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The complex diagnostic and the video-assisted thoracoscopic treatment of the hydatid lung cyst


Author: Tudor Balaban
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2007
Scientific adviser: Nicolae Gladun
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 29 November, 2006
Approved by NCAA on the 18 January, 2007

Abstract

Adobe PDF document0.66 Mb / in romanian

Keywords

hydatid cyst, lung, video-assisted thoracic surgery

Summary

The work is based on analysis of 292 patients diagnosed with hydatid lung cyst among which 146 treated by VATS in the Department Thoracic Surgery of Republican Clinical Hospital (Moldova), in collaboration with the Department Thoracic Surgery (Pr.T.Kilani) of Hospital ,,A.Mami”, Ariana (Tunisia), between January 1996 and December 2004. The number of the analyzed cases constituted 8,3% (treated by VATS) of the total of patients with hydatidosis disease. The age of patients varied from 11 to 75 with average of 33,8±1,67. Man- 43,8%, women- 56,2%.

Objectives: To estimate the role of VATS in the surgical treatment of hydatid cyst. Based on our experience we suggest mini-invasive modalities of surgical treatment to this disease.

In most of the cases the diagnosis was based on the standard X-ray exam. In 58,9% of the cases additionally thoracic ultrasound exam was performed that also confirmed the evolution stage of the hydatid lung cyst. In 38,4% cases computer tomography (CT) scan was done, 41,8 % cases required FBS and 31,5% of cases undertook ELISA test since the diagnosis was dubious.

All of these identified 219 cysts therefore184 were localized superficially. There were done 182 surgeries of which 64 (38,3%) via VT (videothoracoscopy) and 92 (55,1%) via VATS (video-assisted thoracic surgery), among which 8 cases of VT and 7cases of VATS associated with simultaneous contra lateral thoracotomy as well as 11(6,58%) cases of VT required conversion among which 5 cases associated with simultaneous contra lateral VT approach.

The rate of complication was 5,48 %: six cases of secondary pneumothorax, one case the persistent air leak because of bronchial fistulae, one case of stroke with hemi paresis. Two cases of recurrences was observed (1,37%). Drain removal was done in the average at the 4th day after the surgery. In patient treatment was in average 6±1,4 days. Operative and postoperative mortality was nil. The utilization of the elaborated diagnostic algorithm and differential surgical tactic in diverse evolutional forms of hydatid cyst permitted to obtain goods results.

The potential advantages of VATS include less postoperative pain, earlier mobilization, lower overall morbidity, a shortened hospital stay with reduced costs, a cosmetic incision, and for some procedures, a reduced operating time. VATS is a promising method in the treatment of hydatid lung cyst and the early diagnosis increases the possibility of using it.