• Journal of Chest Surgery
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• 제39권3호
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• pp.214-219
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• 2006

배경: 식도천공은 비교적 흔하지 않지만, 높은 이환율과 사망률을 나타낸다. 치료와 결과는 증상의 시간에 따라 크게 결정된다. 저자들은 식도천공 환자들을 최근의 치료방법으로 치료하여 결과를 후향적으로 조사하여 보았다 대상 및 방법: 1990년 3월부터 2005년 3월까지 식도 파열로 치료한 환자들을 후향적 분석하였다. 28명 환자들에서(남자 22명, 여자 6명: 평균나이 51세, 최소 17세에서 최고 82세)천공의 원인을 보면 이물질 9명, 외상 7명, 자연적 파열 7명, 의인성 5명이었다. 환자중 18명은 24시간 내 진단되었으며, 10명은 24시간 이후에 진단되었다. 21명($75\%$)에서 일차 봉합술을 시행하였으며, 4명에서는 식도 절제술, 3명의 환자에서는 위루술과 배농술를 시행하였다. 결과: 병원 사망률은 $18\%$이며, 그리고 의인성에서 사망률이 증가하였다(p <0.05). 천공위치, 천공 후 시간, 치료방법은 사망률에 영향을 미치지 못했다. 수술 후 누출은 4명의 환자에서 생겼으며, 보존적인 치료로 회복이 되었다. 결론: 식도 파열은 진단과 치료가 어렵기 때문에 아직도 위험한 질환이다. 대부분의 환자에서 증상의 발현시간에 관계없이 일차 재건술이 사망률을 낮출 수 있다. 정확한 진단과 조기 치료가 식도파열 환자들의 성공적인 치료에 필수적이다.

• Journal of Chest Surgery
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• 제23권5호
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• pp.1035-1039
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• 1990

All 10 cases of spontaneous rupture of esophagus had violent vomiting as precursor. 9 patients were male, 1 case was female. Chief complaints were chest pain and dyspnea. Chest P \ulcornerA and esophagogram were mainly used as confirm diagnostic tool. Perforation sites of all cases were at distal esophagus near the G-E junction. 6 cases were received primary repair within 24 hrs, other cases were managed with surgical drainage after exclusion and diversion of esophagus. Empyema was the most frequent complication. Other complications were sepsis, pneumonia, leaking etc. Overall mortality rate was about 70.0%.

• Journal of Chest Surgery
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• 제31권1호
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• pp.46-51
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• 1998

식도 천공후 수술시까지 24시간이상이 경과된 환자의 치료법은 아직도 논란이 많다. 1990년이후 연세 대학교 흉부외과학 교실에서는 식도 천공후 24시간이상 경과된 환자 10예중 전예를 일차 봉합술로 치료 하였다. 그중 4명은 인위적인 천공 이었고, 3명은 자연성 천공, 2명은 이물의 연하, 나머지 한명은 외상이 원인 이었다. 식도 천공후 수술시까지 소요된 시간은 평균 116시간 이었고 중앙값은 48시간 이었다. 봉합방법은 천공된 점막부위의 위 아래로 정상 점막이 나올때까지 식도근 절개술을 시행한 후 염증이 있는 점막부위를 변연 절제한다. 식도의 원위부 폐쇄가 있을 경우 수술대에서 식도 확장술을 시행하고 점막과 근육층을 단층 혹은 층층 봉합한다. 봉합부위 위에 늑막이나 심낭 지방을 이용하여 봉합을 강화하였다. 수술 사망은 1예에서 수술후 33일째 발생 하였는데 사망원인은 위괘양의 합병증으로 위출혈이었다. 술후 5명의 환자에서 봉합부위의 유출이 있었지만 사망한 1예를 제외하고 모두 고식적 치료로 완치할 수 있었다. 식도 천공 환자에서 치료법은 여러 가지 방법이 있겠으나 비록 수술시까지 시간이 많이 지났다하더라도 천공의 원인이 양성이고 원위부 폐쇄가 교정될 수 있다면 일차 봉합과 적절한 배농이 우선 되어야 할 것이다.

• Clinical Endoscopy
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• 제56권6호
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• pp.754-760
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• 2023

Background/Aims: Endoscopic vacuum therapy (EVT) can heal a variety of defects within the gastrointestinal (GI) tract via applying negative pressure, which reduces the defect size, aspirates the infected fluid, and promotes granulation tissue. Here we present our experience with EVT as it relates to both spontaneous and iatrogenic upper GI tract perforations, leaks, and fistulas. Methods: This retrospective study was conducted at four large hospital centers. All patients who underwent EVT between June 2018 and March 2021 were included. Data on multiple variables were collected, including demographics, defect size and location, number and intervals of EVT exchanges, technical success, and hospital length of stay. Student t-test and the chi-squared test were used to analyze the data. Results: Twenty patients underwent EVT. The most common defect cause was spontaneous esophageal perforation (50%). The most common defect location was the distal esophagus (55%). The success rate was 80%. Seven patients were treated with EVT as the primary closure method. The mean number of exchanges was five with a mean interval of 4.3 days between exchanges. The mean length of hospital stay was 55.8 days. Conclusions: EVT is a safe and effective initial management option for esophageal leaks and perforations.

• 대한유전성대사질환학회지
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• 제14권2호
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• pp.168-173
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• 2014

혈관형 엘러스-단로스 증후군은 상염색체 우성 유전질환으로 COL3A1 유전자의 돌연변이로 인해 제 3형 콜라겐 합성이 결핍되면서 피부, 관절, 혈관, 폐, 내장 등에서 증상이 나타나는데 생명에 위협이 되는 합병증인 동맥 파열이나 장 천공과 같이 발생한 뒤에 진단이 늦게 내려지는 경우가 많다. 본 증례는 11세에 장천공 및 복막염의 수술력이 있는 16세 남아가 각각 운동과 경미한 손상 이후 발생한 두 차례의 근혈종으로 내원하여 시행한 COL3A1 유전자 검사에서 새로운 돌연변이 c.2931+2dupT가 발견되어 보고하는 바이다.

• Journal of Chest Surgery
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• 제9권2호
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• pp.298-310
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• 1976

A clinical analysis was performed on 118 cases of the benign esophageal diseases experienced at Department of Thoracic Surgery, Seoul National University Hospital during 20 year period from 1957 to 1976. Of 118 cases of the benign esophageal diseases, there were 84 patients of esophagenal stenosis, 14 of esophageal perforation, 8 of esophageal atresia, 7 of achalasia, 2 of hiatal hernia, 2 of esophageal foreign body and one of esophageal diverticulum. Fifty-one patients were male and sixty-seven were female, and ages ranged from one day to sixty-four years with peak incidence in the age group of 20 to 29 years. All but one of the esophageal stenosis were caused by corrosive esophagitis and ages ranged from three to sixty-four years with peak incidence in third decade. Main symptoms of the esophageal stenosis were dysphagia, weight loss and chest pain in order and mostly began between one month and one year after ingestion of corrosive agents. Corrosive esophageal stenosis developed most frequently in middle one-third of the esophagus and about one-forth of them were diffuse. Operations were performed on 72 patients of esophageal stenosis of whom 26 patients had esophagocologastrostomy, 21 gastrostomy, 20 esophagogastrostomy, 4 esophagojejunogastrostomy and 2 pharyngogastrostomy. There were 5 deaths in the postoperative period, an operative mortality of 6.9 percent, and 20 patients had one or two complications; eight were anastomotic leaks, 6 gangrenes of replaced loop, 4 wound abscesses and others. The causes of the esophageal perforation were traumatic in 7 cases, caustics in 4 and spontaneous in 3, and the most frequent site of the perforation was lower one-third of the esophagus. Frequent symptoms of the esophageal perforation were pain, fever, dysphagia and dyspnea, and preoperatively there were mediastinitis in 8 cases, empyema in 7, lung abscess in 3 and others. All 14 patients of the esophageal perforation underwent operation: primary closure in 7 cases, drainage in 4, esophagogastrostomy in 2 and 'esophageal diversion in one. There were 4 postoperative deaths and 11 postoperative complications occurred in 7 patients. The duration of symptoms in achalasia was between 3 months and 25 years, with an average duration of 6. 2 years. Frequent symptoms of the achlasia esophagi were dysphagia, regurgitation, pain and weight loss in order. All 7 patients of achlasia underwent modified Heller's operation where 2 patients had complications, restenosis in one and esophageal perforation in another. All 8 patients of congenital esophageal atresia had distal tracheoesophageal fistula and were admitted within 5 days of life, but there were pneumonic consolidation on chest X-ray in patients. Five patients underwent one staged operation with the result of 2 deaths and one anastomotic leak.

• Journal of Chest Surgery
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• 제41권3호
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• pp.347-353
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• 2008

배경: 식도천공은 빠른 진단과 효과적인 치료를 요하는 응급상황이다. 잘못된 진단과 치료의 지연은 이환율과 사망률을 증가시킨다. 대상 및 방법: 1990년 1월부터 2006년 12월까지 본 의료원 병원들에서 수술한 식도천공 환자는 37명을 대상으로 환자의 생존에 영향을 미치는 인자를 알아보기 위해 식도천공의 수술적 치료결과를 후향적으로 조사하였다. 결과: 환자의 연령분포는 21세에서 87세까지 이었고 평균 연령은 $52.7{\pm}16.98$세이었다. 남자가 31명, 여자가 6명이었다. 자연성 천공인 경우가 23 예(62%)이었고 외상성 경우가 10예(27%), 의인성인 경우가 4예(11%)이었다. 식도천공의 위치는 경부가 5예, 흉부가 31예, 복부가 1예 이었다. 식도 일차봉합술은 29예의 환자에게 시행하였고 5예의 환자에서는 T-tube 배액술을 시행하였다. 배제술과 전환술은 2예, 식도제거술은 1예에서 시행하였다. 6명의 환자가 사망하였고(16.22%) 15명의 환자에서(40.5%) 25예의 술 후 합병증이 있었다. 천공 후 치료까지의 시간이 24시간 이상인 군이 사망률과 이환율이 유의하게 높았다(p<0.05). 결론: 식도천공의 가장 중요한 위험인자는 천공에서 치료시작까지의 소요시간이었다. 사망률과 이환율을 낮추기 위해 신속한 진단과 효과적인 치료가 필요하다.

• Journal of Chest Surgery
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• 제49권6호
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• pp.478-480
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• 2016

Spontaneous perforation of the esophagus after forceful vomiting is known as Boerhaave syndrome, a rare and life-threatening condition associated with a high rate of mortality. The management of Boerhaave syndrome is challenging, especially when diagnosed late. Herein, we report the successful management of late-diagnosed Boerhaave syndrome with T-tube drainage in a 55-year-old man. The patient was transferred to our institution 8 days after the onset of symptoms, successfully managed by placing a T-tube, and was discharged on postoperative day 46 without complications.

• Journal of Chest Surgery
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• 제33권1호
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• pp.79-84
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• 2000

Background: Esophageal perforation is an extremely lethal injury that requires careful management for survival,. Material and Method: We performed a retrospective clinical revi-ew of 14 patients treated for esophageal perforation at the Department of Thoracic and Cardiovascular Surgery hanyang University Hospital between July 1986 and August 1998. Cardiovascular Surgery Hanyang University Hospital between July 1986 and August 1998. Result: The ration between male and female patients was 12:2 and their ages ranged from 9 to 68 years( average: 446 years). Iatrogenic perforations were found in 6 patients(42.9%) spontaneous perforations in 3 patients(21.4%) traumatic perforations in 2 patients(14.3%) and caustic perforations foreign body origin and esophagel cancer in 1 patient (7.1%) each. Four of the patients(28.6%) had esophageal ruptures located cancer in 1 patient (7.1%) each. Four of the patients (28.6%) had esophageal ruptures located in the cervical esophagus and 10 patients (71.4%) in the thoracic esophagus, The most frequent location was in the mid third portion of the esophagus (35.7%) there were also 2 patients(14.3%) in the upper third portion and 3 patients(21.4%) in the lower third portion. Complications encountered included mediastinitis empyema or pleural effusion mediastinal or lung abscess sepsis and aspiration pneumonia. The most frequent complication that occurred was mediastinitis in 9 cases (57%) Three patients underwent conservative treatment. Among the patients who underwent surgical treatment 5 patients underwent primary closure 6 patients underwent open drainage and 2 patients underwent reconstrumction (1 patients had an initial primary closure and 1 patient had an initial open drainage procedure). The mortality rates for those with conservative and surgical treatment were 66.7% (2cases) and 9.1% (1 cases) respec- tively. Conclusion: Perforation of the esophagus although very rare has a high mortality rate and thus aggressive operative therapy is necessary.

• 한국군사과학기술학회지
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• 제6권2호
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• pp.9-19
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• 2003

Nitrogen oxide gases which were produced by spontaneous reaction of nitrocellulose(NC) in the single base propellant accelerate the decomposition of propellant, and result in the reduction of shelf life. The amount of nitrogen oxide was reduced by the addition of 0.3wt% $CaCO_3$ to conventional stabilizer(DPA) and down of the solvent leaching temperature from $64^{\circ}C$ to $56^{\circ}C$, which extended the shelf life of the single base propellant as much as twice compare with commercial propellant. The perforation diameter increase of propellant from 0.64mm to 0.77mm could compensate for the drop of burning rate which was caused the addition of $CaCO_3$.