Funda İNCEKARA, Göktürk FINDIK, Abdullah İrfan TAŞTEPE, Ebru SAYILIR GÜVEN, Selim Şakir Erkmen GÜLHAN, Sadi KAYA, Leyla Nesrin ACAR, Pınar BIÇAKÇIOĞLU, Ertan AYDIN, Sezgin KARASU

Bronşektazide cerrahi tedavi: 23 yıllık deneyimimiz

Amaç: Bu çalışmada, bronşektazi tedavisinde cerrahinin ve tam rezeksiyonun başarısı değerlendirildi ve 23 yıllık cerrahi deneyimimiz sunuldu.Ç a l ı ş m a p l a n ı :Ocak 1991 - Aralık 2013 tarihleri arasında kliniğimizde bronşektazi tanısı ile pulmoner rezeksiyon yapılan toplam 1.357 hasta (667 erkek, 690 kadın; ort. yaş 30.5±14.3 yıl); dağılım, 3-73 yıl) retrospektif olarak incelendi. Hastaların demografik ve klinik özellikleri, etiyolojileri, semptomları, lokalizasyonları, cerrahi işlemler ve uzun dönem takip sonuçları değerlendirildi.Bul gu lar: Hastaların 37’sinde (52.7) iki taraflı hastalık olduğu için toplam 1.394 cerrahi yapıldı. Cerrahi işlemler arasında lobektomi (n=702, %50.3), pnömonektomi (n=183, %13.1), segmental rezeksiyonlar (n=114, %8.2), bilobektomi (n=83, %6.0) ve lobektomi + segmentektomi (n=312, %22.4) vardı. Ameliyat sonrası dönemde 1.269 (%93.5) hasta ortalama 51.6 (dağılım, 1-120) ay süre ile takip edildi. Ameliyat sonrasında hastaların 774’ü (%61) asemptomatik idi, 456’sında (%35.9) iyileşme görüldü ve 39’unda (%3.1) yanıt ya da kötüleşme yoktu.S o n u ç :Bronşektazili hastalarda cerrahi tedavi, klinik ve semptomatik iyileşmede önemli bir rol oynamaktadır. Cerrahi, titiz bir ameliyat öncesi hazırlık ve uygun şekilde seçilmiş olgularda morbidite ve mortalite oranlarını azaltır.A n a h t a r s ö z c ü k l e r :Bronşektazi, rezeksiyon, cerrahi.

Surgical treatment of bronchiectasis: Our 23 years of experience

Background:In this study, we aimed to evaluate the success of surgery and a complete resection for bronchiectasis treatment and to present our 23 years of surgical experience.Methods: Between January 1991 and December 2013, a total of 1,357 patients (667 males, 690 females; mean age 30.5±14.3 years; range, 3 to 73 years) with the diagnosis of bronchiectasis who underwent pulmonary resection in our clinic were retrospectively analyzed. Demographic and clinical characteristics of the patients, etiologies, symptoms, localizations, surgical procedures, and long-term follow-up results were evaluated.Results:There were 1,394 surgeries, as 37 (2.7%) patients had bilateral disease. The surgical procedures included lobectomy (n=702, 50.3%), pneumonectomy (n=183, 13.1%), segmental resections (n=114, 8.2%), bilobectomy (n=83, 6.0%), and lobectomy + segmentectomy (n=312, 22.4%). During the postoperative period, 1,269 (93.5%) patients were followed at a mean duration of 51.6 (range, 1 to 120) months. After surgery, 774 (61%) patients were asymptomatic, 456 (35.9%) showed an improvement, and 39 (3.1%) had no response or deterioration.Conclusion:The surgical treatment plays an important role in the clinical and symptomatic improvement of patients with bronchiectasis. Surgery reduces the morbidity and mortality rates with careful preoperative preparation and appropriately selected cases.Keywords:Bronchiectasis, resection, surgery.

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O’Donnell AE. Bronchiectasis. Chest 2008;134:815-23.
Laënnec RTH. On mediate auscultation, or a treatise on the diagnosis of diseases of the lungs and heart. Paris: J.-A. Brosson et J.-S. Chaudé; 1819.
Zhang P, Jiang G, Ding J, Zhou X, Gao W. Surgical treatment of bronchiectasis: a retrospective analysis of 790 patients. Ann Thorac Surg 2010;90:246-50.
Hill AT, Pasteur M, Cornford C, Welham S, Bilton D. Primary care summary of the British Thoracic Society Guideline on the management of non-cystic fibrosis bronchiectasis. Prim Care Respir J 2011;20:135-40.
Kutlay H, Cangir AK, Enön S, Sahin E, Akal M, Güngör A, et al. Surgical treatment in bronchiectasis: analysis of 166 patients. Eur J Cardiothorac Surg 2002;21:634-7.
Agasthian T, Deschamps C, Trastek VF, Allen MS, Pairolero PC. Surgical management of bronchiectasis. Ann Thorac Surg 1996;62:976-8.
Doğan R, Alp M, Kaya S, Ayrancioğlu K, Taştepe I, Unlü M, et al. Surgical treatment of bronchiectasis: a collective review of 487 cases. Thorac Cardiovasc Surg 1989;37:183-6.
Chalmers JD, Goeminne P, Aliberti S, McDonnell MJ, Lonni S, Davidson J, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med 2014;189:576-85.
Ringshausen FC, de Roux A, Pletz MW, Hämäläinen N, Welte T, Rademacher J. Bronchiectasis-associated hospitalizations in Germany, 2005-2011: a population-based study of disease burden and trends. PLoS One 2013;8:e71109.
Ashour M, Al-Kattan K, Rafay MA, Saja KF, Hajjar W, Al-Fraye AR. Current surgical therapy for bronchiectasis. World J Surg 1999;23:1096-104.
Balkanli K, Genç O, Dakak M, Gürkök S, Gözübüyük A, Caylak H, et al. Surgical management of bronchiectasis: analysis and short-term results in 238 patients. Eur J Cardiothorac Surg 2003;24:699-702.
Al-Refaie RE, Amer S, El-Shabrawy M. Surgical treatment of bronchiectasis: a retrospective observational study of 138 patients. J Thorac Dis 2013;5:228-33.
Nadir A, Kaptanoğlu M, Gönlügür U, Büyükkayhan D, Günay İ, Doğan K, et al. Bronşektazinin Cerrahi Tedavisi: 36 Olgunun Değerlendirilmesi. T Klin Tıp Bilimleri 2003;23:359-65.
Gursoy S, Ozturk AA, Ucvet A, Erbaycu AE. Surgical management of bronchiectasis: the indications and outcomes. Surg Today 2010;40:26-30.
Caylak H, Genc O, Kavakli K, Gurkok S, Gozubuyuk A, Yucel O, et al. Surgical management of bronchiectasis: a collective review of 339 patients with long-term follow-up. Thorac Cardiovasc Surg 2011;59:479-83.
Washington L, Miller WT. Computed tomography of the lungs, pleura and chest wall: In: Shilds TW, Lo Cicero III J, Ponn RB, Rusch VW, editors. General Thoracic Surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 145-64.
Miller JI. Bacterial infections of the lung and bronchial compressive disorders: In: Shilds TW, Lo Cicero III J, Ponn RB, Rusch VW, editors. General Thoracic Surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 1219-32.
Ashour M, Al-Kattan KM, Jain SK, Al-Majed S, Al-Kassimi F, Mobaireek A, et al. Surgery for unilateral bronchiectasis: results and prognostic factors. Tuber Lung Dis 1996;77:168-72.
Agarwal R. Bronchiectasis in acute pneumonia ... Pseudobronchiectasis. Chest 2007;132:2054-5.
Roviaro G, Varoli F, Rebuffat C, Vergani C, D’Hoore A, Scalambra SM, et al. Major pulmonary resections: pneumonectomies and lobectomies. Ann Thorac Surg 1993;56:779-83.
Zhou ZL, Zhao H, Li Y, Li JF, Jiang GC, Wang J. Completely thoracoscopic lobectomy for the surgical management of bronchiectasis. Chin Med J (Engl) 2013;126:875-8.
Zhang P, Zhang F, Jiang S, Jiang G, Zhou X, Ding J, et al. Video-assisted thoracic surgery for bronchiectasis. Ann Thorac Surg 2011;91:239-43.
Haciibrahimoglu G, Fazlioglu M, Olcmen A, Gurses A, Bedirhan MA. Surgical management of childhood bronchiectasis due to infectious disease. J Thorac Cardiovasc Surg 2004;127:1361-5.
Enön S, Kavukçu HS. Bronşektazi. In: Ökten İ, Kavukçu Ş, editörler. Göğüs Cerrahisi 2.Baskı. İstanbul: İstanbul Tıp Kitabevi; 2013. p. 997-1006.
Balci AE, Balci TA, Eren Ş, Nazaroğlu H, Eren MN. The role of operation in bronchiectasis: Comparison of surgical and medical treatment. Turk Gogus Kalp Dama 2002;10:95-101.
Vallilo CC, Terra RM, de Albuquerque AL, Suesada MM, Mariani AW, Salge JM, et al. Lung resection improves the quality of life of patients with symptomatic bronchiectasis. Ann Thorac Surg 2014;98:1034-41.
George SA, Leonardi HK, Overholt RH. Bilateral pulmonary resection for bronchiectasis: a 40-year experience. Ann Thorac Surg 1979;28:48-53.
Mazières J, Murris M, Didier A, Giron J, Dahan M, Berjaud J, et al. Limited operation for severe multisegmental bilateral bronchiectasis. Ann Thorac Surg 2003;75:382-7.
Aghajanzadeh M, Sarshad A, Amani H, Alavy A. Surgical management of bilateral bronchiectases: results in 29 patients. Asian Cardiovasc Thorac Ann 2006;14:219-22.
Laros CD, Van den Bosch JM, Westermann CJ, Bergstein PG, Vanderschueren RG, Knaepen PJ. Resection of more than 10 lung segments. A 30-year survey of 30 bronchiectatic patients. J Thorac Cardiovasc Surg 1988;95:119-23.
Prieto D, Bernardo J, Matos MJ, Eugénio L, Antunes M. Surgery for bronchiectasis. Eur J Cardiothorac Surg 2001;20:19-23.
Cobanoglu U, Yalcinkaya I, Er M, Isik AF, Sayir F, Mergan D. Surgery for bronchiectasis: The effect of morphological types to prognosis. Ann Thorac Med 2011;6:25-32.
Eren S, Esme H, Avci A. Risk factors affecting outcome and morbidity in the surgical management of bronchiectasis. J Thorac Cardiovasc Surg 2007;134:392-8.
Dai J, Zhu X, Bian D, Fei K, Jiang G, Zhang P. Surgery for predominant lesion in nonlocalized bronchiectasis. J Thorac Cardiovasc Surg 2017;153:979-85.