TORAKOTOMİ TEKRARINA NEDEN OLAN POSTOPERATİF KOMPLİKASYONLAR VE TEDAVİ SONUÇLARI

Öz

Çalışmamızda 2004-2011 yılları arasında akciğer veya mediasten hastalığı nedeniyle torakotomi geçiren hastalardan, gelişen komplikasyonlar nedeniyle torakotomi tekrarına başvurduğumuz olgular geriye dönük olarak incelendi. Kliniğimizde 2004-2011 yılları arasında, 1182 olguya torakotomi uygulandı. Gelişen komplikasyonlar nedeniyle retorakotomiye aldığımız 25 olgu çalışmaya dahil edildi. Olgular ameliyat endikasyonu, yaş, cinsiyet, retorakotomi endikasyonu, retorakotomi sırasında yapılan cerrahi girişim, retorakotomi zamanı, retorakotomi sonrası komplikasyonlar açısından değerlendirildi. Retorakotomiye alınan 25 olgunun 11’i kadın (%44), 14’ü erkekti (%56). Yaş aralığı 14-66 arasında ve ortalama yaş 43.4 olarak tesbit edildi. Olguların ilk ameliyat tanılarında 8 olgu malign, 17 olgu bening tanılı olduğu görüldü. Olguların 15’inde (%60) kanama nedeniyle retorakotomi uygulandı. En sık kanama nedeni, toraks duvarı kaynaklıydı (8 olgu, %53.3). Retorakotomi, olguların 17’sinde postoperatif ilk 3-4. günlerde gerçekleştirilirken, diğer olgularda postoperatif 8. günden sonra gerçekleştirildi. Retorakotomili olguların hastanede yatış süreleri uzadı. Bu olgularda taburculuk süresi retorakotomiden sonra 6-42 ( ortalama 14.2±5.8) gün arasında değişti. Kanama, toraks cerrahisi sonrası, en sık rastladığımız komplikasyondur. Torakotomili olguların postoperatif dönemde çok iyi takibi gerekir. Retorakotomi gereken durumlarda çok hızlı davranılması gerekmektedir. Ayrıca diğer cerrahi komplikasyonların erken tesbiti sağlanmalıdır. Böylece, komplikasyonlu olguların retorakotomi ve revizyonuyla, mortalite ve morbidite önlenmiş olacaktır.

Anahtar Kelimeler

• Torakotomi, torakotomi tekrarı, kanama, fistül

POSTOPERATIVE COMPLICATIONS WHICH CAUSES RETHORACOTOMY AND THE RESULTS OF TREATMENT

Abstract

In our study, we evaluated patients who underwent rethoracotomy between 2004-2011 due to postoperative complications following surgery for lung or mediastinal diseases, retrospectively. In our clinic, 1182 patients underwent thoracotomy between 2004-2011 years. Because of postoperative complications 25 of these patients (%2.1) was rethoracotomy. The cases were evaluated according to operative indication, age, gender, indication for rethoracotomy, the time of rethoracotomy, the complications of rethoracotomy and the surgical procedure during rethoracotomy. Totally 25 patients underwent rethoracotomy, of these 11 (%44) were women and 14 men (%56). The age range was between 14-66, and the average age was determined of 43.4. Initial operations had been performed for malign and benign diseases in 8 and 17 patients. Rethoracotomy was performed in 15 patients (%60) due to postoperative bleeding. The most common cause of bleeding, chest wall originated (8 cases, 53.3%). In 17 cases rethoracotomy was performed postoperative 3-4 days but the other cases were opereted on after postoperative 8th days. The lenght of hospital stay was delayed in these patients and the time of discharge after rethoracotomy have changed between 6-42 (mean 14.2 ± 5.8) days. The most commonly encountered complications after thoracic surgery is bleeding. The follow-up patients with thoracotomy in the postoperative period must be very good. Rethoracotomy must be treated very quickly when needed. In addition, early detection of the other surgical complications, should be provided. Thus, in patients with complications by means of rethoracotomy and revision mortality and morbidity will be prevented.

Keywords

• Thoracotomy, rethoracotomy, hemorrhage, fistula

Kaynakça

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