THE ADVANTAGES OF DIFFERENTIATED TACTICS OF VIDEOTHORACOSCOPY IN PATIENTS WITH PLEURAL EFFUSION SYNDROME
Abstract
The standard procedure of videothorascopic intervention has a series of disadvantages, connected with intubation narcosis, that limit the contingent of patients, who can undergo it.
Aim of the work is to raise the efficacy of diagnostic videothoracoscopy at pleural effusion syndrome on the base of its differentiated tactics.
Materials and methods. Differentiated tactics of the choice of method of diagnostic videothoracoscopy in patients with pleural effusion syndrome was introduced in the work of thoracic surgery department. Its essence is in fact that before operation after evacuation of effusion from the pleural cavity there was created an artificial pneumothorax, the state of hemithorax was radiologically assessed. According to the results of radiological examination, the patients, who underwent videothoracoscopy in simplified way, were selected. As opposite to the standard method, at simplified way the intravenous sedation was used instead of endotracheal, muscle rexalants were not used, the additional surgical manipulations were not carried out. For assessment of the efficacy of this tactics 124 cases of diagnostics and treatment of pleural effusion syndrome using videothoracoscopy we analyzed.
Results. In the result of introduction of differentiated tactics of videothorascopic diagnostic in patients with pleural effusion syndrome the number of postanesthetic side effects was reduced by 65,9 %, the frequency of anesthesia by narcotic analgetics – from 2,8 to 1,4 times/day, the term of recovery of independent stool – from 72,0 to 34,3 hours, the term of activation after surgery (independent movement) – from 23,8 to 10,3 hours, the duration of staying in the intensive care department was reduced from 24,8 to 9,7 hours, duration of postsurgical treatment was reduced from 16,0 to 10,1 days.
Results. The main advantages of introduction of differentiated tactics of videothorascopic diagnostics were: the reliable acceleration of activation after surgery, recovery of adequate peristalsis and independent stool, decrease of duration of staying in the intensive care department, decrease of the necessity in anesthesia with narcotic analgetics, reduction of the number of postanesthetic side effects and mean duration of postsurgical treatment. The received result is connected with the fact that two thirds of patients did not undergo the effect of preparations for intubation narcosis.
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References
Baumer, J. H. (2005). Parapneumonic effusion and empyema. Archives of Disease in Childhood – Education and Practice, 90 (1), ep21–ep24. doi: 10.1136/adc.2005.073478
Davies, H. E., Davies, R. J. O., Davies, C. W. H. (2010). Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010. Thorax, 65, ii41–ii53. doi: 10.1136/thx.2010.137000
Wrightson, J. M., Maskell, N. A. (2012). Pleural infection. Clinical Medicine, 12 (1), 82–86. doi: 10.7861/clinmedicine.12-1-82
Bhatnagar, R., Maskell, N. (2014). Pleural fluid biochemistry – old controversies, new directions. Annals of Clinical Biochemistry: An International Journal of Biochemistry and Laboratory Medicine, 51 (4), 421–423. doi: 10.1177/0004563214531236
Biswas, A., Bhatracharya, S. (2008). Diagnostic role of closed pleural biopsy in the investigation of exudative pleural effusions. J. Indian Med. Assoc, 106 (8), 525–526.
Brown, J., Ricketts, W., Bothamley, G. (2012). P118 Abrams-Needle Pleural Biopsy Remains a Useful Investigation in Suspected Pleural Tuberculosis. Thorax, 67, A113.2–A113. doi: 10.1136/thoraxjnl-2012-202678.401
Tsakiridis, K., Zarogoulidis, P. (2013). An interview between a pulmonologist and a thoracic surgeon – Pleuroscopy: the reappearance of an old definition. Journal of Thoracic Disease, 5, 449–451. doi: 10.3978/j.issn.2072-1439.2013.05.14
Dixon, G., Fonseka, D., Maskell, N. (2015). Pleural controversies: image guided biopsy vs. thoracoscopy for undiagnosed pleural effusions? J. Thorac. Dis., 7 (6), 1041–1051. doi: 10.3978/j.issn.2072-1439.2015.01.36
Golden, M. P., Vikram, H. R. (2005). Endoscopic approach to pulmonary diseases: Clinical utility of medical thoracoscopy in diagnosis of pleural diseases. American Family Physician, 9 (72), 1761–1768.
Skachkov, А. М., Fedoseev, V. F., Sobinin, О. V. (2010). Thoracoscopy for exudative pleuritis. Abstracts of the XIV Congress of Russian society of endoscopic surgeons, 140–141.
Tuhtin, N. S., Stogova, N. А., Giller, D. B. (2010). Pleura disorders. Moscow: Medicine, 256.
Czarnecka, K., Yasufuku, K. (2012). Interventional pulmonology: Focus on pulmonary diagnostics. Respirology, 18 (1), 47–60. doi: 10.1111/j.1440-1843.2012.02211.x
Detterbeck, F. C. (2013). Thoracoscopy. Clinics in Chest Medicine, 34 (1), 93–98. doi: 10.1016/j.ccm.2012.12.002
Safonov, V. Je. (2008). Efficiency of using videothoracoscopic operations in complex diagnosis and treatment for disorders of lung, pleura and mediastinum. State organization “National institute of phthisiology and pulmonology named by F. G. Yanovsky National academy of medical sciences of Ukraine”. Kyiv, 23.
Dhooria, S., Singh, N., Aggarwal, A. N., Gupta, D., Agarwal, R. (2013). A Randomized Trial Comparing the Diagnostic Yield of Rigid and Semirigid Thoracoscopy in Undiagnosed Pleural Effusions. Respiratory Care, 59 (5), 756–764. doi: 10.4187/respcare.02738
Akulian, J., Yarmus, L., Feller-Kopman, D. (2013). The Evaluation and Clinical Application of Pleural Physiology. Clinics in Chest Medicine, 34 (1), 11–19. doi: 10.1016/j.ccm.2012.11.001
DePew, Z. S., Wigle, D., Mullon, J. J., Nichols, F. C., Deschamps, C., Maldonado, F. (2014). Feasibility and Safety of Outpatient Medical Thoracoscopy at a Large Tertiary Medical Center. Chest, 146 (2), 398–405. doi: 10.1378/chest.13-2113
Loddenkemper, R., Mathur, P. N., Lee, P., Noppen, M. (2011). History and clinical use of thoracoscopy/pleuroscopy in respiratory medicine. Breathe, 8 (2), 144–155. doi: 10.1183/20734735.011711
Hooper, C. E., Welham, S. A., Maskell, N. A. (2014). Pleural procedures and patient safety: a national BTS audit of practice: Table 1. Thorax, 70 (2), 189–191. doi: 10.1136/thoraxjnl-2013-204812
Doelken, P. (2008). Clinical Implications of Unexpandable Lung Due to Pleural Disease. The American Journal of the Medical Sciences, 335 (1), 21–25. doi: 10.1097/maj.0b013e31815f1a44
Alar, T., Ozcelik, C. (2013). Single-incision thoracoscopic surgery of pleural effusions for diagnosis and treatment. Surgical Endoscopy, 27 (11), 4333–4336. doi: 10.1007/s00464-013-3060-y
Copyright (c) 2016 Volodymyr Ivashchenko, Igor Kalabukha, Oleg Khmel, Evgeniy Maetniy, Ruslan Veremeenko
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