• Journal of Chest Surgery
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• 제15권2호
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• pp.188-193
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• 1982

Between 1967 and 1980, a total of 99 patients with a benign stricture of esophagus, resulting from a chemical burn, underwent a reconstructive procedure in which various segments of colon were used to bridge the gap between the cervical esophagus and the stomach. There were 42 males and 57 females and most were in their twenties and thirties. The most frequent site of the stricture was upper 1/3 of the thoracic esophagus [48.5%] and the next most common site was the low cervical esophagus [23.2%]. In 89 cases, the right colon with or without the terminal ileum was used as the conduit in an isoperistaltic manner and in 10, the left colon was used in an antiperistaltic position, because the right colon was not suitable as the conduit. There was a higher incidence of regurgitation [90% vs 0%], leakage at cervical anastomosis [80% vs 27%] and stenosis at anastomotic site [70% vs 15%] in an antiperistaltic left colon anastomosis, as compared to isoperistaltic right colon anastomosis. This was felt to be due to the orad peristaltic motion of the transplanted colon which acted as a functional obstruction distal to the esophagocolic suture line, resulting in breakdown of the anastomosis, leakage and eventual stenosis at the site of anastomosis. In conclusion, colon is useful and effective conduit as an esophageal substitute. Either the right or the left colon can be used for this purpose, provided that it is placed in an isoperistaltic position to minimize some of the complications listed above.

• Journal of Chest Surgery
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• 제23권1호
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• pp.90-94
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• 1990

Between Dec. 1958 and Oct. 1989, we had been experienced 14 cases of the esophageal corrosion carcinoma among 562 cases of corrosive esophageal stricture, which incidence was revealed 5.6 % of total esophageal carcinoma cases and 2.5 9o of total benign esophageal stricture cases. The age distribution was from 15 to 64 years, and the mean age was 45.6 years. Ten of the patients were women. The caustic agents were lye in 12 patients and hydrochloric acid in 2 patients. The latent time from injury to the development of carcinoma was from 12 years to 45 years, and the mean latent time was 29 years. In majority of cases, the developing site of carcinoma was just or just above the benign stricture portion of the esophagus. Corrective surgery were made in seven cases; three cases were made esophagectomy and esophagogastrostomy, and the other four cases were made esophagectomy and colon interposition. Palliative surgery including feeding gastrostomy were made in seven cases. All cases had a longstanding history of difficult oral swallowing especially at the site of stricture. We think chronic food irritations of stricture portion of the esophagus induced the development of corrosion carcinoma. In conclusion, we had to suspect possibility of carcinoma in patient with long standing history of benign esophageal stricture. So we recommended preoperative esophagoscopic biopsy in such cases.

• 대한기관식도과학회지
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• 제5권2호
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• pp.182-190
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• 1999

OBJECTIVES : To determine the results of posterior cricoid split with costal cartilage graft in the treatment of moderate and severe subglottic stenosis in adults, and to assess the effect of T-tube as a stent in this surgery. PATIENTS AND METHODS : Four adults with moderate and severe subglottic stenosis who underwent posterior cricoid split with costal cartilage graft from 1994 to 1995. Three patients were male and one was female. All of the patients had acquired subglottic stenosis, 2 of whom had a bilateral vocal folds paralysis. The surgical procedure we used included a cricoid lamina split with costal cartilage grafting and T-tube stenting. Arytenoidectomy was a added in 2 patients with bilateral vocal folds paralysis. RESULTS : Three of the 4 patients underwent decannulation, and 1 is still undergoing treatment. 3 patients who underwent decannulation demonstrated marked improvement in their symptoms of airway obstruction and good postoperative voice quality. CONCLUSIONS : The posterior cricoidotomy lumen augmentation with costal cartilage grafting is a safe and effective technique for the treatment of moderate and severe subglottic stenosis in adults and T-tube is a good alternative stenting material for this procedure.

• 대한기계학회논문집A
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• 제28권7호
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• pp.915-922
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• 2004

A stent is small tube-like structure expanded into stenotic arteries to restore blood flow. The stent expansion behaviors define the effectiveness of the surgical operation. In this paper, finite-element method was employed to analyze expansion behaviors and fatigue life of a typical diamond-shaped balloon-expandable stent. Beyond safety considerations, this type of analysis provides mechanical properties that are often difficult to obtain by experiments. Mechanical properties of the stent expansion pressure, radial recoil, longitudinal recoil and foreshortening were simulated using commercial FEM code, ANSYS and fatigue life were estimated using NISAII ENDURE. The FEM results showed that the pressures necessary to expand the stent up to a diameter of 3mm, 4mm and 5mm were 0.75MPa, 0.82MPa and 0.97MPa. The fatigue lifes according to expansion diameter were 114${\times}$10$^{7}$cycles, 714${\times}$$^{6}$cycles and 163${\times}$10$^{6}$cycles. As a result, a finite element model used in this study can simulate expansion behaviors of stents and should be useful to design new stents or analyze actual stents.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1982년도 제16차 학술대회연제순서 및 초록
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• pp.7.4-8
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• 1982

오늘 날, 물질 문명이 고도로 발달함에 따라 인두 및 인두 손상이 날로 증가하는 경향을 보이고 있다. 교통 사고나 운동 경기는 폐쇄적 외상을 일으키기 쉽고 빈도는 적지만 심각한 증상을 초래하는 개방적 외상의 원인으로는 총상이나 자상 등을 들 수 있다. 인후두의 개방적 외상에서 가장 문제가 되는 것은 적절한 치료에 있다. 이 부위의 외상은 손상의 정도나 범위에 따라 차이는 있지만 신속한 처치가 요구되고 협착이나 누출 등과 같은 심각한 후유증을 남기기 때문에 적절한 치료 방법이 요구되는 것이다. 일반적으로 이에 대한 치료는 적절한 기도 유지를 위한 기관절개술과 단순 봉합등을 일차적으로 시행하고 차후에 후유증에 대한 이차 수술을 시행하는 것이 보통이다. 최근, 저자들은 자상으로 인해 인두 뿐만 아니라 인두까지 광범위한 개방적 외상을 입고 이차 감염까지 일으켜 인후두 조직 및 전경부 피부의 심한 결손을 보인 환자에게 잔여 후두 적출술을 시행한 후 피부봉이나 육경피부변을 사용하지 않고 전경부 피부변을 이용해서 피부 결손부를 얻었기에 문헌적 고찰과 함께 보고하는 바이다.

• Advances in pediatric surgery
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• 제17권1호
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• pp.88-92
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• 2011

The onset of hypertrophic pyloric stenosis in the postoperative course of esophageal atresia with tracheoesophageal fistula is rarely reported. The diagnosis could be delayed due to its mimicking symptoms of other postoperative complications including gastroesophageal reflux or anastomotic stricture. We present an infant who had surgery for esophageal atresia with tracheoesophageal fistula. He had never fed since birth. The infant presented with an increased amount of orogastric tube drainage and consistently distended gastric air on simple abdominal X-ray. Abdominal ultrasonography showed hypertrophic thick pyloric muscle. The diagnosis of pyloric stenosis was confirmed d is rarely reported. The diagnosis could be delayed due to its mimicking symptoms of other postoperative complications including gastroesophageal reflux or anastomotic stricture. We present an infant who had surgery for esophageal atresia with tracheoesophageal fistula. He had never fed. The infant presented with uring surgery, After pyloromyotomy, the patient's condition improved.

• 대한기관식도과학회지
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• 제9권2호
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• pp.60-64
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• 2003

Restenosis frequently develops with granulation and overgrowth of scar following surgical treatment for laryngotracheal stenosis. Various methods such as stenting or CO2 laser application have been used to prevent restenosis, but they were seldom unsatisfactory. Mitomycin is an antineoplastic antibiotics derived from Streptomyces caespitosus; it inhibits fibroblast proliferation and acts as an alkylating agent to inhibit DNA synthesis. This study was desinged to evaluate effectiveness and determine indications of usage of topical mitomycin for laryngotracheal stenosis as a nonsurgical means of reducing postoperative granulation and scar tissue formation. Patients and Method : A retrospective study was performed on eight cases of laryngotracheal stenosis with topical mitomycin application. The author analyzed clinical outcomes of operative treatment with topical mitomycin. Patients underwent laryngotracheal reconstruction, endoscopic granulation removal, or bronchoscopic bougienage followed by topical application of mitomycin (0.4 mg/$m{\ell}$, 4minuntes) on the lesion intraoperatively. Result : Overall success rate of decannulation was 38% ($\frac{3}{8}$). Successful decannulation was possible in 75% ($\frac{3}{4}$) of laryngeal stenosis patients, 75% ($\frac{3}{4}$) of children, 60% ($\frac{3}{5}$) of the patients without previous surgery, and 75% ($\frac{3}{4}$) of bronchoscopic bougienage. Conclusion : The topical application of mitomycin in laryngotracheal stenosis was effective in untreated pediatric laryngeal stenosis which underwent bronchoscopic bougienage. Our results show that the topical mitomycin application for laryngotracheal stenosis could be a effective adjuvant treatment.

• 대한기관식도과학회지
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• 제1권1호
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• pp.122-128
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• 1995

The experience with treatment of acquired subglottic stenosis in 20 adults is reviewed. Nine of the 20 patients (45%) had opeated by other institues before treatment. Causes of the disease were 10(50%) of blunt neck trauama and 10(50%) of prolonged intubation. The most common associated airway diseases were nine patients (45%) of bilateral vocal cord fixations. Twelve patients (60%) underwent anterior cartilage grafts, five patients (25%) had anterior and posterior cartilage grafts and three patients (15%) had end to end anastomosis according to the severity of cricoid deformities and mucosal defects. Associated procedures were 9 patients (45%) of arytenoidectomy. Thirteen of 20 patients (65%) have been decannulated. Fe-male group was significantly higher decannulation rate than male group (p=0.0074). Decannulation rates were decreased from anterior cartilage graft group to anterior and posterior cartilage grafts group and to end to end anastomosis group (p= 0.00247), this finding suggested the patients with severe cricoid deformitiy were higher likely hood of failure because we selected the method used in this study according to the severity of cricoid deformities and mucosal defects. Our results support the more aggressive treatment is indicated for subglottic stenosis in adults.

• Advances in pediatric surgery
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• 제6권1호
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• pp.40-44
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• 2000

Congenital esophageal stenosis (CES) is a narrowing of the esophageal lumen from birth. Three types of CES have been described; tracheobronchial remnants (TBR), membranous web (MW), and fibromuscular stenosis (FMS). We reviewed the clinical features and the surgical outcome of 14 patients, pathologically confirmed as CES. Nine patients had TBR, 3 FMS, and 2 MVV. The mean age at operation was 3.8 years. Five patients were boys and 9 girls. Four patients had other congenital anomalies. Segmental resection of the lesion and end to end anastomosis was utilized in all cases except one who underwent myotomy. The stenotic segment was located at the distal esophagus in all patients. There were 8 complications in 6 patients, but no mortality. The mean follow-up period was 68 months. There were no feeding problems but 3 patients had minor gastroesophageal reflux. Our result indicates that segmental resection and anastomosis is a satisfactory surgical procedure in the management of CES.

• 대한기관식도과학회지
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• 제7권1호
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• pp.40-45
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• 2001

Management of laryngotracheal stenosis remains one of the most challenging problems facing the otolaryngologist. The key to success is to obtain adequate rigid circular support with normal mucosal lining. Four Patients with laryngotracheal stenosis were surgically treated in our institution in 2000. All the patients were male adults. The cause of stenosis were longterm or repeated endotracheal intubation and tracheostomy in our patients. All patients were successfully decannulated following segmental resection of the stenotic portion including the anterior arch of the cricoid cartilage and end-to-end anastomosis after suprahyoid laryngeal release. The time between treatment and decannulation was just one day in three patients. These results suggest the Possibility of early decannulation even if the cricoid cartilage was partially resected. It is better to prevent laryngotracheal stenosis rather than to treat it once it has occurred.