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

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.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.Ameliyat endikasyonu, hastaların 91’inde (%81.2) nüks pnömotoraks iken 21’inde (%18.7) 7 günden fazla devam eden uzamış hava kaçağı idi. Paryetal plevrayamekanik 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 zımparakullandığımız grupta, nüks ve takip süresi istatistiksel olarak anlamlı derecede düşüktü. Diğer parametreler açısından iki grup arasında istatistiksel olarak anlamlıbir ilişki saptanmadı.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.

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

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. 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. 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. 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.

PDF

___

1. Kuzucu A, Soysal O, Ulutaş H. Optimal timing for surgical treatment to prevent recurrence of spontaneous pneumothorax. Surg Today 2006;36:865-8.
2. Guo Y, Xie C, Rodriguez RM, Light RW. Factors related to recurrence of spontaneous pneumothorax. Respirology 2005;10:378-84.
3. Bialas RC, Weiner TM, Phillips JD. Video-assisted thoracic surgery for primary spontaneous pneumothorax in children is there an optimal technique? J Pediatr Surg. 2008;43:2151-2155.
4. Muramatsu T, Shimamura M, Furuichi M, et al. Cause and management of recurrent primary spontaneous pneumothorax after thoracoscopic stapler blebectomy. Asian J Surg 2011;34:69-73.
5. Casadio C, Rena O, Giobbe R, Maggi G. Primary spontaneous pneumothorax. Is video-assisted thoracoscopy stapler resection with pleural abrasion the gold-standard? Eur J Cardiothorac Surg. 2001;20:897-898.
6. Bertrand PC, Regnard JF, Spaggiari L, et al. Immediate and long-termresults after surgical treatment of primary spontaneous pneumothorax by VATS. Ann Thorac Surg 1996;61:1641–5.
7. Sawada S, Watanabe Y, Moriyama S. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: evaluation of indications and long term outcome compared with conservative treatment and open thoracotomy. Chest 2005;127:2226–30.
8. Bille A, Barker A, Maratos EC et al. Surgical access rather than method of pleurodesis (pleurectomy or pleural abrasion) influences recurrence rates for pneumothorax surgery: systematic review andmeta-analysis. Gen Thorac Cardiovasc Surg 2012;60:321–325.
9. MacDuff A, Arnold A, Harvey J et al. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65(Suppl 2):18–31
10. Joshi V, Kirmani B, Zacharias J. Thoracotomy versus VATS: is there an optimal approach to treating pneumothorax? Ann R Coll Surg Engl 2013;95:61–4.
11. Torresini G, Vaccarili M, Divisi D, Crisci R. Is video-assisted thoracic surgery justified at first spontaneous pneumothorax? Eur J Cardiothorac Surg 2001;20:42-5.
12. Cardillo G, Carleo F, Giunti R, Carbone L, Mariotta S, Salvadori L, et al. Videothoracoscopic talc poudrage in primary spontaneous pneumothorax: a single-institution experience in 861 cases. J Thorac Cardiovasc Surg. 2006; 131: 322–328.
13. Margolis M, Gharagozloo F, Tempesta B, Trachiotis GD, Katz NM, Alexander EP. Video-assisted thoracic surgical treatment of initial spontaneous pneumothorax in young patients. Ann Thorac Surg 2003; 76: 1661–1663.
14. Ling ZG, Wu YB, Ming MY, Cai SQ, Chen YQ. The effect of pleural abrasion on the treatment of primary spontaneous pneumothorax: a systematic review of randomized controlled trials. PLoS One. 2015;10(6):1-12.
15. Sudduth CL, Shinnick JK, Geng Z, McCracken CE, Clifton MS, Raval MV. Optimal surgical technique in spontaneous pneumothorax: a systematic review and meta-analysis. J Surg Res. 2017;210:32-46.
16. Montes JF, Ferrer J, Villarino MA et al. Infl uence of talc dose on extrapleural talc dissemination after talc pleurodesis. Am J Respir Crit Care Med 2003;168:348-55.
17. Huh U, Kim YD, Cho JS, I H, Lee JG, Lee JH. The effect of thoracoscopic pleurodesis in primary spontaneous pneumothorax: apical parietal pleurectomy versus pleural abrasion. Korean J Thorac Cardiovasc Surg 2012;45:316–319.
18. Lee S, Kim HR, Cho S, Huh DM, Lee EB, Ryu KM, et al. Staple line coverage after bullectomy for primary spontaneous pneumothorax: a randomized trial. Ann Thorac Surg. 2014;98:2005–2011
19. Rena O, Massera F, Papalia E, Della Pona C, Robustellini M, Casadio C. Surgical pleurodesis for Vanderschueren's stage III primary spontaneous pneumothorax. Eur Respir J. 2008;31:837–841.
20. Chen JS, Hsu HH, Huang PM, Kuo SW, Lin MW, Chang CC, et al. Thoracoscopic pleurodesis for primary spontaneous pneumothorax with high recurrence risk: a prospective randomized trial. Ann Surg 2012;255:440–445.