thoracic surgery ppt #4
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Minimally Invasive Surgery for Pericardial Effusion and Tamponade
Minimally Invasive Surgery for Pericardial Effusion and Tamponade
• Partial pericardiectomy
• Hemostasis• Chest tube drainage
Pericardial window
Thoracoscopic Pericardiectomy for Malignant Effusion:Survival in Months
Thoracoscopic Pericardiectomy for Malignant Effusion:Survival in Months
0 1 2 3 4 5 6 7 8 9 10 11 12
S u rv i v a l i n mo . N=2 2
0%10%20%30%40%50%60%70%80%90%
100%
``
Thoracoscopic PericardiectomySurvival in Months N=22
Thoracoscopic PericardiectomySurvival in Months N=22
0%
50%
100%
months 2 4 6 8 10 12
lu n g N=1 0
b re a st N=9
h e ma to lo g ic N=3
lung N=10
breast N=9
hematologicN=3
Malignant Pericardial Effusion:Comparative Survival
Malignant Pericardial Effusion:Comparative Survival
0%
20%
40%
60%
80%
100%
120%
Alb subx N=82Mem sclerosis N=37COH tscop N=22
Malignant Pericardial Effusion: Comparative Survival Breast CA Malignant Pericardial Effusion:
Comparative Survival Breast CA
1 2 3 4 5 6 7 8 9 10 11 12
C OH tsc o p N= 9
A lb su b x N =2 3
0%
20%
40%
60%
80%
100%
COH tscop N=9Alb subx N=23
Malignant Pericardial Effusion: Comparative Survival Lung CA (NSC)
Malignant Pericardial Effusion: Comparative Survival Lung CA (NSC)
1 2 3 4 5 6 7 8 9 10 11 12
A lb su b x N =3 0
C OH tsc o p N= 1 0
0%
20%
40%
60%
80%
100%
Alb subx N=30
COH tscop N=10
Conclusion:Conclusion:
• Thoracoscopic pericardiectomy is a
• Simple
• Safe
• Effective
• technique for the management of malignant pericardial effusion and tamponade
Pleural Effusion• Very common clinical
problem.• Starling forces• DDx by Light criteria
– Sp. Gr., protein, glucose, LDH, cultures
• Pleural Bx > thoracoscopy• DOE caused by
paradoxical diaphragm• Rx depends upon Dx
Inverts the diaphragm, so thoracic cavity gets smaller with inspiration L2 dyspnea
Always do a pleurocentesis
Malignant Pleural Effusion
• Very common clinical problem in tumors that involve thoracic nodes
• Lung>Breast>Lymphoma.
• Short survival
• Adverse QOL
• Effective palliative Rx is currently by pleurodesis.
Almost never a transudate
Any CA can cause this, but most common w/
Stick parietal w/ visceral pleura
Thoracoscopy:
• Minimally invasive technology
• Better visualization of intrathoracic structures
• Limited palpation• Technical Limitations
• Technology is in evolution
• Diagnostic• Therapeutic
– benign nodules and mediastinal tumors
– metastases
– lung CA? Nope
Tumor nodule
Pleurodesis
• Instill a substance into the pleura that causes inflammation and symphysis of the visceral and parietal pleura.
• No residual space is left for recurrence of effusion.
• Chest tube alone <40%• Tetra-Doxycycline • < 60%• Bleomycin better than
Doxy but $$$.• Talc <70-90%
– slurry– powder via thoracoscope Cheap; like mud
PleurX Catheter:
• New technique• Outpatient placement
of silastic cuffed catheter.
• Outpatient drainage of recurrent pleural effusion for palliation.
For pleurodesis
catheter
Other Tx can be given thru this catheter
Chylothorax:• Leakage of chyle from a
defect in the thoracic duct.
• High fat, protein loss.• Death by starvation.• Etiology
– congenital
– trauma
– tumor
• Rx thoracic duct ligation
Usu. milky white liquid
Tx