Sezai ÇELİK, Bülent AYDEMİR, Oya UNCU, TAMER OKAY, Muharrem ÇELİK

Semptomatik perikardiyal efüzyonların cerrahi tedavisinde VATS, subksifoid ve minitorakotomi perikardiyal pencerenin etkinliği

Amaç: Perikardiyal efüzyon potansiyel olarak ciddi morbidite ve mortalite nedenidir. Video-yardımlı torakoskopik cerrahi (VATS), subksifoid ve minitorakotomi perikardiyal pencere sıklıkla kullanılan cerrahi tedavi seçenekleridir. Bu çalışmanın amacı, semptomatik perikardiyal efüzyonun tedavisinde bu üç yöntemin sonuçlarını ve etkinliğini araştırmaktır. Yöntemler: Ekim 2007 ile Aralık 2011 tarihleri arasında Dr. Siyami Ersek Hastanesinde perikardiyal efüzyon nedeniyle ameliyat edilen 88 hasta cerrahi tedavi yöntemlerine göre [Grup 1 (VATS,n=24), Grup 2 (Subksifoid, n=28), Grup 3 (Minitorakotomi, n=36)] üç grup olarak çalışmaya alındı. Gruplar demografik bilgiler, etiyoloji, ameliyat sırası ve sonrasına ait veriler ve sonuçlar, nüks, takip bilgileri, morbidite, mortalite ve sağkalım yönünden incelendi ve mukayese edildi. Bulgular: 88 hasta (37 kadın, 51 erkek, ortalama yaşları 54,47±16,81) çalışmaya alındı. Gruplar cinsiyet dağılımı ve etiyoloji hariç benzer perioperatif özelliklere sahipti. Her üç cerrahi yöntem hastalar tarafından genel olarak iyi tolere edildi. Gruplar ameliyat mortalitesi, 30 günlük mortalite, tüm ameliyat sonrası komplikasyonlar, nüks ve sağkalım oranları yönünden benzer sonuçlara sahipti. Grup 3teki hastaların ameliyat süreleri belirgin olarak daha kısa idi (p

The efficacy of VATS, subxiphoid and minithoracotomy pericardial window for surgical management of symptomatic pericardial effusions

Objective: Pericardial effusion potentially cause significant morbidity and mortality. Pericardial window by videoassisted thoracic surgery (VATS), subxiphoid and minithoracotomy is available surgical treatment options. The aim of this study is to determine the efficacy and outcome of the three different methods for surgical management of symptomatic pericardial effusions. Methods: A retrospective study of patients operated for pericardial effusion between October 2007 to December 2011 at Dr. Siyami Ersek Hospital were divided into three groups according to surgical treatment d: Group 1 (VATS, n=24), Group 2 (Subxiphoid, n=28) Group 3 (Minithoracotomy, n=36). The groups were analyzed and compared using demographic information, operative and postoperative details and course, recurrence, follow-up data, morbidity, mortality and survival. Results: A total of 88 patients (37 women, 51 men, with mean age 54.47±16.81) underwent pericardial window were included in the study. The groups had similar perioperative characteristics except sex distribution and etiology. VATS, Subxiphoid and minithoracotomy pericardial window were well tolerated by patients, resulted in similar rates of mortality, 30-day mortality, overall postoperative complications, recurrence rates and survival. Operative time was significantly shorter in group 3 (p<0.01). Drained volume at operation and diagnostic value of pericardial biopsy significantly higher in group 3 (p<0.05, p<0.05). Patients undergoing Group 1 had a lower length of chest tube stay, intensive care unit stay and hospital stay but they did not reach to statistical significance (p>0.05). Group 2 had a significantly higher lenght of hospital stay (p<0.05). Conclusion: Minithoracotomy pericardial window provides rapid and definitive diagnosis and treatment for pericardial effusions of all causes acceptable morbidity rates. On the other hand, VATS and subxiphoid pericardial window should be performed in selected cases.

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1. Yüksel C, Hüseyin S, Okyay A, et al. Erişkinlerde subksifoidal perikardiyostomi yöntemi ile perikardiyal efüzyon tedavisi. Turkish J Thorac Cardiovasc Surg 2012;20:492-496.
2. Tsang SM, Seward BJ, Barnes EM, et al. Outcomes of primary and secondary treatment of pericardial effusion in patients with malignancy. Mayo Clin Proc 2000;75:248-253.
3. Markiewicz W , Borovik R, Ecker S. Cardiac tamponade in medical patients: treatment and prognosis in the echocardiographic era. Am Heart J 1986;111:11381142.
4. Ohtsuka T, Takamoto S, Nakajima J, Miyairi T, Kotsuka Y. Minimally invasive limited pericardiectomy: hybrid approach. Ann Thorac Surg 2000;70:1429-1430.
5. Piehler JM, Pluth JR, Schaff HV, et al .Surgical management of effusive disease. Influence of extent of pericardial resection on clinical course. J Thorac Cardiovac Surg 1985;90:506-516.
6. Campione A, Cacchiarelli M, Ghiribelli C, et al. Which treatment in pericardial effusion? J Cardiovasc Surg (Torino) 2002;43:735-739.
7. Cullinane AC, Benjamin PI, Smith D, et al. Prognostic factors in the surgical management of pericardial effusion in the patient with concurrent malignancy. Chest 2004;125:1328 1334.
8. Liberman M, Labos C, Sampalis JS, et al. Ten-year surgical experience with nontraumatic pericardial effusions: a comparison between the subxyphoid and transthoracic approaches to pericardial window. Arch Surg 2005;140:191- 195.
9. Ahmed Muhammed MI. The pericardial window: is a better than a surgical approach? Interact CardioVasc Thorac Surg 2011;12:174-178.
10. Georghiou GP, Stamler A, Sharoni E, et al. Video-assisted thoracoscopic pericardial window for diagnosis and management of pericardial effusions. Ann Thorac Surg 2005;80:607-610.
11. Fibla JJ, Molins L, Mier JM, Vidal G: Pericardial window by videothoracoscope in the treatment of pericardial effusion and tamponade. Cir Esp 2008;83:145-148.
12. OBrien PK, Kucharczuk JC, Marshall MB, et al. Comparative study of subxiphoid versus video-thoracoscopic pericardial window. Ann Thorac Surg 2005;80:2013-2019.
13. Youn SW, Kim DK, Kim JW, et al. Video assisted thoracic surgery of pericardial window operation. Korean J Thorac Cardiovasc Surg 2002;35:812-816.
14. Landreneau RJ, Hazelrigg SR, Mack MJ, et al. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg 1993;56:1285-1289.
15. Bitran JD, Evans R, Brown C. The management of cardiac tamponade in patients with breast cancer. J Surg Oncol 1984;27:42-44.
16. Kopecky SL, Callahan JA, Tajik AJ, Seward JB. Percutaneous pericardial catheter drainage: report of 42 consecutive cases. Am J Cardiol 1986;58:633-635.
17. Mueller XM, Tevaearai HT, Hurni M, et al. von Segesser LK. Long-term results of surgical subxiphoid pericardial drainage. Thorac Cardiovasc Surg 1997;45:65-69.
18. Van Trigt P, Douglas J, Smith PK, et al. A prospective trial of subxiphoid pericardiotomy in the diagnosis and treatment of large pericardial effusion. A follow-up report. Ann Surg 1993;218:772-778.
19. Becit N, Unlü Y, Ceviz M, et al. Subxiphoid pericardiostomy in the management of pericardial effusions: case series analysis of 368 patients. Heart 2005;91:785-790.
20. Ertaş F, Polat N, Yıldız A, et al. Anticoagulant-induced hemopericardium with tamponade: A case report and review of the literature. J Clin Exp Invest 2013;4:229-233.
21. Celik S, Celik M, Aydemir B, et al. Surgical properties and survival of a pericardial window via left minithoracotomy for benign and malignant pericardial tamponade in cancer patients. World J Surg Oncol 2012;10:123.
22. Olsen PS, Sørensen C, Andersen HO. Surgical treatment of large pericardial effusions. Etiology and long-term survival. Eur J Cardiothorac Surg 1991;5:430-432.