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

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

3. Tracheal and bronchial stenosis: palliative treatment

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

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

9. 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

12. Percutaneous tracheostomy

14. Technique of open tracheostomy

16. 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

20. Palliative removal of the tumour

24. Laser cautery of the tumour

27. How to maintain good results? Stents!

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

30. Tracheal and bronchial silicone Dumon stents

31. Tracheal stents „Mesh”

32. „Z” stents

34. Tracheal stent „Polyflex”

41. Tracheal and esophageal stent

44. Treatment of pleural effusions

45. Left hydrothorax

46. Massive left hydrothorax

47. Pleural effusion with pneumothorax (right side).

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

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

51. Pleural puncture

52. Pleural puncture- technique

53. Pleural puncture

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

55. Pleural effusion: treatment
Better prognosis
Pleurodesis
talc
tetracyclin
bleomycin
Pleurectomy

56. Pleural effusion: pleurodesis

57. Pleural drainage: technique

58. Pleural drainage: technique

59. Chest drainage

60. Thoracoscopy

65. Pericardiocentesis

66. Pericardial window

67. Thank you