دور النافذة التامورية في تشخيص وعلاج انصبابات التامور

Authors

  • دمر رومية

Abstract

إن الهدف الأساسي من هذه الدراسة هو تحليل جميع حالات انصباب التامور - ما عدا التالية لجراحة القلب - التي أدخلت إلى قسم الجراحة في مشفيي الأسد وتشرين الجامعيين في الفترة الزمنية الواقعة بين 2007-2016. تمت دراسة (63) حالة انصباب تامور، (38) مريضاً و(25) مريضة تتراوح أعمارهم بين (67-17) عاماً.

كان أهم سببين لحدوث انصبابات التامور هما القصور الكلوي بنسبة 50.7% والخباثات بنسبة 34.9% وعلى رأسها سرطان الرئة الذي شكل 50% من مجموع الخباثات ونسبة 17.4% من مجموع المرضى العام.

إجراء النافذة التامورية بفتح الصدر الأيسر كان هو الإجراء المفضل في مرضانا حيث بلغت نسبة إجرائه 68.2% وكانت نسبة النكس 4.6%، وكانت كمية الانصباب الناكس بسيطة جداً ولم تحتج إلى أي إجراء آخر. بزل التامور أجري عند 39.6% من المرضى وكانت نسبة النكس عالية جداً 80% لذلك ابتعدنا عن البزل كإجراء علاجي واقتصر دوره فقط عند المرضى غير المستقرين هيموديناميكياً أو كخطوة أولى وتحضير للنافذة التامورية.

تم إجراء النافذة التامورية عبر مدخل تحت الرهابة بالتخدير الموضعي عند 11.11% من المرضى، وكانت نسبة النكس 28.6%، حيث اعتمدنا هذه الطريقة فقط في الحالات التي تكون فيها حالة المريض لا تسمح بإجراء المداخل الجراحية الأخرى أو أن عمر المريض قصير ومحدود.

إجراء النافذة التامورية بتنظير الصدر المساعد عند 15.8% مع نسبة نكس 10% ونتائج واعدة.

أمكن القيام أثناء إجراء النافذة التامورية بفتح الصدر أو التنظير ببعض الإجراءات التشخيصية والعلاجية الأخرى وذلك عند (19) مريضاً. لعب إجراء النافذة التامورية والإجراءات المرافقة دوراً هاماً في تشخيص الحالات مجهولة السبب بنسبة 23.8%.

The main aim of this study is to analyze all cases of pericardial effusions - except post cardiac procedures - who were admitted to surgical department in Al-Assad and Tichreen University Hospital in the period between 2007-2016.

(63) cases of Pericardial effusions were analyzed, (38) male and (25) female, their ages were ranging between (17-67) years.

The most important two causes of pericardial effusions were renal failure (50.7%) and Malignancies (34.9%). lung cancer was the leading cause of Malignancies accounting 17.4% of whole cases and 50% of Malignancies.

Pericardial window via left mini thoracotomy was the preferred procedure in our study. 68.2% of the patients under went this procedure, recurrent rate was 4.6%, and the amount of recurrent pericardial effusion was minimal and didn’t need any management.

Pericardiocentesis was performed in 39.6% of our patients, recurrent rate was very high 80%, therefore it was abondend as a method of treatment and its role was considered only in hemodynamically unstable patients or as a first step of preparation for pericardial window.

Pericardial window via subxyhoid under local anesthesia was performed in 11.11%; recurrent rate was high 28.6%.We consider this approach only in patients who are not fit to undergo other approaches or when the expected survival is very limited.

Pericardial window via thoracoscopic approach was performed in 15.8% of our patients; recurrent rate was 10% with encouraging results. During performance of pericardial window via minithoracotomy or thoracoscopically we were able to perform in (19) patients many other diagnostic and therapeutic procedures such as pleurectomy, Biopsies from the lungs, mediastinal tumors, and mediastinal lymph nodes as well.

The histopathological examination of the resected pericardial window and concurrent procedures played an important diagnostic role in 23.8% of idiopathic pericardial effusions.

References

. KLEIN, AL; ABBARA, S; et al.: American Society of echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease. J Am Soc Echocadiagr, 26(9) 2013; 965-1012.

. MAGDI ,IBRAHIM A.M. the pericardial window: is a video–assisted thoracoscopy approach better than a surgical approach?. Interactive cardio Vascular and Thoracic Surgery, Vol.12. Issues 2, Feb 2011, 174 -178

. SARAH E.LANGDON; et al. Contemporary outcomes after pericardial window surgery: impact of operative technique. J.Cardiothorac Surg. 2016, 11-73.

. LITTLE, A. G; et al. Operations for diagnosis and treatment of pericardial effusions. Surgery, Oct: 96(4): 1984, 738-44.

. GUMRUKCUOGLU, H. A; et al. Management of Cardiac Tamponade : A Imperative study between Echo-guided pericardiocentesis and surgery – A report of 100 patients. Cardio Res Pract. 2011, 1978, 38 .

. MAGGIOLINI, S; et al. The role of early contrast-enhanced chest computed tomography in the etiological diagnosis of patients presenting with cardiac tamponade or large pericardial effusion. Eur Heart J cardiavasc imaging. 17(4) : 2016, April 421-8.

. KABUKCU, M; et al. pericardial tamponade and large pericardial effusion: casual factors and efficacy of percutaneous catheter drainage in 5 patients . Tex Heart inst J 31: 2004,398-403.

. CORNILY, J. C; et al. Cardiac tamponade in medical patients: a 10 years follow-up survey. Cardiology 111: 2008,197-201.

. COLOMBO, A; OLSON, H. G; et al. Etiology and prognostic implications of a large pericardial effusion in men. Clin Cardial 1988: 11, 389, 94.

. YASUCHI, M; et al. long-Term Outcomes after video-assisted thoracoscopic pericardiectomy for pericardial effusion. Ann thorac cardiovasc Surg. 23(6): 2017, 304_308.

. PAWLAK, CIESLIK A; et al. Diagnosis of malignant pericarditis: A single center experience. Kardiol pol 70: 2012; 1147-58.

. CHEN R. J; et al. pericardial window for malignant pericardial effusion with lung cancer have worse long-term outcomes than other cancers. Am J of Respiratory and critical care Medicine. 2017; 195–198.

. LAHAM R. J; et al. Pericardial effusion in patients with cancer : outcome with contemporary management strategies. Heart. 75(1): 1996:67-71.

. SAMUEL E; Horr j; et al. Comparison of outcomes of percardiocentesis versus surgical pericardial window in patients requiring drainage of pericardial effusions. Am. Journal of Cardiology. Sep.1, Vol.120 . 2017, 883-890.

. LANDRENEAN R. J; et al. prevelance of chronic pain after pulmonary resection by thoracotomy or video_assisted thoracic surgery. J.Thorac Cardiovasc Surg .1994 Vol.107 (1079-1086).

. FIOCCO, M; KRASNA M. j. the management of malignant pleural and pericardial effusions. Hematol oncol clin North AM,11(2) : 1997, 253-265.

. O’BRIEN, P. K; et al. Comperative Study of subxiphoid versus video thoracoscopical pericardial window. Ann thorac Surg. 80(6): 2005,2013-2019.

. VAKAMUDI, S; et al. pericardial effusions : causes, Diagnosis and management. prg Cardiovasc Dis 59(4): 2017 .Jan; 380-388.

. SHABETAI, R. pericardial effusion, hemodynamic spectrum. Heart, Vol.90 , 2004, (255-256).

. SPODICK, D. H. Medical history of the pericardial , the hairy hearts of hoary heroes. Am J Cardial, 26(5): 1970,447-454.

. JEFFREY T.SUGMPOTO; et al. pericardial window: Mechanism of efficacy. The Annals of thoracic surgery. Vol.50, set.1990. Issue 442-445.

. PIEHLER, J. M; PLUTH, J.R; et al. surgical management of effusive pericardial disiease. J thorac Cardiovase Surg, Vol.90. 1985, (506-516).

. LIBERMAN, M; LABOS, C; et al. Ten-year surgical experience with non-traumatic effusion, a comparison between the subxiphoid and transthoracic approaches to pericardial window. Arch Surg. 140(2): 2005,191-195.

. NAUNHEIM, K. S; KESTER, K. A; et al. pericardial drainage: supxiphoid v.s transthoracic approach. Eur J Cardiothorac Surg. 5(2): 1991, 99-103.

. MUELLER, K; et al. Long-Term Results of surgical supxiphoid pericardial Drainage. Thorac Cardiovax Surg. 45(2): 1997;65-69.

. CELIK, S; CELIK, M; et al. Surgical properties and survival of a pericardial window via left mini thorocotony for benign and malignant pericardial tamponade in Cancer patients.World J Surg Oncol.2012 Jun 28,10,123.

. SARIGUL, B; et al. Subxiphoid approach for treatment of pericardial effusion. Asian Cardiovasc and thoracic Annals. Vol.7, 1999, 297-300.

. JOSÉ , HONORIO PALMA et al.: Video-thoracoscopoc pericardial drainage in the treatment of pericardial effusions. Brazilian Journal of Cardiovaseular Surgery. 2009, Vol.2;No1.

. RUDOLF MARTIN Duehmke et al.: An unusual Compication of a pericardial window. Eur .Heart Journal , Vol.28, 2007 ,2840.

. PARK ,CHANG et al. Single-port thorocascopic pericardial window under local Anesthesia. Technology and Techniques in Cardiothoracic and Vascular Surgery: Jan, Feb, Vol.13, 2018.62-64.

. POMPEO, E; SORGE, R; et al. Non-intubated thoracic Surgery – A Survey from the European Society thoracic Surgeons. Ann Trans Med-2015, 3:37.

. KATLI, C. M; FAKTOR, M. A. Non-intulated video-assisted thoracic Surgery in patients aged 80 years and older. Ann Trans1 Med. 2015 May: 3(8): 101.

. SEZAI GELIK; et al. Systemic chemotherapy in Combination with pericardial window has better outcomes in malignant pericardial effusions. J Thorac Cardiovasc Surg. Nov. Vol.148. 2014,2288-2293.

. LESTUZZI, C; et al. Which is the best approach for neoplastic pericardial effusions? aretrospective analysis of 264 Cases. Eur.Heart Journal, Vol.34, Aug.2013, 4483.

. MACK, M. J; LANDRENEAN, R. J; et al. Video thoracoscopic management of benign and malignant pericardial effusions. Vol.103, Chest 1993, 3905-3935.

. NATAF, P; CACOUB, P; REGAN, M. Video thoracoscopic pericardial window in the diagnosis and treatment of pericardial effusions. Am J Cardiol. Vol.82, 1998, (124-126).

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Published

2018-12-27

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رومية د. دور النافذة التامورية في تشخيص وعلاج انصبابات التامور. Tuj-hlth [Internet]. 2018Dec.27 [cited 2024Apr.23];40(6). Available from: https://journal.tishreen.edu.sy/index.php/hlthscnc/article/view/5781

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Vol. 40 No. 6 (2018): العلوم الصحية

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