Ufuk ÇOBANOĞLU, Mehmet MELEK, Yeşim EDİRNE, Özcan HIZ

Is muscle-sparing thoracotomy advantageous?

Amaç: Bu çalışmada latismus dorsi ve serratus anterior kasları birlikte korunarak (KKT-L) ve serratus anterior kası tek başına korunarak yapılan kas koruyucu torokotomileri (KKT-S) birbirleri ile ve standart posterolateral torakotomiler (SPLT) ile avantaj ve dezavantajları açısından karşılaştırıldı.Çalışma planı: Çalışmaya torakotomi endikasyonu olan 60 hasta (18 kadın, 42 erkek; ort. yaş 42.6±16.6 yıl; dağılım 15-72 yıl) alındı ve hastalar rasgele üç gruba ayrıldı. Gruplar torakotominin, omuz hareket açıklığına, kas güçlerine, akciğer fonksiyonlarına, ameliyat sonrası ağrı durumuna ve hastanede kalış süresine etkileri açısından karşılaştırıldı.Bulgular: Omuz hareket açıklığı ve serratus anterior kas gücü SPLT grubunda diğer gruplara göre anlamlı derecede düşük idi. Latismus dorsi kas gücü KKT-L grubunda diğer gruplara göre anlamlı ölçüde daha iyi idi. Akciğer fonksiyon parametrelerinin 3. ve 7. günde KKT-L grubunda diğer gruplara göre anlamlı ölçüde daha iyi olduğu görüldü. Hastanede kalış süresi KKT-L grubunda diğer gruplara göre anlamlı ölçüde kısa idi.Sonuç: Göğsün duvar kasları korunarak yapılan torakotomilerde solunum fonksiyonları daha erken düzelmekte, kasların kesilmesine bağlı olarak gelişen ameliyat sonrası komplikasyonlar azalmaktadır. Her ne kadar SPLT ve KKT-S ile elde edilen görüş alanı KKT-L'ye göre daha iyi olsa da KKT-L'nin sağlayacağı diğer avantajlar göz önünde tutularak acil durumlar dışında bütün torakotomilerin KKT-L ile başlatılmasını önermekteyiz.

Kas koruyucu torakotomi avantajlı mı?

Background: The aim of this study was to compare muscle-sparing thoracotomy for the latissimus dorsi and the serratus anterior muscles (MST-L), and muscle-sparing thoracotomy for serratus anterior muscle (MST-S) with each other and with standard posterolateral thoracotomy (SPLT) in terms of advantages and disadvantages.Methods: Sixty patients (18 females, 42 males; mean age 42.6±16.6 years; range 15 to 72 years) in whom thoracotomy was indicated were randomly grouped into three categories. The groups were compared in terms of the effects of thoracotomy on shoulder range of motion, muscle strength, pulmonary function, postoperative pain, and duration of hospitalization.Results: Shoulder range of motion and serratus anterior muscle strength in the SPLT group were significantly lower than in the other groups. The latissimus dorsi muscle strength in the MST-L group was significantly better than that of the other groups. The parameters of pulmonary function on days 3 and 7 in the MST-L group were significantly better than those of the other groups. The duration of hospitalization in the MST-L group was significantly shorter than that of the other groups.Conclusion: The improvement of pulmonary function occurs earlier in thoracotomies that spare the chest wall muscles, and postoperative complications due to detachment are decreased. Although there is a better field of view in SPLT and MST-S than that of MST-L, considering the other advantages of MST-L, we recommend initiating with MST-L in all thoracotomies, except in emergency cases.

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