Burcu KILIÇ, Akif TURNA, H. Volkan KARA, Ezel ERŞEN, Selim BAKAN

TRANSTORASİK İĞNE ASPİRASYON BİYOPSİSİ SONRASI GELİŞEN İATROJENİK PNÖMOTORAKS YÖNETİMİ

Amaç: Pnömotoraks Trans Torasik İğne Aspirasyon Biopsisinin (TTIAB) en sık komplikasyonudur. Tedavisinde konservatif takip ve göğüs tüpü uygulamasının yeri tartışılmakta ve tercihler farklılık göstermektedir. Bu çalışmanın amacı TTIAB sonrası pnömotoraks tedavisini farklı yaklaşımlarla değerlendirmektir. Hastalar ve Yöntem: Çalışmamız retrospektif kesitseldir. Ocak 2016 ve Aralık 2017 arası TTIAB sonrası gelişen pnömotoraks vakaları incelenmiştir. Pnömotoraks tedavisi için: yüksek akım (8-10 lt nazal oksijen) ile konservatif ve göğüs tüpü yerleştirmesini kullanarak oluşturduğumuz 3 tedavi protokolü pnömotoraks yüzdesine göre uygulayıp sonuçları değerlendirilmiştir. Bulgular: Toplamda 187 hastaya akciğerdeki kitle lezyon tespiti ve malign hastalık öntanısıyla TTIAB işlemi uygulandı. Hastaların 24 ünde (%12,8) işlem sonrası pnömotoraks tespit edildi. Tanımladığımız protokoller kullanılarak toplamda 9 hastada (%37,5) göğüs tüpü yerleştirildi. On beş hasta (%62,5) konservatif ( yüksek akım nazal oksijen ile) tedavi edildi. Ortalama hastane kalış süresi tüm çalışma grubu için 3,2 gün idi . Hastalarda mortalite yada morbidite izlenmedi Sonuç: TTIAB sonrası iatrojenik pnömotoraks riski mevcuttur. Pnömotoraks yüzdesine göre oluşturduğumuz 3 protoke dayalı algoritmamız basit olarak uygulanabilir ve sonuçları başarılıdır. Bu hastaların yakın takibi ve gerektiğinde acil göğüs tüpü yerleştirilebilmesi için multidisipliner takım çalışmasına ihtiyaç vardır.

Management of Iatrogenic Pneumothorax, Following Transthoracic Needle Aspiration Biopsy

Purpose: Pneumothorax is the most common complication following Trans Thoracic Needle Biopsy (TTNB).The treatment plan choice is either conservative treatment with high flow (8-10 lt) nasal oxygen andsurgical treatment with chest tube is still varying. The aim of this study to evaluate the treatment plans forpneumothorax after TTNB and efficacy different treatment approachesPatients and Methods: This is a retrospective cross-sectional study. Patients with pneumothorax followingTTNB between January 2016 and December 2017 are evaluated. According to the size of the pneumothorax,we have created 3 treatment protocols consisting of follow up with high flow (8-10 lt) nasal oxygen and –orchest tube insertion . The results were analyzedResults: There were 187 patients who had CT guided TTNB for diagnosis of a lung mass. Of those 24 patients(12,8%) had pneumothorax following the procedure. Overall 9 patients needed chest tube (37,5 %) Themean hospitalization for the whole group was 3,2 days There was no mortality or morbidity in the studygroup.Conclusion: Pneumothorax following TTNB may be seen.Our algorithm of 3 protocols depending on the sizeof pneumothorax is simple to use and results successful.There is a need for a multidisciplinary teamwork,close follow up and preparation for urgent chest tube insertion.

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