[Surgical emergency induced by chest tumors].
Mechanisms and therapeutic procedures for emergencies induced by chest tumors are reviewed. 1) Carcinomatous pleuritis is the most frequently encountered situation for clinicians. At first, pleural effusion should be punctured for diagnosis and chest drainage should be performed consequently. Intrathoracic chemotherapy and pleurodasis (OK-432 is usually used) are then used if necessary. 2) Airway stenosis is the most critical state. Conventionally, violent incubation throughout the stenotic portion of the airway has been used with poor results. Recently, however, irradiation of Nd:YAG laser can be utilized, and the prognosis of the airway stenosis is much improved. Another effective procedure is the insertion of several kinds of airway stent. Silicon stents like T-tube, Dumon tube and Dynamic stent or metallic stents like EMS (Expandable Metallic Stent) are generally used. The advantages of EMS are easy installation and little disturbance of sputum excretion. The disadvantages of EMS are difficult removal and re-stenosis of the airway. On the other hand, silicon tubes are easy to be removed, re-insertion is possible and re-stenosis is rare, but the insertion should be performed under general anesthesia and sputum excretion may pose problems. A case of laser irradiation and two cases of stent insertion are presented. 3) Airway bleeding is also emergent. Bronchofiberscopic ethanol injection (BEI) is effective against continuous bleeding of the central airway. We performed BEI for 33 lung cancer cases, and the method was effective for all cases. 4) Cardiac tamponade, SVC syndrome, esophago-bronchial fistula, bronchial stump fistula are also important emergencies induced by chest tumors. Standard therapeutic procedures are explained for all oncology surgeons and physicians.
Yamaguchi
Y
Y
Dept. of Surgery, School of Medicine, Chiba University.
Mitsunaga
S
S
D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery; D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D004630:Emergencies; D005260:Female; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D008297:Male; D015607:Stents; D013899:Thoracic Neoplasms / Q000150:complications*; D014133:Tracheal Diseases / Q000601:surgery; D014135:Tracheal Stenosis / Q000209:etiology / Q000601:surgery*