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HEPATİK HİDROTORAKSA GÖĞÜS CERRAHİ BAKIŞ AÇISI

Yıl 2017, Cilt: 31 Sayı: 1, 25 - 32, 01.05.2017

Öz

Giriş: Hepatik hidrotoraks karaciğer transplantasyonu yapılan merkezlerde sık karşılaşılan, tedavisi medikal ve/veya cerrahi olan klinik bir antite olup, göğüs cerrahisi uzmanlarının konsültasyon istenme gerekçelerindendir. Çalışmamızın amacı karaciğer nakli yapılan hasta grubumuzda preoperatif ve erken postoperatif dönemde görülebilen hepatik hidrotoraks sıklığını saptamak, tedavi sürecimizi gözden geçirmek, tedavi süreci ve sonuçlarını paylaşmaktır. Gereç ve Yöntem: Hastanemiz karaciğer nakil ekibi tarafından Mart 2012-Aralık 2015 tarihleri arasında karaciğer transplantasyonu gerçekleştirren 172 hastanın (97 erkek, 75 kadın; ortalama yaş 52,56±12,1) sonuçları retrospektif olarak değerlenirildi. Hastaların demografik, klinik, radyolojik özellikleri irdelendi. Hastalar efüzyon miktarına göre evrelendi. Durumun yoğun bakım, hastanede yatış süresine ve mortaliteye etkisi incelendi. Bulgular: Preoperatif hidrotoraks olan hastalarda postoperatif hidrotoraks görülme ihtimalinin de yüksek olduğu izlendi (p=0.033). Preoperatif dönemde efüzyon saptanan hastaların %25,5ine, postoperatif dönemde efüzyon saptanan hastaların %29,9una grade 2 olduğu için drenaj uygulandı. Preoperatif veya postoperatif hidrotoraks gelişimi ile hastaların yoğun bakımda yatış süresi, hastanede kalma süresi ve mortalite oranları arasında anlamlı fark bulunmadı. Tartışma: Sadece grade 2 olarak tanımladığımız hasta grubuna drenaj uygulayarak iyi sonuçlara ulaşılabileceğini gösterdiğimiz çalışmada; sonuçlarımızın hepatik hidrotoraks sebebiyle danışılan göğüs cerrahlarına yaklaşım konusunda yardımcı olacağı görüşündeyiz.

Kaynakça

  • 1. Badillo R, Rockey DC. Hepatic hydrothorax: clinical features, management, and outcomes in 77 patients and review of the literature. Medicine (Baltimore) 2014; 93(3): 135-42.
  • 2. Garcia N Jr, Mihas AA.Hepatic hydrothorax: pathophysiology, diagnosis, and management. J Clin Gastroenterol 2004; 38(1): 52-8.
  • 3. Cardenas A, Kelleher T, Chopra S. Review article: hepatic hydrothorax. Aliment Pharmacol Ther 2004; 20(3): 271-9.
  • 4. Doraiswamy V, Riar S, Shrestha P, Pi J, Alsumrain M, Bennet-Venner A et al. Hepatic hydrothorax without any evidence of ascites. ScientificWorldJournal 2011; 7(11): 587-91.
  • 5. Serrat J, Roza JJ, Planella T.Hepatic hydrothorax in the absence of ascites: respiratory failure in a cirrhotic patient. Anesth Analg 2004; 99(6): 1803-4.
  • 6. Imai D, Ikegami T, Toshima T, Yoshizumi T, Yamashita Y, Ninomiya M et al. Preemptive thoracic drainage to eradicate postoperative pulmonary complications after living donor liver transplantation. J Am Coll Surg 2014; 219(6): 1134-42.
  • 7. Bağlar E, Türkay C. Hepatopulmoner Sendrom. Güncel Gastroenteroloji 2012; 41:147-155.
  • 8. Siddappa PK, Kar P. Hepatic hydrothorax. Trop Gastroenterol 2009; 30(3): 135-41.
  • 9. Krok KL, Cárdenas A. Hepatic hydrothorax. Semin Respir Crit Care Med 2012; 33(1): 3-10.
  • 10. Cerfolio RJ, Bryant AS. Efficacy of videoassisted thoracoscopic surgery with talc pleurodesis for porous diaphragm syndrome in patients with refractory hepatic hydrothorax. Ann Thorac Surg 2006; 82(2): 457-9.
  • 11. Golfieri R, Giampalma E, Morselli Labate AM, d'Arienzo P, Jovine E, Grazi GL et al. Pulmonary complications of liver transplantation: radiological appearance and statistical evaluation of risk factors in 300 cases. Eur Radiol 2000; 10(7): 1169-83.
  • 12. Tekin Y, Güngör A. Asbest ile ilişkili plevra ve akciğer hastalıkları. Klinik Gelişim 2010; 23(4): 49-55.
  • 13. Jain A, Reyes J, Kashyap R, Dodson SF, Demetris AJ, Ruppert K et al. Long term survival after liver transplantation in 4,000 consecutive patients at a single center. Ann Surg 2000; 232(4): 490-500.
  • 14. Bozbas SS, Eyuboglu FO, Ozturk Ergur F, Gullu Arslan N, Sevmis S et al. Pulmonary complications and mortality after liver transplant. Exp Clin Transplant 2008; 6(4): 264-70.
  • 15. Juang SE, Chen CL, Liao WT, Wang CH, Cheng KW, Huang CJ et al. Two cases of massive pleural effusion noted only after induction of anesthesia in living donor liver transplantation. J Anesth 2011; 25(3): 418-21.
  • 16. Russo MW, Levi DM, Pierce R, Casingal V, Eskind L, deLemos A et al. Prospective study of a protocol that reduces readmission after liver transplantation. Liver Transpl 2016; 22(6): 765-72.
  • 17. Yataco M, Cowell A, David W, Keaveny AP, Taner CB, Patel T. Predictors and impacts of hospital readmissions following liver transplantation. Ann Hepatol 2016; 15(3): 356- 62.
  • 18. Caragata R, Wyssusek KH, Kruger P. Acute kidney injury following liver transplantation: a systematic review of published predictive models. Anaesth Intensive Care 2016; 44(2): 251-61.
  • 19. Klaus F, Keitel da Silva C, Meinerz G, Carvalho LM, Goldani JC, Cantisani G et al. Acute kidney injury after liver transplantation: incidence and mortality. Transplant Proc 2014; 46(6): 1819- 21.

PERSPECTIVE OF THORACIC SURGEONS ON HEPATIC HYDROTHORAX

Yıl 2017, Cilt: 31 Sayı: 1, 25 - 32, 01.05.2017

Öz

Introduction: Hepatic hydrothorax treated medically and/or surgically which is frequently encountered in liver transplant centers is one of the indications thoracic surgeons are called for consultations. The aim of our study is to estimate the rate of hepatic hydrothorax in our transplant cases in the pre-posttransplant period, to make an overview of our treatment protocol and to assess the effect of treatment and its results. Material and Methods: Data of 172 hepatic transplant patients(97 male,75 female;mean age: 2.56±12.1) operated between March 2012- December 2015 were retrospectively reviewed. Demographic, clinical and radiologic features were evaluated. Patients were graded according to the volume of effusion. Taking surgical interventions into consideration, the role of the presence of hepatic hydrothorax was evaluated with respect to intensive care, hospital stay, morbidity and mortality. Results: atients who had preoperative hydrothorax tended to have more frequent hydrothorax postoperatively (p=0.03). 25.2% of preoperatively determined hydrothorax patients, and 29.9% of postperative hydrothorax patients underwent thoracic drainage owing to their grade was2. Hepatic hydrothorax didnt affect duration of stay in postoperative intensive care unit and hospital, and mortality. Conclusion: Our study that we reached good results by performing drainage to patients described grade2, may provide a perspective to consultant thoracic surgeons in the management of hepatic hydrothorax.

Kaynakça

  • 1. Badillo R, Rockey DC. Hepatic hydrothorax: clinical features, management, and outcomes in 77 patients and review of the literature. Medicine (Baltimore) 2014; 93(3): 135-42.
  • 2. Garcia N Jr, Mihas AA.Hepatic hydrothorax: pathophysiology, diagnosis, and management. J Clin Gastroenterol 2004; 38(1): 52-8.
  • 3. Cardenas A, Kelleher T, Chopra S. Review article: hepatic hydrothorax. Aliment Pharmacol Ther 2004; 20(3): 271-9.
  • 4. Doraiswamy V, Riar S, Shrestha P, Pi J, Alsumrain M, Bennet-Venner A et al. Hepatic hydrothorax without any evidence of ascites. ScientificWorldJournal 2011; 7(11): 587-91.
  • 5. Serrat J, Roza JJ, Planella T.Hepatic hydrothorax in the absence of ascites: respiratory failure in a cirrhotic patient. Anesth Analg 2004; 99(6): 1803-4.
  • 6. Imai D, Ikegami T, Toshima T, Yoshizumi T, Yamashita Y, Ninomiya M et al. Preemptive thoracic drainage to eradicate postoperative pulmonary complications after living donor liver transplantation. J Am Coll Surg 2014; 219(6): 1134-42.
  • 7. Bağlar E, Türkay C. Hepatopulmoner Sendrom. Güncel Gastroenteroloji 2012; 41:147-155.
  • 8. Siddappa PK, Kar P. Hepatic hydrothorax. Trop Gastroenterol 2009; 30(3): 135-41.
  • 9. Krok KL, Cárdenas A. Hepatic hydrothorax. Semin Respir Crit Care Med 2012; 33(1): 3-10.
  • 10. Cerfolio RJ, Bryant AS. Efficacy of videoassisted thoracoscopic surgery with talc pleurodesis for porous diaphragm syndrome in patients with refractory hepatic hydrothorax. Ann Thorac Surg 2006; 82(2): 457-9.
  • 11. Golfieri R, Giampalma E, Morselli Labate AM, d'Arienzo P, Jovine E, Grazi GL et al. Pulmonary complications of liver transplantation: radiological appearance and statistical evaluation of risk factors in 300 cases. Eur Radiol 2000; 10(7): 1169-83.
  • 12. Tekin Y, Güngör A. Asbest ile ilişkili plevra ve akciğer hastalıkları. Klinik Gelişim 2010; 23(4): 49-55.
  • 13. Jain A, Reyes J, Kashyap R, Dodson SF, Demetris AJ, Ruppert K et al. Long term survival after liver transplantation in 4,000 consecutive patients at a single center. Ann Surg 2000; 232(4): 490-500.
  • 14. Bozbas SS, Eyuboglu FO, Ozturk Ergur F, Gullu Arslan N, Sevmis S et al. Pulmonary complications and mortality after liver transplant. Exp Clin Transplant 2008; 6(4): 264-70.
  • 15. Juang SE, Chen CL, Liao WT, Wang CH, Cheng KW, Huang CJ et al. Two cases of massive pleural effusion noted only after induction of anesthesia in living donor liver transplantation. J Anesth 2011; 25(3): 418-21.
  • 16. Russo MW, Levi DM, Pierce R, Casingal V, Eskind L, deLemos A et al. Prospective study of a protocol that reduces readmission after liver transplantation. Liver Transpl 2016; 22(6): 765-72.
  • 17. Yataco M, Cowell A, David W, Keaveny AP, Taner CB, Patel T. Predictors and impacts of hospital readmissions following liver transplantation. Ann Hepatol 2016; 15(3): 356- 62.
  • 18. Caragata R, Wyssusek KH, Kruger P. Acute kidney injury following liver transplantation: a systematic review of published predictive models. Anaesth Intensive Care 2016; 44(2): 251-61.
  • 19. Klaus F, Keitel da Silva C, Meinerz G, Carvalho LM, Goldani JC, Cantisani G et al. Acute kidney injury after liver transplantation: incidence and mortality. Transplant Proc 2014; 46(6): 1819- 21.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Diğer ID JA34ZJ29NP
Bölüm Araştırma Makalesi
Yazarlar

Tugba Cosgun Bu kişi benim

Ali Özer Bu kişi benim

Hikmet Aktaş Bu kişi benim

Gül Dabak Bu kişi benim

Remzi Emiroğlu Bu kişi benim

Yayımlanma Tarihi 1 Mayıs 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 31 Sayı: 1

Kaynak Göster

APA Cosgun, T., Özer, A., Aktaş, H., Dabak, G., vd. (2017). HEPATİK HİDROTORAKSA GÖĞÜS CERRAHİ BAKIŞ AÇISI. İzmir Göğüs Hastanesi Dergisi, 31(1), 25-32.