RESUMEN
OBJECTIVE: To present modern aspects of improving surgical techniques in tracheal resection developed in recent years. MATERIAL AND METHODS: The authors have the most extensive experience in tracheal surgery (>2.000 patients over the past 50 years). Diagnostic capabilities, perioperative management and surgical techniques have changed over such a long period. This concerns the proposed classification of cicatricial tracheal stenosis, features of endoscopic and X-ray diagnostics, indications for various surgeries, choice of surgical approach, technique of tracheal tube mobilization and anastomosis after tracheal excision. Preventive measures for severe postoperative complications are described. CONCLUSION: Such an extensive experience allowed the authors to develop an algorithm for the treatment of patients with tracheal stenosis. This significantly reduced the incidence of postoperative complications and mortality. Replication of such equipment is associated with technical support of hospitals and professional level of specialists consisting of endoscopist, anesthesiologist, intensive care specialist and thoracic surgeon.
Asunto(s)
Cirujanos , Estenosis Traqueal , Humanos , Estenosis Traqueal/diagnóstico , Estenosis Traqueal/etiología , Estenosis Traqueal/cirugía , Anastomosis Quirúrgica/efectos adversos , Complicaciones Posoperatorias , AlgoritmosRESUMEN
Treatment of bronchopleural fistula after pneumonectomy is still an urgent problem for thoracic surgeons. Transsternal bronchial stump occlusion should be preferable if possible. However, this is not enough for curing in some cases. We present a patient with concomitant cancer and tuberculosis of lungs whose postoperative period was complicated by bronchial stump failure. Preoperative diagnostic data are presented. We describe the indications for surgeries and main surgical stages. Some interventions including reconstructive surgery using a muscle flap led to recovery. Latissimus dorsi muscle flap on thoracodorsal artery is the best option for reconstructive surgical treatment in patients with extensive chest wall defects and thoracostomy.
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Fístula Bronquial , Procedimientos de Cirugía Plástica , Enfermedades Pleurales , Cirugía Plástica , Pared Torácica , Humanos , Fístula Bronquial/diagnóstico , Fístula Bronquial/etiología , Fístula Bronquial/cirugía , Enfermedades Pleurales/diagnóstico , Enfermedades Pleurales/etiología , Enfermedades Pleurales/cirugía , Procedimientos de Cirugía Plástica/efectos adversos , Neumonectomía/efectos adversos , Pared Torácica/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugíaRESUMEN
OBJECTIVE: To assess the factors causing air leakage after anatomical lung resections and present a rational tactical approach for timely establishing the cause and level of bronchial fistula. MATERIAL AND METHODS: We analyzed 723 patients who underwent anatomical lung resection (pneumonectomy - 136 patients, anatomical lobectomy and segmentectomy - 513, video-assisted anatomical resection - 74 patients). RESULTS: In 506 (69.9%) cases, complete lung inflation after surgery was observed within 24-48 hours. Persistent air discharge for more than 3 days was observed in 141 (19.5%) patients. Prolonged air leakage for more than 7 postoperative days occurred in 50 (6.9%) patients. Air discharge for more than 10 days was considered abnormal and observed in 20 (2.8%) patients. Redo surgeries were performed in 49 patients with bronchopleural fistula at the level of segmental bronchi. Forty-two patients after primary thoracoscopy and 6 ones after primary thoracotomy underwent video-assisted resection of the lung with bronchopleural fistula after previous surgery. In 11 patients, re-thoracotomy was performed: middle lobectomy after previous right-sided upper lobectomy in 2 patients, lung resection after previous segmentectomy in 8 cases and atypical resection of bulla after previous right-sided lower lobectomy in 1 case. CONCLUSION: Surgical approach for persistent postoperative air leakage involves various surgical interventions. The best option is minimally invasive thoracoscopic procedure. This method is valuable to visualize bronchopleural fistula, eliminate air leakage, additionally reinforce pulmonary suture and perform targeted adequate drainage of the pleural cavity.
Asunto(s)
Fístula Bronquial , Neoplasias Pulmonares , Enfermedades Pleurales , Humanos , Fístula Bronquial/diagnóstico , Fístula Bronquial/etiología , Fístula Bronquial/cirugía , Enfermedades Pleurales/diagnóstico , Enfermedades Pleurales/etiología , Enfermedades Pleurales/cirugía , Bronquios/cirugía , Neumonectomía/efectos adversos , Neumonectomía/métodos , Pulmón , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/complicacionesRESUMEN
BACKGROUND: Gastropleural fistula is an exceptionally rare condition, the incidence of which is currently unknown (Kunieda et al. in Intern Med 51(3):331, 2012, https://doi.org/10.2169/internalmedicine.51.6823 , Iqbal et al. in Cureus 11(2):e4136, 2019, https://doi.org/10.7759/cureus.4136 , Kathayanatt et al. in Lung India 37(2):174-175, 2020, https://doi.org/10.4103/lungindia.lungindia_242_17 ). The etiology varies from traumatic or iatrogenic injury to perforation in a herniated stomach due to ischemia, ulceration, or malignancy. CASE PRESENTATION: A 27-year-old European male presented to our hospital with complaints of general weakness and shortness of breath. The patient had a single episode of hemoptysis before admission. A computed tomography scan demonstrated a left-sided pyopneumothorax, a defect in the left main bronchus, and signs of pneumonia in the lower sections of the right lung. Therefore, a rare complication of perforation of a gastric fundus ulcer with the formation of a subdiaphragmatic abscess, gastropleural fistula, gangrene of the left lung with circular necrosis of the left main bronchus and diastasis of its edges, and pleural empyema on the left is presented in this report. CONCLUSIONS: Although, a radical surgery may be preferable for this suspected malignancy; it should be weighed carefully against the risk of sepsis and the morbidity associated with a prolonged procedure in a sick patient. Damage-control surgery may be a viable option for a very sick patient, with more extensive resection reserved for later, provided the risk of infection and bleeding has been mitigated.
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Empiema Pleural , Fístula Gástrica , Enfermedades Pleurales , Úlcera Gástrica , Humanos , Masculino , Adulto , Fundus Gástrico , Úlcera , Fístula Gástrica/etiología , Fístula Gástrica/cirugía , Fístula Gástrica/diagnóstico , Úlcera Gástrica/complicaciones , Úlcera Gástrica/cirugía , Empiema Pleural/etiologíaRESUMEN
OBJECTIVE: To evaluate the early outcomes of simultaneous surgeries in patients with concomitant lung cancer and coronary artery disease. MATERIAL AND METHODS: We retrospectively reviewed 37 consecutive patients who underwent CABG with adjunct endarterectomy (n=21) or long segmental coronary artery reconstruction (n=25) and lung resection between 2003 and 2019. Mean age was 61.4±6.7 (range 58-71) years. Males prevailed (n=32, 86.4%). Median sternotomy was used in all patients. Myocardial revascularization was followed by on-pump lung resection. The most common procedure was lobectomy (94.6%) of the right upper lobe (83.7%). Lymph node dissection was performed in all patients. RESULTS: CPB time was 162±19.3 min, aortic cross-clamping time 71±14.2 min. There was no in-hospital mortality. Incidence of perioperative myocardial infarction was 5.4%. Postoperative complications were atrial fibrillation (n=6, 16.6%), re-exploration for bleeding (n=1, 2.7%), pneumonia (n=2, 5.4%). Mean hospital-stay was 14.4 days (range 11-21). CONCLUSION: Simultaneous lung resections and coronary artery reconstruction is a safe and reliable surgical method in patients with diffuse coronary atherosclerosis and lung cancer. The developed system of choice, evaluation and surgical treatment of patients with concomitant cardiopulmonary pathology is fundamental for successful treatment of these difficult patients. We need larger randomized studies for certainty.
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Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria , Neoplasias Pulmonares , Neumonectomía , Anciano , Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/cirugía , Endarterectomía , Femenino , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/cirugía , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Neumonectomía/métodos , Estudios Retrospectivos , Esternotomía , Resultado del TratamientoRESUMEN
OBJECTIVE: To summarize our experience in transsternal occlusion of main bronchus fistula. MATERIAL AND METHODS: We have performed 146 transsternal occlusions of the main bronchi for the period from 1979 to 2018. There were 123 (84.2%) men and 23 (15.7%) women. Mean age of patients was 63 years. Lung tuberculosis was diagnosed in 36 (24.7%) patients, lung cancer - 91 (62.3%) patients, non-specific suppurative lung diseases - 14 (9.6%) patients, trauma - 5 (3.4%) patients. All patients underwent transsternal occlusion of the main bronchi fistulae with or without pericardial cavity dissection. Wedge-shaped bronchial resection or tracheal bifurcation resection were carried out for a short stump fistula. RESULTS: Perioperative complications occurred in 28 (19.2%) out of 146 patients. Intraoperative complications developed in 4 (2.6%) patients. Postoperative complications were observed in 25 (17.1%) patients. Intraoperative mortality rate was 1.4% (n=2), postoperative mortality - 6.2% (n=9). Thus, overall mortality rate was 7.6% (n=11 It should be noted that intraoperative complications were absent if dissection of the pericardium and pulmonary artery stump ligation were not performed. CONCLUSION: Transsternal occlusion of the main bronchi fistulae was successful in 80.8% of patients. In these cases, healing of fistulae was not associated with any complications. Thus, we believe that transsternal occlusion of the main bronchial stump fistula should be considered as preferable surgical strategy.
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Bronquios/cirugía , Fístula Bronquial/cirugía , Enfermedades Pulmonares/cirugía , Neumonectomía/efectos adversos , Procedimientos Quirúrgicos Torácicos/métodos , Bronquios/lesiones , Fístula Bronquial/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esternón/cirugía , Procedimientos Quirúrgicos Torácicos/efectos adversosRESUMEN
We report one-stage radical surgical treatment of a 54-year-old patient with extensive cicatricial posttracheostomy tracheal stenosis complicated by tracheomalacia of anterior tracheal wall and previous numerous unsuccessful endoscopic attempts of tracheal recanalization. A new method of prevention of tracheal anastomosis failure was applied.
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Anastomosis Quirúrgica/métodos , Tráquea/cirugía , Estenosis Traqueal/cirugía , Traqueomalacia/cirugía , Traqueostomía/efectos adversos , Humanos , Persona de Mediana Edad , Tráquea/lesiones , Estenosis Traqueal/etiología , Traqueomalacia/etiologíaRESUMEN
OBJECTIVE: To compare the early outcomes of video-assisted and robot-assisted lobectomy. MATERIAL AND METHODS: There were 74 robot-assisted lung resections for the period 2017-2018. Sixty-six patients underwent lobectomy and 8 - segmentectomy. Patients were divided into 2 groups to compare thoracoscopic procedures. The main group consisted of 66 patients after robot-assisted lobectomy. The control group included 247 patients after video-assisted lobectomy. Mean age of patients was 60.5 years (range 35-70). There 72% men and 28% women. CONCLUSION: Both thoracoscopic procedures are characterized by high efficiency and safety. However, certain disadvantages are peculiar to both methods.
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Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Procedimientos Quirúrgicos Robotizados , Cirugía Torácica Asistida por Video , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIM: To present possibility and technical aspects of anesthetic management during video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. MATERIAL AND METHODS: The article describes the proposed modified anesthetic method that is suitable for video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. Nine patients with myasthenia underwent VATS-thymectomy. Anesthesia was performed with artificial airway and auxiliary ventilation without muscle relaxants administration.
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Miastenia Gravis/cirugía , Cirugía Torácica Asistida por Video , Timectomía/instrumentación , Humanos , Timectomía/métodos , Timo/cirugía , Resultado del TratamientoRESUMEN
Biological compatibility of a tissue engineered construct of the trachea (synthetic scaffold) and allogenic mesenchymal stem cells was studied on laboratory Papio hamadryas primates. Subcutaneous implantation and orthotopic transplantations of tissue engineered constructs were carried out. Histological studies of the construct showed chaotically located filaments and mononuclear cells fixed to them. Development of a fine connective tissue capsule was found at the site of subcutaneous implantation of the tissue engineered construct. The intact structure of the scaffold populated by various cell types in orthotopic specimens was confirmed by expression of specific proteins. The results indicated biological compatibility of the tissue engineered construct with the mesenchymal stem cells; no tissue rejection reactions were recorded; simulation of respiratory disease therapy on Papio hamadryas proved to be an adequate model.
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Cuerpos Extraños/cirugía , Trasplante de Células Madre Mesenquimatosas , Tereftalatos Polietilenos/farmacología , Ingeniería de Tejidos/métodos , Andamios del Tejido , Tráquea/trasplante , Animales , Biomarcadores/metabolismo , Adhesión Celular/efectos de los fármacos , Expresión Génica , Queratinas/genética , Queratinas/metabolismo , Lectinas Tipo C/genética , Lectinas Tipo C/metabolismo , Leucocitos Mononucleares/citología , Leucocitos Mononucleares/efectos de los fármacos , Leucocitos Mononucleares/metabolismo , Masculino , Receptor de Manosa , Lectinas de Unión a Manosa/genética , Lectinas de Unión a Manosa/metabolismo , Células Madre Mesenquimatosas/citología , Células Madre Mesenquimatosas/metabolismo , Papio hamadryas , Receptores de Superficie Celular/genética , Receptores de Superficie Celular/metabolismo , Tejido Subcutáneo/cirugía , Trasplante Autólogo , Vimentina/genética , Vimentina/metabolismoRESUMEN
We studied the properties of a tissue-engineered trachea consisting of a polyethylene terephthalate scaffold populated with autologous bone marrow mononuclear cells. The tissue-engineered constructs were obtained before surgery, during the postoperative period, and during autopsy. Cytomorphological analysis during the postoperative period showed the presence of mesenchymal stem cells on the inner surface of the implant on day 3 after surgery and cells of the respiratory epithelium on day 10-14. In autopsy samples, single epithelial cells, endothelial cells, and basal cells were found. Biocompatibility of the tissue-engineered trachea with autologous mononuclear cells of the patient was demonstrated.
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Materiales Biocompatibles/farmacología , Leucocitos Mononucleares/efectos de los fármacos , Tereftalatos Polietilenos/farmacología , Andamios del Tejido , Tráquea/cirugía , Antígenos CD34/genética , Antígenos CD34/metabolismo , Materiales Biocompatibles/síntesis química , Biomarcadores/metabolismo , Células de la Médula Ósea/citología , Células de la Médula Ósea/metabolismo , Líquido del Lavado Bronquioalveolar/química , Líquido del Lavado Bronquioalveolar/citología , Adhesión Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Expresión Génica , Humanos , Queratina-7/genética , Queratina-7/metabolismo , Antígeno Ki-67/genética , Antígeno Ki-67/metabolismo , Leucocitos Mononucleares/citología , Leucocitos Mononucleares/metabolismo , Leucocitos Mononucleares/trasplante , Proteínas de la Membrana/genética , Proteínas de la Membrana/metabolismo , Tereftalatos Polietilenos/síntesis química , Ingeniería de Tejidos , Trasplante Autólogo , Vimentina/genética , Vimentina/metabolismoAsunto(s)
Nalgas/patología , Neoplasias de los Músculos , Neurofibroma Plexiforme , Neurofibromatosis 1 , Neoplasias Pélvicas , Pelvis/patología , Procedimientos Quirúrgicos Operativos/métodos , Adulto , Nalgas/diagnóstico por imagen , Nalgas/cirugía , Disección/métodos , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Neoplasias de los Músculos/etiología , Neoplasias de los Músculos/patología , Neoplasias de los Músculos/fisiopatología , Neoplasias de los Músculos/cirugía , Neurofibroma Plexiforme/etiología , Neurofibroma Plexiforme/patología , Neurofibroma Plexiforme/fisiopatología , Neurofibroma Plexiforme/cirugía , Neurofibromatosis 1/complicaciones , Neurofibromatosis 1/diagnóstico , Neurofibromatosis 1/fisiopatología , Neoplasias Pélvicas/etiología , Neoplasias Pélvicas/patología , Neoplasias Pélvicas/fisiopatología , Neoplasias Pélvicas/cirugía , Pelvis/diagnóstico por imagen , Pelvis/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoAsunto(s)
Drenaje/métodos , Hidronefrosis , Litiasis , Nefrostomía Percutánea/métodos , Pancreatoyeyunostomía/métodos , Pancreatitis Crónica , Absceso Retrofaríngeo , Humanos , Hidronefrosis/diagnóstico , Hidronefrosis/etiología , Hidronefrosis/fisiopatología , Hidronefrosis/cirugía , Litiasis/complicaciones , Litiasis/diagnóstico , Litiasis/cirugía , Masculino , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Páncreas/patología , Páncreas/cirugía , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/diagnóstico , Pancreatitis Crónica/cirugía , Absceso Retrofaríngeo/diagnóstico , Absceso Retrofaríngeo/etiología , Absceso Retrofaríngeo/fisiopatología , Absceso Retrofaríngeo/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
The article presents the experience of video-assisted thoracoscopic lobectomies in patients without endotracheal intubation and sparing of spontaneous breathing. The results of intraoperative monitoring and laboratory data of all perioperative period are described. In view of these data it was concluded that such approach can decline the severity of stress-response against surgical aggression in this group of patients.
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Anestesia , Neumonectomía , Respiración Artificial , Cirugía Torácica Asistida por Video , Humanos , Neoplasias Pulmonares/cirugíaRESUMEN
The authors admit the risks of blood transfusion, as well as the fact that the blood is a limited resource. These conclusions became the basis of the research in order to make an analysis and develop transfusion strategies in the hospital. An assessment of blood components application was performed in specific cases. There was changed the management of blood transfusion and further monitoring was continued. It was shown that the efficacy of an introduction of a new transfusion strategy confirmed the decrease of the rate of inappropriate blood transfusions, the quantity of patients who obtained transfusion of allogenic blood components and as a result, the new methods reduced the number of blood transfusions.
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Pérdida de Sangre Quirúrgica/prevención & control , Transfusión Sanguínea , Uso Excesivo de los Servicios de Salud/prevención & control , Procedimientos Quirúrgicos Pulmonares , Transfusión Sanguínea/métodos , Transfusión Sanguínea/estadística & datos numéricos , Volumen Sanguíneo , Humanos , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/organización & administración , Manejo de Atención al Paciente/normas , Selección de Paciente , Procedimientos Quirúrgicos Pulmonares/efectos adversos , Procedimientos Quirúrgicos Pulmonares/métodos , Procedimientos Quirúrgicos Pulmonares/estadística & datos numéricos , Mejoramiento de la Calidad , Federación de RusiaRESUMEN
Hereditary breast-ovarian cancer syndrome contributes to as much as 5-7% of breast cancer (BC) and 10-15% of ovarian cancer (OC) incidence. Mutations in the "canonical" genesBRCA1andBRCA2occur in 20-30% of affected pedigrees. In addition toBRCA1andBRCA2 mutations, germ-line lesions in theCHEK2,NBS1, andPALB2genes also contribute to familial BC clustering. The epidemiology of hereditary breast-ovarian cancer in Russia has some specific features. The impact of the "founder" effect is surprisingly remarkable: a single mutation,BRCA15382insC, accounts for the vast majority ofBRCA1defects across the country. In addition, there are two other recurrentBRCA1alleles:BRCA14153delA andBRCA1185delAG. BesidesBRCA1, in Russia breast cancer is often caused by germ-line alterations in theCHEK2andNBS1genes. In contrast toBRCA1andBRCA2, theCHEK2andNBS1heterozygosity does not significantly increase the OC risk. Several Russian breast cancer clinics recently started to investigate the efficacy of cisplatin in the therapy ofBRCA1-related cancers; initial results show a unique sensitivity ofBRCA1-associated tumours to this compound.