• Journal of Chest Surgery
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• 제24권8호
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• pp.765-772
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• 1991

Between 1985 and 1990, 41 patients underwent treatment of the tracheal stenosis. Nineteen patients underwent resection and end-to-end anastomosis including three cases of the subglottic stenosis. Other patients had had treatment such as LASER therapy, bronchoscopic removal, insertion of the Montgomery silastic T-tube or stent insertion Nineteen patients which underwent resection and end-to-end anastomosis were excellent result from three years to sixth months. Other patient were followed at OPD for the other complication or restenosis. There were no hospital death but one patient was managed by bronchoscopic removal of the granulation tissue and other one patient had underwent reoperation for the dehiscence at the anastomotic site.

• 대한두개안면성형외과학회지
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• 제25권3호
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• pp.155-158
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• 2024

One important complication of the tracheostomy procedure is the depressed scar left after the tube is removed. A depressed tracheostomy scar can be aesthetically and functionally unacceptable. Tracheostomy scar treatment aims to fill lost soft tissue volume and correct tracheal skin tug. There are various techniques described to manage post-tracheostomy scars, including the use of autologous tissue or allogenic material and the creation of muscle flaps. In this article, the authors introduce a surgical method using four layers: the scar, the strap muscles, the platysma muscle, and the skin. This procedure has been used in two patients with depressed scar after prolonged tracheostomy placement. The tracheal tug was eliminated in each patient, and an imperceptible cutaneous scar remained. In each case, patient satisfaction was complete. The authors recommend this technique as a simple and effective method of closure for these troublesome tracheostomy scars.

• 동국한의학연구소논문집
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• 제6권2호
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• pp.135-143
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• 1998

산업 발달과 더불어 경제가 발전하고 있으나, 그것에 따른 매연의 증가로 인해 호흡기 질환으로 고생하고 있는 환자가 날로 늘어나고 있는 실정으로 임상에서 특히 많이 발생되는 만성 호흡기질환 중 호흡기 조직 자체에 손상을 일으킬 수 있는 질환이 많기에, 이에 소자도담강기탕이 인위적으로 호흡기 조직을 손상시킨 것에 대해 얼마나 효과가 있는지 알아보고저 본실험을 하였는 바, 방법은 흰쥐를 대상으로 $SO_2$를 흡인시킨 후 5일간, 그리고 $SO_2$ 흡입 전 10일과, 흡입 후 5일간 연속으로 소자도담강기탕을 경구투여하여 기관상피 및 전액분비세포를 관찰하여 유의한 효과를 얻었기에 보고하는 바이다.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1993년도 제27차 학술대회 초록집
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• pp.81-81
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• 1993

소아의 기관협착은 대부분이 장기간의 기관내삽관에 의해 초래되며 그 치료방법은 기관 협착의 정도 및 부위에 따라 다르다. 협착의 정도가 경하고 주로 육아조직에 의한 경우는 반복적인 내시경적인 처치만으로도 치유가 되지만 협착부위가 광범위하거나 정도가 심한 경우는 수술적인 기관재건이 필요하게 된다. 저자들은 이러한 기관재건술로 윤상갑상연골절제 및 연골이식, 그리고 협착부절제 및 단단문합의 방법 등을 현재까지 사용하였으며 괄목할 만한 결과를 얻었다. 저자들은 지금까지 경험한 9 명의 소아 기관협착 환자에서의 단단문합술에 의한 치험과 단단문합술의 적응증을 제시하고자 한다.

• 대한기관식도과학회지
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• 제15권1호
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• pp.50-55
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• 2009

Objectives: Endoscopic airway dilatation and stenting has been developed to treat the airway stenosis without potential morbidities of open surgery. We report the clinical results of endoscopic airway dilatation with silicone stenting in patients with posttuberculous bronchial stenosis(PTBS) and with severe main tracheal stenosis who have poor general conditions Methods : A prospective observation study of five patients, who have undergone endoscopic airway dilatation and silicone stenting between Feb 2007 and Feb 2009. A total of twelve patients were treated with endoscopic airway dilatation, among them 5 patients were included in this study. three patients were treated with newly designed silicone stent (Natural stent: TNO Co., Seoul, South Korea) because of poor surgical conditions and longer stenotic segment Results: 3 patients were grade III PTBS, and the other 2 patients were grade IV post tracheotomy main tracheal stenosis. One patient of PTBS were treated with silicone stent following endoscopic dilatation because of longer stenotic segment. Two patients of main tracheal stenosis patients were treated with silicone stent because of tracheal lumen collapse. There was no severe postoperative complications except mild granulation tissue formations Conclusions : Endoscopic dilatation including silicone stenting could be a useful method for treating patients with PTBS, and for main tracheal stenosis patients with poor general surgical conditions

• 대한기관식도과학회지
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• 제4권2호
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• pp.165-170
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• 1998

Background and Objectives : Decannulation failure may result from factors such as inadequate ability 0 clear secretion, mucosal induration, granulation tissue, restenosis, tracheal wall depression and vocal cord palsy. We were to evaluate the effectiveness of surgical treatment on the basis of site and type of stenosis. Materials and Method : A series of 44 cases of decannulation difficulty between 1993 and 1997 were reviewed. The following data were collected on each of these patients : primary disease, indication for tracheostomy, site of stenosis, endoscopic findings of stenosis, surgical techniques used for treatment. Results : Primary diseases were 30 head trauma, 4 neck injury, 10 other diseases. Indication for tracheostomy were 37 prolonged intubation, 4 emergency tracheostomy, 3 laryngeal trauma. Endoscopic findings of stenosis were 24 granulation tissue, 16 laryngotracheal collapse, 4 combined with granulation tissue and collapse. Site of stenosis were 3 glottic, 9 subglottic, 24 stomal, 1 substomal, 7 mixed. 22 of 24 cases were decannulation using endoscopic treatment. Conclusion : The most common cause of failed decannulation was sternal granulation tissue. The most effective treatment of granulation tissue was endoscopic technique.

• Journal of Chest Surgery
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• 제35권2호
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• pp.149-152
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• 2002

저자들은 이중 기관기관지 스텐트를 성공적으로 거치하여 상당히 긴 부분에 걸쳐 협착이 있는 환아에서 환기유지를 할 수 있었던 증례를 보고한다. 생후 1개월된 환아가 출생 시부터 시작된 빈호흡과 이산화탄소저류를 주소로 응급실로 내원하였다. 술전 흉부단층촬영에서 폐동맥 슬립과 진성성대 직하부부터 양측주기관지 입구에 이르는 상당히 긴 부분에 걸쳐 미만성 기관협착을 확인하였다. 수술소견에서 양측 주기관지의 입구는 3m미만이었으며 기관지협탁부위는 완전환형기관연골이었다. 체외순환 상태에서 좌폐동맥을 잘라 주폐동맥으로 재이식하고 자가심낭편을 이용하여 기관을 확대성형하였다. 그러나, 기관내 육아조직의 성장과 이식한 자가심낭편의 호기시 운동성 폐쇄에 의해 여전히 이산화탄소저류와 호흡곤란은 지속되었다. 이 문제를 해결하기 위해 기관스텐트를 기관내에 거치하였으나, 여전히 양측 주기관지 입구의 협착으로 인해 호흡곤란 증세가 해결되지 않았다. 결국 이중 기관기관지 스텐트를 삽입하여 기도폐쇄를 해결할 수 있었다.

• Journal of Chest Surgery
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• 제38권7호
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• pp.461-467
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• 2005

기관 또는 기관지의 이식이나 기관문합술 후 그리고 폐절제술 후 기관지의 봉합면에 빠른 재혈관화를 통해 감염이나 허혈성 괴사를 막기위해 흉막, 심외막, 심외지방, 횡격막, 장막, 늑간 근육 등을 이용하여 보강해 주는 경우가 많다. 이 연구는 실험동물에서 자가기관을 흉막, 장막 및 횡경막에 이식했을 때 생존에 미치는 영향을 알아보고자 하였다. 대상 및 방법 : 실험동물로 무게는 $250\~350g$ 정도의 Sprague-Dawley rats가 사용되었다. 장막, 횡격막, 흉막 세 군으로 나누어서 각 군별로 5마리씩 실험하였다. 복막 내 마취 후 기관 삽관을 시행하였고 기관을 노출시켜 세마디의 기관이식편을 잘라내었다 잘라낸 기관을 장막, 횡격막, 흉막에 각각 이식하였고 2주 후 쥐를 희생시켜 얻은 조직으로 병리조직학적 검사를 하였다. 병리조직학적으로 절단기관편의 생존능력을 비교하기 위하여 각각의 상피조직, 점막하조직, 연골조직의 괴사정도를 점수화하여($0\~3$점) 그 결과의 평균값을 표시하였다. 결과 : 병리 조직학적 검사상 장막군이 가장 좋은 보존 상태를 보였다. 괴사 점수는 흉막이식군에서 상피층서 $2.17\pm0.983$, 점막하층 $1.67\pm0.516$, 연골층 $2.17\pm0.753$으로 나타났고 장막이식군의 경우 각각 1.00\pm0.00,\;1.60\pm0.548,\;1.8\m0.447$, 횡격막이식군은 $1.40\pm0.894,\;2.40\pm0.547,\;2.2\pm0.447$으로 관찰되었다. 전체 괴사 점수는 흉막이식군에서 $6.00\pm1.789$, 장막이식군에서 $4.40\pm0.894$, 횡격막이식군에서 $6.00\pm1.414$보였다. 걸론: 세 그룹간의 비교시 통계적 유의성은 없었으나 장막에 이식한 기관에서 가장 낮은 괴사점수가 나와 장막이 횡격막이나 흉막보다 기간 봉합면을 보호하고 신혈관 생성에 더 좋은 역할을 하는 경향을 보였다.

• 대한한방내과학회지
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• 제19권1호
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• pp.385-408
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• 1998

Pyeongpaesan (平肺散) has been used in Korea for many centuries as a treatment for respiratory disease. The effect of Pyeongpaesan (平肺散) on tracheal smooth muscle is not known. The purpose of the present study is to determine the effect of Pyeongpaesan (平肺散) on histamine and acetylcholine induced tracheal smooth muscle contraction in rats and guinea pigs. Guinea pig (500 g, male) and Sprague Dawley rats (200 g, male) were killed by $CO_2$ exposure and a segment (8-10 mm) of the thoracic trachea from each rat and guinea pig was cut into equal segments and mounted 'in pairs' in a tissue bath. Contractile force was measured with force displacement transducers under 0.5 g loading tension. The dose of histamine (His) and acetylcholine (Ach) which evoked 50% of maximal response ($ED_{50}$) was obtained from cumulative dose response curves for histamine and acetylcholine $(10^{-7}{\sim}10^{-4}M)$. Contractions evoked by His $(ED_{50})$ and Ach $(ED_{50})$ were inhibited significantly by Pyeongpaesan (平肺散). In guinea pig tracheal smooth muscle, the mean percent inhibition of acetylcholine induced contraction was 13.5% (p<0.05) after $10{\mu}l/ml$ Pyeongpaesan (平肺散), $64.6\(p<0.01)\;after\;30{\mu}l/ml$ Pyeongpaesan (平肺散), and $92.8\(p<0.01)\;after\;100{\mu}l/ml$ Pyeongpaesan (平肺散). In rat tracheal smooth muscle, the mean percent inhibition of acetylcholine induced contraction was $60.9\(p<0.01)\;after\;30{\mu}l/ml$ Pyeongpaesan (平肺散), and $91.2\(p<0.01)\;after\;100{\mu}l/ml$ Pyeongpaesan (平肺散). Also, in guinea pig tracheal smooth muscle, the mean percent inhibition of histamine induced contraction was $104.8\(p<0.01)\;after\;30{\mu}l/ml$ Pyeongpaesan (平肺散) and $142.3\(p<0.01)\;after\;100{\mu}l/ml$ Pyeongpaesan (平肺散). In rat tracheal smooth muscle, the mean percent inhibition of histamine induced contraction was $63.7\(p<0.01)\;after\;30{\mu}l/ml$ Pyeongpaesan (平肺散), and $107.5\(p<0.01)\;after\;100{\mu}l/ml$ Pyeongpaesan (平肺散). Propranolol $(10^{-7}M)$ slightly but significantly attenuated the inhibitory effects of Pyeongpaesan (平肺散). Following treatment with propranolol, the mean percent inhibition caused by $100{\mu}l/ml$ Pyeongpaesan (平肺散) fell to 15.7% (p<0.05) in guinea pig induced by acetylcholine contraction and the mean percent inhibition caused by $100{\mu}l/ml$ Pyeongpaesan (平肺散) fell to 22.3% (p<0.05) in guinea pig induced by histamine contraction and by $100{\mu}l/ml$ Pyeongpaesan (平肺散) fell to 28.7% (p<0.01) in rat induced by histamine contraction. Indomethacin and methylene blue $(10^{-7}\;M)$ did not significantly alter the inhibitory effect of Pyeongpaesan (平肺散). Also, I could find the effects of Pyeongpaesan (平肺散) and Pyeongpaesanga (平肺散加) morphine on the tracheal smooth muscle in guinea pig and rat did not change significantly. These results indicate that Pyeongpaesan. (平肺散) can relax histamine and acetylcholine-induced contraction of guinea pig and rat tracheal smooth muscle, and that this inhibition involves sympathetic effects and the release of cyclooxygenase products.

• 대한기관식도과학회지
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• 제8권1호
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• pp.29-34
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• 2002

Background and Objectives : Sulfur dioxide gas is one of the major airborne Pollutants noxious to human in industrialized countries. The most vulnerable areas in the human respiratory system were the trachea and main bronchi and a gradient of decreasing damage was observed in the peripheral tracheobronchial tree. Induced functional alteration was increased mucosal permeability, and morphological changes were epithelial sloughing, intracellular edema, mitochondrial swelling, widened intercellular spaces, and ciliary cytoplamic extrusions. The laminins are a family of extracellular matrix glycoproteins localized in the basement membrane. Their primary role is cell-matrix attachment, but many additional biologic activities, including Promoting cell growth and migration, tumor growth and metastasis, wound repair, and graft survival, have been demonstrated. Materials and Methods : Histologic changes and expression of laminin in tracheal mucosa sacrificed at 1 day, 2 day, 3 day, 1 week, 2 weeks, and 3 weeks after continued SO2 exposure of 250 ppm for 30 minutes a day(to 7week) were studied in rats. In this study, mild immune reaction for laminin was noted at the apical cytoplasm of epithelial cells and basement membrane one day after a 7 week $SO_2$ exposure. The cilia and nucleoi of epithelial cells were normal and no immune reaction was noted in Goblet cells. The lamina propria of the tracheal tissue was infiltrated by monocytes and lymphocytes. Results : At 24 hours after exposure, all tracheal cells except Goblet cells revealed a mild immune reaction for laminin. No immune reactions were noted in the basement membrane. At 72 hours after exposure, mild or moderate immune reactions for laminin was seen in the tracheal cell cytoplasm. Irregular faint immune reaction for laminin was noted in the basement membrane. At 1 week after exposure, strong immune reaction for laminin was detected over all tracheal cells, and the basement membrane was seen clearly. At 2~3 weeks after exposure, strong immune reaction for laminin was seen in all tracheal epithelial cells except Goblet cells and a mild immune reaction was partly revealed in the basement membrane. Conclusion : Our study suggests that 502 produces histologic damage on the tracheal mucosa. Longer duration after exposure of $SO_2$ makes more progressive healing on the tracheal mucosa and increased immunoreactivity for laminin.