Razi Journal of Medical Sciences
مجله علوم پزشکی رازی
RJMS
Medical Sciences
http://rjms.iums.ac.ir
39
journal39
2228-7043
2228-7051
en
jalali
1391
12
1
gregorian
2013
3
1
19
105
online
1
fulltext
fa
مطالعه گذشته نگر درمان آمپیم مزمن با دو روش توراکوسکوپی و توراکوتومی
Retrospective study of management of chronic organized empyema with thoracoscopy versus thoracotomy
جراحی عمومی
General Surgery
پژوهشي
Research
<font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: kashida text-kashida: 0%" dir="rtl"><b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">زمینه و هدف</span></b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">:
آمپیم همچنان به</span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"></span><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">عنوان
موضوع قابل بررسی در حیطه جراحی مطرح است. در مراحل اولیه آمپیم اساس درمان آنتیبیوتیک
تراپی و درناژ فضای پلور میباشد ولی در آمپیم ارگانیزه که </span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">Pleural Peel</span><span dir="rtl"></span><span style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span> <span lang="AR-SA"><font face="B Mitra" size="2">تشکیل شده نیاز به تخلیه چرک لکوله و دکورتیکاسیون
جهت کمک به اتساع ریه وجود دارد. هر چند ارزش (</font></span></span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">Video Assisted Thoracoscopic Surgery (VATS</span><span dir="rtl"></span><span style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span> <span lang="AR-SA"><font face="B Mitra" size="2">در درمان آمپیم شناخته
شده است ولی ارزش درمانی آن در آمپیم ارگانیزه کماکان مورد بحث است. در این مطالعه
دو روش درمانی </font></span></span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">VATS</span><span dir="rtl"></span><span style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span> <span lang="AR-SA"><font size="2"><font face="B Mitra">و توراکوتومی در درمان
آمپیم ارگانیزه بررسی و مقایسه شده است. <o:p /></font></font></span></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: kashida text-kashida: 0%" dir="rtl"><b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">روش کار</span></b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">:
50 بیمار که طی 7 سال در این مرکز با تشخیص آمپیم ارگانیزه مقاوم به درمان تحت عمل
دکورتیکاسیون قرار گرفته بودند،</span><span dir="ltr"></span><span lang="AR-SA" style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"><span dir="ltr"></span> </span><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">بررسی
و مقایسه شدند.</span><span dir="ltr"></span><span lang="AR-SA" style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"><span dir="ltr"></span> </span><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">مطالعه
به صورت توصیفی گذشته</span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"></span><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">نگر
از طریق بازخوانی پرونده</span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"></span><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">ها
از سال 1383 تا 1390 در بیمارستان حضرت رسول اکرم (ص) انجام و اطلاعات با استفاده از
نرم افزار</span><span dir="ltr"></span><span lang="AR-SA" style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"><span dir="ltr"></span> </span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">SPSS</span><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">آنالیز شده است.<o:p /></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: kashida text-kashida: 0%" dir="rtl"><b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">یافته</span></b><b><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"></span></b><b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">ها</span></b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">:
21 مورد از طریق </span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">VATS</span><span dir="rtl"></span><span style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span> <span lang="AR-SA"><font face="B Mitra" size="2">و 29 مورد از طریق توراکوتومی
درمان شدند. متوسط سن بیماران 6/37 سال و 86% از بیماران مرد بودند. میزان مورتالیتی
در کل 5/6% بود که بین دو گروه تفاوتی وجود نداشت. مدت زمان جراحی در گروه توراکوتومی
از گروه </font></span></span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">VATS</span><span dir="rtl"></span><span style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span> <span lang="AR-SA"><font face="B Mitra" size="2">کوتاهتر بود. مدت زمان
نیاز به آنتیبیوتیک قبل و بعد از جراحی و نیز مدت زمان نیاز به درناژ فضای پلورال
در گروه </font></span></span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">VATS</span><span dir="rtl"></span><span style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span> <span lang="AR-SA"><font face="B Mitra" size="2">کوتاهتر بود. میزان تبدیل
</font></span></span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">VATS</span><span dir="rtl"></span><span style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span> <span lang="AR-SA"><font face="B Mitra" size="2">به توراکوتومی 33% بود.</font></span></span><span dir="ltr"></span><span lang="AR-SA" style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"><span dir="ltr"></span> </span><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">میزان موفقیت نیز بین دو گروه با یکدیگر تفاوتی نداشت.<o:p /></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal unicode-bidi: embed direction: rtl text-justify: kashida text-kashida: 0%" dir="rtl"><b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">نتیجه</span></b><b><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"></span></b><b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">گیری</span></b><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">:
با توجه به نتایج حاصل از مطالعه مذکور ارزش درمانی </span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">VATS</span><span dir="rtl"></span><span style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span> <span lang="AR-SA"><font face="B Mitra" size="2">و توراکوتومی در درمان آمپیم ارگانیزه مرحله </font></span></span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">III</span><span dir="rtl"></span><span style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span> <span lang="AR-SA"><font face="B Mitra" size="2">که </font></span></span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">Pleural Peel</span><span dir="rtl"></span><span style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span> <span lang="AR-SA"><font face="B Mitra" size="2">تشکیل شده یکسان بوده است. ولی با توجه به مزایای
شناخته شده </font></span></span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr">VATS</span><span dir="rtl"></span><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt"><span dir="rtl"></span>، به مطالعات مداخلهای با حجم بزرگ</span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"></span><span lang="AR-SA" style="font-family: "B Mitra" font-size: 10pt mso-ascii-font-family: "Times New Roman" mso-hansi-font-family: "Times New Roman" mso-ansi-font-size: 9.0pt">تر جهت مقایسه این دو روش در درمان آمپیم
مزمن نیاز است.</span><span style="font-family: "Times New Roman","serif" font-size: 9pt mso-bidi-font-family: "B Mitra" mso-bidi-font-size: 10.0pt" dir="ltr"><o:p /></span></p><font face="Times New Roman" size="3"> </font>
<font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal text-justify: kashida text-kashida: 0%"><b><span style="font-family: "Times New Roman","serif""><font size="3">Background: </font></span></b><span style="font-family: "Times New Roman","serif""><font size="3">Empyema remains a challenging
issue for<span dir="rtl"></span><span dir="rtl"><span dir="rtl"></span><font face="Times New Roman"> </font></span>thoracic
surgeons. In the early stages of empyema antibiotic therapy and pleural space
drainage are the treatment of choice.<span style="mso-spacerun: yes"><font face="Times New Roman"> </font></span></font><font size="3">In
organized empyema with pleural peel and re-expandable underlying lung,
decortication is the procedure of choice. There is agreement about the value of
Video Assisted Thoracoscopic Surgery (VATS) in the management of stages I and
II empyema, but there are doubts about its efficacy in stage III empyema. We
seek to evaluate the comparative merits of thoracoscopic versus open decortication
in the surgical management of patients with chronic postpneumonic pleural
empyema. <o:p /></font></span></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal text-justify: kashida text-kashida: 0%"><font size="3"><b><span style="font-family: "Times New Roman","serif"">Methods:</span></b><span style="font-family: "Times New Roman","serif""> From March 2004 to December
2010, 50 patients (43 males, 7 females, mean age: 37.6 years, range: 13-75
years) with chronic postpneumonic pleural empyema underwent<span dir="rtl"></span><span dir="rtl"><span dir="rtl"></span><font face="Times New Roman"> </font></span>decortications. It was a retrospective
cross-sectional study. The data was gathered by investigating the patients
medical records and analysed by SPSS17.<o:p /></span></font></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal text-justify: kashida text-kashida: 0%"><font size="3"><b><span style="font-family: "Times New Roman","serif"">Results:</span></b><span style="font-family: "Times New Roman","serif""> Decortication was performed by
open thoracotomy in 29 (58%) patients and VATS in 21 (42%). Mortality was 6.5%
.There was no difference in terms of re-operation, mortality and success rates.
The operation time in (OT) thoracotomy group was shorter (p=0.03). Hospital
stay, drainage duration and antibiotic therapy in VATS group was shorter. There
was no statistical difference in regard to the success rate between the two
groups.<span lang="AR-SA" dir="rtl"><o:p /></span></span></font></p><font face="Times New Roman" size="3"> </font><p class="MsoNormal" style="margin: 0in 0in 0pt text-align: justify line-height: normal text-justify: kashida text-kashida: 0%"><font size="3"><b><span style="font-family: "Times New Roman","serif"">Conclusion:</span></b><span style="font-family: "Times New Roman","serif""> According to the results of this
study we found that success rate of VATS decortication is comparable to open
thoracotomy, however, a multicentric-randomized trial should be performed
before video thoracoscopic decortication becomes the gold standard for the
treatment of pleural empyema. <span lang="AR-SA" dir="rtl"><o:p /></span></span></font></p><font face="Times New Roman" size="3"> </font>
توراکوتومی، توراکوسکوپی، آمپیم، دکورتیکاسیون.
Thoracotomy, Thoracoscopic surgery, Empyema, Decortication.
1
7
http://rjms.iums.ac.ir/browse.php?a_code=A-10-1-1382&slc_lang=fa&sid=1
Hamid Reza
Kadkhodaei
حمید رضا
کدخدایی
3900319475328460022779
3900319475328460022779
No
Tehran University of Medical Sciences
دانشگاه علوم پزشکی تهران
Mahtab
Vasigh
مهتاب
وثیق
3900319475328460022780
3900319475328460022780
Yes
Tehran University of Medical Sciences
دانشگاه علوم پزشکی تهران