Şehnaz OLGUN YILDIZELİ, Davor STAMENOVIC, Korkut BOSTANCI, Hakan ÖMERCİKOĞLU, Mustafa YÜKSEL, Zeynep Bilgi, Çağatay ÇETİNKAYA

İleri amfizem tedavisinde endobronşiyal sarmallar: Tek merkez deneyimi

Amaç: Bu çalışmada ileri amfizem nedeniyle endobronşiyal akciğer hacim küçültme uygulanan hastalarda endobronşiyal sarmal ile deneyimimiz sunuldu. Çalışma planı: Çalışmaya ileri amfizem nedeniyle endobronşiyal sarmal ile endobronşiyal akciğer hacim küçültme uygulanan 46 hasta (45 erkek, 1 kadın; ort. yaş 61.7±8 yıl; dağılım, 43-80 yıl) dahil edildi. Hastaların yaşı, cinsiyeti, pulmoner fonksiyon testleri, tedavi sonrası morbiditesi, mortalitesi, tedavi öncesi ve sonrası (6 ay) altı dakika yürüme mesafesi, modifiye Medikal Araştırma Konseyi dispne skorları, kronik obstrüktif akciğer hastalığı değerlendirme testi ve Hastane Anksiyete ve Depresyon Ölçeği skorları kaydedildi. Bulgular: Hastaların ortalama sigara kullanım öyküleri 65 paket/yıl idi. Lob başına ortalama 11 (dağılım, 9-15) sarmal yerleştirildi (sağ üst lob=35, sol üst lob=19, sağ alt lob=2, sol alt lob=4). Ortalama takip süresi 12.6 ay (±5.6 ay) idi. Tedavi sonrası birinci saniye zorlu ekspirasyon volümü, rezidüel volüm ve altı dakika yürüme mesafesi değerleri istatistiksel olarak anlamlı şekilde düzeldi. Yaşam kalitesinde de modifiye Medikal Araştırma Konseyi, kronik obstrüktif akciğer hastalığı değerlendirme testi ve Hastane Anksiyete ve Depresyon Ölçeği skorlarıyla ölçümlenen belirgin düzelme görüldü. Ameliyatın hemen sonrasında majör komplikasyon yaşanmazken 30 gün içinde üç hastada kronik obstrüktif akciğer hastalığı alevlenmesi, iki hastada pnömoni ve bir hastada önceki nörolojik hastalığın nüksü gelişti. Sonuç: Endobronşiyal sarmal uygulaması ileri amfizemli seçilmiş hastalarda akciğer hacim küçültme cerrahisi ile karşılaştırıldığında daha düşük morbidite ve mortalite ile beraber pulmoner fonksiyonlarda ve yaşam kalitesinde belirgin düzelme sağlar.

Endobronchial coils in treatment of advanced emphysema: A single center experience

Background: This study aims to present our experience withendobronchial coils in patients who underwent endobronchial lungvolume reduction due to advanced emphysema.Methods: The study included 46 patients (45 males, 1 female; mean age61.7±8 years; range, 43 to 80 years) who underwent endobronchial lungvolume reduction with endobronchial coils for advanced emphysema.Patients’ age, gender, pulmonary function tests, post-treatment morbidity,mortality, pre- and post-treatment (6 months) six-minute walkingdistance, modified Medical Research Council dyspnea scores, chronicobstructive pulmonary disease assessment test and Hospital Anxiety andDepression Scale scores were recorded.Results: Patients had an average of 65 pack/year smoking history. Anaverage of 11 (range, 9-15) coils were placed per lobe (right upperlobe=35, left upper lobe=19, right lower lobe=2, left lower lobe=4).Mean follow-up duration was 12.6 months (±5.6 months). Post-treatmentforced expiratory volume in one second, residual volume and six-minutewalking distance values were improved with statistical significance.Also, significant improvement was seen in quality of life, quantifiedby modified Medical Research Council, chronic obstructive pulmonarydisease assessment test and Hospital Anxiety and Depression Scalescores. While no immediate major postoperative complicationsoccurred, three patients developed chronic obstructive pulmonarydisease exacerbation, two developed pneumonia, and one developedrecurrence of previous neurologic disorder within 30 days.Conclusion: Endobronchial coil administration provides lowermorbidity and mortality compared to lung volume reduction surgery aswell as significant improvement in pulmonary functions and quality oflife in selected patients with advanced emphysema.

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