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Tuberculosis & Respiratory Diseases

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Vol.59 No.5
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중심성 폐암환자에서 악성 기도폐쇄에서 전기 탐침과 투열올가미를 사용한 전기 소작술의 효과

Bronchoscopic Electrocautery with Electroprobe and Diathermic Snare in Patients with Malignant Airway Obstruction

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2005, v.59 no.5, pp.504-509
유홍준 (고신대학교)
장태원 (고신대학교)
정만홍 (고신대학교)
최평락 (고신대학교)
박은호 (고신대학교)
양재홍 (고신대학교)
김형준 (고신대학교)
김주훈 (고신대학교)
옥철호 (고신대학교)
조현명 (왈레스 기념 침례병원)
유홍준, 장태원, 정만홍, 최평락, 박은호, 양재홍, 김형준, 김주훈, 옥철호, & 조현명. (2005). 중심성 폐암환자에서 악성 기도폐쇄에서 전기 탐침과 투열올가미를 사용한 전기 소작술의 효과. Tuberculosis & Respiratory Diseases, 59(5), 504-509.
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초록

배 경 : 폐암의 경과 중 종양에 의한 기도폐쇄로 발생하는 호흡곤란은 환자의 삶의 질을 저하시키는 중요한 요인이다. 이런 환자들에서 전기탐침과 투열 올가미를 이용하여 굴곡성 기관지경을 통해 시행한 전기 소작술의 치료효과를 조사하였다. 방 법 :기도를 침범한 종괴로 인해서 호흡곤란을 호소하는 19명의 폐암환자(편평상피암 14례, 선암 1례, 전이성 폐암 4례)를 대상으로 하였다. 평균 나이는 61±10세였으며 남자가 17명 여자가 2명이었다. 폐쇄부위는 기관이 2례, 주기관지가 17례였다. 국소마취 하에서 굴곡성 기관경을 통해 전기소작술을 총 29회 시행하였으며 소작시 30W의 전력을 사용하였다. 치료 전에 modified Borg category scale(0～10), 환기기능검사 및 기관지 내시경검사를 실시하였고 시술 후 3-4일 후에 modified Borg category scale(0～10)의 변화 및 환기기능 검사를 시행하였고, 정화 기관지경술(clean- up bronchoscopy)을 시행하여 기도폐쇄의 완화의 정도를 측정하였다.

keywords
Lung cancer, Airway obstruction, Electrocautery, Lung cancer, Airway obstruction, Electrocautery

Abstract

Background : Endobronchial tumors cause life-threatening dyspnea and can lower the quality of life due to central airway obstruction. In those cases with an intraluminal tumor, various bronchoscopic techniques are available for tumor debulking. The therapeutic effect of bronchoscopic electrocautery for palliation in patients with a symptomatic tumor obstruction was studied. Method : Nineteen patients with bronchogenic carcinomas (n=15) and metastatic tumors affecting the bronchi (n=4), between March 2002 and March 2005, were enrolled in this study. Electrocautery was performed under local anesthesia using an electroprobe and diathermic snare. Using flexible bronchoscopy, a follow-up bronchoscopic examination was performed 3-4 days later. Symptom improvement was evaluated by FEV1, FVC and dyspnea score (Modified Borg Category Scale (0∼10)), both before and after the electrocautery. Results : The success rate of electrocautery on the follow up examination was 84%. Patients with endoluminal airway lesions had a mean overall decrease in the size of the obstruction to 47.8±15.7%. The mean Improvement in the dyspnea score immediately after the endobronchial tumor debulking was 2.78±1.42.  The average improvements in the FEV1 and FVC after electrocautery were 0.32±0.19L and 0.5±0.22L, respectively. There were 2 cases of complications related with electrocautery (one each of pneumothorax and pneumonia). Conclusion : Electrocautery using an electroprobe and diathermic snare was an effective and safe palliative treatment for a symptomatic endoluminal airway obstruction in lung cancer. (Tuberc Respir Dis 2005; 59: 504-509)

keywords
Lung cancer, Airway obstruction, Electrocautery, Lung cancer, Airway obstruction, Electrocautery

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Tuberculosis & Respiratory Diseases

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