외상성 흉부대동맥 파열 수술

함시영,주석중,송현,이재원,송명근 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.9

Background: Although traumatic thoracic aortic rupture is potentially a fatal condition requiring surgical attention, the presence of concomitant injury involving other parts of the body may greatly increase the risk of cardiopulmonary bypass. We report our experience of treating associated injuries prior to the thoracic aortic rupture in these patients. Material and Method: From 1997 to 2003, the medical records of 24 traumatic aortic rupture patients were retrospectively reviewed and checked for the presence of associated injury, surgical method, postoperative course, and complications. Surgical technique comprised thoracotomy with proximal anastomosis under deep hypothermic circulatory arrest followed by side arm perfusion to reestablish cerebral circulation. CSF drainage was performed to prevent lower extremity paraplegia. Result: Major concomitant injuries (n=83) were noted in all of the reviewed patients. Of these, there were 49 thoracic injuries, 18 musculoskeletal injuries, and 13 abdominal injuries. Operations for associated injuries (n=16) were performed in 12 patients on mean 7.6±12.6 days following the injury. The diagnosis of aortic rupture at the time of injury was detected in only 18 patients. Delayed surgery of the thoracic aorta was performed on average 695±1350 days after injury and there were no deaths or progression of rupture in any of these patients during the observation period There were no operative deaths and no major postoperative complications. Conclusion: Treating concomitant major injuries prior to the aortic injury in traumatic aortic rupture may reduce surgical mortality and morbidity. 배경: 외상성 흉부대동맥 파열은 수술적 치료가 요구되는 치명적 손상이며 이외에 다른 부위에 복합 손상이 동반되면 심폐 바이패스에 의한 위험도를 크게 증가시킬 수 있다. 여기서 저자들은 심한 동반손상을 먼저 치료한 후 대동맥수술을 하고 그 결과를 관찰하였다. 대상 및 방법: 1997년부터 2003년까지 외상성 흉부 대동맥질환으로 수술을 받은 24명의 환자를 대상으로 의무기록을 후향적으로 검토하여, 동반손상 여부, 수술방법, 수술 후 경과, 합병증 등을 분석하고 국내외 문헌들과 비교하였다. 수술은 초저온 심정지법하에서 심폐 바이패스를 이용한 개흉술로 하였는데 근위부 연결 후 곁가지를 통해 뇌관류를 시행하였고 요추 카테터를 통한 뇌척수액 배액으로 하반신 마비를 예방하였다. 결과: 대상환자 전원에서 83예의 동반손상이 발생하였는데, 흉부손상이 49예, 근골격계 손상 18예, 복부 손상 13예였고, 수상 후 12명의 환자에서 7.6 12.6일에 16예의 동반손상에 대한 수술이 행해졌다. 수상 당시 18예에서만 대동맥 손상이 진단되었다. 중환자실에서 혈압을 약물투여로 조절하면서 안정시키고 수상 후 695 1350일에 지연수술을 시행하였는데, 관찰기간 중 사망이나 대동맥 파열의 진행은 없었다. 수술 사망은 없었으며, 술 후 큰 합병증은 없었다 결론: 외상성 흉부대동맥 파열에 있어서 다른 부위 손상이 동반되면 심한 동반손상을 먼저 치료한 후 수술하는 것이 수술 사망률이나 이병률 면에서 좋은 결과를 가져온다.

성인 개심술 후 발생한 심내막하 심근경색에서의 효소 변화에 관한 연구

함시영 한양대학교 의과대학 1997 한양의대 학술지 Vol.17 No.2

A prospective study was performed to ascertain if postoperative changes of the patients in serum CK and LDH after open heart surgery could differentiate subendocardial infarction from other ischemic changes. Sixty-three patients were divided into 4 groups on the basis of serial electrocardiographic findings. The acute myocardial infarction group (AMI) (n=10) consisted of 1 Q-wave infarction and 9 non-Q-wave infarction with persistent ST elevation or depression and/or T wave inversion. The ischemic group (ISCH) (n=21) and nonspecific change group (NSST) (n=22) with temporary ST- T changes were divided only by voltage difference. The normal EKG group (n=10) has no EKG change after open heart surgery. To eliminate the factor of muscular injury, thoracotomy patients without manipulation of heart (n=10) were used as control group. This study suggest that serial changes of total CK, CK-MB, total LDH, LDH 1, LDH 1/LDH 2 and sGOT can support the diagnosis of subendocardial infarction. Nonspecific ST- T changes and significant ST - T changes without evidence of acute myocardial infarction are same in view of enzyme changes.

저항동맥의 수축성에 대한 연구

함시영,김기환,서경필,Ham, Si-Yeong,Kim, Gi-Hwan,Seo, Gyeong-Pil 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery (J Chest Surg) Vol.28 No.12

Recently endogenous digitalis-like substances were found in the blood of various cardiovascular diseases and they have been considered one of the causes of evoking hypertension. However, the mechanism of endogenous digitalis-like substances-induced hypertension is not clarified yet. Therefore, the effects of Na-K pump inhibition on the contractility of vascular smooth muscle[conduit and resistant artery were investigated, using organ bath and bioassay experiment. Aortic and carotid arterial rings[conduit artery and the branches of brachial and superior mesenteric artery[resistant artery were used to find the effect of Na-K pump inhibition. The results obtained were as followes;The magnitudes of contractions induced by norepinephrine, serotonin, or acetylcholine in all these arteries were significantly increased by the inhibition of Na-K pump. The increased contractile responses to these agonists, especially to serotonin, were much more prominant in resistant arteries. Nitroprusside-induced relaxations were attenuated by Na-K pump inhibition and there were no significant differences in the effects of Na-K pump inhibition on nitroprusside-induced relaxations of these blood vessels. Endothelium-dependent relaxation was suppressed by the inhibition of Na-K pump, especially by the administration of ouabain, and this inhibitory effect was much more prominent in the branches of superior mesenteric artery, compared with other arteries. In the branches of superior mesenteric arteries, endothelium-dependent relaxation was completely blocked by ouabain. The release of EDRF was partially suppressed by Na-K pump inhibition.From the above results, it is suggested that the hypertension due to the increase in vascular resistance can be evoked by the inhibition of Na-K pump and endogenous digitalis-like substances induce hypertension through this mechanism.

삼첨판 폐쇄 type III 수술치험 4례

함시영 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.4

We have experienced 4 cases of modified Fontan operation for Tricuspid atresia type III from February 1983 to May 1987 at the department of Thoracic 8 Cardiovascular Surgery, Seoul National University Hospital. There were 3 cases with left juxtaposition of right atrial auricle. The operatic mortality rate was 25% [one case death].

원발성 폐암 수술의 장기성적

함시영,성숙환,김주현,Ham, Si-Yeong,Seong, Suk-Hwan,Kim, Ju-Hyeon 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.4

From Nov. 1980 to Jun. 1987, 270 primary lung cancer patients were operated on at the department of Thoracic & Cardiovascular Surgery, Seoul National University Hospital. There Were 223 males & 47 females with 55.5 years of mean age. There were 151 [55.9%] squamous cell ca., 43 [18.8%] adenoca., 8 [3.5%] undiff. large cell, 9 [3.9%] undiff. small cell ca. & 18 [7.9%] mixed type, and also composed of 65 [28.3%] stage I, 31 [13.5%] stage II and 133 [58.1%] of stage III cases. They received 78 [34.1%] lobectomies, 62 [27.1%] pneumonectomies and 60 [26.2%] exploratory thoracotomies with 70% resectability rate. The five year actuarial survival rate of all patients was 37%. According to TNM stage, five year survival rate of the patients in stage I was 71%, those of stage II was 29% and of stage III 21%. According to histological cell type, five year actuarial survival rate of the squamous cell ca. was 35%, of adenoca. 49%, of undiff. large cell. 22%, 2 year survival rate of undiff. small cell was 31% and 3 year survival rate of mixed type was 47%. Hospital death was 2 case with a 1.3% early postop. mortality rate.

IonescuShiley 조직판막 치환수술후 발생한 판막부전에 관한 임상적 연구 -7년간의 장기성적-

함시영 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.1

The result of valve failure with the lonescu-Shiley pericardial xenograft was presented with the review of current knowledge. This study reviewed 557 patients, who underwent total of 683 lonescu-Shiley pericardial valve replacement from 1979 to 1985 at Seoul National University Hospital. There were 357 patients who had mitral valve replacement, 73 with aortic valve and 127 with double valve replacement. There were 35 operative deaths. The survivors were followed at OPD. There were 32 patients who had prosthetic valve failure, whose ages ranged from 11 to 58 years [mean 27.8] and their postop interval was 56 ~ 22 months [range; 6-87] The causes of valve failure are prosthetic valve endocarditis in 14, primary disruption or calcification in 13, paravalvular leakage in 4, and others in 2 patients. Redo valve replacement was done in 12 patients after a mean interval of 50 * 20 months. [range; 6-79 months] Actuarial analysis of late results indicates actuarial freedom from endocarditis at 6 year is 87.9 ~ 6.8%, and actuarial freedom from primary disruption or calcification or paravalvular leakage at 5 year is 84.4 * 2.3%. In this series, however, valve failure due to thrombosis is not included.

새로운 대동맥판 성형술

함시영,정동섭,제형곤,주석중,강덕현,김재중,송재관,서준범,임태환,송명근 대한심장학회 2006 Korean Circulation Journal Vol.36 No.2

Background and Objectives:The purpose of this study was to assess the results of a newly developed aortic valverepair technique. Subjects and Methods:Between December 1997 and April 2005, 75 aortic valvuloplasties wereperformed using a new technique that addressed the 3 main components of the aortic root; annulus, sinotubularjunction and leaflet. An internal synthetic strip and ring were implanted along the fibrous annulus to reduce theannulus and sinotubular junction, and additional leaflets were implanted for leaflet correction. Based on theprimary pathology, there were 35, 22 and 18 cases of isolated aortic regurgitation, aortic regurgitation due toascending aortic aneurysm and aortic regurgitation due to annuloaortic ectasia, respectively. Results:The averageage of the subjects was 46.4±16 years; there were 51 and 24 males and females, respectively. There was no operativemortality, with a 2-year freedom from reoperation rate of 97%. Follow up echocardiograms showed significantimprovements in the grade of aortic regurgitation, from a preoperative mean of 3.1±1.2 to 1.08±0.7 immediatepostoperatively, to 1.15±0.6 at the final follow up. Conclusion:The results of the current study showed thistechnique to be effective in the treatment of aortic regurgitation of various causes. Although long-term results arepending, it is our contention that this aortic valve repair technique will be a reliable method in the future.(Korean Circulation J 2006;36:140-149) 배경 및 목적:이 연구의 목적은 새로이 개발된 대동맥판 성형술의 결과를 알아보기 위한 것이다.방 법:대동맥 근부의 세가지 중요한 요소인 판막륜, 동관연결부,판막엽의 교정에 중점을 둔 새로운 대동맥판 성형술이 1997년 12월부터 2005년 4월까지 75명의 환자에서 시행되었다.이는 ring과 strip을 이용해 대동맥 판막륜과 동관연결부의직경을 줄이고 주로 판막엽 첨가술을 이용하여 비정상적인 판막엽을 교정하는 술식으로 구성되어 있다. 병리학적 소견에따라 순수 대동맥판 폐쇄부전증 35명, 상행대동맥류에 의한대동맥판 폐쇄부전증 22명, 그리고 대동맥 근부확장증에 의한 대동맥판 폐쇄부전증 18명이 있었다.

Effect of antioxidant reagent in viologen eletrochromism

양시영,김영순,김은경,함경상,박종윤 한국고분자학회 2007 한국고분자학회 학술대회 연구논문 초록집 Vol.2007 No.4

식도재건술후 문합부 합병증

이철범,함시영,김혁,정원상,김영학,강정호,백홍규,Lee, Chul-Burm,Hahm, Shee-Young,Kim, Hyuk,Jung, Won-Sang,Kim, Young-Hak,Kang, Jung-Ho,Baik, Hong-Kyu 대한기관식도과학회 2000 大韓氣管食道科學會誌 Vol.6 No.1

Background: For the purpose of reducing operating time and rate of anastomotic leakage, we have performed esophagovisceral anastomosis with an EEA stapler using the largest size possible. If any difficulty in the approach of the EEA stapler was encountered one-layer interrupted hand-sewn anastomosis. Because the rate of postoperative benign anastomotic stricture was higher than expected, a retrospective study was done on all patients who underwent esophageal reconstruction. Material and Method: Over a period of 3 years from January 1996 to December 1998, we performed esophageal reconstructions on 30 patients. Patients were divided into two groups ; EEA stapler group(Group Ⅰ) comprised of 21 patients and hand-sewn group(Group Ⅱ) comprised of 9 patients.Result:The hospital mortality was 6.67 %(2/30) and the anastomotic leakage rate was 3.33 %(1/30). Among the discharged patients, the rate of recurrent anastomotic tumor was 3.57 %(1/28) and the rate of benign anastomotic stricture stricture rate was 35 %(7/20) in Group Ⅰ and 12.5 %(1/8) in Group Ⅱ, which was not significant. Conclusion: Although nontumor benign stricture was significantly higher in Group Ⅱ than in Group Ⅰ(p=0.0492), the incidence of anastomotic complications did not differ between the two groups. The one-layer interrupted hand-sewn esophagovisceral anastomosis by maintaining a wide lumen and close approximation of mucosa to mucosal layers with evenly spaced sutures could be one of the preferred surgical method to reduce benign anastomotic strictures.

동맥 흉곽 출구 증후군을 일으킨 쇄골하동맥 맥관 육종 -1례 보고-

이철범,함시영 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery (J Chest Surg) Vol.29 No.10

저자들은 지금까지 발생보고 예가 없는 좌쇄골하동맥 맥관육종 1례 수술을 치험하였다. 제 1늑골의 기형이 있는 19세 여자 환자로, 1년 전부터 점진적으로 심해진 동맥 흉곽 출구 증후군의 증상을 나타냈다. 쇄골 중앙부를 절제한 후 폐쇄된 쇄골하 동맥 제 3부분과 상완 동맥 분절을 절제하고 대복재 정맥을 이용하여 우회로 조성술을 시행하였다. 쇄골하 동맥의 병리 조직 소견은 벽재성형 맥관 육종이었으며 혈액 응고 인자 WII과 관련되는 항원에 대한 조직 화학적 염색 소견도 양성이었다. 수술전 일상 생활을 할 수 없을 정도 심한 증상이 수술후 거의 소실되었으며, 수술후 4개월된 현재 직장 생활을 계속하고 있다. We report a case of an angiosarcoma arising from the subclavian artery, a site not previously described. A 19-year-old girl, born with a rudimentary first rib, has been suffered from arterial thoracic outlet syndrome due to a complete occlusion of the third portion of the subclavian artery for 1 year. Partial claviculectomy, excision of completely occluded arterial segment, and reconstruction with great r saphenous vein graft were done. Histologic study for the subclavlan artery revealed mural type anglosarcoma. The histochemici1 staining for factor VIII related antigen was positive. The debilitating symptoms that did not allow her a normal daily life, almost subsided postoperatively. And she has remained well with no clinical evidence of disease for 4 months post-operation.