초록접수 현황
| 16F-271 | 포스터 발표 |
Non-intubated Thoracoscopic Pleurodesis for Refractory Pneumothorax in Patients with Pneumoconiosis
Kyung Soo Kim, June Lee, Seha Ahn, Jinwon Shin
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, The Catholic University College of Medicine, Seoul, Korea
Background : Non-intubated video-assisted thoracoscopic surgery (NIVATS) has been demonstrated its safety and efficacy in treatment for various pulmonary diseases. However, secondary pneumothorax in patients with pneumoconiosis has poor lung condition that decision for bullectomy is difficult. Thus, we applied NIVATS pleurodesis without bullae resection for management of persistent air leakage in cases expecting diffuse fibrotic pleural adhesion.
Methods : We performed NIVATS talc pleurodesis in two selective cases who showed persistent air leakage with loculated pneumothorax in lower thorax. Case 1: A 77 years old male with 20 years’ occupational history; Case 2: A 73 years old male with 40 years’ working history. The chest tomography is corresponding with secondary pneumothorax with emphysematous lung. Progressive massive fibrosis and apical fibrotic pleural adhesion is also identified. The patient was placed in the lateral decubitus position. Intravenous sedation using propofol and remifentanil with simple mask ventilation was used under multi-monitoring. VATS exploration was performed through the previous chest tube site and 5mm instrument port was placed at the adjacent intercostal space. Talc pleurodesis was performed and two chest tubes were placed through the port sites.
Results : The operation time took 35 minutes and 30 minutes, respectively without any intra-operative events in both cases. The drainage tubes were removed on the POD#2 and POD#3 in case 1; POD#3 and POD#7 in case 2. The patients discharged on POD#4 and POD#9. There was no pulmonary complication and recurrence was not occurred during follow of 9 months and 7 months, respectively.
Conclusion : NIVATS talc pleurodesis method for refractory pneumothorax in pneumoconiosis patients demonstrated its feasibility without pulmonary complication. However, this method should be performed carefully in selective cases and long term follow up is needed.
Methods : We performed NIVATS talc pleurodesis in two selective cases who showed persistent air leakage with loculated pneumothorax in lower thorax. Case 1: A 77 years old male with 20 years’ occupational history; Case 2: A 73 years old male with 40 years’ working history. The chest tomography is corresponding with secondary pneumothorax with emphysematous lung. Progressive massive fibrosis and apical fibrotic pleural adhesion is also identified. The patient was placed in the lateral decubitus position. Intravenous sedation using propofol and remifentanil with simple mask ventilation was used under multi-monitoring. VATS exploration was performed through the previous chest tube site and 5mm instrument port was placed at the adjacent intercostal space. Talc pleurodesis was performed and two chest tubes were placed through the port sites.
Results : The operation time took 35 minutes and 30 minutes, respectively without any intra-operative events in both cases. The drainage tubes were removed on the POD#2 and POD#3 in case 1; POD#3 and POD#7 in case 2. The patients discharged on POD#4 and POD#9. There was no pulmonary complication and recurrence was not occurred during follow of 9 months and 7 months, respectively.
Conclusion : NIVATS talc pleurodesis method for refractory pneumothorax in pneumoconiosis patients demonstrated its feasibility without pulmonary complication. However, this method should be performed carefully in selective cases and long term follow up is needed.
책임저자: Kyung Soo Kim
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, The Catholic University College of Medicine, Seoul, Korea
발표자: Kyung Soo Kim, E-mail : cskks@catholic.ac.kr