• Journal of Chest Surgery
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• 제28권8호
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• pp.772-777
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• 1995

Bronchoplastic procedure has been considered as an appropriate surgery for traumatic bronchial disruption and occasionaly for primary bronchial tumors or tuberculosis because it can bring preservation of pulmonary tissue for patients without compromising the chance for cure. Nowadays bronchoplastic procedure is also applicable for the selected cases of bronchogenic carcinomas with favorable long term survival, when compared to standard pneumonectomy.Eighteen bronchoplastic procedures were performed with or without pulmonary resection at Department of Thoracic and Cardiovascular Surgery, Catholic University Medical College, between 1990 and 1994. The patients were 11 men and 7 wemen with average age of 57 years [range, 19 to 71 years . Tumor comprised 56% of the lesions, including 6 squamous cell carcinoma [33% , 2 bronchial adenoma [11% , 1 leiomyoma and 1 metastatic osteogenic sarcoma. Cicatrical stenosis secondary to endobronchial tuberculosis and traumatic disruption occurred in 6 [33% and 1 patient respectively.Applied bronchoplastic procedures were as follows ; sleeve lobectomy, 8 cases [right upper : 6, left upper : 1, right middle : 1 : bronchial segmental resection without pulmonary resection, 2 cases : sleeve bi-lobectomy, 1 cases :patch dilating bronchoplasty with or without concomitant lobectomy in 7. There was no perioperative mortality. Morbidity in 4 patients included 1 transient recurrent laryngeal nerve palsy, 1 unstability of bronchial patch resulting atelectasis of afftected lung and 2 bronchial stenosis of anastomotic site.Throughout our experiences, we feel strongly that bronchoplastic procedure is a safe and effective surgical method preserving normal pulmonary tissue below affected bronchus for the wide range of various bronchial lesion including selected cases of bronchogenic carcinoma with acceptable complication and mortality.

• Tuberculosis and Respiratory Diseases
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• 제45권2호
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• pp.416-420
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• 1998

저자들은 기관지결핵의 후유증으로 좌주기관지 협착이 있었던 환자가 이상성 기류유량곡선을 보인 후 금속스텐트 삽입후 교정되었다가 스텐트 삽입 2개월 후부터 육아종형성에 따른 좌주기관지의 재협착이 나타나 다시 기류유량곡선상 이상성 기류유량곡선을 보인 증례를 경험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제34권8호
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• pp.640-643
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• 2001

26세 여자 환자로 좌측 주기관지 협착과 좌하엽 무기폐를 동반한 기관지결핵 1례를 보고한다. 환자는 9개월간 항결핵제치료를 받았으나 흉통과 기침을 호소하고 있었고, 기관지조영술상 좌상엽 기관지는 개방성을 보이며 좌하엽 기관지는 협착이 있으면서 기관지확장증 소견을 보여 좌하엽 절제술 및 기관지성형술을 시행받았다. 수술 후 폐기능의 의미있는 증가를 보였다. 기관지결핵의 수술적 치료는 논란이 있지만 기관지성형술은 폐기능을 보존해서 환자의 증상을 경감시킬 수 있으므로 결핵성 기관지협착의 효과적인 치료가 될 수 있다.

• Tuberculosis and Respiratory Diseases
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• 제39권4호
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• pp.318-324
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• 1992

기관지내 팽창성 금속 스텐트의 사용은, 아직은 외국의 경우에서도, 추적 관찰기간이 짧고 시술받은 환자의 수도 많지 않으며 장기간 삽입후의 변화에 대하여는 그 결과가 예측하기 힘들다는 점등을 생각할 때는 현재 이의 시행은 아직은 실험적 단계라 할 수 있다. 그러나 내과적 혹은 외과적인 문제로 수술적 기관지 보존술등을 시행받기 어려운 상태에 있는 기관지 협착환자에서는 단독으로, 혹은 laser therapy, electrocoagulation, cryotherapy, balloon dilatation 및 다른 tracheal devices (예(例): Montgomery T-tube)등 의 치료방법들과 같이 병행하여, 팽창성 금속 스텐트의 삽입은 기관기관지 협착증의 치료에 도움이 되리라 생각된다. 또 국내에서는 아직도 유병율이 높은 폐결핵환자에서 충분한 기간동안 약물치료후에도 일부 환자에서는 기관지 결핵에 의하여 기관지 협착이 발생하는데 이때 수술적 치료외에는 적절한 치료방법이 없는 실정이다. 이러한 환자에서 만약 협착부위가 한쪽 주 기관지에 부분적으로 국한 되어 있으며 그 이하의 폐실질파괴가 심하지 않다면 스텐트 삽입은 수술적 치료이전에 시도하여 볼 수 있으리라 사료된다.

• Journal of Chest Surgery
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• 제20권1호
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• pp.177-181
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• 1987

For the treatment of bronchial stenosis due to trauma, inflammatory and neoplastic lesion, bronchoplastic procedure in the interest of preservation of lung tissue are relatively new developments in the field of thoracic surgery. We reported on case of bronchoplasty using to pericardial patch for the treatment of bronchial stenosis due to chronic inflammation. The patient was 26 years old female and chief complaint was respiratory difficulty. Bronchogram revealed diffuse stenosis of left main bronchus about 4cm and especially, at just below the carina marked narrowing of lumen and fine serration in the wall. At the time of operation, longitudinal incision was made at left main bronchus about 5cm and reconstructed bronchus using to pericadial patch at membranous compartment of bronchus. The postoperative course was uneventful and post-operative follow up bronchography showed that improvement of bronchoplastic segmented region.

• Korean Journal of Radiology
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• 제24권5호
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• pp.424-433
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• 2023

Objective: To assess the safety and efficacy of balloon dilatation under dual guidance using fluoroscopy and bronchoscopy for treating bronchial stenosis following lung transplantation (LT), and to elucidate the factors associated with patency after the procedure. Materials and Methods: From September, 2012, to April, 2021, 50 patients (mean age ± standard deviation, 54.4 ± 12.2 years) with bronchial stenosis among 361 recipients of LT were retrospectively analyzed. The safety of balloon dilatation was assessed by evaluating procedure-related complications. Efficacy was assessed by evaluating the technical success, primary patency, and secondary patency. Primary and secondary cumulative patency rates were calculated using the Kaplan-Meier method. The factors associated with patency after the procedure were evaluated using multivariable Cox hazard proportional regression analysis. Results: In total, 65 bronchi were treated with balloon dilatation in 50 patients. The total number of treatment sessions was 277 and the technical success rate was 99.3% (275/277 sessions). No major procedure-related complications were noted. During the mean follow-up period of 34.6 ± 30.8 months, primary patency was achieved in 12 of 65 bronchi (18.5%). However, the patency rate improved to 76.9% (50 of 65 bronchi) after repeated balloon dilatation (secondary patency). The 6-month, 1-year, 3-year, and 5-year secondary patency rates were 95.4%, 90.8%, 83.1%, and 78.5%, respectively. The presence of clinical symptoms was a significant prognostic factor associated with reduced primary patency (adjusted hazard ratio [HR], 0.465; 95% confidence interval [CI], 0.220-0.987). Early-stage treatment ≤ 6 months (adjusted HR, 3.588; 95% CI, 1.093-11.780) and prolonged balloon dilatation > 5 min (adjusted HR, 3.285; 95% CI, 1.018-10.598) were associated with significantly higher secondary patency. Conclusion: Repeated balloon dilatation was determined to be safe and effective for treating bronchial stenosis following LT. Early-stage treatment and prolonged balloon dilatation could significantly promote long-term patency.

• Tuberculosis and Respiratory Diseases
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• 제59권4호
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• pp.368-373
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• 2005

연구배경 : 기관지 탄분 섬유화증은 주로 만성기관지염, 만성폐쇄성폐질환, 또는 천식 등과 같은 만성 기도 질환의 형태로 발현되며, 질환의 경과 중에 폐렴, 폐결핵과 같은 실질성 병변들이 동반될 수 있다. 저자들은 기관지 탄분 섬유화증에서 환기장애의 병형별 빈도 및 동반된 기관지 협착에 따른 기도의 환기기능 및 역학을 알아보고자 하였다. 방 법 : 기관지내시경검사 상 기관지 탄분 섬유화증으로 진단받은 환자 가운데 폐기능 검사를 실시한 113례의 환자를 대상으로 폐기능 검사에서 구한 여러 계측치들과 협착을 보인 기관지의 수와의 상관관계를 구하였다. 결 과 : 폐쇄성 환기장애가 56례(49.6%), 제한성 환기장애가 8례(7.1%), 혼합성 환기장애가 2례(1.8%), 그리고 정상환기가 47례(41.6%)였다. 노력성 호기곡선에서 구한 계측치 가운데 $FEV_1/FVC$ 및 $FEF_{25{\sim}75%}$은 상관계수가 각각 -0.208, -0.310으로 협착을 보인 기관지의 수에 따라 유의하게 감소하였다(p<0.05, p<0.005). 기류-용량 곡선에서 구한 PEF, $FEF_{25%}$, $FEF_{50%}$ 및 FEF75%는 모두 낮게 관찰되었으며, 상관계수가 각각 -0.309, -0.303, -0.416, 그리고 -0.318로 협착을 보인 기관지의 수에 따라 유의하게 감소하였다(p<0.05). Raw도 0.477로 협착을 보인 기관지의 수에 따라 유의하게 증가하였다(p<0.001). 결 론 : 기관지 탄분 섬유화증은 협착을 보인 기관지의 수가 많을수록 세소기도 병변과 함께 주로 폐쇄성 환기장애를 나타내는 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제38권4호
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• pp.347-356
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• 1991

Endobronchial tuberculosis is a serious disase because it frequently leaves airway obstruction as the complication, and the treatment of airway obstruction is generally troublesome. In the tumorous type of endobonchial tuberculosis, the bronchial patency is partially or completely compromised with lymph node contents when the necrotic focus of the lymph node ruptures into the bronchial lumen to form a bronchoglandular fistula. To investigate the transition of endobronchial lesion and to evaluate the therapeutic role of bronchoscopic electrocautery in the tumorous type of endobronchial tuberculosis, we performed electrocautery in addition to the combination chemotherapy with steroid and anti-tuberculous drugs in two cases which had airway obstruction proximal to lobar bronchus with the impairment of pulmonary function. We also treated another two cases only with chemotherapy and we have followed up four cases over a 36-month period. In cases that bronchoscopic electrocautery was done, the bronchial patency was completely restored and the impairment of pulmonary function disappeared just after cautery and these effects have remained for 12 months or more. But in cases of medical treatment only, bronchial stenosis was inevitable as the tumorous type of endobronchial tuberculosis changed to the stenotic type with fibrosis. It can be concluded that bronchoscopic electrocautery can nip the occurence of bronchial stenosis in the bud when it is applied in addition to combination chemotherapy with steroid and antituberculous drugs in the tumorous type of endobronchial tuberculosis.

• Tuberculosis and Respiratory Diseases
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• 제38권2호
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• pp.108-115
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• 1991

Endobronchial tuberculosis is a serious disease which is frequently complicated with bronchial stenosis, and it may simulate a bronchial asthma or bronchogenic carcinoma. We have analyzed the clinical characteristics of endobronchial tuberculosis in 166 patients, and we introduce new classification of endobronchial tuberculosis. Endobronchial tuberculosis is classified into seven subtypes as stenotic type with fibrosis, stenotic type without fibrosis, actively caseating type, tumorous type, ulcerative type, granular type and nonspecific bronchitic type, according to the bronchoscopic findings. Actively caseaing type, stenotic type without fibrosis, nonspecific bronchitic type and stenotic type with fibrosis are predominant in the order of frequency, but ulcerative type and granular type are relatively rare. Stenotic type with or without fibrosis, actively caseating type and tumorous type of endobronchial tuberculosis are closely related to bronchial stenoses. We believe that our new classification of endobronchial tuberculosis, which is based on bronchoscopic features, is helpful to understand the pathogenesis of disease and to make a therapeutic plan for preventing or minimizing bronchial stenosis.

• Journal of Chest Surgery
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• 제36권11호
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• pp.874-877
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• 2003

괴사성 기관지 국균증은 대부분 면역 기능이 저하된 환자에서 발생하며 국균이 기관지 상피를 침범하여 기관지 내에 종괴나 협착을 유발하는 질환이다. 당뇨병이 있는 78세 남자가 호흡곤란과 기침을 주소로 내원하여 시행한 단순 흉부 X-선 촬영과 흉부 전산화 단층 촬영 결과 좌상엽 기관지를 완전히 막고 있는 종괴와 좌상엽의 허탈이 발견되었고, 기관지 내시경을 통한 생검 결과 만성 염증 소견을 보였다. 확진과 치료를 위해 시험적 개흉술을 통해 좌상엽 소매 절제술을 시행하였고 치종 조직검사 상 괴사성 기관지 국균증으로 진단되었다. 저자들은 당뇨병이 있는 고령의 환자에서 발생한 괴사성 기관지 국균증 1예를 문헌 고찰과 함께 보고하는 바이다.