• 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.

• 대한기관식도과학회지
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• 제11권1호
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• pp.15-20
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• 2005

Background : It is well-known that esophageal perforation (EP) is difficult in diagnosis and has high mortality rate despite proper management. There are disputes in regarding the reatment in cases of delayed diagnosis although in the early diagnosed cases, operation is recommended without arguments. Methods: From April, 2001 to December, 2004, nine patients who were diagnosed as EP in our hospital were analyzed retrospectively about the causes, the interval between the cause and the treatment, and operation methods. Results: There were 8 male and one female with men age of 49.3 years (range: 25-67 years). The causes of EP included perforations following operations of corvical spine in three cases, spontaneous perforation(Boehaave syndrome) in two cases, foreign bodies in two cases, operation of esophageal diverticulum in one case and blunt trauma bytraffic accident in one case. Mean interval between the first treatments and the causes was 11.6 days (range: 2-30 days). The sites of perforation were upper third of esophagus in three cases, middle third in three cases and lower third in three cases. All except two cervical cases presented as mediastinitis or empyema at the time of diagnosis. Primary repair and irrigation had been performed in 7 cases but five cases out of them required more than two procedures. Conclusions : More than one procedure wasrequired in the treatment of EP because of contaminations and infections which had been spread at the time of initial manifestatios, howeverprimary closure and massive irrigation is the best method in order to preserve esophagus unless the remaining esophagus is extensively damaged.

• Journal of Chest Surgery
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• 제23권1호
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• pp.95-106
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• 1990

Between May 1979 and April 1989, 213 patients with esophageal injuries visited the Department of the Thoracic and cardiovascular surgery Department, Yonsei University College of Medicine. There were 159 non perforated esophageal injuries accompanied by hematemesis, and 54 perforated esophageal injuries. The causes of non perforated esophageal injuries were Mallory-Weise Syndrome [%], corrosive esophagitis [54], esophageal carcinoma [4], foreign bodies [2], sclerotherapy due to esophageal varices [3]. The causes of perforated esophageal injuries were esophageal anastomosis[13], malignancies[17], esophagoscopy or bougienage[5], chest trauma[5], foreign bodies[5], paraesophageal surgery[3], others[6] In esophageal perforation due to foreign bodies, esophagoscopy or bougienage, there were 6 cervical esophageal perforations and 9 thoracic esophageal perforations. There were no mortalities in the treatment of the cervical esophageal perforations and 5 deaths resulted in the treatment of 9 thoracic esophageal perforations. And four of six patients with thoracic esophageal perforations died in the initiation of treatment over 24 hours, after trauma. There were another 12 deaths in the patients with chest trauma, malignancies or chronic inflammation except esophageal injuries due to foreign bodies or instruments during the hospital stay or less than 30 days after esophageal injuries. One patient with esophageal carcinoma died due to bleeding and respiratory failure after irradiation. Another patient with esophago gastrostomy due to esophageal carcinoma died of sepsis due to EG site leakage. One patient with a mastectomy due to breast cancer followed by irradiation died of sepsis due to an esophagopleural fistula. Two patients with Mallory-Weiss syndrome died; of hemorrhagic shock in one and of respiratory failure due to massive transfusion in the other. One patient with TEF died of respiratory failure and another died of pneumonia and respiratory failure. One patient with esophageal perforation due to blunt chest trauma died of brain damage accompanied with chest trauma.

• Journal of Chest Surgery
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• 제24권11호
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• pp.1107-1114
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• 1991

We have experienced fourteen patients of esophageal perforation at the department of thoracic and cardiovascular surgery, Chonbuk National University Hospital during the period from mar. 1980 to Oct. 1990. The ratio between male and female patients was 5 : 9, and their age ranged from 22 years to 69 years. The causes of th eesophageal perforation were iatrogenic in 6 cases, foreign body 5 cases, diverticulitis 2 cases, and postpneumonectomy 1 case. The locations were cervical esophagus in 2 cases, upper thoracic in 2 cases, mid-thoracic 4 cases, and lower thoracic 6 cases. The underlying diseases associated with perforation were lye stricture, diverticulum, achalasia, and postpneumonectomy empyema. The treatments were supportive in 6 cases and combined with surgical measures in 8 cases. surgical measurs were as follows : incision and drainage in 2 cases, esophagectomy with esophagogastrostomy 3 cases, esophagocardiomyotomy with partial fundoplication in 1 case, simple closure with myoplasty and thoracoplasty 1 case, and empyema drainage and gastrostomy 1 case. There was no mortality.

• Journal of Chest Surgery
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• 제16권2호
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• pp.231-242
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• 1983

A clinical study was performed on 75 cases of the esophageal cancer and benign esophageal diseases experienced at Department of thoracic & cardiovascular surgery, School of Medicine, Keimyung University during 3 year period from 1978 to 1982. Of 75 cases of the surgical esophageal diseases, there were 35 patients of the esophageal cancer. 17 patients of benign esophageal stenosis, 10 patients of esophageal perforation, 4 patients of diverticulum. 3 patients of achalasia, 2 patients of congenital T-E fistula, one of upper esophageal web, one of esophageal foreign body, one of leiomyoma and patient of hemangioma. First, esophageal carcinoma was more frequent in men than in women by a ratio of five to one, and the peak incidence occurred in the 5th to 6th decade. Dysphagia was the most common symptom in 88.6 percent of our cases. The tumor was located mostly in the middle & the lower one third [91.4%]. The histological diagnosis was made in 35 cases. The squamous cell carcinoma was the most common [82.9%] and the rest was the adenocarcinoma in the lower one third [17.1%]. Thirty-five cases were operated and resection was feasible in the twenty-five patients [71.4%] with 2 cases of hospital mortality [5.7%]. All but two of the esophageal stenosis were caused by corrosive esophagitis and ages ranged from 7 to 70 years with average age of 32 years. Corrective operations were performed on 17 patients of esophageal stenosis of whom 12 patients had esophagocologastrostomy, 3 patients esophagogastrostomy and in non-corrosive esophageal stenosis one case and esophagoplasty and another case had release of external compression. There was one complication of stenosis of the esophageal perforation were traumatic in five cases, empyema in three cases, caustics in one case and postemetic in one case. 10 patients of the esophageal perforation underwent operation: primary closure in 5 cases, two staged colon interposition in 2, esophagogastrostomy in 1 and closed thoracotomy in 2 cases There were 2 complications of leakage of anastomosis sites in postoperative period. 4 patients of traction type of diverticulum underwent diverticulectomy & 3 patients of achalasia underwent modified Heller`s operation. 2 patients of congenital esophageal atresia had distal tracheoesophageal fistula & underwent one staged operation with the results of one death caused by pneumonia. Upper esophageal web had divulsion through the esophagoscope and foreign body in upper esophagus was removed through cervical esophagotomy. One case of leiomyoma in esophagus had esophagectomy and reconstruction with right colon. And one case of hemangioma in esophagus had esophagectomy & esophagogastrostomy.

• Advances in pediatric surgery
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• 제2권1호
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• pp.42-45
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• 1996

Children tend to ingest foreign bodies. The majority present in children between the ages of 6 months and 3 years. We experienced 2 cases of unusual gastrointestinal complications caused by ingested foreign bodies. First case was a 10-month-old male with intestinal perforation due to two pieces of ingested magnetic heads. Second case was a 7-month-old girl with esophageal stricture due to an ingested particle of plastic toy.

• Journal of Chest Surgery
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• 제17권4호
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• pp.762-774
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• 1984

A clinical analysis was performed on 49 cases of the benign esophageal diseases experienced at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital during 7 year period from 1977 to 1983. Of 49 cases Of the benign esophageal diseases, there were 19 patients of esophageal stricture, 11 of achalasia, 6 of perforation, 3 of bronchoesophageal fistula, 3 of esophageal perforation, 3 of esophageal leiomyoma and one of esophageal foreign body. Twenty three patients were male and 26 were female. Ages ranged from 4 years to 74 years with the average age of 34.7 years. Of 19 patients of esophageal strictures, 7 patients were male and 12 were female and ages ranged from 6 years to 74 years with the average being 33.8 years. Causes of esophageal strictures were corrosive of esophageal strictures were dysphagia, vomiting, general weakness, weight loss and pain that order and developed on several different parts of esophagus. Operations were performed in 18 cases, of whom 7 patients were performed by esophagocologastrostomy, 4 gastrostomy, 4 esophagogastrostomy, 1 esophageal resection and esophagoesophagostomy, 1 esophagotomy and dilatation and 1 scar revision. Five patients had one or two complications; 2 anastomotic leakage, 1 wound infection, 1 localized empyema, 1 bilateral pneumothorax and 1 respiratory failure. One patient expired due to respiratory failure arising from aspiration pneumonia. The average age of achalasia patients was 33.1 years and symptom durations were from 2 months to 10 years with the average of 3.3 years. Main symptoms were dysphagia, vomiting, weight loss, pain and cough in that order. Modified Hellers myotomy was performed in 11 patients with one complication of restenosis. One patient was operated on by using longitudinal incision and transverse sutures with good result. Of 6 patient of esophageal diverticulum, 2 patients were traction diverticulum on the midesophagus, 2 were pulsion diverticulum on the midesophagus and 2 were pulsion diverticulum on the lower esophagus. Diverticulectomy was performed on 2 cases of traction diverticulum and esophagocardiomyotomy with or without diverticulectomy was erformed on 4 cases of pulsion diverticulum with good results. Of 5 patients of congenital bronchoesophageal fistula, the chief complaints were productive cough in 4 patients and hematemesis without respiratory symptoms in one patient. Two patients were operated on by using fistulectomy only and 3 by fistulectomy with pulmonary lobectomy. Of 3 patients of esophageal perforation, causes were foreign body ingestion, esophageal stricture after ECG and corrosive esophagitis. Two patient were operated on by using drainage and gastrostomy with symptomatic improvement but one patient died due to septic shock after thoracotomy. Three patients of esophageal leiomyoma were all male and 2 patients were operated on by using enucleation and one by distal esophagectomy with esophagogastrostomy. In one patient of esophageal foreign body, it was removed by esophagotomy through the right thoracotomy.

• 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.

• 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.

• Journal of Chest Surgery
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• 제39권5호
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• pp.387-393
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• 2006

배경: 위내시경 검사나 기관삽관 시 식도 손상에 의한 식도 천공례는 대단히 드물다. 그러나 식도 천공의 발생 시 신속한 처치가 이루어지지 않는다면 예후는 매우 불량하다. 저자들은 기구에 의한 식도 천공례에서 기존 치료에 대한 효과를 알아보기 위하여 후향적 분석을 시행하였다. 대상 및 방법:1999년 1월부터 2005년 3월까지 저자들이 치험하였던 기구에 의한 식도 천공환자 12예를 대상으로 하였다. 천공의 원인과 부위, 내원까지의 지연 시간, 그리고 치료방법 등에 따른 예후 등을 분석하였다. 결과: 위내시경 검사에 의한 천공이 6예로 가장 많았으며(50.0%), 식도확장술에 의한 경우가 4예(33.3%), 그리고 내시경 포트삽입술과 기관삽관에 의한 경우가 각각 1예(8.3%)씩 있었다. 이 중 7예가 흉부 식도의 천공이었으며, 5예가 경부 식도의 천공이었다. 치료 방법으로는 식도절제 및 재건술이 5예, 절개 및 배농술이 4예, 폐쇄성 흉강 삽관술이 1예, 그리고 내과적 치료가 2예였다. 수술에 의한 위중한 합병증은 없었으며, 경미한 폐렴과 창상 감염이 각각 1예에서 발생되었다. 수술을 거부하여 내과적 치료를 시행하였던 1예에서 사망하여 사망률은 8.3%이었다. 결론: 기구에 의한 식도 천공에서 부위와 지연 시간에 상관없이 외과적 수술은 안전하며 또한 효과적인 치료방법이라고 생각되었다.