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이철범,함시영,김혁,정원상,김영학,강정호,백홍규,Lee, Chul-Burm,Hahm, Shee-Young,Kim, Hyuk,Jung, Won-Sang,Kim, Young-Hak,Kang, Jung-Ho,Baik, Hong-Kyu 대한기관식도과학회 2000 大韓氣管食道科學會誌 Vol.6 No.1
Background: For the purpose of reducing operating time and rate of anastomotic leakage, we have performed esophagovisceral anastomosis with an EEA stapler using the largest size possible. If any difficulty in the approach of the EEA stapler was encountered one-layer interrupted hand-sewn anastomosis. Because the rate of postoperative benign anastomotic stricture was higher than expected, a retrospective study was done on all patients who underwent esophageal reconstruction. Material and Method: Over a period of 3 years from January 1996 to December 1998, we performed esophageal reconstructions on 30 patients. Patients were divided into two groups ; EEA stapler group(Group Ⅰ) comprised of 21 patients and hand-sewn group(Group Ⅱ) comprised of 9 patients.Result:The hospital mortality was 6.67 %(2/30) and the anastomotic leakage rate was 3.33 %(1/30). Among the discharged patients, the rate of recurrent anastomotic tumor was 3.57 %(1/28) and the rate of benign anastomotic stricture stricture rate was 35 %(7/20) in Group Ⅰ and 12.5 %(1/8) in Group Ⅱ, which was not significant. Conclusion: Although nontumor benign stricture was significantly higher in Group Ⅱ than in Group Ⅰ(p=0.0492), the incidence of anastomotic complications did not differ between the two groups. The one-layer interrupted hand-sewn esophagovisceral anastomosis by maintaining a wide lumen and close approximation of mucosa to mucosal layers with evenly spaced sutures could be one of the preferred surgical method to reduce benign anastomotic strictures.
전순호,정태열,송동섭,김혁,함시영,이철범,강정호,정원상,김영학,지행옥,Chon, Soon-Ho,Chung, Tae-Yul,Song, Dong-Sub,Kim, Hyuck,Hahm, Shee-Young,Lee, Chul-Burm,Kang, Jung-Ho,Chung, Won-Sang,Kim, Yong-Hak,Jee, Heng-Ok 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.1
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.
성인 개심술 후 발생한 심내막하 심근경색에서의 효소 변화에 관한 연구
함시영 한양대학교 의과대학 1997 한양의대 학술지 Vol.17 No.2
A prospective study was performed to ascertain if postoperative changes of the patients in serum CK and LDH after open heart surgery could differentiate subendocardial infarction from other ischemic changes. Sixty-three patients were divided into 4 groups on the basis of serial electrocardiographic findings. The acute myocardial infarction group (AMI) (n=10) consisted of 1 Q-wave infarction and 9 non-Q-wave infarction with persistent ST elevation or depression and/or T wave inversion. The ischemic group (ISCH) (n=21) and nonspecific change group (NSST) (n=22) with temporary ST- T changes were divided only by voltage difference. The normal EKG group (n=10) has no EKG change after open heart surgery. To eliminate the factor of muscular injury, thoracotomy patients without manipulation of heart (n=10) were used as control group. This study suggest that serial changes of total CK, CK-MB, total LDH, LDH 1, LDH 1/LDH 2 and sGOT can support the diagnosis of subendocardial infarction. Nonspecific ST- T changes and significant ST - T changes without evidence of acute myocardial infarction are same in view of enzyme changes.
거대 긴장성 낭종으로 내원한 폐 Langerhans 세포 조직주증
양석철,손장원,윤호주,신동호,박성수,함시영,장세진,박용욱 한양대학교 의과대학 2000 한양의대 학술지 Vol.20 No.1
Pulmonary Langerhans cell histiocytosis is a hetergenous group of conditions of unknown etiology characterized by an abnormal proliferation of antigen presenting cell of bone marrow derivation known as Langerhans cells that invade and destroy distal bronchioles. The outcome is highly variable, ranging from rapid spontaneous resolution to irreversible respiratory failure. We describe a patient with biopsy-confirmed pulmonary Langerhans cell histiocytosis who presented with large tension cyst, treated with pneumothorax tube with Heimlich flutter valve.