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Pleural coagulation is a condition in which a thrombus forms a clot, which accumulates in the pleural space. Laparoscopic hemothorax is the main procedure performed to completely remove the pleural clot.1. 1. What is laparoscopic coagulation surgery?
Pleural coagulation is a condition in which a thrombus forms a clot, which accumulates in the pleural space. Hemothorax may progress to hemothorax. Laparoscopic thoracocentesis is the main procedure performed to completely remove pleural blood clots, monitor hemostasis, irrigate, improve lung expansion and prevent sequelae of pleural thickening.2. Indications and contraindications for endoscopic hemothorax surgery
Indications for laparoscopic coagulation surgery when:Residual pleural coagulation, failure to drain after 24-72 hours but still clot, ultrasound with fibrin fluid, pleural drainage failure, or no out more. Superinfective pleural coagulation Post-traumatic hemothorax comes late after 5-7 days. Moderate or greater intrapleural blood clot, or septal closure, is localized. Contraindicated laparoscopic coagulation surgery when:
There is diffuse or progressive lung disease; bronchial stenosis causing atelectasis. Myocardial infarction, uncontrolled heart failure. The patient could not tolerate prolonged surgery if one lung collapsed. Blood clotting disorder.
Bệnh nhân rối loạn đông máu có chống chỉ định phẫu thuật nội soi
3. Steps to perform laparoscopic surgery to collect pleural blood clots
Step 1: Prepare ventilator, continuous negative pressure suction system... to meet the requirements of thoracic and vascular surgery; Monitor arterial blood pressure, venous blood pressure, oxygen saturation, breathing rate, electrocardiogram; endoscopes; laparoscopic surgical instruments; thoracic surgery tools for conversion to open surgery when needed; operating table, electric knife, lighting system qualified for thoracic surgery.Step 2: Collapse the lung on the affected side by isolating the lung by bronchoscopy.
Step 3: Place the trocar. The best camera hole is at LS 7-8, posterior axillary line, where the remaining trocars should be placed, with camera hole 1 triangular, located on the expected thoracic opening, and the lowest hole will be for duct placement. Save
Step 4: Absorb the pleural blood clot and break the sticky cord, then investigate the lungs, mediastinum, chest wall, diaphragm, wound entrance... to handle and stop bleeding. Next, squeeze the balloon to maximize lung expansion, check for air leaks.
Step 5: Wash before closing the chest.
Step 6: Place a closed drainage tube to drain the fluid and re-establish physiological negative pressure in the pleural space.
4. Monitoring and management of complications after laparoscopic coagulation surgery
Sau phẫu thuật bệnh nhân cần được theo dõi tình trạng chảy máu, giảm đau, hút đờm dãi, hô hấp tích cực cũng như tập thổi bình
Monitor bleeding status Reduce pain, aspirate sputum Active respiration Practice blowing the bottle to help the lungs gradually expand Manage complications after endoscopic surgery to collect membrane clot Lungs:
If bleeding is >1000ml or >200ml/hour for 2-3 hours, laparoscopic surgery or thoracotomy is required to stop the bleeding. Early detection if atelectasis, respiratory failure so that the patient can practice breathing, flapping, and loosening phlegm. Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. and hospital treatment.
To register for examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register online HERE.
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