• Tuberculosis and Respiratory Diseases
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• 제70권6호
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• pp.516-520
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• 2011

Bronchial carcinoid tumor accounts for less than 5% of all primary lung tumors in adults. Although surgical resection is the treatment of choice, here we report a case of bronchial carcinoid tumor treated with flexible bronchoscopic resection. A 19-year-old-man presented with a history of wheezing with dyspnea for six months. A simple chest x-ray showed no abnormal findings, but a pulmonary function test showed a moderate obstructive lung disease pattern without a bronchodilator response. A computed tomogram of the thorax revealed an enhanced $15{\times}12$ mm nodule in the left main bronchus. Bronchoscopic examination showed a polypoid mass with a stalk in the left main bronchus, which almost completely occluded the left main bronchus. Histopathology of the resected specimen revealed a bronchial carcinoid tumor. We treated the carcinoid tumor with a flexible bronchoscopic resection. During the follow up period of 6 months, the previous tumor didn't relapse. Initial bronchoscopic resection should be considered when bronchial carcinoid tumor can be approached by bronchoscopy.

• Tuberculosis and Respiratory Diseases
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• 제73권4호
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• pp.197-203
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• 2012

Recent advances in bronchoscopy have led to changes in clinical diagnostics and therapeutics in pulmonary medicine. In diagnostic bronchoscopy, there have also been new developments in endobronchial ultrasound technology which may be incorporated into clinical practice in the near future. Functional bronchoscopy, which evaluates information such as airway pressure, airflow, or gas exchange, suggests promising clinical advances in the near future. In therapeutic bronchoscopy, bronchoscopic volume reduction is a novel approach for the treatment of severe emphysema. In this review, seven recently published articles representing current advances in bronchoscopy are summarized and discussed.

• Journal of Chest Surgery
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• 제28권10호
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• pp.911-916
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• 1995

Thirteen patients with lung cancer have undergone bronchoplastic procedures from January 1991 to July 1994 in Kyung Hee univ. Hospital.Among them,twelve patients were male and one patient was female from 33 to 76 years of age.[ mean 56.6 11.5 years of age The pathologic diagnoses were squamous cell carcinoma in twelve patients and adenoid cystic carcinoma in one patient.The bronchoplastic procedures consisted of seven right upper sleeve lobectomies, one right middle sleeve lobectomy, one left lower sleeve lobectomy and four sleeve pneumonectomies. In these sleeve pneumonectomies, right sleeve pneumonectomy was done in three patients and the other was left sleeve pneumonectomy. Including the four sleeve pneumonectomies, carinoplasty was performed in seven patients. Postoperatively, we carried out bronchoscopic suction of intrabronchial secretions in necessary for the prevention of postoperative complication. All except one were discharged without any complication and have been in good condition. Postoperative mortality was in one patient who expired 25days after right middle sleeve lobectomy with respiratory failure.

• Journal of Yeungnam Medical Science
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• 제29권1호
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• pp.54-57
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• 2012

Neurilemmoma is a benign and slowly growing neurogenic tumor. Intrathoracic neurilemmoma often develops in the chest wall and posterior mediastinum, but endobronchial neurilemmoma is extremely rare. The diagnosis of endobronchial neurilemmoma with preoperative imaging findings is challenging and is usually made via postoperative pathological examination. These authors encountered a case of primary endobronchial neurilemmoma in a 52-year-old woman who had no symptoms. A $3.0{\times}2.6$ cm mass in the right lower lobe projecting into the mediobasal segmental bronchus was shown in the results of the contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) of the chest. Benign neurilemmoma was confirmed via bronchoscopic biopsy, and surgical resection (sleeve bronchial excision and end-to-end anastomosis) was performed.

• Journal of Chest Surgery
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• 제14권4호
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• pp.331-338
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• 1981

The inhalation of a foreign body into the tracheobronchial tree is a child is a life-threatening accident. Forgotten foreign bodies In the airways cause chronic pulmonary infections, allergic asthma, bronchiectatic changes, and lung abscess Foreign bodies that cannot be grasped by bronchoscopic forceps should be removed by thoracotomy and bronchotomy. This report describes our experience In 16 patients who were treated to remove inhaled foreign bodies from the airways after repeated bronchoscopies had been unsuccessful from 1963 to 1981 at the department thoracic surgery of Seoul National University Hospital. The surgical procedures are as follows: 12 patients bronchotomy, 2 patient pneumonectomy, 2 patients lobectomy. In these cases, the foreign bodies are 8 metallic material, 3 plastic material, 1 bean, 1 black snail, and 3 cases of no records. Bronchotomy must be performed as soon as possible in order to avoid more advanced pathologic changes In the Involved lung, such as bronchiectasis, fibrosis or abscess.

• 대한기관식도과학회지
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• 제4권1호
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• pp.27-34
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• 1998

Despite improvement in respiratory care, including use of low pressure and high volume cuffed tubes, tracheal stenosis remains a serious complication after a long-term tracheal intubation and tracheostomy. In such patients, tracheal resection and primary anastomosis is still considered ideal therapeutic modality. Between 1989 and 1997, we performed tracheal resections with end-to-end anastomosis on 14 patients with no operative mortality and some morbidity. Tracheal stenosis was caused by tracheostomy in nine patients, by endotracheal intubation in three patients and by thyroid carcinoma in two patients. The length of stenosis was various from 2cm to 4.5cm. All patient underwent segmental tracheal resection and primary anastomosis(14 patients) and additional procedures were cricoid cartilage reconstruction(2 patients), suprahyoid laryngeal release(3patients), carinal release technique(2 patients) and arytenoidectomy(2 patients). We have nine complications: granulona at anastomosis site in four patients, vocal cord palsy in two patients and restenosis, pneumonia, skin necrosis in each of those patients. The granuloma was removed by bronchoscopic forceps(4 patients). Vocal cord palsy was treated by arytenoidectorny(2 patients), restenosis by T-tube insertion, pneumonia by antibiotics and skin necrosis was treated by skin graft. We reviews our expenence of clinical features of tracheal stenosis and surgical treatment by tracheal one-to-end anastomosis with additional procedures to avoid postoperative complications for sucessful results.

• Journal of Chest Surgery
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• 제23권1호
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• pp.73-80
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• 1990

A total of 129 patients with a confirmed diagnosis of primary lung cancer were treated at Dep. of Thoracic k Cardiovascular Surgery, National Medical Center, Seoul, Korea, between July, 1981 and Dec., 1988. Particular emphasis was given in this review to the 72 patients that underwent surgical resection of their primary lung lesion. Factors such as histology, type of resection, sex, age, staging, and degree of dissemination were considered possible influences on survival. The age group of fifty k sixty decade occupied 55.8 %, and the youngest being 24 years and oldest 78 years. The incidence ratio of male to female was 3,2:1. The subjective symptoms of the patients were coughing [72.6%], chest pain [48.2%] and hemoptysis [35.6%], which were due to primary local influence. The confirmed diagnostic procedures were bronchoscopic biopsy, sputum cytology needle aspiration biopsy, open lung biopsy, anterior mediastinotomy & lymph node biopsy. By pathologic classifications, the squamous cell carcinoma was the most prevalent, 67 cases [51.9 %], and the adenocarcinoma in 36 cases [27.9%], undifferentiated small cell carcinoma in 13 cases [10.1 %], undifferentiated large cell carcinoma in 9 cases [6.9%], bronchioloalveolar carcinoma was 4 cases [3.1%]. The lymph node dissection with pneumonectomy [42 cases], lobectomy [14 cases] and pneumonectomy [6 cases], lobectomy [9 cases] without lymph node dissection were performed. The post operative TNM Staging[AJC] in 72 cases were Stage I in 24 cases, Stage II in 27 cases, and Stage III in 21 cases. Overall resectable was possible in 72 cases [55.8 %], and the operation mortality was 5.6 % [4 cases].

• Tuberculosis and Respiratory Diseases
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• 제48권3호
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• pp.365-376
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• 2000

연구배경 : 굴곡성 기관지경검사가 임상에 도입된 이후 호흡기계질환의 진단 및 치료에 중요한 역할을 해왔기 때문에 필요에 따라 기관지경검사를 2회 이상 시행하게 되는 경우를 드물지 않게 경험하게 된다. 본 연구에서는 여러가지 적응증을 설정하여 전향적으로, 기관지경검사를 반복적으로 시행한 후 결과를 분석하여 이 검사의 임상적 유의성에 대하여 연구하고자 하였다. 방 법 : 인하대의대 부속병원에서 1996년 7월부터 1998년 11월까지 굴곡성 기관지경검사를 진단적, 또는 치료적인 목적으로 2회 이상 시행한 156명의 환자를 대상으로 하였다. 굴곡성 기관지경검사를 반복적으로 시행하는 적응증은 1) 확진을 위해, 2) 객혈의 부위나 원인 질환을 진단하기 위한 경우, 3) 경과 관찰이나 재발 여부를 확인하기 위한 경우, 4) 치료 목적의 시술을 위한 경우 등으로 분류하였고 각각의 경우에 합당한 환자에서 전향적으로 검사를 시행하여 그 결과를 분석하였다. 결 과 : 반복적 기관지경검사는 23.0%의 비교적 높은 빈도를 보였고 악성질환이나 세포형을 확진하기 위한 검사는 25예로, 이중 2예는 세번째 기관지경검사에서, 3예는 외과적 절제술로 확진되었다. 객혈환자에서는 53.8%에서 출혈부위를 확인하였다. 소세포폐암환자중 3예에서 흉부전산화단층촬영술로도 확인되지 않았던 병변이 잔존 또는 재발한 것올 발견하였으며 병변부위가 협착된 소견을 보였던 기관지결핵 환자에서 다시 시행한 결과 66.7%에서 더 악화된 소견을 보였다. 치료목적으로 다시 시행한 굴곡성 기관지경검사는 모두 126회이었고 이중 기관지 흡인이 69.8%로 가장 많았다. 기관지경검사를 시행하였을 때의 합병증은 검사를 반복함에 따라 점차 감소하는 경향을 보였으나 유의한 차이는 없었다. 결 론 : 악성 질환을 진단하기 위한 검사에서는 21예중 85.7%의 진단율올 보였기 때문에 적절하게 선택된 경우에 유용하였으며 적극적인 검사가 필요할 것으로 생각되었다. 소세포폐암에서는 경과 관찰이나 재발 여부를 확인하는 데에 유용할 가능성을 관찰할 수 있었다. 그러나 객혈이나 기관지결핵 환자에서는 진단이나 치료, 그리고 경과와 명확한 관계가 없기 때문에 반복적인 기관지경검사의 유의성올 확인할 수 없었다.

• Journal of Chest Surgery
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• 제32권6호
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• pp.536-542
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• 1999

배경: 비소세포성 폐암의 치료방법 중에서 아직까지 장기 생존을 기대할 수 있는 가장 좋은 방법은 수술적 완전 절제술이지만, 그 때문에 불필요한 시험적 개흉술을 시행받는 환자도 해마다 상당한 수에서 보고되고 있다. 본 연구에서는 비소세포성 폐암에서 시행된 개흉술에서 수술적 절제가 불가능하였던 원인을 분석하여 불필요한 개흉술을 줄이는데 일조하고자 한다. 대상 및 방법: 1990년 1월부터 1996년 12월까지 본원에서 원발성 폐암으로 개흉술을 시행받은 616명의 환자중에서 시험적 개흉술을 시행받은 59명(9.6%)을 대상으로 하여 그 임상기록을 관찰하여 기관지 내시경 소견, 조직 진단 방법, 컴퓨터 단층 촬영 결과, 페기능 검사 및 폐관류 스캔, 절제가 불가능했던 원인, 수술후 보조요법 여부 등을 분석하였고, 수술후 생존기간을 추적하였다. 결과: 폐암종의 세포 유형은 편평세포암종 38명, 선암종 15명, 대세포암종 3명, 기타 3명이었고 원발부위는 우상엽 20명, 우중엽 6명, 우하엽 8명, 좌상엽 13명, 좌하엽 4명, 기타 8명이었다. 절제가 불가능했던 원인으로는 종격동내 인근조직이나 기관으로의 암세포 침윤이 41명으로 가장 많았으며, 흉강내 암세포 파종 8명, 광범위한 흉벽 침윤 3명, 피막을 포함한 림프절 암전이 2명, 기타 5명 등이었다. 추적관찰이 가능했던 58명에서 시험적 개흉술후 생존율은 12개월 생존율이 55.2%, 24 개월 생존율이 17.2% 이었고, 평균 생존기간은 14개월이었다. 폐암종의 세포유형이나 수술후 보조치료 요법에 따른 생존율의 차이는 없었다. 세포유형에 따른 특성은 편평세포암종의 경우 기관지 폐색과 무기폐를 잘 동반하였으며 종격동내 구조물로의 암세포 침윤이 시험적 개흉술을 시행한 주된 이유였다. 선암종에서는 흉강내 암세포 파종이 편평세포암종에서보다 의미있게 많았다. 결론: 본 연구의 자료분석을 통하여 시험적 개흉술을 시행받은 환자중 일부는 시험적 개흉술을 피하거나 수술적 절제를 할수도 있었을 것으로 생각되었다. 선암종으로 흉막 삼출액, 흉막내 암세포 파종이 의심되는 환자에서는 개흉술전 흉강경술을 도입하고, 편평세포암종의 종격동 침윤이 의심되는 환자에서는 MRI, 개흉술전 흉강경술의 도입등으로 수술전에 수술적 절제 가능성을 면밀히 판단하고 일단 개흉시에는 보다 적극적인 수술적 절제를 시행하는 것이 비소세포성 폐암의 시험적 개흉술을 줄이는데 필요할 것으로 사료되었다.