Öz
Amaç: Spontan hemopnömotoraks (SHP), nadir görülen bir
hastalıktır. Zamanında tanınmaz ve tedavi edilmezse hayatı tehdit
edebilir. Bu çalışmanın amacı SHP’ lı hastaların tedavisinde
kurumumuzun deneyimlerini paylaşmaktır.
Hastalar ve Yöntemler: Temmuz 2005-Mayıs 2017 yılları
arasında 610 adet spontan pnömotoraks hastası kliniğimize
başvurdu. Hastaların yaşı, cinsiyeti, etkilenen taraf, drenaj
miktarı, klinik bulguları ve tedavi sonuçları retrospektif olarak
değerlendirildi.
Bulgular: Tüm hastaların ön-arka akciğer (PA Akc) grafisi,
bilgisayarlı toraks tomografisi (BT), tam kan, biyokimya ve
koagulasyon testleri değerlendirildi. Tüm hastalara kapalı su altı
drenajı uygulandı. Altıyüz on hastadan 7 (%1,14)’sinde SHP tesbit
edildi. Toraks drenaj takibi sonrası 7 hasta operasyona alındı.
Üç hastaya video yardımlı torakoskopik cerrahi (VYTC), diğer
hastalara torakotomi yapıldı. Postoperatif komplikasyon olmadı.
Sonuç: Travma hikâyesi olmadan ani başlayan göğüs ağrısı ve
nefes darlığı olan hastalarda, radyografide pnömotoraksla beraber
sıvı seviyesi var ise SHP düşünülmelidir. İlk tedavi yaklaşımı
tüp torakostomi olmalıdır. Sonrasında, hasta yakın klinik ve
hemodinamik kontrol altında tutulmalı ve eğer kanama devam
ederse öncelikli olarak VATS veya acil torakotomi uygulanmalıdır.
Böylece erken tanı ve uygun cerrahi yaklaşımla gelişebilecek
ölümcül komplikasyonlar önlenebilir.
Anahtar Kelimeler
Kaynakça
- Homma T, Sugiyama S, Kotoh K, Doki Y, Tsuda M, Misaki T. Early surgery for treatment of spontaneous hemopneumothorax. Scand J Surg 2009; 98: 160-3. doi: 10.1177/145749690909800306
- Tatebe S, Kanazawa H, Yamazaki Y, Aoki E, Sakurai Y. Spontaneous hemo-pneumothorax. Ann Thorac Surg 1996;62:1011-5. doi: 10.1016/0003-4975(96)00445-6
- Calvin SH NG, Anthony PC Y. Spontaneous hemopneumothorax. Curr Opin Pulm Med 2006;12:273-7.
- Hsu CC, Wu YL, Lın HJ, et al. Indicators of haemothorax in patients with spontaneous pneumothorax. Emerg Med J 2005; 22: 415-7. doi: 10.1136/emj.2003.013441
- Abyholm F, Storen G. Spontaneous hemopneumothorax. Thorax 1973; 28:376-8.
- Kakamad F, Othman S. Primary spontaneous hemopneumothorax: A meta-analysis study. Edorium J Cardiothorac Vasc Surg 2016;2:6-11. doi: 10.5348/C04- 2016-10-OA-2
- Tulay CM, Aygün M. Emergency surgery for spontaneous hemopneumothorax. J Coll Physicians Surg Pak 2014;24:435- 47. doi: 06.2014/JCPSP.435437
- Tay CK, Yee YC, Asmat A. Spontaneous hemopneumothorax: Our experience with surgical management. Asian Cardiovasc Thorac Ann 2015;23:308-10. doi: 10.1177/0218492314561502
- Haciibrahimoglu G, Cansever L, Kocaturk C, Aydogmus U, Bedirhan MA. Spontaneous Hemopneumothorax: Is conservative treatment enough? Thorac Cardiovasc Surg 2005; 53: 240-2. doi: 10.1055/s-2005-837647
- Çobanoğlu U, Sayır F, Sertoğullarından B, Mergan, Aydın İ. Spontaneous Hemopneumothorax: Analysis of 8 cases. J Clin Anal Med 2012;3:59-62. doi: 10.4328/JCAM.561
- Ng CSH, Lee TW, Wan S, Yim APC. Video assisted thoracic surgery in the management of spontaneous pneumothorax: the current status. Postgrad Med J 2006;82:179-85. doi: 10.1136/pgmj.2005.038398
- Kim ES, Kang JY, Pyo CH, Jeon EY, Lee WB. 12 year experience of spontaneous hemopneumothorax. Ann Thorac Cardiovasc Surg 2008:14:149-53.
- Miyazawa M, Fujita T, Misawa R, et al. Thoracoscopic treatment for spontaneous hemo-pneumothorax. Surg Endosc 2002;16:1106. doi: 10.1007/s00464-001-4182-1
- Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinianidze L, Iqbal Y, Lawrence DR. Etiology and management of spontaneous hemothorax. J Thorac Dis 2015:7:520-6. doi: 10.3978/j.issn.2072-1439.2014.12.50
Öz
Objective: Spontaneous hemopneumothorax (SHP) may threaten
life unless timely diagnosed and appropriately treated. The aim
of this study was to review our institutional experience in the
management of patients with SHP.
Patients and Methods: We retrospectively analyzed age, gender,
the affected side, the amount of drainage, clinical findings, and
treatment outcomes of 610 patients with diagnosis of spontaneous
pneumothorax at emergency department. Later, they were admitted
to the Department of Thoracic Surgery, Dicle University Hospital.
Results: Posteroanterior chest radiographs, thoracic computed
tomography (CT) scans, biochemistry and coagulation test results of all
patients were evaluated. All patients underwent closed chest drainage.
Seven (1.14%) of 610 patients were diagnosed with SHP. These patients
underwent operation after thoracic drainage. Three of them were
operated by video-assisted thoracoscopic surgery (VATS) and the others
by thoracotomy. No postoperative complication was observed.
Conclusion: SHP should be considered in patients presenting
with sudden chest pain and dyspnea when there is air-fluid level
in addition to pneumothorax on radiography. The first treatment
approach should be the application of tube thoracostomy. Next
step should include close clinical and hemodynamic control and
be followed primarily by VATS or urgent thoracotomy in case of
continued bleeding. An early diagnosis and appropriate surgical
approach can prevent fatal complications.
Anahtar Kelimeler
Kaynakça
- Homma T, Sugiyama S, Kotoh K, Doki Y, Tsuda M, Misaki T. Early surgery for treatment of spontaneous hemopneumothorax. Scand J Surg 2009; 98: 160-3. doi: 10.1177/145749690909800306
- Tatebe S, Kanazawa H, Yamazaki Y, Aoki E, Sakurai Y. Spontaneous hemo-pneumothorax. Ann Thorac Surg 1996;62:1011-5. doi: 10.1016/0003-4975(96)00445-6
- Calvin SH NG, Anthony PC Y. Spontaneous hemopneumothorax. Curr Opin Pulm Med 2006;12:273-7.
- Hsu CC, Wu YL, Lın HJ, et al. Indicators of haemothorax in patients with spontaneous pneumothorax. Emerg Med J 2005; 22: 415-7. doi: 10.1136/emj.2003.013441
- Abyholm F, Storen G. Spontaneous hemopneumothorax. Thorax 1973; 28:376-8.
- Kakamad F, Othman S. Primary spontaneous hemopneumothorax: A meta-analysis study. Edorium J Cardiothorac Vasc Surg 2016;2:6-11. doi: 10.5348/C04- 2016-10-OA-2
- Tulay CM, Aygün M. Emergency surgery for spontaneous hemopneumothorax. J Coll Physicians Surg Pak 2014;24:435- 47. doi: 06.2014/JCPSP.435437
- Tay CK, Yee YC, Asmat A. Spontaneous hemopneumothorax: Our experience with surgical management. Asian Cardiovasc Thorac Ann 2015;23:308-10. doi: 10.1177/0218492314561502
- Haciibrahimoglu G, Cansever L, Kocaturk C, Aydogmus U, Bedirhan MA. Spontaneous Hemopneumothorax: Is conservative treatment enough? Thorac Cardiovasc Surg 2005; 53: 240-2. doi: 10.1055/s-2005-837647
- Çobanoğlu U, Sayır F, Sertoğullarından B, Mergan, Aydın İ. Spontaneous Hemopneumothorax: Analysis of 8 cases. J Clin Anal Med 2012;3:59-62. doi: 10.4328/JCAM.561
- Ng CSH, Lee TW, Wan S, Yim APC. Video assisted thoracic surgery in the management of spontaneous pneumothorax: the current status. Postgrad Med J 2006;82:179-85. doi: 10.1136/pgmj.2005.038398
- Kim ES, Kang JY, Pyo CH, Jeon EY, Lee WB. 12 year experience of spontaneous hemopneumothorax. Ann Thorac Cardiovasc Surg 2008:14:149-53.
- Miyazawa M, Fujita T, Misawa R, et al. Thoracoscopic treatment for spontaneous hemo-pneumothorax. Surg Endosc 2002;16:1106. doi: 10.1007/s00464-001-4182-1
- Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinianidze L, Iqbal Y, Lawrence DR. Etiology and management of spontaneous hemothorax. J Thorac Dis 2015:7:520-6. doi: 10.3978/j.issn.2072-1439.2014.12.50
Ayrıntılar
| Konular | Klinik Tıp Bilimleri |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 22 Ekim 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 30 Sayı: 3 |