자가정맥편을 이용한 관상동맥 혈관성혈술

류경민,김삼현,박성식,류재옥,서필원 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.6

Background: Onlay vein patch coronary angioplasty has been known to be an option for coronary artery stenosis in the selective iesions Material and method: During the period between July 1997 and August 1999, coronary angioplasty using autologous saphenous vein was done on 16 sites in 14 cases for the stenotic lesion at the bifurcation area and significantly stenosis distal to anastomosis. Result: Early patency of the angioplasty site was 85.7% at postoperative day 7. There was no statistically difference in graft patency, operative parameters, and complications compared to conventional anatomosis(p>0.05). Conclusion: Despite the small number of cases, the patency rate of the coronary patch angioplasty was comparable to the conventional CABG. Coronary artery only patch angioplasty could be performed in highly selected coronary arteries.

개심술 중 심폐기 이탈에 실패한 환자에게 적용한 경피적 심폐순환 보조장치

류경민,박성식,서필원,류재욱,김석곤 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.5

Background: Recently, percutaneous cardiopulmonary support (PCPS) has been widely used to rescue patients in cardiogenic shock or cardiac arrest. However, patients with cardiopulmonary bypass (CPB) weaning failure during open heart surgery still have very poor outcomes after PCPS. We investigated clinical results and prognostic factors for patients who underwent PCPS during open heart surgery. Material and Method: From January 2005 to December 2008, 10 patients with CPB weaning failure during open heart surgery underwent PCPS using the CAPIOX emergency bypass system (EBSⓇ, Terumo Inc, Tokyo, Japan). We retrospectively reviewed the medical records of those 10 patients. Result: The average age of the patients was 60.2±16.5 years (range, 19∼77 years). The mean supporting time was 48.7±64.7 hours (range, 4∼210 hours). Of the 10 patients, 6 (60%) were successfully weaned from the PCPS While 5 (50%) were able to be discharged from the hospital. Complications were noted in 5 patients (50%). In univariate analysis, long aortic cross clamp time during surgery, mediastinal bleeding during PCPS and high level of Troponin-I before PCPS were significant risk factors. All of the discharged patients are still surviving 34±8.6 months (range, 23∼48 months) post-operatively. Conclusion: The use of PCPS for CPB weaning failure during open heart surgery can improve the prognosis. More experience and additional clinical studies are necessary to improve survival and decrease complications. 배경: 최근 경피적 심폐순환 보조장치는 여러 원인의 심인성 쇼크나 심정지의 치료에 매우 활발하게 적용되고 있다. 하지만 개심술 후 체외순환 이탈에 실패한 경우 적용하는 경피적 순환보조는 아직 예후가 매우 불량하다고 알려져 있다. 본 연구는 개심술 후 체외순환 이탈에 실패하여 경피적 심폐순환보조장치를 적용한 환자들의 임상성적을 알아보고, 이들의 예후에 영향을 미치는 요인들에는 어떠한 것들이 있는지 알아보고자 시행하였다. 대상 및 방법: 2005년 1월부터 2008년 12월까지 개심술 후 심폐기 이탈에 실패하여 경피적 순환 보조장치(CAPIOX emergent bypass system, EBSⓇ, Terumo Inc, Tokyo, Japan)를 적용한 10명의 환자들의 의무기록을 후향적으로 분석하였다. 결과: 평균 연령은 60.2±16.5세(19∼77세)였고, 평균 체외순환보조기간은 48.7±64.7시간(4∼210시간)이었다. 순환 보조장치를 이탈할 수 있었던 경우는 6예(장치 이탈율 60%), 생존퇴원은 5예(생존율 50%)였다. 합병증은 5명(50%)에서 발생하였다. 단변량 분석에서 수술 중 대동맥 겸자시간이 길었던 경우, 순환 보조기간 중 종격동 출혈이 있었던 경우, 순환 보조장치 삽입전의 Troponin-I 수치가 높았던 경우가 사망에 영향을 미치는 인자로 조사되었다. 퇴원한 환자는 모두 생존하여 평균 34±8.6개월(23∼48개월)간 추적관찰 중이다. 결론: 개심술 후 체외순환 이탈에 실패하게 되는 경우 매우 높은 사망률을 보이는 바 이들 환자에 대하여 적극적인 경피적 순환 보조장치의 적용으로 향상된 생존율을 기대할 수 있었다. 앞으로 지속적인 생존율 향상 및 합병증 감소를 위한 보다 많은 경험 및 임상연구가 필요할 것으로 생각된다.

관상동맥 우회수술의 조기성적 (술후 혈관조영술을 통한 분석)

류경민,김삼현,박성식,류재옥,서필원 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.6

Background: Early patency of the coronary artery bypass grafting is determined mainly by surgical technique and status of coronary artery. We analyzed the early result, focusing on the relationship between postoperative angiographic findings and the patency rate. Material and method: During the period of July 1997- August 1999, 86 cases of CABG were performed and the postoperative coronary artery angiography was done in 76 cases on postoperative day 7 to assess the graft patency. Result: Overall graft patency was 90.2% on the angiographic finding. Factors influencing the early graft occlusion were the surgeon's experience, small coronary artery size less than 1.5mm in diameter, coronary arteries related to pre-operative myocardial infarction, and local atheroma at the anastomosis site(p<0.001). Operative mortailty was 2.3%. Early recurrence of the symptom was 19.8% during the follow up period. Conclusion: We examined the postoperative coronary angiography and found that the surgeon's experience, small coronary artery size less than 1.5mm in diameter, bypass surgery on the coronary arteries related to pre-operative myocardial infarction, and local atheroma at the anastomosis site were the factors for the graft occlusion.

관광호텔 외식사업체의 구조조정 현황 및 제도개선에 관한 연구

류경민,이동근 한국관광서비스학회 2001 관광서비스연구 Vol.1 No.1

하부식도에 발생한 악성 위장관 간질종양 - 1례 보고 -

류경민,조석기,성숙환,이혜승,전상훈,Ryu, Kyoung-Min,Cho, Suk-Ki,Sung, Sook-Whan,Lee, Hye-Seung,Jheon, Sang-Hoon 대한기관식도과학회 2005 大韓氣管食道科學會誌 Vol.11 No.2

원발성 자연기흉 환자에 대한 CP의 개발과 적용

류경민,이영미,이민희,이정미,김은경,전지수,남주양,김미순,김현정 한국의료QA학회 2008 가을학술대회 Vol.2008 No.3

Surgical Treatment of Native Valve Aspergillus Endocarditis and Fungemic Vascular Complications

류경민,서필원,김삼현,박성식,류재욱 대한의학회 2009 Journal of Korean medical science Vol.24 No.1

Systemic infection with Aspergillus is an opportunistic disease that affects mainly immunocompromised hosts, and is associated with a high mortality rate. It typically occurs in patients with several predisposing factors, but Aspergillus endocarditis of native valves is rare and experience in diagnosis and treatment is limited. We report a case of native valve endocarditis caused by Aspergillus. A 35-yr-old male patient who underwent pericardiocentesis four months previously for pericardial effusion of unknown etiology presented with right leg pain and absence of the right femoral artery pulse. Cardiac echocardiography revealed severe mitral insufficiency with large mobile vegetations, and computed tomographic angiography showed embolic occlusion of both common iliac arteries. We performed mitral valve replacement and thromoembolectomy, and Aspergillus was identified as the vegetation. We started intravenous amphotericin B and oral itraconazole, but systemic complications developed including superior mesenteric artery aneurysm and gastrointestinal bleeding. After aggressive management, the patient was discharged 78 days post surgery on oral itraconazole. He was well at 12 months post discharge but died in a traffic accident 13 months after discharge.

폐암에서 NF-kappaB 기저활성화에 대한 면역조직화학적 연구

류경민,명나혜,이재환,조은미,박재석,김건열,이계영 대한결핵 및 호흡기학회 1999 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.89 No.0

움직이는 다면체(Move Form)

류경민 한국수학교육학회 2014 수학교육 학술지 Vol.2014 No.2

복부 대동맥류에 대한 수술

류경민,서필원,박성식,류재욱,김석곤,이욱기 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.3

Background: Open surgical repair of abdominal aortic aneurysms was initiated by Dubost in 1952. Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized for curative intent. We retrospectively analyzed surgical outcome, complications, and mortality-related factors for patients with abdominal aortic aneurysms over a 6 year period. Material and Method: We analyzed 18 patients who underwent surgery for abdominal aortic aneurysms between March 2002 and March 2008. The indications for surgery were rupture, a maximal aortic diameter >60 mm, medically intractable hypertension, or pain. Result: The mean age was 66.6±9.3 years (range, 49∼81 years). Twelve patients (66.7%) were males and 6 patients were females. Extension of the aneurysm superior to the renal artery existed in 6 patients (33.3%), and extension to the iliac artery existed in 13 patients (72.2%). Five patients (27.8%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was 72.2±12.9 mm (range, 58∼109 mm). Surgery was performed by a midline laparotomy, and 6 patients underwent emergency surgery. The mean total ischemic time from aorta clamping to revascularization was 82±42 minutes (range, 35∼180 minutes). The mortality rate was 16.7%; the mortality rate for patients with ruptured aneurysms was 60%, and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included one each of renal failure, femoral artery and vein occlusion, and wound infection. The patients who were discharged had a long-term survival of 34±26 months (range, 4∼90 months). Rupture and emergency surgery had a statistically significant mortality-related factor (p<0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have a high mortality, but unruptured cases are repaired with relative safety. Successfully operated patients had long-term survival. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, aggressive application should be determined with care. Experience and systemic support of each center is important in the treatment plan. 배경: Dubost 등이 1952년에 실시한 신동맥 하부 대동맥류 수술을 시작으로 복부 대동맥류의 근치적인 수술적 치료가 시작되었다. 최근에 경피적 대동맥 스텐트 삽입술의 비약적인 발전으로 외과적 수술이 감소하고는 있으나, 여전히 근치를 위한 치료로 인정되고 있다. 저자들은 지난 6년간 시행한 복부 대동맥류의 수술성적 및 그 예후에 미치는 영향인자에 대해 분석하여 보았다. 대상 및 방법: 2002년 3월부터 2008년 3월까지 복부 대동맥류로 수술 받은 환자 18명을 대상으로 하였다. 수술의 적응은 파열, 60 mm 이상의 최대직경, 크기의 증가, 내과적으로 조절 안되는 고혈압이나 통증이 있는 경우 등이었다. 결과: 환자들의 평균 나이는 66.6±9.3세(49∼81)였고, 남자가 12명(66.7%), 여자가 6명이었다. 신동맥 상부까지 진행된 경우는 6명(33.3%), 장골동맥까지 진행된 경우는 13명(72.2%)이었다. 진단 당시 대동맥이 파열되어 있었던 환자들은 5명(27.8%)이었다. 대동맥의 평균 최대직경은 72.2±12.9 mm (58∼109 mm)였다. 수술은 모두 정중 복부절개를 통한 복강 내 접근으로 시행하였고, 응급수술은 6명의 환자에서 시행하였다. 대동맥 겸자 후 양쪽 하지로 혈류개통이 될 때까지의 허혈시간은 평균 82±42분(35∼180분)이었다. 전체 환자 중 3명이 사망하여 전체 사망률은 16.7%였고, 파열된 환자의 사망률은 60%, 파열되지 않은 환자의 사망률은 0%였다. 수술 후 합병증으로는 신부전, 대퇴동 정맥 폐쇄, 창상감염이 각 1예씩 있었다. 생존 환자들은 34±26개월(4∼90개월)간의 추적관찰 기간동안 대동맥 내 문제는 없이 장기생존 중이다. 사망에 영향을 주는 인자로는 파열, 응급수술이 의미있었다(p<0.05). 결론: 파열된 복부대동맥류에 대한 응급수술은 여전히 높은 사망률을 보이나, 파열되지 않은 복부대동맥류의 수술은 비교적 안전하게 진행할 수 있으며 수술 후 생존한 환자는 장기생존을 보인다. 비록 경피적 대동맥 스탠트 삽입술이 최근의 치료 경향이나 종래의 수술방법도 만족할 만 한다.