• Journal of Chest Surgery
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• 제29권9호
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• pp.1003-1009
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• 1996

식도위장문합술에서 주로 사용되는 원형기계를 사용하는 문합술은 편리하며 누공발생률이 적은 술기이나 문합부의 협착이 잘 생기며 이는 문합기가 작은 경우에 발생빈도가 높다. 경부에서 식도위장문합시 기계문합식으로 편리하게 수술하면서 협착을 방지하는 수술수기로흉강경용 봉합기를 사용하는 방법을 고폰하여서 임상적용한 결과를 보고한다. 식도암 환자 13례에서 식도재건술에 흉강경용 봉합기를 사용하여 경부식도위장 문합을 하였고 수술후 평균 8개월 관찰하여 문합부의 헙착발생을 관찰하였다. 식도암환자 13례중 수술후 사망한 1례를 제외한 12례중 1례에서 술후 위장궤사에 의한 누공이 있었고, 11례에서는 협착증상 없었다. 경부식도위장 문합술에서 흉강경용 봉합기를 사용한 결과 수술이 편리하고 협착 및 누공의 발생률은 매우 낮다. 흉강경용 봉합기 문합술식은수술이 간편하고,작은 내경의 식도와위장문합에서 생기는문합부의 협착을 방지할 수 있는 수술로 경부의식도장관문합의 변형술식으로 적용할 수 있다.

• Journal of Gastric Cancer
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• 제14권4호
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• pp.229-237
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• 2014

Purpose: Laparoscopic distal gastrectomy (LDG) is a well-established procedure for the treatment of early gastric cancer. Several reconstruction methods can be adopted after LDG according to tumor characteristics and surgeon preference. This study aimed to compare the remnant gastric functions after different reconstructions. Materials and Methods: In total, 221 patients who underwent LDG between March 2005 and October 2013 were reviewed retrospectively. The patients were classified into four groups based on the reconstructive procedure: Billroth I (BI) anastomosis, Billroth II (BII) with Braun anastomosis, Roux-en-Y (RY) reconstruction, or uncut RY reconstruction. Patient demographics, surgical outcomes, and postoperative endoscopic findings were reviewed and compared among groups. Results: Endoscopic evaluations at $11.8{\pm}3.8$ months postoperatively showed less frequent gastritis and bile reflux in the remnant stomach in the RY group compared to the BI and BII groups. There was no significant difference in the gastric residue among the BI, BII, and RY groups. The incidence of gastritis and bile reflux in the uncut RY group was similar to that in the RY group, while residual gastric content in the uncut RY group was significantly smaller and less frequently observed than that in the RY group (5.8% versus 35.3%, P=0.010). Conclusions: RY and uncut RY reconstructions are equally superior to BI and BII with Braun anastomoses in terms of gastritis and bile reflux in the remnant stomach. Furthermore, uncut RY reconstruction showed improved stasis compared to conventional RY gastrojejunostomy. Uncut RY reconstruction can be a favorable reconstructive procedure after LDG.

• Archives of Plastic Surgery
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• 제39권5호
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• pp.546-550
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• 2012

Background This study was designed to introduce the feasibility of toe tissue transfer without venous outflow for fingertip reconstruction. Methods Five cases of fingertip defects were treated successfully with this method. Four cases were traumatic fingertip defects, and one case was a hook-nail deformity. The lateral pulp of a great toe or medioinferior portion of a second toe was used as the donor site. An arterial pedicle was dissected only within the digit and anastomosis was performed within 2 cm around the defect margin. The digital nerve was repaired simultaneously. No additional dissection of the dorsal or volar pulp vein was performed in either the donor or recipient sites. Other surgical procedures were performed following conventional techniques. Postoperative venous congestion was monitored with pulp temperature, color, and degree of tissue oxygen saturation. Venous congestion was decompressed with a needle-puncture method intermittently, but did not require continuous external bleeding for salvage. Results Venous congestion was observed in all the flaps, but improved within 3 or 4 days postoperatively. The flap size was from $1.5{\times}1.5cm^2$ to $2.0{\times}3.0cm^2$. The mean surgical time was 2 hours and 20 minutes. A needle puncture was carried out every 2 hours during the first postoperative day, and then every 4 hours thereafter. The amount of blood loss during each puncture procedure was less than 0.2 mL. In the long-term follow-up, no flap atrophy was observed. Conclusions When used properly, the free toe tissue transfer without venous anastomosis method can be a treatment option for small defects on the fingertip area.

• Journal of Chest Surgery
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• 제33권7호
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• pp.565-569
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• 2000

배경; 기관 협착의 가장 흔한 원인은 기관 삽관에 따른 합병증이다. 기관 협착에 대한 치료 방침은 병변의 범위에 따라 달라진다. 전막부분의 국소적인 병변의 경우에는 레이저 절제요법을 적용할 수 있지만, 기관의 전층에 병변이 있는 경우는 기관 절제 후 단단 문합 수술을 시행하여야 좋은 치료 결과를 얻을 수 있다. 대상 및 방법; 경상대학교병원 흉부외과에서는 1998년 4월부터 1999년 5월까지 기관 삽관의 합병증으로 발생한 기관협착증 환자 12명에게 기관협착부위를 절제하고 단단 문합 수술을 시행하였다. 결과; 수술 후 사망자는 없었고, 조기 합병증으로 일시적인 성대마비가 5명, 창상 감염이 1명에서 발생하였다. 수술 후 평균 18개월간 추적하는 동안 재협착은 발견되지 않았다. 결론; 기관 삽관 후 발생한 기관협착증에 대한 외과적 치료로서 절제 및 단단 문합술은 비교적 우수한 치료버빙라 할 수 있다.

• Journal of Gastric Cancer
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• 제11권4호
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• pp.219-224
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• 2011

Purpose: The Roux en Y method has rarely been performed due to longer operation time and high risk of complication, despite several merits including prevention of bile reflux. We conducted a retrospective review of the result of Roux en Y reconstruction using two circular staplers after subtotal gastrectomy. Materials and Methods: From December 2008 to May 2009, a total of 26 patients underwent Roux en Y reconstruction using two circular staplers after subtotal gastrectomy, and seventy-two patients underwent Billroth-I reconstruction. Roux en Y anastomosis was performed using two circular staplers without hand sewing anastomosis. We compared clinicopathologic features and surgical outcomes between the two groups. All patients underwent gastrofiberscopy between six and twelve months after surgery to compare the bile reflux. Results: No significant differences in clinicopathologic findings were observed between the two groups, except for the rate of minimal invasive surgery (P=0.004) and cancer stage (P=0.002). No differences in the rate of morbidity (P=0.353) and admission duration (P=0.391) were observed between the two groups. Gastrofiberscopic findings showed a significant reduction of bile reflux in the remnant stomach in the Roux en Y group (P=0.019). Conclusions: When compared with Billroth-I reconstruction, Roux en Y reconstruction using the double stapler technique was found to reduce bile reflux in the remnant stomach without increasing postoperative morbidity. Based on these results, we planned to begin a randomized controlled clinical trial for comparison of Roux en Y reconstruction using this method with Billroth-I anastomosis.

• 대한기관식도과학회지
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• 제6권1호
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• pp.62-71
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• 2000

Background: For the purpose of reducing operating time and rate of anastomotic leakage, we have performed esophagovisceral anastomosis with an EEA stapler using the largest size possible. If any difficulty in the approach of the EEA stapler was encountered one-layer interrupted hand-sewn anastomosis. Because the rate of postoperative benign anastomotic stricture was higher than expected, a retrospective study was done on all patients who underwent esophageal reconstruction. Material and Method: Over a period of 3 years from January 1996 to December 1998, we performed esophageal reconstructions on 30 patients. Patients were divided into two groups ; EEA stapler group(Group Ⅰ) comprised of 21 patients and hand-sewn group(Group Ⅱ) comprised of 9 patients.Result:The hospital mortality was 6.67 %(2/30) and the anastomotic leakage rate was 3.33 %(1/30). Among the discharged patients, the rate of recurrent anastomotic tumor was 3.57 %(1/28) and the rate of benign anastomotic stricture stricture rate was 35 %(7/20) in Group Ⅰ and 12.5 %(1/8) in Group Ⅱ, which was not significant. Conclusion: Although nontumor benign stricture was significantly higher in Group Ⅱ than in Group Ⅰ(p=0.0492), the incidence of anastomotic complications did not differ between the two groups. The one-layer interrupted hand-sewn esophagovisceral anastomosis by maintaining a wide lumen and close approximation of mucosa to mucosal layers with evenly spaced sutures could be one of the preferred surgical method to reduce benign anastomotic strictures.

• Journal of Chest Surgery
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• 제30권11호
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• pp.1069-1076
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• 1997

1992년 5월부터 1996년 6월까지 외과적으로 치료한 31례의 대동맥축착증의 중단기 성적을 검토하였다. 모두 31명의 환아중 19명(61.3%)이 신생아였으며 26명(83.9%)이 생후 3개월이내의 유아였다. 동반기형에 따라 세군으로 나누었는데 중요한 기형이 동반되지 않은 군(group I)이 9명, 심실중격결손을 동반한 군(group II)이 15명, 복잡심기형이 동반된 군(group III)이 7명이었다. 35.5%(11명)의 환아에서 대동맥궁의 형성부전이 동반 되었다. 수술방법으로는 17명의 환아에서 확장단단문합술, 7명에서 단단문합술과 쇄골하동맥편성형술을 함 께 시행(combined resection and flap pmcedure)하였고, 나머지 7례에서는 쇄골하동맥편성형술을 시행하였다. 술후 잔존협착은 술후 쟌존협착을 측정하였던 28례중 7례(25%)에서 발생하였고 쇄골하동맥편성형술후 6례중 2례(33.3%), 단단문합술과 쇄골하동맥편성형술을 함께 시행한후 7례중 없었으며, 확장단단문합술을 시행한 15례의 환아중 5례(33.3%)에서 발생하였다. 생존환아에서 평균 20.5개월의 추적기간후 술후 대동맥축착은 모 두 3례로 12%(3/25)였다. 이를 수술방법에 따른 빈도를 보면 쇄골하동맥편성형술후 6 恪\ulcorner2례(33.3%), 단단문 합술과 쇄골하동맥편성형술을 함께 시행한 7례중 없었으며, 확장단단문합술을 시행한 12례의 환아중 1례 (8.3%)에서 발생하였다. 대동맥축착증의 수술과 관련된 사망은 3례(9.7%)로 모두 복잡심기형을 동반한 군에서 발생하였다. 결론적으로 복잡기형을 동반하지 않은 경우(1, ll군)는 대동맥축착증의 수술과 관련된 수술사 망은 없었으며 복잡기형을 동반한 대동맥축착증의 수술은 높은 사망률을 보였다. 또한 대동맥궁형성부전증 이 있었던 경우에서 없었던 경우보다 더 높은 술후 잔존정착의 빈도를 보여 이의 적절한 치료가 요구되었다.

• Journal of Chest Surgery
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• 제28권11호
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• pp.1025-1031
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• 1995

Thirty patients who underwent esophageal resections due to esophageal carcinoma and benign strictures, and esophagovisceral anastomoses were performed by hand suture in 11 patients[Group I and by using the end to end anastomosis[EEA stapler in 19 patients[Group II . Anastomoses were performed in the thoracic cavity in 24 patients[Right 19, Left 5 and in the cervical area in 6 patients. There was one operative mortality[3.3% in a cancer patient who underwent Ivor-Lewis operation using EEA stapler. She expired on POD 38 days due to renal failure and sepsis. There were two anastomotic leakage in the sutured group and no anastomotic leakage in the stapled group. Late anastomotic strictures occurred in 10 patients[52.6% in the stapled group compared to 2 patients[18.1% in the sutured group. Most of the patients with late anastomotic strictures responded to one or two trials of TTS dilations. Using EEA stapler in performing esophagovisceral anastomosis is a safe method with acceptable range of complication rate, and total admission period after the operation for group I was 30.3 days compared to 25.4 days in group II although it had no clinical significance. The follow up was possible in 23 patients; 5 patients in group I died within mean 12.6 months and 9 patients in group II within mean 14.2 months.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1299-1304
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• 1992

We experienced 5 cases of tracheal stenosis and 7 cases bronchial stenosis treated surgically at the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Hanyang University during 5 years. The causes of tracheal stenosis were prolonged endotracheal intubation 1 case, tracheostomy 1 case, the sequela of endobronchial tuberculosis 2 cases and tracheomalacia 1 case. The causes of bronchial stenosis were all endobronchial tuberculosis. The managements of tracheal stenosis were tracheal resection and end to end anastomosis. The resected lengths of trachea were 1.5cm, 3cm and 7.5cm. One case of suglottic stenosis was underwent the resection of trachea, 8cm in length, and the laryngotracheal anastomosis was done, but the re-stenosis of trachea was developed after 4 weeks post-operatively. One case of tracheomalacia was done permanent tracheostomy only, because the entire trachea was adhered to the surrounding tissue. The managements of bronchial stenosis were resection of involved lobe or one lung, in the 5 case. One case with Lt. main bronchial stenosis and atelectasis of Lt. upper lobe was done the lobectomy of Lt. upper lobe only and then, the Lt. pneumonectomy was done re-operatively because the atelectasis of Lt. lower lobe had continued. The other one case with stenosis of Rt. main bronchus, failed the insertion of metalic stent, was underwent the Rt. upper lobe lobectomy, sleeve resection and side to end anastomosis

• Journal of Chest Surgery
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• 제34권9호
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• pp.692-697
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• 2001

배경: 좌주관상동맥 협착 치료로서 혈관 성형술이 제한된 환자에게 우수한 치료로 국내외 제시되어 있으며, 저자들은 96년 단기성적을 보고한 이래 계속적인 혈관 성형술을 시행해 왔으며, 이를 정리하고 중장기 성적으로 보고하고자 한다. 대상 및 방법: 한림대학교 강동성심병원 흉부외과에서는 1994년 7월부터 2000년 10월까지 22례의 좌주관상동맥 협착환자에서 좌주관상동맥 성형술을 시행하였다. 남자가 11명, 여자가 11명이었으며 연령은 평균 54.1$\pm$12.3(35-72세)세였다. 14례에서 좌주관상동맥 성형술을 단독 시행하였고, 5례에서 관상동맥 우회술을 병행하였으며, 1례에서 좌우관상동맥 개구부의 성형술과 대동맥판막치환술을 동시에 시행하였다. 또한 승모판치환술과 부분방실중격결손증 수술을 동반한 예가 각각 1례씩 있었다. 21례에서 전방접근법을 사용하였으며, 1례에서 대동맥 판막치환술을 시행하면서 상방접근법을 사용하였다. 전방접근법을 사용한 21례중 9례에서 시야확보를 위해 폐동맥을 절단하였다. 첨포로써 자가심낭은 6례에서 소심낭은 16례에서 사용하였다. 결과: 수술사망은 없었고, 퇴원전 시행한 관상동맥 조영술상 3례에서 30~50%의 접합부 협착이 관찰되었다. 5개월에서 15개월 사이에 시행한 5례의 관상동맥 조영술상 2례에서 40~60%의 접합부 협착이 관찰되었다. 추적기간 48.2$\pm$22.5개월(7~76개월)동안 원인불명으로 42개월째 1명이 사망하였고 나머지 21례에선 흉통의 재발을 보이지 않았다. 결론: 중장기적으로 관상동맥 조영술의 추적관찰이 미흡했으나 임상적 추적 관찰중 비교적 훌륭한 결과를 얻었기에 보고하는 바이며, 앞으로 장기성적에 대한 추적 관찰이 필요할 것으로 생각된다.