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Características clínicorradiológicas preoperatorias /DV FDUDFWHUtVWLFDV SUHRSHUDWRULDV GHO HSLVRGLR DFWXDO GH QHXPRWyUD[ TXH PRWLYDODLQWHUYHQFLyQTXLU~UJLFDDSDUHFHQUHFRJLGDVHQOD7DEOD\FRPSUHQGHQ o 5HYLVLyQGHODVSUXHEDVGHLPDJHQSUHRSHUDWRULDV 5DGLRJUDItD GH WyUD[ SUHRSHUDWRULD )LJXUD QR FRQGLFLRQD GLIHUHQFLDV HVWDGtVWLFDPHQWH VLJQLILFDWLYDV HQWUH ORV JUXSRV S YDORU 7& )LJXUD QR HV HVWDGtVWLFDPHQWH VLJQLILFDWLYD SYDORU o 7UDWDPLHQWR LQLFLDO SUHYLR D OD FLUXJtD GH HVH HSLVRGLR GH QHXPRWyUD[ ORVGRVJUXSRVVRQKRPRJpQHRVSXHVQRVHKDGHWHFWDGRHQWUHHOORV GLIHUHQFLDVHVWDGtVWLFDPHQWHVLJQLILFDWLYDVSYDORU 3RUWDQWR\UHVSHFWRDODVFDUDFWHUtVWLFDVSUHRSHUDWRULDVGHORVHSLVRGLRVGH QHXPRWyUD[ORVGRVJUXSRVVRQKRPRJpQHRV 5HVXOWDGRVGHOD9$76HQHOQHXPRWyUD[HVSRQWiQHRSULPDULR0-RUJH p-valor(1) Abrasión (n=115) Técnica mixta (n=123) Rx preoperatoria QW[ QW[GHUUDPH TC QRUHDOL]DGD VLQKDOOD]JRVSDWROyJLFRV HQILVHPDEXOORVR EXOOD~QLFD ILEURVLV P~OWLSOHVEXOODVEOHEV QHXPDWRFHOH GHUUDPH Tratamiento preoperatorio UHSRVRR[tJHQR GUHQDMH SXQFLyQHYDFXDGRUD 1GHFDVRV &RQWUDVWHȤ 7DEOD5HVXOWDGRVFDUDFWHUtVWLFDVSUHRSHUDWRULDV )LJXUD5DGLRJUDItDGHWyUD[HQSDFLHQWHPXMHUGHDxRVGHHGDGFRQQHXPRWyUD[L]TXLHUGR 6HDSUHFLDHOSXOPyQFRODSVDGRHKLSHUFODULGDGFRQDXVHQFLDGHWUDPDYDVFXODUHQHOKHPLWyUD[ L]TXLHUGR 5HVXOWDGRV )LJXUD7&WRUiFLFDEXOODVDSLFDOHVGHUHFKDVHQSDFLHQWHYDUyQGHDxRVGHHGDG $Vt SXHV GLVSRQHPRV GH GRV JUXSRV KRPRJpQHRV HQ FXDQWR D VXV DQWHFHGHQWHV SHUVRQDOHV \ FDUDFWHUtVWLFDV SUHRSHUDWRULDV (VWR QRV DXWRUL]D D DQDOL]DU \ FRPSDUDUORV UHVXOWDGRV LQWUD \ SRVWRSHUDWRULRV OD HYROXFLyQ LQPHGLDWD \ ORV UHVXOWDGRV D ODUJR SOD]R FRQ FDGD XQD GH ODV WpFQLFDV SOHXUDOHV DSOLFDGDV \ D HVWDEOHFHU TXH ODV GLIHUHQFLDV HQFRQWUDGDV HQ FXDQWR D HVWRV UHVXOWDGRV HQWUH DPERVJUXSRVVRQDWULEXtEOHVDOSURFHGLPLHQWRSOHXUDOHQFXHVWLyQ 2. Resultados intraoperatorios /D KRPRJHQHLGDG HVWDGtVWLFD GH DPERV JUXSRV HQ FXDQWR D FDUDFWHUtVWLFDV LQWUDRSHUDWRULDVVHLOXVWUDHQOD7DEODFRQEDVHHQODVVLJXLHQWHVYDULDEOHV o /D LQGLFDFLyQ TXLU~UJLFD OD GLVWULEXFLyQ GH ORV YDORUHV GH OD YDULDEOH HQWUHQXHVWURVGRVJUXSRVHVHTXLYDOHQWHSYDORU (Q QXHVWUD FDVXtVWLFD QR VH UHFRJH QLQJ~Q FDVR GH KHPRQHXPRWyUD[HVSRQWiQHR o 7LSRGHDERUGDMHVHKDQUHDOL]DGR&97\&97$/DGLVWULEXFLyQ GHODVWpFQLFDVHQWUHORVGRVJUXSRVHVWDEOHFLGRVQRJHQHUDGLIHUHQFLDV HVWDGtVWLFDPHQWH VLJQLILFDWLYDV /RV SYDORUHV DVRFLDGRV D ORVWLSRV GH DERUGDMHVUHDOL]DGRVVRQPD\RUHVTXHSYDORU 5HVXOWDGRVGHOD9$76HQHOQHXPRWyUD[HVSRQWiQHRSULPDULR0-RUJH Abrasión (n=115) Técnica mixta (n=123) p-valor(1) Indicaciones IXJDSHUVLVWHQWH QW[UHFLGLYDQWHLSVLODWHUDO QW[UHFLGLYDQWHFRQWUDODWHUDO VRFLRODERUDO QW[ELODWHUDOVLPXOWiQHR QW[SULPDULRFRQOHVLRQHVHQOD7& Abordaje &97 &97$ Estadio Vanderschueren ,VLQSDWRORJtD ,,DGKHUHQFLDV ,,,EXOODVFP ,9EXOODV!FP Técnica sobre el parénquima pulmonar %XOOHFWRPtD &XxDDWtSLFDDSLFDO Ubicación de la resección /6' /0 /,' 'REOHGHUHFKR /6, /,, 'REOHL]TXLHUGR Hemorragia intraoperatoria Transfusión intraoperatoria 1GHFDVRV &RQWUDVWHȤ 7DEOD5HVXOWDGRVLQWHUYHQFLyQTXLU~UJLFD o +DOOD]JRVDQDWRPRSDWROyJLFRVPDFURVFySLFRVVHJ~QODFODVLILFDFLyQGH 9DQGHUVFKXHUHQVLFRQVLGHUDPRVODWRWDOLGDGGHORVSURFHGLPLHQWRVHO HVWDGLR , VXSRQH XQ GHOWRWDO GH ORV FDVRV HO,,XQHO,,, HO \ HO ,9 HO /D GLVWULEXFLyQ SRU HVWDGLRV VHJ~Q HO JHVWR SOHXUDO HPSOHDGR SXHGH FRQVXOWDUVH HQ OD 7DEOD \ QR VXSRQH GLIHUHQFLDVVLJQLILFDWLYDVSYDORU 5HVXOWDGRV o /D WpFQLFD DSOLFDGD VREUH HO SDUpQTXLPD SXOPRQDU QR JHQHUD GLIHUHQFLDVVLJQLILFDWLYDVHQWUHDPERVJUXSRVSYDORU (QXQ GHORVFDVRVTXHFRPSRQHQQXHVWUDVHULHQRVHYLVXDOL]DURQDQRPDOtDV SDUHQTXLPDWRVDV \ VH RSWy SRU OD UHDOL]DFLyQ GH XQD FXxD DWtSLFD DSLFDO o /DWHUDOLGDG GH ORV SURFHGLPLHQWRV \ XELFDFLyQ GH OD UHVHFFLyQ SDUHQTXLPDWRVD (Q HO JUXSR GH ODV DEUDVLRQHV KD\ XQ WRWDO GH SURFHGLPLHQWRVGHUHFKRV\L]TXLHUGRVSDUDODWpFQLFDPL[WDVRQ \UHVSHFWLYDPHQWH(VWDGLVWULEXFLyQDOLJXDOTXHODORFDOL]DFLyQGH OD UHVHFFLyQ SDUHQTXLPDWRVD WDPSRFR FRQOOHYD GLIHUHQFLDV HVWDGtVWLFDPHQWHVLJQLILFDWLYDVHQWUHDPERVJUXSRVSYDORU o 1R VH SUHVHQWy QLQJ~Q FDVR GH KHPRUUDJLD LQWUDRSHUDWRULD QL IXH QHFHVDULD OD UHDOL]DFLyQ GH XQD WUDQVIXVLyQ VDQJXtQHD FRQ LQGHSHQGHQFLDGHOSURFHGLPLHQWRUHDOL]DGRVREUHODSOHXUD (Q OD 7DEOD VH PXHVWUDQ ORV UHVXOWDGRV UHODWLYRV DO WLHPSR TXLU~UJLFR /D PHGLD GHO WLHPSR RSHUDWRULR IXH PD\RU HQ HO FRQMXQWR GH SURFHGLPLHQWRV GH OD WpFQLFDPL[WDPLQXWRVTXHHQHOGHDEUDVLRQHVPLQXWRVVLHQGR ODGLIHUHQFLDHVWDGtVWLFDPHQWHVLJQLILFDWLYDSYDORU $VtPLVPRFDEHGHVWDFDUODQHFHVLGDGGHUHFRQYHUVLyQDFLUXJtDDELHUWDGHO WRWDO GH LQWHUYHQFLRQHV FRUUHVSRQGLHQWHV D SDFLHQWHV FRQ QHXPRWyUD[ HVSRQWiQHR SULPDULR HMHFXWDGDV HQWUH ORV DxRV ± VH SUHFLVy OD UHFRQYHUVLyQ D WRUDFRWRPtD DELHUWD HQ VLHWH FDVRV GH XQ WRWDO GH SURFHGLPLHQWRV TXH FRPHQ]DURQ FRPR 9$76 VyOR VH FRPSOHWDURQ 3RU WDQWR QXHVWUD WDVD GH UHFRQYHUVLyQ D FLUXJtD DELHUWD GH SURFHGLPLHQWRV LQLFLDGRV PHGLDQWH 9$76 HV GHO Tiempo quirúrgico (minutos) Abrasión (n=115) Técnica mixta (n=123) p-valor r r 0,00(1) (**) 1GHFDVRV 7HVWGH0DQQ:KLWQH\ 0HGLD'HVYLDFLyQWtSLFD 6LJQLILFDWLYLGDGDOSYDORU 7DEOD5HVXOWDGRVWLHPSRTXLU~UJLFR 5HVXOWDGRVGHOD9$76HQHOQHXPRWyUD[HVSRQWiQHRSULPDULR0-RUJH 3. Resultados del postoperatorio precoz /RV UHVXOWDGRV REWHQLGRV GHO HVWXGLR \ DQiOLVLV GH ODV YDULDEOHV UHODWLYDV DO SRVWRSHUDWRULRSUHFR]VHSODVPDQHQOD7DEOD $OUHVSHFWRSRGHPRVUHPDUFDUTXH o (QFRQWUDPRV LJXDOGDG HQWUH ORV GRV JUXSRV QR KD\ GLIHUHQFLDV VLJQLILFDWLYDVUHVSHFWRD 0HGLDGHODGXUDFLyQGHOGUHQDMHSOHXUDOSYDORU +DOOD]JRV HQ OD UDGLRJUDItD GH WyUD[ HIHFWXDGD HQ ODV SULPHUDV KRUDV GHO SRVWRSHUDWRULR SYDORU /D )LJXUD PXHVWUDODUHH[SDQVLyQSXOPRQDUFRPSOHWDSRVWRSHUDWRULD(QOD )LJXUDVHUHSURGXFHXQDLPDJHQGHFiPDUDDpUHDUHVLGXDOD ORVFXDWURGtDVGHODLQWHUYHQFLyQ ,QLFLRGHODGHDPEXODFLyQSYDORU 0HGLDGHODHVWDQFLDKRVSLWDODULDSRVWRSHUDWRULDSYDORU Abrasión (n=115) Técnica mixta (n=123) p-valor Retirada drenajes(días) Rx postoperatoria (24 h) VLQFRPSOLFDFLRQHV FROHFFLyQOtTXLGD FiPDUDDpUHDUHVLGXDO Inicio deambulación (días) Estancia postoperatoria (días) 1GHFDVRV 0HGLD'HVYLDFLyQ7tSLFD 7HVW0DQQ:KLWQH\ &RQWUDVWHȤ 7DEOD5HVXOWDGRVSRVWRSHUDWRULRSUHFR] 5HVXOWDGRV )LJXUD5HH[SDQVLyQSXOPRQDUFRPSOHWD3RVWRSHUDWRULRSUHFR]SULPHUDVKRUDV )LJXUD&iPDUDDpUHDUHVLGXDO3RVWRSHUDWRULRSUHFR] 5HVXOWDGRVGHOD9$76HQHOQHXPRWyUD[HVSRQWiQHRSULPDULR0-RUJH 3.1. 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Resultados del seguimiento clínico 4.1. Tiempo medio de seguimiento clínico (O WLHPSR PHGLR GH VHJXLPLHQWR FOtQLFR QR PRVWUy GLIHUHQFLDV VLJQLILFDWLYDV HQWUHDPERVJUXSRVSYDORU (OWLHPSRPHGLRGHVHJXLPLHQWRFOtQLFRIXHGH PHVHVHQHOJUXSRVRPHWLGRDDEUDVLyQSOHXUDO\GHPHVHVHQ ORVFDVRVHQTXHVHOOHYyDFDERODWpFQLFDPL[WDFRQXQYDORUPtQLPRGHXQPHV\ XQYDORUPi[LPRGHWUHVPHVHVHQDPERVJUXSRV7DEOD Seguimiento clínico (meses) Abrasión (n=115) Técnica mixta (n=123) pvalor(1) 7HVW0DQQ:KLWQH\ 0HGLDGHVYLDFLyQWtSLFD 7DEOD5HVXOWDGRVGXUDFLyQGHOVHJXLPLHQWRFOtQLFR 4.2. Resultados radiológicos 1R VH HQFXHQWUDQ GLIHUHQFLDV HVWDGtVWLFDPHQWH VLJQLILFDWLYDV HQWUH DPERV JUXSRVHQORUHIHUHQWHDODDXVHQFLDGHVHFXHODVUDGLROyJLFDVRELHQDODSUHVHQFLD GH GHUUDPH SOHXUDO ODPLQDU KHPDWRPD SOHXUDO ORFDOL]DGR R QHXPRWyUD[ ODPLQDU UHVLGXDOSYDORU FRPRVHUHIOHMDHQOD7DEOD 5HVXOWDGRV Radiografía de control ambulatoria VLQVHFXHODVUDGLROyJLFDV GHUUDPHSOHXUDOODPLQDU KHPDWRPDSOHXUDOORFDOL]DGR QW[ODPLQDUUHVLGXDO Abrasión (n=115) Técnica mixta (n=123) p-valor(1) 1GHFDVRV &RQWUDVWHȤ 7DEOD5HVXOWDGRVUDGLRJUDItDGHWyUD[DORVGtDVGHODLQWHUYHQFLyQ 4.3. Dolor al mes de la intervención /RV UHVXOWDGRV UHODWLYRV D OD SUHVHQFLD GH GRORU GXUDQWH HO SHULRGR GH VHJXLPLHQWRFOtQLFRVHPXHVWUDQHQOD7DEOD(OGRORUWRUiFLFRUHVLGXDOGXUDQWHHO SULPHUPHVSRVWRSHUDWRULRHVWiSUHVHQWHHQHOFDVRVGHODVSOHXURGHVLV SRU DEUDVLyQ \ HQ HO FDVRV GH ORV SURFHGLPLHQWRV HIHFWXDGRV FRQ OD WpFQLFDPL[WD/DGLIHUHQFLDHVHVWDGtVWLFDPHQWHVLJQLILFDWLYDHQWUHDPERVJUXSRVS YDORU o (Q QXHVWUD VHULH QLQJXQD GH ODV DEUDVLRQHV SOHXUDOHV UHTXLULy HO PDQWHQLPLHQWR GH OD SDXWD DQDOJpVLFD PiV DOOi GHO SULPHU PHV SRVWRSHUDWRULR o 6LQHPEDUJRHOGRORUSHUVLVWtDHQHOGHORVSURFHGLPLHQWRVHQHO JUXSR GH OD WpFQLFD PL[WD 7DQWR HO SDFLHQWH UHLQWHUYHQLGR PHGLDQWH QXHYD &97 FRPR HO HQIHUPR VXEVLGLDULR GH SOHXURGHVLV TXtPLFD FRPXQLFDURQXQGRORULQWHQVR6HSUHFLVyHOPDQWHQLPLHQWRGHODSDXWD DQDOJpVLFDQRRSLRLGHGXUDQWHWUHVPHVHV o 8QR GH ORV FDVRV GH OD WpFQLFD PL[WD IXH UHPLWLGR QXHYDPHQWH DO VHUYLFLR GH &LUXJtD 7RUiFLFD DO DxR GH OD FLUXJtD SRU SHUVLVWHQFLD GHO GRORU±GHWLSRLQWHUPLWHQWH\GLVHVWHVLDVHQOD]RQDGHORVWUyFDUHV 5HVXOWDGRVGHOD9$76HQHOQHXPRWyUD[HVSRQWiQHRSULPDULR0-RUJH Ausencia de dolor Abrasión (n=111)(1) Técnica mixta (n=122)(1) p-valor(2) 0,00** 6HKDH[FOXtGRORVGDWRVGHORVSDFLHQWHVUHLQWHUYHQLGRVGXUDQWHHO SRVWRSHUDWRULRSUHFR]SRUWRUDFRWRPtDDQWHODSUHVHQFLDGHFRPSOLFDFLRQHVFRPR IXJDDpUHDSURORQJDGDRKHPRWyUD['HHVWHPRGRPDQWHQHPRVFDVRVHQHO JUXSRGHODVDEUDVLRQHV\SDUDORVSURFHGLPLHQWRVPL[WRV 7HVWȤ 6LJQLILFDWLYLGDGDOSYDORU 7DEOD5HVXOWDGRVDXVHQFLDGHGRORUDOPHVGHODLQWHUYHQFLyQ 5. Resultados del estudio anatomopatológico de las muestras /D GLVWULEXFLyQ GH ORV KDOOD]JRV DQDWRPRSDWROyJLFRV GH ODV PXHVWUDV SDUHQTXLPDWRVDV UHPLWLGDV WDPSRFR PXHVWUD GLIHUHQFLDV HVWDGtVWLFDPHQWH VLJQLILFDWLYDVHQWUHDPERVJUXSRVSYDORU FRQIRUPHFRQOD7DEOD(QGLFKD WDEODVHUHVHxDQLJXDOPHQWHORVKDOOD]JRVDQDWRPRSDWROyJLFRVDQLYHOGHODSOHXUD SDULHWDOHQHOJUXSRVRPHWLGRDODWpFQLFDPL[WD AP parénquima EXOODVVXESOHXUDOHV HQILVHPDEXOORVR FDPELRVFLFDWULFLDOHVLQIODPDWRULRV Abrasión (n=115) Técnica mixta (n=123) p-valor(1) AP pleura ILEURVLVSOHXUDO SOHXULWLVFUyQLFD QRUPDO 1GHFDVRV &RQWUDVWHȤ 7DEOD5HVXOWDGRV$QDWRPtD3DWROyJLFD 6. Resultados del seguimiento a largo plazo (OWLHPSR PHGLR GH VHJXLPLHQWRD ODUJR SOD]R 7DEOD KD VLGRGH DxRVSDUDODVDEUDVLRQHVFRQXQYDORUPtQLPRGH\XQYDORUPi[LPRGH DxRV \ GH DxRV SDUD OD WpFQLFDPL[WD FRQ XQ YDORU PtQLPR GH \ XQ YDORU Pi[LPR GH DxRV VLQ TXH HVWR VXSRQJD GLIHUHQFLDV VLJQLILFDWLYDV S YDORU 5HVXOWDGRV 6yORVHKDUHFRJLGRXQFDVRGHp[LWXVDODUJRSOD]RSRUFDXVDVDMHQDVDOD HQIHUPHGDGDHVWXGLR Seguimiento del estudio (años) Abrasión (n=111)(1) Técnica mixta (n=117)(1) p-valor(2) 6HKDH[FOXtGRORVGDWRVFRUUHVSRQGLHQWHVDORVSURFHGLPLHQWRVGHORVSDFLHQWHV SHUGLGRVGXUDQWHHOVHJXLPLHQWRDODUJRSOD]R 7HVWGH0DQQ:KLWQH\ 0HGLD'HVYLDFLyQWtSLFD 7DEOD5HVXOWDGRVGXUDFLyQGHOVHJXLPLHQWRDODUJRSOD]R (O Q~PHUR GH UHFLGLYDV LSVLODWHUDOHV HQWUH ORV GRV JUXSRV SUHVHQWD XQD GLIHUHQFLDHVWDGtVWLFDPHQWHVLJQLILFDWLYDSYDORU 7DOFRPRVHSXHGHDSUHFLDU HQOD7DEODODSUREDELOLGDGGHDSDULFLyQGHXQDUHFLGLYDLSVLODWHUDOHQHOJUXSRGH ODV DEUDVLRQHV HV GHO SURFHGLPLHQWRV PLHQWUDV TXH HQ HO FRQMXQWR GH LQWHUYHQFLRQHV OOHYDGDV D FDER PHGLDQWH OD WpFQLFD 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