초록접수 현황
| 14F-170 | 구연 발표 |
Management of Post-pneumonectomy Syndrome Using Tissue Expanders
조종호¹, 김홍관¹, 최용수¹, 김관민², 김진국¹, 조재일¹, 심영목¹
성균관대학교 의과대학 삼성서울병원 흉부외과학교실¹, 서울대학교 의과대학 분당서울대학교병원 흉부외과학교실²
Background : Post-pneumonectomy syndrome (PPS) is a rare syndrome that is characterized by trachea-bronchial stenosis and severe dyspnea; these symptoms are caused by mediastinal shifting either after pneumonectomy or from similar disease status like severely destroyed lung or congenital pulmonary agenesis. In this study, we retrospectively evaluated the clinical outcomes in patients who underwent placement of tissue expanders for PPS.
Methods : Patients who underwent placement of tissue expanders for PPS were analyzed for preoperative characteristics, surgical techniques, and postoperative outcomes. Between 1997 and 2014, a total of 10 patients were treated for PPS by tissue expanders.
Results : There were 10 patients with a median age of 45 (range, 16-70). Four patients had undergone right pneumonectomy, three patients had undergone left pneumonectomy, and three patients had post-pneumonectomy-like syndrome (two patients had severely destroyed lung due to pulmonary tuberculosis, and one patient had congenital pulmonary agenesis). Preoperatively, seven patients initially received high oxygen therapy for hypoxemia but progressed to respiratory failure, and three patients required mechanical ventilator support. Among these three patients, one patient needed intraoperative extracorporeal membrane oxygenation support because of sudden cardiac arrest during preparation for surgery. The median follow-up was 59.5 months (range, 2-204 months). The median interval between pneumonectomy and repositioning was 13 months (range, 8-581). One patient underwent placement of single tissue expander, and two tissue expanders were placed in nine of 10 patients. The median volume of tissue expanders inflated with saline was 450 cc (range, 60-850 cc) per tissue expander. There was no perioperative mortality in our study. Complications occurred in four patients: pneumonia in two patients, and two patients required reoperation because of leakage of the tissue expander. Postoperatively, nine patients showed significant improvement and were able to discharge without oxygen. However, one patient still required mechanical ventilator even after tissue expander placement, and transferred to local hospital for supportive care.
Conclusion : PPS is a rare and unpredictable complication after pneumonectomy. Tissue expander can be a useful means of mediastinal repositioning for PPS with acceptable morbidity and mortality.
Methods : Patients who underwent placement of tissue expanders for PPS were analyzed for preoperative characteristics, surgical techniques, and postoperative outcomes. Between 1997 and 2014, a total of 10 patients were treated for PPS by tissue expanders.
Results : There were 10 patients with a median age of 45 (range, 16-70). Four patients had undergone right pneumonectomy, three patients had undergone left pneumonectomy, and three patients had post-pneumonectomy-like syndrome (two patients had severely destroyed lung due to pulmonary tuberculosis, and one patient had congenital pulmonary agenesis). Preoperatively, seven patients initially received high oxygen therapy for hypoxemia but progressed to respiratory failure, and three patients required mechanical ventilator support. Among these three patients, one patient needed intraoperative extracorporeal membrane oxygenation support because of sudden cardiac arrest during preparation for surgery. The median follow-up was 59.5 months (range, 2-204 months). The median interval between pneumonectomy and repositioning was 13 months (range, 8-581). One patient underwent placement of single tissue expander, and two tissue expanders were placed in nine of 10 patients. The median volume of tissue expanders inflated with saline was 450 cc (range, 60-850 cc) per tissue expander. There was no perioperative mortality in our study. Complications occurred in four patients: pneumonia in two patients, and two patients required reoperation because of leakage of the tissue expander. Postoperatively, nine patients showed significant improvement and were able to discharge without oxygen. However, one patient still required mechanical ventilator even after tissue expander placement, and transferred to local hospital for supportive care.
Conclusion : PPS is a rare and unpredictable complication after pneumonectomy. Tissue expander can be a useful means of mediastinal repositioning for PPS with acceptable morbidity and mortality.
책임저자: 김홍관
성균관대학교 의과대학 삼성서울병원 흉부외과학교실
연락처 : 조종호, Tel: 02-3410-1696 , E-mail : jongho.cho@gmail.com
