흉막질환에서 흉강경 (비데오흉강경술)의 역할

김광택 ( Kwang Taik Kim ) 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.47 No.6

식도 평활근종에 의한 속발성 식도이완불능증

김광희(Kwang Hee Kim),송치욱(Chi Wook song),최재현(Jai Hyun Choi),이흥식(Hong Sik Lee),김창덕(Chang Duck Kim),류호상(Ho Sang Ryu),현진해(Jin Hai Hyun),백만종(Man Hong Paek),김광택(Kwang Taik Kim) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.2

Achalasia is a motor disorder of esophagus with characteristic clincal, radiographic, and manometric features. Neoplastic involvement of distal esophagus could result in a clinical pic- ture that mimics idiopathic achalasia. Failure to identify such cases may delay effective treatment of curable tumor. We report a case of secondary achalasia resulting from the leio- myoma of the lower esophagus in a 20 year old woman. After the excision of mass and myoto- my of lower esophagus she showed clinical inprovement.(Korean J Gastroenterol 1994; 26: 321 -326)

한국형 이동식 심폐소생기 개발 보고 I. 실험견을 이용한 개흉식과 폐쇄식 심폐소생술 비교

김형묵,이인성,백만종,선경,김광택,김연수,김맹호,이혜원,이규백,김학제,Kim, Hyoung-Mook,Lee, In-Sung,Baek, Man-Jong,Sun, Kyung,Kim, Kwang-Taik,Kim, Yeon-Soo,Kim, Maeng-Ho,Lee, Hye-Won,Lee, Kyu-Back,Kim, Hark-Jei 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.9

배경: 고려대학교 흉부외과학교실에서는 심폐소생술에서 인공심 사용이 기존의 표준 심폐소생술에 비해 나은 결과를 보인다는 점에 착안하여 한국형 이동식 심폐소생기를 개발하고자 하였다. 1997년 1월부터 8월까지 한국형 이동식 심폐소생기 개발의 전단계로 심폐정지 모델 결정 및 표준 폐쇄식/ 개흉식 심폐소생술의 비교와 관찰지표 설정을 위한 준비실험을 실시하였다. 대상 및 방법: 실험은 한국산 잡견 9마리(28-35kg)를 대상으로 폐쇄식 심폐소생술군 4마리와 개흉식 심폐소생술군 5마리로 나누어, 4분 간의 심정지 및 15분간의 일차 심폐소생술(basic life support; BLS)과 30분간의 이차 심폐소생술(advanced life support; ALS)을 실시하였다. 심장압박은 폐쇄식군의 경우 흉부에 압박을 가하였고 개흉식군에서는 직접 심장을 맛사지하였다. 소생술기간에 양군 모두 동일한 조건의 폐환기 상태를 유지하였으며, 자발성 순환회복은 이차심폐소생술 기간 초기부터 재세동과 에피네프린 및 탄산수소 나트륨을 투여하여 유도하였다. 결과: 심폐소생술 기간안에 평균 체동맥압은 BLS 동안 폐쇄식군이 33$\pm$11 mmHg인데 비해 개흉식군은 45$\pm$15 mmHg로 높게 유지되었으며, ALS 동안에도 폐쇄식군 44$\pm$15 mmHg에 비해 개흉식군이 83$\pm$36 mmHg로 높게 유지 되었으나 통계상의 유의성은 없었다. 한편 평균 폐동맥압은 BLS 동안 폐쇄식군에서 32$\pm$10 mmHg로 평균 체동 맥압과 비슷한 정도로 증가하였으나 개흉식군은 22$\pm$4 mmHg로 평균 체동맥압의 약 50%정도까지만 증가하였고, ALS 동안에도 폐쇄식군은 32$\pm$15 mmHg로 개흉식군의 24$\pm$10 mmHg보다 높게 유지되었으나 통계처리상 유의성 은 없었다. 자발성 순환회복(restoration of spontaneous circulation; ROSC) 및 심폐소생 성공 여부에서 폐 쇄식군은 4마리 모두 사망하였으나 개흉식군은 5마리중 4마리가 생존하였고 생존기간은 384$\pm$705시간이였다 (p<.05). 결론: 본 연구 결과 개흉식 심폐소생술은 폐쇄식 소생술에 비해 비록 통계학상의 차이는 없었으나 소생술 기간 동안 비교해서 안정된 혈역학 상태를 유지하여서 자발성 순환회복 및 장단기 생존율을 향상시킬 수 있었다고 판단된다. Background: Effective cardiopulmonary resuscitation (CPR) should provide acceptable hemodynamics for the vital organs during cardiac arrest and early restoration of spontaneous circulation that guarantees long-term, neurologically intact survival. CPR using heart-lung bypass has been suggested as an option for that use. This study was designed to determine the effectiveness of standard CPR techniques, closed-vs. open-chest CPR, which could be used in the future study verifying the role of heart-lung bypass CPR. Material and Method: By using adult mongrel dogs, closed-chest CPR (CCCPR, n=4) and open-chest CPR (OCCPR, n=5) were compared with respects to hemodynamics, restoration of spontaneous circulation(ROSC), and survival. Ventricular fibrillation-cardiac arrest (VF-CA) was induced by electrical shock in all animals. After 4 minutes of cardiac arrest, basic life support (BLS) was applied for 15 minutes and followed by advanced life support (ALS). ALS was maintained until achi ving ROSC but not longer than 30 minutes regardless of the recovery. Resuscitation procedures in either group were standardized by adopting the protocol of American Heart Association. Result: Prearrest baseline hemodynamic data was not different between two groups. During resuscitation, substantially higher systolic pressure was maintained in OCCPR group than in CCCPR group (45$\pm$15 vs. 33$\pm$11 mmHg during BLS, 83$\pm$36 vs. 44$\pm$15 mmHg during ALS; p=NS). Mean pulmonary arterial pressure went up to the level of mean systemic arterial pressures in CCCPR group and to half of that in OCCPR group, and had kept higher in CCCPR group throughout CPR (32$\pm$10 vs. 22$\pm$4 mmHg during BLS and 32$\pm$15 vs. 24$\pm$10 mmHg during ALS; p=NS). ROSC was obtained in 4 of 5 dogs receiving open-chest CPR and 2 of 4 closed-chest CPR. Prolonged survival was noted in all dogs in OCCPR group (6 to 1440 hours) but not in CCPR group (p<.05). Conclusion: These findings indicate that open-chest CPR can be more effective t maintain hemodynamics during cardiac arrest and to obtain restoration of spontaneous circulation and survival. Further experiment will be designed to compare heart-lung bypass CPR with open-chest CPR.

자연개구부 내시경수술

김광택,Kim, Kwang-Taik 대한기관식도과학회 2010 大韓氣管食道科學會誌 Vol.16 No.1

NOTES (Natural orifice transluminal endoscopic surgery) is a new technique in minimally invasive procedure, surgeon use normal orifice and hollow viscus for procedurs as approaching route, Currently the NOTES are performed for diagnostic and therapeutic purpose by some investigators in research setting. NOTES has potential benefit in terms of sear, pain, post op recovery. Rut Bacterial contamination, deal with major complication are needed more stud) and development.

기도-기관지 질환의 냉동치료

김광택,Kim, Kwang-Taik 대한기관식도과학회 2009 大韓氣管食道科學會誌 Vol.15 No.2

식도 재건술 시 흉강경용기계문합기을 이용한 경부식-장문합술

김일현,김광택,박성민,이승렬,백만종,선경,김형묵,이인성,Kim, Il-Hyeon,Kim, Kwang-Taik,Park, Sung-Min,Lee, Seung-Yeoll,Baek, Man-Jong,Sun, Kyung,Kim, Hyoung-Mook,Lee, In-Sung 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.10

Background: The use of the stapler n esophageal reconstruction after esophageal resection for benign or malignant esophageal diseases has become popular because it has less leakage at the anastomotic site and shorter operation time than manual sutures. However, the use of classic circular stapler has some complications such as stenosis and dysphagia that requires additional treatment. Such complications are closely related to the inner diameter of the anastomotic sites. In this study, the diameter of anastomotic site was compared after the use of circular stapler(EEA) and straight endoscopic stapler(endo GIA). Material and Method: The patients who received esophageal reconstruction by stapler from August 1995 to September 1997 were reviewed. The patients were divided into 2 groups. One group need the circular stapler, and the other group the straight endo GIA(14 cases with endo GIA 30mm, 24 with endo GIA 45mm). After a cervical esophago-enteric anastomosis, the stricture of anastomotic site and the incidence of dysphagia were compared between the 2 groups using an esophagography and the patient's symptoms. The follow-up period was 12months in average. Result: In the former group in which the circular stapler was used, 2 cases of anastomotic stenosis were reported. In comparison, none were reported in the latter group. Dysphagia were reported in 8 cases of the former group, and in 3 cases of the latter group(1 case in endo GIA 30 mm, 2 cases in endo GIA 45 mm). Conclusion: The use of endo GIA in esophago-enteric anastomosis resulted in a wider diameter of the anastomotic site, lesser stricture, and lesser incidence of dysphagia compared to the use of former circular stapler. Therefore, it is thought to be a better method in esophageal reconstructions.

후복막강 내시경을 이용한 요추 교감신경절 절제술 - 2례 보고 -

이송암,김광택,백만종,이인성,김형묵,김학제,이건,Lee, Song-Am,Kim, Kwang-Taik,Baek, Man-Jong,Lee, In-Sung,Kim, Hyoung-Mook,Kim, Hark-Jei,Lee, Gun 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.2

고대 안암병원 흉부외과에서는 각각 1개월과 20개월전에 수족장부 다한증으로 흉강경하 흉추 교감신경절 절제술을 시행받았으나 족장부 다한증이 지속되는 환자 2명에 대해 후복막강 내시경을 이용한 요추 교감신경절 절제술을 시행하였다. 첫 번째 환자의 경우 우측에서 트로카 삽입중 기복이 발생하여 개복적 방법으로 전환해야 했으며, 우측 요추 교감신경절의 불완전한 절제로 발한이 지속되어 재수술을 시행하였다. 술후 각각 70일과 30일이 경과한 시점에서 추적관찰하였으며 만족도 결과를 매우만족, 만족, 보통, 불만족으로 평가하였다. 첫 번째 환자는 '매우만족', 두 번째 환자는 항문주위 대상성 다한증이 있었으나 대체로 '만족'을 나타내었다. 족장부 다한증에 대한 후복막강 내시경하 요추 교감신경절 절제술은 통증이 적고 반흔이 작으며, 회복기간과 입원기간을 줄일 수 있어 족장부 다한증의 유용한 치료방법의 하나이다. We have experienced 2 patients who underwent retroperitoneal endoscopic lumbar sympathectomy(RELS) for bilateral plantar hyperhidrosis. They had underwent thoracic sympathectomy by thoracoscopy 20 months and 1 month ago, respectively. The first patient had to be converted to the open procedure due to pneumoperitonium and she was reoperated due to continous sweating by the incomplete sympathectomy on right side. At follow-up after 70 and 30 days postoperatively, RELS results were graded as excellent, good, fair, or poor. The first patient was very satisfied as "Excellent" and the second was slightly less satisfied as "Good" with compensatory hyperhidrosis at perianal area. This RELS is a feasible procedure to plantar hyperhydrosis patients with less pain, minimal scar, short period of convalescence, and short hospital stay.short hospital stay.

반사성 교감신경 위축증의 흉강경하 흉추교감신경절제술 - 치험 1례 -

김태식,김광택,김형묵,김학제,이건,Kim, Tae-Sik,Kim, Kwang-Taik,Kim, Hyoung-Mook,Kim, Hak-Jei,Lee, Gun 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.2

반사성 교감신경 위축증은 과도하며 지속적인 통증, 혈관운동성 및 그 밖의 자율성 장애, 기능회복의 지연과 이영양성 변화를 특징으로 하는 중요한 임상양상이다. 이 증후군은 임상에서 자주 마주치는 문제중 하나일뿐더러 정확한 진단과 치료가 결정적이기 때문에 중요하다. 유발인자는 사고나 수술, 또는 다양한 질환이 될 수 있다. 정확한 진단과 치료는 증상의 빠른 소실과 완전한 회복을 기대할 수 있다. 56세 남자환자로 1996년 5월 좌측 제2수지 원위관절부 완전절단상을 입었고, 고대부속병원 재건성형외과에서 응급으로 재접합술을 시행받았다. 그 후, 좌측 제 2수지의 경감되지 않는 지속적인 통증과 좌측상지 근위부로 퍼져가는 통증 및 좌측 견갑부 운동장애를 호소해 왔다. 많은 치료법이 사용되었지만 효과적이지는 못하였다. 그리하여 좌측 흉부 교감신경절제술을 본 과에서 시행하였다. 이 후 성공적으로 통증이 완화되었고, 견갑부 운동상태도 향상되었기에 문헌고찰과 함께보고하는 바이다. Reflex sympathetic dystrophy is an important clinical entity that is characterized by excessive or prolonged pain, vasomotor and other autonomic disturbances, delayed recovery of function, and trophic changes. This syndrome is among the most frequently encountered problems in clinical medicine, and proper diagnosis and therapy are critical. Accidental or surgical trauma or one of a variety of disease states may become a precipitating factor. Proper recognition and treatment result in rapid elimination of symptoms and complete recovery. A 56-years old male accidented total amputation of the proxomal part of the left index finger in May, 1996. Emergently, complete replantation procedure was successfully performed in the department of reconstructive surgery, medical center, Korea University. Afterward, he began to suffer from uncontrolled, prolonged pain in left index finger, proximally spreading pain to the left upper extremity and limited joint movement of the left shoulder. Although many treatments were used for this syndrom, not all of them were effective. Furthermore, the treatments which proved effective had detrimental side effects. However, thoracoscopic left thoracic sympathectomy was performed in our department. This therapy successfully relieved the pain and improved shoulder joint movement.

안면 다한증의 하부성상 교감신경절 절제술

김일현,김광택,이인성,김형묵,김학제,이건,Kim, IL-Hyeon,Kim, Kwang-Taik,Lee, In-Sung,Kim, Hyoung-Mook,Kim, Hark-Jei,Lee, Gun 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.3

최근 흉강경 수술수기 및 기구의 발달로 본태성 안면 다한증 치료에 대한 흉강경을 이용한 교감신경절 절제술은 안전하고 효과가 우수한 치료방법으로 적용이 늘고있다. 고려대학교 안암병원 흉부외과에서는 1996년 7월부터 1997년 4월까지 본태성 안면 다한증을 호소한 43명의 환자를 대상으로 비디오 흉강경을 이용한 하부성상 교감신경절 절제술을 시행한 후 효과를 조사하였다. 대상이된 환자들의 성별은 남자가 33명 여자가 10명이었으며, 평균 연령은 37세였고, 다한증 부위는 순수 안면 다한증 23례, 수부 및 족부동반 안면 다한증 20례였다. 수술부위는 하부성상 교감신경절 절제술 12례, 하부성상 교감신경절 및 제 2번 흉부 교감신경절 절제술 28례였으며, 하부성상 교감신경절 및 제 2번, 3번 흉부 교감신경절 절제술이 3례였다. 수술후 합병증으로는 흉부 통증 8례, 안검하수 4례, 기흉 1례있었다. 보상성 다한증은 36례(83.7%)에서 발생하였으며, 부위별로는 체간 19례, 대퇴부 3례, 족부 2례, 체간 및 대퇴부 10례, 체간 및 족부가 2례발생하였다. 수술결과는 퇴원후 3개월 이상 경과후 추적관찰 결과 다한증 증상에 있어 32례(74.4%)에서 매우 호전을 보였고 11례에서 수술전보다 호전을 보였으며, 만족도에서도 "만족한다"가 33례(76.7%), "대체로 만족한다"가 8례(18.6%)였으며 "불만족"도 2례(4.6%)에서 조사되었다. 본태성 안면 다한증에서 비디오 흉강경을 이용한 하부성상 교감신경절 절제술은 증상 호전에서 만족할만한 결과를 보였으나, 보상성 다한증은 수술후 만족도를 저하시키는 주된 부작용으로, 이에 대한 개선 연구가 필요하다. With recent advancements in the instrumentation and technique of VATS, it has become the method of choice to cure facial hyperhidrosis. From July 1996 to April 1997, we performed 43 thoracic lower stellate ganglionectomy with VATS for facial hyperhidrosis. There were 33 men and 10 women whose ages ranged from 17 to 63 years(mean age, 37 years). Of those patients, 23 complained only of facial hyperhidrosis, and 20 complained of facial hyperhidrosis along with excessive sweating of the palm or foot. Thoracoscopic sympathetic ganglionectomy procedures included lower stellate ganglionectomy in 12 patients; lower stellate ganglionectomy and T2-sympathetic ganglionectomy in 28 patients; and lower stellate, T2 and T3 sympathetic ganglionectomy in 3 patients. Common complications were compensatory hyperhidrosis(36 patients) and causalgia(8 patients). At the end of the follow-up period(minimum, 3 months) ninety-five percent of the patients reported satisfactory results. Thoracic lower stellate ganglionectomy with VATS is an efficient, safe and minimally invasive surgical procedure for facial hyperhidrosis.

결핵성 기관-기관지 협착에서 제거형 니티놀 스텐트 삽입요법 -1례-

정봉규,김광택,박성민,선경,김형묵,이인성,Chung, Bong-Kyu,Kim, Kwang-Taik,Park, Sung-Min,Sun, Kyung,Kim, Hyoung-Mook,Lee, In-Sung 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.1

Although a tracheal stent can be an option for inoperable tracheal stenoses there still are some troublesome side effects including overgranulation from foreign body irritation restenosis and patient's discomfort associated with the procedure. We report a successful case of a retrievable stent made of self-expandable 'shape memory' metal and polyurethane in a 24 year old female patient with respiratory distress and tight stenosis in the trachea and left main bronchus, The stent was inserted following a balloon dilatation and was successfully removed on the 7th days after the procedure. She regained a normal active life without any repiratory symptoms and a follow-up of 8 months showed satisfactory results.