NÜKS PRİMER SPONTAN PNÖMOTORAKS TEDAVİSİNDE İKİ FARKLI MEKANİK PLEVRAL ABRAZYON YÖNTEMİNİN KARŞILAŞTIRILMASI

Amaç Nüks primer spontan pnömotoraksın cerrahi tedavisi, apikal bül rezeksiyonu ve plörodezisi içerir. Postoperatif nüks oranları %5 ile %10 arasında bildirilmektedir. Bu çalışmada, kliniğimizde uyguladığımız iki farklı mekanik plevral abrazyon yönteminin etkinliğini ve nüks oranlarını karşılaştırmayı amaçladık. Gereç ve Yöntem Ocak 2012 ve Aralık 2019 tarihleri arasında 112 hastaya primer spontan pnömotoraks için cerrahi tedavi olarak videotorakoskopik bül rezeksiyonu ve paryetal plevra abrazyonu uygulandı. Hastaların yaş, cinsiyet, sigara içme hikayesi, ameliyat nedeni, ameliyatta bül varlığı, plörodez yöntemi, göğüs tüpü drenaj süresi, hastanede yatış süresi, ameliyat sonrası komplikasyonlar, ameliyat sonrası nüks ve takipleri geriye dönük olarak incelendi. Bulgular Ameliyat endikasyonu, hastaların 91’inde (%81.2) nüks pnömotoraks iken 21’inde (%18.7) 7 günden fazla devam eden uzamış hava kaçağı idi. Paryetal plevraya mekanik plöredezis için abrazyon; 38 (%33.9) hastada gazlı bez ile uygulanırken, 74 (%66.1) hastada steril zımpara ile uygulandı. Paryetal plevra abrazyonu için steril zımpara kullandığımız grupta göğüs tüpü drenaj süresi, gazlı bez kullandığımız gruba göre istatistiksel olarak anlamı derecede yüksekti. Ancak steril zımpara kullandığımız grupta, nüks ve takip süresi istatistiksel olarak anlamlı derecede düşüktü. Diğer parametreler açısından iki grup arasında istatistiksel olarak anlamlı bir ilişki saptanmadı. Sonuç Sonuç olarak nüks primer spontan pnömotoraks veya uzamış hava kaçağı tedavisinde videotorakoskopik bül rezeksiyonu ve plevral abrazyon, düşük nüks oranı ile güvenli bir yöntemdir. Ayrıca paryetal plevra abrazyonu için steril zımpara kullanımı göğüs tüpü drenaj süresini bir miktar artırmakla birlikte daha az nüks oranına sahiptir.

Anahtar Kelimeler:

Primer spontan pnömotoraks, nüks, plevral abrazyon

COMPARISON OF TWO DIFFERENT MECHANICAL PLEURAL ABRASION METHODS IN THE TREATMENT OF RECURRENT PRIMARY SPONTANEOUS PNEUMOTHORAX

Objective Surgical treatment of recurrent primary spontaneous pneumothorax involves resection of apical bulla and pleurodesis. Postoperative recurrence rates between 5 and 10% are reported. In this study, we aimed to compare the effectiveness and recurrence rates of two different mechanical pleural abrasion methods that we applied in our clinic. Materials and Methods Between January 2012 and December 2019, 112 patients underwent videothoracoscopic bullectomy and parietal pleural abrasion as a surgical treatment for primary spontaneous pneumothorax. Patients' age, gender, smoking history, reason for surgery, presence of bulla in surgery, pleurodesis method, chest tube drainage time, length of hospital stay, postoperative complications, postoperative recurrence and follow-up were retrospectively analyzed. Results The indication for surgery was recurrent pneumothorax in 91 (81.2%) of the patients, while prolonged air leakage continued for more than 7 days in 21 (18.7%) patients. For mechanical pleurodesis to the parietal pleura, 38 (33.9%) patients were abrasion with gauze, while 74 (66.1%) patients were performed with sterile sandpaper. In the group where we used sterile sandpaper for parietal pleural abrasion, the chest tube drainage time was statistically significantly higher than the group in which we used gauze. However, the recurrence and follow-up time was statistically significantly lower in the group in which we used sterile sandpaper. There was no statistically significant relationship between the two groups in terms of other parameters. Discussion In conclusion, videothoracoscopic bullectomy and pleural abrasion is a safe method with low recurrence in the treatment of recurrent primary spontaneous pneumothorax or prolonged air leakage. In addition, the use of sterile sandpaper for parietal pleural abrasion increases the chest tube drainage time slightly but has less recurrence rate.

Keywords:

Primary spontaneous pneumothorax, recurrent, pleural abrasion,

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