tailieunhanh - Báo cáo y học: " Carinal surgery: experience of a single center and review of the current literature"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Carinal surgery: experience of a single center and review of the current literature. | Parissis and Young Journal of Cardiothoracic Surgery 2010 5 51 http content 5 1 51 Jdfrs JOURNAL OF CARDIOTHORACIC SURGERY RESEARCH ARTICLE Open Access Carinal surgery experience of a single center and review of the current literature Haralabos Parissis 1 and Vincent Young2 Abstract Background To report our experience for the treatment of lung tumors of the right main bronchus RMB invading the carina. Methods From February 2000 till January 2007 we have identified 8 cases requiring carinal surgery. Plan of action Close cooperation with anaesthetics long flexible ET tube Right posterolateral thoracotomy no irrevocable steps until resection guaranteed mobilization of trachea and main bronchus division of the trachea Left main bronchus. Intubate across surgical field. Tailoring for airway size discrepancies appropriately. Construction of the tracheobronchial anastomosis around the ventilatory tube. Skillfull reintubation over a long boogie. Results Mortality due to ARDS one patient Morbidity anastomotic stenosis requiring stent one patient . Follow-up 52 11 months. Recurrences 2 patients both with pathological N2 disease on histology . Conclusions Success of carinal surgery depends on careful patient selection team approach and attention to detail. Patients with N2 disease carry the worst prognosis. Background Until recently the TNM classification staged tumours invading the carina as T4 IIIB. By implication these tumours are inoperable due to local criteria. However a subgroup of those patients can be treated by carinal resection and reconstruction with potential cure. Therefore there is an argument that this subgroup should the staged as IIIA 1 especially since this small group of patients consists of a potentially surgical group with favourable outcome and a five years survival up to 40 -45 2 . Indications for carinal resection are reported 3 as bronchogenic carcinoma other airway neoplasms and benign or .