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The diagnostic and therapeutic role of Pericardial Window in Pericardial effusions

دور النافذة التامورية في تشخيص و علاج انصبابات التامور

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 Publication date 2018
  fields Medicine
and research's language is العربية
 Created by Shamra Editor




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The main aim of this study is to analyze all cases of pericardial effusions - except post cardiac procedures - who were admitted to surgical department in Al-Assad and Tichreen University Hospital in the period between 2007-2016. (63) cases of Pericardial effusions were analyzed, (38) male and (25) female, their ages were ranging between (17-67) years. The most important two causes of pericardial effusions were renal failure (50.7%) and Malignancies (34.9%). lung cancer was the leading cause of Malignancies accounting 17.4% of whole cases and 50% of Malignancies. Pericardial window via left mini thoracotomy was the preferred procedure in our study. 68.2% of the patients under went this procedure, recurrent rate was 4.6%, and the amount of recurrent pericardial effusion was minimal and didn’t need any management. Pericardiocentesis was performed in 39.6% of our patients, recurrent rate was very high 80%, therefore it was abondend as a method of treatment and its role was considered only in hemodynamically unstable patients or as a first step of preparation for pericardial window. Pericardial window via subxyhoid under local anesthesia was performed in 11.11%; recurrent rate was high 28.6%.We consider this approach only in patients who are not fit to undergo other approaches or when the expected survival is very limited. Pericardial window via thoracoscopic approach was performed in 15.8% of our patients; recurrent rate was 10% with encouraging results. During performance of pericardial window via minithoracotomy or thoracoscopically we were able to perform in (19) patients many other diagnostic and therapeutic procedures such as pleurectomy, Biopsies from the lungs, mediastinal tumors, and mediastinal lymph nodes as well. The histopathological examination of the resected pericardial window and concurrent procedures played an important diagnostic role in 23.8% of idiopathic pericardial effusions.


Artificial intelligence review:
Research summary
تهدف هذه الدراسة إلى تحليل حالات انصباب التامور غير المرتبطة بجراحة القلب التي تم إدخالها إلى قسم الجراحة في مشفيي الأسد وتشرين الجامعيين بين عامي 2007-2016. شملت الدراسة 63 حالة، منها 38 ذكور و25 إناث، تتراوح أعمارهم بين 17 و67 عامًا. كان السبب الرئيسي لانصباب التامور هو القصور الكلوي بنسبة 50.7%، يليه الأورام بنسبة 34.9%، حيث كان سرطان الرئة هو الأكثر شيوعًا بين الأورام. تم استخدام عدة إجراءات علاجية، منها النافذة التامورية بفتح الصدر الأيسر، التي كانت الأكثر تفضيلًا بنسبة نكس 4.6%، بينما كانت نسبة النكس بعد بزل التامور 80%. أظهرت الدراسة أن النافذة التامورية بفتح الصدر الأيسر أو التنظير الصدري كانت الأكثر فعالية في العلاج والتشخيص، خاصة في الحالات مجهولة السبب. توصي الدراسة باستخدام بزل التامور فقط في الحالات غير المستقرة هيموديناميكيًا أو كخطوة تحضيرية لإجراء النافذة التامورية.
Critical review
تعتبر هذه الدراسة شاملة ومفصلة في تحليلها لحالات انصباب التامور وأسبابها وطرق علاجها. ومع ذلك، يمكن أن تكون هناك بعض النقاط التي تحتاج إلى توضيح أو تحسين. على سبيل المثال، لم يتم توضيح المعايير الدقيقة لاختيار المرضى لإجراء النافذة التامورية بفتح الصدر الأيسر مقارنة بالإجراءات الأخرى. كما أن الدراسة لم تتناول بشكل كافٍ تأثير العوامل الأخرى مثل الحالة الصحية العامة للمرضى أو وجود أمراض مزمنة أخرى على نتائج العلاج. بالإضافة إلى ذلك، كان من الممكن توسيع نطاق الدراسة ليشمل عددًا أكبر من المرضى لتحسين دقة النتائج. على الرغم من هذه النقاط، فإن الدراسة تقدم مساهمة قيمة في فهم وتشخيص وعلاج انصباب التامور.
Questions related to the research
  1. ما هي الأسباب الرئيسية لانصباب التامور وفقًا للدراسة؟

    الأسباب الرئيسية لانصباب التامور هي القصور الكلوي بنسبة 50.7% والأورام بنسبة 34.9%، مع كون سرطان الرئة الأكثر شيوعًا بين الأورام.

  2. ما هو الإجراء العلاجي الأكثر تفضيلًا في الدراسة؟

    الإجراء العلاجي الأكثر تفضيلًا هو النافذة التامورية بفتح الصدر الأيسر، حيث كانت نسبة النكس 4.6%.

  3. ما هي نسبة النكس بعد إجراء بزل التامور؟

    نسبة النكس بعد إجراء بزل التامور كانت 80%.

  4. ما هي التوصيات الرئيسية للدراسة بشأن استخدام بزل التامور؟

    توصي الدراسة باستخدام بزل التامور فقط في الحالات غير المستقرة هيموديناميكيًا أو كخطوة تحضيرية لإجراء النافذة التامورية.


References used
KLEIN, AL; ABBARA, S; et al.: American Society of echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease. J Am Soc Echocadiagr, 26(9) 2013; 965-1012
MAGDI ,IBRAHIM A.M. the pericardial window: is a video–assisted thoracoscopy approach better than a surgical approach?. Interactive cardio Vascular and Thoracic Surgery, Vol.12. Issues 2, Feb 2011, 174 -178
SARAH E.LANGDON; et al. Contemporary outcomes after pericardial window surgery: impact of operative technique. J.Cardiothorac Surg. 2016, 11-73
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