Applied research thoracoscopic surgery in the treatment for primary spontaneous pneumothorax

INTRODUCTION Pneumothorax is defined as the appearance of gas in the pleural cavity The most important characteristic of spontaneous pneumothorax in general and primary spontaneous pneumothorax (PSP) in particular are or recurrent The relapse rate of PSP range from 16% to 52% Thus for spontaneous pneumothorax, treatment consists of goals: solving gas leaks makes the lungs expand and preventing relapse In Vietnam since 1995, video assisted thoracic surgery (VATS) treatment of pneumothorax was conducted in some hospitals like 103 Hospital, National Lung Hospital, Vietnam-Germany Hospital in Hanoi, Vietnam Czech Hospital in Haiphong Pham Ngoc Thach Hospital, have conducted VATS to treat PSP since 2005 and have used the technique of pleurectomy, pleural abrasion against recurrence There have been many reports on the results of treatment of spontaneous pneumothorax with VATS is announced but these particular studies on treatment of PSP with VATS no more During surgery, the selection technique is effective and appropriate, choose methods pleural adhesion results, including monitoring of recurrence after surgery has not been paying much attention Stemming from the practical requirements mentioned above, we question the research aims to: Research objectives: Comment some clinical features, imaging of spontaneous pneumothorax primary Pham Ngoc Thach Hospital Evaluation of the results of treatment of spontaneous pneumothorax primary endoscopic surgical thoracic Pham Ngoc Thach Hospital New contributions of the thesis PSP disease common in young people, can rise making and is characterized by relapsing Without treatment interventions to prevent recurrence, the recurrence rate from 16% to average 52% The goal of treatment of pneumothorax is resolved as lung air leaks and prevent further expansion VATS treatment PSP with pleural adhesion mechanics are effective in preventing relapse with low complication rates, shorter hospital stays, less trauma, low recurrence rate Pleural abrasion for adhedsion in surgery endoscopic thoracic does not cause significant impact on pulmonary function of patients after surgery The size of pneumothorax on radiograph lung can predict the likelihood of air leakage prolong the patient from which the indication of early surgery Thesis structure The thesis is presented in 124 pages (excluding references and appendices) The thesis is divided into: Background: pages Chapter 1: Overview document 31 pages Chapter 2: Objects and methods of research 24 pages Chapter 3: Findings 28 pages Chapter 4: Communicate 28 pages Conclude; pages and 1npage petition The thesis includes 40 tables and charts In 111 reference document 13 Vietnamese, 98 English documents Appendices include studies, references, measuring pain intensity scale, medical research, patient list CHAPTER 1: OVERVIEW 1.1 Certain anatomical features lung - pleura, pathophysiology, pathology related to PSP 1.2 The clinical features, imaging in PSP 1.2.3 The image of X-ray, computed tomography of pneumothorax 1.2.3.1 Image on chest radiograph BTS (2010) divided into two categories: + Small: when the distance measured on X-ray film from the visceral pleura of the chest to the shore in less than 2cm + Large: the distance from the shore in the visceral pleura of the chest over 2cm 1.2.3.2 Image on Film computed tomography chest CT Scanner is particularly effective in the detection of blebs and bullae 1.3 Treatment of spontaneous pneumothorax primary 1.4 VATS in the treatment of thoracic PSP 1.4.2 Endoscopic surgical treatment of PSP world 1.4.2.2 Identification and management of the lesions Use endoscopic stapler to cut through the air blebs and bullae advantages: easy to implement, shortening surgery, the rate of air leakage patients after surgery is lower 1.4.2.3 Pleurodesis methods in VATS treatment of PSP Pleurectomy: Deslauries J (1980) came into the pleurectomy apices based on the observed peak that most air blebs appear at the top of his lungs Pleural abrasion: In 1968, Clagett has suggested using common methods pleural parietal abrasion into the advantages of safety, less pain, not affect respiratory function steaming p 1.5 Situation VATST treatment PSP in Vietnam 1.5.1 Surgical treatment situation PSP by VATS in Vietnam In Vietnam, VATS has been used in the treatment PSP since 1995 in some hospitals such as Vietnam-Germany Hospital, Vietnam-Serbia Hospital, National Lung Hospital, 103 Military Hospital , Cho Ray Hospital, University Hospital of Medicine and recently Trung Vuong Emergency Hospital (HCMC), Pham Ngoc Thach Hospital (HCMC) 1.5.2 Findings treated by VATS PSP chest in Vietnam There have been many studies of thoracoscopic surgery treatment PSP in Vietnam, mainly focused on clinical characteristics and treatment outcomes of spontaneous pneumothorax general Chapter 2: SUBJECTS AND METHODS 2.1 Research subjects Included 118 PSP patients treated with VATS pleural adhesion by mechanical methods in Pham Ngoc Thach hospital from 01/2007 to 08/2013 2.1.2 Criteria selected patients - Disagnostic PSP - Treatment by VATS and pleurodesis mechanic - Age: over 15 years old - About: both sexes (male and female) - Agree to participate in research 2.1.3 Exclusion criteria - Patients PSP treated with other methods - Disagree to surgery or surgery í contraindicated - Patients PSP treatment by VATS but pleurodesis by other methods - Disagree to participate in research, the patient was unable to communicate - The patients does not have enough information reseach 2.2 Research Methods The study describes the analytical tracking along, convenient sample size 2.5.1 Some clinical features, imaging in PSP 2.5.1.1 Clinical Features The research indicators: age, gender, smoking history, history of pneumothorax, BMI, onset symptoms, functional symptoms at admission, duration of hospitalization, physical symptoms when hospitalized 2.5 The parameters, variables sudied 2.5.1.2 Chest X-ray image The research criteria: degree of pneumothorax, the number of blebs 2.5.1.3 Image computed tomography chest The research criteria: size and number of blebs detected 2.5.2 Technique, results PSP primary treatment by endoscopic thoracic surgery The research targets: - Results surgery: surgical indications, troca amount, number and size of blebs (bullae), treatment and leaves the blebs (bullae) and parietal pleural, duration of surgery, intraoperative blood loss, complications surgery, postoperative air leak duration, duration of postoperative drainage, postoperative drain tube remove, postoperative complications, pain intensity discharge - Subscribe after surgery (for the group to scratch leaf): The average follow-up period, respiratory function, recurrence 2.6 Gathering and processing data The clinical study was standardized and coded variables and advances are collected and processed by Epi Info CHAPTER 3: FINDINGS 3.1 Some clinical features, imaging in PSP 3.1.1 General features The average age is 28.2 ± 10.2 (16 to 55) Group from 20 - 39, includes 77 trays of entrepreneurs (65.2%) The ratio male / female was 6.4 / 77.1% had a BMI times Comment: Pneumothorax T ran more times, the time between two times shorter pneumothorax 3.1.2.3 The reason for hospitalization Chest pain has the rate of 95.8%, chest pain with dyspnea is 60.6% 3.1.2.6 Physical symptoms There are 76.3% pedestal committing triad Galliard, 10.2% have no clinical symptoms 3.1.3 Chest X-ray Image 3.1.3.1 The pneumothorax The rate of pneumothorax the right side is 56.8%, the left site is 43.2% 3.1.3.2 The degree of pneumothorax Up to 72.9% of patients with pneumothorax high rate Only 24.6% of patients with localized pneumothorax 3.1.4 Image computed tomography chest 3.1.4.2 The size blebs, bullae Has 25.7% have bullae> cm, 74.3% have air blebs ≤ 2cm 3.2 Techniques and Results thoracic VATS treatment of PSP 3.2.1 Indications for surgery There are 83 persons (70.3%) indicated surgery is recurrent pneumothorax No pneumothorax cases of blood spilled Table 3.15: The relationship between the size of pneumothorax and indication for surgery Size of pneumothorax Indications for surgery Prolonged Patient % Recurrence Patient% p Small or localized 14.3 27 32.5 Large 30 85.7 56 67.5 Total 35 100 83 100 cm) and 37,9% air blebs (≤2cm) Table 3.19: Value detect air blebs (bullae) on computed tomography Blebs (bullae) detected by Blebs (bullae) detected Total Blebs Bullae N of % N of pts Pts There are air blebs (bullae) 35 54.7 34 No blebs (Bullae) Total % N of Pts % 87.2 69 67 cm detection rate was 87.2% 3.2.2.3 Dealing with injuries Methods of treatment physical injury The ball crossed by gas cutting machine stitching takes 61.2%, 10 patients (8.6%) gas ball is crossed by means of clamping sleeve cut and sewn The treatment leaves a pleural rub There were 39 patients using a pleural peel leaf and 79 patients using the pleural leaves scratch 3.2.2.4 Time surgery Table 3:23: Time average surgical management of pleural group Methods of Surgical time (minutes) management Patient Shortest Longest P X ± SD Pleurectomy 39 45 190 78.1 ± 31 0.05) 3.2.2.5 Blood loss Table 3:26: The average amount of blood loss during surgery Blood loss (ml) Surgical approach p Patient At least Most ± SD X Pleurectomy 38 30 2300152.1 ± 362.6 Pleural abrasion 37 20 400 78.9 ± 76.4 Both groups 75 20 2300116 ± 264.4 days Pleural hematoma p 13 n of Proportion n of Proportion Pts % Pts % Pleural abrasion 80 25 Pleurrectomy 20 75 Total 100 100 [...]... About the way in of TROCA, all the authors are based on the principles arranged in "diamond" shape to ensure the procedure is advantageous in the surgery Our studies used 3 troca: 1 troca 10 mm in the middle axillary line intercostal VIII, 1 troca 12mm intercostal V in front armpit and 1 troca 5mm in intercostal V just below the muzzle 4.2.2.2 Detection of air blebs, bullae Methods for determination... Comments: The group of the leakage pneumothorax lasting over 5 days has 80% of patients from the group leaves a scratch Complications pleural hematoma has 75% from peel off foil heading into the pleural (p ... leakage prolong the patient from which the indication of early surgery Thesis structure The thesis is presented in 124 pages (excluding references and appendices) The thesis is divided into: Background:... About the way in of TROCA, all the authors are based on the principles arranged in "diamond" shape to ensure the procedure is advantageous in the surgery Our studies used troca: troca 10 mm in the. .. blebs in surgery with a BMI