2 research outputs found
Nem tapinthatĂł tĂŒdĆgĂłcok drĂłt- Ă©s izotĂłpjelölĂ©s segĂtsĂ©gĂ©vel törtĂ©nĆ minimĂĄlinvazĂv mƱtĂ©ti eltĂĄvolĂtĂĄsa = Minimally invasive resection of nonpalpable pulmonary nodules after wire- and isotope-guided localization
Absztrakt:
BevezetĂ©s: Napjainkban egyre kisebb mĂ©retƱ tĂŒdĆgĂłcok kerĂŒlnek
felismerĂ©sre, melyek esetĂ©n az elsĆdleges vĂĄlasztĂĄs azok minimĂĄlinvazĂv mƱtĂ©ti
technikĂĄval törtĂ©nĆ eltĂĄvolĂtĂĄsa diagnosztikus Ă©s terĂĄpiĂĄs cĂ©llal. SzĂĄmos elĆnye
mellett a minimĂĄlinvazĂv technika hĂĄtrĂĄnya a tĂŒdĆ ĂĄttapintĂĄsĂĄnak
korlĂĄtozottsĂĄga, a tĂŒdĆgĂłcok felkeresĂ©se. CĂ©lkitƱzĂ©s: A
problĂ©ma megoldĂĄsĂĄra több lehetĆsĂ©g is rendelkezĂ©sre ĂĄll. Ezek közĂŒl kettĆt
prĂłbĂĄltunk ki pĂĄrhuzamosan, a drĂłt-, illetve az izotĂłpjelölĂ©ssel törtĂ©nĆ
tĂŒdĆgĂłc-lokalizĂĄciĂłt. Anyag Ă©s mĂłdszer: Az OrszĂĄgos OnkolĂłgiai
IntĂ©zet MellkassebĂ©szeti OsztĂĄlyĂĄn öt betegnĂ©l tĂĄvolĂtottunk el tĂŒdĆgĂłcot
minimĂĄlinvazĂv technikĂĄval kettĆs, azaz drĂłt- Ă©s izotĂłpjelölĂ©s mellett. A
tĂŒdĆgĂłcok mĂ©rete 0,5 Ă©s 1,2 cm között vĂĄltakozott. A betegek Ă©letkora 44 Ă©s 65
Ă©v között volt; minden beteg alacsony mƱtĂ©ti rizikĂłjĂș csoportba tartozott,
sĂșlyos tĂĄrsbetegsĂ©g nĂ©lkĂŒl. EredmĂ©nyek: Minden betegnĂ©l
sikeresen eltĂĄvolĂtĂĄsra kerĂŒlt a tĂŒdĆgĂłc a kettĆs jelölĂ©s mellett. JelölĂ©s utĂĄn
közvetlenĂŒl egy betegnĂ©l 2â3 mm-es lĂ©gmellet Ă©szleltĂŒnk, mely azonnali
beavatkozåsra nem szorult, és egy betegnél a drót miatt kiterjedt bevérzés
jelent meg a szĂșrcsatornĂĄban. A mƱtĂ©t sorĂĄn, a tĂŒdĆkollapszusnĂĄl kĂ©t betegnĂ©l a
drĂłt kimozdult, egynĂ©l pedig az emlĂtett kiterjedt bevĂ©rzĂ©s a mellĂŒregbe kerĂŒlt,
Ă©s diffĂșz izotĂłpaktivitĂĄs jelent meg. Egy betegnĂ©l a mƱtĂ©t sorĂĄn drĂłtjelölĂ©ses
terĂŒletet reszekĂĄlva tovĂĄbbi izotĂłpaktivitĂĄs ĂĄllt fenn, mert a jelölt tĂŒdĆgĂłc a
reszekciĂłs sĂk alatt volt. KövetkeztetĂ©s: Mind az izotĂłppal,
mind a drĂłttal törtĂ©nĆ tĂŒdĆgĂłcjelölĂ©s segĂtsĂ©get nyĂșjt a nem tapinthatĂł
tĂŒdĆgĂłcok minimĂĄlinvazĂv technikĂĄval törtĂ©nĆ eltĂĄvolĂtĂĄsĂĄban. Kezdeti
tapasztalataink alapjĂĄn azonban az izotĂłpos jelölĂ©s esetĂ©n a tĂŒdĆgĂłc mĂ©lysĂ©gi
megĂtĂ©lĂ©se pontosabb, Ă©s nem kell a drĂłtkimozdulĂĄssal jĂĄrĂł kellemetlensĂ©gre
szĂĄmĂtani. Ugyanakkor az infrastrukturĂĄlis hĂĄttĂ©r, illetve a mƱtĂ©ti idĆpont
tervezĂ©se az izotĂłpbeadĂĄs esetĂ©ben nagyobb kihĂvĂĄst jelent, szemben a
drĂłtjelölĂ©ssel. Orv Hetil. 2018; 159(34): 1399â1404.
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Abstract:
Introduction: Nowadays ever smaller, sub-centimetre lung nodules
are screened and diagnosed. For these, minimally invasive resection is strongly
recommended both with diagnostic and therapeutic purpose. Aim:
Despite many advantages of minimally invasive thoracic surgery, thorough
palpation of the lung lobes and thus the localization of lung nodules are still
limited. There are several options to solve this problem. From the possibilities
we have chosen and tried wire- and isotope-guided lung nodule localization.
Materials and methods: In 2017, at the Thoracic Surgery
Department of the National Institute of Oncology we performed wire- and
isotope-guided minimally invasive pulmonary nodule resection in five patients.
The diameter of the lung nodules was between 0.5 and 1.2 cm. The age of the
patients was between 44 and 65 years and none of them had severe comorbidities,
which meant low risk for complications. Results: We
successfully performed the minimally invasive atypical resection in all cases.
After the wire and isotope placement we found a 2â3 mm pneumothorax in one
patient that did not need urgent drainage. In another patient we found that high
amount of intraparenchymal bleeding surrounded the channel of the wire. During
the operation, two wires were displaced when the lung collapsed, and in another
case the mentioned bleeding got into the thoracic cavity and made it difficult
to detect the nodule. In one case we resected the wire-guided lung tissue, but
the isotope-guided lung nodule was below the resection line.
Conclusion: Both techniques could help to localize the
non-palpable lung nodules. Based on our initial experiences, the isotope-guided
method provides more details to estimate the exact depth of the nodule from the
visceral surface of the pleura and we can avoid the unpleasantness of wire
displacement. On the other hand, the production of the isotope requires a more
developed infrastructure and the exact timing of the operation after the isotope
injection is more strict. Orv Hetil. 2018; 159(34): 1399â1404