폐 기능검사가 불량한 2기 폐암환자에서 시행한 우전폐절제술 - l예 보고 -

진웅,이선희,전진영,홍성진,심성보,박재길,곽문섭,Jin, Ung,Lee, Sun-Hee,Chon, Jin-Young,Hong, Sung-Jin,Sim, Sung-Bo,Park, Jae-Kil,Kwack, Moon-Sub 대한기관식도과학회 2000 大韓氣管食道科學會誌 Vol.6 No.2

Pulmonary function test is used as a guideline for safe pulmonary resection without complications. Usually FEVl lower than 1 liter is considered as a contraindication of lobectomy. Therefore, the curative operation of resectable lung cancer can not be performed in the case of poor pulmonary functions. Nowadays, there are some arguing points about the value of preoperative PFTs before the pulmonary resection. We performed a right pneumonectomy for stage H lung cancer in a patient with poor lung function test; FVC 2.17L, FEVl 0.97L, FEVl/FVC 44%, FEF 25-75% 0.42L/sec, MVV 28L/min, TLC 5.18L, RV 2.99. During 4 months follow up, the patient had been tolerable. The follow up PFTs at postoperative 3 months 18 days showed up as follows; FVC 1.20L, FEVI 0.63L, FEVl/FVC 53%, FEF 25-75% 0.31L/sec, MVV 25L/min, TLC 3.80L, RV 2.33L.

St.Jude 기계판막을 이용한 인공심장판막 치환의 외과적 고찰

진웅,나석주,조규도,김치경,조건현,왕영필,이선희,곽문섭,김세화,이홍균,Jin, Ung,Rha, Suk-Joo,Cho, Kyu-Do,Kim, Chi-Kyung,Jo, Keon-Hyon,Wang, Young-Pil,Lee, Sun-Hee,Kwak, Moon-Sub,Kim, Se-Wha,Lee, Hong-Kyun 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.4

Total 400 St.Jude Medical Bileaflet Valves were implanted in 336 pts from January 1983 to June 1993; 64 were aortic, 205 were mitral, 64 were double valve and 3 were tricuspid position. The follow up period extended from 6 months to 10 years[mean 24.3 months]. Male to female ratio was 1:1.7. There were total 27 deaths[cardiac related 20, cardiac non-related 7]. Overall mortality was 2.9%/pt-yr. There were 10 early deaths[3.0%] and 10 late cardiac related deaths [3.0%]. Prosthetic valve related complications occurred in 19 patients[5.7%] and among them, seven died; four died of thromboembolic events, two died of anticoagulants therapy related hemorrhagic complications and one died of bacterial endocarditis. NYHA class improved significantly especially in aortic valve replacement and double valve replacement. In AVR cases, the mean NYHA was 2.8 preoperatively and 1.3 postoperatively. And in DVR cases, 3.3 preoperatively and 2.2 postoperatively. The decision to employ a particular prosthesis was made according to the anticipated or known complications of the valve. The St.Jude Medical Valve retains all the hazards of other mechanical valves, most notably, thromboembolism. But the hemodynamic performance of St.Jude Medical Valve compared most favorably with other substitute valves in many reports. 0ur experience didn`t show any differences compared other authors in terms of valve related complication. So we concluded St. Jude Medical Valve can be primarily considered in the selection of artificial valve except in the patients when the usage of anticoagulant therapy is contraindicated.

영아에서 발생한 식도열공탈장 수술치험 -1례 보고-

진웅,이선희,김우찬,박재길,곽문섭,김세화,Jin, Ung,Lee, Sun-Hee,Kim, Woo-Chan,Park, Jae-Kil,Kwack, Moon-Sub,Kim, Se-Wha 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.1

The esophageal hiatal hernia is a rare disease in Korea especially in children and infant. We experienced a case of type III esophageal hiatal hernia in 9 months female. She had no specific past history and familial history except recurrent URI and postprandial habitual vomiting. The chest X-ray and Barium swallowing showed herniated stomach in Rt. thoracic cavity and posterior mediastinum. We performed modified Belsey Mark IV procedure with using the 3-0 and 4-0 Pledgeted Ticrons. In operative field, the stomach cardia portion was herniated into the Rt.thoracic cavity and posterior mediastinum with elevation of the esophagogastric junction above the diaphragm. But there was no evidence of short esophagus and combined anomaly. The postoperative courses were uneventful and good without specific complication for about 5 months to this point.

신장이식환자의 관상동맥우회로술 -2례 보고-

진웅,윤정섭,조건현,곽문섭,김세화,Jin, Ung,Yoon, Jeong-Seob,Jo, Keon-Hyon,Kwack, Moon-Sub,Kim, Se-Wha 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.1

Doing CABG in patient with renal transplantation requires special concern to keep and preserve renal function safely during and after operation. We experienced two cases of CABG for treatment of myocardial ischemia. who underwent renal transplantation 2 and 3 years ago respectively. The first patient received single reversed saphenous vein graft at LAD and second one received double saphenous vein graft at LAD and OMI. Peri & postoperative urinary volume and renal function test were comparable with preoperative status in both cases. Although abnormal lipid metabolism due to long term use of immunosuppressive regimen act a causative role in development and progression of coronary artherosclerosis in renal transplantation patient, CABG can be done safely with some precaution including maintenance of adequate mean blood pressure and blood level of immunosupressive regimen during cardiopulmonary bypass.

관상동맥우회술 후 발생한 뇌혈관계 합병증

진웅,김영두,윤정섭,김치경,Jin, Ung,Kim, Young-Doo,Yoon, Jeong-Seob,Kim, Chi-Kyung 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.11

배경: 뇌혈관계 합병증은 관상동백우회술 후 발생하는 사망률 중 10% 이상을 차지하는 치명적인 질환이다. 최근들어 고령 환자, 고혈압, 당뇨병 등이 병발하고 고 위험군에 대한 수술이 증가하면서 뇌혈관계 합병증은 오히려 증가하고 있다. 본 연구는 관상동맥우회술을 받은 환자의 의무기록을 조사하여 관상동맥우회술 후 발생되는 뇌혈관계 질환의 위험 인자를 밝히고자 한다. 대상 및 방법: 1991년 3월부터 1999년 7월 사이에 관상동맥우회술을 받은 185명을 조사하여, 뇌혈관계 합병증의 위험 인자들을 통계적으로 검증하였다. 결과: 뇌혈관계 합병증의 유병율은 7.57%(14명)였으며 이중 5예는 사망하였다. 동 기간 중 전체 사망은 11예이므로 사망자의 45.5%가 뇌혈관계 합병증으로 사망한 것이다. 통계적의의가 있는 뇌혈관계 합병증 위험 인자로는 수술 후 부정맥(p=0.0064), 기왕의 뇌혈관계 병력(p=0.0090), 체외순환시간(p=0.0181), 대동맥의 동맥경화(p=0.03575) 및 당뇨병(p=0.0452) 등이었다. 경동맥협착이 동반되어 경동맥 혈관내막 절제술(carotid endarterectomy)을 동시에 시술한 경우는 2예였으나, 뇌혈관계 합병증은 발생하지 않았다. 75세 이상의 고령환자는 3명이었으며 모두 뇌혈관계 합병증은 발생하지 않았다. 결론: 관상동맥우회술 후 발생하는 뇌혈관계 질환과 통계적으로 유의한 위험요인은 수술 후 부정맥, 뇌혈관이상의 기왕력, 체외순환시간, 대동맥궁의 동맥경화, 당뇨 등이었다.

흉부식도 파열에 대한 외과적 치험 - 4례 보고 -

진웅,박재길,이선희,곽문섭,Jin, Ung,Park, Jae-Kil,Lee, Sun-Hee,Kwack, Moon-Sub 대한기관식도과학회 1999 大韓氣管食道科學會誌 Vol.5 No.1

Perforating injury of the thoracic esophagus leads to an almost Immediate exposure of the mediastinum to both oral secretions and refluxed gastric contents. And necrotizing inflammatory response developed inevitably. So, without proper managements, mediastinitis results in severe dehydration or septic conditions, and consequently the life of the patient can be threaten. We experienced recently 4 cases of esophageal perforation. Three cases were Boerhaave's syndromes and the other one was instrumental perforation in patient with corrosive esophageal stricture. Curative surgical procedures were done in 3 cases and the drainage procedure was only possible in the other one due to hepatic failure. And the patient with the drainage management was dead.

흉부 단순 촬영상 전반적 폐 침윤을 보이는 환자에서 시행한 수술적 폐 생검

진웅,윤정섭,김치경,곽문섭,Jin, Ung,Yoon, Jeong-Seob,Kim, Chi-Kyung,Kwack, Moon-Seob 대한기관식도과학회 2000 大韓氣管食道科學會誌 Vol.6 No.2

The patient with findings of diffuse infiltrative lung on chest X-ray has various causes; therefore, the prognosis is different and the treatment should be changed according to the cause. We are trying to identify the meaning of operative lung biopsy and to 11nd a more accurate and effective procedure. We reviewed 46 medical records of patients with the findings of diffuse infiltrative lung on chest X-ray who had undergone operative lung biopsy or biopsies for 8 years. The open lung biopsy were done in 22 cases(47.8%) and thoracoscopic lung biopsy in 24 cases(52.2%). There is no significant difference in the rate of diagnosis(p=0.452) and the incidence of complications(p=0.155) between these groups. The number of cases with more than two biopsies are 9(19.6%) and that of one biopsy are 37(80.4%). There are no statistical difference in the rate of diagnosis(p=0.928) and the incidence of complications(p=0.125). The postoperative complications occurred in 8 cases,7 cases of air leak more than 7 days and 1 case of respiratory insufficiency. In the diagnosis and treatment of the patients with findings of infiltrative lung on chest X-ray, the operative lung biopsy is the very necessary course, and shows satisfactory rate of diagnosis with negligible complications.

중증 폐기종 환자에서의 폐용적 감축술, 7례

진웅,이선희,김시훈,왕영필,조규도,박재길,곽문섭,김세화,Jin, Ung,Lee, Sun-Hee,Kim, Si-Hoon,Wang, Young-Pil,Cho, Kyu-Do,Park, Jae-Kil,Kwak, Moon-Sub,Kim, Se-Wha 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.6

배경: 폐용적 감축술은 말기 폐기종환자의 치료에 폐장이식의 대치술 혹은 전단계 시술로 최근 이용되고 있는 술식이다. 또한 심한 폐기종환자에서 종양이 동반되는 경우, 종양절제술과 동반하여 사용될 수 있을 것으로 생각된다. 저자들은 폐종양 절제술을 동시 시행한 2례를 포함하여 7례의 폐용적 감축술후 평균 21개월간의 추적 관찰 결과를 보고한다. 대상 및 방법: 가톨릭대학교 흉부외과에서는 1996년 7월부터 1997년6월까지 수술당시 폐 종양이 의심되었던 환자 2례를 포함하여 만성폐기종환자 7명에서 폐용적 감축술을 시행하였다. 술후 검사는 3개월, 6개월, 1년, 2년에 각각 시행하였으며 현재까지 평균 21개월의 추적관찰을 시행하였다. 결과: 술후 사망은 술후 13개월에 뇌 전이를 동반한 평편상피암이 좌상엽에서 발견된 환자 1례에서 있었다. 나머지 6례의 환자는 평균 21개월의 추적관찰 중으로 현재까지 양호한 경과를 보이고 있다. 결론: 폐용적 감축술은 심한 폐기종환자의 치료에 유용하며 앞으로 적절한 적응증이 확인되고 장기성적이 보고되는 등의 계속적인 연구 결과가 필요한 것으로 생각된다. 또 폐 기능의 여유가 없는 폐기종환자의 초기 폐종양치료에 술후 폐 기능의 개선을 위하여 종양절제술과 동시에 폐용적 감축술을 시행할 수 있을 것으로 생각된다. Background: These days, lung volume reduction surgery (LVRS) is used as an alternative or a bridge operation to lung transplantation in treating patients with severe emphysema. The procedure can be used in patients with pulmonary nodules combined with severe emphysema. We report the results of 21 months follow up after lung volume reduction surgery in 7 cases including 2 cases of concurrent resection of pulmonary nodules. Material and Method: Seven patients with emphysema, including 2 cases of preoperatively suspected lung cancer were operated with LVRS technique between July 1996 and June 1997. Result: Postoperative mortality was observed in a case of squamous cell carcinoma in LUL with brain metastasis, detected at postoperative 13months. Average of 21months(19-25months) follow up was done for other cases without specific events. Conclusion: LVRS is a useful operation in the treatment of patients with severe emphysema, but further evaluation should be done about the long term results and precise criteria for patient selection. Simultaneous LVRS and tumor resection could be done in patients with emphysema with marginal reserve in the hope of maximizing postoperative lung functions.

기관지협착환자에서 기관지내 팽창성 급속 스텐트 삽입후 재발한 기관지협착 치험 2례

김우찬,진웅,나석주,조건현,이선희,곽문섭,김세화,Kim, Woo-Chan,Jin, Ung,Rha, Suk-Joo,Jo, Keon-Hyon,Lee, Sun-Hee,Kwack, Moon-Sub,Kim, Se-Wha 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery (J Chest Surg) Vol.28 No.5

Since the insertion of self expandable metalic stent[SEMS has became popular method for hollow organ stenosis, many attempts for further apply the stent to airway stenosis as an simple procedure has been made, but intrabronchial migration of stent or occurrence of inflammatory granuloma around stent develop occasionally and sometimes it worsen bronchial stenosis further more. This report describes 2 case of surgically treated bronchial restenosis in whom intrabronchial stent were applied for release of bronchial stenosis. Our surgical option was pneumonectomy and bronchoplasty with sleeve right middle and upper lobectomy respectively. During the operation we found the SEMSs were tightly impacted in restenotic bronchial lumen with overgrowth of granulation tissues. The bronchial obstructions occupied more than 90% of lumens in both cases, and needed much complicated procedure to be relieved. Therefore, even though the insertion of SEMS remains as a prcedure determined by the physician`s preference, it has to be considered prudently that the use of SEMS can cause severe restenosis and the surgeon has more difficulties in performing segmental resection of restenotic bronchus in patient with SEMS previously inserted. Throughout these experiences we can conclude that the insertion of SEMS must be performed only in very selected cases of bronchial stenosis.

백혈구제거 혈액성 충진액이 체외순환 후 심폐부종에 미치는 영향

김시훈,김영두,진웅,조건현,Kim, Si-Hoon,Kim, Young-Du,Jin, Ung,Jo, Keon-Hyun 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.9

심장수술을 위한 심정지 기간 중에 우리 몸의 혈액순환을 대신하는 인공심폐기에 의한 체외순환은 생명유지를 위하여 필수적인 과정이다. 그러나 혈액이 정상적인 혈관 이외의 부위에 노출됨으로서 발생하는 전신성 염증반응과 활성화된 백혈구는 치명적인 심폐부종을 초래하기도 한다. 저자는 이러한 위험을 줄이는 방법을 모색하고자, 인공심폐기를 구성하고 있는 산화기 및 회로르 채우는 충진액을 백혈구를 제거한 혈액성 충진액과 백혈구를 제거하지 않은 혈액성 충진액 및 비혈액성 충진액으로 구분하여 각각 체외순환을 시행한 후에 충진액내의 동종혈액의 백혈구가 심폐부종에 미치는 영향을 비교 관찰하였다. 대상 및 방법: 실험군은 15마리의 한국산 잡견을 충진액의 성분에 다라 비혈액성 정질용액, 백혈구를 제거하지 않은 동종혈액성 충진액, 백혈구를 제거한 동종혈액성 충진액을 사용한 군으로 각각 다섯 마리씩 세 군으로 나누었다. 세 군 모두에서 2시간의 체외순환 및 연속된 4시간의 마취유지 경과후에 폐조직 일부와 심근조직 일부를 적출하여 습건중량비를 비교하고, 동맥혈 가스분압과 동맥혈 이산화탄소분압 및 동맥혈 이산화탄소분압과 호기말 이산화탄소분압의 차이를 관찰하여 각 군간의 폐 환기능을 비교하였다. 결과: 1. 각 군간의 동맥혈 산소분압 및 이산화탄소분압의 유의한 차이는 없었다. 2. Pa$CO_2$-Et$CO_2$값으로 판단한 폐 환기능의 정도는 비혈액성 충진액을 사용한 군과 혈액성 충진액을 사용한 군 사이의 유의한 차이가 없었으나, 백혈구 제거군이 백혈구를 제거하지 않은 군보다 좋은 결과를 보였다(P<0.05). 3. 심근 및 폐조직의 습건중량비(Wet/Dry weight ratio)는 비혈액성 충진액을 사용한 군과 백혈구를 제거하지 않은 동종혈액성 충진액을 사용한 군간의 차이는 없었으나, 백혈구 제거군이 다른 두 군보다 유의하게 적게 나타났다. 결론: 위와 같은 실험 결과를 통하여 백혈구를 제거한 동종혈액을 사용한 충진액이 체외순환 후 나타나는 폐 환기능의 변화 및 심폐부종의 발생을 경감시키는데 효과가 있음을 관찰할 수 있었다. Background: Extracorporeal circulation using pump-oxygenator is an inevitable process to keep vital sign during cardiac arrest for open heart surgery. However, the diversion of blood through nonendothelialized channels appears to stimulate inflammatory response, and leukocyte activation may lead to cardiopulmonary edema. Our study evaluated the effect of leukocyte-induced cardiopulmonary edema using three different pump-oxygenator priming solutions; non-hemic crystalloid solution ; leukocyte-depleted homologous blood; non leukocyte-depleted homologous blood in priming solutions. Material and Method: Each different priming solution was used on five dogs, and the effect of leukocyte-induced cardiopulmonary edema during cardiopulmonary bypass(CPB) was evaluated. For each dog after 2 hours of exracorporeal circulation and another 4 hours of post-pump period, the dog was sacrificed and its heart and lung tissues were obtained for measuring Wet/Dry ratio. Arterial $O_2$partial pressure(PaO$_2$) and $CO_2$partial pressure(Pa$CO_2$) were checked. For the evaluation of ventilatory function, $CO_2$partial pressure difference between arterial blood (Pa$CO_2$) and exhaled air(Et$CO_2$) was measured. Result: 1. No significant difference was seen in arterial PaO$_2$and Pa$CO_2$among groups. 2. Ventilatory function evaluated by Pa$CO_2$and Et$CO_2$showed no significant difference between non-hemic and blood-mixed priming solution (P<0.05). 3. Cardiac and lung Wet/Dry ratios were remarkedly lower in the leukocyte-depleted group. There was no significant difference between the non-hemic and blood-mixed groups. Conclusion: Based upon this result, we concluded that the leukocyte depletion from homologous blood of CPB priming solution has a beneficial effect in reducing cardiopulmonary edema compared with non leukocyte-depleted or crystalloid priming solutions.