• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제7권2호
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• pp.179-185
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• 2004

목적: 대구 부산 지역에서 신생아 시기에 수술이 시행된 소화기 질환의 최근 현황과 이와 관련된 임상적 소견들을 살펴보고 현재 소아 소화기 질환의 술 후 합병증과 사망률 등의 치료성과에 대해 살펴보았다. 방법: 1996년 1월부터 2003년 7월까지 부산대학교, 경북대학교, 영남대학교 및 대구가톨릭대학교 병원에서 생후 1개월 이내에 소화기 질환으로 수술을 시행받은 202명을 대상으로 하여 임상적 소견을 분석하였다. 결과: 1) 항문 직장 기형이 48명(23.8%), 선천성 중장 폐쇄가 27명(13.4%), 비후성 유문 협착증이 27명(13.4%), 선천성 거대 결장이 22명(10.9%), 십이지장 폐쇄가 15명(7.4%) 등의 빈도순을 보였다. 2) 남녀비는 2.8 : 1로 남아가 우세하였고, 비후성 유문 협착증과 장 회전 이상에서는 남아가 10배 이상 많았다. 3) 동반 기형의 빈도는 선천성 심장 기형, 잠복 고환, 수신증 등의 순서로 많았으며, 제대 기저부 탈장에서는 50%에서 동반 기형이 있었다. 4) 20명(9.9%)의 환아가 산전에 진단되었는데, 선천성 장폐쇄, 십이지장 폐쇄, 복벽 개열증, 제대 기저부 탈장과 같이 장 내 공기 패턴이 특이 소견을 보이는 경우였다. 5) 평균 입원 기간은 22.8일이었고, 신생아 괴사성 장염이 44.7일로 가장 길었다. 6) 술 후 합병증은 주로 창상 감염 또는 문합부 누출 등 사소한 합병증으로 18례(8.9%)에서 발생하였다. 7) 사망률은 횡격막 탈장증(37.5%), 식도 폐쇄(28.6%), 제대 기저부 탈장(20.0%) 순으로 많았으며, 12명이 사망하여 5.9%의 사망률을 보였다. 결론: 대구 부산 지역에서 신생아 시기에 소화기 질환으로 수술을 받았던 환자들의 질병 종류가 다양해졌고, 술 후 합병증과 사망률이 현저히 감소함을 알 수 있었으며, 이것은 관련 분야의 발전에 기인한 것으로 판단된다.

• Journal of Chest Surgery
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• 제29권4호
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• pp.433-439
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• 1996

경북대 학교병원에서는 1980년 1월부터 1995년 7월까지 들상에 의한 횡격 막 손상 환자 32례와 관통상 에 의한 12례를수술 치료하였다. 평균연령은둔상의 경우)7.6세,관통상의 경우29.2세로,들상의 경우 가 평 균 8.4세가 높았다(p<0.05). 진단은 단순 흉부 X-선 사진으로 횡격막 손상을 진단한 경우가 둔상에서는 24례 (75%), 관통상에서는 4fl (33%)였다. 관통상에서는 횡격막 손상의 의심 없이 다른 장기손상으로 수술하여 횡격막 파열이 발견 된 경우가 7례 (58%)였다. 탈장은 둔상시 24례 (75%), 관통상시 5례 (42%)에서 발생 하였다. 탈장이 발생 한 29례의 횡격막 손상의 크기는 10.9 $\pm$ 4.3cm, 발생하지 않은 15례는 3.5 $\pm$ 2.9cm로 양군간의 크기 의 차 이가 있어 (p<0.05) 횡격막 손상의 크기와 탈장과는 밀접한 관계가 있었다. 수출은 진단 즉시 시 행하였으며, 수술시 절개방법은 들상의 경우 20례 (6)%)에서 개흥술, 9례 에서 개 복술, 2례 에서 개흥복술, 1례 에서 개흥술 및 개복술을 분리 시행하였으며, 관통상시에는 6례 (50%)에서 개복술, 4례에서 개흥술, 2례에서 개흥술 및 개복술을 분리 시행하였다. 수술 후 합병증은 둔상시 6례 (19%), 관통 澯\ulcorner3례 (25%)에서 발생하여 비교적 높았다. 수술 후 사망률은 들상의 경우 2례 에서 사망하 였고(6.3%), 관통상의 경우는 사망례가 없어 전체 사망률은 4.5%였다. 결론적으로흥복부 외상시 횡격막 손상의 가능성을 염두에 두어야하며, 둔상의 경우횡격막손상의 크기는 관통상에 의한 경우보다 더 크며, 탈장도 횡격막 손상의 길이 에 비례하여 더 많이 발생하였다.

• Clinical and Experimental Pediatrics
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• 제51권2호
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• pp.219-221
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• 2008

저자들은 발열과 식욕저하를 주소로 패혈증 의증으로 전원 된 27일된 신생아에서 구토와 혈변 등은 없었으나, 입원 당시 복부팽만과 단순복부촬영에서 보인 소장 확장소견으로 개복술을 실시한 결과 선천성 밴드에 의해 내탈장된 소장이 압박되어 유발된 장폐색증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제26권4호
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• pp.337-341
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• 1993

Since the first deliberate repair of hiatal hernia by Wm. J. Mayo in 1911, counterless procedure have been performed to correct herniation of the stomach into the posterior mediastinum. Recently,we experienced 51 years old female patient with large paraesophageal hernia and complete intrathoracic stomach which combined with multiple gastric erosion with chronic blood loss. So gastric ulcer within a diaphragmatic hernia is a distinct physiophathologic and clinical entity that our patient suffered from severe anemia due to chronic blood loss. The hernia was repaired transabdominally including reduction of stomach, excision of sac, closure of defect, anterior gastropexy, and gastr6stomy. Because of absent gastroesophageal refiux, no another antireflux procedure was required and erosion was managed by H2 receptor blocker.

• Journal of Chest Surgery
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• 제28권11호
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• pp.1067-1070
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• 1995

We experienced a case of congenital paraesophageal hiatal hernia[Type;IV in seventeen day-old female and treated through the right thoracotomy, reduction of the herniated viscera ,stomach and some part of transverse colon and omentum by gentle finger push, and narrowing the esopahgeal hiatus. Paraesophageal hiatal hernia accounts for only 5% per cent of all diaphragmatic defects but is a potentially dangerous lesion due to compressed lung by the herniated viscera. Symptoms are related to this, including exertional dyspnea, vomiting, cough, Tachypnea but noncyanotic, etc. Barium study shows that the stomach has herniated into the right pleural cavity. The speckled appearance in the herniated stomach in the herniated stomach was due to food material. It strongly suggests paraesophageal hiatal hernia. The operation was done. We report the case with the brief review of literatures.

• Journal of Chest Surgery
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• 제13권2호
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• pp.154-157
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• 1980

A twenty three year old, Primigravida and 32 week pregnant woman who has been complained dyspnea, chest pain, nausea and vomiting was admitted to this chest surgical department on Feb. 19, 1979. Physical findings were those of acutely ill appearance, decreased thoracic excursion and absence of breath sounds in the left hemithorax. Roentgen examination of the chest revealed reticular cystic densities in the left, particularly in lower lung field with collapse of the left lung. Correction of the diaphragmatic hernia was carried out with reduction and repair of the hernia through transperitoneal approach. On exploration, the defect of the diaphragm was 12 x 12 cm in size and was located posterolateral area of left diaphragm. Hernia contents were stomach, spleen, omentum and splenic flexure of large bowel. The baby was normal full term spontaneous delivered at 36th POD. Diaphragmatic hernia complicated by pregnancy is a rarity and mortality is extremely high. Therefore, the literatures have reviewed and the case is reported.

• Journal of Chest Surgery
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• 제12권4호
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• pp.429-433
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• 1979

Morgagni hernia is a rare condition of the congenital diaphragmatic hernia which Is located at the anteromedial portion of the diaphragm, and is located immediately posterior to the sternum. Its cause is considered by embryologic defect and the abdominal organs are passed through a defect. The incidence is predirected women over 50 years old. Its synonym is hernia of subcostosternal, retrosternal, parasternal, rectocostoxiphoid, anterior diaphragmatic or Larrey`s. This report presents a symptomatic Morgagni hernia of ten months old male child on whom the diagnosis was established and was operated at the Busan Gospel Hospital. This patient was admitted with the chief complaints of mild cyanosis, frequent upper respiratory infections and protrusion of the right lower anterior chest. Herniorrhaphy was performed through the upper abdominal midline incision, hernial contents of the omentum and the colon, and sac as noticed from the Larrey`s space measuring 4 x 2 cm. in diameter and oval in shape. Interrupted sutures without difficulty repaired the defect. The cyanosis was disappeared and the patient had uneventful course of post-operative period. The patient was discharged at 7th. postoperative day. This case presentation with a brief review of literatures is given.

• Journal of Chest Surgery
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• 제20권4호
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• pp.825-828
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• 1987

Authors carried out a retrospective study in 22 infants with Bochdaleck`s hernia who were operated upon, the results are; 1] the male to female ratio was 2:1 and the incidence of left side was threefold prevalent than right, 2] the chief complaint of those who were operated upon in neonatal period was dyspnea and diagnosis was possible by chest A-P, 3] primary repair was possible except one patient in whom a prosthesis was used. 4] complication occurred in 41% and pulmonary complication was most common including 5 pneumothorax, 5] mortality rate was 14%, the deaths occurred in infants who were operated upon within 48 hours of life and the lesion was left without sac, the defect was larger than average and all died within 72 hours after operation.

• Journal of Chest Surgery
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• 제26권5호
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• pp.417-421
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• 1993

Congenital diaphragmatic hernia through Bochdalek foramen, posterolateral diaphragmatic hernia, is the result of a congenital malformation of the posterolateral region of the diaphragm. Bochdalek hernia is the most common type of congenital diaphragmatic hernia, but it is a extremely rare anomaly which is detected in adulthood because it has severe cardiopulmonary and gastrointestinal symptoms after birth immediately.We experienced two cases of Bochdalek hernia which were detected in adulthood. Among them, one was a 43 years old man who was treated with simple closure in left Bochdalek hernia and the other was 41 years old woman who was treated with patch closure using silastic sheet in right Bochdalek hernia. Their postoperative courses were uneventiful. So we report two cases of rare Bochdalek hernia which was detected in adulthood with review of literatures.

• 한국임상수의학회지
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• 제20권2호
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• pp.255-258
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• 2003

A 2.5 kg, three-month-old. intact male Shih-tzu was referred to the Veterinary Teaching Hospital of Kyungpook National University to examine the postoperative inflammation and suspected diaphragmatic defect which had been found during the surgical correction of umbilical hernia by the referral veterinarian. An umbilical hernia had been surgically repaired one month earlier at the time. Radiographic findings were enlarged cardiac silhouette containing soft tissue and gas densities and overlapping of cardiac and diaphragmatic borders. Ultrasonographic findings revealed the discontinuity of the diaphragm and the partial herniation of the liver into the pericardial sac. According to these findings, it was diagnosed as congenital peritoneopericardial diaphragmatic hernia(PPDH). Because the dog showed no serious clinical signs of PPDH and the owner didn't want a surgery to correct it, the dog was discharged the day of the examination after treatment of the inflammatory surgical site. On the follow-up after three months, the dog showed no distinct clinical signs of PPDH and was in good physical condition.