만성염증성 폐질환에서 전폐절제술의 임상적 평가

최필조,방정희,김시호,조광조,우종수 대한흉부외과학회 2006 Journal of Chest Surgery (J Chest Surg) Vol.39 No.6

배경: 염증성 폐질환을 위한 전폐절제술은 동반된 합병증률과 사망률로 인해 흉부외과의에게는 난제이며 늑막외전폐절제술의 경우는 더욱 그러하다. 이 연구의 목적은 늑막외전폐절제술을 시행 받은 환자에서의 수술 성적과 합병증 등을 단순 전폐절제술을 받은 환자와 비교분석하고 이들 환자에서의 합병증 발생에 영향을 미치는 요인에 대해 알아보고자 보고자 하였다. 대상 및 방법: 1992년 1월부터 2004년 12월까지 만성염증성폐질환으로 전폐절제술을 시행 받은 98명을 대상으로 후향적 분석을 시행하였다. 늑막외전폐적출술(A군)은 48명에서, 단순 전폐절제술(B군)은 50명에서 시행되었다. 두 군 환자의 임상적 특징, 수술 후 성적 및 합병증 등을 비교 분석하고 늑막외전폐절제술(A군)을 받은 환자에서 수술 후 합병증 발생에 영향을 미치는 인자를 수술 전, 수술 중 요인으로 나누고 이들의 유의성을 단변량 및 다변량 분석을 통하여 평가하였다. 결과: 수술로 인한 조기 사망은 1명으로 수술 후 성인성 호흡곤란증후군(adult respiratory distress syndrome, ARDS)으로 인한 경우였다. 21명(21.4%)의 환자에서 23예의 주요 수술 후 합병증을 나타내었다. 가장 흔한 합병증으로는 수술 후 출혈로 인해 재개흉이 필요했던 경우 8예, 농흉(기관지-흉막루 포함)의 발생 8예였다. A군 48명 중 14명(29.2%)의 환자에서, B군 50명 중 7명(14.0%)에서 각각 합병증을 보였다. 높은 합병증을 보인 A군의 경우, 농흉(기관지-흉막루 포함)의 발생 6예, 수술 후 출혈로 인해 재개흉이 필요했던 경우 6예로 가장 흔한 합병증이었고, 수술 후 합병증 발생의 위험인자를 알기 위해 단변량 분석을 시행한 결과, 우측 전폐절제술(p=0.0022), 완성전폐절제술(p=0.023), 1,000 mL 이상의 출혈(p=0.005), 수술 중 흉강 내 오염(p=0.035) 등이 위험인자로 판명되었고, 다변량 분석에서는 수술 중 흉막강 내 오염이 되었던 경우가 통계적 유의성을 보였다(p=0.028). 결론: 만성 염증성 폐질환의 치료를 위한 전폐절제술은 만족할 만한 사망률과 합병증률을 보였다. 그러나 늑막외전폐절제술은 수술 술기상 고난도이며 고위험군의 수술임을 확인할 수 있었다. 특히 수술 중 세심한 박리 조작으로 폐병소부위의 파열로 인한 흉막강 내의 오염의 발생을 최소화하기 위한 수술 중의 특별한 노력이 필요함을 알 수 있었다.

원발성 종격동 종양에 관한 임상적고찰

최필조,이종수,이성광,Choe, Pil-Jo,Lee, Jong-Su,Lee, Seong-Gwang 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.1

Author made a clinical study of 48 cases of primary mediastinal tumors experienced in the dept. of the thoracic and cardiovascular surgery of Pusan National University Hospital during the 12 years period from march 1978 to march 1989. There were 34 males and 14 females. Their age distribution was from 4 months to 70 years, with the mean age of 34.4 years. 8.3 % of the patients were younger than 15 years old. There were teratoma 14 cases[29%], thymoma 11 cases[23%], neurogenic tumor 10 cases[21 %], lymphoma 6 cases[13 %], benign cyst 6 cases[13 %], and one case of fibrous histiocytoma in the histological distribution. The malignant tumors were 12 cases[25 %]. The common symptoms were chest pain and discomfort[35.4], coughing[18.8], general weakness and dyspnea. 16.7% of the patients were asymptomatic at admission. The successful removal was done in all cases of benign mediastinal tumors. In malignant cases, the surgical removal could be done in 5 cases. There was not postop. mortality. The frequent complications were atelectasis, infection, bleeding.

선천성 식도 폐쇄증의 외과적 치료

최필조,전희재,이용훈,조광조,성시찬,우종수 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.6

배경: 선천성 식도 폐쇄증의 수술적 교정은 많은 개선을 보였으나 아직도 사망률과 합병증률이 높은 상태이다. 방법: 1992년 1월부터 1997년 3월까지 본 동아대학교 병원 흉부외과학 교실에서는 27명의 선천성 식도 폐쇄증을 수술적 치료하였기에 이를 후향적으로 분석하고자 하였다. 결과: 남아가 21명 여아가 6명이었으며 평균 출생시 체중은 2.62$\pm$0.38 kg이었다. 원위부 기관식도루를 가진 식도폐쇄증이 24명이었고 나머지 3명은 순수 식도 폐쇄증이었다. Waterston의 위험군 분류상 A군이 4명, B군이 18명, C군이 5명이었다. 18명에서 동반 기형을 가졌으며 심혈관계 이상이 가장 흔한 동반 기형이었다. 식도 폐쇄증의 상하 식도 맹단 간의 거리는 1 cm이내의 short gap이 9명, 1내지 2 cm의 medium gap이 8명, 2 cm이상의 long gap이 7명, 3.5 cm 이상의 ultra-long gap이 3명이었다. 수술은 순수 식도 폐쇄증의 3례에서는 단계적으로 위루술 및 경부식도조루술을 시행하였고 나머지 24례는 모두 경흉강적 도달법으로 일시적 근치 교정술을 시행하였다. 추적기간 중 27명 중5명이 사망 하였는데 수술과 관련된 사망은 2명으로 그 중 1명은 급성 신부전으로 사망하였고, 1명은 문합부 누출로 인한 농흉 발생으로 사망하였다. 3명의 후기 사망이 있었는데 1명은 순수 식도 폐쇄증으로 식도-위-대장 문합술을 시행하였으나 인슐린 의존성 당뇨병으로 술후 29개월 째 사망하였고 1명은 동 괴사성장염(necrotizing enterocolitis)으로 사망, 나머지 1명은 \ulcorner선 확장술의 합병증으로 인해 술후 220일 째 십이지장 천공으로 인한 폐혈증으로 사망하였다 사망례의 분석을 통해 사망률에 영향을 미쳤던 요인들을 살펴 보았는데 gap length가 long gap이상일 경우가 사망률에 영향을 미치는 요소로서 통계적 유의성(p value<0.05)을 보였다. 결론: 수술적교정과 관련된 합병증률은 높은 편이나 이것이 수술사망률과 직결되는 것은 아니다. 전체적인 생존율은 효과적인 동반기형의 치료와 적극적인 수술후 관리가 병행될 때 더욱 향상시킬 수 있을 것이다. Background: Surgical correction of the full spectrum of esophageal atresia with tracheoesophageal fistula has improved over the years, but the mortality and morbidity assoiated with repair of these anomalies still remains high. Material and Method: We retrospectively analyzes 27 surgically treated patients with esophageal atresia and tracheoesophageal fistula at Dong-A University Hospital between January 1992 and March 1997. Result: There were 21 male and 6 female patients. Mean birth weight was 2.62$\pm$.385 kg(2.0~3.4 kg). Twenty- four(88.9%) had esophageal atresia with distal tracheoesophageal fistula, and 3(11.1%) had pure esophageal atresia. Four(14.8%) infants were allocated to Waterston risk group A, 18(66.7%) to group B, and 5(18.5%) to group C. In eighteen(66.7%) infants with associated anomalies, cardiovascular anomalies were the most common. Three had a gap length of 3.5 cm or greater(ultra-long gap) between esophageal segments, 7 had 2.0 to 3.5 cm(long gap), 8 had 1.0 to 2.0 cm(medium gap), and 9 had 1 cm or less(short gap) gap length. Among 27 neonates, 3 cases underwent staged operation, late colon interposition was done in 2, and all other 24 cases underwent primary esophageal anastomosis. Oerative mortality was 2/27(7.4%). Causes of death included acute renal failure(n=1), empyema from anastomotic leak(n=1), necrotizing enterocolitis(n=1), sepsis(n=1), insulin-dependent diabetus mellitus(n=1 . There were 4 anastomosis- related complications including stricture in 3, leakage in 1. Mortality was related to the gap length(p<.05). Conclusion: Although the complication rate associated with surgical repair of these anomalies is high, this does not always implicate the operative mortality. The overall survival can be improved by effective treatment for combined anomalies and intensive postoperatve care.

우측 쇄골하 동맥 기시이상으로 인한 연하 곤란 - 수술 치험 1례 -

최필조 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.1

An aberrant right subclavian artery is a rare congenital anomaly that usually does not produce symptoms. Symptomatic patients require surgical intervention. Ligation of the aberrant artery through a left thoracotomy has been advocated as the operation of choice. If development of vertebrobasilar insufficiency is anticipated, division and ligation of he aberrant artery and its anastomosis to the right common carotid artery or aortic arch are performed at a second operation. Experience with successful surgical treatment of a patient with an aberrant subclavian artery is described. A right thoracotomy incision was utilized for division of the subclavian artery and for reestablishment of arterial continuity with Dacron graft. Postoperative arteriography demonstrated a good reconstruction and normal blood flow was established to the right upper extremity.

식도암에 있어서 Fascin의 발현과 예후와의 상관관계에 대한 연구

최필조,정상석,방정희,조광조,우종수,노미숙 대한흉부외과학회 2008 Journal of Chest Surgery (J Chest Surg) Vol.41 No.1

Backgrond: Fascin is an actin-bundling protein that induces membrane protrusions and it increases cell motility in various transformed cells. Esophageal cancer is one of the most lethal malignancies, and it exhibits extensive local invasion or frequent regional lymph node metastasis even after curative surgery. We investigate the expression of fascin by performing immunohistochemistry to evaluate the clinical characteristics and prognostic significance of its expression in esophageal cancer patients. Material and Method: Immunochemistry for fascin was performed on 76 tumor samples from 76 patients who underwent esophageal cancer operations. The expression levels of fascin in the 76 esophageal cancer tissues were compared with those in the corresponding normal esophageal epithelium. The fascin-positive samples were defined as those showing more than 75% of fascin-positive cells. Result: Overall, a fascin positive expression was detected in 39 (51.3%) out of the total 76 cases. The tumors with positive fascin expression tended to more frequently show a higher stage (p=0.030), and a higher T-factor (p=0.031). The prognosis of the fascin negative group was significantly better than that of the fascin positive group (p=0.004). Multivariate analysis revealed that lymphovascular invasion and the fascin expression were independent prognostic factors. Conclusion: Fascin was expressed in 51.3% of the esophageal cancer tissues, and a positive expression of fascin was associated with more advanced tumor progression and recurrence. Our study suggests that the fascin expression may be an independent prognostic factor for an unfavorable clinical course for those patients suffering with esophageal cancer.

식도암의 근치적 식도 절제술 후 폐합병증의 발생에 영향을 미치는 위험인자의 임상적 분석

최필조,정상석,Choi, Phil Jo,Jeong, Sang Seok 대한기관식도과학회 2011 大韓氣管食道科學會誌 Vol.17 No.2

Purpose Pulmonary complications continue to be the major cause of morbidity and mortality after esophageal resection. The aim of this study was to compare and analyze retrospectively the factors which effect for postoperative pulmonary complications in patients who underwent curative resection for esophageal cancer. Material and Method A total of 118 patients were enrolled in the study from January 1994 to March 2009, and patients with previous neoadjuvant chemotherapy or radiotherapy were excluded. Of the total 118 patients, 27 patients developed pulmonary complications within 30 days of their operation. the factors which effect for postoperative pulmonary complications were compared and analyzed. Results There were 7 patients in-hospital deaths. 51 patients (43.2%) developed complications, and of them, the most common complication was pulmonary complication and occurred in 27 patients (22.9%). In univariate analysis, diabetes mellitus, cervical anastomosis through the retrosternal route, old age and poor lung function were risk factors contributing to postoperative pulmonary complications (p<0.05). In multivariate analysis, statistically significant factor was old age (65 years or older). Conclusion Clinical factor for the pulmonary complications after esophagectomy of esophageal cancer was significantly associated with diabetes mellitus, cervical anastomosis through the retrosternal route, old age (65 years or older) and poor lung function (FEV1<80%). Of these, old age was the most significant factor.

Acriflavine-Guanosine 복합제 (AG60)가 Ehrlich 암세포를 이식한 생쥐 막창자꼬리점막상피세포의 DNA합성 및 미세구조에 미치는 영향

최필조,안의태,박경호,박대균,고정식 대한해부학회 2006 Anatomy & Cell Biology Vol.39 No.5

Prognosis of Recurrence after Complete Resection in Early-Stage Non-Small Cell Lung Cancer

최필조,정상석,윤성실 대한흉부외과학회 2013 Journal of Chest Surgery (J Chest Surg) Vol.46 No.6

Background: Tumor recurrence is the most common cause of treatment failure, even after complete resection of early-stage non-small cell lung cancer (NSCLC). In this study, we investigated the prognosis of patients with early recurrence in order to identify independent risk factors related to early recurrence. Methods: Between February 1995 and December 2012, 242 patients who underwent surgical resection for stage I NSCLC at Dong-A University Hospital were reviewed. The factors predicting overall survival (OS) and early recurrence were investigated. We also investigated the relationship between the patterns and period of recurrence and clinicopathological factors. Results: For patients with stage IA and IB NSCLC, the 5-year OS rate was 75.7% and 57.3% (p=0.006), respectively. A multivariate Cox proportional hazards model demonstrated that gender (p=0.004), comorbidity number (p=0.038), resection type (p=0.002), and tumor size (p=0.022) were the statistically significant predictors of OS. Moreover, the multivariate analysis revealed that smoking history (p=0.023) and histologic grade (p=0.012) were the independent predictors of early recurrence. Additionally, only histologic grade (poor differentiation) was found to be significantly associated with a higher frequency of distant metastasis; there was no relationship between the patterns and period of recurrence and clinicopathological factors. Conclusion: The present study demonstrated that smoking history and histologic grade were independent prognostic factors for early recurrence within two years in patients with early-stage NSCLC. Patients with these predictive factors may be good candidates for adjuvant therapy.

좌심 체외순환을 이용한 재개통된 동맥관 개존증 - 수술 치험 1례 -

최필조 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.1

We experienced a rare case of a recanalization and aneurysmal formation of the previously ligated PDA on 18 year-old-girl. Continuous murmur was noted 3 months after operation and this recanalization was confirmed by angiography and cardiac catheterization. It was impossible to mobilize aneurysmal PDA with safety, so we closed the defect using left heart bypass to prevent spinal card injury. Postoperative course was uneventful and the patient was discharged in good condition.

응급실로 내원한 복부 대동맥류 환자의 임상적 고찰

최필조,한상국,신동혁,권운용,송형곤,송근정,정연권 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Purpose: In old age, abdominal aortic aneurysm (AAA) is not a rare disease and potentially fatal. Also, there has been a lack of concern for this disease in the emergency department. Our study investigated the clinical characteristics of AAAs seen in the emergency center to assess the needs of the diagnostic approach to this disease in the emergency center. Methods: Eighty patients with an AAA between Jan. 1995 and Jul. 2002 were enrolled. Data were obtained from a retrospective review of medical records. We analyzed the clinical characteristics of the AAA on the basis of the patient's age and sex, risk factors, presenting symptoms and signs, physical findings, diagnostic tools, and findings. Results: AAAs were predominant in males (82.5%). A smoking history (57.5%), old age over 65 (71.3%) and hypertension (50.0%) were the most common risk factors. In this study, the initial diagnosis of a AAA was mostly determined by the existence of a pulsating abdominal mass, and the overall sensitivity of a pulsating abdominal mass was 57.5%. Although the most common presenting symptom was abdominal pain(51.3%), about one third of the patients had no subjective symptoms. Twenty-one of the patients had a ruptured AAA at the time of diagnosis. There was no remarkable difference in the incidence of large AAA (>5 ㎝) or ruptured AAA between elderly (>65 years) and the young (<65 years). Conclusion: Because of the absence or vagueness of symptoms and signs, an AAA might be initially excluded without a careful examination. For the early detection and prevention of a ruptured AAA, emergency medical doctors should carefully evaluate and assess patients with risk factors even though they have non-specific symptoms of the gastrointestinal or urinary system.