Muhammet Reha ÇELİK, Hakkı ULUTAŞ, Akın KUZUCU

Bronşektazili çocuk/ergen ve erişkin hastalarda mevcut cerrahi tedavinin yeri

Amaç: Bu çalışmada, bronşektazili çocuk ve erişkin hastalarda klinik bulgular, cerrahi endikasyonlar, cerrahi işlemler, ameliyat sonrası komplikasyonlar ve cerrahi tedavi sonuçları karşılaştırıldı. Çalışma planı: Ocak 2000 - Aralık 2013 tarihleri arasında bronşektazi nedeni ile Göğüs Cerrahisi bölümünde ameliyat edilen toplam 99 hasta (40 erkek, 59 kadın; ort. yaş 33.3 yıl; dağılım 10-67 yıl) geriye dönük olarak incelendi. Grup 1 (n=28) çocuk hastalardan (≤18 yıl) ve grup 2 (n=71) erişkin hastalardan (>18 yıl) oluşuyor idi. Klinik semptomlar, yapılan cerrahi tedavi kriterleri, cerrahi tedavi yaklaşımları, ameliyat sonrası komplikasyonlar, hastanede kalış süreleri ve tedavi sonuçları değerlendirildi. Bulgular: Her iki grupta en yaygın semptom prodüktif öksürüğü takiben tekrarlayan enfeksiyonlar idi. Gruplar arasında bu semptomların görülme sıklığı açısından anlamlı bir fark saptanmadı. Toplamda 104 cerrahi yapıldı. Grup 1’de 29 cerrahinin 26’sı torakotomi ve üçü video yardımlı torakoskopik cerrahi idi. Grup 2’de 75 cerrahinin 60’ı torakotomi ve 15’i video yardımlı torakoskopik cerrahi idi. Grup 1’de sekiz ameliyatta (27.6%) ve grup 2’de 18 ameliyatta (24%) ameliyat sonrası komplikasyonlar izlendi. Ameliyat sırası ve sonrası mortalite gözlenmedi. Grup 1’de 28 hastanın tamamında ameliyat sonrası iyileşme izlenir iken, 23 sonuç (%82.1) mükemmel (tam remisyon) ve beş sonuç (%17. 9) iyileşmiş (semptomlarda azalma) olarak tanımlandı. Grup 2’de 63 sonuç (%88.7) mükemmel ve yedi sonuç (%9.9) iyileşmiş olarak tanımlandı; ancak bir hastada (1.4%) iyileşme izlenmedi. Sonuç: Seçilmiş olgularda, hastanın yaşından bağımsız olarak, bronşektazinin cerrahi tedavisi tatmin edicidir ve kabul edilebilir mortalite ve morbidite oranları ile ilişkilidir. Çalışma sonuçlarımıza göre, cerrahi bu hastalığı tedavi edebilir ve tedavi edemediği durumlarda dahi, hastanın yaşam kalitesini iyileştirebilir.

The role of current surgical therapy for pediatric/adolescent and adult patients with bronchiectasis

Background: This study aims to compare clinical manifestations, surgical indications, surgical procedures, postoperative complications, and outcomes of surgical treatment in pediatric and adult patients with bronchiectasis.Methods: Between January 2000 and December 2013, a total of 99 patients (40 males, 59 females; mean age 33.3 years; range 10 to 67 years) who underwent surgery for bronchiectasis at the Department of Thoracic Surgery were retrospectively analyzed. Group 1 (n=28) were pediatric patients (≤18 years) and group 2 (n=71) were adult patients (>18 years). Clinical symptoms, criteria surgical treatments applied, surgical treatment approaches, postoperative complications, the length of hospital stay, and treatment outcomes were evaluated.Results: In both groups, the most common symptom was productive cough, followed by recurrent infections. There were no significant differences in the frequency of these symptoms between the groups. In total, 104 surgeries were performed. Of 29 surgeries in group 1, 26 were thoracotomies and three were video-assisted thoracoscopic surgery. Of 75 surgeries in group 2, 60 were thoracotomies and 15 were video-assisted thoracoscopic surgery. Postoperative complications were seen in eight operations (27.6%) in group 1 and 18 operations (24%) in group 2. There was no intra- or postoperative mortality. All 28 patients in group 1 showed improvement after surgery, while 23 outcomes (82.1%) were rated excellent (complete remission) and five outcomes (17.9%) were rated improved (reduced symptoms). In group 2, 63 outcomes (88.7%) were excellent and seven outcomes (9.9%) were rated improved; however, one patient (1.4%) showed no improvement.Conclusion: In selected cases, surgical treatment for bronchiectasis is satisfactory and associated with acceptable mortality and morbidity rates, irrespective of the age of the patient. Based on our study results, surgery can cure this condition and can improve the quality of life, even when not curative.

PDF

___

38. Mitchell JD, Yu JA, Bishop A, Weyant MJ, Pomerantz M. Thoracoscopic lobectomy and segmentectomy for infectious lung disease. Ann Thorac Surg 2012;93:1033-9.
37. Turhan K, Özdil A, Erol Y, Çakan Alpaslan, Çağırıcı U. Synchronous bilateral thoracoscopic lobectomy in a patient with bronchiectasis. Turk Gogus Kalp Dama 2016;24:148-50.
36. Weber A, Stammberger U, Inci I, Schmid RA, Dutly A, Weder W. Thoracoscopic lobectomy for benign disease--a single centre study on 64 cases. Eur J Cardiothorac Surg 2001;20:443- 8.
35. 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.
34. Sahin A, Meteroglu F, Kelekci S, Karabel M, Eren C, Eren S, et al. Surgical outcome of bronchiectasis in children: long term results of 60 cases. Klin Padiatr 2014;226:233-7.
33. Sirmali M, Karasu S, Türüt H, Gezer S, Kaya S, Taştepe I, et al. Surgical management of bronchiectasis in childhood. Eur J Cardiothorac Surg 2007;31:120-3.
32. Balci AE, Balci TA, Ozyurtan MO. Current surgical therapy for bronchiectasis: surgical results and predictive factors in 86 patients. Ann Thorac Surg 2014;97:211-7.
31. Fujimoto T, Hillejan L, Stamatis G. Current strategy for surgical management of bronchiectasis. Ann Thorac Surg 2001;72:1711-5.
30. 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.
29. Laros CD, Westermann CJ. Dilatation, compensatory growth, or both after pneumonectomy during childhood and adolescence. A thirty-year follow-up study. J Thorac Cardiovasc Surg 1987;93:570-6.
29. Laros CD, Westermann CJ. Dilatation, compensatory growth, or both after pneumonectomy during childhood and adolescence. A thirty-year follow-up study. J Thorac Cardiovasc Surg 1987;93:570-6.
28. Blyth DF, Buckels NJ, Sewsunker R, Soni MA. Pneumonectomy in children. Eur J Cardiothorac Surg 2002;22:587-94.
27. Kosar A1, Orki A, Kiral H, Demirhan R, Arman B. Pneumonectomy in children for destroyed lung: evaluation of 18 cases. Ann Thorac Surg 2010;89:226-31.
26. Sanderson JM, Kennedy MC, Johnson MF, Manley DC. Bronchiectasis: results of surgical and conservative management. A review of 393 cases. Thorax 1974;29:407-16.
25. Otgün I, Karnak I, Tanyel FC, Senocak ME, Büyükpamukçu N. Surgical treatment of bronchiectasis in children. J Pediatr Surg 2004;39:1532-6.
24. 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.
23. Prieto D, Bernardo J, Matos MJ, Eugénio L, Antunes M. Surgery for bronchiectasis. Eur J Cardiothorac Surg 2001;20:19-23
22. 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.
20. Schneiter D, Meyer N, Lardinois D, Korom S, Kestenholz P, Weder W. Surgery for non-localized bronchiectasis. Br J Surg 2005;92:836-9.
21. Dadaş E, Tanju S, Kılıçgün A, Toker A, Dilege Ş. Surgical treatment of bronchiectasis: clinical characteristics and long-term outcomes. Turk Gogus Kalp Dama 2014;22:583-8.
19. Ulutas H, Celik MR, Kuzucu A. Surgical management of upper- and lower-lobe bronchiectasis without middle lobe involvement: is middle lobectomy necessary? J Pediatr Surg 2012;47:25-8.
18. Andrade CF, Melo IA, Holand AR, Silva ÉF, Fischer GB, Felicetii JC. Surgical treatment of non-cystic fibrosis bronchiectasis in Brazilian children. Pediatr Surg Int 2014;30:63-9.
17. King P. Pathogenesis of bronchiectasis. Paediatr Respir Rev 2011;12:104-10.
16. Redding GJ. Bronchiectasis in children. Pediatr Clin North Am 2009;56:157-71.
15. Gaillard EA, Carty H, Heaf D, Smyth RL. Reversible bronchial dilatation in children: comparison of serial high-resolution computer tomography scans of the lungs. Eur J Radiol 2003;47:215-20.
14. King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW. Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med 2006;100:2183-9.
13. Eastham KM, Fall AJ, Mitchell L, Spencer DA. The need to redefine non-cystic fibrosis bronchiectasis in childhood. Thorax 2004;59:324-7.
12. Gursoy S, Ozturk AA, Ucvet A, Erbaycu AE. Surgical management of bronchiectasis: the indications and outcomes. Surg Today 2010;40:26-30.
11. 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.
10. Kapur N, Karadag B. Differences and similarities in non-cystic fibrosis bronchiectasis between developing and affluent countries. Paediatr Respir Rev 2011;12:91-6.
9. Roberts HJ, Hubbard R. Trends in bronchiectasis mortality in England and Wales. Respir Med 2010;104:981-5.
8. O'Donnell AE. Bronchiectasis. Chest 2008;134:815-23.
7. Feldman C. Bronchiectasis: new approaches to diagnosis and management. Clin Chest Med 2011;32:535-46.
6. Seitz AE, Olivier KN, Adjemian J, Holland SM, Prevots DR. Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest 2012;142:432-9.
5. Campbell DN, Lilly JR. The changing spectrum of pulmonary operations in infants and children. J Thorac Cardiovasc Surg 1982;83:680-5.
4. 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.
3. Agasthian T, Deschamps C, Trastek VF, Allen MS, Pairolero PC. Surgical management of bronchiectasis. Ann Thorac Surg 1996;62:976-8.
2. Corless JA, Warburton CJ. Surgery vs non-surgical treatment for bronchiectasis. Cochrane Database Syst Rev 2000;4:002180.
1. Barker AF, Bardana EJ Jr. Bronchiectasis: update of an orphan disease. Am Rev Respir Dis 1988;137:969-78.