GÖNÜL SAĞIROĞLU

Trakea rezeksiyonu uygulanan 42 olgunun analizi

Amaç: Çalışmamızda trakea rezeksiyonu uygulanan treakeal stenoz olgularını etiyoloji, tanı, tedavi, komplikasyon ve mortalite açısından değerlendirmeyi amaçladık. Gereç ve yöntem: Ocak 2006-Ocak 2010 tarihleri arasında trakea rezeksiyonu ve rekonstrüksiyonu uygulanan 42 olgu retrospektif olarak incelendi. Vakaların yaş, cinsiyet, yandaş hastalıklar, trakea stenozu nedenleri, semptomlar, stenozun yeri, cerrahi yaklaşım biçimi, insizyon teknikleri, rezeke edilen trakea uzunluğu, sütur materyali, anestezi süresi, cerrahi süre ve postoperatif yoğun bakım ünitesine entübe transport oranı, morbidite nedenleri, mortalite oranı analiz edildi. Bulgular: Yaş ortalaması 48 (9-79) yıl olan olguların 26’sı erkek 16’sı kadındı. Trakeal stenoz nedenleri 30 hastada entübasyon sonrası trakea stenozu, 10’unda trakea tümörleri, 1 travmatik trakea yaralanması ve 1 konjenital trakea stenozu idi. Semptomlar dispne, öksürük, stridor ve hemoptizi idi. Trakea üst yarısında olan olgulara sadece servikal (n=36) veya servikal ve üst kısmi sternotomi (n=4); trakea alt yarısında olanlara ise total sternotomi yapılmıştı. Rezeke edilen trakea kısmı 2-5.2 cm arasında (3-9 halka) değişmekte olup ortalama 4.1 cm (7.2 halka) rezeke edilmişti. Vakalarımızın morbidite nedenleri solunum yetersizliği, sekresyon retansiyonu ve atelektazi, pnömoni, sepsis ve trakeal restenoz olarak tespit edildi. Postoperatif mortalite 4 (%9.5) olguda gözlendi. Sonuç: Trakeal rezeksiyon ve rekonstrüksiyon ameliyatlarında komplikasyona yol açan en önemli sorun ventilasyon ve bronş sistemine aspirasyondur. Komplikasyon ve mortaliteyi azaltmak için cerrah, anestezist ve yoğun bakım uzmanının yakın işbirliği en önemli yaklaşımdır

Analysis of 42 patients who underwent tracheal resection

Objectives: We aimed to analyze the etiology, diagnostic and surgical methods, complications and mortality of the patients who underwent tracheal resection for tracheal stenosis. Materials and methods: Between January 2006 and January 2010, 42 patients who underwent tracheal resection and reconstruction was retrospectively analyzed in terms of age, sex, co-morbid disease, etiology of tracheal stenosis, symptoms, the location of stenosis, surgical approach, incision techniques, length of resected segment, types of different suture materials, length of anesthesia and surgery, the ratio of prolonged intubation, morbidities and mortality ratios were analyzed. Results: There were 26 men and 16 female with the mean age was 48 (9-79) years. The etiology was tracheal stenos in 30 patients, tracheal tumor in 10 patients, trauma and congenital tracheal stenos in one each. Symptoms were dispnea, cough, stridor and hemoptysis. Surgical technique was performed through cervical incision (n=36) and cervical incision plus partial sternotomy (n=4) in patients with high tracheal stenosis where the stenosis is lower then complete sternotomy was performed. The mean tracheal segmental resection was 4.1 cm (2-5.2 cm). The morbidities were respiratory insufficiency, secretion retention and atelectasis, pneumonia, sepsis and tracheal re-stenosis. The postoperative mortality was seen in 4 (%9.5) patients. Conclusion: The most important issue leading to complication during tracheal surgery is the ventilation and aspiration towards bronchus. The intense collaboration between surgeon, anesthesiologist and intensive care physician is a necessity in order to reduce complication rates and mortality.

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