항인지질 증후군과 전신성 홍반성 루푸스 환자에게 발생된 만성 폐혈전색전성 폐동맥 고혈압에 대해 시행한 혈전내막제거술

강필제,이재원,김정원 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.12

항인지질 증후군(antiphospholipid syndrome)은 정맥, 동맥의 혈전증, 혈소판 감소증, 반복적인 유산 등과 함께 lupus anticoagulant (LAC)와 anticardiolipin antibody (aCL)가 반복적으로 양성 반응을 보이는 질환을 말하며 호흡기 증후 발현은 상대적으로 드물다. 저자들은 항인지질 증후군 및 전신성 홍반성 루푸스 환자에서 발생한 만성적인 폐혈전색전증에 대하여 폐동맥 내막절제술, 특히 원위부에 있는 폐혈전색전증을 왼쪽 폐의 대열을 분리한 뒤 좌하엽 구역 동맥을 절제하여 혈전색전 제거술을 성공적으로 시행하였기에 문헌고찰과 함께 국내 최초로 보고하는 바이다.

폐실질 내에 위치한 소결절 및 간유리 병변에서 흉부컴퓨터단층촬영 유도하에 Hook Wire를 이용한 위치 선정 후 시행한 흉강경 폐절제술의 유용성

강필제,김용희,박승일,김동관,송재우,도경현 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.5

Background: Making the histologic diagnosis of small pulmonary nodules and ground glass opacity (GGO) lesions is difficult. CT-guided percutaneous needle biopsies often fail to provide enough specimen for making the diagnosis. Video-assisted thoracoscopic surgery (VATS) can be inefficient for treating non-palpable lesions. Preoperative localization of small intrapulmonary lesions provides a more obvious target to facilitate performing intraoperative resection. We evaluated the efficacy of CT-guided localization with using a hook wire and this was followed by VATS for making the histologic diagnosis of small intrapulmonary nodules and GGO lesions. Material and Method: Eighteen patients (13 males) were included in this study from August 2005 to March 2008. 18 intrapulmonary lesions underwent preoperative localization by using a CT-guided a hook wire system prior to performing VATS resection for intrapulmonary lesions and GGO lesions. The clinical data such as the accuracy of localization, the rate of conversion-to-thoracotomy, the operation time, the postoperative complications and the histology of the pulmonary lesion were retrospectively collected. Result: Eighteen VATS resections were performed in 18 patients. Preoperative CT-guided localization with a hook-wire was successful in all the patients. Dislodgement of a hook wire was observed in one case. There was no conversion to thoracotomy. The median diameter of lesions was 8 mm (range: 3∼15 mm). The median depth of the lesions from the pleural surfaces was 5.5 mm (range: 1∼30 mm). The median interval between preoperative CT-guided localization with a hook-wire and VATS was 34.5 min (range: 10∼ 226 min). The median operative time was 43.5 min (range: 26∼83 min). In two patients, clinically insignificant pneumothorax developed after CT-guided localization with a hook-wire and there were no other complications. Histological examinations confirmed 8 primary lung cancers, 3 cases of metastases, 3 cases of inflammation, 2 intrapulmonary lymph nodes and 2 other benign lesions. Conclusion: CT-guided localization with a hook-wire followed by VATS for treating small intrapulmonary nodules and GGO lesions provided a low conversion thoracotomy rate, a short operation time and few localization-related or postoperative complications. This procedure was efficient to confirm intrapulmonary lesions and GGO lesions. 배경: 폐실질 내에 위치한 소결절 및 간유리 병변은 깊이나 크기에 따라서 조직학적 진단이 기존의 방법으로는 어려운 경우가 있다. 이에 연구자는 흉부 전산화 단층 촬영 소견에서 흉강경을 통한 육안 확인이 어려울 것으로 예상되거나 경피 세침 흡인생검술이 부적절하였던 폐실질 내에 위치한 소결절 및 간유리 병변에서 수술 전에 흉부컴퓨터단층촬영 유도하에 Hook wire를 이용한 위치 선정 (CT-guided localization with hook wire)을 시행한 후 흉강경 폐절제술을 시행하였고, 그 결과를 보고하고자 한다. 대상 및 방법: 2005년 8월부터 2008년 3월까지 흉부 전산화 단층 촬영 소견에서 폐실질 내에 위치한 소결절 및 간유리 병변을 보인 18명 환자(남자 13명, 나이 중앙값 56세)를 대상으로 수술 흉부컴퓨터단층촬영 유도하에 Hook wire를 이용한 위치 선정을 시행한 후 흉강경 폐절제술을 시행하였다. Hook wire 위치의 정확도, 개흉술 전환 정도, 수술 시간, 수술 후 합병증, 폐병변의 조직학적 진단의 정확성 등을 분석하였다. 결과: 18명의 환자가 18개의 폐실질 내에 위치한 소결절 및 간유리 병변에 대해 흉강경 폐절제술을 받았다. 수술 전 흉부컴퓨터단층촬영 유도하에 Hook wire를 이용한 위치 선정은 전례에서 성공적으로 시행되었으나, 흉강경 소견에서 wire가 이탈된 경우가 1예 있었다. 수술 전 CT에서 폐 병변 크기의 중앙값은 8 mm (3∼15 mm)였고, 내장 흉막에서 폐병변까지 깊이의 중앙값은 5.5 mm (1∼30 mm)였다. 흉부컴퓨터단층촬영 유도하에 Hook wire를 이용한 위치 선정 후 마취 시작까지 걸린 대기 시간의 중앙값은 34.5분(10∼226분)이었다. 폐병변에 대한 흉강경 폐절제술의 수술 시간은 43.5분(26∼83분)이었다. 흉부컴퓨터단층촬영 유도하에 Hook wire를 이용한 위치 선정과 관련된 합병증으로 2예에서 기흉이 발생하였으나, 임상적으로 유의한 증상은 없었다. 폐병변의 절제 단면은 모든 경우에서 이상 소견이 없었으며, 조직학적 진단은 원발성 폐암 8예, 전이성 폐암 3예, 비특이적 염증성 소견 3예, 폐내 림프절 2예, 기타 2예 등이었으며 조직학적 진단을 하지 못한 경우는 없었다. 결론: 폐실질 내에 위치한 소결절 및 간유리 병변의 조직학적 진단을 위하여 시행한 흉부컴퓨터단층촬영 유도하에 Hook wire를 이용한 위치 선정 후 시행한 흉강경 폐절제술은, 낮은 합병증 발생률, 짧은 수술 시간 및 정확한 조직학적 진단율을 보였다. 따라서 경피 세침 흡인생검술로 정확한 진단이 어렵거나 흉강경을 통한 육안 확인이 불가능한 폐실질 내의 소결절 및 간유리 병변을 조직학적으로 진단하기 위하여 흉부컴퓨터단층촬영 유도하에 Hook wire를 이용하여 위치를 선정한 후 흉강경 폐절제술을 시행하는 것은 매우 효과적이라고 생각한다.

다빈치 수술로봇을 이용한 심장수술 20예 보고 - 단일 기관 보고

제형곤,정재승,강필제,주석중,이용직,정성호,이재원,송현,정철현 대한흉부외과학회 2008 Journal of Chest Surgery (J Chest Surg) Vol.41 No.4

Background: The interest in robotic cardiac surgery has recently grown but there has not been much clinical research reported on this. The aim of this study is to examine our initial experience, since August 2007, with robotic cardiac surgery using the da VinceTM surgical system and to evaluate the feasibility and safety of it. Material and Method: Between August and December 2007, a total of 20 patients underwent robotic cardiac surgery using the da Vinci surgical system. For mitral valve repair (n=11), tricuspid valve repair (n=1), and ASD repair (n=1), cannulation, antegrade cardioplegia and transthoracic aortic cross-clamping were conducted for the right femoral vessels and the right internal jugular vein. For minimally invasive direct CABG (MIDCAB) (n=7), the internal thoracic artery (ITA) was harvested with the da Vinci surgical system. Result: The mean age of the patients was 50.1 (range: 26∼78) years. Three concomitant Maze procedures and one tricuspid annuloplasty were combined with mitral valve repair. The mean cardiopulmonary bypass time was 208.0±61.3 minutes and the aortic cross clamp time was 158.8±40.6 minutes. No patients showed more than mild mitral regurgitation after repair and the median hospital stay was 4 days. The robotic-harvested ITA was used for either left ITA (n=6) or bilateral ITA (n=1). The mean harvest time was 43.2±12.0 minutes. The harvested ITA showed good flow and it was anastomosed under direct vision after left anterolateral thoracotomy. The patency of all the grafts was 100% (18/18) in MIDCAB. Conclusion: Robotic cardiac surgery using the da Vinci surgical system was variously adapted to areas such as mitral and tricuspid valve repair, ASD repair and ITA harvest for MIDCAB. The early results of the robotic cardiac surgery showed its safety and feasibility. With this primary report, we anticipate that clinical applications and further studies on robotic cardiac surgery using the da Vinci surgical system will be actively conducted in Korea.

Transit Time Flowmetry and Vein Size Are Predictive of Arteriovenous Fistula Maturation

권예리,조영종,강필제,조원철 대한흉부외과학회 2020 Journal of Chest Surgery (J Chest Surg) Vol.53 No.5

Background: This study aimed to assess the effect of vessel size and flow characteristics on the maturation of autogenous radiocephalic arteriovenous fistulae (RCAVFs). Methods: We retrospectively reviewed records of patients undergoing RCAVF creation at a single medical center from January 2013 to December 2019. Operative variables were compared between patients whose fistulae matured and those whose fistulae failed to mature. Results: Overall, 152 patients (33 of whom were women) with a mean age of 62.6±13.6 years underwent RCAVF creation; functional maturation was achieved in 123. No statistically significant differences were observed between patients in whom maturation was or was not achieved in terms of the following variables: female sex (20.3% vs. 25.0%), radial artery size (2.5 vs. 2.4 mm), and pulsatility index (0.69 vs. 0.62). Low intraoperative transit time flowmetry (TTF; 150.4 vs. 98.1 mL/min) and small vein size (2.4 vs. 2.0 mm) were associated with failure of maturation. The best cutoff diameter for RCAVF TTF and cephalic vein size were 105 mL/min and 2.45 mm, respectively. Conclusion: In patients who undergo RCAVF creation, vein diameter on preoperative ultrasonography and intraoperative TTF are predictors of functional maturation. We identified an intraoperative TTF cutoff value that can be used for intraoperative decision-making.

좌측 완전 심낭결손증을 동반한 Communicating Bronchopulmonary Foregut Malformation -1예 보고-

유동곤,김종욱,박종빈,강필제,이종혁 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.11

Clinical implications of pleural effusion following left ventricular assist device implantation

임소민,김아람,현준호,이상언,강필제,정성호,김민석 대한중환자의학회 2024 Acute and Critical Care Vol.39 No.1

Background: Studies on the association between pleural effusion (PE) and left ventricular assist devices (LVADs) are limited. This study aimed to examine the characteristics and the clinical impact of PE following LVAD implantation.Methods: This study is a prospective analysis of patients who underwent LVAD implantation from June 2015 to December 2022. We investigated the prognostic impact of therapeutic drainage (TD) on clinical outcomes. We also compared the characteristics and clinical outcomes between early and late PE and examined the factors related to the development of late PE.Results: A total of 71 patients was analyzed. The TD group (n=45) had a longer ward stay (days; median [interquartile range]) (31.0 [23.0–46.0] vs. 21.0 [16.0–34.0], P=0.006) and total hospital stay (47.0 [36.0–82.0] vs. 31.0 [22.0–48.0], P=0.002) compared to the no TD group (n=26). Early PE was mostly exudate, left-sided, and neutrophil-dominant even though predominance of lymphocytes was the most common finding in late PE. Patients with late PE had a higher rate of reintubation within 14 days (31.8% vs. 4.1%, P=0.004) and longer hospital stays than those without late PE (67.0 [43.0–104.0] vs. 36.0 [28.0–48.0], P<0.001). Subgroup analysis indicated that female sex, low body mass index, cardiac resynchronization therapy, and hypoalbuminemia were associated with late PE.Conclusions: Compared to patients not undergoing TD, those undergoing TD had a longer hospital stay but not a higher 90-day mortality. Patients with late PE had poor clinical outcomes. Therefore, the correction of risk factors, like hypoalbuminemia, may be required.

Extracorporeal Life Support in Adult Patients with Hematologic Malignancies and Acute Circulatory and/or Respiratory Failure

조성빈,조원철,임주영,강필제 대한흉부외과학회 2019 Journal of Chest Surgery (J Chest Surg) Vol.52 No.1

Background: The primary goal of this study was to characterize the clinical outcomes of adult patients with hematologic malignancies (HM) who were treated with extracorporeal membrane oxygenation (ECMO) support when conventional treatments failed. Methods: In this retrospective, observational study at a tertiary medical center, we reviewed the clinical course of 23 consecutive patients with HM requiring ECMO who were admitted to the intensive care unit at Asan Medical Center from March 2010 to April 2015. Results: A total of 23 patients (8 female; median age, 44 years; range, 29–51 years) with HM and severe acute circulatory and/or respiratory failure received ECMO therapy during the study period. Fourteen patients received veno- arterial ECMO, while 9 patients received veno-venous ECMO. The median ECMO duration was 104.7 hours (range, 37.1–221 hours). Nine patients were successfully weaned from ECMO. The in-hospital mortality rate was 91.1% (21 of 23). There were complications in 3 patients (cannulation site bleeding, limb ischemia, and gastrointestinal bleeding). Conclusion: ECMO is a useful treatment for patients with circulatory and/or pulmonary failure. However, in patients with HM, the outcomes of ECMO treatment results were very poor, so it is advisable to carefully decide whether to apply ECMO to these patients.

F-119 : 급성호흡곤란증후군에서 체외막 산소화 장치를 적용한 환자의 치료 성적 및 임상양상

이병희,조우현,김윤성,전두수,이승은,김도형,손봉수,강필제 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.0

배경: 급성호흡곤란증후군(Adult respiratory distress syndrome, ARDS) 환자에서 고식적 기계환기 치료로 반응하지 않을 경우 체외막 산소화 장치(Extracorporeal membrane oxygenation, ECMO)를 적용한 치료 사례가 늘어나고 있으며 국내에서도 적용하는 증례가 늘고 있다. 실제 급성 호흡곤란 증후군에서 치료 효과 및 임상적 특징들을 확인하고자 연구를 진행하였다. 방법: 2011년 1월 1일부터 2013년 6월 30일까지 양산부산대학교병원에 내원한 환자 중 급성호흡곤란증후군(Berlin definition)범주에 속하면서 ECMO를 적용한 31명의 임상 양상에 대하여 후향적으로 조사하였다. 결과: 연구 대상 환자들의 평균 연령은 59.8±13.9세로 ECMO 적용 전 평균 APACHE II, SOFA, Murray lung injury 점수는 각각 19.93±7.36, 11.34±5.39, 3.97±0.49 였으며 적용 전 인공호흡기 사용기간은 평균 60.33±99.65시간이었으며 평균 256.05±182.68시간동안 ECMO를 적용하였다. 이들 중 11명(35.5%)이 성공적으로 이탈하였으며 폐이식 전 적용을 제외한 25명중에서 6명(24%)이 생존퇴원이 가능하였다. 결론: 본 기관에서 ECMO를 이용한 ARDS 치료 성적은 아직까지 국외 보고와는 차이가 있었다. 그러나 ARDS의 치료에 ECMO를 도입하기 시작한 초기 결과에 비해 최근 성적이 나아지는 경향을 관찰할 수 있어 추후 경험의 축적이 치료성적에 좋은 영향을 줄 것으로 판단된다.

F-120 : Free Paper Presentation ; The Feasibility of Extracorporeal Membrane Oxygenation Support for Inter-hospital Transport and as a Bridge to Lung Transplantation

손봉수,김도형,조우현,김윤성,이상권,강필제,이영석,이광하 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

Background: Regional lung transplantation centers should be equipped with an inter-hospital transport program that can provide life-support for lung transplant candidates who develop acute respiratory failure outside the hospital. The purpose of this study was to assess the value of extracorporeal membrane oxygenation (ECMO) as a means of support during transport and as a bridge to lung transplantation for transplant candidates who develop respiratory failure outside the transplantation center. Methods: We retrospectively analyzed data from 7 patients who developed acute lung failure during treatment of end-stage lung diseases at other hospitals and for whom inter-hospital transport to the lung transplantation center at our hospital was requested between December 2011 and June 2013. Result: All 7 patients were treated with ECMO via a Terumo Emergency Bypass Systemⓡ (EBSⓡ) during transport, and all were transported without incident. There were no adverse events related to ECMO. All patients maintained stable vital signs during transport. Four patients received lung transplant within 10.5±2.3 days (range 7 to 12 days) after transport, 1 patient was weaned from ECMO without transplant, and 2 patients died with multi-organ failure while awaiting donor lungs. Conclusion: ECMO was useful for transfer of lung transplant candidates who developed acute respiratory failure at other institutions and as a bridge to lung transplantation.Background: Regional lung transplantation centers should be equipped with an inter-hospital transport program that can provide life-support for lung transplant candidates who develop acute respiratory failure outside the hospital. The purpose of this study was to assess the value of extracorporeal membrane oxygenation (ECMO) as a means of support during transport and as a bridge to lung transplantation for transplant candidates who develop respiratory failure outside the transplantation center. Methods: We retrospectively analyzed data from 7 patients who developed acute lung failure during treatment of end-stage lung diseases at other hospitals and for whom inter-hospital transport to the lung transplantation center at our hospital was requested between December 2011 and June 2013. Result: All 7 patients were treated with ECMO via a Terumo Emergency Bypass Systemⓡ (EBSⓡ) during transport, and all were transported without incident. There were no adverse events related to ECMO. All patients maintained stable vital signs during transport. Four patients received lung transplant within 10.5±2.3 days (range 7 to 12 days) after transport, 1 patient was weaned from ECMO without transplant, and 2 patients died with multi-organ failure while awaiting donor lungs. Conclusion: ECMO was useful for transfer of lung transplant candidates who developed acute respiratory failure at other institutions and as a bridge to lung transplantation.

Right ventricular assist device with an oxygenator using extracorporeal membrane oxygenation as a bridge to lung transplantation in a patient with severe respiratory failure and right heart decompensation

오동규,심태선,조경욱,박승일,김동관,최세훈,이근동,정성호,강필제,홍상범 대한중환자의학회 2020 Acute and Critical Care Vol.35 No.2

Right heart decompensation is a fatal complication in patients with respiratory failure, particularly in those transitioned to lung transplantation using veno-venous extracorporeal membrane oxygenation (V-V ECMO). In these patients, veno-arterial (V-A ECMO) or veno-arterialvenous extracorporeal membrane oxygenation (V-AV ECMO) is used to support both cardiac and respiratory function. However, these processes may increase the risk of device-related complications such as bleeding, thromboembolism, and limb ischemia. In the present case, a 64-year-old male patient with idiopathic pulmonary fibrosis developed respiratory failure and commenced treatment with V-V ECMO as a bridge to lung transplantation. Unfortunately, the patient developed right heart decompensation and required both cardiac and respiratory support during treatment with V-V ECMO. Instead of adding arterial cannulation, he was switched to a novel configuration, a right ventricular assist device with an oxygenator (Oxy- RVAD) using ECMO, with drainage cannulation from the femoral vein and return cannulation to the main pulmonary artery. The patient was successfully bridged to lung transplantation without serious complications after 10 days of Oxy-RVAD support. To the best of our knowledge, this is an extreme rare and challenging case of Oxy-RVAD using ECMO in a patient successfully bridged to lung transplantation.