الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
In human anatomy the pleural cavity is the potential space between the two pleurae (visceral and parietal) of the lungs. The pleura is a serous membrane which folds back onto itself to form a two-layered membrane structure. The thin space between the two pleural layers is known as the pleural cavity and normally contains a small amount of pleural fluid. The outer pleura (parietal pleura) is attached to the chest wall. The inner pleura (visceral pleura) covers the lungs and adjoining structures, via blood vessels, bronchi and nerves.
Carcinoma of any organ can metastasize to the pleura. However, carcinoma of the lung is the most common malignancy to invade the pleura and produce malignant and paramalignant effusion.
An important feature of the parietal pleura is lymphatic stomata, i.e. openings between parietal pleural mesothelial cells. The stomata and their associated lymphatic channels form lymphatic lacunae immediately beneath the mesothelial layer. The lacunae coalesce into collecting lymphatics, which join the intercostals trunk vessels, with flow directed mainly toward the mediastinal lymph nodes. The lymphatic system of the parietal pleura plays a major role in the resorption of pleural liquid and proteins. Interference with the integrity of the lymphatic system anywhere between the parietal pleura and the mediastinal lymph nodes can result in a pleural effusion. Autopsies have indicated that impaired lymphatic drainage from the pleural space is the predominant mechanism for the accumulation of fluid associated with malignancy.
A pleural effusion in the setting of lung cancer usually excludes operability; however, approximately 5% of these patients have a paramalignant effusion or effusion from another cause, and may be operable and curable. Thus, it is essential to establish the cause of the pleural effusion before deciding that the patient is no longer a candidate for curative surgery.
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue or other parts of the body. Most cancers that start in lung, known as primary lung cancers, are carcinomas that derive from epithelial cells. The main types of lung cancer are small-cell lung carcinoma (SCLC), also called oat cell cancer, and non-small-cell lung carcinoma (NSCLC). The most common symptoms are coughing (including coughing up blood), weight loss and shortness of breath.
The aim of the present work was to evaluate the role of pleurectomy in conjunction with lung resection in the management of operable lung malignancies.
We enrolled 40 patients into our study
• Group I: Twenty patients (n=20) who had undergone pleurectomy in conjunction with lung resection
• Group II: Twenty patients (n=20) who had undergone lung resection only as a control group.
There was no significant difference between the two groups regarding the preoperative and operative parameters.
As regards postoperative parameters; early postoperative complications were significantly reduced in group I who had undergone pleurectomy in conjunction with lung resection; there were no early postoperative complications in 16 patients (80%) and there were 4 patients (20%) with early postoperative complications; incomplete lung expansion in 1 patient (5%), atelactasis in 2 patients (10%) and effusion in 1 patient (5%) while in group II; there were no early postoperative complications in 10 patients(50%) and there were 10 patients (50%) with early postoperative complications; incomplete lung expansion in 2 patients(10%), atelactasis in 3 patients(15%) and effusion in 5 patients (25%).
The postoperative hospital stay (days) was significantly reduced in group I who had undergone pleurectomy in conjunction with lung resection; ranged from 4-7 with a mean 5,1 while in group II ranged from 4-13 with a mean 7,8. 25% of patients who had undergone pleurectomy in conjunction with lung resection (group I) had positive pleural histopathology.
Complications developed in the follow up for 6 months in patients who had undergone pleurectomy in conjunction with lung resection (group I) were significantly reduced; In the follow up of patients of group I there was uneventful follow up in 14 patients (70%), atelactasis in 1 patient (5%), empyema in 1 patient (5%) and 4 patients died (20%) while in group II there was uneventful follow up in 8 patients (40%),malignant pleural effusion in 7 patients (35%) and 5 patients died(25%).