• Journal of Chest Surgery
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• v.34 no.5
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• pp.386-392
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• 2001

배경: 기관지에 광범위한 협착을 가지고 있는 환자들에게서 협착된 기관지 이하 부위에 있는 폐를 절제하지 않고 기관지 협착 부위를 교정하여 폐환기를 원할하게 하고자 하는 다양한 술식의 기관지 성형술이 고안시도되어 왔지만 만족할만한 술기는 아직 정립되어 있지 않다. 저자들은 이러한 기관지 협착을 교정하기 위한 술식의 하나로서 기관지 대치물을 이용한 기관 성형술의 효과를 조사하기 위하여 본 실험을 시행하였다. 대상 및 방법: 기관지 대치물로 사용한 두 종류의 첨포에 따라 성숙견을 실험 동물로 하여 두 군으로 분류하였으며 A군(5예)에서는 좌측 주기관지 전측방 부위를 0.5$\times$0.5cm 크기의 직사각형으로 절제한 후 늑연골에 자가 심낭편을 댄 동일한 크기의 첨포를 절제 부위에 부착하였고 B군(5예)에서는 동일한 크기의 기관지 절제 부위에 glutaraldehyde로 처리된 우심낭편을 부착하였다. 첨포를 이용한 기관지 성형술 12주후에 실험견을 도살하고 육안적 및 현미경적으로 관찰하였다. 결과: A군이 기관지 성형술 부위에서는 첨포의 외면은 주위의 결합조직과 막상유착을 이루고 있었으며 첨포의 가장자리는 자가 기관지에 잘 부착되어 있었다. 기관지 내면은 내경의 협착이 없이 윤기 있는 점막으로 잘 유지되어 있었고 자가 기관지와 첨호와의 경계면은 신생육아조직이 일부 차지하고 있었으며 새로운 이행 상피가 가교를 이루고 있는 현미경적 소견을 보았다. B군의 기관지 성형술 부위에서는 첨포의 와부는 암갈색으로 변화된 부분적 괴사의 양상을 보였다. 기관지 내면은 첨포와 가자기관지 경계부위에서 염증성 육아조직과 부분적 출현 양상을 보고 기관지 내경의 일부가 수축되었으며 자가 기관지로부터 첨포내로의 새로운 상피 형성은 되어 있지 않았다. 결론: 늑연골에 자가 심낭편을 댄 첨포는는 자가 기관지와 상피 가교를 형성하고 기관지 내강의 협착이 없이 구조를 유지하므로 기관지 협착 및 결손의 치료를 위한 기관지 성형술시에 기관지 대치물로 사용될수 있는 것으로 사료된다.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.793-796
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• 2010

Tuberculosis involving the central airway occasionally results in diffuse stenosis in the distal trachea and main bronchus. When the stenosis is more limited to the main bronchus, sleeve resection can be performed with high likelihood of a good result. Bronchial stenosis limited to 2 cm is considered favorable for bronchial sleeve resection. However, a longsegment stenosis may make sleeve resection difficult or impossible, and pneumonectomy or therapeutic bronchoscopy may be performed. An extended sleeve lobectomy is a procedure to remove more than one lobe using a bronchoplasty technique and its applications to the patients with locally advanced lung cancer were reported. We performed an extended sleeve lobectomy in a patient with tuberculous bronchial stenosis involving the right main bronchus, bronchus intermedius, right middle lobar bronchus and right lower lobar bronchus, and report this case with review of literatures.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.231-234
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• 1996

In the bronchial stenosis due to benign causes, bronchoplastic procedure has been considered as one of the best surgical treatment, because of preserving normal lung tissue below the affected bronchi. We have treated 2 patients (tracheal leiomyoma, bronchial stenosis due to chronic inflammatory cicatrization) that suffered from benign tracheal and bronchial stenosis by bronchoplastic procedure using autologous costal cartilage covered with pericardium. Patients showed good patency of bronchoplastic bronchi in bronchoscopic examination that was performed at 6 months afte the operation.

• Journal of Chest Surgery
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• v.38 no.9 s.254
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• pp.622-626
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• 2005

Background: Non-invasive interventional therapy has been performed for main bronchial obstruction by endobronchial tuberculosis because of the risk of main bronchial reconstruction regardless of the pulmonary function. But, effects of the inteeventional therapy are attacked by arguments. This study was aimed at interpreting the risk and effectiveness of bronchoplasty for benign bronchial stenosis over the last ten years in our hospital by reviewing the results based on clinical progression. Material and Method: We retrospectively reviewed the clinical records and out-patient medical records including 2f consecutive patients who underwent main bronchial reconstruction for obstruction by endobronchial tuberculosis. All of them had past medical history of anti-tuberculosis medication. They were preoperatively evaluated by bronchoscopy and chest computed tomography. Result: There were no incidences of postoperative mortality and signifcant morbidity. There were 2 cases of retained secretions but these problems were resolved by therapeutic bronchoscopy or intubation. All of the patients are still alive without obstructive airway problem. Conclusion: Bronchoplasty should be considered as one of the primary treatment modalities, if it is anatomically feasible.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.494-503
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• 1994

Background: Fibrostenosis of large airway due to tuberculosis is one of the most perplexing clinical problems not only because it can lead to respiratory failure but also because of difficulty in the management. No one technique, such as balloon dilatation or insertion of self expandable metallic stent, has proved totally satisfactory in the management of fibrostenosis. We evaluated the effect of laser therapy in patient with severe fibrostenosis due to tuberculosis. Method: We classified the fibrostenosis to three types by bronchoscopic finding - the diaphragm type: stenosed by fibrous diaphragm, sparing the tracheobronchial wall, the collapse type: stenosed by collapse of the wall due to destruction of the cartilage, and the combined type: stenosed by nonspecific inflammatory scar tissue within internal lumen with collapse of the wall. We have treated 10 patients complaining dyspnea due to with severe fibrostenosis of the diaphargm or the combined type using a neodymiumyttrium aluminum garnet(Nd-Y AG) laser through a flexible bronchoscopy. Results: Eight of the 10 cases improved after laser therapy and maintained during a follow up period of average 31.9 months. All of the cases undergoing laser therapy showed no serious complication to need the therapy. Conclusion: The results of our present study indicate that the Nd-YAG laser therapy is an effective and safe method for the management of selective tuberculous fibrostenosis.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1987.05a
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• pp.18.1-18
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• 1987

1972년 Jako와 Strong이 후두질환에 $CO_2$레이저 사용을 발표한 이래 최근 이비인후과영역에서 $CO_2$레이저를 이용한 수술방법이 각광을 받고 있으며 특히 후두 및 기관지 협착증에서의 $CO_2$레이저 이용은 현재까지 가장 좋은 방법의 하나로 소개되고 있다. 이와 더불어 최근 레이저를 이용한 기관지경술이 이용되고 있는데, 이는 기관 및 기관지의 여러 질환중에서 유두종등의 양성종양의 제거, 기관 및 기관지 협착증의 치료, 그리고 원발 혹은 전이에 의한 기관내 악성종양의 고식수술(姑息手術)등에 이용되고 있다. 최근 저자들은 성문하부 및 기관내에 발생한 후두 및 기관유두종 2례와 육아조직에 의한 성문하부 및 기관협착증 2례에서 coherent $CO_2$레이저 기관지경을 이용한 기관지경술로 만족할 만한 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• v.38 no.12 s.257
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• pp.863-865
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• 2005

We experienced tracheobronchial stenosis caused by malrotation of the heart in a 3-year-old girl. Malrotation of the heart is induced by the decreased right lung volume, which was the result of right lung hypoplasia and herniation of the left thoracic cavity. We corrected the right lung volume and location of the heart to treat tracheobronchial stenosis.

• Tuberculosis and Respiratory Diseases
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• v.42 no.1
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• pp.25-34
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• 1995

Background: Endobronchial tuberculosis is classified into 7 subtypes as fibrostenotic type, edematous-hyperemic type, actively caseating type, tumorous type, ulcerative type, granular type and nonspecific bronchitic type by bronchoscopic features, and we make a prospective study to follow up how bronchoscopic findings change during treatment-course in each subtype of active endobronchial tuberculosis. Methods: We planned to do follow-up bronchoscopic examination every month until there was no significant change in endobronchial lesion, then every 3 months and at the end of the treatment in each patient with biopsy proven endobronchial tuberculosis from May, 1990 to August, 1993. Results: 1) This study included 66 cases, but bronchoscopic follow-up was completed as scheduled in 47 cases. 2) In actively caseating and edematous-hyperemic type, bronchostenosis occurred within 2 or 3 months of treatment in about 2/3 of total cases. 3) In fibrostenotic type, bronchostenosis did not improve in spite of the treatment. 4) In tumorous type, the changes in bronchoscopic findings were unpredictable because new lesions occured on other sites even 4 or 6 months after treatment in 2 cases and the size of initial mass increased 6 months after treatment in 1 case (among 7 cases). 5) Granular and nonspecific bronchitic type improved without significant sequelae within 2 or 3 months of treatment. Conclusion: It may be necessary to follow up the patient with bronchoscopy repeatedly 2 or 3 months after starting treatment in active endobronchial tuberculosis, and it is better to perform bronchoscopic examination at 6 months of treatment, especially in patients with tumorous type because there is possibility that new endobronchial lesion occurs. Aggressive therapeutic modalities such as stent-insertion, laser therapy or electrocautery should be considered to prevent bronchostenosis in cases with granulation tissue, fibrostenotic and tumorous types of endobronchial tuberculosis.

• Tuberculosis and Respiratory Diseases
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• v.58 no.1
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• pp.18-24
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• 2005

Background : Endobronchial tuberculosis often complicates bronchostenosis, which can cause dyspnea due to an airway obstruction, and can be misdiagnosed as bronchial asthma or lung cancer. This study investigated the possible correlation between the $interferon-{\gamma}$($IFN-{\gamma}$) and transforming growth $factor-{\beta}$($TGF-{\beta}$) levels in the serum and bronchial washing fluid and the treatment results in endobronchial tuberculosis patients. Methods : Sixteen patients, who were diagnosed as endobronchial tuberculosis using bronchoscopy, and 10 healthy control subjects were enrolled in this study. The $IFN-{\gamma}$ and $TGF-{\beta}$ levels were measured in the serum and bronchial washing fluid of 16 endobronchial tuberculosis patients before and after treatment using the ELISA method. The endobronchial tuberculosis patients were divided into those who showed bronchial fibrostenosis after treatment and those who did not. Results : The $IFN-{\gamma}$ and $TGF-{\beta}$ levels in the bronchial washing fluid in endobronchial tuberculosis patients were elevated comparing to the control (p<0.05). After treatment, 7 of the 16 endobronchial tuberculosis patients showed bronchial fibrostenosis and the other 9 cases healed without this sequela. In the patients with fibrostenosis after treatment, the initial serum $TGF-{\beta}$ level was lower than the patients without fibrostenosis after treatment (p<0.05). Moreover, the serum $TGF-{\beta}$ level after treatment further decreased comparing to the patients without fibrostenosis after treatment(p<0.05). Conclusion : Elevated $IFN-{\gamma}$ and $TGF-{\beta}$ levels in the bronchial washing fluid in endobronchial tuberculosis patients are believed to be related to the pathogenesis of endobronchial tuberculosis. The decreased initial serum $TGF-{\beta}$ level and the change in the serum $TGF-{\beta}$ level after treatment are believed to be involved in bronchial fibrostenosis during the course of the disease.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.219-225
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• 1997

Although most of the patients with endobronchial tuberculosis have some degree of bronchial stenosis, more aggressive treatment is needed to restore the patency of the involved tracheobronchial tree for some patients not responding well to antituberculous chemotherapy combined with steroids. In our first case, we reseated stenotic trachea in a 42 years old women who showe overgrowing granulation tissue through the modified Gianturco steno wire which was previously inserted and anastomosed end to end. Another case was a 37 years old male with left main bronchial rcstenosis complicate, $\boxUl$ after inserting a Strecker stent and sleeve left upper lobectomy was performed.