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1.
Niger J Clin Pract ; 24(11): 1669-1673, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34782507

RESUMO

Background: Primary spontaneous pneumothorax (psp) results from spontaneous rupture of bleb or bulla. Aims: We planned to discuss the etiologic factors, clinical and radiological findings, and treatment results of psp cases. Materials and Methods: 402 patients were evaluated. Patients were divided into two groups as patients receiving positive results with thoracostomy and patients who received positive results"> thoracotomy/video-assisted thoracoscopic surgery (vats). Groups were compared. Results were evaluated"> using Chi-square or Fishers' exact test. P < 0.05 was considered as significant. Results: Gender difference (P: 1.00) and localization of disease (P: 0.45)were not significant for psp. Smoking and being subtotal or total compared to partial had a substantial effect on the implementation of thoracotomy/vats (P < 0.05). Furthermore, psp was most frequently seen in August and September. Discussion: Risk factors of psp are described as genetic predisposition, being tall, smoking, and autosomal dominant heredity. The main determinant factor in the treatment of psp is the degree of pneumothorax. Conclusion: Psp was frequently observed in smokers. The preferred method for overall psp is tube thoracostomy. Thoracotomy/vats is more commonly performed for subtotal or total psp compared to partial psp.


Assuntos
Pneumotórax , Tubos Torácicos , Humanos , Pneumotórax/etiologia , Pneumotórax/cirurgia , Recidiva , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Toracotomia , Resultado do Tratamento
2.
Pan Afr Med J ; 40: 68, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34804336

RESUMO

Introduction: aortic valve replacement is usually performed through a median full sternotomy (MFS) in our department. Minimally invasive aortic valve replacement (MIAVR) has been recently adopted as a new approach. According to the literature, the superiority of MIAVR is controversial. In this study we report early post-operative outcomes in MIAVR compared with MFS access with reference to blood Loss, wound infections, post-operative recovery, morbidity and mortality. Methods: this study was a prospective data collection from 36 consecutive patients undergoing isolated valve replacement. Two population study was identified, MIAVR group (group I n=18) and MFS group (group II n=18). Patients´ data were collected and analyzed using IBM SPSS statistics 21 software and Khi2 test has been used to compare the variables. The study variables are presented as numbers, percentage, median with interquartile range. Pre-operative planning was performed so that to obtain similar characteristics. Results: in group I, upper mini-sternotomy was used in 12 patients and right mini-thoracotomy in 6 patients. There was no difference in term of mortality and morbidity. MIAVR was associated with longer CPB time (93.25 (58-161) vs 131 (75-215) mins, P=0.047) with no significant difference in term of ACC time (81 (33-162) vs 58.8 (59-102) mins P=0.158). MIAVR´ Patients had likely lower incidence of red blood cells transfusion (16.7 vs 52.3%) without significant difference about post-operative haemoglobin (P = 0,330). Patients in group I had shorter ventilation time (2.35 (1-12) vs 9.3 (1-48) hours P < 0.01), shorter ICU stay (2.44 (1-8) vs 4.25 (1-9) days, P = 0,024). The length of hospital stay was shorter, 6.5 (5-9) days in group I vs 7.4 (6-11), P=0.0274. Length of chest tube stay was shorter in group I (mean 1.53 vs 2.4 days, P=0,033). Wound infections were not found in both groups. Conclusion: minimally invasive aortic valve replacement is associated with less blood loss, faster post-operative recovery faster post-operative recovery but increase operation time.


Assuntos
Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Toracotomia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Esternotomia , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento , Adulto Jovem
3.
BMC Surg ; 21(1): 403, 2021 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-34809633

RESUMO

BACKGROUND: To compare the clinical outcomes between thoracoscopic approach and thoracotomy surgery in patients with Gross type C Esophageal atresia (EA) and tracheoesophageal fistula (TEF). METHODS: Patients with Gross type C EA/TEF who underwent surgery from January 2007 to January 2020 at Beijing Children's Hospital were retrospectively analyzed. The patients were divided into two groups according to surgical approaches. The perioperative factors and postoperative complications were compared among the two groups. RESULTS: One hundred and ninety patients (132 boys and 58 girls) with a median birth weight of 2975 (2600, 3200) g were included. The primary operations were performed via thoracoscopic (n = 62) and thoracotomy (n = 128) approach. After comparison of clinical characteristics between the two groups, we found that there were statistically significant differences in associated anomalies, method of fistula closure, duration of mechanical ventilation after surgery, feeding option before discharge, management of pneumothorax, and prognosis (all P < 0.05). To a certain extent, thoracoscopic surgery reduced the incidence of anastomotic leakage and increased the incidence of anastomotic stricture in this study. However, there were no statistically significant differences between the two groups in terms of operative time, postoperative pneumothorax, anastomotic leakage, anastomotic stricture, and recurrent tracheoesophageal fistula (all P > 0.05). CONCLUSIONS: Thoracoscopy surgery for Gross type C EA/TEF is a safe and effective, minimally invasive technique with comparable operative time and incidence of postoperative complications.


Assuntos
Atresia Esofágica , Fístula Traqueoesofágica , Criança , Atresia Esofágica/cirurgia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Toracoscopia , Toracotomia , Fístula Traqueoesofágica/epidemiologia , Fístula Traqueoesofágica/cirurgia , Resultado do Tratamento
4.
Surg Clin North Am ; 101(6): 1111-1121, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34774272

RESUMO

As care of the injured patient continues to evolve, new surgical technologies and new resuscitative therapies can change the algorithms that drive trauma care. In particular, the advent of resuscitative endovascular balloon occlusion of the aorta has changed the way trauma surgeons treat patients in extremis. The science of resuscitation continues to evolve, leading to controversy about the optimal administration of fluid and blood products. Laparoscopy has given additional tools to the trauma surgeon to potentially avoid exploratory laparotomy, and rib fracture fixation can be beneficial in the proper patient.


Assuntos
Aorta/lesões , Oclusão com Balão , Costelas/cirurgia , Choque Hemorrágico/terapia , Toracotomia/métodos , Lesões do Sistema Vascular/cirurgia , Oclusão com Balão/métodos , Tratamento de Emergência , Procedimentos Endovasculares , Humanos , Laparoscopia , Laparotomia , Costelas/lesões , Choque Hemorrágico/etiologia , Lesões do Sistema Vascular/terapia
5.
Braz J Cardiovasc Surg ; 36(4): 461-467, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34617427

RESUMO

INTRODUCTION: End-to-end anastomosis and extended end-to-end anastomosis are typically used as surgical approaches to coarctation of the aorta (CoAo) with access at the subclavian artery or an interposition graft. The objective of this study is to analyze the impact of surgical and anatomical characteristics and techniques on early outcomes after surgical treatment of CoAo without cardiopulmonary bypass through left thoracotomy. METHODS: This is a quantitative, observational, and cross-sectional analysis of patients who underwent repair of CoAo between July 1, 2010 and December 31, 2017. Seventy-two patients were divided into three groups according to age: 34 in group A (≤ 30 days), 24 in group B (31 days to one year), and 14 in group C (≥ 1 year to 18 years). RESULTS: Aortic arch hypoplasia was associated in 30.8% of the cases, followed by ventricular septal defect (13.2%). The preductal location was more frequent in group A (73.5%), ductal in group B (41.7%), and postductal in group C (71.4%). Long coarcted segment was predominant in groups A and C (61.8% and 71.4%, respectively) and localized in group B (58.3%). Extended end-to-end anastomosis technique was prevalent (68%), mainly in group A (91.2%). Mortality in 30 days was 1.4%. CONCLUSION: Most of the patients were children under one year of age, and extended end-to-end anastomosis was the most used technique, secondary to arch hypoplasia. Further, overall mortality was low in spite of moderate morbidity in the first 30 postoperative days.


Assuntos
Coartação Aórtica , Toracotomia , Adulto , Aorta Torácica/cirurgia , Coartação Aórtica/cirurgia , Criança , Estudos Transversais , Humanos , Lactente , Recém-Nascido , Procedimentos Cirúrgicos Vasculares
6.
Artigo em Inglês | MEDLINE | ID: mdl-34662005

RESUMO

Reopening the chest in patients with left ventricular assist devices at the time of a heart transplant is challenging due to adhesions and the possibility of injury to vital structures. The sternal sparing bilateral thoracotomy approach utilized to implant a left ventricular assist device minimizes the chances of such injuries and offers a cosmetically better outcome. We demonstrate a procedure for implanting a left ventricular assist device in a 54-year-old man diagnosed with dilated cardiomyopathy who suffered rapid decompensation despite maximum medical therapy.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Esterno , Toracotomia , Resultado do Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-34705353

RESUMO

The Warden procedure has been described for the repair of a partial anomalous pulmonary venous connection that is inserted high in the superior vena cava. One long-term concern remains, which is related to the narrowing of the superior vena caval anastomosis. In fully grown teenagers and adults, we have modified the procedure by using an interposition graft that consists of a descending thoracic aortic homograft. It usually matches the size of the superior vena cava and avoids the need for anticoagulation. We also insert the homograft into the free wall of the right atrium rather than into the atrial appendage. We present the technique in a 16-year-old girl through a vertical right axillary thoracotomy.


Assuntos
Comunicação Interatrial , Veias Pulmonares , Adolescente , Adulto , Aloenxertos , Feminino , Comunicação Interatrial/cirurgia , Humanos , Veias Pulmonares/cirurgia , Toracotomia , Veia Cava Superior/cirurgia
9.
J Laparoendosc Adv Surg Tech A ; 31(10): 1157-1161, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34609926

RESUMO

Indications for pulmonary lobectomy in infants and children include cystic pulmonary adenomatoid malformation, congenital lobar emphysema, chronic infection, and malignancy. These procedures can now all be done thoracoscopically avoiding the short- and long-term morbidity of an open thoracotomy. In this article we describe the technique of thoracoscopic lobectomy as well as the preoperative and postoperative care.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão , Enfisema Pulmonar , Criança , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Humanos , Lactente , Pulmão/cirurgia , Pneumonectomia , Enfisema Pulmonar/cirurgia , Toracotomia , Resultado do Tratamento
10.
J Cardiothorac Surg ; 16(1): 266, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544460

RESUMO

BACKGROUND: To compare the short-term safety and efficacy of right anterolateral minithoracotomy (ALMT) and median sternotomy (MS) for the surgical treatment of atrial septal defects (ASDs). METHODS: The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for comparative studies focusing on surgical repair of ASDs via ALMT or MS published up to the end of April 27, 2020. We used random-effect or fixed-effect models to obtain pooled estimates. RESULTS: A total of 7 publications, including 665 patients (ALMT 296 and MS 369), were included. Age (WMD: 1.80 years, 95% CI 0.31-3.29), weight (WMD: - 0.91 kg, 95% CI - 5.57 to 3.75), sex distribution (OR: 1.00, 95% CI 0.74-1.35) and surgical type (patch or direct closure) (OR: 1.00, 95% CI 0.67-1.49) were comparable in the ALMT group and MS group. No significant differences in the success rate (OR 0.23; 95% CI 0.05-1.07) or severe complication rate (OR 1.46; 95% CI 0.41-5.22) were found between the ALMT group and the MS group. In addition, the differences in the cardiopulmonary bypass (CPB) time (WMD 6.33; 95% CI - 1.92 to 14.58 min, p = 0.13) and the operation time (WMD 5.23; 95% CI - 12.49 to 22.96 min, p = 0.56) between the ALMT group and the MS group were not statistically significant. However, the ALMT group had a significantly longer aortic cross-clamp time (2.37 min more, 95% CI 1.07-3.67 min, p = 0.0003). The intubation time was 1.82 h shorter (95% CI - 3.10 to - 0.55 h; p = 0.005), the intensive care unit (ICU) stay was 0.24 days shorter (95% CI - 0.44 to - 0.04 days; p = 0.02), and the postoperative hospital stay was 2.45 days shorter (95% CI - 3.01 to - 1.88 days; p < 0.00001) in the ALMT group than in the MS group. Furthermore, the incision length was significantly shortened by 8.97 cm in the ALMT group compared with the MS group (95% CI - 9.36 to - 8.58 cm; p < 0.00001). CONCLUSIONS: In the surgical treatment of ASD, ALMT and MS are equally safe and effective in terms of success rates and severe complication rates. The surgical procedures are equally difficult, but ALMT is associated with a faster functional recovery and better cosmetic results. Compared to MS, ALMT is the better choice for select ASD patients.


Assuntos
Comunicação Interatrial , Esternotomia , Comunicação Interatrial/cirurgia , Humanos , Recém-Nascido , Tempo de Internação , Procedimentos Cirúrgicos Minimamente Invasivos , Toracotomia , Resultado do Tratamento
11.
Kyobu Geka ; 74(10): 746-751, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34548440

RESUMO

It has been reported that there are some risks of coronary artery graft injury while redo sternotomy was required for valve surgery after coronary artery bypass grafting (CABG). Also it is well known that clinical results after graft injury was poor. For avoiding graft injury, coronary artery graft must be placed away from the sternum at the time of initial CABG. For redo sternotomy, 3-dimensional-computed tomography can be useful. For aortic valve surgery after CABG, treatment of patent in-situ graft have to be discussed. For common practice, dissecting and clamping the patent in-situ graft during cardiac arrest were required. However, there are some reports showing good clinical results with moderate hypothermia, non-dissection and non-clamping graft. Furthermore, less mobidity rate results of transcatheter aortic valve implantation( TAVI) after CABG was reported. For mitral valve surgery after CABG, right mini-thoracotomy was reported as preferred procedure recently. Dissection area could be reduced than re-median sternotomy, although clamping aorta and patent graft were technically difficult. Two procedures were reported such as hypothermia and ventricular fibrillation or normothermia and beating heart. MitraClip procedure can be considered for high risk patients. Newly developed surgical and catheter technique may change the strategy for heart valve disease after CABG.


Assuntos
Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Ponte de Artéria Coronária , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Humanos , Esternotomia , Toracotomia
12.
Kyobu Geka ; 74(10): 758-762, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34548442

RESUMO

Transcatheter mitral valve intervention, including repair and replacement, has been developed as an alternative treatment to mitral valve surgery with advanced technology in recent years, but the therapeutic indication is still limited to only a part of all, high-risk or inoperable patients. Although reoperative valve surgery is generally known to be associated with increased morbidity and mortality, conventional mitral valve surgery after previous aortic valve replacement is needed due to limited usage of catheter intervention as increasing of aged population. It is usually necessary to undergo redo median sternotomy with care as same as other reoperation, or right thoracotomy approach in some cases. In any cases, there is a tendency to poor visualization of the mitral valve, in especially, a view of anterior annulus due to rigid aortic prosthetic cuff. Of course, optimal visualization of the mitral valve is a successful key factor in reliable maneuver for either repair or replacement. Here we describe operative tips and pitfalls including operative indication, re-opening of the chest, left atrial approach.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Idoso , Valva Aórtica/cirurgia , Humanos , Valva Mitral/cirurgia , Reoperação , Esternotomia , Toracotomia , Resultado do Tratamento
13.
J Cardiothorac Surg ; 16(1): 276, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34583735

RESUMO

BACKGROUND: The right and left lung anatomy are similar but asymmetrical. The right lung consists of three lobes, and the left lung consists of two lobes. Our study is unique because of discovering a very rare morphological feature of the left lung which has not been reported yet. By the way, we compared two different available chemical agents for pleurodesis (talc and bleomycin) according to side effects, complications, and pneumothorax recurrence. CASE PRESENTATION: We reported a case of bilateral primary spontaneous pneumothorax, who underwent talc slurry and bleomycin pleurodesis at right and left side retrospectively, and then complicate with left-sided recurrent spontaneous pneumothorax, so underwent open thoracotomy and was surprisingly and accidentally found to have 4 lobes and 3 fissures in left lung. CONCLUSION: In our case report, there were one main oblique fissure and two accessory fissures which divided the lung into 4 separated lobes, and this discovery in human's and other animals' lung anatomy has not been previously reported. In our case study, the talc slurry was more effective in preventing spontaneous pneumothorax recurrence, but with more side effects than bleomycin. We could hypothesize that the morphological variation of the lung might affect spontaneous pneumothorax development and recurrence.


Assuntos
Pneumotórax , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Pleurodese , Pneumotórax/cirurgia , Recidiva , Estudos Retrospectivos , Talco , Toracotomia
15.
J Ayub Med Coll Abbottabad ; 33(3): 526-528, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34487671

RESUMO

Pneumothorax (Pnx) is the presence of air or gas in the pleural space which hinders the lungs to function appropriately. Pneumothorax that presents in the absence of any underlying aetiology is called primary spontaneous pneumothorax (PSP) and on the other hand, it may present as a complication of underlying lung disease which is known as secondary spontaneous pneumothorax (SSP). Iatrogenic Pneumothorax (IP) is a type of SSP and is caused by medical interventional procedures which include transthoracic needle biopsy (24%), sub clavicular catheterization (22%), thoracocentesis (20%), transbronchial biopsy (10%), pleural biopsy (8%) and positive pressure ventilation (7%). We had a 51-year-old patient with a history of COPD/emphysema who presented with respiratory distress. Large bullae were mistaken as pneumothorax, unnecessary Chest Tube Insertion (thoracostomy) was performed resulting in IP. An extensive review of the literature shows there are only a few reported cases of unnecessary thoracotomy and IP in settings of giant bulla mimicking pneumothorax. Iatrogenic Pneumothorax resulting from giant bullae mimicking pneumothorax leading to unnecessary chest tube insertion. Physicians should be aware of such aetiology of pneumothorax as it has been rarely reported in the literature.


Assuntos
Pneumotórax , Tubos Torácicos/efeitos adversos , Humanos , Doença Iatrogênica , Pessoa de Meia-Idade , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Toracotomia
16.
J Card Surg ; 36(12): 4808-4810, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34549458

RESUMO

A 54-year-old male was admitted to our hospital with a prolonged dypsnea, orthopnoea, and chest pain that has lasted for almost 2 weeks. Physical examination revealed symptoms of heart failure. Transthoracic echocardiography revealed a ventricular septal defect located at the apical segment of the interventricular septum, mild mitral regurgitation, and hypokinesia of the apex of the left ventricle. Coronary angiography showed a critical proximal lesion of the left anterior descending artery. He was diagnosed with postmyocardial infarction ventricular septal defect. Our patient underwent minimal invasive coronary artery bypass and ventricular septal defect repair via left anterior minithoracotomy. Postoperative period was uneventful and our patient was released on a postoperative Day 7. Postoperative transthoracic echocardiography revealed no residue of repaired ventricular septal defect with improved left ventricular functions.


Assuntos
Comunicação Interventricular , Infarto do Miocárdio , Vasos Coronários , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Toracotomia
17.
BMJ Open Respir Res ; 8(1)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34493540

RESUMO

INTRODUCTION: The type of lung cancer surgery impacts on tumour manipulation during surgery and may drive dissemination of cancer cells into the vasculature, thus facilitating metastatic spread. The aim of this study was to investigate the impact of surgically induced trauma using peripheral blood from preoperative and postoperative patients with non-small cell lung cancer (NSCLC) undergoing thoracotomy or video-assisted thoracoscopic surgery (VATS) resection. METHODS: Imaging flow cytometry was used to measure circulating cancer-associated cells (CCs). Circulating cell-free DNA (ccfDNA) isolation was performed using Promega dsDNA HS Assay Kit. DNA integrity measurements were calculated by the ALU247 to ALU115 ratio and cytokine levels measured using the Luminex screening assay. RESULTS: CCs were increased in postoperative blood samples in 54 patients with NSCLC. Patients who underwent thoracotomy instead of VATS had higher numbers of EpCAM (p=0.004) and PanCK-labelled (p=0.03) CCs postoperatively. ccfDNA and DNA integrity index were also significantly increased in postoperative samples (p=0.0009 and p=0.04), with concomitant increase in interleukin 6 and interleukin 10 levels in the same cohorts (p=0.0004 and p=0.034, respectively). CONCLUSIONS: In this study we have shown the potential clinical utility of several biomarkers from liquid biopsies to guide perioperative management, as well as provide a snapshot of the type of surgical resection in terms of circulating tumour cell release. Obtaining reliable readouts from blood can provide crucial information for disease progression, as well as being of prognostic value monitoring patients' response to treatment.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Ácidos Nucleicos Livres , Neoplasias Pulmonares , Células Neoplásicas Circulantes , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Toracotomia
18.
Pain Physician ; 24(6): E753-E759, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34554693

RESUMO

BACKGROUND: Patients undergoing thoracic surgery frequently suffer from chronic pain after thoracotomy. Chronic pain can lead to a significant decline in a patient's quality of life. However, the effect of single-shot thoracic paravertebral block (TPVB) combined with intravenous analgesia on chronic pain incidence is unclear. OBJECTIVE: The objective was to evaluate the impact of single-shot TPVB combined with intravenous analgesia versus continuous thoracic epidural analgesia (TEA) on chronic pain incidence after thoracotomy. STUDY DESIGN: A randomized controlled study. SETTING: Hospital department in China. METHODS: Ninety-six patients undergoing thoracotomy were randomly assigned to 2 groups: single-shot TPVB combined with intravenous analgesia (Group P) and continuous TEA (Group E). The pain intensity was assessed using the Verbal Rating Scale (VRS). The outcome measures were chronic pain incidence and the acute and chronic pain intensity. RESULTS: The chronic pain incidence at rest in Group P was significantly higher than that in Group E at 3 months and 12 months postoperation  (55.2% versus 28.6%, P = 0.019; 34.5% versus 14.3%, P = 0.027). The patients in Group E showed less pain intensity at rest compared with those in Group P at 3 months postoperation (0.0 versus 1.0, P = 0.034). At 6 hours and 24 hours postoperation, the acute pain intensity at coughing and at rest in Group E was lower than that in group P (VRS at coughing: 6 hours: 0.0 versus 2.0, P = 0.001; 24 hours: 3.0 versus 5.0, P = 0.010. VRS at rest: 6 hours: 0.0 versus 2.0, P = 0.000; 24 hours: 1.0versus. 2.0, P = 0.001). LIMITATIONS: An important limitation of this study is that it is not a double-blind study. CONCLUSIONS: In patients undergoing thoracotomy, continuous TEA significantly reduced the chronic pain incidence at rest at 3 months and 12 months after operation and provided better acute pain relief up to 24 hours after operation compared with single-shot TPVB combined with intravenous analgesia.


Assuntos
Analgesia Epidural , Dor Crônica , Analgésicos Opioides , Dor Crônica/tratamento farmacológico , Humanos , Dor Pós-Operatória/tratamento farmacológico , Qualidade de Vida , Toracotomia/efeitos adversos
19.
Lung Cancer ; 159: 135-144, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34340110

RESUMO

OBJECTIVES: To compare the perioperative and oncologic outcomes following pneumonectomy performed by uniportal video-assisted thoracoscopic surgery (U-VATS) and thoracotomy in patients with centrally located non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Patients with NSCLC who underwent pneumonectomy at the Shanghai Pulmonary Hospital (SPH) and Sun Yat-sen University Cancer Center (SYUCC) with the U-VATS approach or open approach between 2011 and 2016 were selected. Propensity score matching (1:3) was performed to balance the baseline covariates. Overall survival (OS) rates and recurrence-free survival (RFS) rates were estimated and compared using the Kaplan-Meier method, respectively. RESULTS: The enrollees in the study were 579 patients in the SPH cohort, with 501 (86.5%) in the open group and 48 (13.5%) in the U-VATS group, and 271 patients in the SYUCC cohort, with 245 (90.4%) in the open group and 26 (9.6%) in the U-VATS group. After propensity score matching, morbidity rates and 30-day mortality rates were found to be similar between the U-VATS group and open group in both the SPH and SYUCC cohorts. The long-term OS rate of patients who underwent U-VATS pneumonectomy did not significantly differ compared with the patients who underwent open pneumonectomy in both cohorts (SPH, p = .900; SYUCC, p = .240). Cox regression analysis revealed that the surgical option was not a risk factor for the OS rate (SPH: hazard ratio [HR], 0.925; 95% confidence interval [CI], 0.555 to 1.542; SYUCC: HR, 1.524; 95% CI, 0.752 to 3.087). CONCLUSION: U-VATS can be used to safely perform pneumonectomy in patients with centrally located NSCLC without compromising the perioperative and oncologic outcomes compared with an open approach.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/cirurgia , China/epidemiologia , Humanos , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Pontuação de Propensão , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Toracotomia , Resultado do Tratamento
20.
Ned Tijdschr Geneeskd ; 1652021 05 19.
Artigo em Holandês | MEDLINE | ID: mdl-34346628

RESUMO

Myoepithelial tumors are described very rarely in the thorax. We report a case of such a tumor. A 64 year old female presented with shortness of breath. A CT-scan was performed which showed a giant tumor occupying the left hemithorax. Thoracotomy with excision of the myoepithelial tumor was performed.


Assuntos
Toracotomia , Tórax , Dispneia , Feminino , Humanos , Pessoa de Meia-Idade , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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