Palliative thoracic surgery

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Presentation transcript:

Palliative thoracic surgery Curative treatment is not possible The procedure does not cure the patient but brings relief. Anastomosis (by-pass). Prosthesis.

Palliation in thoracic surgery Indications: Tracheal (bronchial) steosis. Tracheo (broncho)-esophageal fistula. Recurrent pleural effusion.

Tracheal and bronchial stenosis: palliative treatment

Tracheostomy tube Only larynx and upper part of the trachea stenosis Speech disorders Early restenosis Permanent care of the tube is required

Indications for tracheostomy: Upper Airway Obstruction Alveolar Hypoventilation Excessive Secretions Miscellaneous

Upper Airway Obstruction Trauma Intubation Facial and neck Burn or Intoxication Infection Epiglottitis Diphtheria Abscess Congenital Neoplasm Benign Malignant Granulomas Foreign body Tracheomalacia Vocal cord paralysis Sleep apnea Allergic reactions

Percutaneous tracheostomy

Technique of open tracheostomy

Tracheal stenosis: methods of treatment Rigid bronchoscopy: -Mechanical removal of the tumour (edge and forceps) -LASER therapy (cautery: Nd-YAG) Brachytherapy: neodymium-doped yttrium aluminium garnet

Palliative removal of the tumour

Laser cautery of the tumour

How to maintain good results? Stents!

How to maintain patency? Dumon stent Dynamic stent – Y Gianturco stent – Z Wallstent, Palmas - net Different methods of introducing stents

Tracheal and bronchial silicone Dumon stents

Tracheal stents „Mesh”

„Z” stents

Tracheal stent „Polyflex”

Tracheal and esophageal stent

Treatment of pleural effusions

Left hydrothorax

Massive left hydrothorax

Pleural effusion with pneumothorax (right side).

Neoplastic pleural effusion 24% cancer patients (total): 36% lung cancer patients 25% breast cancer patients 10% leukemias 46% - first symptom of neoplastic disease

Pleural effusion: diagnosis Pleural puncture: 50% - 70% Thoracoscopy: 93%

Pleural puncture

Pleural puncture- technique

Pleural puncture

Pleural effusion: prognosis pH < 7,3 glucose level < 60 mg% Poor prognosis Survival < 2 months

Pleural effusion: treatment Better prognosis Pleurodesis talc tetracyclin bleomycin Pleurectomy

Pleural effusion: pleurodesis

Pleural drainage: technique

Pleural drainage: technique

Chest drainage

Thoracoscopy

Pericardiocentesis

Pericardial window

Thank you