Video Yardımlı Torakoskopik Perikardiyal Pencere Uygulamasında Karşılaşılan Zorluklar için Öneriler

Yıl 2022, Cilt: 6 Sayı: 2, 197 - 202, 30.08.2022

Selçuk Gürz Serkan Burç Deşer Necmiye Gül Temel

https://doi.org/10.46332/aemj.1002463

Öz

Amaç: Perikardiyal pencere, tekrarlayan perikardiyal efüzyonu tedavi etmek için kullanılır. Bu çalışmada, günümüzde daha çok öne çıkan video yardımlı torakoskopik cerrahi (VATS) kullanılarak perikardiyo-plevral pencere (PPF) uygulamalarında yaşanan sorunların ve çözüm önerilerinin değerlendirilmesi amaçlanmıştır.

Araçlar ve Yöntem: Temmuz 2018 - Aralık 2020 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi'nde VATS PPF uygulanan toplam 8 hasta (3 erkek, 5 kadın; ortanca yaş: 51.8 yıl, aralık: 23-65 yıl), retrospektif olarak değerlendirildi ve bulgular literatürde bildirilen sonuçlarla karşılaştırıldı.

Bulgular: Ekokardiyografide inferior duvara komşu ölçülen sıvı ile boşaltılan perikardiyal sıvı miktarı arasında istatistiksel olarak anlamlı pozitif korelasyon vardı (p=.032). Daha kısa cerrahi süre, sağ lateral 45° pozisyon ve tek port müdahaleleri ile korele idi (p=.020). Göğüs tüpünün ortalama çıkarılma süresi 3,1 gün (min: 2,0-maks: 7,0) ve ortalama taburcu olma süresi 6,1 gündü (min: 3,0-maks: 10,0).

Sonuç: Sağ lateral 45° pozisyonda tek port ile 4. interkostal aralıktan gerçekleştirilen VATS PPF, tedavi şekline rağmen tekrarlayan perikardiyal efüzyonu olan hastalarda güvenle kullanılabilecek cerrahi tedavi yöntemidir.

Anahtar Kelimeler

perikardiyal efüzyon, perikardiyal fenestrasyon, VATS

Recommendations for Overcoming Difficulties in Video Assisted Thoracoscopic Pericardial Fenestration

Öz

Purpose: Pericardial fenestration is used to treat recurrent pericardial effusion. This study aimed to assess the issues and solutions in pericardio-pleural fenestration (PPF) applications using video-assisted thoracoscopic surgery (VATS), which is more prominent today.

Materials and Methods: Between July 2018 and December 2020, a total of 8 patients (3 males, 5 females; median age: 51.8 years, range: 23–65 years), who underwent VATS PPF in the Ondokuz Mayıs University Faculty of Medicine, were retrospectively evaluated using the hospital database and the findings were compared with the results reported in previous literature.

Results: The amount of pericardial fluid drained and the measurement of fluid next to the inferior wall on echocardiography had a statistically significant positive and high correlation (p=.032). Shorter surgical time was correlated with the right lateral 45° position and single port interventions (p=.020). The average time to remove the chest tube was 3.1 days (min: 2.0-max: 7.0), and the average time to discharge was 6.1 days (min: 3.0-max: 10.0).

Conclusion: VATS PPF conducted through the 4th intercostal space with a single port in the right lateral 45° position is a procedure that can be safely used in patients with recurrent pericardial effusion, despite the type of therapy. 

Anahtar Kelimeler

pericardial effusion, pericardial fenestration, VATS

Kaynakça

• 1. Mouton W, Miirmann J, Mouton K. Survival Following Video-Assisted Thoracic and Mini-Thoracotomy Pericardial Fenestration. Int Surg. 2018;103(3-4):222-226.
• 2. Georghiou G, Stamler A, Sharoni E, et al. Video-assisted thoracoscopic pericardial window for diagnosis and management of pericardial effusions. Ann Thorac Surg. 2005;80(2):607-610.
• 3. Geissbuhler K, Leiser A, Fuhrer J, Ris H. Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions. Eur J Cardiothorac Surg. 1998;14(4):403-408.
• 4. Miller J. Therapeutic Thoracoscopy - New Horizons for an Established Procedure. Ann Thorac Surg. 1991;52(5):1036-1037.
• 5. Sagrista-Sauleda J, Angel J, Permanyer-Miralda G, Soler-Soler J. Long-term follow-up of idiopathic chronic pericardial effusion. New Engl J Med. 1999;341(27):2054-2059.
• 6. Fernandez J, Robles R, Acosta F, Sansano T, Parrilla P. Cardiovascular changes during drainage of pericardial effusion by thoracoscopy. Brit J Anaesth. 2004;92(1):89-92.
• 7. Dogusoy I, Koc T, Demirbag H, et al. Comparison of VATS and thoracotomy in treatment of patients with pericardial effusion. Turk Gogus Kalp Dama. 2011;19(4):607-612.
• 8. Ohuchi M, Inoue S, Ozaki Y, Namura Y, Ueda K. Single-trocar thoracoscopic pericardio-pleural fenestration under local anesthesia for malignant pleural effusion: a case report. Surg Case Rep. 2019;5(1):136.
• 9. Gonzalez-Rivas D, Stupnik T, Fernandez R, et al. Intraoperative bleeding control by uniportal video-assisted thoracoscopic surgerydagger. Eur J Cardiothorac Surg. 2016;49(1):17-24.
• 10. Caspari G, Bartel T, Mohlenkamp S, et al. [Contrast medium echocardiography-assisted pericardial drainage]. Herz. 2000;25(8):755-760.
• 11. Fibla J, Molins L, Mier J, Vidal G. Pericardial window by videothoracoscope in the treatment of pericardial effusion and tamponade. Cir Esp. 2008;83(3):145-148.
• 12. Bary M, Abdel-aal K, Mohamed R, Abdel-maboud A, Helmy A. Video-assisted thoracoscopic pericardial window for massive pericardial effusion: South Egypt experience. Journal of the Egyptian Society of CardioThoracic Surgery. 2017;25(1):73-78.