비데오 흉강경을 이용한 종격동 종양 절제술;2례 보고

이두연,김해균,문동석,Lee, Du-Yeon,Kim, Hae-Gyun,Mun, Dong-Seok 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.7

We have experienced two cases of video thoracosopic excision of mediastinal tumors at the department of thoracic and cardiovascular surgery, Yonsei University, College of medicine. Histologically the mediastinal tumors were cystic thymoma in one & bronchogenic cyst in another. The operative times were rather short and the post-operative courses were not eventful. These patients were discharged with less chest discomforts in post-operative 5 days & have been in good conditions to now.

식도결장문합후 병발한 결장팽대부 확장증 -수술치험 1례-

이두연,백효채,배기만,Lee, Du-Yeon,Baek, Hyo-Chae,Bae, Gi-Man 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery (J Chest Surg) Vol.29 No.6

식도결장문합후 결장팽대부 확장은 매우 드문 부작용으로 천공의 위 험성이 높아서 매우 위험하다. 그 리하여 신속한 수술적 치료법이 요망된다. 기존의 수술방법에 의한 수술시야 확보 및 병변의 절제는 아 주 어렵다. 저자등은 내시경 자동봉합기(endo GIA)를 이용하여 결장팽대부 확장을 간편하고 안전하게 제거하여 양호한 결과를 보였기 에 보고하는 바이다. The dilated haustra of colon after esophagocolostomy was a rare complications, but it may be extremely dangerous because of the potential for perforation of the thin- walled esophageal substitute. Therefore a prompt surgical correction of the lesion should be done. The conventional surgical exploration and resection of the lesion site was very difficult. The use of the ends GIA to eliminate the dilated haustra of colon was simple and safe method and the postoperative results were good. We report a case of experience and methods.

조직접합제를 이용한 기관지식도루 폐쇄술 -치험2예-

이두연,윤치순,홍승록,Lee, Du-Yeon,Yun, Chi-Sun,Hong, Seung-Rok 대한흉부심장혈관외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.5

This BEF will be resolved with tissue adhesive application The bronchoesophageal fistula[BEF] is a rare lesion in thoracic surgical diseases & is difficult to be closed surgically. Tissue adhesives has been used widely in surgical fields, or in endoscopy, for some time and seems to be potentially useful in cardiothoracic surgery. We have experienced the closure of BEF with tissue adhesive Tisseel in 2 cases recently. One is 60 years old male who had taken the closure of BEF with Tisseel through right bronchotomy. The other is 57 years old female who had taken the closure of BEF with Tisseel with flexible gastrofiberscopy. The postoperative courses are uneventful for 4 months to now.

식도 재건 수술후 발생한 합병증 치험

이두연,윤치순,홍승록,Lee, Du-Yeon,Yun, Chi-Sun,Hong, Seung-Rok 대한흉부심장혈관외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.5

Post-anastomotic leakage and stenoses remain major complications and are still responsible for many mortalities after esophageal reconstructive procedures. If the hand-suture is used, anastomotic leaks developed frequently than stenoses. But post-anastomotic leakages are more critical than post-anastomotic stenoses. If the stapler is used, anastomotic stenoses will develop frequently and not critical than anastomotic leakages. The stapler suture method is easier and quicker than the hand suture method in the esophageal anastomotic procedures. But the disadvantages of the stapler suture method is that there is not reachable site with anastomotic stapler the thoracic inlet region and the cost is expensive. We have treated 44 cases of the surgical complications after esophageal reconstructive procedure with conservative and surgical treatment for 10 years from January, 1980 to December, 1989. The anastomotic site stenoses were 8 cases in the hand-suture methods and 4 cases in the stapler-suture methods. The anastomotic leaks were 8 cases in hand-suture methods and 5 cases in stapler-suture methods. There were one death in the surgical repair of four post-operative anastomotic stenoses and two deaths in the surgical repair of three post-operative anastomotic leakages. Ever though we consider that there is more anastomotic leakage than stenoses after the hand-suture methods in esophageal reconstructive procedures. the cost with long stay in the intensive care unit to treat anastomotic leakage after the hand-suture, would be more expensive than-the cost of the treatment of the anastomotic stenoses after auto-suture.

쇄골하정맥을 이용한 J 형의 전극도자를 가진 심방 Pacemaker 이식치험 2예

이두연,홍승록,이웅구,Lee, Du-Yeon,Hong, Seung-Rok,Lee, Ung-Gu 대한흉부심장혈관외과학회 1983 Journal of Chest Surgery (J Chest Surg) Vol.16 No.2

The management of cardiac arrhythmias by cardiac pacing has increased greatly since the treatment of complete heart block with an external transcutaneous pacemaker in 1952, followed by the use of myocardial wires connected to an external pulse generation, by external transvenous pacing, and then by transvenous pacing with implantable components in thoracic wall.By now, the three bases of modern cardiac pacing for bradyarrhythmias had been established [1] an implantable device [2] the transvenous approach [3] the ability of the pacemaker to sense cardiac activity and modify its own function accordingly. In transvenous implantation of a pacemaker, any one of four vessels at the root of the neck is suitable for passage of the electrode - cephalic vein, external jugular vein, internal jugular vein, costo-axillary branch of the axillary vein. The new technique of direct puncture of the subclavian vein, either percutaneously or after skin incision only has been made, is invaluable & is used routinely. We have experienced one 25 years old patient who had rheumatic mitral stenosis & minimum aortic regurgitation with sinus bradycardia associated with premature atrial tachycardia & another 54 years old female patient who was suffered from sick sinus syndrome with sinus bradycardia & sinus arrest. The 1st patient was taken open mitral commissurotomy & aortic valvuloplasty and then was taken atrlal pace-maker implantation through If subclavian puncture method in post-op 14 days, and the second patient was taken atrial pacemaker implantation through If subclavian puncture method. Their postop course was in uneventful & were discharged, without complication. Their condition have been good to now.

늑간신경에 발생한 신경초종 1예

이두연,계기식,송계용,Lee, Du-Yeon,Gye, Gi-Sik,Song, Gye-Yong 대한흉부심장혈관외과학회 1978 Journal of Chest Surgery (J Chest Surg) Vol.11 No.3

Recently, we experienced a case of rare neurilemmoma originated from intercostal nerve [9th] in the right chest wall in a 25 year old male officer. The tumor was incidentally found in the routine chest X ray, where the round well circumscribed mass tumor the ninth rib with notching and sclerotic margin, suggesting slowly growing benign benign of chest wall was revealed and the tumor mass was easily extirpated in the exploratory thoracotomy, with uneventful recovery. Grossly, the tumor was firm, partly soft and well circumscribed, measuring 4.5X3.0X 3.0 cm with yellowish smooth outer surface, attached with intercostal nerve trunk. Cut surface exhibits partly grayish white and largely hemorrhagic areas. Microscopically, the characteristic palisading arrangement of schwann cells and Verocay bodies are seen but dominant features are cystic degeneration and hemorrhage with organization and fibrosis. The sheath of intercostal nerve and capsule of neurilemmoma were con joined. There is no evidence of malignancy. The tumor was confirmed as neurilemmoma of intercostal nerve, Antony type B.

폐 구역절제 혹은 기포절제 수술후 발생한 페늑막루 폐쇄 -조직접합제 사용 4예-

이두연,김해균,문동석,Lee, Du-Yeon,Kim, Hae-Gyun,Mun, Dong-Seok 대한흉부심장혈관외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.10

The bullectomy, or sedge resection of the lung including bullae is the treatment of choice for the recurrent spontaneous pneumothorax, and but results in pleuropulmonary fistulae in postoperative periods in some emphysematous lungs. There are many methods to close the air leakages with T-M, Talc powders. Or the closure of air leakage sites can be closed c resuture, wedge resection or lobectomy through re-explothoracotomy. Tisseel, a in thoracic surgical areas in recents. We have sealed the post-operative air leakage sites after bullectomy or segmental resection for 4 recurrent spontaneous pneumothorax with the spray of Tisseel & throbin through thoracoscope without re-explothoracotomy. The post-operative courses are uneventful to now.

폐기종 환자에서의 흉강내시경을 이용한 폐용적 감축술 -1례 보고-

이두연,조현민,문동석,Lee, Du-Yeon,Jo, Hyeon-Min,Mun, Dong-Seok 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.8

폐용적 감축술(Lung volume reduction surgery : Lns)은 최근들어 활동이 어려운 심한 폐기종 환자에서 폐이식의 대체요법이나 폐이식의 전단계 시술로 추천되고 있다. 이 시술은 폐기종 환자의 호흡곤란을 감소 시키고 일상생활의 수행을 개선시키기 위한 고식적인 치료방법이다. 범발성 폐기종 환자에 대한 폐용적 감축술(LVRS)의 개념은 병변이 심한 기능이 없는 폐를 절제함으로써 남아있는 병변이 적은 폐의 기능을 개선 시킨다는 것이다. 폐용적 감축술UnS)의 성공에 결정적인 영향을 미치는 요소들로는 철저한 환자의 선택 (patient selection), 정확한 수술부위의 위치선정, 신중한 마취 및 수술기법, 그리고 집중적인 술후 처치 등이 있다. 본 병원에서는 심한 폐기종으로 입원한 59세 남자환자에서 철저한 선택과정patient selection)과 호흡기재활 (pulmonary rehabilitation)을 거쳐 흉강내시경을 이용하여 폐용적 감축술InnS)을 시행하였으며 술후 경과 양 호하녀 퇴원 후 현재 외래 추적관찰 중이다. Lung volume reduction surgery(LVRS) has recently been advocated as an alternative or a bridge to lung transplantation for patients with evere dibbling emphysema. This procedure is a palliative treatment performed to alleviate the dyspnea of patients with emphysema and improve performance in the activities of daily living. The rationale of lung volume reduction for generalized emphysema is that the removing of the diseased and functionless lung may improve the function of remaining, less diseased lung. The factors critical to the success of LVRS are careful patient selection, accurate localization of target areas, meticulous anesthetic and operative technique, and intensive postoperative support. We have experienced a case of severe emphysema in a 59-year-old male patient. After selection process and pulmonary rehabilitation, the patient was treated with video-assisted thoracoscopic LVRS and the post-operative course was uneventful.

흉강내시경을 이용한 교감신경절 절제수술

이두연,강정신,Lee, Du-Yeon,Gang, Jeong-Sin 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.11

본태성 다한증이란 신체의 일부에서 과도하게 땀이 많이 나는 병적인 상태이며 대부분에서 일상 생활을 영위하는데 어려움이 있다. 연세대학교 의과대학 영동세브란스병원 호흡기센터 흉부외과에서는 1992년 6월부터 1996년 5월까지 211예 에서 흉강내시경을 이용한 홉부교감 신경절 절제수술을 시행하였으며 이중 192예가 수부다한증이었으며 19예가 안면 다한증이었다. 이중 남자가 121예, 여자가 90예이었으며 연령분포는 10세에서 67세 사이로서 평균 24.82이었다. 평균 수술시간은 91.94분이었고 입원기간은 4.31일이었다. 수술전후 합병증은 없었으며 수술후 즉시 증상호전이 있었으며 등과 가슴 일부에 보상성 다한증이 발견되었으나 우려 할 상황은 아니었다. 안면 다 한증등과 같은 경우 흉강내시경 수술에서 개흉수술로의 전환 가능성은 배제할 수 없겠으나 흉강내 시경 흉부교감신경절 절제수술은 다한증 수술치료에선 매우 안전하고 유용한 수술로 생각되어진다. Essential hyperhidrosis is a condition with excessive sweating, which may be localized in any part of the body Excessive sweating has a strong negative impact on the qual ty of life for many persons. From June 1992 to May 1996, 211 cases of thoracoscopic thoracic sympathectomy were performed in the Department of Thoracic Surgery, Yongdong Severance Hospital, Seoul, Korea. Among the 211 cases, 192 patients had palmar hyperhidrosis, and 19 cases had facial hyperhidrosis. There were 121 males and 90 (tamales, and the ages ranged from 10 to 67 years(average: 24.82 years old). The average operation time and the average postoperative hospital stay were 91.94 minutes and 4.31 days, respectively. Perioperative courses were uneventful, and all the patients had immediate and complete relief of symptoms with mild compensatory sweating on the chest wall and the back. Even though a thoracoscopy has the possibility of emergency conversion to a thoracotomy and technical difficulties still exist, especially in patients with facial hyperhidrosis, our experience indicates that video-assisted thoracoscopic thoracic sympathectomy is a very safe and useful procedure for h perhidrosis.

고양이의 절제된 폐단면에 histoacryl 의 폐쇄효과에 대한 실험적 연구

이두연,오중환,방정현,Lee, Du-Yeon,O, Jung-Hwan,Bang, Jeong-Hyeon 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.2

Segmental resection or wedge resection of the lung and direct cutting across of bronchi frequently results in postoperative airleaks or bronchopleural fistula in some cases. Many methods have been devised to handle air leak problems by oversuturing the raw edges, the application of pleural onlay flaps, the use of cautery or tissue adhesives, but these still has not solved the problem of air leaking from raw surfaces of the lung with only partial successful we have tried the use of histoacryl to closure the raw surface of the resected lung and compared it’s results with of the closure with chromic catgut sutures in cats from May 1989 to Jan. 1990 at the department of the thoracic and cardiovascular surgery, Yonsei University, College of Medicine. Ninety lobe of the lungs were used in this study and forty nine of which have been divided segmentally and closed with histoacryl on the raw surfaces. Forty one of which have been divided segmentally and closed with sutures using chromic catgut for control. There were air leakages in twelve cases among 49 cases with applying histoacryl and airleak were in two cases among 12 cases with reapply histoacryl, But there were air leak in two cases among 41 cases with sutures using chromic catgut and airleak were in one case among with resutures using chromic catgut.