• Tuberculosis and Respiratory Diseases
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• 제48권1호
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• pp.78-83
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• 2000

기관지내 연골종은 드문 양성 종양으로 폐 절제술 또는 내시경적 절제술로 치료가 가능하므로 다른 질환과의 감별이 중요할 것으로 생각된다. 본 종례는 2년간의 호흡곤란으로 치료를 받았으나 호전되지 않아 굴곡성 기관지 내시경, 흉부 전산화 촬영 후 기관지내 결핵 및 악성 종양 의심하에 기관지 절제술 및 단단 문합술을 시행 받고 기관지내 연골종으로 최종 진단 받은 환자로 현재 특별한 문제없이 외래 추적 관찰중이다.

• Journal of Chest Surgery
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• 제51권3호
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• pp.167-171
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• 2018

Background: Heart transplantation (HTx) can be a life-saving procedure for patients in whom single ventricle palliation or one-and-a-half ($1\text\tiny{1/2}$) ventricle repair has failed. However, the presence of a previous bidirectional cavopulmonary shunt (BCS) necessitates extensive pulmonary artery angioplasty, which may lead to worse outcomes. We sought to assess the post-HTx outcomes in patients with a previous BCS, and to assess the technical feasibility of leaving the BCS in place during HTx. Methods: From 1992 to 2017, 11 HTx were performed in patients failing from Fontan (n=7), BCS (n=3), or $1\text\tiny{1/2}$ ventricle (n=1) physiology at Asan Medical Center. The median age at HTx was 12.0 years (range, 3-24 years). Three patients (27.3%) underwent HTx without taking down the previous BCS. Results: No early mortality was observed. One patient died of acute rejection 3.5 years after HTx. The overall survival rate was 91% at 2 years. In the 3 patients without BCS take-down, the median anastomosis time was 65 minutes (range, 54-68 minutes), which was shorter than in the patients with BCS take-down (93 minutes; range, 62-128 minutes), while the postoperative central venous pressure (CVP) was comparable to the preoperative CVP. Conclusion: Transplantation can be successfully performed in patients with end-stage congenital heart disease after single ventricle palliation or $1\text\tiny{1/2}$ ventricle repair. Leaving the BCS in place during HTx may simplify the operative procedure without causing significant adverse outcomes.

• Archives of Reconstructive Microsurgery
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• 제23권2호
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• pp.97-100
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• 2014

The number of patients with chronic renal failure who require renal replacement therapy is increasing and dialysis is still the mainly used renal replacement therapy. The first choice of surgical technique currently used is side-to-end anastomosis of the radial artery and the cephalic vein. The authors report on a case of an effective arteriovenous shunt operation performed using microscopy. A 53-year-old male with chronic renal failure was referred to plastic and reconstructive surgery department to undergo an arteriovenous shunt operation. Venography was performed before surgery in order to find the appropriate vessel for the arteriovenous shunt operation. The cephalic vein on the wrist showed a diameter of over 4 mm, which was appropriate for an arteriovenous shunt operation. Anastomosis of the vessels was performed under microscopy using Nylon #9-0. Blood flow and vessel diameter were evaluated by venography after surgery and showed well maintained function of the shunt. Complications such as bleeding, edema of the upper arm, and wound dehiscence did not occur. Many factors and certain complications may affect the long-term patency of an arteriovenous shunt; however, exquisite surgical technique is the most important factor in a successful operation. Thus, arteriovenous shunt operation using microscopy is thought to be a good treatment option.

• Journal of Gastric Cancer
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• 제4권2호
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• pp.121-125
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• 2004

Purpose: Esophagojejunal anastomotic complications after a total gastrectomy include leakage, stenosis, bleeding, and abscess formation. Especially, the mortality rate for esophagojejunal anastomotic leakage is $80\%$. Although these complications hare been reduced by the usage of the EEA stapler, they are still serious and depend on various factors: the surgeon's experience, the stage of disease, the extent of surgical intervention, the method of operation, and the patient. Some local factors, such as vascularization of the graft, traction on the anastomosis suture line, and local infections, have been implicated as contributing to these complications. Materials and Methods: During the period $1995\∼2003$, of the 850 gastrectomies for gastric carcinomas, 171 were intra-abdominal total gastrectomies. All of these 171 operations were performed by one surgeon using a routine D2 lymph-node dissection and a 25-mm EEA stapler on an antecolic end-to-side esophagojejunostomy. In the 77 cases a seromuscular reinforced suture at the esophagojejunostomy site was performed, and in 94 cases, a whole layer reinforced suture with absorbible materials was used. We evaluated the incidence of complications according to age, sex, stage of patients, and combined resection. Also, we compared the incidences of complications for seromuscular and whole layer reinforced sutures. Results: The complications are major leaks ($2.9\%$), minor leaks ($3.5\%$), stenosis, bleeding ($1.8\%$), and abscess formation formation ($1.8\%$). In the five cases of major leaks, there were four mortalities with operative methods. The other patients with stenosis, bleeding, and abscess formation were treated conservatively with success. The incidences of complications were not related with age, sex, stages, and combined resection. The incidences of complications for the whole layer reinforced suture group ($2.9\%$) were less than those for the seromuscular reinforced group ($8.8\%$, P=0.04). Conclusion: The most serious complication of esophagojejunal anastomosis is major leakage with an $80\%$ mortality. The other complications are stenosis, bleeding, and abscess formation, for which no mortalities occurred during this study. Whole layer suture of the esophagojejunal anastomotic site is an important method for preventing leakage.

• Journal of Chest Surgery
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• 제37권10호
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• pp.856-860
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• 2004

심내기형을 동반한 대동맥궁 단절은 매우 중한 자연경과를 갖고 있는 희귀한 선천성 심장 기형이다. 식도 폐쇄증과 기관 식도루를 동반한 심첨부 근육성 심실 중격 결손과 대동맥궁 단절을 생후 3일된 체중 2.6 kg의 신생아에서 단계적 수술법으로 치료한 경험을 보고한다. 1차 수술로서 우측 개흉술을 통한 식도 폐쇄증의 교정과 함께 좌측 개흉술에 의한 대동맥궁 광범위 단-단 문합술 및 폐동맥 교약술을 시행하였다. 1차 수술 후 87일째 정중 흉골 절개를 통해 심첨부 근육성 심실 중격 결손을 폐쇄하였다. 심실 중격 결손 폐쇄 전 유문부 근육절개술, 대동맥 전방고정술, 대동맥 풍선확장술 등의 추가 시술이 필요하였다. 최종 수술 후 3개월째 양호한 추적 결과를 경험하였기에 보고하는 바이다.

• Journal of Gastric Cancer
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• 제17권3호
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• pp.255-266
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• 2017

Purpose: Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several advantages, such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This prospective randomized clinical trial aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers by comparing this novel method to Billroth-I (B-I) reconstruction. Materials and Methods: A total of 118 patients were randomly allocated into the R-Y (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using two circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach evaluated using endoscopic and histological findings at 6 months after surgery. Results: No significant differences in clinicopathological findings were observed between the 2 groups. Although anastomosis time was significantly longer for the patients of the R-Y group (P<0.001), no difference was detected between the 2 groups in terms of the total surgery duration (P=0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P<0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P=0.026). Conclusions: The results of this randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure. This clinical trial study was registered at www.ClinicalTrials.gov (registration No. NCT01142271).

• 한국임상수의학회지
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• 제20권1호
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• pp.12-21
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• 2003

이 연구에서는 개의 소장에 세가지 장문합법이 유착에 어떠한 영향을 미치는 지 알아보았다. 스물 여섯 마리의 개를 무작위로 세 군으로 나누었다. Group I은 단순 연속봉합을 실시하였고, Group II은 단순 결절 접합봉합을 실시하였으며, Group III는 단층 연속 코넬 봉합을 실시하였다. 모든 실험견에 단단장문합술 후 대망막이식을 실시하고, 복막을 닫기 바로 전에 1% Sodium carboxymethylcellulose을 체중 kg 당 5ml되는 용량으로 복강안에 주입하였다. 수술후 14일째 되는날 실험견들의 수술후의 유착소견을 관찰하였다. 모든 개에서 장문합 부위와 대망막 이식 부위 사이의 유착이 발견되었으며, 장막끼리의 유착이 Group I에서 두 마리, Group II에서 세미리, Group III에서 세 마리가 관찰되었다. 모든 군의 평균 유착 점수는 2이하였다. 장문합부와 대망막사이의 유착길이는 Group I에서 13.13$\pm$4.97mm(mean$\pm$S.D.), Group II에서 17.29$\pm$4.68mm, Group III에서 14.64$\pm$3.80mm가 관찰되었다. 단순 연속 봉합법이 유착을 가장 적게 일으켰고, 단순 결절 접합 봉합법이 가장 유착을 많이 일으켰다. 그러나 유착정도에 있어서 세가지 봉합법의 유의성 있는 큰 차이는 나타나지 않았다. 수술후 합병증인 장중적이 한 마리에서만 나타났고, 수술후 생존하였다. 14일간 매일 체온, 활력, 식욕, 배변 및 배뇨를 관찰하였다. 모두 정상범위에 속했으며, 군간의 뚜렷한 차이는 없었다. 결론적으로 개에서 세가지 단단장문합 봉합법이 유착정도에 미치는 영향에서 군간 유의성 있는 차이가 관찰되지 않았지만, 단순 연속 봉합법이 유착을 가장 적게 일으키므로 단단장문합법시에 다른 두기지 봉합법보다 더 권장될 수 있을것이라 사료된다.

• Journal of Chest Surgery
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• 제27권5호
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• pp.413-417
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• 1994

Adenoid cystic carcinoma usually grows in the trachea or near its bifurcation and causes obstruction of the air way. We recently experienced a 33 year-old male patient who had adenoid cystic carcinoma in the left main bronchus with the chief complaint of productive cough. On the bronchoscopy, the mass obstructed the left main bronchus completely and had nodularity and increased vascularity.The trachea was shifted to the left side and the lower lobe of the left lung was atelectatic on chest X-ray and computed axial tomogram.He underwent left tracheal sleeve pneumonectomy and lymph node dissection through bilateral thoracotomy. At first,we attempted left tracheal sleeve pneumonectomy through the left thoracotomy,however, it was very difficult to perform carinoplastic procedure after sleeve resection of 2.5cm of distal trachea and 1cm of proximal right main bronchus including whole left lung because of poor operative field and difficulty in the anastomosis of the right main bronchus to the distal end of the trachea without tension.Therefore after radical resection of the left lung we made right thoracotomy,through which we could anastomosed the distal trachea and right main bronchus with 4-0 PDS interrupted suture after mobilization of the right hilum without difficulty. The tumor was confirmed to be adenoid cystic carcinoma with metastasis to subcarinal lymph node histopathologically. Postoperative course was uneventful but he needed two bronchoscopic procedure to clear distal airway of the retained bronchial secretion. He was discharged at 14 days after operation with complete recovery.

• Journal of Chest Surgery
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• 제41권1호
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• pp.1-11
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• 2008

배경: Damus-Kaye-Stansel (DKS) 술식은 체심실유출로 협착과 폐동맥고혈압을 완화하기 위하여 근위주폐동맥을 대동맥에 문합시키는 고식적수술이다. 본 연구는 DKS 술식의 적응증, 결과 및 결과에 영향을 주는 요인, 그리고 반월판막 기능과 DKS 경로의 장기 결과들을 알아보고자 하였다. 대상 및 방법: 1994년 5월에서 2006년 4월 사이에 본원에서 DKS 술식을 시행받은 28명의 임상기록을 토대로 후향적으로 분석하였다. 수술시 연령은 중앙값 5.3개월($13일{\sim}38.1$개월), 체중은 중앙값 5.0 kg ($2.9{\sim}13.5\;kg$)이었고, 술전 체심실 유출로 압력차는 $25.3{\pm}15.7\;mmHg$ ($10{\sim}60\;mmHg$)였다. 18명은 초기고식적 수술로 폐동맥교약술을 시행하였으며, 술전 진단은 양대혈관 우심실 기시증이 9명, 심실-대혈관연결 불일치가 있는 양방실판막 좌심실유입이 6명, 그 외 기능성 단심실이 5명, Criss-cross 심장이 4명, 완전 방실중격 결손증이 3명, 그리고 좌심 저형성증후군의 이형이 1명이었다. 수술방법은 팻취를 이용한 측단문합이 14명, 고전적 측단문합이 6명, Lamberti 방법이 3명, 그 외가 5명이었으며, 양방향성 상대정맥 폐동맥 단락술을 6명에서, 폰탄수술을 2명에서 같이 시행하였다. 결과: 병원내 사망은 4명(14.3%)이었고, 평균 $62.7{\pm}38.9$개월 ($3.3{\sim}128.1$개월)의 추적관찰기간 동안 만기사망은 3명(12.5%)이었으며, 10년 누적 생존율은 $71.9{\pm}9.3%$였다. 다변량 분석에서 우심실형 단심실(위험도=13.960, p=0.006)과 일차 DKS 술식의 시행(위험도=6.767, p=0.042)이 사망의 유의한 인자였다. DKS 술식 후 4명은 단계적 양심실성 교정을, 그리고 13명은 폰탄수술까지 시행하였으며, 체심실 유출로 협착은 1명 이외에는 발생하지 않았다. 중등도 이상의 반월판막역류나, 반월판막에 대한 재수술은 없었으나, DKS경로에 의한 폐동맥협착으로 인한 재수술이 고전적 측단문합을 시행했던 1례(3.6%)에서 필요하였다. DKS경로나 반월판막에 대한 재수술의 자유도는 10년에 87.5%였다. 결론: DKS 술식은 체심실 유출로 협착을 동반한 환자군에서 유용한 방법이며, 출생직후 양심실교정이 어려웠던 일부 환자군에서 단계적 양심실 교정을 안전하게 시행할 수 있었다. 체심실유출로 협착이 심하지 않은 경우에 DKS 술식전에 폐동맥 교약술을 시행하여 폐혈관 저항을 감소시킨 후 DKS 술식의 성공률을 향상시킬 수 있었다. DKS 술식후 반월판막기능, DKS 경로와 체심실유출로협착의 완화에 대한 장기 결과는 만족할만하다.

• 대한기계학회논문집A
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• 제23권6호
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• pp.912-921
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• 1999

Shear stress acting on the arterial wall by blood flow is an important hemodynamic factor influencing blocking of blood vessel by thickening of an arterial wall. In order to study the effects of wall elasticity on the wall shear rate distribution in an artery-divergent graft anastomosis, a rigid and a elastic model are manufactured. These models are placed in a pulsatile flow loop, which can generate the desired flow waveform. Flow visualization method using a photochromic dye is used to measure the wall shear rate distribution. The accuracy of measuring technique is verified by comparing the measured wall shear rate in the straight portion of a model with the theoretical solution. Measured wall shear rates depend on the wall elasticity and flow waveform. The mean and maximum shear rate in the elastic model are lower than those in rigid model, and the decreases are more significant near the end of a divergent tube. The reduction of mean and maximum of wall shear rate in an elastic model are up to 17 percent.