Özcan GÜR, Selami GÜRKAN, Demet ÖZKARAMANLI GÜR, Adnan YÜKSEK, Şeref ALPSOY, Cavidan ARAR

Perikardiyal Efüzyon Sebebiyle Cerrahi Uygulanan Olgularda Perikardiyopulmoner Pencere Açılma yöntemi ile Anteriyor Perikardiyal Tüp Drenajı Tekniklerinin Karşılaştırılması

Amaç: Perikardiyum kalbi çift tabaka halinde saran bir zar tabakasıdır. Perikardiyal kavitede anormal sıvı birikimi perikardiyal efüzyon olarak tanımlanır. Efüzyon kalbin fonksiyonlarını sınırlar ise kardiak tamponad ortaya çıkar ve drene edilmesi gerekir. Çalışmamızda perikardiyoplevral pencere açılması yöntemi ile subksifoidal perikardiostomi tekniklerinin karşılaştırılması amaçlandı. Materyal ve metot: Çalışmamız retrospektif bir çalışma olup perikardiyopulmoner pencere açılması ile subksifoidal perikardiostomi teknikleri karşılaştırılmıştır. Perikardiyoplevral pencere grubunda perikard sol mini anterolateral torakotomi ile 4. interkostal aralıktan mini sternal ekartör kullanılarak açıldı. Subksifoidal perikardiostomi grubunda ise perikard mini anteriyor insizyon ile açılarak rezeke edildi. Her iki grupta 28 F silikon dren kullanıldı. Drenler günlük 150 ml altında sıvı gelmesi durumunda çekildi.Bulgular: Perikardiyal efüzyon sebebiyle toplam 18 hastaya drenaj işlemi uygulandı. Olguların ortalama yaş 56.25 ± 9.27 yıl olup (min: 45, max: 83), 6’sı (33.3%) kadın, 12’si (66.6%) erkek idi. Perikardiyopulmoner pencere açılan grupta postoperative 10. günde 1 hasta serebrovasküler olaya bağlı olarak eks oldu (%11.1). Rekürren perikardiyal efüzyon sebebiyle subksifoidal perikardiostomi grubunda ise 2 hasta postoperative 1. ayda reopere edildi (%22.2). Sonuç: Perikardiyal efüzyon sebebiyle uygulanacak olan cerrahi tekniğin seçimi çok önemli olup, rekürren perikardiyal efüzyon beklenen olgularda perikardiyopulmoner tekniğin kullanılması, diğer durumlarda ise subksifoidal perikardiostomi tekniğinin kullanımının uygun olacaği kanaatindeyiz.

Anahtar Kelimeler:

Perikardiyal efüzyon, cerrahi teknik, sonuç

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Aim Pericardium is a tough double layered membrane which covers the heart. Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. If the effusion is compromising heart function and causing cardiac tamponade, it needs to be drained. In our study we aimed to compare pericardiopulmonary window and anterior subxiphoidal pericardiostomy techniques. Materials and Methods In this retrospective study pericardiopulmonary window and anterior pericardiostomy techniques were compared. In pericardiopulmonary window group, pericardium was opened via a left mini anterothoracotomy through the fourth intercostal area using a mini sternal retractor and pericardium was resected (approximately 4x6 cm), In pericardiostomy group pericardium was exposed via subxiphoidal approach and chest drainage tube was inserted by mini anterior incision. 28 F drainage tubes were used for drainage in all patients. The drainage tube was removed when amount of daily drainage was below 150 ml. Results A total of 18 patients underwent an initial drainage procedure for a pericardial effusion. The mean age of the patients were 56.25±9.27 years (range, 45–83 years). 6 (33.3%) were female and 12 (66.6%) were male. On 10th postoperative day one patient died due to cerebrovascular accident (%11.1) in pericardiopulmonary window group. Reoperation was required in two patients in subxiphoidal pericardiostomy group for reccurence of pericardial effusion one month later (%22.2). Conclusion The choice of surgical technique for pericardial effusion is very important. We think that, while pericardiopulmonary window technique is suitable for patients with recurrent pericardial effusion, subxiphoidal pericardiostomy technique is suitable for other situations

Keywords:

Pericardial effusion, surgical technique, result,

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