Çocuklarda Ampiyem Tedavisinde Tüp Torakostomi ile Torakoskopik Debridmanın Karşılaştırılması

Abstract

Amaç: Ampiyem çocuklarda, pnömoni sonrası gelişen önemli bir sorundur. Antibiyoterapi ve pürülan sıvının drenajı tedavinin temelini oluşturur. Drenaj amacıyla çeşitli yöntemler kullanılır. Minimal invaziv yöntemlerin de gelişmesiyle günümüzde torakoskopik debridman yaygın olarak kullanılmaktadır. Bu çalışmada, kliniğimizde torakoskopik debridman kullanılmaya başlamadan önceki dönemde ampiyem nedeniyle tedavi edilen olgularla, torakoskopik debridman kullanılmaya başladıktan sonraki dönemde tedavi edilen olgular karşılaştırılmışlardır.

Gereç ve yöntem: Bu amaçla kliniğimizde torakoskopik debridman öncesi olgular (Grup 1, n=25) ile torakoskopik debridman sonrası olgular (Grup 2, n=28) çeşitli yönleriyle karşılaştırılmışlardır. İlk gruptaki tüm olgulara tüp torakostomi uygulanırken, ikinci gruptaki olgulara öncesinde tüp torakostomi uygulansın ya da uygulanmasın torakoskopik debridman uygulanmıştır.

Bulgular: Torakoskopik debridman uygulanan grupta, uygulanmayan gruba göre ateş yüksekliği, lökositoz, solunum sıkıntısı ve pürülan drenaj daha kısa sürmüş, yani klinik iyileşme daha hızlı olmuştur. Torakoskopik debridman uygulanan grupta, uygulanmayan gruba göre tüp torakostomi süresi daha kısa, torakotomi ihtiyacı daha az saptanmıştır.

Sonuç: Torakoskopik debridman, çocuklarda ampiyemde iyileşmeyi hızlandırmaktadır. Bunda, plevral boşluktaki fibrin ve septasyonların kamera görüşü altında daha etkili ve hızlı debride edilmesi etkilidir. Bu nedenle ampiyem tedavisinde ilk seçenek zaman kaybetmeden torakoskopik debridman olmalıdır.

Keywords

• Ampiyem
• torakoskopi
• debridman
• tüp torakostomi
• çocuk

Comparison of tube thoracostomy and thoracoscopic debridement in the treatment of empyema in children

Abstract

Objective: Empyema is an important problem that develops after pneumonia in children. Antibiotherapy and drainage of purulent fluid form the basis of treatment. Various methods are used for drainage. Thoracoscopic debridement is widely used today with the development of minimally invasive methods. In this study, patients who were treated for empyema in the period before the use of thoracoscopic debridement in our clinic were compared with the patients who were treated in the period after the use of thoracoscopic debridement. Materials and methods: For this purpose, cases before thoracoscopic debridement (Group 1, n = 25) and patients after thoracoscopic debridement (Group 2, n = 28) were compared in various aspects. While tube thoracostomy was applied to all cases in the first group, thoracoscopic debridement was applied to the cases in the second group whether or not tube thoracostomy was applied. Results: Fever, leukocytosis, respiratory distress and purulent drainage lasted shorter in the group in which thoracoscopic debridement was applied, in other words, clinical improvement was faster. In the group in which thoracoscopic debridement was applied, the duration of tube thoracostomy was shorter and the need for thoracotomy was less than in the group not applied. Conclusion: Thoracoscopic debridement accelerates the recovery of empyema in children. In this, it is effective to debride fibrin and septations in the pleural space more effectively and quickly under the camera view. Therefore, thoracoscopic debridement should be the first option in the treatment of empyema without delay.

Keywords

• Empyema
• Thoracoscopic debridement
• Tube thoracostomy
• children

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