Levent ALPAY, Tunç LAÇİN, Hakan KIRAL, Aysun MISIRLIOĞLU, İlhan OCAKCIOĞLU, Tuğba COŞGUN, Volkan BAYSUNGUR, İrfan YALÇINKAYA

Pnömonektomilerde Majör Mortalite ve Morbidite Kriterleri

Amaç: Çalışmamızın amacı pnömonektomi yapılan hastaların mortalitesini ve morbiditesini incelemek, komplikasyonları özellikle bronkoplevral fistülleri BPF ayrıntılı olarak irdelemektir. Metod: Ekim 2005-Ocak 2011 tarihleri arasında pnömonektomi yapılan 178 hasta retrospektif olarak değerlendirildi. Yaş, cinsiyet, operasyon tarafı, indüksiyon terapisi, eşlik eden sistemik hastalık ve kanser evreleri belirlendi. İstatistik olarak lojistik regresyon analizi uygulandı. Hastaların morbidite ve mortalite değerlerinin bu parametrelerle ilişkisi değerlendirildi. Bulgular: Ortalama yaş 57,3 olarak belirlendi. 40 hastada %22,4 majör morbidite gelişti; 11 hastada %6,1 bronkoplevral fistül BPF , 11 hastada %6.1 postoperatif aritmi, 5 hastada akut respiratuvar yetmezlik %2.8 , 5 hastada pnömoni %2.8 ve 8 hastada %4.6 diğer morbiditeler gelişti. Neoadjuvan tedavi alan 11 hastadan 5 kişide %44.9 bronkoplevral fistül görüldü p=0.01 . Ondört hastada %8.1 mortalite görüldü. Bu 14 hastanın 5‘i %35.7 geç dönem bronkoplevral fistül ve fistül komplikasyonları nedeniyle kaybedildi. Bronkoplevral fistül riski sağ pnömonektomi sonrası 7/77,%9 , sol pnömonektomiye oranla 4/101,%3.9 daha yüksekti. Morbiditeyi artıran faktörler ileri yaş p=0.01 ve sağ pnömonektomi p=0.03 idi. Mortaliteyi anlamlı düzeyde etkileyen faktör ise ileri yaş p=0.049 idi. Sonuç: Pnömonektomi akciğer rezeksiyonları içinde hastaların yaşam kalitesini en kötü etkileyen, mortalite ve morbidite oranı en yüksek operasyon şeklidir. Bu sebeple operasyon sonrası daha çok risk taşıyan grupların değerlendirilebilmesi ve dikkatli olunması önemlidir. Operasyon sonrası gelişebilecek komplikasyonlara karşı erken tanı için hastalar iyi takip edilmelidir.

Anahtar Kelimeler:

pnömonektomi, mortalite, morbidite, komplikasyon

The Major Morbidity and Mortality Criteria in Pneumonectomies

Aim: We aimed to investigate the major morbidity and mortalities, especially bronchopleural fistulas in patients who underwent pneumonectomy. Methods: Between October 2005 and January 2011, 178 patients were retrospectively analyzed who underwent pneumonectomy. The patient characteristics of age, sex, lateralization, induction therapy, co-morbid diseases and pathologic stages were set. Statistical analyses were performed with logistic regression analyses to compare the parameters with mortality and morbidity. Results: The mean age was 57.3. Major morbidity occurred in 49 27.5% patients. The morbidities included 11 bronchopleural fistula 6.1% , 11 6.1% aritmia, 5 2.8% respiratory insuffiency, 5 2.8% pneumonia, and 8 4.6% other morbidities. Discussion: Pneumonectomy itself has high morbidity and mortality rates, which also has a negative impact on the quality of life among patients with lung resections. Therefore, it should be noted that high risk patients must be carefully investigated and close monitorization must be applied.

Keywords:

pneumonectomy, mortality, morbidity, complication,

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