ABSTRACT
@#Objective To evaluate whether surgical intervention can be performed in initial onset of primary spontaneous pneumothorax (PSP) patients and whether pleural abrasion should be performed regularly in PSP treatment. Methods The clinical data of 326 PSP patients undergoing bullectomy or bullectomy combined with pleural abrasion (BLPA) between January 2008 and December 2013 were retrospectively reviewed. There were 267 males and 59 females, with a mean age of 24 years ranging from 20 to 31 years. Results The initial onset of PSP was in 229 patients, and recurrent PSP in 115 patients. Ten patients had postoperative PSP recurrence after a mean follow-up of 47 months ranging from 1 to 95 months. For the patients with initial onset of PSP, the recurrence rate was 3.1% (7/229), and that in patients with recurrent PSP was 2.6% (3/115, P=0.82). Compared with the bullectomy group (5.8%, 7/120), recurrence rate in the BLPA group was lower (1.3%, 3/224, P=0.02). There were no mortalities or significant complications in both groups. There was significant difference in body mass index (P=0.04), intraoperative adhesion (P<0.05), operation duration (P<0.01), number of bullae (P<0.01), and bullae location (P<0.01) between bullectomy and BLPA groups. Postoperative drainage (P<0.01), air leak (P=0.01) and extubation duration (P<0.01) were significantly lower in the bullectomy group. Total cost was significantly higher in the BLPA group (P<0.01). Conclusion Surgical intervention could provide satisfactory outcomes for PSP patients. Compared with bullectomy, BLPA has much lower recurrence rate, but with more drainage, longer drainage duration and higher cost.
ABSTRACT
Introducción: el tratamiento del derrame pleural maligno constituye un reto para los cirujanos. Su erradicación permanente ha constituido un largo bregar, y para ello se ha utilizado un numeroso grupo de sustancias. Objetivo: mostrar los resultados del uso de diferentes sustancias químicas para conseguir la fusión de las pleuras en el derrame pleural maligno. Métodos: fueron estudiados 116 pacientes con derrames malignos de pleura tratados mediante toracocentesis y escleroterapia química en el Hospital Universitario Comandante Manuel Fajardo entre enero de 2001 y el 2013. El diagnóstico del 100 por ciento de los pacientes fue clínico e imaginológico, con estudio del líquido pleural. Después de la toma de muestra se evacuó todo el contenido mediante un catéter colector y la instilación de la solución esclerosante. Como agentes irritantes se utilizó bleomicina, tetraciclina, amoxicilina y povidona yodada. Resultados: la causa más frecuente de derrame pleural resultó ser el cáncer de mama, seguido por el de pulmón y el ovario. En el hombre fue más frecuente el cáncer de pulmón y en la mujer el cáncer de mama. Predominó el sexo femenino y, específicamente, la sexta década de la vida. El 52,4 por ciento de los pacientes necesitó dos sesiones terapéuticas y el 15,6 por ciento no presentó recidiva después de la primera sesión. Conclusiones: los resultados fueron similares con todas las sustancias utilizadas. La intervención paliativa logró mejorar la calidad de vida al aliviar los síntomas de los pacientes y disminuir la hospitalización(AU)
Introduction: the treatment of the malignant pleural effusion poses a challenge for the surgeons, its permanent eradication has been a long struggle based on the use of a number of substances. Objective: To show the results of the use of different chemical substances to fuse the pleuras in malignant pleural effusion. Methods: one hundred and sixteen patients with malignant pleural effusions, who were treated with thoracentesis and chemical sclerotherapy at Comandante Manuel Fajardo university hospital from January 2001 through January 2013, participated in the study. Their diagnosis was based on clinical examination and imaging, with additional pleural fluid study. After the sample-taking, a collecting catheter and an instilled sclerosing solution were used to remove the whole pleural content, whereas bleomycin, tetracycline, amoxicillin and povidone iodine acted as irritating agents. Results: the most frequent cause of pleural effusion was breast cancer, followed by lung and ovary cancers. The lung cancer was commonest in men and breast cancer in females. Females and the age of 60 years prevailed. In this group, 52.4 por ciento required two therapeutic sessions and 15.6 por ciento showed no relapse after the first session. Conclusions: the results were similar with all the used substances. The palliative intervention succeeded in improving the quality of life, releasing symptoms and reducing hospitalization(AU)