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Surgery in large anterior mediastinal mass: case series of Hospital Kuala Lumpur 大型前纵隔肿块的外科治疗:吉隆坡医院病例系列
Pub Date : 2021-05-25 DOI: 10.21037/CCTS-20-119
Ammar Ahmad, N. Sathiamurthy, B. Dharmaraj, N. Balasubbiah, Diong Nguk Chai, A. N. M. Kamil, M. Thiagarajan
Background: Mediastinal masses comprise of a wide variety of tumors and accounts for about 3% of tumors within the chest. Very few studies have been produced so far on large anterior mediastinal masses, as this pathology is infrequently encountered in clinical practice and tend to be asymptomatic until compression symptoms occur, which leads to mediastinal mass syndrome (MMS). The aim of this writing is to assess the surgical feasibility, approach, safety of resection and outcome in large anterior mediastinal masses. Methods: A retrospective review was conducted on patients referred for mediastinal mass to the Thoracic Surgery Unit, Hospital Kuala Lumpur from October 2017 until March 2020 (30 months). Patients with evidence of primary anterior mediastinal mass measuring >6 cm on contrast-enhanced computed tomography (CECT) of thorax and had undergone treatment in our centre were included. Data were analysed by proportions, means and standard deviations. Categorical data were expressed as percentage, whereas interquartile range was used to describe continuous variables. Results: Out of 63 patients with anterior mediastinal mass, 16 (25.4%) patients had anterior mediastinal mass larger than 6 cm and was included in the analysis. The average tumor size was 11.9 cm. Five patients (31.3%) had MMS. Twelve out of 16 patients were operated with 75% rate of clear tumor margin. There was no postoperative mortality recorded within 30 days of surgery. Conclusions: Positive outcome of definitive surgery in this series suggests clinical feasibility with acceptable short-term safety. Multidisciplinary approach with adequate preoperative assessment, intraoperative preparation and short- and long-term postoperative care were key features to successful treatment of this disease.
背景:纵隔肿块由多种肿瘤组成,约占胸部肿瘤的3%。到目前为止,很少有关于大的前纵隔肿块的研究,因为这种病理在临床实践中很少遇到,而且在出现压迫症状之前往往是无症状的,从而导致纵隔肿块综合征(MMS)。本文的目的是评估手术的可行性、入路、切除的安全性和治疗前纵隔大肿块的效果。方法:对2017年10月至2020年3月(30个月)因纵隔肿块转诊至吉隆坡医院胸外科的患者进行回顾性审查。纳入了在胸部对比增强计算机断层扫描(CECT)上发现原发性前纵隔肿块尺寸>6cm并在我们中心接受过治疗的患者。数据按比例、平均值和标准偏差进行分析。分类数据以百分比表示,而四分位间距用于描述连续变量。结果:63例前纵隔肿块患者中,16例(25.4%)前纵隔肿块大于6cm,纳入分析。平均肿瘤大小11.9cm,5例(31.3%)有MMS。16例患者中有12例进行了手术,肿瘤边缘清除率为75%。术后30天内无术后死亡率记录。结论:本系列明确手术的积极结果表明临床可行性和可接受的短期安全性。多学科方法,充分的术前评估、术中准备以及短期和长期的术后护理是成功治疗该疾病的关键特征。
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引用次数: 2
A narrative review of the impact of donor factors and selection criteria on outcomes after lung transplantation 供者因素和选择标准对肺移植术后预后影响的叙述性综述
Pub Date : 2021-01-01 DOI: 10.21037/ccts-21-2
M. Peltz
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引用次数: 0
Malignant tracheoesophageal fistula: diagnosis and management 恶性气管食管瘘的诊断与治疗
Pub Date : 2021-01-01 DOI: 10.21037/ccts-21-8
J. Kakuturu, Ankit Dhamija, A. Toker
: Tracheoesophageal fistula (TEF) refers to a pathological connection between the tracheobronchial tree and esophagus, and may be found in 5–15% of esophageal and 1% of tracheo-bronchial malignancies. Individuals with such advanced malignancy resulting in TEF, are usually at terminal stages of disease. They are often burdened with intolerance to feeding and are subject to frequent pulmonary infections secondary to respiratory contamination. Presentation varies from mild coughing to florid sepsis due to aspiration pneumonia. Diagnosis can usually be made by bronchoscopy and esophagoscopy. In cases where the TEF is small and cannot be visualized by these methods, fluoroscopic swallow evaluation may be useful. The primary aims of treatment are to initiate broad spectrum antibiotics when sepsis is present, to separate the esophagus from the respiratory tree preventing soilage, and to ensure enteral nutrition. In order to determine the approach to management, patients may be categorized into those who present with TEF without a diagnosis of a malignancy, those who present with TEF during oncological treatment with chemotherapy and/or radiation, and those in remission after treatment with definitive chemotherapy and/or radiation, and have developed TEF as a complication. The mainstay of therapy is endoscopic stenting of the esophagus and/or airway. Definitive surgical intervention is usually reserved for patients who are tumor free and involves take-down of the fistula with interposition of a muscle flap. Although therapy is mainly palliative in most circumstances, a systematic approach to this disease may provide patients with a better quality of life. fistula (TEF); airway stent tracheal repair, and esophageal repair (4-0 PDS). Post-operative esophagogram showed no evidence of TEF and no strictures of the esophagus.
:气管-食道瘘(TEF)是指气管-支气管树和食道之间的病理连接,可在5-15%的食道和1%的气管-支气管恶性肿瘤中发现。患有这种导致TEF的晚期恶性肿瘤的个体通常处于疾病的晚期。它们经常对喂养产生不耐受性,并经常受到呼吸道污染引起的肺部感染。表现从轻微咳嗽到吸入性肺炎引起的严重败血症不等。诊断通常可以通过支气管镜和食道镜进行。在TEF较小且无法通过这些方法进行可视化的情况下,荧光透视吞咽评估可能是有用的。治疗的主要目的是在出现败血症时使用广谱抗生素,将食道与呼吸道隔离,防止感染,并确保肠内营养。为了确定治疗方法,患者可分为未被诊断为恶性肿瘤的TEF患者、在化疗和/或放疗的肿瘤学治疗期间出现TEF的患者,以及在最终化疗和//或放疗后病情缓解的患者,并将TEF作为并发症发展。治疗的主要方法是食道和/或气道的内窥镜支架置入术。明确的手术干预通常保留给没有肿瘤的患者,包括取下瘘管并插入肌肉瓣。尽管在大多数情况下,治疗主要是姑息性的,但对这种疾病采取系统的方法可能会为患者提供更好的生活质量。瘘管;气道支架气管修复和食道修复(4-0PDS)。术后食管造影显示没有TEF的迹象,也没有食管狭窄。
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引用次数: 3
The importance of thoracic surgery clinics for emergency medicine: a retrospective analysis of consultations 胸外科门诊对急诊医学的重要性:会诊的回顾性分析
Pub Date : 2021-01-01 DOI: 10.26663/cts.2021.0021
İsmail Ertuğrul Gedik, Okan Bardakçı, T. Alar
Background: Thoracic Surgery serves as a consultant for many specialties of medicine. In this study, we aimed to analyze the basic characteristics of the consultations requested by the Department of Emergency Medicine to the Department of Thoracic Surgery in a university hospital. Materials and Methods: This study includes the retrospective analysis of emergency medicine consultations of patients over the age of 18 to the Thoracic Surgery Clinics of Çanakkale Onsekiz Mart University (COMU) Faculty of Medicine between 01/03/2014 and 01/03/2020. The cases were analyzed in two groups: the consultations requested with the initiative of the emergency medicine physician (Group A) and consultations requested as per recommendations of other physicians (Group B). Results: Of 486 consultations that met the inclusion criteria, 434 (89.3%) consultations were requested as per the recommendations of the emergency medicine physicians (Group A) and 52 (11.7%) were requested as per the recommendations of other physicians (Group B). No thoracic surgical diagnosis was established in 107 (22%) consultations. When compared between the two groups, no thoracic surgical pathology was found in 55 (12.6%) consultations from Group A and 52 (100%) consultations from Group B (p < 0.001). Conclusion: In our study, no thoracic surgical diagnosis was established in more than 20% of consultations requested by the emergency service. We believe that adding formal rotation training to thoracic surgery during the residency training of emergency medicine, which is the first specialty that meets emergency applications, will lead the diagnosis and treatment of thoracic surgical emergencies faster and more accurately.
背景:胸外科是许多医学专业的顾问。在本研究中,我们旨在分析某大学医院急诊科向胸外科求诊的基本特征。材料与方法:本研究回顾性分析了2014年3月1日至2020年3月1日期间在Çanakkale Onsekiz Mart大学(COMU)医学院胸外科门诊就诊的18岁以上患者的急诊医学咨询。将病例分为两组进行分析:A组为急诊医师主动就诊,B组为其他医师推荐就诊。在符合纳入标准的486例就诊中,434例(89.3%)就诊是根据急诊医师(A组)的建议进行的,52例(11.7%)就诊是根据其他医师(B组)的建议进行的。107例(22%)就诊未进行胸外科诊断。两组比较,A组55例(12.6%)患者未发现胸外科病理,B组52例(100%)未发现胸外科病理(p < 0.001)。结论:在我们的研究中,超过20%的急诊问诊没有确定胸外科诊断。我们相信,作为第一个满足急诊应用的专科,在急诊医学住院医师培训期间,在胸外科中加入正式的轮转训练,将会引领胸外科急诊更快、更准确的诊断和治疗。
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引用次数: 0
Comparing the outcomes of video-assisted thoracoscopic surgery and rethoracotomy in the management of postoperative hemorrhage 电视胸腔镜手术与开胸手术治疗术后出血的效果比较
Pub Date : 2021-01-01 DOI: 10.26663/cts.2021.0010
V. Erdoğu, M. Onay, A. Çiftçi, Ece Yasemin Emetli, Semih Erduhan, A. Pekçolaklar, M. Doğru, Y. Aksoy, A. Kutluk, M. Metin
Background: Although postoperative hemorrhage after thoracic surgery is uncommon, it is the most common indication for revision surgery after these procedures. Most postoperative hemorrhages are due to surgical technique, although some comorbidities can predispose the patient to bleeding. We investigated whether video-assisted thoracoscopic surgery (VATS) and re-thoracotomy had the same outcomes in the management of postoperative hemorrhage in patients who underwent open thoracotomy or VATS. Materials and Methods: We retrospectively analyzed patients with postoperative hemorrhage after thoracotomy (n = 659) or VATS (n = 883) between 2018 and 2020. Revision surgery was performed after thoracotomy in 22 patients (3.3%) and after VATS in 4 patients (0.4%). Of these, 11 patients (42.3%) were re-operated by re-thoracotomy (Re-thoracotomy Group) and 15 patients (57.7%) by revision VATS (VATS Group). Results: Revision due to postoperative hemorrhage was required significantly more frequently after thoracotomy than VATS (3.3% vs. 0.4%, p < 0.001). In patients with hemorrhage after pneumonectomy (n = 14), revision by VATS was preferred to re-thoracotomy (n = 10, 71.4% vs. n = 4, 28.6%). The mean time to discharge after revision surgery was 5.1 ± 2.2 days (range, 2-12 days) overall and was significantly shorter in the revision VATS Group than in the Re-thoracotomy Group (4.4 ± 1.5 days vs. 6.2 ± 2.5 days, p = 0.004). Conclusions: VATS has similar results to re-thoracotomy and is advantageous in terms of earlier recovery and shorter hospital stay. Therefore, VATS should be the preferred method for postoperative hemorrhage management.
背景:尽管胸外科手术后出血并不常见,但它是胸外科手术后翻修手术最常见的指征。大多数术后出血是由于手术技术,尽管一些合并症可使患者易出血。我们调查了视频辅助胸腔镜手术(VATS)和再次开胸手术在处理开胸或VATS患者术后出血方面是否具有相同的结果。材料和方法:回顾性分析2018年至2020年期间开胸术后出血患者(n = 659)或VATS术后出血患者(n = 883)。22例(3.3%)患者在开胸后进行翻修手术,4例(0.4%)患者在VATS后进行翻修手术。其中11例(42.3%)再次行开胸手术(再次开胸组),15例(57.7%)再次行VATS翻修手术(VATS组)。结果:开胸术后因术后出血需要翻修的频率明显高于VATS (3.3% vs. 0.4%, p < 0.001)。在肺切除术后出血的患者(n = 14)中,VATS翻修优于再次开胸(n = 10, 71.4% vs. n = 4, 28.6%)。翻修手术后平均出院时间为5.1±2.2天(范围,2-12天),翻修VATS组明显短于再次开胸组(4.4±1.5天vs. 6.2±2.5天,p = 0.004)。结论:VATS与再次开胸效果相似,且在恢复较早、住院时间较短方面具有优势。因此,VATS应作为术后出血处理的首选方法。
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引用次数: 1
Pulmonary large cell neuroendocrine carcinoma: a diagnostic challenge 肺大细胞神经内分泌癌:一个诊断挑战
Pub Date : 2021-01-01 DOI: 10.26663/cts.2021.0015
Demet Yaldız, M. Yaldız, A. Tan
Pulmonary large cell neuroendocrine carcinoma (LCNEC) is known by its highly aggressive behaviour. General presentation is early spread to both regional lymph nodes and distant sites. Here we present a totally asymptomatic patient with a huge fluid-filled cystic lesion detected incidentally in a chest radiograph.
肺大细胞神经内分泌癌(LCNEC)以其高度侵袭性行为而闻名。一般表现为早期扩散到局部淋巴结和远处淋巴结。这里我们报告一个完全无症状的病人,偶然在胸片上发现一个巨大的充满液体的囊性病变。
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引用次数: 0
The evidence behind lung cancer screening: a narrative review of randomized clinical trials 肺癌筛查背后的证据:随机临床试验的叙述性回顾
Pub Date : 2021-01-01 DOI: 10.21037/ccts-21-30
V. Mase, Ulaş Kumbasar, F. Detterbeck
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引用次数: 0
Anesthetic management of tracheo-esophageal fistula 气管食管瘘的麻醉处理
Pub Date : 2021-01-01 DOI: 10.21037/CCTS-20-183
F. Uzumcugil
: The anesthetic management of a neonate diagnosed to have tracheoesophageal fistula with or without esophageal atresia (EA) is challenging, especially due to abnormally connected airway and esophagus interfering with patency of the airway and compromising ventilation. The anatomical variations regarding this congenital anomaly and the associated anomalies in various systems, determines both the surgical intervention and the anesthetic management. An urgent surgical intervention may be required within the first 48 hours after birth in case of severe respiratory compromise. On the other hand, a staged approach may be preferred including a gastrostomy in case of either the presence of low-birth-weight, isolated EA or more critical co-morbidities. A laryngotracheobronchoscopy is often performed prior to definitive surgery in order to identify the location and size of fistula, as well as, secondary upper airway anomalies. In the preoperative period, airway must be secured, and optimizing the status of the neonate in terms of other system functions should have a high priority. Intraoperatively, regardless of the agents used, the anesthetic management should focus on adequate depth of anesthesia, and adequate ventilation and oxygenation. The coordination between the anesthetist and the surgeon is crucial during the surgery in order to secure adequate ventilation and oxygenation. The associated anomalies should be considered as the main determinants of perioperative mortality and morbidity, hence, anesthetic management should also focus on intraoperative maintenance of preoperatively optimized functions. The analgesic management in the postoperative period is often provided by multimodal analgesic use. 6
新生儿诊断为气管食管瘘伴或不伴食管闭锁(EA)的麻醉管理是具有挑战性的,特别是由于气道和食管异常连接干扰气道通畅和通气。这种先天性畸形的解剖变异和不同系统的相关异常,决定了手术干预和麻醉管理。如果出现严重的呼吸损伤,可能需要在出生后48小时内进行紧急手术。另一方面,在存在低出生体重、孤立性EA或更严重的合并症的情况下,分期方法可能更可取,包括胃造口术。为了确定瘘管的位置和大小,以及继发性上气道异常,通常在确定手术前进行喉气管支气管镜检查。术前必须确保气道安全,优化新生儿在其他系统功能方面的状态应优先考虑。术中,无论使用何种药物,麻醉管理应注重足够的麻醉深度,充分的通气和氧合。在手术过程中麻醉师和外科医生之间的协调是至关重要的,以确保足够的通气和氧合。相关的异常应被视为围手术期死亡率和发病率的主要决定因素,因此,麻醉管理也应侧重于术中维持术前优化的功能。术后的镇痛管理通常采用多模式镇痛。6
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引用次数: 1
Perioperative pain management for thoracic surgery: a narrative review of the literature 胸外科围手术期疼痛管理:文献综述
Pub Date : 2021-01-01 DOI: 10.21037/ccts-20-184
A. Clairoux, R. Issa, Marie‐Ève Bélanger, R. Urbanowicz, P. Richebé, Véronique Brulotte
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引用次数: 0
Extracorporeal membrane oxygenation for COVID-19: lessons learned 体外膜氧合治疗COVID-19:经验教训
Pub Date : 2021-01-01 DOI: 10.21037/ccts-21-22
G. Schwartz, B. Blough, Kara Monday, R. Weddle, C. Hebert, C. Spak, U. Sandkovsky, R. Gottlieb, O. Hernandez, Kaitlyn Lingle, Dan Meyer
{"title":"Extracorporeal membrane oxygenation for COVID-19: lessons learned","authors":"G. Schwartz, B. Blough, Kara Monday, R. Weddle, C. Hebert, C. Spak, U. Sandkovsky, R. Gottlieb, O. Hernandez, Kaitlyn Lingle, Dan Meyer","doi":"10.21037/ccts-21-22","DOIUrl":"https://doi.org/10.21037/ccts-21-22","url":null,"abstract":"","PeriodicalId":72729,"journal":{"name":"Current challenges in thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43858377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
期刊
Current challenges in thoracic surgery
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