Pulmonary tractotomy
| Pulmonary tractotomy | |
|---|---|
| Specialty | pulmonologist |
A pulmonary tractotomy is a surgical technique to treat a penetrating lung injury. The tract of the lung injury is opened, and open bronchi and blood vessels are ligated (sewn).
Treatment of penetrating lung injuries
[edit]Emergency surgery for a penetrating lung injury, e.g. an accident or a gunshot, is associated with a very high mortality rate.[citation needed]
Such lung injuries cannot be treated with simple surgery; they cannot be oversewn. If treated with simple surgery, blood vessels within the tract of the lung injury may continue to bleed and result in a haematoma which should be avoided. Or the patient may suffer a pulmonary air embolism and subsequently die.[citation needed]
Penetrating lung injuries can be treated with a formal lung resection or with pulmonary tractotomy.[citation needed]
Comparison of treatments
[edit]Pulmonary tractotomy is a lung sparing technique. It can prevent the need for formal lung resection. Its advantages over segmental lung resection include that it can be performed quicker; it offers a rapid way to control bleeding (haemorrhage) and air leaks in patients with penetrating lung injuries. Also, pulmonary tractotomy can preserve healthy pulmonary tissue (parenchyma); this naturally is not possible with lung resection.[1][2][3][4][5][6]
However, overall patient outcome is the same with pulmonary tractotomy and lung resection; both are viable surgical treatment options. This is because patient outcome in penetrating lung injury is related mainly to the severity of injury, rather than the type of treatment.[7]
References
[edit]- ^ Pulmonary tractotomy with selective vascular ligation for penetrating injuries to the lung. Wall MJ Jr, Hirshberg A, Mattox KL. Am J Surg. 1994 Dec;168(6):665-9.
- ^ Stapled pulmonary tractotomy: a rapid way to control hemorrhage in penetrating pulmonary injuries. Asensio JA, Demetriades D, Berne JD, Velmahos G, Cornwell EE 3rd, Murray J, Gomez H, Falabella A, Chahwan S, Shoemaker W, Berne TV. J Am Coll Surg. 1997 Nov;185(5):486-7.
- ^ Pulmonary tractotomy as an abbreviated thoracotomy technique. Wall MJ Jr, Villavicencio RT, Miller CC 3rd, Aucar JA, Granchi TA, Liscum KR, Shin D, Mattox KL. J Trauma. 1998 Dec;45(6):1015-23.
- ^ Lung-sparing surgery after penetrating trauma using tractotomy, partial lobectomy, and pneumonorrhaphy. Velmahos GC, Baker C, Demetriades D, Goodman J, Murray JA, Asensio JA. Arch Surg. 1999 Feb;134(2):186-9.
- ^ Lung-sparing techniques are associated with improved outcome compared with anatomic resection for severe lung injuries. Cothren C, Moore EE, Biffl WL, Franciose RJ, Offner PJ, Burch JM. J Trauma. 2002 Sep;53(3):483-7.
- ^ Pulmonary tractotomy for a patient with traumatic penetrating lung injury: report of a case. Muraoka M, Akamine S, Tagawa T, Sasaki N, Ikuta Y, Inoue M, Yamayoshi T, Hashizume S, Taguchi T, Nomura M, Takagi K, Tagawa Y, Oka T, Nagayasu T. Surg Today. 2005;35(11):972-5.
- ^ Pulmonary tractotomy versus lung resection: viable options in penetrating lung injury. Gasparri M, Karmy-Jones R, Kralovich KA, Patton JH Jr, Arbabi S. J Trauma. 2001 Dec;51(6):1092-5.