누두흉의 수술 교정 -8예 보고-

이양행,우종수,조광현,Lee, Yang-Haeng,U, Jong-Su,Jo, Gwang-Hyeon 대한흉부심장혈관외과학회 1986 Journal of Chest Surgery (J Chest Surg) Vol.19 No.4

Funnel chest is the most common deformity of the sternum. It is characterized by a funnel shaped depression of the sternum with sharp angulation and lengthening of the costal cartilages, with the result that the cartilages point posteriorly. We have experienced with eight cases of funnel chest for 2 years recently, and they were corrected by the method of Ravitch operation with or without Kirschner`s wire. The postoperative course was uneventful. And now we report these with literature review.

후천성 폐탈출증 -2례 보고-

한일용,이양행,황윤호,Han, Il-Yong,Lee, Yang-Haeng,Hwang, Yun-Ho 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.11

Lung hernia is defined as a protrusion of lung parenchyma beyond the confines of the musculoskeletal thorax. To date, less than 300 cases have been reported in the literature. The patients were 37 & 57-year-old men who had traumatic rib fractures in the past, whose chief complaint was a painless soft bulging mass increased in size during expiration or coughing and diminished during inspiration or quiet breathing. The primary repair was performed without any p stoperative recurrance. We report two cases of acquired herniation of lung first time in Korea with a brief review of literature. 폐탈출증은 근골격으로 구성된 흉곽 밖으로 폐실질이 빠져나와 돌출되는 것으로, 최근까지 문헌으로 보고된 예는 300 례 미만이다. 환자는 늑골 골절을 포함한 외상을 입었던 과거력을 가진 37세와 57세 남자 이며 주소는 전흉부에 무통성의 부드러운 종괴로 호기시나 기침시 그 크기가 증가하였고, 흡기시 혹은 조용한 호흡시에는 감소하였다. 수술은 흉벽 결손에 대한 일차 봉합술을 시행하였으며, 술후 재발은 아직 까지 관찰되지 않았다 저자들은 지금까지 국내 발생보고 예가 없는 후천성 폐탈출증 2례를 수술 치험하였기에 문헌고찰과 함께 보고하는 바이다.

성인에서 진단된 선천성 낭포성 유선종 폐기형 6예

박영진 ( Young Jin Park ),정훈 ( Hoon Jung ),박이내 ( I Nae Park ),최상봉 ( Sang Bong Choi ),허진원 ( Jin Won Hur ),이혁표 ( Hyuk Pyo Lee ),염호기 ( Ho Kee Yum ),최수전 ( Soo Jeon Choi ),구호석 ( Ho Seok Koo ),이양행 ( Yang Haeng 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.2

연구배경: CCAM은 드문 하부 호흡기의 선천성 발달 기형으로 대부분은 생후 2년 내에 진단되는 것으로 보고되고 있다. 그리고 매우 드물게 성인이 되어서 호흡기 합병증이 생기거나 무증상인 채로 우연히 진단된 증례들이 보고되었다. 우리는 본원에서 수술을 통해 조직학적 소견으로 확진된 6명의 성인 CCAM 환자들을 기술하였고 이들의 임상적, 방사선학적 및 조직학적 특성을 분석하고자 하였다. 방법: 2001년 8월부터 2007년 2월까지 본원에서 성인기에 수술을 통한 조직학적 소견으로 확진된 6명의 CCAM 환자를 확인하였다. 의무기록 검토를 통해 그들의 인구학적 및 임상적 특성, 흉부 방사선 자료 그리고 조직학적 특성을 후향적으로 분석하였다. 결과: 6명의 CCAM 환자 중 4명이 여자였고 진단 당시의 평균 나이는 23.5세(범위 18∼39세)였다. 내원 당시 주요 임상 양상은 하부 호흡기 감염, 객혈, 그리고 기흉이었다. 흉부 전산화 단층촬영을 보면 5명의 환자는 공기 액체층을 동반한 다발성 격막을 가진 낭종성 병변을 가지고 있었고 나머지 1명에서는 우상엽에 공기 액체층을 동반한 다발성 공동성 병변과 주위에 다발성 침윤성 병변을 가지고 있었다. 모든 환자는 폐엽 절제 수술을 받았는데 5명은 개흉술을 통한 폐엽 절제술을 그리고 1명은 흉강경을 이용한 폐엽 절제술을 시행 받았다. 조직학적 검사결과 Stocker씨 분류법에 따라 3명의 환자는 1형 그리고 나머지 3명은 2형으로 분류되었다. 모든 환자의 검체에서 동반된 악성 종양의 증거는 없었다. 결론: CCAM이 하부 호흡기 감염, 기흉, 객혈 등의 다양한 호흡기 합병증과 악성화를 일으킬 가능성이 있고 수술적 치료와 연관된 합병증이 거의 없기 때문에 CCAM으로 의심되거나 확실치 않은 폐의 낭종성 혹은 공동성 병변이 있을 때 정확한 진단과 적절한 치료를 위해서 반드시 수술적 치료가 필요하다. Background: Congenital cystic adenomatoid malformation of the lung (CCAM) is a rare congenital developmental anomaly of the lower respiratory tract. Most cases are diagnosed within the first 2 years of life, so adult presentation of CCAM is rare. We describe here six adult cases of CCAM and the patients underwent surgical resection, and all these patients were seen during a five and a half year period. The purpose of this study was to analyze the clinical, radiological and histological characteristics of adult patients with CCAM. Methods: Through medical records analysis, we retrospectively reviewed the clinical characteristics, the chest pictures (X-ray and CT) and the histological characteristics. Results: Four patients were women and the mean age at diagnosis was 23.5 years (range: 18∼39 years). The major clinical presentations were lower respiratory tract infection, hemoptysis and pneumothorax. According to the chest CT scan, 5 patients had multiseptated cystic lesions with air fluid levels and one patient had multiple cavitary lesions with air fluid levels, and these lesions were surrounded by poorly defined opacities at the right upper lobe. All the patients were treated with surgical resection. 5 patients underwent open lobectomy and one patient underwent VATS lobectomy. On the pathological examination, 3 were found to be CCAM type I and 3 patients were CCAM type II, according to Stocker`s classification. There was no associated malignancy on the histological studies of the surgical specimens. Conclusion: As CCAM can cause various respiratory complications and malignant changes, and the risks associated with surgery are extremely low, those patients who are suspected of having or who are diagnosed with CCAM should go through surgical treatment for making the correct diagnosis and administering appropriate treatment. (Tuberc Respir Dis 2008;65:110-115)

수술로 치험한 해면상 림파혈관종 2 예

이양행,황윤호,우종수,조광현,박동식 인제대학교 1984 仁濟醫學 Vol.5 No.4

Lymphangiomas are divided into three categories; (1) simple (capillary) lymphangioma, (2) cavernous lymphangioma, and (3) cystic hygroma. This lesion usually occurs in the posterior triangle of the neck but can be present in the axilla, mediastinum, or groin. Recently, we have experienced two cases of cavernous lymphangioma that one occurred in the mediastinum and the other was in the right chest wall, which were surgically removed successfully and confirmed histopathologically.

Ravitch 술식을 이용한 누두흉의 수술 교정

이양행,우종수,조광현 인제대학교 1986 仁濟醫學 Vol.7 No.3

선천성 누두흉 5예를 Ravitch씨식 수술 방법으로 교정하여 좋은 결과를 얻었다. Funnel chest is the most common deformity of the sternum. It is characterized by funnel shaped depression of the sternum with sharp angulation and lengthening of the costal cartilages, with the result that the cartilages point posteriorly. We have experienced with 5 cases of funnel chest for 2 years recently, and they were corrected by the method of Ravitch operation with or without Kirschner wire. The postoperative course was uneventful. And now we report these with literature review.

심내막상 결손증 : 3예 보고 A Report of 3 Cases

황윤호,이양행,우종수,조광현 인제대학교 1986 仁濟醫學 Vol.7 No.4

심내막상 결손증(Endocardial cushion defect)은 선천성 심장기형의 약 3% 정도를 차지하는 비교적 드문 질환이며, 복잡한 동반 기형을 나타내고 있고, 그 수술 방법에 있어서도 많은 논란이 있으며, 사망율도 높은 질환인 바, 저자들은 지난 1년간에 3예의 본 증례에 대한 수술 치험에서 술후 3∼6개월간에 만족할만한 임상적 추적 결과를 얻었기에 보고하는 바이다. In Pusan Paik Hospital, Inje Medical College, there were two complete endocardial cushion defects (ECD) and a partial one, which were successfully repaired in 1986. In a patient of partial ECD, primum atrial septal defect was closed with pericardial patch. In a patient of complete ECD, associated with secundum ASD, pulmonary stenosis and Down's syndrome, the atrial and ventricular septal defects were closed separately with bovine pericardium and Dacron patches respectively, and then pulmonary stenosis was relieved by transannular patch widening in addition to valvotomy and infundibulectomy. In another patient with complete ECD, small interventricular communication was closed with simple suture with pledget, and primum ASD closed with pericardial patch. In all patient, the mitral clefts were closed with three or four 5-0 Prolene interrupted sutures. Transient A-V dissociation developed postoperatively in two patients, and heart failure in complete ECD with Down's syndrome was overcome with medical treatment.

심실중격결손증-치험 1예-

조광현,우종수,황윤호,이양행,박철호,김종성,김철호,이경순,조영일,박태인 인제대학교 1985 仁濟醫學 Vol.6 No.4

A successful treatment of infants and children with congenital heart defects depends upon several factors: diagnosis must be accurate, the operative technique, including techniques of perfusion and myocardial preservation, must be suited to the needs of patients and intensive cares, including accurate anesthesia, must be applied through all stages of investigation and treatment, i.e. before, during and after the operation. Recently we performed a open heart surgery successfully for a six-years old girl who had suffered from frequent upper respiratory tract infection and mild to moderate exertional dyspnea with congenital heart defects (ventricular septal defect, Kirklin type II, with patent foramen ovale). The operation and postoperative course were very smooth. And now we report this with review of literatures.

폐경기의 여성에서 발견된 폐임파관 평활근종증 1례

이옥주,임대건,오경석,김주인,이봉춘,최석진,이양행 인제대학교 1996 仁濟醫學 Vol.17 No.1

임파관 평활근종증은 폐, 종격동, 복부 임파계의 평활근의 비전형적인 증식을 특징으로 하는 드문 질환으로, 주로 가임기 여성에서 발견된다. 저자들은 운동시 호흡곤란을 주소로 내원한 52세 폐경기 여성에서 개흉 폐 생검을 통해 폐 임파관 평활근종증 1례를 경험하였기에 관련 문헌 고찰과 함께 보고하는 바이다. Lymphangioleiomyomatosis is a rare disorder characterized by proliferation of smooth muscle cells in the tissues of the lung and lymphatic vessels of the abdomen. The symptoms of LAM are logically explaines by the extent and location of the smooth muscle proliferation. This rare disorder causes serious respiratory impairment and survival is generally less than 10 years. It generally presents during the child hearing years, and this, together with exacerbation with menses and during pregnancy, has suggested some degree of hormonal influence. We experienced a case of pulmonary lymphangioleiomyomatosis in a post menopausal wowan who had suffered from exertional dyspnea, so we report it with a brief review of the literature.

심장수술 2,450예와 심장이식

조광현,황윤호,이양행,류지윤 인제대학교 1999 仁濟醫學 Vol.20 No.1S

인제대학교 부산백병원에서는 1985년 10원 개심술이 처음 시행된 이후 1998년 말까지 2,450예의 개심및 비개심 심장수술이 이루어졌는데 이중 개심술이 2,290예, 비개심술은 160예 였다. 개심술 중 선천성이 1,697예(74.1%), 후천성이 573예(25.9%)였으며, 선천성 중에는 비청색증군이 1,548예(91.2%), 청색증군이 149예(8.8%)이었다. 후천성 중에는 심장판막질환이 471예(79.6%)로 가장 많았고, 관상동맥우회수술이 73예(12.1%), 대동맥류수술이 28예(4.7%), 심장종양절제술이 15예(2.5%) 및 심장이식수술이 2예, 기타 4예 등이었다. 특히 1993년부터 심장이식술을 위한 기초 및 동물실험 을 계속하다가 1997년 9월 말기심부전증환자에게 심장이식이 성공적으로 이루어져 개심술의 새로운 장을 열게 되었다. 술후 조기 사망은 선천성 비청색증군에서 30예(1.9%), 청색증군에서는 27예(16.7%), 후천성질환군에서는 26예(4.4%)였고, 전체 수술성공률은 96.5% 로 비교적 좋은 성적을 거두었다. From Sep. 1985 to Dec. 1998, 2,450 cases of heart operation including 2 cases of orthotopic heart transplantaion were performed in the Department of Cardiothoracic Surgery, Inje Universty, Pusan Paik Hospital The results of retrospective clinical review of them were obtained as follows. 1.Open heart surgery cases and non-open heart surgery cases were 2.290 and 160, respectively. Among the open heart cases, congenital cases and acquired cases were 1,697(74.1%) and 593 (25.9%), respectively. 2.Among the congenital cases, acyanotic cases and cyanotic cases were 1,548(91.2%) and 149(8.8%), respectively. The postoperative hospital mortality was 1.9% (30 cases) in the acynotic group and 16.6% (25 cases) in the cyanotic group. 3.Among the acquired cases, valvular heart disease, coronary artery disease, aortic aneurysm, cardiac tumor, heart transplantation and others were 471 (79.6%), 73(12.1%), 28(4.7%), 15(2.5%), 2(0.3%) and 4(0.7%) cases, respectively. 4.Prosthetic valve replacement (457 case, 97.0%) and valve reconstructive surgery(14 cases, 3.0%) were performed for the valvular diseases. Postoperative hospital mortality of valve surgery and coronary artery bypass surgery was 2.8% (13 cases) and 28.6% (6 cases), respectively. 5.28 cases of aortic aneurysm (ascending or arch aneurysm) were operated under cardiopulmonary bypass. The causes of aneurysm were annuloaortic ectasia(9), dissecting aortic aneurysm(16), and non-dissecting chronic aneurysm(8). The early postoperative hospital mortality was 8 cases(28.6%). 6.Two cases of heart transplantation were performed successfully using Shumway method .The total ischemic time of donor heart was 80 minutes and 50 minutes respectively. 7.Minimally invasive surgery (using lower sternal incision) was performed successfully in the cases of mitral and tricuspid valve diseases(10) and congenital septal defects (20). In conclusion, the over all postoperative hospital mortality was not so high as 3.5 %, whereas more proper management for congenital cyanotic group was seemed to be necessary.

심장수술 2,450예와 심장이식

조광현,황윤호,이양행,류지윤 인제대학교 1999 仁濟醫學 Vol.20 No.1