Sezgin KARASU, İsmail HABERAL, Oryal ERDİK, Akın YILDIZHAN, Ali AYATA, Ayhan YILDIRIM

349 Torakoskopik sempatektomi ameliyatının cerrahi sonuçları

Amaç: Hiperhidrozis ve vazospastik damar hastalığı göğüs cerrahisi uygulamaları içerisinde ciddi bir yer tutmaktadır. Bu çalışmada kliniğimizde iki-port torakoskopik sempatektomi (İPTS) ile yapılan ameliyatların sonuçları bildirildi.Çalışma planı: Ocak 2002 ile Aralık 2005 tarihleri arasında palmar hiperhidrozis ve/veya aksiller hiperhidrozis ve dorsal hiperhidrozis veya vazospastik damar hastalığı nedeniyle iki-port torakoskopik sempatektomi uygulanan 188 hasta (185 erkek, 3 kadın; ort. yaş 20.7; dağılım 20-32) yaş, cinsiyet, uygulanan ameliyat tekniği, ameliyatın süresi, ameliyat sırasında ve ameliyat sonrası komplikasyonlar ve hastanede kalış süreleri yönünden incelendi.Bulgular: Hiperhidrozis nedeniyle yapılan torakal sempatektomiler 126 hastada ayrı seanslarda iki taraflı, 17 hastada tek taraflı uygulandı. Vazospastik damar hastalığı nedeniyle 35 hastaya ayrı seanslarda iki taraflı, 10 hastaya ise tek taraflı torakal sempatektomi uygulandı. Üç olguda ise ameliyat sırasında değerlendirmede ileri derece yapışıklık saptanması üzerine yapışıklıklar giderildi, torakal sempatik sinir diseksiyonları yapıldı ancak ameliyat sonu yapılan optik gözlem sırasında space'e neden olacak ekspansiyon kusuru fark edildiği için, kalınlaşan üst-orta veya alt lob visseral plevralar dekortike edilerek akciğerler serbestlendi ve ekspansiyon sağlandı. Ameliyat sonrası 10-58 aylık takiplerde sadece iki olguda kompansatris terleme saptandı.Tartışma: Çalışmamızda IPTS yöntemi hiperhidrozis ve vazospastik damar hastalıkların tedavisinde güvenli ve başarılı bulundu.

Surgical results of 349 thoracoscopic sympathectomies

Background: Hyperhydrosis and vasospastic vessel disease (VVD) applications are among the major interventions in thoracic surgery. In this study, the results of thoracoscopic sympathectomy operations with two-ports (TPTS) in our clinic were reported.Methods: Between January 2002 and December 2005, medical records of a total of 188 patients (185 males, 3 females; mean age 20.7 years; range 20-32) admitted to our clinic with palmar hyperhidrosis and/or axillary hyperhidrosis and dorsal hyperhidrosis or VVD which had undergone TPTS were investigated according to gender, age, sex, applied surgical procedure, operation duration, intraoperative and postoperative complications and duration of hospitalization time in the post-operative period.Results: Bilateral thoracic sympathectomies were performed in two different operations to 126 patients with hyperhydrosis. Unilateral thoracic sympathectomy was applied to 17 patients. Because of VVD, bilateral thoracic sympathectomy was applied in two different operations to 35 patients andunilateral thoracic sympathectomy was applied 10 patients. In 3 cases, thoracoscopic decortication was applied and expansion obtained because of intraoperative space of expansion fault for the thickened visceral pleura in the upper-medium or lower lobes. During a postoperative follow-up period of 10-58 months, compensatory sweating was recorded only in two patients.Conclusions: In our study, TPTS procedures were found to be safe and succesfull in the treatment of hyperhidrosis and VVD.

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