NÜKS PRİMER SPONTAN PNÖMOTORAKS TEDAVİSİNDE İKİ FARKLI MEKANİK PLEVRAL ABRAZYON YÖNTEMİNİN KARŞILAŞTIRILMASI

Year 2021, Volume: 28 Issue: 3, 385 - 390, 13.09.2021

Hıdır Esme

https://doi.org/10.17343/sdutfd.747906

Abstract

Amaç
Nüks primer spontan pnömotoraksın cerrahi tedavisi,
apikal bül rezeksiyonu ve plörodezisi içerir. Postoperatif
nüks oranları %5 ile %10 arasında bildirilmektedir.
Bu çalışmada, kliniğimizde uyguladığımız iki farklı mekanik
plevral abrazyon yönteminin etkinliğini ve nüks
oranlarını karşılaştırmayı amaçladık.
Gereç ve Yöntem
Ocak 2012 ve Aralık 2019 tarihleri arasında 112 hastaya
primer spontan pnömotoraks için cerrahi tedavi
olarak videotorakoskopik bül rezeksiyonu ve paryetal
plevra abrazyonu uygulandı. Hastaların yaş, cinsiyet,
sigara içme hikayesi, ameliyat nedeni, ameliyatta bül
varlığı, plörodez yöntemi, göğüs tüpü drenaj süresi,
hastanede yatış süresi, ameliyat sonrası komplikasyonlar,
ameliyat sonrası nüks ve takipleri geriye dönük
olarak incelendi.
Bulgular
Ameliyat endikasyonu, hastaların 91’inde (%81.2) nüks
pnömotoraks iken 21’inde (%18.7) 7 günden fazla devam
eden uzamış hava kaçağı idi. Paryetal plevraya
mekanik plöredezis için abrazyon; 38 (%33.9) hastada
gazlı bez ile uygulanırken, 74 (%66.1) hastada steril
zımpara ile uygulandı. Paryetal plevra abrazyonu için
steril zımpara kullandığımız grupta göğüs tüpü drenaj
süresi, gazlı bez kullandığımız gruba göre istatistiksel
olarak anlamı derecede yüksekti. Ancak steril zımpara
kullandığımız grupta, nüks ve takip süresi istatistiksel
olarak anlamlı derecede düşüktü. Diğer parametreler
açısından iki grup arasında istatistiksel olarak anlamlı
bir ilişki saptanmadı.
Sonuç
Sonuç olarak nüks primer spontan pnömotoraks veya
uzamış hava kaçağı tedavisinde videotorakoskopik
bül rezeksiyonu ve plevral abrazyon, düşük nüks oranı
ile güvenli bir yöntemdir. Ayrıca paryetal plevra abrazyonu
için steril zımpara kullanımı göğüs tüpü drenaj
süresini bir miktar artırmakla birlikte daha az nüks oranına
sahiptir.

Keywords

Primer spontan pnömotoraks, nüks, plevral abrazyon

COMPARISON OF TWO DIFFERENT MECHANICAL PLEURAL ABRASION METHODS IN THE TREATMENT OF RECURRENT PRIMARY SPONTANEOUS PNEUMOTHORAX

Abstract

Objective
Surgical treatment of recurrent primary spontaneous
pneumothorax involves resection of apical bulla and
pleurodesis. Postoperative recurrence rates between
5 and 10% are reported. In this study, we aimed to
compare the effectiveness and recurrence rates of two
different mechanical pleural abrasion methods that we
applied in our clinic.
Materials and Methods
Between January 2012 and December 2019, 112
patients underwent videothoracoscopic bullectomy
and parietal pleural abrasion as a surgical treatment
for primary spontaneous pneumothorax. Patients' age,
gender, smoking history, reason for surgery, presence
of bulla in surgery, pleurodesis method, chest tube
drainage time, length of hospital stay, postoperative
complications, postoperative recurrence and follow-up
were retrospectively analyzed.
Results
The indication for surgery was recurrent pneumothorax
in 91 (81.2%) of the patients, while prolonged air
leakage continued for more than 7 days in 21 (18.7%)
patients. For mechanical pleurodesis to the parietal
pleura, 38 (33.9%) patients were abrasion with
gauze, while 74 (66.1%) patients were performed with
sterile sandpaper. In the group where we used sterile
sandpaper for parietal pleural abrasion, the chest tube
drainage time was statistically significantly higher
than the group in which we used gauze. However,
the recurrence and follow-up time was statistically
significantly lower in the group in which we used
sterile sandpaper. There was no statistically significant
relationship between the two groups in terms of other
parameters.
Discussion
In conclusion, videothoracoscopic bullectomy and
pleural abrasion is a safe method with low recurrence
in the treatment of recurrent primary spontaneous
pneumothorax or prolonged air leakage. In addition, the
use of sterile sandpaper for parietal pleural abrasion
increases the chest tube drainage time slightly but has
less recurrence rate.

Keywords

Primary spontaneous pneumothorax, recurrent, pleural abrasion

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