Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_747_Библиотеки_им_академика_М_И_Перельмана
.pdf
x Contributors
https://t.me/med1917
Jamie Kelly BM BSC MRCS FRCS(GEN SURG)
Upper Gastro Intestinal Fellow, University of Adelaide, Department of
Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Baiya Krishnadasan
MD
Assistant Professor, Department of Surgery, Division of
Cardiothoracic Surgery, University of Washington School of
Medicine, Seattle, Washington, USA
John C Kucharczuk MD
Assistant Professor of Surgery, Division of Cardiothoracic Surgery,
Hospital of the University of Pennsylvania, Philadelphia,
Pennsylvania, USA
Bernard Launois
MD FACS
Professor of Digestive and Transplantation Surgery, Hospital
Pontchaillou, Rennes, France
Luiz Eduardo V Leão
MD PhD
Professor and Chairman, Department of Surgery, Division of Thoracic
Surgery, Escola Paulista de Medicina – Universidade Federal de São
Paulo, São Paulo, Brazil
Alex G Little
MD
Elizabeth Berry Gray Chair and Professor, Department of Surgery,
Wright State University School of Medicine, Dayton, Ohio, USA
Jun-Feng Liu
PhD
Professor and Doctor in Chief, Department of Thoracic Surgery,
Fourth Hospital, Hebei Medical University, The People’s Republic of
China
Robert Ludemann
MD PhD
Research Fellow, University of Adelaide, Department of Surgery,
Royal Adelaide Hospital, Adelaide, South Australia, Australia
Paolo Macchiarini
MD PhD
Professor of Surgery, University of Barcelona Medical School;
Chairman, Department of General Thoracic Surgery, Hospital Clinic
of Barcelona, Spain
Reza Mehran MD FRCS(C)
Assistant Professor of Surgery, University of Ottawa, Ottawa,
Ontario, Canada
Shinichiro Miyoshi
MD PhD
Professor and Chairman, Department of Cardiothoracic Surgery,
Dokkyo University School of Medicine, Mibu, Tochigi, Japan
Francis C Nichols
MD
Assistant Professor of Surgery and Consultant Division of General
Thoracic Surgery, Mayo Clinic College of Medicine, Rochester,
Minnesota, USA
Mark B Orringer
MD FRCS
Professor and Head, Section of Thoracic Surgery, University of
Michigan Medical Center, Ann Arbor, Michigan, USA
Charles N Paidas
MD
Associate Professor Surgery, Pediatrics, Oncology and Anesthesiology
and Critical Care Medicine, Department of Surgery, Division of
Pediatric Surgery, The Johns Hopkins University School of Medicine,
Baltimore, Maryland, USA
Carlos Pellegrini
MD
The Henry N. Harkins Professor and Chairman, Department of
Surgery, University of Washington School of Medicine, Seattle,
Washington, USA
Erino Angelo Rendina
Division of Thoracic Surgery, Universita La Sapienza, Rome, Italy
Joseph B Shrager
MD
Associate Professor, Department of Surgery, University of
Pennsylvania School of Medicine; Chief of Thoracic Surgery, Hospital
of the University of Pennsylvania and Pennsylvania Hospital,
Philadelphia, Pennsylvania, USA
J Rüdiger Siewert
MD
Professor, Director, and Chairman, Department of Surgery, Technical
University of Munich, Munich, Germany
Tomás Angelillo Mackinlay
British Hospital of Buenos Aires, Capital Federal, Buenos Aires,
Argentina
Guy J Maddern
PhD MS FRACS
R. P. Jepson Professor of Surgery, Department of Surgery, University
of Adelaide, Adelaide, South Australia, Australia; Director, Division of
Surgery, The Queen Elizabeth Hospital, Woodville, South Australia,
Australia
Michael T Marrinan
Consultant Cardiothoracic Surgeon, King’s College Hospital, London,
UK
M Blair Marshall
MD
Chief, Division of Thoracic Surgery, Georgetown University Medical
Center, Washington, District of Columbia, USA
Christopher John Martin
Professor of Surgery, University of Sydney; Head of Surgery, Nepean
Hospital, Sydney, Australia
Kenneth L Mattox
MD
Professor and Vice Chair, Michael E. DeBakey Department of Surgery,
Baylor College of Medicine, Houston, Texas, USA
MD
FRCS(ED)
MB BS MSC FRACS
Edward R Townsend
FRCS
Consultant Thoracic Surgeon, Thoracic Surgery Unit, Royal Brompton
and Harefield Hospital NHS Trust, Harefield, Middlesex, UK
Victor F Trastek
MD
Professor of Surgery, Consultant Division of General Thoracic Surgery
and Chair, Board of Governors Mayo Clinic Arizona, Scottsdale,
Arizona, USA
Noriaki Tsubota
MD PhD
Clinical Professor, Department of Thoracic and Cardiovascular
Surgery, Kobe University School of Medicine, Kobe, Hyogo, Japan;
Vice President, Department of General Thoracic Surgery, Hyogo
Medical Center, Akashi, Hyogo, Japan
Ryosuke Tsuchiya
MD
Chief, Division of Thoracic Surgery, National Cancer Center Hospital,
Tokyo, Japan
Harold Clifton Urschel Jr
MD
Chair; Cardiovascular and Thoracic Surgical Research, Education and
Clinical Excellence, Baylor University Medical Center; Professor of
Cardiothoracic Surgery (Clinical), University of Texas Southwestern
Medical Center at Dallas Southwestern Medical School, Dallas,
Texas, USA
Contributors xi
https://t.me/med1917
Andres Varela PhD
Professor, Department of Surgery, Autonomous University of Madrid;
Section Chief of Thoracic Surgery and Lung Transplantation,
Department of Cardiovascular and Thoracic Surgery, Hospital Puerta
de Hierro, Madrid, Spain
Federico Venuta
MD
Division of Thoracic Surgery, Universita La Sapienza, Rome, Italy
Jon-Cecil M Walkes
MD
Cardiothoracic Resident, Michael E. DeBakey Department of Surgery,
Baylor College of Medicine, Houston, Texas, USA
David Ian Watson MB BS MD FRACS
Professor and Head, Flinders University Department of Surgery;
Senior Consultant Surgeon and Head of Gastrointestinal Services,
Flinders Medical Centre, Bedford Park, South Australia, Australia
Randal S Weber
MD FACS
Hubert L. and Oliver Stringer Distinguished Professor of Cancer
Research, Chairman Department of Head and Neck Surgery,
University of Texas; MD Anderson Cancer Center, Houston, Texas,
USA
This page intentionally left blank
https://t.me/med1917
Contributing medical artists
https://t.me/med1917
Angela Christie FMAA
14 West End Avenue, Pinner, Middlesex
Peter Cox
25 Hampton Close, Worcester
Gillian Lee
Gillian Lee Illustrations, 15 Little Plucketts Way, Buckhurst Hill, Essex
Gillian Oliver
7 Princes Street, Stotfold, Hitchin, Hertfordshire
RDD, MMAA, RMIP
FMAA, HonFIMI, AMI, RMIP
FMAA
This page intentionally left blank
https://t.me/med1917
Preface
https://t.me/med1917
It is with considerable pride that the editors are able to present this volume of Operative Surgery which covers the whole
of Thoracic Surgery in one volume joining the skills of the
lung surgeon and the oesophageal surgeon together for the
benefit of many who practice this as a single specialty. Nearly
twenty years have passed since the previous volume was
published, and during this time, quite dramatic changes
have occurred in the management of thoracic and
esophageal diseases. The editors’ believe that each of these
advances has been adequately described in this volume to
reflect the major changes in management. Of particular note
has been the development of thoracoscopic surgery, which
has brought considerable benefits in both the management
of certain lung and oesophageal diseases. Perhaps, the greatest change in surgical practice has been the development of
even more specialised units with the objective of achieving a
sufficient volume of surgical caseload which current evidence based data predict will improve the results of surgical
morbidity, mortality and the long term survival. The results
of our colleagues from China have certainly led the field in
the reduction of mortality of oesophageal resection, and is
an example of the benefits of surgical volume with great
technical skill.
The series of Operative Surgery was founded in the middle
of the 1950s when surgical technique was beginning to crystallise into what we know today as the correct technique and
in the contribution of the skill of the surgeon to outcome.
Performance of the correct operation at the correct time and
in the correct way have been the hallmark of the series. It is
to Charles Robb and Rodney Smith that many surgeons owe
a debt for pioneering this classic series of surgical operative
texts with their ability to display an operation by the use of
excellent illustration with short descriptive notes. No doubt
more technically advanced media will take over from the
written page but, to date, the general editors have yet to find
a medium which will enable the surgeons to flip through a
few pages and be enlightened about the technical aspect of
an operative technique. For this reason we persist with this
series hoping that many will find this volume as useful as the
others.
No illustrative text on Operative Surgery would be possible without the skill, the quite incredible artistry, of Gillian
Lee and her team who have produced a most beautiful series
of operative illustrations which will not date with time. We
editors owe our great thanks to her, and hope that all our
readers will find this form of presentation to their liking.
Finally, our contributors, our technical editors and our publishers should be thanked for what has been a mammoth task
of cooperation, which we hope our readers will appreciate.
The Editors
This page intentionally left blank
https://t.me/med1917
SECTION
https://t.me/med1917
I
Thoracic surgery
This page intentionally left blank
https://t.me/med1917
1
https://t.me/med1917
Repair of pectus excavatum
CHARLES N. PAIDAS MD
Associate Professor of Surgery, Pediatrics, Oncology and Anesthesiology and Critical Care Medicine, Department of Surgery, Division of
Pediatric Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
J. ALEX HALLER, JR. MD
Emeritus Professor of Pediatric Surgery, Department of Surgery, The Johns Hopkins University School of Medicine; Emeritus Chief of Pediatric
Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
HISTORY
Pectus excavatum, or funnel chest, is the most common congenital anomaly of the thorax in children. Although descriptions of repair of pectus excavatum were given in the early
1900s, it was not until the late 1930s that Ochsner and De
Bakey described and repaired the anomaly, taking into
account an overgrowth of cartilage that resulted in a posterior
displacement of the sternum. In 1949, Mark Ravitch provided
a detailed description of the defect and suggested the operation that is in common use to this day. Ravitch observed a
central depressed sternum, rounded shoulders, potbelly,
sloped ribs, and paradoxical movement of the chest wall
inward on deep inspiration. His operation focused on
removal of the deformed, overgrown costal cartilages with
preservation of the perichondrium and stabilization of the
sternum. For nearly 50 years, the Ravitch procedure, with
minor modifications such as the use of stainless steel bar supports for the sternum, has been the benchmark procedure for
pectus excavatum. In 1998, Donald Nuss introduced a minimally invasive technique for repair of pectus excavatum. This
technique (Nuss procedure) has received growing acceptance
as an alternative method of repair, but evidence-based longterm follow-up is needed.
PRINCIPLES AND JUSTIFICATION
The majority of children with pectus excavatum are asymptomatic and are referred for the anatomical deformity and cosmetic concerns. A small subset complains of nonspecific chest
pain. The constellation of physical findings include rounded
shoulders, sloped ribs, potbelly, and sunken chest. The excavatum defect does not cause scoliosis of the spine. The heart
can be displaced into the left hemithorax, and in severe cases
the point of maximum intensity may be in the midaxillary
line.
PREOPERATIVE ASSESSMENT AND
PREPARATION
Chest computed tomographic scan provides the most accurate assessment of heart displacement and lung volumes. The
ratio of the distance between the sternum and vertebral bodies and the transverse diameter of the chest through the deepest portion of the defect may be used to calculate an index of
severity. In normal children, this index is less than 2.5,
whereas the index may range from 3 to 7 in those with severe
deformities.
Simultaneous pulmonary and cardiac evaluation has
shown that a severe deformity can cause compression of the
right side of the heart. Right ventricular outflow distortion
causes decreased cardiac output during strenuous exercise.
Thus, a sunken sternum causes cardiovascular symptoms that
are best characterized as decreased cardiac output during
exercise. Nevertheless, the problem of appropriate selection
of children who will benefit from correction of the defect still
remains. Indications for operative correction include chest
pain on exertion, dyspnea on exertion, cosmetic concerns,
psychological stress, and future need for sternotomy for
replacement of cardiac valves in children with Marfan syndrome who have both pectus excavatum and aortic valve
insufficiency. Reconstruction should not be performed during a growth spurt. Rather, repair is best performed in the
school-age child after a pubertal growth spurt (typically 9–12
years of age).
Exercise stress pulmonary function tests provide baseline
data for symptomatic and asymptomatic patients. The vast
majority of children show normal pulmonary function at
Соседние файлы в папке Библиотека им академика М.И. Перельмана