Pediyatrik Toraks Patolojilerinde Minimal İnvaziv Cerrahi

Öz

Amaç: Çalışmanın amacı pediatrik yaş gruplarında cerrahi torasik patolojilerde minimal invaziv cerrahi seçenekleri göstermektir.Gereç ve Yöntemler: Tek cerrah tarafından torakoskopik ameliyat edilen 45 hasta retrospektif incelendi. Altta yatan cerrahi patolojiler, cerrahi yaklaşım ve anestezi bakış açıları ve postoperatif sonuçlar analiz edildi.Bulgular: On yıllık periyotta 45 çocuğa torakoskopik cerrahi yöntem uygulandı. Torakoskopik cerrahi yaklaşım, Konjenital Diyafragma Hernisi (KDH), Özofagus Atrezisi (ÖA), Konjenital Malformasyonlar, Pulmoner ve Mediastinal Kitleler, Ampiyem, Spontan Pnomotoraks ve İntertisyal Akciğer Hastalık tanısı olan hastalara uygulandı. Hastaların 21’I kız, 24’ü erkek cinsiyetteydi. KDH ve ÖA dışındaki çocukların ortalama yaşı 4,5 yaş’tır (n=33, 2ay-17yaş). KDH ve ÖA’li çocukların ortalama yaşı 5,5 gün’dür (n=12, 1gün- 8ay). Toplam 6 hastada açığa dönüldü.Ortalama göğüs tüpü çıkarılma süresi 6 gündür (1-24 gün). Hastanede yatma süresi ortalama 9 gündür (3-34 gün).Sonuç: Torakoskopi, çocuk yaş grubunda deneyimli ellerde uygulanabilir ve güvenli bir yaklaşımdır. Komplikasyonları önlemek için her çocuk ayrı ayrı değerlendirilmelidir.

Anahtar Kelimeler

• Konjenital Akciğer malformasyonları, Lobektomi, Minimal invaziv akciğer yaklaşımı, Torakoskopi

Minimal Invasive Surgery for Pediatric Thoracic Pathologies

Öz

Objective: The purpose of this study was to discuss minimal invasive surgical options for surgical thoracic pathologies in the pediatric age group.Material and Methods: A retrospective analysis was performed for 45 patients who had undergone thoracoscopic surgery by a single surgeon. The underlying pathologies, surgical procedures and anesthetic aspects and postoperative outcomes were analyzed. Results: Forty-five children underwent thoracoscopic surgery in a ten-year period. The conditions requiring thoracoscopic surgery were congenital diaphragmatic hernia (CDH), esophageal atresia (EA), congenital malformations, pulmonary and mediastinal masses, empyema, spontaneous pneumothorax, and interstitial lung diseases. There were 21 girls and 24 boys. The mean age of the children except the CDH and EA cases was 4.5 years (n=33, 2 months to 17 years). The mean age of the children with CDH and EA was 5.5 days (n=12, 1 day to 8 months). There were 6 conversions in total. The mean chest tube removal time was 6 days (1-24 days). The mean hospital stay was 9 days (3-34 days).Conclusion: Thoracoscopy in the pediatric age group is safe and feasible in experienced hands. Each child and condition should be evaluated individually to avoid complications

Anahtar Kelimeler

• Congenital lung malformations, Lobectomy, Minimal invasive lung surgery, Thoracoscopy

Kaynakça

1. Lau C, Leung J, Hui T, Wong K. Thoracoscopic operations in children. Hong Kong Med J 2014;20:234-40.
2. Huang YK, Chou C, Li CL, Chiu HG, Chang YT. Minimally invasive thoracic surgery in pediatric patients: The Taiwan experience. Biomed Res Int 2013;2013.
3. Lieber J, Urla CI, Baden W, Schäfer J, Kirschner H-J, Fuchs J. Experiences and challenges of thorcoscopic lung surgery in the pediatric age group. Int J Surg 2015;23:169-75.
4. Wang A, D’amico TA, Berry MF. Surgical management of congenital pulmonary malformations after the first decade of life. Ann Thorac Surg 2014;97:1933-8.
5. Kunisaki SM, Powelson IA, Haydar B, Bowshier BC, Jarboe MD, Mychaliska GB, et al. Thoracoscopic vs open lobectomy in infants and young children with congenital lung malformations. J Am Coll Surg 2014;218:261-70.
6. Seong YW, Yoo BS, Kim JT, Park IK, Kang CH, Kim YT. Video- assisted thoracoscopic lobectomy in children: Safety and efficacy compared with the conventional thoracotomy approach. Innovations (Phila) 2012;7:394-8.
7. Singh R, Davenport M. The argument for operative approach to asymptomatic lung lesions. Semin Pediatr Surg 2015;24:187-95.