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El cáncer broncogénico tiene una base genética, que se expresa por factores externos relacionados a la exposición medioambiental y laboral, en los últimos años ha cambiado el perfil epidemiológico con incidencia creciente en mujeres sin hábito tabáquico en rangos de 50-70 años. Paciente femenino de 50 años con el antecedente de exposición a humo de leña y uso de pesticidas, con síndrome de atelectasia pulmonar masiva izquierda. Se realizó estudios fibrobroncoscopicos con toma de biopsia de masa tumoral endobronquial izquierda y se realizó la primera criobiopsia por fibrobroncoscopía en Bolivia, posteriormente paciente fue sometida a neumonectomia izquierda con estudio histopatológico concluyente de carcinoma indiferenciado de células pequeñas con primario pulmonar. Existe una fuerte asociación entre la exposición medio-ambiental y laboral y el cáncer broncogénico en pacientes no fumadores, incluso en variantes histopatológicas infrecuentes en este subgrupo como el cáncer de células pequeñas o microcítico.
Bronchogenic cancer has a genetic basis, which is expressed by external factors related to environmental and occupational exposure. In recent years, the epidemiological profile has changed with increasing incidence in women without tobacco habit in ranges of 50-70 years. A 50-year-old female patient with a history of exposure to wood smoke and pesticide use, with massive left lung atelectasis syndrome. Fibrobronchoscopy studies were performed with a biopsy of the left endobronchial tumor mass and the first cryobiopsy was performed by fibrobronchoscopy in Bolivia, later the patient underwent left pneumonectomy with a conclusive histopathological study of undifferentiated small cell carcinoma with a pulmonary primary. There is a strong association between environmental and occupational exposure and bronchogenic cancer in non-smokers, even in infrequent histopathological variants in this subgroup such as small cell or microcytic cancer.
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Objective:To observe the effect of preoperative application of butorphanol tartrate on postoperative recovery quality in patients undergoing thoracoscopic lobectomy.Methods:A prospective selection was conducted on 96 lung cancer patients who underwent thoracoscopic lobectomy and were admitted to Linyi People′s Hospital from May 2021 to September 2021. They were randomly divided into observation group and control group using a random table number method, with 48 patients in each group. The observation group received intravenous injection of 0.02 mg/kg butorphanol tartrate 15 minutes before anesthesia induction; The control group was given an equal volume of physiological saline. The operation site, operation time, remifentanil dosage during operation, heart rate (HR) and mean arterial pressure (MAP) at each time point of admission (T 0), intubation (T 1), 5 min after intubation (T 2), extubation (T 3), 5 min after extubation (T 4), and 15 min into post-anaesthesia care unit (PACU) (T 5) were recorded; The awakening Restlessness score (RS), Ramsay score, Visual Analogue Scale (VAS) score at T 4 and T 5, the time required from completion to extubation, and postoperative anesthesia related adverse reactions were evaluated. Results:There was no significant difference in the operation site, operation time and remifentanil dosage between the two groups (all P>0.05). Compared with T 0, the HR at T 2, T 3 and T 4, MAP at T 1, T 2, T 3 and T 4 in the two groups decreased significantly (all P<0.05). The HR of the observation group at T 1 and T 3 was significantly lower than that of the control group, and the difference was statistically significant (all P<0.05). The VAS scores of T 4 and T 5 in the observation group were lower than those in the control group after surgery, while the Ramsay score were higher than those in the control group (all P<0.001). The incidence of postoperative restlessness, nausea and vomiting in the observation group was lower than that in the control group ( P<0.05). Conclusions:Administering 0.02 mg/kg butorphanol tartrate 15 minutes before anesthesia induction can improve the quality of recovery in patients undergoing thoracoscopic lobectomy, reduce restlessness and related adverse reactions during recovery.
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Objective:To investigate the effects of thoracic segment epidural anesthesia on inflammatory factors in patients undergoing lung cancer surgery.Methods:The clinical data of 136 patients who underwent lung cancer surgery in the Second People's Hospital of Liaocheng from June 2020 to May 2022 were retrospectively analyzed. According to anesthesia methods, these patients were divided into an observation group ( n = 89) and a control group ( n = 47). The observation group was given thoracic segment epidural anesthesia, while the control group was given remifentanil infusion anesthesia. The tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels in the epithelial lining fluid collected from the non-dependent lung, the plasma levels of TNF-α, IL-6, and malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, the incidence of complications, the incidence of re-operations, numeric rating scale score, and the length of hospital stay were compared between the two groups. The effects of different anesthesia methods on lung cancer surgery were evaluated. Results:In each group, TNF-α, IL-6, and IL-10 levels in the epithelial lining fluid were significantly increased 30 minutes after termination of one-lung ventilation (T2) compared with those measured before one-lung ventilation (T1) ( t = 7.71, 77.10, 7.59, 3.41, 57.51, 5.74, all P < 0.05). In the observation group, TNF- α [(1.59 ± 0.53) ng/L, (1.89 ± 0.64) ng/L] measured at T1 and T2, IL-6 [(2.96 ± 0.82) ng/L] and IL-10 [(1.99 ± 0.53) ng/L] measured at T1 were significantly higher compared with those measured at the corresponding time points in the control group ( t = 10.45, 2.59, 2.00, 7.19, all P < 0.05). In the observation group, IL-6 measured at T2 [(38.91 ± 5.84) ng/L] was significantly lower than that in the control group ( t = 33.25, P < 0.001), and IL-10 measured at T2 [(2.51 ± 0.67) ng/L] was slightly, but not significantly higher than that in the control group ( P > 0.05). There was no significant difference in the plasma level of TNF- α measured at T1 and T2 between the two groups (both P > 0.05). Plasma levels of IL-6 in the two groups [(42.98 ± 5.29) ng/L, (27.93 ± 4.17) ng/L] measured at T2 were significantly increased compared with those measured at T1 ( t = 54.14, 61.06, both P < 0.001). In the observation group, TNF-α measured at T2 [(1.60 ± 0.56) ng/L] and IL-6 measured at T1 and T2 [(0.92 ± 0.16) ng/L, (27.93 ± 4.17) ng/L] were significantly lower compared with the control group ( t = 3.39, 6.96, 18.20, all P < 0.05). There were no significant differences in plasma level of malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, numeric rating scale score, the incidence of complications, the incidence of re-operation, and the length of hospital stay between the two groups (all P > 0.05). Conclusion:Thoracic segment epidural anesthesia can reduce the local inflammatory response of the lung during lung cancer surgery.
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Objective:To investigate the risk factors of moderate to severe pain in patients with non-small cell lung cancer within 3 days after lobectomy.Methods:The clinical data of 297 patients with non-small cell lung cancer who underwent lobectomy in the Department of Thoracic Surgery, Sun Yat-sen University Cancer Center from December 2020 to June 2021 were retrospectively analyzed. A numerical rating scale was used to score the most severe pain within 3 days after surgery. Pain score ≥ 4 was defined as moderate to severe pain. The risk factors for moderate to severe pain were analyzed by binary Logistic regression. General linear model repeated measures and linear mixed models were used to analyze the trend of risk factors influencing postoperative pain with time.Results:The incidence of moderate to severe pain was 34.2% (102/297), 59.8% (178/297), 66.4% (198/297), and 28.2% (84/297) on days 0, 1, 2, and 3 after surgery respectively. The risk for moderate to severe pain was significantly higher in patients undergoing thoracotomy than patients undergoing thoracoscopic surgery on days 1 ( OR = 1.99, P = 0.009), 2 ( OR = 3.08, P < 0.001), and 3 ( OR = 3.88, P < 0.001) after surgery. However, the risk for moderate to severe pain in patients undergoing thoracotomy was slightly, but not significantly, higher than that in patients undergoing thoracoscopic surgery ( OR = 1.53, P = 0.087). The risk for moderate to severe pain was higher in female patients than male patients on day 2 ( OR = 1.62, P = 0.077), and in particular on day 3 after surgery ( OR = 2.39, P = 0.002). Prophylactic use of parecoxib significantly reduced the risk of moderate to severe pain on day 0 ( OR = 0.32, P = 0.004), 1 ( OR = 0.20, P < 0.001), 2 ( OR = 0.36, P < 0.001) and 3 ( OR = 0.56, P = 0.047). Conclusion:The incidence of moderate to severe pain on days 1 and 2 after lobectomy was relatively high in patients with non-small cell lung cancer. Patients undergoing thoracotomy have a higher risk of moderate to severe pain than those who underwent thoracoscopic surgery. Female patients have a higher risk for moderate to severe pain on days 2 and 3 after surgery than male patients. Prophylactic use of parecoxib can decrease the risk for moderate to severe pain in patients with non-small cell lung cancer.
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Objective:The purpose of this study was to investigate the clinical value of CT-guided localization of pulmonary nodules with soft wire hook-wire by trailing technique.Methods:The clinical data of 211 pulmonary nodules of 185 patients from November 2020 to March 2022 in Beijing Aerospace General Hospital were retrospectively analyzed. The pulmonary nodules were localized with soft wire hook-wire by trailing technique before video-assisted thoracic surgery (VATS). The success rate, complications, pathological results and localization operations related data were statistically analyzed.Results:The success rate of localization was 97.63% (206/211), and the success rate of VATS removal was 99.53% (210/211). The average operation time was (7.19 ± 2.62) min, and the average time required for resection of lesions was 27 min (10 to 126 min). During the surgery, the soft wire hook-wire of two patient was found to be dislocated and retracted into the chest wall. The pulmonary nodules were successfully located and removed according traces left by puncture points on the lung surface. It was found that the hook-wire was located in the interlobar fissure in 3 patients. The pulmonary nodules were successfully removed by the hook-wire position and appropriately expanding the resection range. A minor pneumothorax occurred in 49 patients, but no closed drainage was needed; 12 patients developed intrapulmonary hematoma; 15 patients with chest pain were treated with analgesia.Conclusions:For small pulmonary nodules requiring thoracoscopic surgery, the computed tomography-guided pulmonary nodule localization with soft wire hook-wire by trailing technique is more convenient, safe and effective, and is worthy of promotion to use.
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@#Objective To explore the relationship between preoperative fasting plasma glucose (FPG) and postoperative pulmonary complications (PPCs) in type 2 diabetic patients undergoing elective thoracoscopic lung resection, and provide a reference for prediction and prevention of PPCs in the clinic. Methods A retrospective analysis was performed on the type 2 diabetic patients who underwent elective thoracoscopic lung resection for the first time in our hospital from January 2017 to March 2021. According to the level of FPG one day before the operation, the patients were divided into three groups: a hypoglycemia group (<6.1 mmol/L), a medium level blood glucose group (≥6.1 mmol/L and <8.0 mmol/L) and a high blood glucose group (≥8.0 mmol/L). Besides, the patients were divided into a PPCs group and a non-PPCs group according to whether PPCs occurred. The risk factors for PPCs were analyzed by logistic regression analysis, and the predictive value of preoperative FPG level on PPCs was estimated by the area under the receiver operating characteristic curve (AUC). Results A total of 130 patients were included, including 75 (57.7%) males and 55 (42.3%) females with an average age of 63.5±9.0 years. Logistic regression analysis showed that compared to non-PPCs patients, the level of preoperative FPG (P=0.023) and smoking history ratio (P=0.036) were higher and the operation time was longer (P=0.004) in the PPCs patients. High FPG level on preoperative day 1 and longer operation time were associated with PPCs risk. Besides, the preoperative FPG of 6.79 mmol/L was the threshold value to predict the occurrence of PPCs [AUC=0.653, 95%CI (0.559, 0.747), P=0.003]. Conclusion There is a certain correlation between preoperative FPG level and postoperative PPCs, which may be used as an index to predict the occurrence of PPCs.
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Abstract Objective: Identify the one-year survival rate and major complications in patients submitted to pneumonectomy for infectious disease. Methods: Retrospective data from all cases of infectious disease pneumonectomy over the past 10 years were collected from two reference centers. The authors analyzed: patient demographics, etiology, laterality, bronchial stump treatment, presence of previous pulmonary resection, postoperative complications in the first 30 days, the treatment used in pleural complications, and one-year survival rate. Results: 56 procedures were performed. The average age was 44 years, with female predominance (55%). 29 cases were operated on the left side (51%) and the most frequent etiology was post-tuberculosis (51.8%). The overall incidence of complications was 28.6% and the most common was empyema (19.2%). Among empyema cases, 36.3% required pleurostomy, 27.3% required pleuroscopy and 36.3% underwent thoracoplasty for treatment. Bronchial stump fistula was observed in 10.7% of cases. From all cases, 16.1% were completion pneumonectomies and 62.5% of these had some complication, a significantly higher incidence than patients without previous surgery (p = 0.0187). 30-day in-hospital mortality was (7.1%) with 52 cases (92.9%) and 1-year survival. The causes of death were massive postoperative bleeding (1 case) and sepsis (3 cases). Conclusions: Pneumonectomy for benign disease is a high-risk procedure performed for a variety of indications. While morbidity is often significant, once the perioperative risk has passed, the one-year survival rate can be very satisfying in selected patients with benign disease.
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Background: Lung cancer invading left atrium is accepted as T4 tumor and surgical treatment in this situation is controversial. The aim of our study was to determine the prognostic factors of patients with surgically treated non-small cell lung cancer (NSCLC) invading left atrium. Methods: After the approval of local ethics committee, the study was conducted in Gazi University, Department of Thoracic Surgery (Ankara-Turkey). The records of the patients were obtained from the encrypted hospital management software. Sequential codes were given to the data of patients and it was transferred to the statistics program without their names and ID numbers. The data of patients were collected as follows: those who had extended pneumonectomy from the surgery reports were found, then their pathology reports were examined, and those who had atrial muscle tissue were included in the study. Selected cases included as follows: patients who were medically suitable for surgery, patients who could tolerate surgery in cardiology evaluation, patients who had adequate lung capacity for pneumonectomy. Data of patients were analyzed according to age, gender, lymph node invasion, complete resection, and operative mortality. Results: A total of 18 patients were included in the study. There were 16 (88.8%) men and 2 (12.2%) women. The mean age was 60.8 (range: 44 -76; Standard deviation: ± 1.8) years. Cardiopulmonary bypass was used in only one patient. The 30-day mortality was 5.5%. 1, 3, and 5-years overall survivals were 77%, 18.6%, and 9.3%, respectively. Mediastinal lymph node metastasis in N1 and N2 stations was detected 10 and 2, respectively. There was statistically significant correlation between recurrence and lymph node invasion status including N1 and N2 station (P = 0.04). Conclusion: Although surgery is controversial in patients with NSCLC invading left atrium, it can be performed in selected cases. Morbidity and morta
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Objective:To construct the prediction model for the prolonged length of postoperative hospital stay in the patients undergoing thoracoscopic lobectomy.Methods:The patients of both sexes, aged ≥18 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, who received elective thoracoscopic lobectomy with general anesthesia from March 2016 to February 2019 in our hospital, were selected, their clinical data were collected, and the patients were pathologically diagnosed with non-small-cell lung cancer after operation.Basic information (sex, age, smoking history), previous history (dyslipidemia, hypertension, diabetes, cardiovascular and cerebrovascular diseases, peripheral vascular diseases, chronic obstructive pulmonary diseases), allergy history, other tumor history, surgical resection site, anesthetic factors (intraoperative use of non-steroidal anti-inflammatory drugs and glucocorticoids, duration of anesthesia, intraoperative epidural anesthesia + postoperative epidural analgesia) and postoperative complications (pleural effusion, pneumothorax, atelectasis) was collected.The patients were divided into 2 groups according to whether the length of postoperative hospital stay was prolonged: normal group (≤ 7 days) and prolonged group (>7 days).Logistic regression analysis was used to identify the predictors for prolonged length of postoperative hospital stay.The regression model for prediction of prolonged length of postoperative hospital stay was constructed based on the TensorFlow deep learning framework, and the efficacy of prediction was evaluated.A deep neural network was further established based on the TensorFlow framework to construct a classification prediction model for prolonged length of postoperative hospital stay, and the efficacy of prediction was assessed, further comparing it with the prediction model constructed by the traditional machine learning method.Results:A total of 428 patients were finally enrolled in the study.The results of multivariate logistic regression analysis showed that age and anesthesia duration were the risk factors for the prolonged length of postoperative hospital stay, and female, other tumor history and resection of right middle lobe were the protective factors ( P<0.05).The performance of the regression model proved ineffective, getting 2.16 mean absolute error and 11.05 mean square error on the training set, 2.14 mean absolute error and 11.73 mean square error on the test set.The classification model achieved better score with accuracy 75.58%, F1-measure 0.553 and area under the receiver operating characteristic curve 0.702 on the test set, however, it showed no better performance than that of 4 other prediction models established by 4 traditional machine learning methods, specifically Logistic Regression, Random Forest, Gradient Boosting and Support Vector Machine. Conclusions:Sex, age, surgical resection site, other tumor history and duration of anesthesia can serve as the predictors, and a classification prediction model for prolonged length of postoperative hospital stay is constructed based on a deep neural network in the patients undergoing thoracoscopic lobectomy.
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@#A 54-year-old asymptomatic man underwent a video-assisted thoracoscopic left pneumonectomy for squamous-cell carcinoma. During the surgery, a complete left pericardial defect was unexpectedly discovered, but no special intervention was made. The preoperative chest CT was reciewed, which showed the heart extended unusually to the left, but the left pericardial defect was not evident. The operation time was 204 min and the patient was discharged from hospital upon recovery 9 days after the surgery. The pathological result indicated moderately differentiated squamous-cell carcinoma (T2N1M0, stage ⅡB), and metastasis was found in the parabronchial lymph nodes (3/5). The patient did not receive chemotherapy after the surgery, and there was no signs of recurrence 6 months after the surgery. Complete pericardial defects usually do not endanger the lives of patients, and if the patient is asymptomatic, pneumonectomy is feasible.
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Idiopathic Pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic interstitial lung disease with unknown cause, which is closely related to lung cancer. A serious complication called Acute exacerbation of IPF (AE-IPF) is prone to occur after lung resection. It progresses rapidly without effective treatment and has a poor prognosis. A typical case of AE-IPF after lung cancer surgery was reported, and its clinical characteristics, imaging features, diagnosis and treatment were summarized. .
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Humans , Disease Progression , Idiopathic Pulmonary Fibrosis/surgery , Lung Neoplasms/surgery , Treatment OutcomeABSTRACT
@#Objective To discuss the safety and feasibility of no chest tube (NCT) after thoracoscopic pneumonectomy. Methods The online databases including PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to October 2020 to collect the research on NCT after thoracoscopic pneumonectomy. Two reviewers independently screened the literature, extracted the data, and evaluated the quality of the included studies. The RevMan 5.3 software was used for meta-analysis. Results A total of 17 studies were included. There were 12 cohort studies and 5 randomized controlled trials including 1 572 patients with 779 patients in the NCT group and 793 patients in the chest tube placement (CTP) group. Meta–analysis results showed that the length of postoperative hospital stay in the NCT group was shorter than that in the CTP group (SMD=–1.23, 95%CI –1.59 to –0.87, P<0.000 01). Patients in the NCT group experienced slighter pain than those in the CTP group at postoperative day (POD)1 (SMD=–0.97, 95%CI –1.42 to –0.53, P<0.000 1), and POD2 (SMD=–1.10, 95%CI –2.00 to –0.20, P=0.02), while no statistical difference was found between the two groups in the visual analogue scale of POD3 (SMD=–0.92, 95%CI –1.91 to 0.07, P=0.07). There was no statistical difference in the 30-day complication rate (RR=0.93, 95%CI 0.61 to 1.44, P=0.76), the rate of postoperative chest drainage (RR=1.51, 95%CI 0.68 to 3.37, P=0.31) or the rate of thoracocentesis (RR=2.81, 95%CI 0.91 to 8.64, P=0.07) between the two groups. No death occurred in the perioperative period in both groups. Conclusion It is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.
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Objective:To identify the risk factors for postoperative pulmonary complications (PPCs) after thoracoscopic lung resection and evaluate the predictive value for the development of PPCs.Methods:The perioperative data of patients, aged≥18 yr, of American Society of Anesthesiologists (ASA) physical statusⅠ-Ⅲ, were obtained through the electronic medical record system.The blood routine within 24 h after surgery was recorded, and systemic immune-inflammation index (SII) was calculated.According to the development of PPCs, the patients were divided into non-PPCs group and PPCs group.Multivariate logistic regression analysis was used to analyze the variables of which P values were less than 0.05 to identify the risk factors for PPCs, and the receiver operating characteristic curve was drawn to evaluate the predictive value of risk factors. Results:A total of 699 patients were enrolled in this study, including 620 patients in non-PPCs group and 79 patients in PPCs group.The results of logistic regression analysis found that body mass index ≥25 kg/m 2, ASA physical status Ⅲ, lung segmental resection, resection of lobes or above, multi-port thoracoscopic surgery and increased postoperative SII were the risk factors for PPCs ( P<0.05 or 0.01). The AUC (95% confidence interval) of postoperative SII in predicting PPCs was 0.636 (0.599-0.671) ( P<0.05), the cut-off value of SII in predicting PPCs was set at 1 052.3, and the sensitivity and specificity were 68.4% and 57.3%, respectively. Conclusions:Body mass index ≥25 kg/m 2, ASA physical status Ⅲ, lung segmental resection, resection of lobes or above, multi-port thoracoscopic surgery and increased postoperative SII are the risk factors for PPCs.Postoperative SII can predict the occurrence of PPCs to a certain extent in the patients undergoing thoracoscopic lung resection.
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RESUMEN La mayoría de las toracotomías que con más frecuencia son utilizadas en la práctica quirúrgica actual fueron creadas en los quirófanos del siglo XX. En la búsqueda de diferentes opciones terapéuticas para lidiar con afecciones cancerígenas e infecciosas, de órganos torácicos y mediastinales, los padres de la cirugía torácica moderna crearon abordajes que han vencido la prueba del tiempo y se continúan practicando, a pesar del enorme desarrollo de la cirugía torácica de accesos mínimos o video-asistida. Sin embargo, muchos cirujanos desconocen los acontecimientos que rodearon el nacimiento de las principales toracotomías clásicas y, por otra parte, en no pocas ocasiones la historia ha reconocido como padres de algunas técnicas a quienes realmente no merecen ese crédito. En esta tercera parte de nuestra revisión se continúa exponiendo la historia, no del todo conocida, de las incisiones torácicas.
ABSTRACT Most of thoracotomies that are most frequently used in today's surgical practice were created in the operating rooms of the 20th century. In the search for different therapeutic options to treat cancerous and infectious conditions of the thoracic and mediastinal organs, the fathers of modern thoracic surgery created approaches that have stood the test of time and continue to be practiced, despite the enormous development of minimal access or video-assisted thoracic surgery. However, many surgeons are unaware of the events surrounding the birth of the main classical thoracotomies and, on the other hand, on more than a few occasions history has recognized as the fathers of some techniques those who do not really deserve that credit. In this third part of our review we continue to unravel the history of thoracic incisions, not all of which is well known.
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Resumen Los síntomas más frecuentes de los pacientes con infección por SARS-CoV-2 suelen ser fiebre, tos, odinofagia, cefalea, mialgias y diarrea. Un porcentaje mucho menor padece mareos, rinorrea y hemoptisis como síntomas asociados. Sin embargo, la gran magnitud que adquirió esta segunda ola, puede hacer que esta última complicación se presente con más frecuencia. Se describe el caso de un paciente de 49 años con antecedente de infección reciente por COVID-19 con requerimiento de ARM por insuficiencia respiratoria que intercurrió, durante la internación en sala general, con derrame pleural de tipo paraneumónico y episodios de hemoptisis persistente que se resolvió de forma quirúrgica. Durante la cirugía se encontró un importante proceso fibro adherencial y un pulmón congestivo con aumento focal de la consistencia y áreas de necrosis.
Abstract The most common symptoms in patients with SARS-CoV-2 infection are fever, cough, odynophagia, headache, myalgia, and diarrhea. A much smaller percentage have dizziness, rhinorrhea, and hemoptysis as associated symptoms. However, the great magnitude that this second wave acquired, can make this last com plication appear more frequently. This report describes the case of a 49-year-old patient with a history of recent COVID-19 infection with requirement of mechanical ventilation due to respiratory failure, who developed during hospitalization in the general ward with parapneumonic pleural effusion and episodes of persistent hemoptysis that required surgical treatment. During surgery, a significant fibro-adhesion process and a congestive lung with focal increased consistency and areas of necrosis were found.
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ABSTRACT Lung cancer is a type of neoplasia with one of the highest incidences worldwide and is the largest cause of mortality due to cancer in the world today. It is classified according to its histological and biological characteristics, which will determine its treatment and prognosis. Non-small cell lung cancer accounts for 85% of the cases, and these are the cases that surgeons mostly deal with. Small cell lung cancer accounts for the remaining 15%. Surgery is the main method for treating early stage lung cancer, and lobectomy is the preferred procedure for treating primary lung cancer, while sublobar resection is an alternative for patients with poor reserve or with very small tumors. Surgeons need to be trained to use the resources and techniques available for lung resection, including less invasive approaches such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), and need to be familiar with new oncological approaches, including curative, adjuvant or palliative treatments for patients with lung cancer.
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Humans , Carcinoma, Non-Small-Cell Lung/surgery , Surgeons , Lung Neoplasms/surgery , Pneumonectomy , Thoracic Surgery, Video-AssistedABSTRACT
RESUMEN Durante el siglo XIX se constataron más avances en la cirugía torácica que los experimentados en las más de 40 centurias transcurridas desde la escritura del papiro de Edwin Smith. En un período de poco menos de cien años el hombre abordó la cavidad pericárdica no solo para evacuar derrames, sino para suturar satisfactoriamente heridas en el músculo cardíaco. Además, se realizaron las primeras toracotomías con la específica intención de resecar segmentos pulmonares y se abrió por primera vez el esternón en toda su longitud, un abordaje que con el paso del tiempo se convertiría en la más usada de todas las incisiones torácicas. La mayoría de los cirujanos torácicos conoce poco acerca del verdadero origen de muchos de estos procedimientos quirúrgicos que se emplean en los salones de operaciones del siglo XXI. Esta segunda parte de nuestra revisión tiene la intención de seguir develando la desconocida historia de las incisiones torácicas.
ABSTRACT The 19th century saw more advances in thoracic surgery than in the more than 40 centuries since the writing of the Edwin Smith papyrus. In a period of less than a century, man approached the pericardial cavity not only to drain effusions, but to successfully suture wounds in the cardiac muscle. Moreover, the first thoracotomies were performed for the specific purpose of resecting lung segments and the sternum was completely opened for the first time, an incision that would eventually become the most widely used of all thoracotomies. Most thoracic surgeons know little about the true story behind many thoracotomies performed in the operating rooms of the 21st century. This second part of our review further unveils the unknown history of thoracic incisions.
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Abstract Damage control techniques applied to the management of thoracic injuries have evolved over the last 15 years. Despite the limited number of publications, information is sufficient to scatter some fears and establish management principles. The severity of the anatomical injury justifies the procedure of damage control in only few selected cases. In most cases, the magnitude of the physiological derangement and the presence of other sources of bleeding within the thoracic cavity or in other body compartments constitutes the indication for the abbreviated procedure. The classification of lung injuries as peripheral, transfixing, and central or multiple, provides a guideline for the transient bleeding control and for the definitive management of the injury: pneumorraphy, wedge resection, tractotomy or anatomical resection, respectively. Identification of specific patterns such as the need for resuscitative thoracotomy, or aortic occlusion, the existence of massive hemothorax, a central lung injury, a tracheobronchial injury, a major vascular injury, multiple bleeding sites as well as the recognition of hypothermia, acidosis or coagulopathy, constitute the indication for a damage control thoracotomy. In these cases, the surgeon executes an abbreviated procedure with packing of the bleeding surfaces, primary management with packing of some selected peripheral or transfixing lung injuries, and the postponement of lung resection, clamping of the pulmonary hilum in the most selective way possible. The abbreviation of the thoracotomy closure is achieved by suturing the skin over the wound packed, or by installing a vacuum system. The management of the patient in the intensive care unit will allow identification of those who require urgent reintervention and the correction of the physiological derangement in the remaining patients for their scheduled reintervention and definitive management.
Resumen Las técnicas de control de daños aplicadas al manejo de lesiones torácicas han evolucionado en los últimos 15 años. A pesar de que el número de publicaciones es limitado, la información es suficiente para desvirtuar algunos temores y establecer los principios de manejo. La severidad del compromiso anatómico justifica el procedimiento de control de daños solamente en algunos casos. En la mayoría, la magnitud del deterioro fisiológico y la presencia de otras fuentes de sangrado dentro del tórax o en otros compartimientos corporales constituyen la indicación del procedimiento abreviado. La clasificación de la lesión pulmonar como periférica, transfixiante y central o múltiple, proporciona una pauta para el control transitorio del sangrado y para el manejo definitivo de la lesión: neumorrafía, resección en cuña, tractotomía o resecciones anatómicas, respectivamente. La identificación de ciertos patrones como la necesidad de toracotomía de reanimación o de oclusión aórtica, la existencia de un hemotórax masivo, de una lesión pulmonar central, una lesión traqueobronquial o una lesión vascular mayor, así como el reconocimiento de hipotermia, acidosis o coagulopatía, constituyen la indicación de una toracotomía de control de daños. En estos casos, el cirujano concluye de manera abreviada los procedimientos con empaquetamiento de las superficies sangrantes, el manejo primario con empaquetamiento de algunas lesiones pulmonares periféricas o transfixiante seleccionadas y el aplazamiento de la resección pulmonar, pinzando el hilio de la manera más selectiva posible. La abreviación del cierre de la toracotomía se logra con la sutura de la piel sobre el empaquetamiento de la herida, o mediante la instalación de un sistema de presión negativa. El manejo del paciente en cuidados intensivos permitirá identificar aquellos que requieren reintervención urgente y corregir la alteración fisiológica de los restantes para su reoperación programada y manejo definitivo.
ABSTRACT
RESUMEN Fundamento: la incidencia de cáncer de pulmón en la provincia Sancti Spíritus es alta y su diagnóstico por lo general, se realiza en etapas avanzadas por lo cual el tratamiento quirúrgico no siempre es posible. Objetivo: analizar las principales características y resultados de los pacientes operados por cáncer de pulmón. Métodos: se realizó un estudio observacional descriptivo de corte transversal en el servicio de Cirugía General del Hospital Universitario General Camilo Cienfuegos en la provincia Sancti Spiritus en el período comprendido entre enero de 1996 y diciembre de 2019. El universo consistió en 83 pacientes operados con cáncer de pulmón que se sometieron a resección acompañados de muestreo de ganglios linfáticos mediastinales. Resultados: el sexo masculino predominó en el grupo estudiado. Los grupos de edades más frecuentes para ambos sexos fueron los de 51 a 60 años y los mayores de 60 años. El hábito de fumar estuvo presente en la mayoría de los pacientes. La localización tumoral más predominó fue en los lóbulos superiores y la lobectomía fue la técnica más realizada. Las etapas patológicas que predominaron fueron la lB y llB, seguidas de la lllA. El carcinoma de células escamosas fue el tipo histológico más frecuente. Las atelectasias y las infecciones respiratorias fueron las complicaciones más frecuentes. Los fallecidos fueron pocos. Conclusiones: las características demográficas de los pacientes estudiados se corresponden a otras series de pacientes con cáncer del pulmón. La localización tumoral en los lóbulos superiores, el carcinoma epidermoide, así como las etapas tempranas, predominaron en la serie estudiada. La lobectomía fue la técnica quirúrgica que se utilizó con mayor frecuencia y dentro de las complicaciones, las respiratorias fueron las más frecuentes.
ABSTRACT Background: the incidence of lung cancer in the province of Sancti Spíritus is high and its diagnosis is usually made in advanced stages, for which surgical treatment is not always possible. Objective: to analyze the main characteristics and results of patients operated on for lung cancer. Methods: a cross-sectional descriptive observational study was carried out in the General Surgery service of the Camilo Cienfuegos General University Hospital in the Sancti Spiritus province in the period between January 1996 and December 2019. The universe consisted of 83 patients operated with lung cancer who underwent resection accompanied by mediastinal lymph node sampling. Results: the male sex predominated in the studied group. The most frequent age groups for both sexes were those from 51 to 60 years old and those over 60 years old. Smoking was present in most of the patients. The most frequent tumor location was in the upper lobes and lobectomy was the most performed technique. The pathological stages that predominated were lB and llB, followed by lllA. Squamous cell carcinoma was the most frequent histological type. Atelectasis and respiratory infections were the most frequent complications. The deceased were few. Conclusions: the demographic characteristics of the patients studied correspond to other series of patients with lung cancer. Tumor location in the upper lobes, squamous cell carcinoma, as well as early stages, predominated in the series studied. Lobectomy was the most frequently used surgical technique and among complications, respiratory ones were the most frequent.
ABSTRACT
Objective:To evaluate the effect of butorphanol mixed with ropivacaine for erector spinae plane block (ESPB) on postoperative outcomes in the patients undergoing thoracoscopic pulmonary lobectomy.Methods:Eighty patients of either sex, aged 35-64 yr, with body mass index of 19-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective thoracoscopic pulmonary lobectomy, were divided into 2 groups ( n=40 each) using a computer-generated random number table method: butorphanol mixed with ropivacaine for ESPB group (group EB) and ropivacaine for ESPB group (group E). ESPB was performed under ultrasound guidance in both groups.A mixture of 0.1% butorphano 1 ml and 0.375% ropivacaine 20 ml was injected in EB group, and 0.375% ropivacaine 20 ml was injected in E group.The other anesthesia methods were the same in the two groups.And target-controlled infusion was stopped and PCIA was performed at the end of skin suture in the two groups.The intraoperative consumption of remifentanil, first time to press an analgesia pump, requirement for rescue analgesia within 24 h after surgery, and occurrence of ESPB-related complications were recorded.Quality of Recovery-40 (QoR-40) scores were recorded at 7 days after surgery.Before induction of anesthesia (T 1) and at 24 h after operation (T 2), the peripheral venous blood samples were collected for determination of plasma interleukin-6 (IL-6) and IL-10 concentrations, and bedside pulmonary function test was performed, and FEV 1/FVC was calculated. Results:Compared with group E, the QoR-40 scores were significantly increased at 7 days after operation, FEV 1/FVC was increased at T 2, the plasma concentrations of IL-10 were decreased at T 2, the plasma concentrations of IL-10 were increased at T 2, the intraoperative consumption of remifentanil was reduced, the first time to press an analgesia pump was prolonged, and the requirement for rescue analgesia within 24 h after surgery was decreased in group EB ( P<0.05). No ESPB-related complications were found in either group. Conclusion:Butorphanol mixed with ropivacaine for ESPB can improve postoperative outcomes in the patients undergoing thoracoscopic pulmonary lobectomy.