79세로 넓은 연령층(평균 32.0세)을 보였다. 11명의 환자가 초발성 자발성 기흉이었으며 1명은 좌측 자발성 혈기흉을 동반하였고, 2명은 농기흉을 동반하였다. 신생아를 제외한 환자에 있어 흡연률은 13명 중 6명으로 42.8%였다. 결핵을 앓거나 앓았던 환자는 모두 5명(35.7%)이었으며 이 중 2명을 제외하고 현증 활동성 결핵이었다. 14명 중 3명이 사망하였는데 신생아는 메코니움 흉인성 폐렴으로 당일 사망하였으며, 2명은 급성 호흡곤란증후군과 폐렴으로 사망하였다. 동시에 발생한 양측성 자발성 기흉 환자를 비강을 통한 산소 흡인요법, 폐쇄성 흉강삽관술, 개흉술, 흉강경수술과 화학적 흉막유착술을 시행하여 해결하였다. 결론: 동시에 발생한 양측성 자발성 기흉은 총 802명의 자발성 기흉 환자 중 14명(1.7%)에게서 발생하였다. 증상을 완화시키기 위해 즉각적인 폐쇄성 흉강삽관술이 필요하며 자발성 기흉의 재발률을 낮추기 위해 폐쇄성 흉강삽관술 단독보다는 조기에 개흉술 또는 흉강경수술이 필요할 것이라 생각한다.

• Tuberculosis and Respiratory Diseases
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• 제38권2호
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• pp.135-142
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• 1991

We reviewed 15 cases of mesothelioma of the pleura, of which three cases were localized benign form and 12 cases were malignant diffuse form. The tumors were distributed equally in both sexes, and occured most commonly in fifth to seventh decades. The history of exposure to asbestos was present in only one case. The chief complaints were mainly chest pain and dyspnea. Associated symptoms were cough, sputum, hemoptysis, weight loss, anorexia, chill. On physical examination, unilateral, decreased breathing sound was main feature. The simple chest radiograph showed masses in all localized mesotheliomas (100%) and in 2 diffuse mesotheliomas (17%). 8 cases of diffuse mesotheliomas (67%) showed unilateral pleural effusions. Pleural effusions were mainly bloody (67%), and almost all were exudates. In all localized mesotheliomas, final diagnosis was made by open thoracotomy. In diffuse mesotheliomas, final diagnosis was made by open thoracotomy in 7 cases, chest wall mass biopsy in 2 cases, thoracoscopic biopsy in 1 case, pleural biopsy in 1 case, and pleural biopsy combined with axillary lymph node biopsy in 1 case. Localized mesotheliomas were treated by simple excision with good prognosis. In diffuse mesotheliomas, surgical treatment (pleuropneumonectomy, pleurectomy), chemotherapy, or radiotherapy, alone or in combination, were used with dismal prognosis. The prognostic factors were not found due to the small number of cases, incomplete follow up, and early drop out.

• Journal of Chest Surgery
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• 제24권5호
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• pp.451-458
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• 1991

We have observed 101 cases of recurrent spontaneous pneumothorax from Sep. 1979 to Dec. 1989 at the Department of Thoracic & Cardiovascular Surgery, College of Medicine, Inje University, Pusan Paik Hospital and the result obtained as follows. 1] Age range of patients was the first decade to seventh decade. Males outnumbered females by 6.7: l. One or two episodes of recurrent attack were noted in majority cases. 2] In distribution of the lesion sites, right side was 55 cases[55.4%], left 42 cases[41.9%], and bilateral 4 cases[3.0%]. 3] In clinical manifestations, abrupt onset of dyspnea was 78 cases[77.2%], chest pain 48 cases[47.5%], cough 9 cases[8.9%] and chest discomfort 8 cases[7.9%]. 4] Of 101 cases, 48 cases were associated with pulmonary tuberculosis and other cases were associated with subpleural bullae and blebs[26 cases], emphysema[7 cases], bronchiectasis[2 cases], lung cancer[1 case], and silicosis[1 case], 5] In 88 cases[87.2%] of patients, the magnitude of collapse was above 50% in plain chest film. 6] The interval of recurrence after last attack was frequently within 1 year. 7] In the management, closed thoracostomy with underwater-sealed drainage was applied in first recurrent 53 cases but 2nd recurrence was developed in 16 cases. In 52 cases, surgical management was applied. The pleurodesis with chemical agent[tetracycline] via chest tube was applied in 2 cases. Among 51 cases subjected to the open thoracotomy, pleural abrasion was performed in 3 cases, excision of bullae & blebs in 12 cases, wedge resection in 28 cases, lobectomy in 6 cases and wedge resection combined with lobectomy in 2 cases. In one case subjected to the median sternotomy, wedge resection on both lung apex was performed. 8] Postoperative complications were developed in 8 cases but not serious.

• Journal of Korean Neurosurgical Society
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• 제30권5호
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• pp.642-646
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• 2001

A 12-years-old female admitted to the hospital with the complaint of pain on the right upper chest area which persisted about 1 month prior to admission. $Caf{\acute{e}}$-au-lait spots of various size laying on a whole body and freckling on the axilla were found on physical examination. A huge mass was found on the plain chest X-ray and on chest MRI. The mass encroached thoracic spine, posterior rib, back muscles, and then into the neural canal and compressed thoracic spinal cord. On the 5th day of hospitalization, the patient complained tingling on the both legs and 2 days later, monoparesis on the right leg. Open thoracotomy and decompressive laminectomy was done to remove mass. Pathologic reports confirmed rhabdomyosarcoma, embryonal type.

• Journal of Chest Surgery
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• 제25권9호
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• pp.968-975
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• 1992

A clinical analysis was performed on 404 cases of the chest trauma who were admitted and treated at department of thoracic and cardiovascular surgery, Chung Ang University, Yong San Hospital during the past 8 years from July 1984 to April 1992. The results were as follows. 1. The sex ratio was 3: 1 with male predominence. 2. The common age groups were 3rd, 4th, 5th and 6th decades. 3. The most common chief complaint was chest pain[58.2%]. 4. Of 404 cases of chest trauma, 50 cases were resulted from penetrating injuries whereas 354 cases were from non penetrating injuries. The most common cause of the non penetrating injuries was traffic accident[234/354, 66.1%] and of the penetrating injuries were stab wound[47/50, 94%]. 5. The left thorax was the preferred site of chest trauma. 6. The range of hospital stay was from less than 1 week to over 6 weeks and the average duration was about 2 weeks. 7. The common chest trauma was rib fracture[51.6%] and others were simple contusion [18.8%], hemothorax[14.6%], hemopneumothorax[14.9%] and pneumothorax[8.7i]. The rib fracture was prevalent between 4th to 9th rib laterally. 8. There were 92 cases of associated injuries which were bone fracture[66/92, 71.7%], head injury[17/92, 18.5%] and abdominal injury[9/92, 9.8%]. 9. The methods of treatment were conservative management[58.6%], closed tho-racostomy[23.3%], open thoracotomy[3.4%] and others. 10. There were 28 cases[6.9%] of complication, such as pneumonia, atelectasis, emp-yema, respiratory failure and others. 11. The overall mortality was 2.5%[10 cases] and causes of death were hypovolemic shock, acute renal failure, adult respiratory distress syndrome, sepsis and multiple organ failure.

• Journal of Chest Surgery
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• 제7권2호
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• pp.163-168
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• 1974

Five cases of traumatic diaphragmatic hernia were repaired in the Department of Thoracic Surgery, Seoul National University Hospital, during the period from 1967 to 1974. The first case, a 14-year aid girl, was diagnosed as diaphragmatic hernia during laparotomy because of jejunal perforation 3 days after traffic accident. Herniated stomach, transverse colon, spleen and left lobe of the liver were repositioned and the diaphragmatic rupture on left posterolateral portion was repaired with two layers of nonabsorbable sutures by transthoracic approach. The second case, a 26-year old man,was diagnosed immediately after traffic accident at a local clinic and transferred to this hospital 24 hours later. Herniated stomach, transverse colon and jejunum were repositioned amd diaphragmatic rupture,about 9 cm in length,from the posterolat.edge to the base of pericardium was sutured in two layers. The third case, a 26-year old man who had stab wound on the left lower lateral chest two years ago,was admitted with sudden abdominal pain and vomiting. Upper gastrointestinal series with barium meal revealed diaphragmatic hernia. The herniated stomach and transverse colon through the defect,about 3.5cm in diameter, at anterolateral portion on the left side,were repositioned and repaired with two layers of nonabsorbable sutures. The forth case, a 26-year old man, sustained blunt trauma to the chest by a roller and was transferred to the emergency room complaining of dyspnea 40 minutes after the accident. The diaphragmatic rupture extended from left midaxillary line to contralateral anterior axillary line,about 20cm long, at anterior portion of diaphragm, which was repaired with two layers, of nonabsorbable sutures. The fifth case, a 4-year old girl, had two separate diaphragmatic ruptures on both sides, which were caused by traffic accident. Immediate upper gastrointestinal series after injury showed herniated stomach, colon and spleen into left Chest cavity. Another small rupture with anterior edge of right lobe of the liver in chest cavity was noted. These were repaired with non-absorbable sutures via thoracotomy.

• Journal of Chest Surgery
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• 제43권4호
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• pp.454-457
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• 2010

42세 남자 환자가 종합 검진상 발견된 좌측 6번 늑골의 후궁(posterior arc)의 종괴로 내원하였다. 흉부 컴퓨터 전산화 단층 촬영 및 뼈 스캔(bone scan)에서 뼈연골종(osteochondroma)으로 의심되었고, 흉강경하 늑골 절제술을 시행하였다. 수술 과정 중 혈관 및 신경 손상은 없었다. 환자는 수술 후 4일째 합병증 없이 퇴원 하였다. 조직학적 결과는 양성 섬유성 조직구종(benign fibrous histiocytoma)이었다. 본 증례를 통하여 흉강경을 이용한 늑골의 절제는 후측방 절개술을 통한 늑골 절제술에 비해 미용적인 면에서 장점이 있으며, 손쉽게 수행 가능함을 알 수 있었다.

• Journal of Chest Surgery
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• 제43권5호
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• pp.546-549
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• 2010

70세 남자 환자가 심한 복부 및 배부 통증으로 흉부 대동맥류 파열 의심 하에 전원되었다. 환자는 6개월 전 타 병원에서 하행대동맥류 의심 하에 대동맥 스텐트를 삽입하였던 병력이 있었으나 전산화 단층촬영 소견은 후종격동 악성 종양을 시사하였다. 개흉 후 이와 같은 진단이 확인되었으며 종격동의 육종은 거기에 둘러싸인 대동맥과 함께 성공적으로 절제되었다. 본 증례는 최근 주목을 받고 있는 대동맥 스텐트 그라프트 삽입에 대한 맹목적인 선호에 대하여 주의를 환기시키는 교훈적인 경우라고 판단된다.