Utilidad de la cirugía videotoracoscópica en el diagnóstico de los nódulos pulmonares solitarios
Usefulness of video-assisted thoracoscopy for the diagnosis of solitary pulmonary nodules
M. Congregado Loscertales, J.C. Girón Arjona, R. Jiménez Merchán, A. Arroyo Tristán, C. Arenas Linares, J. Ayarra Jarne, J. Loscertales
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jloscert@us.es
Correspondencia: Servicio de Cirugía General y Torácica. Hospital Universitario Virgen Macarena.Avda. Dr. Fedriani, 3. 41071 Sevilla
Correspondencia: Servicio de Cirugía General y Torácica. Hospital Universitario Virgen Macarena.Avda. Dr. Fedriani, 3. 41071 Sevilla
Servicio de Cirugía General y Torácica. Hospital Universitario Virgen Macarena. Sevilla
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Congregado Loscertales, J.C. Girón Arjona, R. Jiménez Merchán, A. Arroyo Tristán, C. Arenas Linares, J. Ayarra Jarne, J. Loscertales" "autores" => array:7 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Congregado Loscertales" ] 1 => array:2 [ "nombre" => "J.C." "apellidos" => "Girón Arjona" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Jiménez Merchán" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Arroyo Tristán" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Arenas Linares" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Ayarra Jarne" ] 6 => array:4 [ "nombre" => "J." "apellidos" => "Loscertales" "email" => array:1 [ 0 => "jloscert@us.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Cirugía General y Torácica. Hospital Universitario Virgen Macarena. Sevilla" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Servicio de Cirugía General y Torácica. Hospital Universitario Virgen Macarena.Avda. Dr. Fedriani, 3. 41071 Sevilla" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Usefulness of video-assisted thoracoscopy for the diagnosis of solitary pulmonary nodules" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2001-01-14" "fechaAceptado" => "2001-05-21" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec190463" "palabras" => array:2 [ 0 => "Nódulo pulmonar solitario" 1 => "Cirugía torácica videoasistida" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec190464" "palabras" => array:2 [ 0 => "Solitary pulmonary node" 1 => "Video-assisted thoracic surgery" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Varios tipos de estrategias se emplean para el diagnóstico y tratamiento de los nódulos pulmonares solitarios indeterminados (NPS). Las nuevas técnicas de imagen y de medicina nuclear parecen añadir más información a esta afección, pero aún es la exéresis quirúrgica el método más sensible y específico para obtener un correcto análisis de la lesión. Con la cirugía videotoracoscópica (CVT) se puede conseguir un diagnóstico histológico sin la necesidad de realizar una toracotomía. En este estudio se expone nuestra ex-periencia en el diagnóstico y tratamiento de los NPS con la CVT</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Desde julio de 1992 a abril de 2001 se ha intervenido a 182 pacientes afectados de NPS en nuestro servicio. Diseño:estudio retrospectivo. Edad media:59,2 años (límites, 12–78). Sexo: un total de 39 mujeres y 143 varones. Localización: exploración visual o instrumental en 102 pacientes, con palpación en 52 casos y con arpón guiado por tomografía computarizada (TC) preoperatoriamente en 25 (cuatro de ellos fallaron). A todos ellos se les realizó una biopsia intraoperatoria y cuando la lesión fue maligna se les practicó una exéresis oncológica en la misma operación</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se ha obtenido un diagnóstico de certeza, por CVT en 178 pacientes (98,3%). En otros 3 pacientes fue necesario practicar biopsia con aguja Trucut® durante la CVT y un caso más hubo de convertirse a cirugía abierta. Histopatología: hamartoma, 11; nódulo fibroso, 10; bron-quiolitis obliterante, 1; neumoconiosis, 1; tumor mesenquimal, 3; seudotumor inflamatorio, 14; mucormicosis, 1; tu-berculoma, 17; linfoma, 1; tumor carcinoide, 6; metástasis, 22, y carcinoma broncogénico, 95. Mortalidad: 0,55%, un paciente por tromboembolia pulmonar masiva. Morbilidad: 5%, nueve complicaciones menores</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La CVT es un abordaje muy efectivo, con baja morbilidad y mortalidad, y en nuestra opinión debe ser la técnica de elección para el diagnóstico de todos los NPS y el tratamiento de algunos, como los nódulos benignos y las metástasis solitarias</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Various approaches are used for the diagnosis and treatment of solitary pulmonary nodules (SPN) of unknown origin. New imaging techniques and nuclear medicine have provided more information about SPN, but surgical removal is still the most sensitive and specific way to ob-tain a correct analysis of the lesion. With video-assisted thoracic surgery (VATS), a histological diagnosis can be obtained without resorting to thoracotomy. In the present study we describe our experience with the diagnosis and treatment of SPN using VATS</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">From July 1992 through April 2001, 182 patients were operated on for SPN in our department. Design: Retrospective study. Mean age: 59.2 years (12-78). Sex: 39 women and 143 men. Localization: Visual or instrumental exploration in 102 patients, with palpation in 52 cases and using a hookwire guided by preoperative computed tomography in 25 (with failure in 4 of those cases). Tissue was biopsied during surgery and when the lesion was malignant, oncological excision was performed during the same operation</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A firm diagnosis was obtained by VATS for 178 patients (98.3%). For three other patients the surgeon had to take a needle biopsy (Tru-cut®) during surgery, and in one case conversion to open surgery was necessary. Histopathology: hamartoma: 11; fibrous nodule: 10; bronchiolitis obliterans: 1; pneumoconiosis: 1; mesenchymal tumor: 3; inflammatory pseudotumor: 14; mucormycosis: 1; tuberculoma:17; lymphoma: 1; carcinoid tumor: 6; metastasis: 22; bronchogenic carcinoma: 95. Mortality was 0.55%, with 1 patient dying from massive pulmonary thromboembolism. Morbidity was 5%, from 9 minor complications</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">VATS is an effective approach, with low morbidity and mortality. We consider it to be the technique of choice for the diagnosis of all SPN and for the treatment of some, such as benign nodules and solitary metastases</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of the indeterminate solitary pulmonary nodule: a pulmonologist's view" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.N. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 4 | 7 |
| 2024 October | 30 | 16 | 46 |
| 2024 September | 24 | 16 | 40 |
| 2024 August | 53 | 27 | 80 |
| 2024 July | 33 | 24 | 57 |
| 2024 June | 34 | 20 | 54 |
| 2024 May | 39 | 34 | 73 |
| 2024 April | 27 | 26 | 53 |
| 2024 March | 29 | 28 | 57 |
| 2024 February | 27 | 38 | 65 |
| 2023 December | 0 | 1 | 1 |
| 2023 November | 0 | 1 | 1 |
| 2023 October | 0 | 2 | 2 |
| 2023 August | 0 | 4 | 4 |
| 2023 July | 0 | 7 | 7 |
| 2023 June | 0 | 12 | 12 |
| 2023 May | 0 | 1 | 1 |
| 2023 April | 0 | 2 | 2 |
| 2023 March | 3 | 3 | 6 |
| 2023 February | 34 | 19 | 53 |
| 2023 January | 22 | 23 | 45 |
| 2022 December | 23 | 34 | 57 |
| 2022 November | 37 | 13 | 50 |
| 2022 October | 22 | 44 | 66 |
| 2022 September | 38 | 47 | 85 |
| 2022 August | 32 | 41 | 73 |
| 2022 July | 20 | 29 | 49 |
| 2022 June | 20 | 30 | 50 |
| 2022 May | 37 | 28 | 65 |
| 2022 April | 34 | 19 | 53 |
| 2022 March | 43 | 30 | 73 |
| 2022 February | 23 | 16 | 39 |
| 2022 January | 24 | 22 | 46 |
| 2021 December | 31 | 42 | 73 |
| 2021 November | 22 | 31 | 53 |
| 2021 October | 23 | 28 | 51 |
| 2021 September | 21 | 43 | 64 |
| 2021 August | 13 | 37 | 50 |
| 2021 July | 27 | 16 | 43 |
| 2021 June | 24 | 32 | 56 |
| 2021 May | 36 | 32 | 68 |
| 2021 April | 47 | 54 | 101 |
| 2021 March | 50 | 12 | 62 |
| 2021 February | 34 | 10 | 44 |
| 2021 January | 29 | 17 | 46 |
| 2020 December | 28 | 19 | 47 |
| 2020 November | 21 | 10 | 31 |
| 2020 October | 18 | 11 | 29 |
| 2020 September | 20 | 6 | 26 |
| 2020 August | 24 | 8 | 32 |
| 2020 July | 35 | 14 | 49 |
| 2020 June | 21 | 8 | 29 |
| 2020 May | 16 | 15 | 31 |
| 2020 April | 38 | 10 | 48 |
| 2020 March | 24 | 13 | 37 |
| 2020 February | 32 | 14 | 46 |
| 2020 January | 41 | 21 | 62 |
| 2019 December | 31 | 21 | 52 |
| 2019 November | 15 | 6 | 21 |
| 2019 October | 14 | 12 | 26 |
| 2019 September | 20 | 15 | 35 |
| 2019 August | 16 | 5 | 21 |
| 2019 July | 21 | 26 | 47 |
| 2019 June | 18 | 23 | 41 |
| 2019 May | 31 | 32 | 63 |
| 2019 April | 62 | 35 | 97 |
| 2019 March | 22 | 14 | 36 |
| 2019 February | 12 | 14 | 26 |
| 2019 January | 19 | 11 | 30 |
| 2018 December | 17 | 17 | 34 |
| 2018 November | 24 | 8 | 32 |
| 2018 October | 41 | 14 | 55 |
| 2018 September | 18 | 5 | 23 |
| 2018 May | 10 | 1 | 11 |
| 2018 April | 11 | 7 | 18 |
| 2018 March | 4 | 7 | 11 |
| 2018 February | 14 | 10 | 24 |
| 2018 January | 14 | 8 | 22 |
| 2017 December | 11 | 10 | 21 |
| 2017 November | 17 | 8 | 25 |
| 2017 October | 9 | 8 | 17 |
| 2017 September | 6 | 8 | 14 |
| 2017 August | 14 | 16 | 30 |
| 2017 July | 12 | 9 | 21 |
| 2017 June | 15 | 13 | 28 |
| 2017 May | 13 | 15 | 28 |
| 2017 April | 8 | 6 | 14 |
| 2017 March | 8 | 10 | 18 |
| 2017 February | 10 | 12 | 22 |
| 2017 January | 11 | 9 | 20 |
| 2016 December | 27 | 11 | 38 |
| 2016 November | 41 | 22 | 63 |
| 2016 October | 43 | 25 | 68 |
| 2016 September | 39 | 21 | 60 |
| 2016 August | 25 | 6 | 31 |
| 2016 July | 25 | 6 | 31 |
| 2016 June | 36 | 14 | 50 |
| 2016 May | 37 | 9 | 46 |
| 2016 April | 18 | 3 | 21 |
| 2016 March | 18 | 3 | 21 |
| 2016 February | 17 | 7 | 24 |
| 2016 January | 28 | 14 | 42 |
| 2015 December | 41 | 16 | 57 |
| 2015 November | 46 | 13 | 59 |
| 2015 October | 214 | 1 | 215 |
| 2015 September | 204 | 0 | 204 |
| 2015 August | 184 | 0 | 184 |
| 2015 July | 278 | 0 | 278 |
| 2015 June | 214 | 0 | 214 |
| 2015 May | 223 | 0 | 223 |
| 2015 April | 160 | 0 | 160 |
| 2015 March | 230 | 0 | 230 |
| 2015 February | 187 | 0 | 187 |
| 2015 January | 170 | 0 | 170 |
| 2014 December | 149 | 0 | 149 |
| 2014 November | 192 | 0 | 192 |
| 2014 October | 198 | 0 | 198 |
| 2014 September | 146 | 0 | 146 |
| 2014 August | 142 | 0 | 142 |
| 2014 July | 149 | 0 | 149 |
| 2014 June | 205 | 0 | 205 |
| 2014 May | 169 | 0 | 169 |
| 2014 April | 174 | 0 | 174 |
| 2014 March | 147 | 0 | 147 |
| 2014 February | 190 | 0 | 190 |
| 2014 January | 153 | 0 | 153 |
| 2013 December | 117 | 0 | 117 |
| 2013 November | 140 | 0 | 140 |
| 2013 October | 136 | 0 | 136 |
| 2013 September | 84 | 0 | 84 |
| 2013 August | 121 | 0 | 121 |
| 2013 July | 107 | 0 | 107 |
| 2013 June | 62 | 0 | 62 |
| 2013 May | 65 | 0 | 65 |
| 2013 April | 58 | 0 | 58 |
| 2013 March | 19 | 0 | 19 |
| 2000 January | 3883 | 0 | 3883 |
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