Spontan Pnömotoraksta Rekurrens Ve Cerrahi Tedavide Zamanlama
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Dosyalar
Tarih
2005
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi Tıp Fakültesi Dergisi
Erişim Hakkı
Attribution 3.0 United States
Özet
Spontan pnömotorakslı olgularda uzamış hava kaçağı ve nüks en sık cerrahi endikasyonları oluşturur. Ancak
cerrahinin zamanlaması hala tartışmalı bir konu olarak kalmıştır.
Gereç ve Yöntem: Bu çalışmada İnönü Üniversitesi Turgut Özal Tıp Merkezi Göğüs Cerrahisi Kliniğinde Ocak
1999 - Aralık 2004 yılları arasında spontan pnömotoraks nedeniyle tedavi gören 90 olgu değerlendirildi. Olguların
dosyaları; yaş, cinsiyet, etiyoloji, cerrahi endikasyonlar, uygulanan cerrahi prosedür ve postoperatif komplikasyonlar
açısından incelendi. Hastalar primer spontan pnömotoraks ve sekonder spontan pnömotoraks grupları olmak üzere
iki grupta değerlendirildi ve gruplar birbirleri ile karşılaştırıldı. İlk epizodda hastaların 17’si opere edildi. Kalan 73
hastanın 24’ünde rekurrens görüldü. Rekurrens gelişen hastaların 15’i ikinci veya üçüncü epizodlarında opere edildi.
Toplam otuziki olgu operasyona gitti. Postoperatif 6 (%18.7) olguda komplikasyon gelişti. Bu olgulardan biri
ampiyem ve kardio-respiratuvar yetmezlik nedeniyle kaybedildi. Opere olan olgularda nüks görülmedi. İlk epizodda
uzamış hava kaçağı veya diğer nedenler ile opere edilen hastalar dışındaki 73 hastanın %65.8’inde rekurrens
görülmedi. İkinci epizod gelişme insidansı %34.2, üçüncü epizod gelişme insidansı %61.1 olarak hesaplandı.
Sonuç: Spontan pnömotoraksta primer tedavi yaklaşımı tüp torakostomidir. İkinci epizod ile gelen ve non- cerrahi
tedavi uygulanan hastalarda yeni bir nüks olasılığı %50’den fazladır. Dolayısıyla ikinci epizodda cerrahi tedavi daha
ön planda tutulabilir. Cerrahi yaklaşım, spontan pnömotoraksta düşük morbidite ve mortalite oranı ile etkin ve
güvenilir tedavi yöntemidir.
In patients with spontaneous pneumothorax, the primary therapeutic approach is chest tube thoracostomy. Prolonged air leak and recurrent pneumothorax are the main indications for the operative procedure. Material Method: In this study 90 patients that were treated at Inönü University, Turgut Özal Medical Center, Department of Thoracic Surgery between January 1999- December 2004 were retrospectively reviewed. Patients were evaluated according to age, gender, localization, etiology of pneumothorax, indications for the operation, operative procedures, and postoperative complications were analyzed. Seventeen patients were operated for the first episode. In 24 patients of 73 patients managed without surgery, recurrent pneumothorax was developed. Of these patients, 15 were operated on for their second or third episode. Thirty-two patients underwent to the operative procedures. In six patients, postoperative complications developed. Complication rate was %18.7. One of them died because of empyema and cardio-respiratuar failure. No recurrence was noted in operated patients. The second episode incidence was 34.2%, the third episode incidence was %61.1. Conclusion: In patients with spontaneous pneumothorax, primary the therapeutic approach is chest tube thoracostomy. If the patients are not managed surgically for second episode , recurrence rate is over 50% for the third episode. Therefore surgical intervention should be considered for the second episode. In properly selected cases, operative procedures are therapeuticly effective and associated with low morbidity rate and low mortality rate and low recurrence rate.
In patients with spontaneous pneumothorax, the primary therapeutic approach is chest tube thoracostomy. Prolonged air leak and recurrent pneumothorax are the main indications for the operative procedure. Material Method: In this study 90 patients that were treated at Inönü University, Turgut Özal Medical Center, Department of Thoracic Surgery between January 1999- December 2004 were retrospectively reviewed. Patients were evaluated according to age, gender, localization, etiology of pneumothorax, indications for the operation, operative procedures, and postoperative complications were analyzed. Seventeen patients were operated for the first episode. In 24 patients of 73 patients managed without surgery, recurrent pneumothorax was developed. Of these patients, 15 were operated on for their second or third episode. Thirty-two patients underwent to the operative procedures. In six patients, postoperative complications developed. Complication rate was %18.7. One of them died because of empyema and cardio-respiratuar failure. No recurrence was noted in operated patients. The second episode incidence was 34.2%, the third episode incidence was %61.1. Conclusion: In patients with spontaneous pneumothorax, primary the therapeutic approach is chest tube thoracostomy. If the patients are not managed surgically for second episode , recurrence rate is over 50% for the third episode. Therefore surgical intervention should be considered for the second episode. In properly selected cases, operative procedures are therapeuticly effective and associated with low morbidity rate and low mortality rate and low recurrence rate.
Açıklama
İnönü Üniversitesi Tıp Fakültesi Dergisi
12(3)169-172 (2005)
Anahtar Kelimeler
Pnömotoraks, Rekurrens, Cerahi, Tedavi, Pneumothorax, Recurrent, Surgery, Treatment
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kuzucu, Akın ;Soysal, Ömer ;Ulutaş, Hakkı ;İnönü Üniversitesi Tıp Fakültesi Dergisi 12(3)169-172 (2005)
