RESULTADOS DE LA CIRUGÍA VIDEOTORACOSCÓPICA EN

Anuncio
FACULTAD DE MEDICINA Y ODONTOLOGÍA
PROGRAMA DOCTORADO 040 F 991 Cirugía y sus especialidades
RESULTADOS DE LA CIRUGÍA VIDEOTORACOSCÓPICA EN EL NEUMOTÓRAX
ESPONTÁNEO PRIMARIO ANALIZANDO LA TÉCNICA DE PLEURODESIS POR
ABRASIÓN VERSUS LA TÉCNICA DE PLEURECTOMÍA MÁS ABRASIÓN
TESIS DOCTORAL
PRESENTADA POR:
MARÍA MERCEDES JORGE SERRA
DIRIGIDA POR:
Dr. GENARO GALÁN GIL
Dr. CARLOS CARBONELL CANTÍ
Dr. ALFONSO MORCILLO AIXELÁ
Valencia, 2013
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INTRODUCCIÓN
1. Definiciones
1.1. Neumotórax
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1. Resultados preoperatorios
1.1. Antecedentes personales
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Técnica mixta
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Técnica
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Técnica
mixta (n=123)
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mixta (n=123)
p-valor(1)
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Abrasión
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Técnica mixta
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pvalor(1)
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Técnica mixta
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p-valor(1)
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Abrasión
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Técnica mixta
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p-valor(2)
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FRQFOX\HTXHla pleurectomía parietal apical más abrasión del resto de la pleura
parietal es mejor alternativa de pleurodesis física que la abrasión pleural en el
tratamiento quirúrgico del neumotórax espontáneo primario mediante Cirugía
Videotoracoscópica, con el fin de garantizar una menor tasa de recurrencias. A
su vez, este procedimiento mixto no supone un incremento de la incidencia de
complicaciones postoperatorias como la fuga aérea prolongada
y el
hemotórax, aunque sí comporta mayor dolor en el postoperatorio.
APÉNDICE
1. Autorización del estudio por el Comité Ético del Hospital Clínico
Universitario de Valencia
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