양성 폐종양의 수술적 치료

박건,조덕곤,박재길,조건현,왕영필,곽문섭,김세화,이홍균,Park, Kuhn,Cho, Deog-Gon,Park, Jae-Kill,Jo, Geon-Hyon,Wang, Young-Pil,Kwack, Moon-Sub,Kim, Se-Wha,Lee, Hong-Kyun 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.3

Benign lung tumors have been considered as relatively rare disease, which comprise approximately 8 to 15% of all solitary pulmonary lesions that are detected radiographically. We clinically analized 30 cases of benign lung tumors underwent the operation from Jan. 1970 to Aug.1991 in the department of thoracic and cardiovascular surgery, Catholic University Medical College. We adopted the classification presented by the World Health Organization[WHO], modified from Liebow, and added benign mesothelioma. There were 11 males & 19 females ranging in age from 2 years to 68 years old % the mean age was 38 years old. Of all 30 benign lung tumors, hamartomas [14 cases, 49%] were the most common & followed by hemangiomas [9 cases, 30%], 3 cases of benign mesotheliomas % a case of teratoma, papilloma, arteriovenous malformation and inflammatory pseudotumor. 14 cases of tumors were asymptomatic & were incidentally detected by plane chest x-ray In other cases, chief complaints at admission were coughing, chest discomfort, dyspnea, hemoptysis, and fever. Diagnosis were made by pathological examination; exploratory thoracotomy in 23 patients[76.7%], bronchoscopy in 4 patients and percutaneous needle aspiration biopsy in 3 patients. Precisely, preoperative diagnosis for confirmation of benign lung tumor was made only in 7 cases[23.6%]. Tumors were located on Rt.side[24 cases], especially Rt. middle lobe, and Lt.side[6 cases]. Operation methods were as follows: 21 cases [70%] of lobectomy, 2 cases of segmentectomy, 2 cases of wedge resection, 1 case of pneumonectomy, 1 case of bronchotomy, 2 cases of wedge resection, 1 case of pneumonectomy, 1 case of bronchotomy removal of the endobronchial hamartoma which located at the rt. main stem bronchus and 3 cases of complete resection in benign mesotheliomas. There were no operative death. The post operative complications were developed in 3 cases; post pneumonectomy empyema, wound infection and atelectasis. In conclusion, benign lung tumors must be histologically diagnosed to confirm of benignity and to provide limited resection for preservation of the lung tissue, whenever possible.

H-type 기관식도루 1례

박건,김영두,권종범,원용순,곽문섭,Park, Kuhn,Kim, Young-Du,Keon, Jong-Bum,Won, Yong-Soon,Kwack, Moon-Sub 대한기관식도과학회 2000 大韓氣管食道科學會誌 Vol.6 No.1

Isolated(H-type) tracheoesophageal fistula without esophageal atresia occurs in approximately 4% of esophageal anomalies, and represents the least form of abnormal laryngotracheo-esophageal communication. Its symptoms such as coughing and choking The during the feeding, abdominal distension and recurrent pneumonitis usually start from birth. Diagnosis is made between 4 days to 4 years using the contrast esophagography and/or tracheoscopy. In case of diagnostic delay the postoperative mortality is not negligible and the most common cause of mortality is respitatory problems(infection, respiratory distress). So early diagnosis is essential in the newborn period with high index of suspicion. We report a case of H-type TEF in which operative repair was successful with references to recent literature.

협소대동맥판륜을 동반한 대동맥판막협착 및 폐쇄부전증 치험 1례 - Nicks 술식에 의한 대동맥판륜 확장술 -

박건,김치경,곽문섭,김세화,이홍균,Park, Kuhn,Kim, Chi-Kyung,Kwak, Moon-Sub,Kim, Se-Wha,Lee, Hong-Kyun 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.3

The presence of a small aortic annulus creates a difficult technical problem. Whenever possible, the smaller prosthesis of any type should be avoided. A case of aortic stenoinsufficiency with fibrous small aortic annulus [17 mm] in 26 years old adult woman patient was successful operated upon with aortic valve replacement [21 mm St. Jude Medical valve] and enlargement of aortic annulus with Gore-Tex patch. The postoperative course was uneventful.

안명부다한증에 대한 흉강경수술 -3례 보고-

정진용,연성모,박건,곽문섭,윤석훈,Jeong, Jin-Yong,Yeon, Seong-Mo,Park, Kuhn,Kwack, Moon-Sub,Yoon, Suk-Hoon 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.3

다한증은 감염이나 일부 종양 등에서 볼 수 있으나, 원인질환이 없이 원발성으로 발생하는 경우도 있다. 원발성 다한증의 경우 땀이 많이 나는 부위는 주로 손바닥이며 안면부에서 땀이 과다하게 나는 경우도 있다. 최근 흉강경을 이용한 흉부교감신경절제술이 다한증의 외과적 치료로 이용되고 있는데, 안면부다한증의 경우에는 성상신경절의 일부를 절제하기 때문에 호너증후군 등의 합병증 발생 가능성이 높다. 저자들은 최근 안면부다한증 3례의 환자에서 흉강경을 이용하여 성상신경절의 일부를 포함한 흉부교감신경절제술를 시행하였다. 수술후 모두에서 증상호전이 있었으며 호너증후군 등의 합병증은 없었다. Facial hyperhidrosis has a symptom of excessive sweating on the face with or without underlying disease. It can be surgically treated by video-assisted thoracic surgery(VATS). We encountered three cases of facial hyperhidrosis which we treated by VATS, which was performed by resection of the lower third of stellate ganglion and T2-T3 sympathetic ganglia with chains. Postoperative symptom was improved in all cases. There were no postoperative complications such as Horner's syndrome or postsympathectomy neuralgia.

외엽형 폐격리증을 동반한 선천성 낭종성 신종양 기형 - 1례 보고 -

이재광,권종범,박건,곽문섭,심성보,Lee, Jae-Kwang,Kweon, Jong-Bum,Park, Kuhn,Kwack, Moon-Sub,Sim, Sung-Bo 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.7

선천성 낭종성 선종양 기형과 외엽형 폐격리증은 아주 드문 질환이다. 본원에서는 4세 된 여자환자에서 좌폐화엽의 선천성 낭종성 선종양 기형을 수술하던 중 우연히 외엽형 폐격리증이 동반된 것을 알고 좌폐하엽 절제술과 외엽형 폐격리증 절제술을 시행하였는데, 외엽형 폐격리증은 흉부대동맥에서 비정상적으로 직접 1개의 동맥으로 유입되고, 늑간정맥을 통하여 기정맥으로 유출되었다. 환자는 수술 후 건강하게 퇴원하였다. Congenital cystic adenomatoid malformation and Extralobar Pulmonary sequestration are very rare congenital anomalies. We experienced a 4 year-old female patient who had Congenital cystic adenomatoid malformation in her lower lobe of left lung. We accidently found extralobar pulmonary sequestration associated with Congenital cystic adenomatoid malformation at operation field. The resection of the left lower lobe and the extralobar pulmonary sequestration were performed. The arterial supply of the extralobar pulmonary sequestration was one anomalous artery arised from the thoracic aorta. The Venous drainage of expralobar pulmonary sequestration was intercostal vein into the azygous vein. The patient was discharged without any problem.

식도암에서의 흉강경 식도적출술 치험 1례

정진용,연성모,박건,곽문섭,곽승수,Jeong, Jin-Yong,Yeon, Seong-Mo,Park, Kuhn,Kwack, Moon-Sub,Kwak, Seung-Soo 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.4

흉강경수술은 최근 기구 및 술기의 급속한 발전으로 인하여 흉부의 간단한 수술 뿐만 아니라 비교적 복잡한 수술까지 적용될 정도로 그 활용이 광범위하게 되었다. 식도암에서의 흉강경을 이용한 식도적출술은 개흉술 및 개복술을 통한 식도적출술 후에 발생할 수 있는 합병증이 적다는 장점이 있으나, 이의 시술에는 많은 어려움이 뒤따르고 있으며 고도의 술기를 요한다. 최근 저자들은 하부식도에 발생한 편평상피세포암에 대해 흉강경을 이용한 식도적출술 및 식도위문합술을 시행하였다. 환자는 59세 남자로 연하곤란을 주소로 내원하였으며 식도조영술과 식도경검사에서 하부식도에 궤양성 종양을 보였으며 전산화단층촬영에서 주위장기으로의 침범이나 림프절종대는 없었다. 수술은 흉강경을 이용하여 흉부식도를 박리하고 개복술로 위관을 형성한 후 경부에서 식도위문합술을 시행하였다. 수술후 애성과 문합부위의 누출이 있었으나, 보존적 치료후 문합부위의 누출은 치유되어 양호한 상태로 퇴원하였으며 애성은 수술후 약 2개월후에 소실되었다. Thoracoscopic esophagectomy can be performed in esophageal diseases to reduce the postoperative complications. Recently, We encountered a case of esophageal cancer and successfully treated it by thoracoscopic esophagectomy with gastric pull-up. A 59-year-old male was presented with swallowing difficulty and an esophagogram, esophagoscopy, and chest CT showed an ulcerating tumor on the lower esophagus. The operation was performed in three stages: mobilization of the esophagus by thoracoscopic surgery, construction of a gastric tube through a laparotomy, and cervical anastomosis between the esophagus and the gastric pull-through. Hoarseness developed postoperatively, and the postoperative esophagogram showed leakage at the esophagogastric anastomotic site. The anastomotic leakage was healed following surgical drainage and the patient was discharged in good health. Hoarseness subsided spontaneously two months after surgery.

의인성 하인두-식도천공에 대한 외과적 고찰

박재길,조규도,박건,왕영필,Park Jae Kil,Cho Kyu Do,Park Kuhn,Wang Young Pil 대한기관식도과학회 2004 大韓氣管食道科學會誌 Vol.10 No.2

Background : Esophageal perforation due to a traumatic endoscopy or intubation is exceedingly rare. If riot noticed immediately or treated promptly, however, the morbidity and mortality is significant. We performed a retrospective review of patients with iatrogenic hypopharyngo-esophageal perforation to assess the outcome of current management techniques. Material and Methods : We retrospectively analyzed all cases iatrogenic hypopharyngo-esophageal perforation diagnosed at our hospital from January, 1999, through April, 2004. The study group consisted of 11 patients (4 men) with a mean age of 47.6 years (range, 21-83 yr). We reviewed the 11 patients with perforated injuries of the hypopharynx or esophagus during the diagnostic or therapeutic procedures. Result: Perforations were due to diagnostic gastroscopy ($54.5\%$, 6/11), esophageal dilation ($27.3\%$, 3/11), endoscopic port insertion ($9.1\%$, l/11), and tracheal intrathoracic ($9.1\%$, 1/11). Seven patients had intrathoracic and 4 had cervical perforations. Treatment included incision and drainage (5), resection and reconstruction (4), drainage only (1), and observation (2). Nonfatal complications included transient pneumonia (1), and wound infection (1). They occurred in advanced mediastinal abscess ]patients. Mortality was $9.1\%$ (1/11) in old patient who managed medically in cervical esophageal perforation. Conclusions : Current mortality rates in iatrogenic esophageal perforation were improved compared to previous published rates of $19\%\;to\;66\%$ for all patients with this condition. We concluded that aggressive and definitive surgery for thoracic esophageal perforations improving the survival rate, whether diagnosed early or late.

기관지 결석의 수술치험 3례

조덕곤,조규도,박건,곽문섭,김치홍,Cho, Deog-Gon,Cho, Kyu-Do,Park, Kuhn,Kwack, Moon-Sub,Kim, Chi-Hong 대한기관식도과학회 1999 大韓氣管食道科學會誌 Vol.5 No.1

Broncholithiasis is defined as a condition in which calcified material is present within the bronchial lumen. It is a rare but troublesome disease that can cause life-threatening complications such as massive fatal hemoptysis. Therefore, pulmonary resection is frequently required to remove the broncholiths and irreversibly damaged parenchyma. We experienced 3 cases of broncholithiasis. In one case, a 36 year old female patient suffered from coughing, massive hemoptysis with lithoptysis caused by intrinsic obstructive broncholiths in the right middle and lower lobe. In the 2nd case, a 41 year old male patient complained of long-standing blood tinged sputum and frequent pneumonic symptoms for 10 months because of extrinsic broncholithiasis where the calcified peribronchial lymph node eroded into the bronchial lumen of the right lower lobe. The remaining case involved a 30 year old female patient who complained of intermittent blood-tinged sputum induced by intrabronchial broncholith in the orifice of the right middle lobe bronchus. Two patients underwent bilobectomy(right middle and lower lobe) for removal of the broncholiths, damaged bronchi and parenchyma. The other patient was treated with right middle lobectomy and stone removal by bronchotomy of bronchus intermedius. In all patients, the post-operative course was uneventful.

체외순환 및 비체외순환하에서의 관상동맥우회로술

박찬범,권종범,박건,원용순,Park, Chan-Beom,Kwon, Jong-Bum,Park, Kuhn,Won, Yong-Soon 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.8

체외순환을 이용한 관상동맥우회로술은 수술적인 관상동맥 재관류 기법에서 보편적인 방법으로 여겨지고 있으나, 체외순환후 발생되는 전신적인 염증반응이나 혈액성분의 기계적 손상, 혈액응고장애등의 여러 가지 문제점들이 보고되고 있어, 이러한 합병증들을 피하기 위하여 체외순환을 이용하지 않는 관상동맥우회로술이 점차로 보편화되고 있어 체외순환 및 비체외순환하에서의 관상동맥후회로술을 비교분석하였다. 대상 및 방법: 1999년 3월부터 2000년 9월까지 비체외순환하에서 관상동맥우회로술 14례, 체외순환하에서 관상동맥후회로술 21례를 시행하였으며, 양군에서의 평균수술시간, 술후 기관삽관기간, 평균중환자실 재원기간, 평균재원기간, 수혈량, 술후 강심제의 사용, 술후 심근효소수치를 비교분석하였다. 결과: 평균수술시간은 심박동하 수술군에서 280$\pm$93.1분, 체외순환하 수술군에서 392.4$\pm$80.4분으로 심박동하 수술군에서 짧았으나 문합혈과 개수의 차이를 고려하면 양군에서의 수술시간은 차이가 없는 것으로 생각된다. 술후 기관삽관 시간은 심박동하 수술군에서 2.4$\pm$2.0hr, 체외순환하 수술군에서는 6.9$\pm$4.9hr으로 역시 심박동수술군에서 유의하게 짧았다(p<0.05). 중환자실 평균재원기간은 심박동하 수술군에서 $1.5\pm$0.7일, 체외순환하 수술군에서 2.3$\pm$3.7day 체외순환하 수술군에서 12.0$\pm$4.0day로서 별다른 차이는 관찰되지 않았다. 수술후 양군에서의 수혈량을 관찰하면 자기수혈량이 심박동하 수술군에서 113.6$\pm$173.1ml 체외순환하 수술군에서 478.6$\pm$310.9ml로서 심박동하 수술군에서의 수혈량이 유의하게 적었으며(p<0.05). 수술후 Dopamine, Dobutamine, Epinephrine의 사용량은 통계학적인 유의성은 발견할 수 없었으나, 심박동하 수술군에서 적은 경향을 관찰할 수 있었으며, 수술후 심근효소수치는 체외순환하 수술군에서 더욱 증가하였다. 결론: 비체외순환하 수술군에서 술후 기관 삽관기간, 평균 중환자실 재원기간이 짧으며, 수혈량 및 술후 강심베의 사용이 적으며, 심근보호효과가 뛰어난 것으로 생각되나, 향후 장기적인 추적관찰이 필요할 것으로 생각된다. Coronary artery bypass graft with cardiopulmonary bypass is a conventional method of operative revascularization of coronary artery disease. Because of many troubles of cardiopulmonary bypass such as systemic inflammatory reaction, mechanical trauma of blood components and coagulopathy, coronary artery bypass graft without cardiopulmonary bypass has been popularized. Material and Method: From March 1999 to September 2000, 35 patients under went CABG at our institution. Among them, 14 patients received CABG without the use of CPB and 21 patients under went CABG with the use of CPB. Mean operative time, mean postoperative tracheal intubation time, mean ICU stay, mean hospital stay, the amount of transfusion, postoperative use of inotropic agents, and postoperative changes of cardiac enzymes were compared in both groups. Result: There were differences between the CABG without CPB group and CABG with CPB group with regard to mean tracheal intubation time, the amount of transfusion and the elevation of postoperative cardiac enzymes(p<0.05). Conclusion: While CABG without CPB provided satisfactory results, more long term follow-up is required.

성인의 선천성 기관지식도루 1례

정진용,연성모,박건,곽문섭,성태현,유홍균,Jeong, Jin-Yong,Yeon, Seong-Mo,Park, Kuhn,Kwack, Moon-Sub,Seong, Tae-Hyon,Yoo, Hong-Kyun 대한기관식도과학회 1997 大韓氣管食道科學會誌 Vol.3 No.2

저자들은 53세 남자환자에서 성인에서는 매우 드물게 발견되는 선천성 기관지식도루 1례를 수술치험 하였기에 문헌고찰과 함께 보고하는 바이다. Congenital bronchoesophageal fistula is rare and usually has an incidious clinical course. We experienced a case of congenital bronchoesophageal fistula in adult. A 53 years old male patient visited our hospital for respiratory arrest following sudden dyspnea. He had experienced chronic coughing after swallowing and recurrent pneumonia since childhood. we could confirm the bronchoesophageal fistula preoperatively by barium swallow examination and performed right pneumonectomy and repair of the fistula. The postoperative course was uneventful.