MANAGEMENT OF CENTRAL AIRWAY OBSTRUCTION BY...
Transcript of MANAGEMENT OF CENTRAL AIRWAY OBSTRUCTION BY...
MANAGEMENT OF CENTRAL AIRWAY OBSTRUCTION BY CRYO SURGERY AND
ARGON PLASMA COAGULATION
ACHMAD MULAWARMAN JAYUSMANBandung , 06 February 2016
Dr. A Mulawarman J, SpP(K), Dr. Eddy Soeratman SpP(K), Dr. Arif R Hanafi, SpP, Dr. Evlina Suzanna, SpPA,, Dr. Tagor Oliver Tambunan SpBT, DR.Dr. Dody Ranuhadi Sp.PD KHOM, DR. Dr. Noorwati S, SpPD KHOM, Dr. Asrul Harsal SpPD KHOM, Dr. Bangun Astarto SpRad(K) Onk Rad, Dr.DewiSoeis SpRad(K) Onk Rad, Dr. Kardinah SpRad, Dr. Sri Hartini SpPK MARS, Dr. Hera Pratiwi SpRM, Dr. Maria Witjaksono MPhal,Dr. Sariningsih SpRad,Dr. Rosalina SpRad, Dr .Maria R Yunti SpPA. Pradnya SKM, Tiarlan SKM, Fariha SKM, Siti Zahara SKM.
TIM KERJA PARURS KANKER DHARMAIS
THERAPEUTIC APPROACHES
Dilation of the airways ( Bronchoplasty )
Electrocautery
Argon Plasma Coagulation
Laser Therapy
Photodynamic Therapy
Cryotherapy
External Beam Radiation & Brachytherapy
Airway Stents Placement
Surgical Resection
BENEFITS
Cryobiopsy• Endobronchial & Transbronchial
• High diagnostic quality
Cryorecanalization
• Exophytic stenoses with immediate effect
• Frontal or tangential approach
Cryodevitalization
• For Ablation tumor ingrowths & overgrowths
CRYO VS LASER
CRYO SURGERY
• Flexible bronchoscope
• Easier
• Freezing
• Minimal haemorage
• Non smoke
• Short time
• More safety
• Cheaper
LASER
• Rigid bronchoscope
• Difficult
• Burning
• High risk
• Smoke
• Longer
• High risk perforation
• More expensive
MULTIDISCIPLINARY TEAM APPROACH
• CHEST RADIOLOGIST
• ANESTHESIOLOGISTS
• INTERVENTIONAL PULMONOLOGISTS
• MEDICAL REHABILITATION
• INTENSIVISTS
• PATHOLOGIST
• BRONCHOSCOPY STAFFS
MULTIDISCIPLIN OF APLICATION FOR THE CRYO
• PNEUMOLOGY : Bronchial stenosis, recanalization,biopsies
• PHLEBOLOGY : Varicous vein of the lower limbs
• THORACIC SURGERY : Post operative cryo analgesia
• GYNECOLOGY : Cervical ectopias and condylomas
• PROCTOLOGY : Inner hemorrhoids of the first and second degree, acut anal fissures
• ENT : Hemangiomas, papillomas, etc
• DERMATOLOGY: Warts, condylomas, etc
INDICATION (1)
Malignant• Primary endolumenal carcinoma
• Metastatic carcinoma to the airway
• Laryngeal carcinoma
• Esophageal carcinoma
• Mediastinal tumors
• Lymphadenopathy associated with malignancy
INDICATION (2)
Non malignant• Limphadenopathy
• Granulation tissue
• Pseudotumor
• Tracheo /bronchomalacia
• Others : Mucus plug
Blood clot
CONTRA INDICATION
• EXTRINSIC COMPRESSION
• A THROMBOCYTE COUNT OF LESS THAN
100 G/L
• ABNORMAL PLASMA CLOTTING
ARGON PLASMA COAGULATION
• A non contact form of electrocoagulation
• Effective for the treatment of endoluminal hemoptysis and airway obstruction
• The procedure can be perform in an outpatient setting or at the bedside in the ICU’s
• Type of APC probe : direct, lateral & circle.
DATA RECORD OF CRYO SURGERY AND APCDHARMAIS HOSPITAL
N %
Male 29 83
Female 6 17
Total 35 100
Carcinoma N %
Lung cancer 15 42.9
Laringeal cancer 10 28.6
Thyroid cancer 5 14.3
Colon cancer 2 5.7
Testis cancer 1 2.8
Vocal cord cancer 1 2.8
Tracheal cancer 1 2.8
Total 35 100
Case 1
• NAME : Mr R
• AGE : 32 yo
• THE MAIN COMPLAINT
- Short breathness
• DIAGNOSIS
- Adenocarsinoma of the left lung
• DURATION
- 75 Minutes
Case 2
• NAME : Mr E
• AGE : 75 yo
• THE MAIN COMPLAINT
- Short breathness
• DIAGNOSIS
- Colon carcinoma metastasis to the left lung
• DURATION
- 120 minutes
IMPACT OF THERAPY
• BETTER QUALITY OF LIFE• SURVIVAL IS IMPRESSIVE
• SO, THE AVAILABLE PRIMARY QUESTION WILL NOT BE ..
- Is therapy helpful ? But...............
- Which therapy is best for a particular patient ?
SUMMARY
• Virtual Bronchoscopy CT scan is needed as preparation for cryosurgery
• For the treatment of Central Air (CAO) by cryo surgery, to be followed Argon Plasma Coagulation (APC) and other lung cancer therapy
• Post cryo surgery is required antifungal therapy
PERTANYAAN 1
Therapy cryo surgery pada obstruksi jalannapas utama, dapat dilakukan pada :
1. Penekanan dari luar (eksternal)
2.Lesi infiltratif dibawah pita suara dapatlangsung dilakukan tindakan cryo surgery
3.Lesi infiltratif yang berasal dari thyroid, trakea dan paru, dapat dilakukan cryo surgery