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1.
Chirurgia (Bucur) ; 117(2): 198-203, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35535781

RESUMO

Introduction: There is an immune response after major surgery and inflammatory complications following complex surgery have a direct impact on morbidity and mortality. Currently, we do not have clinical tools to predict in which subset of patients a major complication will occur. The aim of this study was to evaluate the immediate dynamics of C-reactive protein (CRP), presepsin and procalcitonin in patients in which esophagectomy was performed either through video assisted thoracic surgery (VATS) or open approach. Methods: We conducted a prospective study on 27 patients with a mean age of 61.48 +-6.80 years, 13 patients with VATS and 14 with open approach, most of the patients were on stage III esophageal cancer (81%) and in all cases neoadjuvant treatment was performed. Results: There were increased levels of CRP, presepsin and procalcitonin after both arms of the study with significantly higher values for the open approach and with the same dynamic curves. In 3 cases there were extremely elevated levels of procalcitonin in the absence of a septic complication, in all cases a major complication occurred. Conclusion: Video assisted thoracoscopic esophageal mobilization induces a less immune response, even with the association of laparotomy. An elevated postoperative procalcitonin level can be an early indicator of a major postoperative complication.


Assuntos
Neoplasias Esofágicas , Pró-Calcitonina , Idoso , Proteína C-Reativa , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Receptores de Lipopolissacarídeos , Pessoa de Meia-Idade , Fragmentos de Peptídeos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracoscopia/efeitos adversos , Resultado do Tratamento
2.
Biomed Res Int ; 2022: 5143383, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35445140

RESUMO

Background: In this study, we introduced a novel surgical strategy to protect vagal nerve branches during radical thoracoscopic surgery in right lung cancer and explored the effects of vagal nerve branch preservation. Methods: We retrospectively studied 53 patients with right-sided lung cancer with clinically staged T1N0M0 between 2019 and 2020. All 53 patients were treated with total thoracoscopic lobectomy and mediastinal lymph node dissection in the same number of lymph node stations. Of these, 22 patients adopted a vagus nerve branch protection strategy during lymph node dissection. Another 31 patients were treated with traditional lymph node dissection as the control group. Results: The characteristics of the patients were similar between the two groups. The operation time and intraoperative bleeding in the protection group were longer than those in the control group. However, the protection group had a lower average postoperative pain score and average postoperative hospital stay. The above difference was not statistically significant. Three cases of arrhythmia occurred in the protection group, including 1 case of tachycardia and 2 cases of atrial fibrillation. In the control group, 13 cases of arrhythmia occurred after the operation, including 8 cases of tachycardia and 5 cases of atrial fibrillation. We also tracked changes in the patients' heart rates throughout the treatment process (excluding patients with arrhythmias). An increased heart rate was observed postoperatively in both groups, but the increase of heart rate of the protection group was smaller than that of the control group; however, the difference was not statistically significant. Conclusions: A vagus nerve branch preservation-based approach to radical surgery is a safe and feasible strategy for right lung cancer treatment, which could significantly reduce the risk of postoperative arrhythmia in patients and may also have a potential role in reducing the length of hospital stay and maintaining heart rate stability in the postoperative period.


Assuntos
Fibrilação Atrial , Neoplasias Pulmonares , Fibrilação Atrial/cirurgia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo/efeitos adversos , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Toracoscopia , Nervo Vago/cirurgia
3.
Khirurgiia (Mosk) ; (4): 110-116, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35477211

RESUMO

The review is devoted to clinical picture, main theories of pathogenesis, traditional and innovative methods of diagnosis and surgical treatment of catamenial pneumothorax. Currently, clinicians prefer magnetic resonance imaging and thoracoscopy for diagnosis of this disease. Various researchers are actively searching for laboratory diagnostic methods that can confirm endometrioid nature of pneumothorax. Treatment and prevention of catamenial pneumothorax are a controversial issue depending both clinical picture and preferences of the attending physician. Currently, the majority of authors believe that hormonal therapy combined with diaphragm resection ensures optimal anti-relapse effect in patients with thoracic endometriosis.


Assuntos
Endometriose , Pneumotórax , Endometriose/diagnóstico , Endometriose/patologia , Endometriose/cirurgia , Feminino , Humanos , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Pneumotórax/cirurgia , Recidiva , Toracoscopia
4.
Ther Umsch ; 79(3-4): 181-187, 2022 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-35440190

RESUMO

Minimally Invasive Esophagectomy for Esophageal Cancer Abstract. Oncological esophagectomy with gastric pull up and intrathoracic represents the standard surgical procedure in the curative treatment of malignant tumors of the esophagus and the esophagogastric junction. The procedure, as two or three body cavities are accessed, has a natural level of invasiveness, which suggests lowering the surgical trauma using minimally invasive surgery (MIS). Because of the complexity of the surgical procedure, minimally invasive esophagectomy is an operation with relevant surgical learning curve. As of now, two principally different minimally invasive techniques for esophageal resection are established in clinical routine in specialized centers, the conventional laparoscopy/thoracoscopy based method and the robotic approach. Benefits of minimally invasive esophagectomy are reduced pulmonary complications and reduced postoperative pain. The surgical radicality of both minimally invasive techniques is at least comparable to the open approach and combined MIS/open approach, long-term survival outcomes from randomized controlled trials are pending. The robotic surgical technology has evolved dramatically over the last decade and oncological esophagectomy offers meaningful opportunity for application. Due to further technological progress, robotic surgery is expected to play an even more important role in the future. Focusing on the direct comparison of conventional minimally invasive esophagectomy and robotic-assisted esophagectomy, the randomized ROBOT-2 trial will reveal important evidence.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Humanos , Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Robóticos , Toracoscopia/métodos , Resultado do Tratamento
5.
Zhonghua Yi Xue Za Zhi ; 102(15): 1108-1113, 2022 Apr 19.
Artigo em Chinês | MEDLINE | ID: mdl-35436810

RESUMO

Objective: To investigate the effect of continuous intravenous infusion of subanesthetic dose of esketamine intraoperatively on postoperative opioid consumption in patients undergoing thoracoscopic surgery. Methods: A total of 71 patients with elective thoracoscopic lung surgery in the First Affiliated Hospital of Zhengzhou University from December 2020 to December 2021 were selected. Patients who were classified as grade Ⅰ or Ⅱ by the American Society of Anesthesiologists (ASA) and aged 18-70 years were included, including 32 males and 39 females, with a body mass index (BMI) of 18.5-30.0 kg/m2. The patients were randomly divided into three groups: (1) Control group (group C, n=24): continuous intravenous infusion of normal saline at the same rate during surgery; (2) Subanesthetic dose of esketamine 0.125 mg·kg-1·h-1 group (group ES1, n=23): continuous intravenous infusion of esketamine at a rate of 0.125 mg·kg-1·h-1 during surgery; (3) Subanesthetic dose of esketamine 0.250 mg·kg-1·h-1 group (group ES2, n=24): continuous intravenous infusion of esketamine at a rate of 0.250 mg·kg-1·h-1 during surgery. The main outcome measures were the total consumptions of hydromorphone of 3 groups within 24 and 48 hours after surgery. The secondary outcome measures were the extubation time, length of postanesthesia care unit (PACU) stay, the time of first feeding, and the incidences of adverse effects within 24 h after surgery in 3 groups. Results: The 24 h postoperative consumption of hydromorphone in group C, ES1 and ES2 was (5.4±1.0) mg, (4.5±1.5) mg and (4.0±0.8) mg, respectively. Likewise, the 48 h postoperative consumption of hydromorphone was (9.7±2.2) mg, (9.0±3.0) mg and (7.7±1.8) mg, respectively. Compared with group C, the 24 h postoperative hydromorphone consumptions were significantly reduced in group ES1 and ES2 (both P<0.05). The extubation time, length of PACU stay and the time of first feeding after surgery in group C were (23±10) min,(70±12) min,(17±3) h,in group ES1 were (22±4) min,(69±11) min,(14±5) h,in group ES2 were (16±8) min,(58±12) min,(14±3) h, respectively. Compared with group C and group ES1, both of the extubation time and length of PACU stay were shortened in group ES2 (both P<0.05). Compared with group C, the first postoperative feeding time of group ES1 and ES2 was shortened (both P<0.05). There were no differences in the incidences of adverse effects at postoperative 24 h among 3 groups (all P>0.05). Conclusion: Continuously intravenous infusion of subanesthetic esketamine at a rate of 0.250 mg·kg-1·h-1 can significantly reduce the postoperative opioid consumption and improve the patient's outcomes.


Assuntos
Analgésicos Opioides , Ketamina , Feminino , Humanos , Hidromorfona , Ketamina/uso terapêutico , Masculino , Dor Pós-Operatória/tratamento farmacológico , Toracoscopia
6.
J Cardiothorac Surg ; 17(1): 70, 2022 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-35382835

RESUMO

INTRODUCTION: The efficacy of dexmedetomidine supplementation for thoracoscopic surgery remains controversial. We conduct a systematic review and meta-analysis to explore the impact of dexmedetomidine for thoracoscopic surgery. METHODS: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs) assessing the effect of dexmedetomidine supplementation on thoracoscopic surgery. This meta-analysis is performed using the random-effect model. RESULTS: Six RCTs involving 510 patients are included in the meta-analysis. Overall, compared with control group for thoracoscopic surgery, dexmedetomidine supplementation results in significantly reduced pain scores (SMD = - 1.50; 95% CI = - 2.63-- 0.37; P = 0.009), anesthetic consumption (SMD = - 3.91; 95% CI = - 6.76-- 1.05; P = 0.007), mean heart rate (SMD = - 0.41; 95% CI = - 0.65-- 0.18; P = 0.0007), and the risk ratio (RR) of ICU stay (RR = 0.39; 95% CI = 0.19-0.80; P = 0.01), but showed no obvious effect on mean blood pressure (SMD = - 0.07; 95% CI = - 0.45-0.31; P = 0.72) or hospital stay (SMD = - 0.61; 95% CI = - 1.30-0.08; P = 0.08). CONCLUSIONS: Dexmedetomidine supplementation can substantially improve the analgesic efficacy for thoracoscopic surgery.


Assuntos
Dexmedetomidina , Dexmedetomidina/uso terapêutico , Suplementos Nutricionais , Humanos , Dor Pós-Operatória , Ensaios Clínicos Controlados Aleatórios como Assunto , Toracoscopia
7.
Comput Math Methods Med ; 2022: 2894755, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35401784

RESUMO

Objective: To explore the mechanism of intensive care of the heart after thoracoscopic surgery. Methods: 104 patients with severe cardiac disease were selected after thoracoscopic surgery in our hospital, received nursing care after surgery, and divided into control group (n = 53) and research group (n = 51) according to different nursing methods. Before nursing, the research group carried out targeted nursing and prevention of postoperative complications. The quality of life, complications, anxiety, depression and satisfaction scores, 6-minute walking distance, self-care ability scores, and cardiac function were compared between the two groups. Results: Patients' quality of life scores improved significantly in both groups after treatment, but the increase was greater in the study group than in the control group (P < 0.05); the incidence of complications was 18.9% and 5.9% in the study and control groups, respectively, and the incidence of complications was lower in the study group than in the control group (P < 0.05); and the incidence of complications was lower in the study group than in the control group (P < 0.05). After care, patients' anxiety and depression scores were significantly lower, and satisfaction scores were significantly higher in both groups, with a greater change in the study group than in the control group (P < 0.05); after care, patients' 6-minute walking distance was significantly higher in both groups, with a greater change in the study group than in the control group (P < 0.05); after care, LVEF indicators were significantly higher, and LVESD and LVED indicators were significantly higher, with a greater change in the study group than in the control group. After care, LVEF indexes increased significantly in both groups, while LVESD and LVED indexes decreased significantly in the study group, with a greater change than in the control group (P < 0.05); after care, systolic blood pressure and heart rate increased significantly in both groups, with a greater increase in the study group than in the control group (P < 0.05); after care, systolic blood pressure and heart rate increased significantly in both groups, with a more significant increase. Conclusion: Targeted nursing for patients with severe cardiac disease after thoracoscopic surgery has a significant effect, which can improve patients' anxiety and depression, significantly improve patients' self-care ability and quality of life, and at the same time improve patients' cardiac function, heart rate, and blood pressure, with high patient satisfaction.


Assuntos
Cardiopatias , Qualidade de Vida , Ansiedade/epidemiologia , Ansiedade/etiologia , Cuidados Críticos , Humanos , Toracoscopia
8.
Pediatr Surg Int ; 38(6): 861-865, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35230487

RESUMO

BACKGROUND: This study aims to describe a new method of repairing the diaphragm with a venipuncture indwelling needle under thoracoscopy to treat congenital diaphragmatic hernia (CDH). METHODS: We retrospectively analysed the clinical data of 43 children with CDH who underwent CDH repair with new technology in our hospital. In this study, we used the venipuncture indwelling needle suture method to treat children with CDH. RESULTS: In this study, 3 children were converted to open surgery, and the remaining 40 children achieved better clinical results. Follow-up of 43 children was performed for 1 month to 6 years. Except for two patients who relapsed after surgery, there was no recurrence after another operation. The remaining 41 children recovered well; there were no deaths or serious complications. Postoperative chest X-ray and gastrointestinal angiography showed that the abdominal organs were in a normal position. CONCLUSIONS: The use of a venipuncture indwelling needle to suture the diaphragm under thoracoscopy is a simple new technique. This method can not only improve the efficiency of sutures but also better handle the opening of the "V"-shaped defect of the diaphragm. At the same time, it has the advantages of minimal trauma, fast recovery, and improved cosmetic appearance.


Assuntos
Hérnias Diafragmáticas Congênitas , Criança , Diafragma/cirurgia , Hérnias Diafragmáticas Congênitas/cirurgia , Herniorrafia , Humanos , Estudos Retrospectivos , Toracoscopia/métodos , Resultado do Tratamento
9.
Respir Med ; 196: 106802, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35287006

RESUMO

Roughly 150,000 malignant pleural effusions (MPE) are diagnosed in the United States each year. The majority of cases are caused by lung and breast cancer, and since MPE represents advanced disease, the prognosis is generally poor. In this article we review the pathophysiology, epidemiology, and prognosis of MPE. We then discuss the approach to diagnosis of MPE including the role of imaging, pleural fluid analysis, and medical thoracoscopy. Current management strategies for symptomatic MPE include repeated thoracentesis for patients with very limited life expectancy as well as more definitive procedures such as chemical pleurodesis, tunneled indwelling pleural catheters, and novel combined approaches. The choice of intervention is guided by the efficacy, local expertise, and risk, as well as patient factors and preferences.


Assuntos
Derrame Pleural Maligno , Drenagem/métodos , Humanos , Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/terapia , Pleurodese/métodos , Toracentese/métodos , Toracoscopia/métodos
10.
J Healthc Eng ; 2022: 2011062, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35340236

RESUMO

In this article, we have explored the feasibility and safety of Da Vinci's robotic surgery system in the radical resection of lung cancer. For this purpose, 73 cases of patients with lung cancer who underwent radical resection in the thoracic surgery of our hospital, particularly from July to September 2020, were collected, of which 22 cases operated with the Da Vinci robot were the Da Vinci robot group, including 11 men and 11 women. The 51 patients who underwent thoracoscopic surgery were in the thoracoscopic group, including 24 males and 27 females. All 22 patients in the Da Vinci robot group completed the operation under the Da Vinci robot operation system without conversion to thoracotomy. In the thoracoscopic group, 49 patients successfully completed the operation under thoracoscopy, and 2 patients were converted to thoracotomy. There was a significant difference between the two groups in the average operation time and the number of lymph nodes, but there was no significant difference in the amount of intraoperative bleeding and postoperative hospital stay. Compared with thoracoscopic radical lung cancer surgery, Da Vinci's robotic surgery system is equally safe and effective, and more lymph nodes are cleaned during surgery.


Assuntos
Neoplasias Pulmonares , Procedimentos Cirúrgicos Robóticos , Robótica , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Toracoscopia , Toracotomia
11.
BMC Anesthesiol ; 22(1): 71, 2022 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-35296252

RESUMO

BACKGROUND: Rhomboid intercostal block (RIB) is a new regional anesthesia technique that provides postoperative analgesia for breast surgery and thoracoscopic surgery. The published papers are not yet fully integrated and do not adequately address the impact and safety of the RIB on postoperative pain. METHODS: The PubMed, Web of Science and Embase were searched from 2016 to 2021 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of RIB after thoracic surgery and breast surgery. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. The primary outcome was Postoperative Numerical Rating Scale (NRS) scores of patients at rest recorded 0-1, 6-8, 24 h after surgery. The secondary outcomes included rate of postoperative nausea and vomiting (PONV), postoperative fentanyl consumption and presence of complications of the block. RESULTS: From 81 records identified, four studies met our inclusion criteria, including 216 patients (RIB:108 patients; no block: 108 patients). In the primary outcome, RIB group showed significantly lower postoperative NRS at rest at first 0-1 h and 6-8 h (weighted mean difference [WMD] = -1.55; 95% confidence internal [CI] = -2.92 to -0.19; p < 0.05), (WMD = -0. 69; 95% CI = -1.29 to -0. 09; p < 0. 05). And there was no significant difference between groups in NRS at rest at 24 h (WMD = -0.78; 95% CI = -1.64 to -0.08; p = 0.77). Also, RIB group showed significantly lower postoperative NRS of breast surgery and thoracoscopic surgery at 0-1 h (WMD = -3.00; 95% CI = -3.13 to -2.87; p < 0.01), (WMD = -1.08; 95% CI = -1.98 to -0.18; p < 0.05). In the secondary outcome, the analysis also showed RIB group had significant lower of POVN rates (summary relative risk (RR) = 0.212;95%CI = 0.10 to 0.45; p < 0. 01) and the postoperative consumption of fentanyl (WMD = -57.52;95%CI = -106.03 to -9.02; p < 0. 05). CONCLUSION: This review shows that RIB was more effective in controlling acute pain after breast surgery and thoracoscopic surgery than general analgesia. And it is a trend that RIB may be a kind of effective and safe nerve bock technology and it requires further studies.


Assuntos
Analgesia , Neoplasias da Mama , Bloqueio Nervoso , Analgesia/métodos , Analgésicos Opioides/uso terapêutico , Feminino , Fentanila , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Toracoscopia
12.
BMJ Open Respir Res ; 9(1)2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35277425

RESUMO

INTRODUCTION: Pleural exudative effusions without diagnosis after initial work up are a frequent problem in any respiratory division. Several ways to obtain pleural biopsy exist. Thoracoscopy is one of the most frequently used. Differential diagnosis mainly exists out of malignant pleuritis, tuberculosis, nonspecific pleuritis and rarely systemic or autoimmune disease. We performed a retrospective data analysis of our almost 10-year period experience, the first Belgian data to be published. METHODS: We performed a retrospective data analysis of all patients with unexplained pleural exudates who underwent diagnostic medical thoracoscopy under general anaesthesia in our respiratory department during the period 2006-2015. We report on diagnoses made, sensitivity and specificity, safety of thoracoscopy and follow-up of patients after thoracoscopy. RESULTS: 131 patients underwent diagnostic medical thoracoscopy during the inclusion period. 44.3% (n=58) of the patients were diagnosed with malignant pleuritis, 45.0% (n=59) with nonspecific pleuritis, 7.6% (n=10) with tuberculous pleuritis and some with other benign conditions. Complications are comparable to other data published. Six months follow-up of patients with non-specific pleuritis reveal 8.5% (n=5) of these patients to have malignant pleuritis, and another 8.5% (n=5) with infectious or other benign conditions. CONCLUSION: Medical thoracoscopy under general anaesthesia for diagnostic work up of pleural exudates of unknown origin generally has a high diagnostic yield. It is generally safe, certainly compared with the information it delivers. During follow-up, minority of patients with nonspecific pleuritis will prove to be malignant in origin, benign or autoimmune disease related.


Assuntos
Derrame Pleural , Biópsia/efeitos adversos , Seguimentos , Humanos , Derrame Pleural/diagnóstico , Estudos Retrospectivos , Toracoscopia/efeitos adversos
13.
J Int Med Res ; 50(3): 3000605221078409, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35317641

RESUMO

Advanced thyroid cancer with upper mediastinal lymph node metastasis is not rare in the clinical setting. For patients with severe metastasis, a thoracocervical incision is usually performed for dissection of lymph nodes. However, the difficult operation of three-port thoracoscopy to support performance of a cervical incision in the treatment of upper mediastinal lymph node metastasis has rarely been reported to date. We herein describe a case involving the treatment of thyroid cancer with upper mediastinal lymph node metastasis. The lymph node metastasis was severe, closely adhered to the innominate vein, and fused into a mass. Thoracoscopy with a cervical incision was performed and proved to be a highly difficult surgical maneuver. The patient recovered quickly after the operation. Repeat computed tomography showed no swollen metastatic lymph nodes, indicating that the dissection was thorough. Thoracoscopy with a neck incision is more difficult than conventional longitudinal split sternotomy in the treatment of upper mediastinal lymph node metastasis, but its advantages are less severe trauma and faster recovery. This procedure may be performed by surgeons with proficient skill in cervical surgery and thoracoscopy techniques.


Assuntos
Excisão de Linfonodo , Neoplasias da Glândula Tireoide , Humanos , Excisão de Linfonodo/métodos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Toracoscopia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia
14.
J Bronchology Interv Pulmonol ; 29(2): 109-114, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35318987

RESUMO

BACKGROUND: Anesthesia and analgesia for thoracic procedures, specifically pleuroscopy, present unique challenges given the spectrum of underlying pulmonary disease and susceptibility to respiratory complications. This study describes efforts to reduce postoperative pain and minimize opioid analgesia after thoracoscopic procedures through the use of erector spinae plane block (ESPB). METHODS: This is a single center, retrospective case series of all patients who underwent rigid pleuroscopy with ESPB plus monitored anesthesia care (MAC) from November 2018 through September 2020. The primary outcome measures were postoperative pain scores and analgesic medication requirements. RESULTS: Twenty-six patients underwent pleuroscopy with ESPB plus MAC. Average intraoperative and postoperative opioid consumption in oral morphine equivalents were 18.4±15.8 and 11.2±19.6 mg, respectively. There was no significant difference between average preoperative and postoperative subjective numerical pain scores (P=0.221). There were no complications associated with ESPB. CONCLUSION: This case series demonstrates the feasibility of utilizing single shot ESPB in combination with MAC as the primary anesthetic for thoracoscopic procedures.


Assuntos
Bloqueio Nervoso , Anestésicos Locais , Humanos , Bloqueio Nervoso/métodos , Estudos Retrospectivos , Toracoscopia , Ultrassonografia de Intervenção
15.
J Cardiothorac Surg ; 17(1): 29, 2022 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-35246177

RESUMO

OBJECTIVE: Newer minimally invasive approaches to esophagectomy have brought substantial benefits to esophageal-cancer patients and continue to improve. We report here our experience with a streamlined procedure as part of a comprehensive perioperative-care program that provides additional advances in the continued evolution of this procedure. METHODS: All patients with primary esophageal cancer referred for resection to the Oakland Medical Center of the Kaiser-Permanente Northern California health plan who underwent this approach between January 2013 and August 2018 were included. Operative and clinical outcome variables were extracted from the electronic medical record, operating-room files, and manual chart review. RESULTS: 142 patients underwent the new procedure and care program; 121 (85.2%) were men with mean age of 64.5 years. 127 (89.4%) were adenocarcinoma; 117 (82.4%) were clinical stage III or IVA. 115 (81.0%) required no jejunostomy. Median hospital length-of-stay was 3 days and 8 (5.6%) patients required admission to the intensive care unit. Postoperative complications occurred in 22 (15.5%) patients within 30 days of the procedure. There were no inpatient deaths; one patient (0.7%) died within 30 days following discharge and three additional deaths (2.1%) occurred through 90 days of follow-up. CONCLUSIONS: This approach resulted in excellent clinical outcomes, including short hospital stays with limited need for the intensive care unit, few perioperative complications, and relatively few patients requiring feeding tubes on discharge. This comprehensive approach to esophagectomy is feasible and provides another clinically meaningful advance in the progress of minimally invasive esophagectomy. Further development and dissemination of this method is warranted.


Assuntos
Adenocarcinoma , Neoplasias Esofágicas , Laparoscopia , Adenocarcinoma/cirurgia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Humanos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Toracoscopia/métodos , Resultado do Tratamento
16.
Respirology ; 27(5): 350-356, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35178828

RESUMO

BACKGROUND AND OBJECTIVE: Pleuroscopy with pleural biopsy has a high sensitivity for malignant pleural effusion (MPE). Because MPEs tend to recur, concurrent diagnosis and treatment of MPE during pleuroscopy is desired. However, proceeding directly to treatment at the time of pleuroscopy requires confidence in the on-site diagnosis. The study's primary objective was to create a predictive model to estimate the probability of MPE during pleuroscopy. METHODS: A prospective observational multicentre cohort study of consecutive patients undergoing pleuroscopy was conducted. We used a logistic regression model to evaluate the probability of MPE with relation to visual assessment, rapid on-site evaluation (ROSE) of touch preparation and presence of pleural nodules/masses on computed tomography (CT). To assess the model's prediction accuracy, a bootstrapped training/testing approach was utilized to estimate the cross-validated area under the receiver operating characteristic curve. RESULTS: Of the 201 patients included in the study, 103 had MPE. Logistic regression showed that higher level of malignancy on visual assessment is associated with higher odds of MPE (OR = 34.68, 95% CI = 9.17-131.14, p < 0.001). The logistic regression also showed that higher level of malignancy on ROSE of touch preparation is associated with higher odds of MPE (OR = 11.63, 95% CI = 3.85-35.16, p < 0.001). Presence of pleural nodules/masses on CT is associated with higher odds of MPE (OR = 6.61, 95% CI = 1.97-22.1, p = 0.002). A multivariable logistic regression model of final pathologic status with relation to visual assessment, ROSE of touch preparation and presence of pleural nodules/masses on CT had a cross-validated AUC of 0.94 (95% CI = 0.91-0.97). CONCLUSION: A prediction model using visual assessment, ROSE of touch preparation and CT scan findings demonstrated excellent predictive accuracy for MPE. Further validation studies are needed to confirm our findings.


Assuntos
Derrame Pleural Maligno , Derrame Pleural , Biópsia , Estudos de Coortes , Humanos , Recidiva Local de Neoplasia , Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/patologia , Estudos Prospectivos , Toracoscopia
18.
Khirurgiia (Mosk) ; (2): 62-66, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35147002

RESUMO

Diagnosis of diaphragmatic injury is difficult in some cases. Symptoms of chronic posttraumatic diaphragmatic hernia are very diverse and associated with dysfunctions of the displaced abdominal organs and compression of thoracic organs. Previous blunt or open chest and abdominal trauma, as well as visible scars as a result of injury should be considered. Treatment concept assumes surgical correction of posttraumatic diaphragmatic hernia. Choice of surgical approach and type of intervention are determined individually. Despite the global trend towards minimally invasive endoscopic surgery, there are few reports on thoracoscopic correction of posttraumatic phrenic hernia. The authors report a rare case of thoracoscopic correction of posttraumatic diaphragmatic hernia in an 81-year-old man in 62 years after abdominal injury. Assuming degenerative changes in tissues and risk of defect enlargement following suture eruption, we used titanium nickelide reinforcing protectors. Video-assisted double port thoracoscopic access allowed minimally traumatic and successful correction of diaphragmatic hernia, that ensured early medical and social rehabilitation of the patient.


Assuntos
Hérnia Hiatal , Hérnias Diafragmáticas Congênitas , Traumatismos Torácicos , Idoso de 80 Anos ou mais , Diafragma/cirurgia , Humanos , Masculino , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Toracoscopia
19.
Artigo em Inglês | MEDLINE | ID: mdl-35162891

RESUMO

OBJECTIVES: This study aimed to assess the effectiveness of practicing acupressure on the Shenmen and Neiguan acupoints with a view to reduce anxiety and improve the comfort and physical health of patients undergoing thoracoscopic surgery. METHODS: A total of 100 hospitalized patients undergoing thoracoscopic surgery were assigned randomly into the experimental (n = 49) and control groups (n = 51). Subjects in the experimental group received routine care plus acupressure on the Shenmen and Neiguan acupoints, while those in the control group received regular routine care. The data were collected using demographic information, physical and surgical data, the Visual Analog Scale (VAS)-A, the State-Trait Anxiety Inventory Y Form (STAI-Y1), and Shortened General Comfort Questionnaire scores. The linear mixed model was used to examine the influences of acupressure on VAS-A and STAI-Y1 scores at different time points before and after the surgery to observe group-by-time interactions. RESULTS: The mean age of the subjects was 60.97 years. All subjects had mild-to-moderate anxiety after surgery and showed a statistically significant decline in regression coefficients on the first and second days after the intervention (ß = -11.61, p = 0.002; ß = -18.71, p < 0.001). Similarly, for STAI-YI scores, the data showed a significant difference in the pre-test and post-test interactions between the two groups (ß = 4.72, p = 0.031). Conversely, acupressure did not have a statistically significant difference on comfort (F = 2.953, p = 0.057). Compared with the control subjects, the experimental subjects used less morphine and developed side effects less frequently (p < 0.01). They were also able to get out of bed after surgery 163.79 min earlier (p < 0.05). CONCLUSIONS: Acupressure is a simple and easy-to-practice treatment. Acupressure on the Shenmen and Neiguan acupoints reduces anxiety and improves recovery in patients after undergoing thoracoscopic surgery.


Assuntos
Acupressão , Ansiedade/prevenção & controle , Transtornos de Ansiedade , Humanos , Pessoa de Meia-Idade , Toracoscopia
20.
Chest ; 161(2): e103-e110, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35131062

RESUMO

CASE PRESENTATION: An 85-year-old Japanese man, who was taking aspirin and edoxaban for previous myocardial infarction and atrial fibrillation, came to our hospital with a chief complaint of dyspnea for 3 weeks. Chest radiography showed a massive left pleural effusion (Fig 1A). Analysis of pleural fluid showed an elevated hematocrit level at 32.8% (blood hematocrit level, 32.0%), and he was diagnosed with hemothorax. However, he had neither coagulation disorder nor thrombocytopenia, and the pleural effusion was negative for atypical cells. These findings suggested that the antithrombotic and anticoagulant medications might have induced the hemothorax.


Assuntos
Hemangiossarcoma/complicações , Hemotórax/etiologia , Neoplasias da Bexiga Urinária/complicações , Idoso de 80 Anos ou mais , Autopsia , Biópsia , Diagnóstico Diferencial , Evolução Fatal , Hemangiossarcoma/diagnóstico por imagem , Hemotórax/diagnóstico por imagem , Hemotórax/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Radiografia Torácica , Recidiva , Toracoscopia , Tomografia Computadorizada por Raios X , Neoplasias da Bexiga Urinária/diagnóstico por imagem
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