Fuat SAYIR, Ufuk ÇOBANOĞLU, Abidin ŞEHİTOĞULLARI

TORAKOTOMİ TEKRARINA NEDEN OLAN POSTOPERATİF KOMPLİKASYONLAR VE TEDAVİ SONUÇLARI

Çalışmamızda 2004-2011 yılları arasında akciğer veya mediasten hastalığı nedeniyle torakotomi geçiren hastalardan, gelişen komplikasyonlar nedeniyle torakotomi tekrarına başvurduğumuz olgular geriye dönük olarak incelendi. Kliniğimizde 2004-2011 yılları arasında, 1182 olguya torakotomi uygulandı. Gelişen komplikasyonlar nedeniyle retorakotomiye aldığımız 25 olgu çalışmaya dahil edildi. Olgular ameliyat endikasyonu, yaş, cinsiyet, retorakotomi endikasyonu, retorakotomi sırasında yapılan cerrahi girişim, retorakotomi zamanı, retorakotomi sonrası komplikasyonlar açısından değerlendirildi. Retorakotomiye alınan 25 olgunun 11’i kadın (%44), 14’ü erkekti (%56). Yaş aralığı 14-66 arasında ve ortalama yaş 43.4 olarak tesbit edildi. Olguların ilk ameliyat tanılarında 8 olgu malign, 17 olgu bening tanılı olduğu görüldü. Olguların 15’inde (%60) kanama nedeniyle retorakotomi uygulandı. En sık kanama nedeni, toraks duvarı kaynaklıydı (8 olgu, %53.3). Retorakotomi, olguların 17’sinde postoperatif ilk 3-4. günlerde gerçekleştirilirken, diğer olgularda postoperatif 8. günden sonra gerçekleştirildi. Retorakotomili olguların hastanede yatış süreleri uzadı. Bu olgularda taburculuk süresi retorakotomiden sonra 6-42 ( ortalama 14.2±5.8) gün arasında değişti. Kanama, toraks cerrahisi sonrası, en sık rastladığımız komplikasyondur. Torakotomili olguların postoperatif dönemde çok iyi takibi gerekir. Retorakotomi gereken durumlarda çok hızlı davranılması gerekmektedir. Ayrıca diğer cerrahi komplikasyonların erken tesbiti sağlanmalıdır. Böylece, komplikasyonlu olguların retorakotomi ve revizyonuyla, mortalite ve morbidite önlenmiş olacaktır.

Anahtar Kelimeler:

Torakotomi, torakotomi tekrarı, kanama, fistül

POSTOPERATIVE COMPLICATIONS WHICH CAUSES RETHORACOTOMY AND THE RESULTS OF TREATMENT

In our study, we evaluated patients who underwent rethoracotomy between 2004-2011 due to postoperative complications following surgery for lung or mediastinal diseases, retrospectively. In our clinic, 1182 patients underwent thoracotomy between 2004-2011 years. Because of postoperative complications 25 of these patients (%2.1) was rethoracotomy. The cases were evaluated according to operative indication, age, gender, indication for rethoracotomy, the time of rethoracotomy, the complications of rethoracotomy and the surgical procedure during rethoracotomy. Totally 25 patients underwent rethoracotomy, of these 11 (%44) were women and 14 men (%56). The age range was between 14-66, and the average age was determined of 43.4. Initial operations had been performed for malign and benign diseases in 8 and 17 patients. Rethoracotomy was performed in 15 patients (%60) due to postoperative bleeding. The most common cause of bleeding, chest wall originated (8 cases, 53.3%). In 17 cases rethoracotomy was performed postoperative 3-4 days but the other cases were opereted on after postoperative 8th days. The lenght of hospital stay was delayed in these patients and the time of discharge after rethoracotomy have changed between 6-42 (mean 14.2 ± 5.8) days. The most commonly encountered complications after thoracic surgery is bleeding. The follow-up patients with thoracotomy in the postoperative period must be very good. Rethoracotomy must be treated very quickly when needed. In addition, early detection of the other surgical complications, should be provided. Thus, in patients with complications by means of rethoracotomy and revision mortality and morbidity will be prevented.

Keywords:

Thoracotomy, rethoracotomy, hemorrhage, fistula,

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1. Sirbu H, Busch T, Aleksic I, Lo tfi S, Ruschewski W, Dalichau H. Chest re-exploration for complications after lung surgery. Thorac Cardivasc Surg 1999; 47: 73-6.
2. Shields TW. General features and complications of pulmonary resections. In: Shields TW, editor. General thoracic surgery. 4th. Ed. Philadelphia: Williams & Wilkins; 1994. p.391-414.
3. Lock RL, Triplett HB, Rose G. Contralateral tension pneumo/hemothorax resulting from left subclavian vein cannulation under general anesthesia. Thorac Cardiovasc Surg 1998; 46: 375-6.
4. Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 2006; 81: 1013-9.
5. Onaitis MW, Petersen RP, Balderson SS, et al. Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg 2006; 244: 420-5.
6. Gürkök S, Yazgan S, Gözübüyük A ve ark. Ameliyat sonras› komplikasyonlar nedeniyle tekrarlanan torakotomilerin de¤erlendirilmesi. Türk Gö¤üs Kalp Damar Cer Derg 2005; 13: 274-8.
7. Santambrogio L, Nosotti M, Baisi A, Bellaviti N, Pavoni G, Rosso L. Buttressing staple lines with bovine pericardium in lung resection for bullous emphysema. Scand Cardiovasc J 1998; 32: 297-9.
8. Palffy G, Forrai I, Csekeo A, Kukla F. Analysis of reoperations after 10,000 lung resections. Zentralbl Chir 1984; 109: 72-80.
9. Roviaro G, Varoli F, Vergani C, Maciocco M, Nucca O, Pagano C. Video-assisted thoracoscopic major pulmonary resections: technical aspects, personal series of 259 patients, and review of the literature. Surg Endosc 2004; 18: 1551-8.
10. Duque L, Ra mos G. Early complications in surgical treatment of lung cancer: A prospective, multicenter study. Ann Thorac Surg 1997; 63: 944-50.
11. Massard G, Lyons G, Wihlm JM et al. Early and long term results after completion pneumonectomy. Ann Thorac Surg 1995; 59: 196-200.
12. Al-Kattan, Goldstravv P. Completion pneumonectomy: Indication and outcome. J Thorac Surg 1995; 110: 1125-9.
13. Licker M, de Perrot M, Hohn L, et al. Perioperative mortality and major cardiopulmonary complications after lung surgery for nonsmall cell carcinoma. Eur J Cardiothorac Surg 1999; 15: 314-9.
14. Harpole DH Jr, DeCamp MM Jr, Daley J, Hur K, et al. Prognostic models of thirty-day mortality and morbidity after major pulmonary resection. J Thorac Cardiovasc Surg 1999; 117: 969-79.
15. Myrdal G, Gustafsson G, Lambe M, Hörte LG, Ståhle E. Outcome after lung cancer surgery. Factors predicting early mortality and major morbidity. Eur J Cardiothorac Surg 2001; 20: 694-9.
16. Tneasure RL, Seaworth BJ. Current role of surgery in mycobacterium tuberculosis. Ann Thorac Surg 1995; 59: 1405-7.
17. Milano MJ, Wilkins EW. Indications for reexploration thoracotomy. Current topics in general thoracic surgery 1992; 2: 315-28.
18. Faber LP, Piccione W. Complications of surgery in the lung cancer patient. Pass HI; Lung cancer principles and practice, Philadelphia, Lippincott Raven 1995.
19. Tokat AO, Özdemir N. Rezeksiyon sonras› bronkoplevral fistül geliflimi ve tedavi yaklafl›mlar›. Tüberküloz ve Toraks Dergisi 2004; 52: 103-10.
20. Deschamps C, Bernard A, Allen MS, et al. Empyema and bronchopleural fistula after pneumonectomy: factors affecting incidence. Ann Thorac Surg 2001; 72: 243-7.
21. Asamura H, Naruke T, Tsuchiya R, Goya T, Kondo H, Suemasu K. Bronchopleural fistulas associated with lung cancer operations. Univariate an d multivariate analysis of risk factors, management, and outcome. J Thorac Cardiovasc Surg 1992; 104: 1456-64.
22. Shrager JB, Wright CD, Wain JC, et al. Bronchopulmonary carcinoid tumors associated with Cushing's syndrome: a more aggressive variant of typical carcinoid. J Thorac Cardiovasc Surg 1997; 114: 367-75.
23. Varker KA, Ng T. Management of empyema cavity with the vacuum-assisted closure device. Ann Thorac Surg 2006; 81: 723-5.
24. Zaheer S, Allen MS, Cassivi SD, et al. Postpneumonectomy empyema: results after the Clagett procedure. Ann Thorac Surg 2006; 82: 279-86.
25. Al-Kattan K, Cattelani L, Goldstraw P. Bronchopleural fistula after pneomonectomy for lung cancer. Eur J Cardio-thorac Surg 1995; 9: 479-82.
26. Grillo HC, Shepard JAO, Mathisen DJ, et al. Postpneumonectomy syndrome: diagnosis, management and results. Ann Thorac Surg 1992; 54: 638-51.
27. Wright CD, Wain JC, Mathisen DJ, Grillo HC. Postpneumonectomy bronchopleural fistula after sutured bronchial closure: incidence, risk factors, and management. J Thorac Cardiovasc Surg 1996; 112: 1367-71.
28. Whooley BP, Law S, Alexandrou A, Murthy SC, Wong J. Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer. Am J Surg 2001; 181: 198-203.
29. Lorentz T, Fok M, Wong J. Anastomotic leakage after resection and bypass for esophageal cancer: lessons learned from the past. World J Surg 1989; 13: 472-7.
30. Martin LW, Swisher SG, Hofstetter W, et al. Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg 2005; 242: 392-9.
31. Alanezi K, Urschel J D. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 2004; 10: 71-5.
32. Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 1995; 169: 634-40.
33. Nagasaki F, Flehinger BJ, Martini N. Complications of surgery in the treatment of carcinoma of the lung. Chest 1982; 82: 25-9.
34. Pairolero PC, Deschamps C, Allen MS, et al. Postoperative empyema. Chest Surg Clin North Am 1992; 2: 813-22.
35. Stolz AJ, Sch J, Lischke R, et al. Predictors of prolonged air leak following pulmonary lobectomy. Eur J Cardiothorac Surg 2005; 27: 334-6.
36. Brunelli A, Monteverde M, Borri A, et al. Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg 2004; 77: 1205-10.
37. Stephan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelly B, et al. Pulmonary complications following lung resection: a compherensive analysis of incidence and possible risk factors. Chest 2000; 118: 1263-70.
38. Shinji K, Keizo T, Hitoshi S, et al. Pulmonary torsion following right upper lobectomy. Ann Thorac Surg 2006; 12: 417-9.
39. Berry MF, Friedberg J. Chest wall/diaphragmatic complications. Thorac Surg Clin 2006; 16: 277-85.
40. Dugue L, Sauvanet A, Farges O et al. Output of chyle as an indicator of treatment for chylothorax complicating oesophagectomy. Br J Surg 1998; 85: 1147-9.
41. Mehanna MJ, Israel GM, Katigbak M, Rubinowitz AN. Cardiac herniation after right pneumonectomy: case report and review of the literature. J Thorac Imaging 2007; 22: 280-2.