İsa DÖNGEL, Sümer ŞUA, Sunam SADİ GÜVEN, Murat ÖNCEL, Bekir TEZCAN

Parenchyma-preserving and minimally invasive thoracotomy technique in giant pulmonary hydatid cysts

Amaç: Bu retrospektif çalışmada dev pulmoner kisthidatiklerde parankim koruyucu ve minimal invazivameliyat deneyimlerimiz sunuldu.Çalışmaplanı: Dev kist hidatikli 19 hasta (13 erkek,6 kadın; ort. yaş 22 yıl) ameliyat edildi. Dev kistin endış katmanı olan adventisya normal parankime kadareksize edildi ve önceden tespit edilen bronşiyal kaçaklarkapatıldı. Serbest hale gelen kistin adventisyası karşılıklıolarak parankim içerisine dikildi.Bul gu lar: Kist hidatikler 13 hastada sağ hemitoraksta,beş hastada sol hemitoraksta ve bir hastada iki taraflıidi. Güvenli bronşiyal kapatma parankimi germedenpulmoner hacim kaybını engelledi. Ameliyata bağlıkomplikasyonlar bir hastada plevral efüzyon, iki hastadaatelektazi, bir hastada yara enfeksiyonu ve üç hastadapnömoni idi. Bilgisayarlı tomografi ile ölçülen kistçapları ortalama 10 cm idi. Hastanede ortalama kalışsüresi 7.5 gün idi.Sonuç: Güncel kist hidatik tedavisi kistin cerrahi iletam olarak çıkarılmasını takiben pulmoner parankimingenişlemesine izin vermelidir. Parankim koruyucu veminimal invaziv torakotomi tekniği ile ameliyat edilenhastaların hiçbirinde rezeksiyona gerek kalmadı.Tekniğimizin avantajları; düşük komplikasyon oranıve kistin minimal invaziv torakotomi ile kapitonajgerektirmeden tek bir drenle çıkılmasıdır.

Dev pulmoner kist hidatiklerde parankim koruyucu ve minimal invaziv torakotomi tekniği

Background: This retrospective study aims to present ourparenchyma-preserving and minimally invasive operationexperiences on giant pulmonary hydatid cysts.Methods: Nineteen patients (13 males, 6 females; meanage 22 years) with giant hydatid cysts were operated. Theoutermost layer of the giant cyst, the adventitia, was excisedup to the normal parenchyma, and the previously detectedbronchial leaks were closed. The released adventitia werereciprocally sutured into the parenchyma.Results: Hydatid cysts were in the right hemithorax in13 patients, in the left hemithorax in five patients, andbilateral in one patient. The safe bronchial closure preventedpulmonary volume loss without stretching the parenchyma.Operative complications were pleural effusion in one patient,atelectasis in two patients, wound infection in one patient,and pneumonia in three patients. The diameter of cysts,measured by computed tomography, was approximately10 cm. The mean duration of hospitalization was 7.5 days.Conclusion: Current treatment of hydatid cysts shouldallow pulmonary expansion after complete surgicalremoval of the cyst. Thanks to parenchyma-preserving andminimally invasive thoracotomy technique, none of theoperated patients required resection. Advantages of ourtechnique include low rate of complications, and removalof the cyst using a single thoracic drain with minimallyinvasive thoracotomy without requiring capitonnage.

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