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ABSTRACT Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious and debilitating disease caused by occlusion of the pulmonary arterial bed by hematic emboli and by the resulting fibrous material. Such occlusion increases vascular resistance and, consequently, the pressure in the region of the pulmonary artery, which is the definition of pulmonary hypertension. The increased load imposed on the right ventricle leads to its progressive dysfunction and, finally, to death. However, CTEPH has a highly significant feature that distinguishes it from other forms of pulmonary hypertension: the fact that it can be cured through treatment with pulmonary thromboendarterectomy. Therefore, the primary objective of the management of CTEPH should be the assessment of patient fitness for surgery at a referral center, given that not all patients are good candidates. For the patients who are not good candidates for pulmonary thromboendarterectomy, the viable therapeutic alternatives include pulmonary artery angioplasty and pharmacological treatment. In these recommendations, the pathophysiological bases for the onset of CTEPH, such as acute pulmonary embolism and the clinical condition of the patient, will be discussed, as will the diagnostic algorithm to be followed and the therapeutic alternatives currently available.
RESUMO A hipertensão pulmonar tromboembólica crônica (HPTEC) é uma doença grave e debilitante, causada pela oclusão do leito arterial pulmonar por êmbolos hemáticos e por material fibroso induzido pela presença desses êmbolos. Essa oclusão eleva a resistência vascular e, por consequência, a pressão do território arterial pulmonar, caracterizando a presença de hipertensão pulmonar. Esse aumento da carga imposta ao ventrículo direito leva a progressiva insuficiência do mesmo e, finalmente, ao óbito. No entanto, ao contrário das outras formas de hipertensão pulmonar, a HPTEC possui uma particularidade muito significativa: a existência de tratamento potencialmente curativo através da tromboendarterectomia pulmonar. Dessa forma, o objetivo primordial do manejo deve ser a avaliação do potencial cirúrgico do paciente em um centro de referência em HPTEC. Entretanto, nem todos os pacientes podem ser submetidos à cirurgia. Para esses pacientes outras alternativas terapêuticas viáveis são a angioplastia de artérias pulmonares e o tratamento farmacológico. Nestas recomendações, discutir-se-ão as bases fisiopatológicas para o surgimento de HPTEC, a partir da embolia pulmonar aguda, bem como o quadro clínico apresentado pelo paciente, o algoritmo diagnóstico a ser seguido e as alternativas terapêuticas disponíveis.
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@#The precise resection and suture of bronchia, vascular and pulmonary tissue are the key techniques in thoracic surgery. Mechanical suture technique has gradually become a routine operation in thoracic surgery. However, at present, there is still a lack of consensus and guidelines on the application of this technique in thoracic surgery, neither strong evidence-based medical support. In this study, we discuss the application standard of mechanical suture technique in thoracoscopic surgery, irregular treatment techniques, intraoperative complications, and management principles to promote the standardized application of mechanical suture technique. We also explain the shortcomings of the technique in order to promote the further improvement and perfection.
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Objective: To explore the safety, feasibility and clinical value of Da Vinci robot system-assisted pulmonary surgery. Methods: The clinical data of Da Vinci robot system-assisted pulmonary surgery in our department were collected retrospectively and analyzed. Results: From March 2016 to November 2017, we enrolled 58 patients (42 males and 16 females, mean age 59±11 years) for the robotic system-assisted pulmonary surgery at our hospital. All surgeries were successfully completed, which consisted of lobectomy in 41 cases, segmentectomy in 7 cases, pulmonary wedge-shaped resection in 6 cases, pulmonary sleeve resection in 2 cases, combined resection in 1 case, and wedge-shaped resection & segmentectomy in 1 case. The postoperative diagnosis was benign lesions in 17 cases, and lung cancer in 41 cases. The average operation time was 169.93±66.88 mins for lobectomy and 165.43±56.37 mins for segmentectomy. The lymph node resection ranged from 5 to 26 pieces (mean of 15.1±8.7 pieces). The postoperative drainage time ranged from 2 to 15 days (mean of 6.0±2.6 days) and hospitalization time was 2 to 21 days (mean of 7.95±3.23 days). All but one patient recovered smoothly and were discharged with the total cost ranging from 32 015.57 to 127 087.89 yuan (mean of 78 483.19±15 925.18 yuan). The patient with bronchopleural fistula after resection was successfully treated with lobectomy. Conclusion: Da Vinci robotic system-assisted pulmonary surgery can be performed successfully in a center with extensive experience in thoracoscopic surgery. It is safe, feasible and advantageous in some complex operations, but the relatively expensive cost is an important factor that affects its wide application.
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Objective To explore the improvement of traditional incision in thoracotomy and the application of subaxillary vertical small incision in lung operations. Methods We carried out a retrospective analysis on documents of 680 cases of subaxillary vertical small incision pneumonectomy conducted in this hospital between December 1996 and June 2003. Results The length of incision was 8~13 cm (mean, 11 2 cm). The time for thoracotomy was 4 5~10 min (mean, 6 min) and the operation time was 50~ 170 min (mean, 135 min). The intraoperative blood loss was 100~1200 ml (mean, 350 ml), the postoperative drainage volume was 120~800 ml (mean, 300 ml), and the perioperative blood transfusion, 0~1400 ml (mean, 300 ml). Postoperative pain classification results revealed that 585 cases of grade 1, 60 cases of grade 2 and 35 cases of grade 3 severity were observed. The postoperative hospital stay was 10~21 days (mean, 14 days). No surgical death occurred. Conclusions Subaxillary vertical small incision can be simply made. It offers minimal invasion, less blood loss, mild postoperative pain, quick recovery and good cosmetic results, being a viable option in most operations of pneumonectomy.
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To solve the problem of two separating lobes in a child's pulmonary surgery, this paper introduces the design, manufacture and clinical application of the bronchus blocking tube, which can better ensure patients' safety when anaesthetized.