tailieunhanh - Pediatric Laparoscopy - part 9

Điều này cung cấp một con dấu cầm máu và kín tương đương với thu được với stapler. Mẫu vật từ 2 đến 3 cm trong kích thước có thể thu được theo cách này và sau đó đủ để chẩn đoán. Sinh thiết có thể dễ dàng được lấy từ tất cả năm thùy bằng cách sử dụng kỹ thuật này. Đối với vị trí tổn thương di căn trocar được thay đổi tùy thuộc vào các trang web | Thoracoscopy in Infants and Children 213 base of the specimen and the tissue is sharply excised distal to the ligatures Figs. and . This provides a hemostatic and airtight seal equivalent to that obtained with the stapler. Specimens of 2 to 3 cm in size can be obtained in this manner and are more then adequate for diagnosis. Biopsies can easily be obtained from all five lobes using this technique. For metastatic lesions trocar placement is altered depending on the site of the lesion. Although most of these nodules are peripheral lesions less the one centimeter in diameter or deeper in the parenchyma of the lung may not be readily visible on the surface of the lung. In these cases preoperative localization as previously described should be carried out. At the time of surgery with the lung collapsed the marked area can easily be identified. If the lesion itself is not visible then the area underlying the bloodstain can be wedged out. A frozen section should be obtained to ensure the lesion is included with the specimen. Ongoing improvements in endoscopic ultrasound probes should eventually make this the technique of choice for localization. Resection of bullae or infectious cavitary lesions can be excised using a similar technique Fig. . Any potentially malignant or infectious lesion that will not fit through the inner channel of the trocar should be placed in an endoscopic specimen bag to prevent possible seeding. Once the intrathoracic procedure has been completed a small chest tube is placed through one of the trocars and the collapsed lung is ventilated. In most cases where there is no concern over adequate hemostasis chyle leak or esophageal perforation the chest tube can be removed prior to extubation in the operating room if no evidence of any air leak is present. This avoids the considerable discomfort associated with the chest tube in the postoperative period. A chest x-ray is obtained in the recovery room and if the lung is fully expanded .