• 제목/요약/키워드: 협착증

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기관협착증의 외과적 치료 (Surgical Treatment of Tracheal Stenosis)

  • 조경수
    • Journal of Chest Surgery
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    • 제22권5호
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    • pp.834-838
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    • 1989
  • Tracheal stenosis is being encountered more frequently as ventilatory support and cuffed tubes are increasingly used for treatment of respiratory failure. We experienced 13 cases of tracheal stenosis treated surgically at department of Thoracic and Cardiovascular Surgery, school of medicine, Kyung Hee university during the 4 years. The causes of tracheal stenosis were prolonged endotracheal intubation 5 cases, tracheostomy 3 cases, tracheal tumor 2 cases, thyroid tumor 1 case and congenital double aortic arch 1 case. The methods used to manage the tracheal stenosis were tracheal resection % end to end anastomosis 8 cases, 2 cases of subglottic stenosis were underwent primary laryngotracheal anastomosis, Lt. aortic arch division 1 case, and stent insertion 2 cases. In two cases, who had 6 cm in length of tracheal stenosis, we were underwent tracheal resection k end to end anastomosis with supralaryngeal release procedure. Postoperative courses were uneventful except one case with tracheal tumor.

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대동맥판상협착증 치험 1례 (Surgical Treatment of Supravalvar Aortic Stenosis - A Case Report -)

  • 이성광
    • Journal of Chest Surgery
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    • 제21권4호
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    • pp.721-726
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    • 1988
  • Congenital supravalvar aortic stenosis is an obstruction caused by localized or diffuse narrowing of the aortic lumen commencing immediately above the aortic valve. We experienced a case of diffuse supravalvar aortic stenosis involving ascending aorta from just above the sinuses of Valsalva to the proximal l cm of the innominate artery. Supravalvar aortic stenosis in this patient, in contrast to the form seen in infants and children, was not associated with mental retardation, peculiar faces or the syndrome of hypercalcemia. Diagnosis was confirmed by retrograde left heart catheterization and left ventriculography. Surgical correction was performed by the replacement of oval shaped Woven Dacron patch over the narrow segment of aorta under the cardiopulmonary bypass. Blood pressure was controlled sufficiently with some adjunct of Inderal postoperatively. The patient was discharged with much improvement.

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결절성 뇌경화증과 동반된 좌심실내 횡문근종의 수술치료 -1례보고- (Left Ventricular Rhabdomyoma with Tuberous Sclerosis - A Report of one case-)

  • 문상호;서필원;박성식;임수빈;김삼현
    • Journal of Chest Surgery
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    • 제35권6호
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    • pp.467-470
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    • 2002
  • 횡문근종은 영아에서 발생하는 일차 심종양중 가장 흔한 종양이며, 환자의 약 반수에서 결절성 뇌경화증을 동반한다. 이 종양이 대동맥하 협착을 유발할 경우 그 예후가 좋지 않으므로 수술의 적응증이 된다. 본 단국 대학교 흉부외과 교실에서는 결절성 뇌경화증을 동반한 좌심실내 횡문근종 1례를 수술 치험하였기에 보고하는 바이다.

이첨 대동맥판막협착을 동반한 단일 관상동맥증 -1례 보고- (Single Coronary Artery Associated with Bicupid Aortic Valvular Stenosis -1 Case Report-)

  • 김우찬
    • Journal of Chest Surgery
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    • 제27권6호
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    • pp.472-476
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    • 1994
  • The incidence of single coronary artery is extremely rare in a review of congenital anomalies of the coronary arteries. This 27-year-old male patient was referred for the evaluation of cardiac condition showing exertional dyspnea[NYHA class II-III] and chest discomfort for about 1 year. A complete catheterization study including angiogram disclosed large single coronary artery arising from left aortic sinus [Ogden classification L-4] associated with bicuspid aortic valvular stenosis and low grade supravalvular aortic stenosis. Calcified stenotic aortic valve was fully removed with caution and the 19mm St. Jude Medical valve was then implanted in the small nortic annulus. The patient had an uneventful recovery and was discharged on 13th postoperative day.

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인위적인 기도협착이 동맥혈액가스에 미치는 영향 (Experimental Study of the Influence of the Upper Airway Obstruction on the Blood Gas Analysis)

  • 정해영;김중환;조영상
    • 대한기관식도과학회:학술대회논문집
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    • 대한기관식도과학회 1979년도 제13차 학술대회 연제순서 및 초록
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    • pp.8.2-8
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    • 1979
  • 상부기도가 갑자기 폐쇄증을 일으켜 심한 호흡곤란증을 호소하는 환자에 대하여 응급으로. 기도 및 호흡을 재확보하여야하며 이와같은 예를 임상에서 가끔 직면하게 된다. 이러한 환자에게 적절한 기도확보는 생명을 유지시킬 수 있다. 저자는 토끼를 대상으로 기존 기관의 직경을(약 3.4mm) 약 1/3(1.2mm), 1/4(0.8mm) 및 1/6(0.6mm)로 협소시켜 생리적 변화를 추적하였다. 결과는 다음과 같았다. 1) 혈액가스의 분석결과 직경을 약 1/3로 감소시켰던 군에서 생리적 변동이 별로 없었다. 2) 직경을 약 1/4, 1/6로 감소시켰던 군에서는 $PaO_2,$ $PaCO_2$ 및 pHa에 뚜렷한 변화를 나타내어 저산소혈증, 과탄산혈증 및 대사성산증을 나타내었다. 3) 호흡저항은 모든 군에서 뚜렷하게 증가하여 1회 호흡량도 현저하게 감소하였는데 16G(직경 1.2mm 호흡로)에서는 호흡수의 증가로 폐포환기가 적당하게 영위됨에 따라서 혈액가스 및 vital signs의 변동이 별로 없던 것으로 보아 토끼에서는 이 정도의 호흡로 폐쇄에는 1시간까지 견딜 수 있음을 알았다.

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고콜레스테롤혈증을 유발한 토끼의 대동맥 판막에서 ${\beta}_3$ Integrin 발현의 변화 (Altered Expression of ${\beta}_3$ Integrin on Sclerotic Aortic Valves in a Hypercholesterolemic Rabbit Model)

  • 박찬범;김영두;최미선;진웅;문석환;김용한;김치경;조건현;권종범
    • Journal of Chest Surgery
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    • 제41권6호
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    • pp.687-694
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    • 2008
  • 배경: 대동맥 판막 경화증은 고령에서 흔히 나타나며, 대동맥 판막 협착증처럼 좌심실 유출로를 폐쇄하지는 않으나 심혈관질환으로의 사망 위험성이 50%나 증가되며, 심근경색증의 위험성이 높다. 그러나, 대동맥 판막경화증에서 ${\beta}_3$ integrin의 관련성은 잘 알려져 있지 않다. 대상 및 방법: 20마리의 뉴질랜드산 토끼들을 2군으로 나눈 후, 1군(10마리)에서는 정상식이를 시행하였고, 2군(10마리)에서는 1% 콜레스테롤식이를 시행하였다. 12주간 식이후 실험동물을 희생시켜 대동맥 판막 및 상행대동맥을 채취하였다. 각군의 토끼들의 혈장에서 총 콜레스테롤, 중성지방, 저밀도(LDL)-콜레스테롤, 고밀도(HDL)-콜레스테롤 수치를 측정하였으며, 대동맥 판막과 대동맥에서 HE 염색을 시행하였고, 대동맥 판막에서 근육섬유모세포, 대식세포에 대한 면역조직화학염색을 시행하였으며, ${\beta}_3$, integrin에 대한 정량적검사를 위하여 Real-time polymerase chain reaction (RT-PCR)을 시행하였다. 결과: 총 콜레스테롤($2148.3{\pm}1012.5\;mg/dL$ versus $53.7{\pm}31.8\;mg/dL$, p<0.05), 중성지방($240.4{\pm}218.3\;mg/dL$ versus $31.6{\pm}6.4\;mg/dL$, p<0.05), 저밀도-콜레스테롤 수치($2,065.3{\pm}960.9\;mg/dL$ versus $29.1{\pm}30.9\;mg/dL$, p<0.05)는 정상식이군과 비교해서 콜레스테롤 식이군에서 의미 있게 증가하였다. 대동맥판막의 면역 조직화학염색에서 근육섬유모세포와 대식세포는 콜레스테롤식이군에서 발현이 증가되었다. RT-PCR을 이용한 정량적 검사에서 ${\beta}_3$ integrin mRNA의 발현은 대동맥판막과 대동맥 모두 콜레스테롤 식이군에서 의미 있게 감소되어 있었다(p<0.05). 결론 : 콜레스테롤식이에 의한 고콜레스테롤혈증은 토끼의 대동맥 판막에서 대동맥 판막경화증을 유발하였다. 석회화 대동맥 판막의 초기 상태인대동맥 판막 경화증은 초기죽상경화병변과 유사한 과정을 보이며, 이는 ${\beta}_3$, integrin의 감소가 중요한 역할을 한다고 생각된다.

흉추강 협착증의 수술적 치료 결과와 예후인자에 관한 분석 (The Analysis on Surgical Result and Prognostic Factors of Thoracic Spinal Stenosis)

  • 장웅규;정상기;김동윤;정천기;김현집
    • Journal of Korean Neurosurgical Society
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    • 제30권6호
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    • pp.761-768
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    • 2001
  • Objective : To describe the underlying causes, surgical results, and prognostic factors in thoracic stenosis causing myelopathy, retrospective analysis for 28 cases of thoracic stenosis with surgery was performed Materials & Method : Twenty-eight patients(male, 15 ; female, 13) who underwent decompressive surgery for thoracic stenosis between 1987 and 1997 were analyzed. The mean age was 49 and the mean follow-up was 30.6 months. Statistical analysis with $SPSS^{(R)}$ was performed. Chi-square test was used for the analysis of relationship between subjects and multivariate analysis with general linear model was used to find prognostic factors. Result : Degenerative spondylosis was the most common cause, and three cases were associated with systemic diseases. Decompressive laminectomy was done in 23 cases, anterior decompression in four cases, and combined decompression in one case. Ossification of ligamentum flavum was found in 18 cases, facet hypertrophy in 13, ossification of posterior longitudinal ligament in six, and ventral spur in four. Postoperatively, 16 patients improved functionally and 4 patients worsened. The group of which initial symptom duration was less than two years showed better result(p=0.003). The group with sufficient decompression and no additional proximal stenosis had better outcome(p=0.002, p=0.001). Conclusion : Chronic myelopathy caused by thoracic stenosis can be reversible with appropriate decompression.

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봉약침 병행치료한 요추관 협착증 환자 119례에 대한 임상고찰 (Clinical Observation on 119 Patients with Lumbar Spinal Stenosis Treated with Bee Venom Pharmacopuncture Therapy)

  • 한경완;김은석;우재혁;이슬지;이준석;남지환;김기원;고강훈;유인식
    • Journal of Acupuncture Research
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    • 제28권3호
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    • pp.21-31
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    • 2011
  • Objectives : The purpose of this study was to evaluate the effect of bee venom pharmacopuncture therapy in patients with lumbar spinal stenosis. Methods : This clinical study was carried out on 119 patients with lumbar spinal stenosis, who had been admitted from May, 2009 to March, 2011. Patients were sorted into two groups ; One group(bee venom pharmacopuncture group) was treated with bee venom pharmacopuncture and acupuncture therapy, the other(non-bee venom pharmacopuncture group) with acupuncture therapy only. Verbal numerical rating scale(VNRS) and Oswestry disability index(ODI) were used to evaluate the effectiveness of the treatment in both groups. VNRS and ODI scores of the two groups were statistically compared. Results : The bee venom pharmacopuncture group demonstrated a more significant improvement than non-bee venom pharmacopuncture group when evaluated with VNRS and ODI. Conclusions : In the case of the patients with spinal stenosis, it was found that treatment with combination of bee venom pharmacopuncture and acupuncture was more effective in improving the conditions of the patients (subsidence of the symptoms) than the acupuncture treatment only.

요추 척추관 협착증에 대한 침구치료의 국내 임상근거: 체계적 문헌고찰 (Acupuncture for Lumbar Spinal Stenosis in Korean Literature: a Systematic Review)

  • 김건형;노승희;이병렬;김재규;양기영
    • Journal of Acupuncture Research
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    • 제28권6호
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    • pp.93-105
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    • 2011
  • Objectives : This study aims to evaluate currently available clinical evidence for the use of acupuncture in patients with lumbar spinal stenosis in the context of Republic of Korea. Methods : Five Korean databases were searched for all clinical studies employing acupuncture for patients with lumbar spinal stenosis. The exceptions were case reports and series involving less than 10 patients from their inception to September 2011. Only studies reported in Korean databases were searched. Results : Five retrospective audits among 22 initially identified studies were eligible for analysis in this review. There was no randomized controlled trial for this topic. The number of patients varied between 15 and 119 in each audit, and all the patients analyzed were inpatients. In all the included studies, acupuncture was conducted in combination with other concomitant treatments, including moxibustion, cupping, herbal remedies, acupoint injection, Chuna, and various physical therapies. All the included audits reported symptomatic and/or functional improvements compared to baseline. None of the included audits indicated whether any adverse events were reported. Conclusions : Current evidence for the use of acupuncture in patients with lumbar spinal stenosis in the context of South Korea is based solely on five retrospective audits that are very likely prone to a high risk of bias. Thus, further prospective and methodologically sound clinical trials to overcome this huge gap between clinical practice and the available evidence for the use of acupuncture in patients with lumbar spinal stenosis are needed.

요추 척추관 협착증 환자 118례에 대한 임상적 고찰 (The Clinical Study on Spinal Stenosis of Lumbar Spine)

  • 조재희;이효은;문자영;임명장;강인;이한;정호석;김지형
    • 척추신경추나의학회지
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    • 제3권2호
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    • pp.77-85
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    • 2008
  • Object : These studies are designed to make a survey of the effectiveness of the non surgical oriental medicine treatment with Chuna on spinal stenosis of lumbar spine. Methods : The clinical study was done on 118 cases of patients with spinal stenosis of lumbar spine diagnosed by M.R.I, symptoms and physical test who was in the admission in Ja-Seng Oriental Medcine Hospital from October 2006 to October 2008. after treatment we checked VNRS score to estimate the efficacy of treatment. Results : 1. As a Objectivity treatment record, they test excellent 17%, good 69%, fair 8%, poor 6%. 2. The mean NRS score decreased about 3.26 after the treatment. Conclusions : Non surgical oriental medicine treatment with Chuna has on useful effect on spinal stenosis of lumbar spine.

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