Plevral ampiyemlerin tedavisinde video-yardımlı torakoskopik cerrahinin rolü
Küçük Resim Yok
Tarih
2007
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ankara Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Plevral ampiyemler her yaş grubunu etkileyebilen ciddi bir sağlık problemidir ve tedavisinde halen standart bir yaklaşım yoktur. Bu çalışma plevral ampiyemlerin tedavisinde video-yardımlı torakoskopik cerrahi (VATS)’nin etkinliğini göstermek amacıyla yapıldı. Ocak 1997-Aralık 2004 tarihleri arasında ampiyem tanısı alan 83 hasta çalışmaya alındı. Olguların 54’ü erkek, 29’u kadın ve yaş ortalamaları 39.4 yıl idi. VATS öncesi şikayet süresi ortalama 27.3 gündü. Light’ın plevral efüzyon ve ampiyem sınıflamasına göre hastaların 22’si grup-5, 44’ü grup-6, 17’si grup-7 idi. VATS öncesi genel durumu bozuk 21 hastaya göğüs tüpü takıldı. On üç hastada çeşitli nedenlerle aynı seansta torakotomiye geçildi. VATS esnasında tüm hastalara debridman ve serum fizyolojik ile irrigasyon yapıldı. Tanı için plevra ve parankimden biyopsiler alındı. Elli sekiz (%69.9) hastada VATS ile kür sağlanırken, ortalama drenaj süresi 7.63 gündü. VATS sonrası dönemde ekspansiyon kusuru ve pakiplörit nedeniyle 12 hastada torakotomi gerekti. Torakotomi gerektiren bu olgulardan 10’u grup-7, ikisi ise grup6 idi. Torakotomi ihtiyacı açısından grup-7 ile diğer gruplar arasında istatistiksel anlamlı fark saptandı (p= 0.006). Postoperatif patolojik incelemede 60 (%72.3) olguda nonspesifik plörit, 19’unda kazeifiye granülomatöz plörit ve dördünde çeşitli tanılar elde edildi. Postoperatif mortalite olmadı; 14 hastada minör komplikasyonlar meydana geldi. Plevral ampiyemlerin tedavisinde VATS güvenilir ve etkin bir yöntemdir. Loküle ve septalı ampiyemlerin tedavisinde erken dönemde yapılan VATS ile debridman, ampiyemin kronikleşmesini önleyerek torakotomi ihtiyacını azaltır.
Pleural empyema is a serious problem which affects any age group and still there is no standart approach. Our purpose in this study was to assess the safety, feasibility and efficacy of the video-assisted thoracoscopic surgery (VATS). Between 1997 and 2004 83 patients with empyema were enrolled in this study. Fifty-four patients were male, 29 females and the mean age was 39.4. The mean duration time of symptoms before VATS was 27.3 days. Twenty-two patients were in group5, 44 in group-6 and 17 in group-7 according to Light’s classification of parapneumonic effusions and empyema. Twentyone patients underwent chest tube before VATS because of their conditions. VATS was converted to thoracotomy in 13 patients. All patients underwent debridement and irrigation during VATS. The cure was achieved in 58 (69.9%) patients with the mean 7.63 days drainage time. Twelve patients were underwent open decortication in the follow-up period. Ten of them were group-7 and 2 in group-6 (p= 0.006). The diagnosis was achieved in 60 (72.3%) patients as nonspecific pleuritis, tuberculosis in 19 and various diagnosis in 4. There was no mortality and minor complications occured in 14 patients. VATS is a safety and efficacy procedure in the treatment of early stage empyema. Use of VATS in early period of multiloculary empyema, prevents patients from unnecessary thoracotomies.
Pleural empyema is a serious problem which affects any age group and still there is no standart approach. Our purpose in this study was to assess the safety, feasibility and efficacy of the video-assisted thoracoscopic surgery (VATS). Between 1997 and 2004 83 patients with empyema were enrolled in this study. Fifty-four patients were male, 29 females and the mean age was 39.4. The mean duration time of symptoms before VATS was 27.3 days. Twenty-two patients were in group5, 44 in group-6 and 17 in group-7 according to Light’s classification of parapneumonic effusions and empyema. Twentyone patients underwent chest tube before VATS because of their conditions. VATS was converted to thoracotomy in 13 patients. All patients underwent debridement and irrigation during VATS. The cure was achieved in 58 (69.9%) patients with the mean 7.63 days drainage time. Twelve patients were underwent open decortication in the follow-up period. Ten of them were group-7 and 2 in group-6 (p= 0.006). The diagnosis was achieved in 60 (72.3%) patients as nonspecific pleuritis, tuberculosis in 19 and various diagnosis in 4. There was no mortality and minor complications occured in 14 patients. VATS is a safety and efficacy procedure in the treatment of early stage empyema. Use of VATS in early period of multiloculary empyema, prevents patients from unnecessary thoracotomies.
Açıklama
Anahtar Kelimeler
Ampiyem, VATS, Tüberküloz, Empyema, VATS, Tuberculosis
Kaynak
Tüberküloz ve Toraks Dergisi
WoS Q Değeri
Scopus Q Değeri
Q3
Cilt
55
Sayı
Künye
Eryiğit, H., Örki, A., Koşar, A., Akın, O., Kıral, H., Ürek, Ş. ve Arman, B. (2007). Plevral ampiyemlerin tedavisinde video-yardımlı torakoskopik cerrahinin rolü / The role of video-assisted thoracoscopic surgery in the treatment of pleural empyema. 55, s. 71-76.
