체내에 남은 거즈가 원인인 횡격막 하 농양

황의두,원태희,김시욱,나명훈,유재현,임승평,이영 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.1

ighty-four-year old man who had lapalotomy for stomach ulcer perforation 35 years ago was admitted for left lower chest discomfort. Chest X-ray and CT showed a large mass with air fluid level in left lower lung field. The tentative diagnosis was infected bronchogenic cyst. After a thoracotomy, the mass was confirmed as elevated diaphragm and subphrenic abscess with a foreign body, retained surgical gauze. The pus and gauze were located between stomach and diaphragm. His hospital course was smooth and uneventful, he was discharged with good outcome on postoperative day 9. 35년 전 궤양성 위 천공으로 개복 수술을 받은 84세 남자 환자가 좌하부 흉부 불편감을 주소로 내원하였다. 흉부 단순촬영과 컴퓨터단층촬영에서 좌하부 폐야에 air fluid level을 보이는 커다란 종물을 발견하였다. 추정진단은 염증성 기관지성 낭종이었다. 개흉술 후 그 종물은 상승된 횡격막과 위 사이에 이물인 잔여 거즈를 포함한 횡격막 하 농양으로 확진되었다. 농과 거즈는 횡격막과 위장 사이에 있었다. 수술 후 경과는 좋았고 술 후 9일째 퇴원하였다.

흉벽에 발생한 악성 신경초종 -1례 보고-

황의두,황경환 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.10

악성신경초종은 Schwan cell 또는 신경초 세포(nerve sheath cell)에서 발생하는 아주 드문 종양으로 빈번히 신경섬유종증(Von Rechlinghausen's disease)과 연관되어 있다. 환자는 64세 남자로 우측 가슴에 내원 2개월전부터 있던 무통성 종물을 주소로 내원하였으며 신경섬유종 증과의 동반은 없었다 전산화 단층촬영상 종물의 크기는 6 $\times$ 6 cm였으며, 11번 늑골과 횡경막을 침범하였 고 우신을 앞쪽으로 밀고 있었다. 본 교실에서는 흉벽에 발생한 악성신경초종을 경험하였기에 문헌고찰과 함께 보고한다. Malignant schwannoma is rare tumor which is derived from schwas cells or nerve sheath cells, and it is frequently associated with Von Rechlinghausen's disease. We experienced one case of malignant schwannoma on the right chest wall without Von Rechlinghausen's disease. Patient was 64-year-old man who presented painless palpable mass on the right lower -chest wall for about 2 months. On chest computed tomography, the mass which was 6$\times$6 cm in size and had central necrosis, involved 11th rib with destruction, invaded the diaphragm and displaced the kidney anteriorlly. He underwent on-bloc resection of the tumor and discharged without any problem after 20 days.

수술적 처치가 필요했던 식도이물에 관한 임상적 고찰

황의두,황경환 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.11

충남대학교병원에서 1980년7월부터 1995년 8월까지 경험한 식도이물 10례를 수술 치료하였다. 나이는 25 세에서 71세로, 평균 나이는 45.3세였고 남녀의 비는 6:4였다 가장 흔한 증상은 연하곤란, 발열, 이물감, 경부 동통이였다. 이물질은 생선뼈 3례였고, 거품 약포장지가 2례였고, 맥주병 마개,욕조 물마개, 깨진 사발 조각, 닭고기, 콩이 각각 1례였다. 진단은 수용성 식도 조영제와 식도 내시경을 이용하였다. 10례중 2례에서는 과거에 가성소다 섭취로 인해 식도 협착이 있었다. 1례에서는 정신과적 문제가 있었다. 식도이물은 모두 수술적 처치로 제거하였다 5례에서는 경부식도절게술을 시행하였고 1례는 우측 개흉술 을, 1례는 개복하여 위를 통해 위관을 역류성으로 통과 제거하였으며, 2례는 경부농양이 있어 절개후 배농하 였다. 3례는 수술 후 누출이 있었으나 수술치료없이 보존적 요법으로 호전되었으며,1례는 일시적인 애성이 있 었다. 1례는 외상성 기흉이 발생하여 폐쇄적 홉관 삽관술로 치료하였다. 수술 사망자는 없었다. Ten cases with esophageal foreign body were treated surgically from July 1980 to October 1995 at the Departme t of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. The mean age was 45.3 years, with a range from 25 to 71. Out of ten cases, 6 were female and four were male. Common symptoms were dysphagia, fever, foreign body sensation and neck pain. Three cases of foreign bodies were of fish bones, two of bubble paclcage of drugs, one case of a Eeer bottle cap, one of a piece glass, one of a bathtub plug, one of chicken and one of a bean. The diagnosis was established by esophagography using a water soluble contrast material and esophagoscopy. Among of ten cases, two had esophageal stricture due to the ingestion of Aye at a young age. One case had experienced psychological problems. All foreign bodies were removed by surgical procedures. Five cases were treated by cervical esophagostomy, one case by right thoracotomy, one case by retrograde bougienation through gastrostomy and two cases by cervical incision and drainage for cervical abscess. Three cases developed pos operative esophageal leaks which healed spontaneously and transient hoarseness developed in one case. One case developed traumatic pneumothorax and subcutaneous emphysema which was treated by closed thoracostomy. There were no operative deaths. C(ocean J Thorac Cardiovasc Surg 1997;30:1117-20)

Video-assisted Thoracoscopic Surgery Versus Transaxillary Thoracotomy for Primary Spontaneous Pneumothorax

Yu, Jae-Hyeon,Hwang, Eui Doo,Yoon, Soo Young,Park, Sang Soon 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

최근 비디오내시경의 발달로 비디오흉강수술은 자연기흉의 치료에 새로운 방법으로 발전되었고, 일반적으로 개흉술에 견줄만큼 안전하고 좋은 임상결과를 보이고 있다. 저자들은 자연성기흉의 치료에 있어 비디오흉강경으로 수술을 시행한 환자들과 정중액와 개흉술에 의해 수술한 환자들을 대상으로 그 임상적 결과를 비교하였다. 대상환자들은 1995년 2월부터 1997년 8월까지 일차성자연기흉으로 기포의 쐐기절제술 및 늑막유착술을 시행한 환자로서 비디오흉강경수술을 시행한 환자 37명과 정중액와개흉술에 의한 환자 30명을 대상으로 하여 두군간의 수술적응증, 수술시간(피부절개에서 피부봉합까지), 술후 진통제투여일수, 술후 흉관삽입기간, 술후 재원기간, 술후 합병증 및 술후 재발의 수를 비교하였다. 대상환자들의 추적기간은 8개월에서 38개월이었다. 수술은 1군(비디오흉강경수술) 37명에서 42례의수술(양측 5례), 2군(정중액와 개흉술) 30명에서 39례의 수술(양측 9례)을 시행하였다. 수술방법은 2례(1군)를 제외하고 모두 기포절제술 및 늑막의 기계적유착술을 시행하였다. 환자의 연령, 성별, 수술적응증은 두군간에 큰 차이가 없었다. 수술적응증은 재발이 35례, 지속적인 공기누출이 8례, 반대측에 기흉이 있었던 경우 6례, 흉부 X-ray상에 기포가 존재한 경우 15례, 양측성 3례로 두 군간의 큰차이가 없었다. 술후 진통제 사용일수, 수술후 흉관 삽입기간, 술후 재원일수는 흉강경 수술군에서 유의하게 낮았으나, 술후 재발율은 흉강경수술군에서 약간 높았다. 비비디오 흉강경 수술은 수술후 빠른 회복, 술후 재원 기간의 감소, 통증의 감소 및 미용상의 문제 등으로 자연기흉의 치료에 있어 개흉술보다 많은 장점이 있으나 재발율의 증가가 해결되어야 할 문제이다. 이는 장기적으로 외과의의 경험의 축적과 적극적인 늑막유착술의 병행으로 개흉술에 견줄만한 결과를 보이리라 생각된다.

승모판막 재치환의 임상적 고찰

이영,황의두 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Ten cases of mitral valve replacement were done at Department of Chest Surgery in Chungnam National University Hospital during the period from Nov. 1991 till Dec. 1997 were covered in this study. All case were replaced using lonescu-Shiely glutealdehyde treated bovine pericardial valve at the first operation. The average time interval between reoperation and previous operaration was 10 years (ranged from 5 years to 13.2 years). The most pronounced pathology of the failed xenograft valves was calcification and fixation of cusp. The failed tissue valves were replaced with CarboMedics bileaflets valve(9 cases) and Sorin(1 case) mechanical valve. One patient was died of failure of weaning from cardiopulmonary bypass.

手術的 處置가 必要했던 食道異物에 關한 臨床的 考察

李榮,黃義斗 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

Nine cases with esophageal foreign body were treated surgically during the period from Oct. 1985 to Oct. 1995 at the department of thoracic and cardiovascular surgery, Chungnam National University Hospital. The mean age was 45.8 years range from 25 to 71. Out of nine, 5 cases were female and four cases were male. Common symptoms were dysphagia, foreign body sensation and neck pain. The foreign bodies were three cases of fish bone, two cases of bubble package of drug, a case of beer bottle cap, a case of bath tub plug, a case of chicken and a case of bean. The diagnosis was established by esophagography using water soluble contrast material and esophagoscopy. Out of nine, two cases were esophageal stricture due to the ingestion of lye at their young age. One case had experienced psychological problems. All foreign bodies were removed by surgical procedures. Five case were treated by cervical esophagostomy, one case by right thoracotomy, one case by retrograde bougienation through gastrostomy and one case by cervical incision and drainage for cervical abscess. Three cases developed post operative esophageal leaks which healed spontaneously and transient hoarseness in one case. There were no operative death.

우측 쇄골하동맥 기시 이상에 의한 동맥-식도루

황경환,황의두 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.11

혈관륜이 있는 경우 드물게 동맥 식도루가 발생하여 대출혈이 발생할 수 있다. 42세 남자환자가 교통사고 후 7주간 비위관을 삽입하고 있던 중 상부 위장관 출혈이 발생하여 응급수술을 하였다. 수술 소견상 우측 쇄골하동맥 기시이상이 있었으며 오랜 비위관 상관으로 발생된 것으로 생각되는 동맥-식도루가 있어 이를 수술교정 하였다. 술후 환자상태는 안정 되었으나 술후 5일째 흉관 자극과 염증에 기인 하는 대동맥 봉합부위의 출혈이 발생하여 재수술을 하였고 의식불명 상태로 술후 8일째 사망하였다. A case of fatal hematemesis due to an aberrant right subclavian arterioesophageal fistula which is a rare complication of the vascular ring is presented. A 42-year-old man with multiple injury by traffic accident presented severe upper gastrointestinal bleeding and was taken emergent operation. He was keeping tracheostomy tube and nasogastric tube for 7 weeks. We could find an aberrant right subclavian arterioesophageal fistula through left thoracotomy which was made by irritation of the prolonged nasogastric ube. We carried division of the aberrant right subclavian artery and fistulectomy. He was doing well postoperatively. But massive bleeding occurred at the fifth postoperative day. We performed emergent reoperation at CCU and found the tear point on the suture site of the aorta, which might be developed due to irritation of the chest tube andfor infection of the surrounding tissues. He was expired at the 8th postoperative day due to ischemic brain damage.

식도암 수술후 흉곽내 위 천공 -치험 2례-

이영,황의두,황경환,윤수영,나명훈,유재현,임승평,Lee, Young,Hwang, Eui-Doo,Hwang, Kyung-Hwan,Yoon, Su-Young,Na, Myung-Hoon,Yu, Jae-Hyun,Lim, Seung-Pyung 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.9

We report our experience with 2 cases of perforation of intrathoracic stomach after Ivor Lewis operation for esophageal cancer. There was no problem in the anastomotic site, but the drainage from pleural cavity increased after oral intake. The stomach perforation was proved by rethoracotomy. The perforation site was repaired by sutures with pedicled intercostal muscle. 충남대학교 의과대학 흉부외과학 교실에서 흉부식도암 수술적 치료로 흉곽내 위문합 Ivor Lewis 수술후 흉곽내 위천공이 발생한 환자 2례를 치험하였다. 문합부는 문제가 없었으나 경구섭취 후 흉강을 통한 배액이 증가되었다. 위천공은 재수술을 위해 개흉술을 시행하여 확인 할 수 있었다. 위천공 부위는 재봉합 후 늑간근을 이용하여 보강하였다.

자연기흉의 외과적 치료

이영,황의두,윤수영 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

Eighty- six patients with spontaneous pneumothorax were treated surgically at the department of thoracic and cardiovascular surgery Chungnam National University Hospital during period from Oct. 1993 till Dec. 1997. ratio between male and female was 8 : 1, their age ranged from 15 years to 76 years old(average, 26.3). The surgical indications were recurrent pneumothorax, continuous air leakage, bullae on chest x-ray film, previous contralatera pneumothorax and hemopneumothorx. The methods of thoracotomy were axillary approach(41 cases), posterolateral incision(21cases), anterolateral approach and VATS(22 cases). Post operative complications were air leakage, wound infection, bleeding, pleural effusion, brachial plexus injury and ptosis. The brachial injury and ptosis were transient and recovered completely three weeks after surgery. There was no mortality.

Circulating Tumor Cell Detection in Lung Cancer Animal Model

정유영,정용채,황의두,조현진,강민웅,나명훈 대한흉부외과학회 2021 Journal of Chest Surgery (J Chest Surg) Vol.54 No.6

Background: Metastasis and recurrence of primary cancer are the main causes of cancer mortality. Disseminated tumor cells refer to cancer cells that cause metastasis from prima- ry cancer to other organs. Several recent studies have suggested that circulating tumor cells (CTCs) are associated with the clinical stage, cancer recurrence, cancer metastasis, and prognosis. There are several methods of isolating CTCs from whole blood; in particu- lar, using a membrane filtration system is advantageous due to its cost-effectiveness and availability in clinical settings. In this study, an animal model of lung cancer was established in nude mice using the human large cell lung cancer cell line H460. Methods: Six-week-old nude mice were used. The H460 lung cancer cell line was inject- ed subcutaneously into the nude mice. Blood samples were obtained from the orbital area before cell line injection, 2 weeks after injection, and 2 weeks after tumor excision. Blood samples were filtered using a polycarbonate 12-well Transwell membrane (Corning Inc., Corning, NY, USA). An indirect immunofluorescence assay was performed with the epithelial cell adhesion molecule antibody. The number of stained cells was counted using fluorescence microscopy. Results: The average size of the tumor masses was 35.83 mm. The stained cells were counted before inoculation, 2 weeks after inoculation, and 2 weeks after tumor excision. Cancer cells generally increased after inoculation and decreased after tumor resection. Conclusion: The CTC detection method using the commercial polycarbonate 12-well Transwell (Corning Inc.) membrane is advantageous in terms of cost-effectiveness and convenience.