Hasan NAZAROĞLU, Akın Eraslan BALCI, Ansal Tansel BALCI, Mehmet Nesimi EREN

Bronşektazide operasyonun rolü: Cerrahi ve medikal tedavinin karşılaştırması

Amaç: Modern antibiyoterapi çağında, bronşektazi tedavisinde operasyonun rolünü araştırmak için, 162 bronşektazi hastası değerlendirildi. Materyal ve Metod: Hastaların 118'i cerrahi (A grubu), 28'i medikal olarak (B grubu) tedavi edildi. Her iki grup yaş, hastalıklı segment sayısı ve izlem süresi bakımından benzerdi. Bulgular: Operasyon endikasyonları %51.7 medikal tedavinin yetmezliği, %20.3 hemoptizi ve %14.4 gelişme geriliğiydi. Bilateral hastalık A grubunda %17.8, B grubunda %21.4'ü. En sık (%39'a karşın 32.1) alt lob bazal segmentler tutulmuştu. Hastalıklı segment sayısı ortalama 4.8'e karşın 4.7 idi. Lobektomi %73.7, pnömonektomi %9.3, wedge-segmentektomi %8.4 oranında yapıldı. Tam rezeksiyon tek taraflı hastalıkta %95, iki taraflı hastalıkta %28.5 başarıldı. Morbidite %21.2, mortalite %3.4'dü. A grubu hastalarda ortalama postoperatif hastane süresi B grubundan daha kısaydı (8.6'ya karşılık 13.2 gün). İki yıllık izlemde tam rezeksiyonun başarıldığı hastaların %94.4'ü, B grubu hastaların ise %60'ı asemptomatik kaldı (p < 0.05). Sonuç: Rezeksiyon, iyi seçilen hastalarda düşük morbidite ve mortaliteyle yapılabilir ve uzun dönemde medikal tedaviye üstünlük taşır.

The role of operation in bronchiectasis: Comparison of surgical and medical treatment

Background: To assess the role of operation in the management of bronchiectasis, 162 patients with bronchiectasis were reviewed in the modern era of antibiotic therapy. Methods: One-hundred-eighteen patients were treated surgically (Group A), and 28 nonoperatively (Group B). Both two groups were similar by taking the features of age, involved segment and mean follow up, into consideration. Results: The indication for operation was failure of medical therapy (51.7%), hemoptysis (20.3%) and failure of growth (14.4%). The disease was bilateral in 17.8% of group A and in 21.4% of group B. Lower lobes basal segments were involved most frequently (39% versus 32.1%). The mean number of the involved segments was 4.8 versus 4.7. Lobectomy was performed in 73.7%, pneumonectomy in 9.3 % and wedge-segmentectomy in 8.4% of surgical group. Complete resection was achieved in 95% of uniletaral bronchiectasis and in 28.5 % of bilateral bronchiectasis. Morbidity was 21.2% and mortality was 3.4%. Mean postoperative hospital stay in group A was less than in group B (8.6 vs. 13.2 days). The patients involving 94.4% of group A and 60% of group B were asymptomatic, during 2 year follow-up period (p < 0.05). Conclusion: Resection, in selected patients, can be done with low mortality and morbidity and superior to medical therapy in long term follow up.

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