PLEVRAL HASTALIKLARIN TANISINDA VATS’IN ETKİNLİĞİ

Year 2021, , 269 - 274, 15.06.2021

Kerim Tülüce , Gökçen Sevilgen

https://doi.org/10.17343/sdutfd.837596

Cited By: 1

Abstract

Plevral hastalıklar klinikte karşımıza plevral kalınlaşma
ve plevral efüzyon olarak çıkmaktadır. Plevral
efüzyon, plevral boşlukta sıvı birikmesidir. Çalışmamızda,
plevral efüzyon veya plevral kalınlaşma nedeni
ile kliniğimize yatırdığımız ve Video Yardımlı Torakoskopik
Cerrahi (VATS) yaptığımız hastaların klinik
özelliklerini ve postoperatif patolojik sonuçlarını literatür
bilgileri eşliğinde paylaşmayı amaçladık.
Gereç ve Yöntem
2017 Ocak ile 2020 Ekim arasında plevral efüzyon
ve plevral kalınlaşma nedeniyle Recep Tayyip Erdoğan
Üniversitesi Eğitim Araştırma Hastanesi Göğüs
Cerrahisi Kliniği’ne yatırılan ve VATS uygulanan 58
hastanın dosyaları retrospektif olarak incelendi. Hastaların
yaş, cinsiyet, hastanede yatış süreleri belirlendi.
Plevral sıvıların biyokimyasal testleri, sitolojileri,
plevral biyopsi sonuçları ve hastanede yatış süreleri
kaydedildi. Plevral biyopsilerin patolojileri malign ve
benign olarak ayrılıp karşılaştırmalı olarak incelendi.
Bulgular
VATS ile biyopsi yapılan 58 hastanın 42’si (%72,4)
erkek, 16’sı (%27,6) kadındı. Ortalama yaş 58,4
±16,2 idi. Erkeklerin yaş ortalaması 58,2, kadınların
yaş ortalaması ise 61,2 idi. Hastanede yatış süresi
ortalama 4,1±1,4 gün idi. Hastaların 12’sinde (%20
,6) plevral efüzyona eşlik eden plevral kalınlaşma
mevcuttu. Plevral sıvı sitolojilerine bakıldığında 44
(%75,8) hastanın benign, 14 (%24,2) hastanın malign
sitoloji olduğu görüldü. Biyopsi sonucu 17 (%29,3)
hastada malign iken 41 (%70,7) hasta benign olarak
değerlendirildi. Malign olarak sonuçlanan hastaların
11’i (%64,7) adenokarsinom idi. Benign sonuçların ise
29’u (%70,7) kronik aktif inflamasyon olarak sonuçlandı.
Sonuç
Analizlerimizin sonucunda, VATS’ın plevral hastalıkların
tanı ve tedavisinde güvenle kullanılabilecek efektif
minimal invaziv bir yöntem olduğunu düşünüyoruz.

Keywords

Plevral efüzyon, VATS, Biyopsi

Supporting Institution

Yok

EFFECTIVENESS OF VATS IN PLEURAL DISEASES

Abstract

Pleural diseases appears as pleural effusion or pleural
thickening in the clinics. Pleural effusion is accumulation
of fluid in the pleural space. In this study, we
aimed to share the clinical features and postoperative
pathological outcomes of patients who were hospitalized
for pleural effusion or pleural thickening and underwent
Video Assisted Surgery (VATS).
Materials and Methods
58 patients who were referred to Recep Tayyip Erdoğan
University Thoracic Surgery Department due
to pleural effusion or pleural thickening between retrospectively. Age, sex, pleural biopsy pathologies,
pleural fluid cytology and biochemical results and the
duration of hospitalization were recorded. Pleural biopsy
pathologies were classified as malign and benign
then they were compared.
Results
Of the 58 patients who underwent VATS, 42 (72,4%)
were male and 16 (27,6%) were female. The mean
age was 58,4 ±16,2. Median age for men was 58,2
and for women was 61,2. The mean duration of hospitalization
was 4,1±1,4 day. 12 patients (20,6%)
had pleural thickening accompanying pleural effusion.
Pleural fluid cytology was benign in 44 patients
(75,8%) and malignant in 14 patients (24,2%). Pleural
biopsy pathology was reported as benign in 41
patients (70,7%) and as malignant in 17 patients
(29,3%). Pleural fluid cytology was benign in 29 patients
(82.85%) and malignant in 6 patients (17.15%).
In patients with malignant pleural biopsy 11 (64,7%)
of them were adenocarcinoma. In patents with benign
pleural biopsy 29 (70,7%) of them were chronic active
inflamation.
Conclusion
As a result of our analysis we suggest that VATS is a
minimal invasive method that can be used effective
and safely in both diagnosis and treatment of pleural
disease.

Keywords

Pleural effusion, VATS, Biopsy

References

• 1. Hallifax RJ, Corcoran JP, Ahmed A, Nagendran M, Rostom H, Hassan N, et al. Physician-based ultrasound-guided biopsy for diagnosing pleural disease. Chest 2014;146:1001-6.
• 2. Ali SJ, Light RW, Maldonado F. Pleuroscopy or video-assisted thoracoscopic surgery for exudative pleural effusion: a comparative overview. J Thorac Dis 2019;11(7):3207-3216.
• 3. Atalay F, Ernam D, Atikcan Ş. Akciğer Kanseri ve Plevral Efüzyon. Solunum Hastalıkları 2001; 12: 274-278.
• 4. Loddenkemper R. Thoracoscopy: state of the art. Eur Respir J 1998; 11: 213-21.
• 5. Collins TR, Sahn SA. Thoracocentesis. Clinical value, complications, technical problems, and patient experience. Chest 1987;91:817-22.
• 6. Thomas M, Ibrahim WH, Raza T, Mushtaq K, Arshad A, Ahmed M, et al. Medical thoracoscopy for exudative pleural effusion: an eight-year experience from a country with a young population. BMC Pulm Med 2017;17:151.
• 7. Porcel JM, Gasol A, Bielsa S, Civit C, Light SW, Salud A. Clinical features and survival of lung cancer patients with pleural effusions. Respirology 2015;20:654-9.
• 8. Metintas M. Pleuroscopy. Turk Klin J Int Med Sci 2006; 2: 35- 41.
• 9. Hatzinger M, Kwon ST, Langbein S, Kamp S, Hacker A, Alken P. Hans Christian Jacobaeus: Inventor of human laparoscopy and thoracoscopy. J Endourol 2006;20:848-50.
• 10. Braimbridge MV. The history of thoracoscopic surgery. Ann Thorac Surg 1993;56:610-4.
• 11. Rahman NM, Ali NJ, Brown G, Chapman SJ, Davis RJO, Downer RJ, et al. Local anaesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65 Suppl 2:ii54-60.
• 12. Ernst A, Hersh CP, Herth F, Thurer R, LoCicero 3rd J, Beamis J, et al. A novel instrument for the evaluation of the pleural space: an experience in 34 patients. Chest 2002;122:1530-4.
• 13. Diaz-Guzman E, Dweik RA. Diagnosis and management of pleural effusions: a practical approach. Compr Ther Winter 2007; 33: 237-46.
• 14. Light RW. Pleural effusion. N Engl J Med 2002;346: 1971-7.
• 15. Ünlü M, Şahin Ü, Akkaya A, Doğan A. Plevral efüzyonların etyolojisinin araştırılması. Solunum Hastalıkları 2001; 12: 212-5.
• 16. Şenyiğit A, Işık FB, Coşkunsel N, Anık H, Özbay B, Topçu F. 305 plevral efüzyonlu vakanın incelenmesi. Solunum Hastalıkları 1996; 7: 395-404.
• 17. Kart L, Gülmez İ, Kiraz K, Demir R, Özesmi M. Plörezilerde etyolojik faktörler. Solunum Hastalıkları 1998; 9: 619-26.
• 18. Conner BD, Lee CG, Branca P, Rogers JT, Rodriguez RM, Light RW. Variations in pleural fluid WBC count and differential couts with different sample containers and different methods. Chest 2003; 123:1181-7.
• 19. Light RW. Pleural diseases. 4th ed. California: A WaWerly Co, 2001;1-196.
• 20. Heffner JE, Brown LK, Barbieri CA. Diagnostic value of test that discriminate between exudative and transudative pleural effusions. Chest 1997;111:970-80.
• 21. Kinasewitz, GT. Transudative pleural effusions. Eur Respir J 1997; 10: 714-718.
• 22. Sahn SA. State of the art. The pleura. Am Rev Respir Dis 1988; 138: 184- 234.
• 23. Yim AP, Chung SS, Lee TW, Lam CK, Ho JK. Thoracoscopic management of malignant pleural effusions. Chest 1996; 109:1234-8.
• 24. Boutin C, Rey F. Thoracoscopy in pleural malignant mesothelioma: A prospective study of 188 consecutive patients. Cancer 1993; 72: 389-93.
• 25. Wu H, Khosla R, Rohatgi PK, Chauhan SS, Paal E, Chen W. The minimum voluma of pleural fluid to diagnose malignant pleural effusion. A retrospective study. Lung India 2017;34:34
• 26. Bayrak MG, Erkan L, Uzun O, Fındık S, Atıcı AG, Özkaya Ş. Plevral Efüzyonlu 153 Hastanın Değerlendirilmesi. Solunum Hastalıkları 2006; 17: 66-72.
• 27. Köktürk O, Sezer Ö, Ekim NN, Türktaş H. Plevral Efüzyonlu 112 Olgunun Değerlendirilmesi. Gazi Tıp Dergisi 1990; 2: 90-5.
• 28. Öz N, Sarper A, Dertsiz L, Erdoğan A, Ertuğ Z, Demircan A, Işın E. Plevral Effüzyonlu Olgularda Tanı ve Tedavi Amaçlı Video Yardımlı Torasik Cerrahi. GKDC Dergisi 1998; 6: 351-356.
• 29. Hucker J, Bhatnagar NK, al-Jilaihawi AN, Forrester-Wood CP. Thoracoscopy in the diagnosis and management of recurrent pleural effusions. Ann Thorac Surg 1991; 52: 1145-7.
• 30. Kodak A, Öğüş AC, Özdemir T. Plevral sıvılarda transuda-eksuda ayırımında kolesterol değerleri ile serum-plevral sıvı albumin gradientinin Light kriterleri ile karşılaştırılması. Solunum 1999;3:100-2.
• 31. Tokgöz F, Göksenoglu N, Bodur Y, Aksoy E, Aktaş O, Sevim T. Retrospective Analysis of 240 Cases with Pleural Effusion. Eurasian J Pulmonol 2014; 16: 78-83.
• 32. Hamm H, Brohan U, Bohmer R, Missmahl HP. Cholesterol in pleural effusions-a diagnostic aid. Chest 1987;92:296-302.
• 33. Marel M, Stastny B, Melínová L, Svandová E, Light RW. Diagnosis of pleural effusions. Experience with clinical studies, 1986 to 1990. Chest 1995;107:1598-603.
• 34. Romero-Candeira S, Hernández L, Romero-Brufao S, Orts D, Fernández C, Martín C. Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions? Chest 2002;122:1524-9.
• 35. Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med 1991; 114: 271–276.
• 36. Chakrabarti B, Ryland I, Sheard J, Warburton CJ, Earis JE. The role of Abrams percutaneous pleural biopsy in the investigation of exudative pleural effusions. Chest 2006; 129: 1549–1555.
• 37. Sheth S, Hamper UM, Stanley DB, Wheeler JH, Smith PA. US guidance for thoracic biopsy: a valuable alternative to CT. Radiology 1999; 210: 721– 726.
• 38. Kürkçüoğlu C, Karaoğlanoğlu N, Eroğlu A, Ünlü M. Pleural effusions and video assisted thoracoscopy. J. Turk. Thorac. Cardiovasc. Surg. 8, 712-714.
• 39. Valchev D., Peeva K., Petrov D. Are postoperative pain and patient satisfaction influenced by the number of ports in VATS for malignant pleural effusion treatment? Postgraduate Med 2020, Vol. 132, No. 1, 62–65.
• 40. Dumanlı A., Öz G. Vats pleura biopsy experiences: Analysis of 35 cases. Med J SDU / SDÜ Tıp Fak Derg. 2020:27(3):261- 266.