• Title/Summary/Keyword: 수술 합병증

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Surgical Treatment of Tracheal Stenosis (기관 협착증의 외과적 치료)

  • 최준영;장인석;김종우;김병균;이정은;김성호;이상호
    • Journal of Chest Surgery
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    • v.33 no.7
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    • pp.565-569
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    • 2000
  • Background; Post-intubation injury is known to be the most common cause of tracheal stenosis. Treatment strategy for tracheal stenosis varies accoring to the extent of pathologic lesion. Focal mucosal lesion can be treated with laser photoablation, but full thickness tracheal lesion should be treated with resection and anastomosis. Material and Method; From Aptil 1998 to May 1999, twelve patients suffering from tracheal stenosis as a complication of endotracheal intubation were managed by resection and end-to-end anastomosis in the Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital. Result; There was no operative mortality. Five temporary vocal cord paralysis and one wound infection occurred as early complications. During 18 months of follow-up, re-stenosis was not found. Conclusion; Tracheal resection and anastomosis can be considered as an excellent surgical treatment for tracheal stenosis which developed as a complication of endotracheal intubation.

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Vacuum-assisted Closure for the Treatment of Lymphorrhea Following Surgery of the Femoral Artery (대퇴동맥 수술 후 발생한 임파루의 음압 요법 치료)

  • Chang, Won-Ho;Youm, Wook;Oh, Hong-Chul;Han, Jung-Wook;Kim, Hyun-Jo
    • Journal of Chest Surgery
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    • v.43 no.5
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    • pp.562-564
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    • 2010
  • Lymphorrhea is a common complication after inguinal dissection for exposure of the femoral artery. Injury of the lymphatics occurs frequently because they are anatomically close to blood vessels. Uncontrolled lymph drainage increases postoperative morbidity, and wound infection may follow. Despite current treatment options, lymphorrhea after inguinal dissection is still difficult to manage and results in a prolonged hospital stay. A vacuum-assisted closure device was used in a 72-year-old woman who had lymphorrhea after vascular surgery by groin incision. Vacuum-assisted control for lymphorrhea resulted in earlier closure of the wound and reduced the length of hospital stay.

Therapeutic Results of Radiotherapy in Rectal Carcinoma - Comparison of Sandwich Technique Radiotherapy with Postoperative Radiotherapy (직장암의 방사선 치료 결과 - Sandwich Technique 방사선 치료와 수술후 방사선 치료의 비교)

  • Huh Cil Cha;Suh Hyun Suk;Lee Hyuk Sang;Kim Re Hwe;Kim Chul Soo;Kim Hong Yong;Kim Sung Rok
    • Radiation Oncology Journal
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    • v.14 no.1
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    • pp.25-31
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    • 1996
  • Purpose : To evaluate the potential advantage for 'sandwich' technique radiotherapy compared to Postoperative radiotherapy in resectable rectal cancer. Materials and Methods : Between January 1989 and Mar 1994, 60 patients with resectable rectal cancer were treated at Inje University Seoul and Sanggye Paik Hospital. Fifty one patients were available for analysis: 20 patients were treated with sandwich technique radiotherapy and 31 patients were treated with Postoperative radiotherapy. In sandwich technique radiotherapy(RT), Patients were treated with preoperative RT 1500 cGy/5fx, followed by immediate curative resection. Patients staged as Astler-Coiler B2, C were considered for postoperative RT with 2500-4500 cGy. in postoperative RT total radiation dose of 4500-6120 cGy, 180 cGy daily at 4-Sweets was delivered. Patients were followed for median period of 25 months. Results : The overall 5-year survival rates for sandwich RT group and postoperative RT group were $60\%$ and $71\%$, respectively(p>0.05). The 5-rear disease free survival rates for each group were $63\%$. There was no difference in local failure rate between two groups($11\%$ versus $7\%$) Incidence of distant metastasis was $11\%$(2/20) in the sandwich technique RT group and $20\%$(6/31) in the postoperative RT group(p>0.05). The frequencies of acute and chronic complications were comparable in both groups. Conclusion : The sandwich technique radiotherapy group shows local recurrence and survival similar to those of Postoperative RT alone group but reduced distant metastasis compared to Postoperative RT group. But long term follow-up and large number of patients is needed to make an any firm conclusion regarding the value of this sandwich technique RT.

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The Risk Factors of Morbidity and Mortality after Pulmonary Resection (폐절제술후 사망율과 이환율에 영향을 미치는 요소)

  • 서연호;김민호;구자홍;조중구;김공수
    • Journal of Chest Surgery
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    • v.32 no.12
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    • pp.1100-1105
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    • 1999
  • 배경 :폐절제술은 절제가능한 폐암 또는 염증성 폐질환 선천성 폐질환의 치교적 술식이 된다. 술후 경과에 영향을 줄수 있는 예측기능 요소를 인지하는 것은 중요하나 합병증에 이환된 경향이 높은 환자에 대하여 각별한 주의를 기울임으로서 술후 합병증 및 사망률은 감소시킬수 있을 것이다 방법 및 대상: 술후 결과에 영향을 미치는 요소를 예측하기 위해 1994년부터 1998 년까지 본 병원에서 종양성 및 염증성 폐질환으로 폐절저술을 시행받은 153명의 환자를 대상으로 입원챠트를 열람하여 연구하였다 평균 연령은 54.3$\pm$10.6세였다. 96명 (62%) 의 환자는 폐암화자였으며 47명 (30%)의 환자의 염증성 폐질환자였고 10명 (7%)의 환자는 선천성 폐질환자이거나 기타 폐질환자였다. 결과: 전체 153명중 폐엽절제술이 118례 전폐절제술이 29례 폐분엽절제술이 6례 시행되었다. 7명 (4.5%)의 환자가 술후 사망하였다 술후 원내 사망률의 가장 유의한 예측요소는 동반된 내과적 질환의 유무(p<0.001)과 70세 이상의 고령이다(p<0.003) 총 57명의 환자에게 67가지의 합병증이 발병되었다 그중 수술자체와 관련된 합병증이 50례 (32%) 호흡기계 합병증이 14례(9.1%) 심혈관계가 1례(0.6%) 기타 합병증이 2례(1.3%)였다 술후 합병증 이환율에 영향을 미치는 요소는 70세 이상의 고령이었다(p<0.004) 결론 : 동반된 내과적 질환과 70세 이상의 고령은 술후 사망률에 영향을 미치는 유의한 예측요소가 되며 또한 70세이상의 고령은 술 후 합병증 이환율에도 영향을 미치는 요소이다.

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Limbal Lensectomy with or without Anterior Vitrectomy for the Management of Lens Subluxation (비외상성 수정체이탈 환자에서 시행한 윤부 수정체절제술)

  • Chang, Ju-Hee;Cha, Soon-Cheol
    • Journal of Yeungnam Medical Science
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    • v.24 no.2
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    • pp.243-251
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    • 2007
  • Purpose : This study was conducted to assess the surgical outcomes of limbal lensectomy with or without anterior vitrectomy for the management of lens subluxation. Materials and Methods : The medical records of 20 consecutive patients (33 eyes) with lens subluxation who had undergone limbal lensectomy with or without anterior vitrectomy from February 1999 to January 2004 were retrospectively reviewed. Results : All the patients, except one high axial myopic patient, were implanted with scleral sutured posterior chamber intraocular lens. We evaluated the preoperative, postoperative visual acuity and postoperative complications and compared the results in group I (limbal lensectomy with anterior vitrectomy, 27 eyes) to those in group II (limbal lensectomy without anterior vitrectomy, 6 eyes). The preoperative best-corrected visual acuity was 0.21 and postoperative best-corrected visual acuity was improved by 2 lines or more in all 27 eyes in group I, and in 5 eyes in group II (p>0.05). The most frequent postoperative complication was intraocular lens dislocation in four eyes (14.8%) in group I alone. No retinal detachment occurred in either group, even in patients with high myopia. Conclusion : Limbal lensectomy without anterior vitrectomy improved visual acuity similarly to limbal lensectomy with anterior vitrectomy without significant increase of postoperative complications. This results of this study suggest that anterior vitrectomy is not necessarily required for the management of lens subluxation.

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Closure of VSD in a Patient with Tracheostoma-A case report- (기관절개구가 있는 환아에서 심실중격결손증의 치험-1례보고-)

  • 김상익;박철현;박국양;오상준
    • Journal of Chest Surgery
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    • v.34 no.3
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    • pp.246-251
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    • 2001
  • 심장 탈장은 심낭을 열고 전폐절제술을 시행 후 드물게 발생되는 합병증으로 수술이 끝날때나 수술직후 발생된, 44세 남자환자에서 심낭을 열고 좌측 폐를 전절제술 후 심낭 결손부위를 인공조직으로 봉합하였다. 수술이 종료될 때 심장탈장이 발생되어 개흉에 의한 응급 복원을 시행하였으나 심한 저 산소성 뇌 손상이 발생되었다.

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Clinical Analysis of 500 Cases of Coronary Artery Bypass Grafting (관상동맥 우회술 500례의 임상적 고찰)

  • Shin, Yoon-Cheol;Kim, Ki-Bong;Ahn, Hyuk;Chae, Hurn;Rho, Joon-Ryang;Suh, Kyung-Phill
    • Journal of Chest Surgery
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    • v.32 no.6
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    • pp.525-531
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    • 1999
  • Background: We analyzed five hundred patients who underwent either isolated or concomitant coronary artery bypass grafting(CABG) between November 1981 and June 1997. Material and Method: There were 330 males and 170 females with a mean age of 57.4$\pm$8.9 years. To evaluate the preoperative status, we performed electrocardiograghy, echocardiography, MIBI scan, Duplex sonogram, common blood test including CK and LDH and coronary angiography. Result: Preoperative clinical diagnoses were unstable angina in 282 (56.4%), stable angina in 141 (28.2%), postinfarction angina in 58 (11.6%), acute myocardial infarction in 8 (1.6%), variant angina in 7 (1.4%) and failed percutaneous transluminal coronary angioplasty in 4 (0.8%) patients. Preoperative angiographic diagnoses were three-vessel disease in 263 (52.6%), two-vessel disease in 93 (18.6%), one-vessel disease in 71 (14.2%), left main disease in 68 (13.6%), and others in 5 (1.0%) patients. Patients had various risk factors for coronary disease, and the frequency of the risk factors such as hypertension, diabetes and smoking showed increasing tendency year by year. We used saphenous vein grafts in 1143, internal thoracic artery grafts in 442, radial artery graft in 17, and gastroepiploic artery graft in 1 anastomosis. The mean number of grafts was 3.2$\pm$1.2 per patient. Concomitant operations were prosthetic valve replacement or valvuloplasty in 31, coronary endarterectomy and angioplasty in 27, left main coronary angioplasty in 13, carotid endarterectomy in 5, and neurologic problems, bleeding, and perioperative myocardial infarction. The mean follow-up period was 25$\pm$23 months and there were 5 cases of reoperation. Conclusion: We hope that the surgical results would improve with the accumulation of experience, application of new myocardial protection technique, and timely intervention of mechanical assisted devices.

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The Clinical Analysis of Patient with Patent Ductus Arteriosus (동맥관개존증의 임상적 고찰)

  • Kang, Meyun-Shick;Lee, Cheol-Joo;Lee, Dong-Hyup;Jung, Tae-Eun
    • Journal of Yeungnam Medical Science
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    • v.3 no.1
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    • pp.287-292
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    • 1986
  • A clinical analysis was performed on 61 cases of patent ductus arteriosus experienced at Yeungnam University Hospital during 3 years period from Aprial, 1984 to December, 1986. Of the 61 patient of PDA, 13 patient were male and 48 patient were female and age ranged 2 months to 26 years old with the average age of 9.4 years. The chief complaints on admission were frequent URI and dyspnea on exertion. Main diagnostic procedure were Doppler Echocardiogram(in 53 among 61). All of the operations were performed the method of ligation of PDA. Three posterative complication were developed, but there was no operative mortality.

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Recovery of Pulmonary Function according to the Operative Sites after General Anesthesia (전신마취를 이용한 수술에서 수술부위에 따른 폐기능의 회복)

  • Kim, Hyeon-Tae;Lee, Sang-Moo;Uh, Soo-Taek;Chung, Yeon-Tae;Kim, Yong-Hoon;Park, Choon-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.3
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    • pp.250-258
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    • 1993
  • Background: After general anesthesia, decrease of functional residual capacity and lung compliance, ventilation/perfusion imbalance, and transpulmonary shunting can provoke hypoxemia during postoperative periods. Diaphragmatic dysfunction may be the main cause of these physiological abnormalities. Thus, we evaluated the change of pulmonary function after general anesthesia according to the operative sites, which could suggest clinical course and critical period of respiratory care of postoperative patients. Method: Preoperative portable spirometric evaluation and arterial blood gas analysis were performed at sitting or most-sitting position just previous day of surgery. Pulmonary function tests were also as same condition from postoperative day 1 to day 5. Results: 1) For thoracic surgery, FEV1 and FVC were not recovered at day 5, but FEV1/FVC was not decreased. $PaCO_2$ was slightly elevated at postoperative one day. 2) After upper abdominal surgery, postoperative day 5 did not show the recovery of FEV1 and FVC, but mild hypoxemia was developed at postoperative day 1. 3) Pulmonary function was recovered as preoperative value at postoperative day 5 in lower abdominal operation, but mild hypoxemia was also noted at postoperative day 1. 4) Surgery of peripheral areas did not show significant pulmonary function change and hypoxemia and hypercapnia from postoperative day 1. Conclusion: Surgery involving diaphragm provoke significant postoperative pulmonary function change after day 5. For the operation of peripheral sites adequate respiratory care during operation and postoperative period within 24 hours could prevent patients from respiratory complication.

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Clinical Results of Pulmonary Resection for Hemoptysis of Inflammatory Lung Disease (염증성 폐질환에 의한 객혈 환자의 폐절제술 후 임상결과)

  • Kim Nan Yeol;Kuh Ja Hong;Kim Min Ho;Seo Yeon Ho
    • Journal of Chest Surgery
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    • v.38 no.10 s.255
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    • pp.705-709
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    • 2005
  • Background: To assess the outcome of pulmonary resection in the management of hemoptysis caused by benign inflammatory lung disease. Material and Method: A longitudinal cohort study of 45 consecutive patients who were presented with hemoptysis and were treated with pulmonary resection from January 1995 to May 2004. The predictive preoperative risk factors of morbidity and recurrence of hemoptysis were analyzed. The mean age of the patients was 47.1 years. The mean follow-up was $35\pm34$ months. Result: The overall hospital mortality rate was $4.4\%(2/45)$. Postoperative complications occurred in 8 patients $(18.6\%)$. Complications were more common in patients who received blood transfusion than non-transfused patients (p=0.002). Patients with tuberculous destroyed lung disease had more amount of preoperative hemoptysis (p=0.002), more probability of transfusion (p=0.001), more probability of undergoing pneumonectomy (p=0.039) and more probability of postoperative morbidity. Patients of undergoing pneumonectomy had more probability of reoperation due to postoperative bleeding (p=0.047). Hemoptysis recurred in five patients but three had been subsided and two sustained during follow-up. A latter two patients had been prescribed with antituberculosis medication due to relapse of tuberculosis. Conclusion: A tuberculous destroyed lung disease has a higher rate of postoperative morbidity than other inflammatory lung diseases. A pneumonectomy in patients of inflammatory lung disease should be performed with great caution especially because of postoperative bleeding. Future study with longer and larger follow-up might show the reasons of recurrence of hemoptysis.