• Title/Summary/Keyword: 우측개흉술

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A Case of Localized Fibrous Tumor of the Pleura (흉막에 발생한 국소성 섬유성 종양 1예)

  • Kim, Yong-Hwan;Rha, Suk-Joo;Kwack, Moon-Sub
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.3
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    • pp.388-393
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    • 2000
  • Localized fibrous tumor of the pleura is very rare. Most of them are benign, but some are malignant. This clause does not relate with the rest of the sentence. The single best predictor of clinical benignity is whether the tumor can be totally resected. We experienced a case of localized fibrous tumor of the pleura in a 57 year old man with right chest pain and cough. He was informed of a $8{\times}5cm$ mass in his right lower lung field, which was benign 3 years ago. Preoperative chest x-ray showed an increased hazy density at right lower lung field, and CT scan showed a $12{\times}8cm$ huge mass, which was located in right lower thorax. Left thoracotomy was done to excise a $12{\times}8{\times}5cm$(1200gm) sized large mass delete. The patient was discharged without any complications postoperatively.

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Comparison of Mitral Valve Repair between a Minimally Invasive Approach and a Conventional Sternotomy Approach (승모판 성형술에 있어 최초 침습적 수술방식과 고전적 정중 흉골 절개술을 통한 접근방식의 비교)

  • Cho, Won-Chul;Je, Hyoung-Gon;Kim, Jeong-Won;Lee, Jae-Won
    • Journal of Chest Surgery
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    • v.40 no.12
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    • pp.825-830
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    • 2007
  • Background: Minimally invasive cardiac surgery appears to offer certain advantages such as earlier postoperative recovery and a greater cosmetic effect than that achieved through conventional sternotomy. However, this approach has not yet been widely adopted in Korea to replace complex open heart surgery such as mitral valve reconstruction. This study compared the results of robot assisted minimally invasive mitral valve repair with those results of conventional sternotomy. Material and Method: From December 1993 to December 2005, 520 consecutive patients underwent mitral valve reconstruction for mitral regurgitation in our institution. These patients were subdivided according to those whose surgery used the conventional sternotomy approach (Group S, n=432) and those who underwent minimally invasive right anterior thoracotomy (Group M, n=88); we then compared the clinical results of both groups. When we performed minimally invasive right thoracotomy, we used a robot (AESOP 3000) and made an incision less than 5 cm. Result: Our study patients in both groups were similar for their age, gender and preoperative ejection fraction. There were two hospital mortalities in group S. but there was no mortality in the group M patients. Significant reductions in the ICU stay and the postoperative hospital stay were observed in the group M patients compared with the group S patients. However, both the bypass time and the aortic cross-clamp time were significantly longer in the group M patients. In spite of the confined incision in the group M patients, there were no limitations on the mitral valve repair techniques. There was a similar frequency of postoperative significant residual mitral regurgitation in both groups. Conclusion: In this study, the minimally invasive mitral valve repair showed comparable early results with the conventional sternotomy patients. We will now need long-term follow-up of these patients who underwent minimally invasive mitral valve repair, but we anticipate that based on the results of this study, we will begin to routinely perform minimally invasive cardiac surgery as out primary approach for mitral valve reconstruction.

Perforation of IVC by Chest Draings Tube -Report A Case (흉강삽관술시 하대정맥 천공 치험 1례)

  • Jeong, Won-Seok;Mun, Dong-Seok
    • Journal of Chest Surgery
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    • v.30 no.11
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    • pp.1128-1131
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    • 1997
  • Injuries to versa cave continue to be associated with a high mortality. Essentials to successful treatment are immediate recognition of the injury and prompt control of the hemorrhage. We have experienced one case of inferior versa java perforation by a chest rainage tube in the patient with post-operative chronic empyema thoracic. The patient was 38-year old male who was taken RLL lobectomy after 6 cycle of chemotherapy due to small cell carcinoma in the RLL & suffered from post-operative chronic empyema thoracis at D hospital. He moved to our hospital for further evaluation with accidental removal of chest drainge tube. We inserted closed drainage tube and dark blood gushed out abruptly just after insertion of the drainage tube. CTscan, MRI, and angiogram were performed and showed the perforation of IVC just below RA. The IVC was repaired using simple interrupted 4-0 Prolene suture through right posterolateral thoracotomy. The patient recovered without event and doing well until now.

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A Case of Bronchial Foreign Body With Contralateral Pneumothorax (기흉을 동반한 기도이물 1예)

  • 나기상;김무명;김광현;박찬일
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1982.05a
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    • pp.5.3-6
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    • 1982
  • Foreign body in the air passage is not uncommon in the field of otolaryngology. The majority of bronchial foreign bodies can be removed by bronchoscopy, but some cases may require surgical procedure. Recently, we experienced an impacted foreign body (ball-pointed pen cap) in the left main bronchus with pneumothorax on the right side. Authors tried bronchoscopic removal under the general anesthesia but failed. Lateral thoracotomy was performed by chest surgeon and foreign body was successfully removed.

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Catamenial Hemoptysis - Report of one case - (월경성 각혈 - 1예 보고 -)

  • 곽영태;맹대현;배철영;이신영;김정숙;이혁표
    • Journal of Chest Surgery
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    • v.33 no.7
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    • pp.597-600
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    • 2000
  • Pulmonary endomertiosis is a rare disorder with the typical symptom of hemoptysis during menstruation (catamenial hemoptysis). We report a case of a 19-year-old woman, gravida 0, with 3-month history of catamenial hemoptysis which was confirmed with chest computed tomography. She was treated by means of thoracoscopic wedge resection for the right lesion and fuperior segmental resection through the left thoracotomy, successively. Preoperative fluoroscopy-guided hooking for thoracosopic target lwsion was helpful in circumstances with one lung anesthesia. Four months of follow-up after an uneventful discharge revealed out no recurrence of catamenial hemoptysis in symptoms and images.

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Long-Term Result of Surgical Treatment for Esophageal Cancer -500 cases- (식도암에서 외과적 요법의 장기성적에 대한 임상적 고찰 -500예 보고-)

  • 임수빈;박종호;백희종;심영목;조재일
    • Journal of Chest Surgery
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    • v.34 no.2
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    • pp.148-155
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    • 2001
  • 배경: 본 연구는 1987년부터 1997년까지 원자력병원에서 수술을 시행한 500명의 식도암환자를 대상으로 하여 휴향적 방법을 통해 조기 및 장기성적, 재발양상, 예후인자 등을 보고하고자 한다. 대상 및 방법: 대상환자 중에서 발병암이 있는 경우, 인두식도 경계부위나 위식도 경계부위 암, 고식적 우회술 또는 인공식도 삽입예 그리고 시험적 개흉술이나 개복술 만을 시행한 경우는 제외 시켰다. 식도 절제는 대부분 우측 개흉술을 이용한 Ivor Lewis 술식을 사용하였고 대부분의 문합은 stapler를 사용하였다. Extended lymph node dissection은 1994년 8월부터 시행하였고 그 이전에는 standard lymph node dissection을 하였다. 96.8%에서 위를 식도 대체장기로 사용하였고 경부에서 절제 및 재건술을 시행한 경우를 제외한 모든 식도재건은 후종격동을 통해 시행하였다. 결과: 474예(94.8%)가 편평상피 세포암이었고 대부분(58.2%)은 중부식도에 위치하였다. 술후병기는 47.4%가 stage III이었고 25%가 stage IIA이었다. 392예에서 근치적 절제가 가능하였고 74예는 고식적 절제를 시행하였으며, 식도열공을 통한 식도절제술과 경부에서의 유리공장 이식술을 시행한 34예는 위분류에서 제외하였다. 술후 유병율은 38.4%이었고 수술 사망률은 5.8%로 호흡기 감염, 문합부 유출이 주요 원인이었다. 대상환자의 99.8%에서 추적은 가능하였고 수술사망 예를 포함한 전체환자의 1, 2, 5년 생존율은 각각 63.5%, 38.9%, 19.4% 이었다. Standard lymph node dissection 그룹에서의 1, 2, 5년 생존율이 60.7%, 35.9%, 16.9%이었으나 extended lymph node dissection그룹에서는 1, 2, 4년 생존율이 70.2%, 46.5%, 30.9%이었다. 근치적 절제의 경우는 1, 2, 5년 생존률이 69.4%, 43.9%, 21.9%이었고, 고식적 절제의 경우는 37.8%, 17.6%, 7.3%이었다. 수술사망을 제외한 근치적 절제술과 extended lymph node dissection을 함께 시행한 경우의 4년 생존율은 35.6%이었다. 수술후 재발은 226예에서 발견되었고 주로 국소임파절(69%; 경부, 종격동, 복부)이었으며, 전신재발은 간, 폐, 뼈, 뇌 등의 순이었다. 결론: 저자들은 적절한 술후 환자관리가 선행되어야 하지만 근치적 절제와 광범위한 임파절 절제가 장기성적의 향상에 필수적 요소이고, 진행된 식도암에 있어서는 보다 효과적인 보강적 복합치료가 연구되어야 할 것으로 생각된다.

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Interrupted Aortic Arch with Apical Muscular Ventricular Septal Defect Associating Esophageal Atresia with Tracheoesophageal Fistula (식도폐쇄 및 기관식도루를 동반한 심첨부 근육성 심실 중격 결손과 대동맥궁 단절 -1예 보고-)

  • 조정수;이형두
    • Journal of Chest Surgery
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    • v.37 no.10
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    • pp.856-860
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    • 2004
  • Interrupted aortic arch with concomitant intracardiac defects is a rare congenital anomaly that has an unfavorable natural course. We report a successful staged operation of interrupted aortic arch with apical muscular ventricular septal defect associating esophageal atresia with tracheoesophageal fistula in a 3-day-old neonate weighing 2.6 kg. We repaired esophageal atresia through the right thoracotomy and subsequently performed extended end-to-end anastomosis of the aortic arch with pulmonary artery banding through the left thoracotomy at same operation. The apical muscular VSD was repaired 87 day after first operation. The patient required multiple additional interventions before closure of the apical muscular ventricular septal defect, such as pyloromyotomy for idiopathic hypertrophic pyloric stenosis, anterior aortopexy for airway obstruction, and balloon aortoplasty for residual coarctation. She is now doing well.

Dorsal Cavoatrial Bypass for Congenital Interruption of IVC (선천성 하대정맥 중단 환자의 후방 대정맥-우심방 우회 수술 치료 증례)

  • Choe, Ju-Won;Hong, Joon-Hwa;Sohn, Dong-Suep;Cho, Dai-Yun
    • Journal of Chest Surgery
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    • v.43 no.5
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    • pp.525-528
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    • 2010
  • Congenital interruption of the inferior vena cava (IVC) can lead to secondary hepatic congestion, portal hypertension, and liver cirrhosis. A 49-year-old woman was admitted to the gynecology department with symptoms of menorrhalgia, known uterine myoma, and anemia. Abdominal computed tomography (CT) and venography performed at our hospital revealed congenital interruption of the IVC. The patient underwent retrohepatic cavoatrial bypass surgery with a polytetrafluoroethylene (PTFE) 16-mm ringed graft via posterolateral thoracotomy, and recovered without major complications. A retroperitoneal approach via posterolateral thoracotomy provides appropriate visualization during dorsal cavoatrial bypass in treating patients with congenital interruption of IVC.

Clinical Analysis of Traumatic Diaphragmatic injuries Report of 28 cases (외상성 횡경막 손상 28례 분석보고)

  • 장진우;이연재
    • Journal of Chest Surgery
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    • v.30 no.4
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    • pp.402-407
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    • 1997
  • The records of 28 patients with traumatic diaphragmatic injuries seen at Masan Samsung Hospital from march 1986 o March 1995 were reviewed. We treated 21 male and 7 female patients ranging in ages from 5 to 68 years. Thc diaphragimatic injuries were due to blunt trauma in'20 cases(Trawc accident 18, compression injury 1, Human trauma 1) and penetrating injuries 8 cases (all stab wound). Most common symptoms were dyspnea 27 (96%), chest pain 26 (93%), abdomianl pain 8 (29%), comatose mentality 36 (11 %). Chest X-ray were elevated diaphragm in 20 cases(71%) find hemothorax in 18 cases (64%) and 25 cascs (89%) were diagnosed or suspected as diaphragmatic inju,rims prcopcrativcly. The repair of 28 cases were performed with thoracic approach in 20 cases, abdominal approach 7, thoracoabdominal approach in 1 cases. There were 5 death (18%) and all death related to the severity of associated injury. (hypovolcmic shock 3, combined head injury 1, renal failure 1).

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Interventional Treatment of Chemical Pleuritis and Hemothorax Caused by Iatrogenic Internal Jugular Vein Perforation after Central Venous Port System Implantation: A Case Report (중심정맥포트 삽입 후 의인성 속목정맥 천공에 의한 화학적 늑막염과 혈흉의 중재적 치료: 증례 보고)

  • Do Woo Kim;Young Hwan Kim;Ung Rae Kang
    • Journal of the Korean Society of Radiology
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    • v.81 no.6
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    • pp.1459-1465
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    • 2020
  • The perforation of the intrathoracic internal jugular vein during the placement of an implantable central venous chemoport is a rare complication that is manifested by hemothorax or hemorrhagic shock. Furthermore, inappropriate instillation of a chemotherapeutic agent in the chemoport can cause chemical pleuritis, and the diagnosis of these complications prior to the instillation of chemotherapeutic agents and open thoracic surgery is mandatory. We report a patient with chemical pleuritis and hemothorax following an inappropriate instillation of a chemotherapeutic agent, through the perforated right internal jugular vein after placement of an implantable central venous chemoport. Treatment by embolization using coils and N-butyl cyanoacrylate, after percutaneous drainage, was successful.