Mehmet YILDIRIM, Tamer OKAY, Oya İMAMOĞLU, Murat YAŞAROĞLU, Bülent AYDEMİR, Tuba KOÇ, Ilgaz DOĞUSOY, Hatice DEMİRBAĞ

Perikard efüzyonlu hastaların tedavisinde VATS ve torakotominin karşılaştırılması

Amaç: Bu çalışmada perikard efüzyonu bulunan ve torakoskopik perikard pencere ile klasik anterior torakotomi yapılan olgularda, klinik sonuçlar karşılaştırılarak, video yardımlı torakoskopik cerrahinin (VATS) günlük cerrahi pratikteki önemi değerlendirildi. Bunun sonucunda torakoskopik cerrahinin klasik yöntemlere göre potansiyel üstünlükleri ve olası zayıf yönleri literatür bilgileri ile karşılaştırıldı ve tartışıldı. Çalışma planı: Kliniğimizde Ocak 2006 - Aralık 2009 tarihleri arasında, daha önce uygulanan medikal tedavilere yanıt vermeyen veya yapılan multipl perikardiyosentezler sonrasında nükseden 94 perikard efüzyonlu veya tamponadlı olguya cerrahi yöntemlerle parsiyel perikard rezeksiyonu uygulandı. Çalışmaya dahil edilen 94 olgunun 50’sine VATS ile perikardiyektomi yapıldı, 44’ü ise anterolateral torakotomi ile ameliyat edildi. Bu olgular; yaş ve cinsiyet dağılımı, etyoloji, ameliyat şekli, ameliyat süresi, drene edilen perikard sıvısının niteliği ve miktarı, yoğun bakım ünitesinde (YBÜ) kalış süresi, göğüs tüpü drenajı ve hastanede kalış süresi, patolojik tanı, komplikasyon, nüks, maliyet, morbidite ve mortaliteleri açısından incelendi. Bulgular: Malignite olan ve olmayan hastalarda anlamlı farklılıklar saptandı. Malignite olan olgularda; ameliyat tekniğine göre yaş, cinsiyet, nüks, ameliyat süreleri ve drenaj miktarları arasında istatistiksel olarak anlamlı farklılık bulunmadı (p>0.05). Ameliyat şekline göre YBÜ kalış süreleri, hastanede kalış süreleri, dren çekilme süreleri ve maliyetler arasında istatistiksel olarak VATS lehine anlamlı farklılıklar bulundu (p0.05). Ameliyat tekniğine göre bu hastalarda hastanede kalış süreleri ile dren çekilme süreleri arasında VATS lehine istatistiksel olarak anlamlı farklılıklar bulundu (p

Comparison of VATS and thoracotomy in treatment of patients with pericardial effusion

Background: In this study we evaluated the importance of videoassisted thoracoscopic surgery (VATS) in the daily surgical practice by comparing the clinical results of patients with pericardial effusions who underwent classical anterior thoracotomy with thoracoscopic pericardial window. We also compared and discussed the potential advantages and possible weaknesses of thoracoscopic surgery versus the classical techniques with data available from the literature. Methods: Between January 2006 and December 2009, 94 patients diagnosed with pericardial effusion and/or tamponade who did not respond to previous medical treatments or who had a recurrence after multiple pericardiosynthesis procedures underwent surgical partial pericardial resection using surgical methods. Of these 94 patients 50 were operated on using pericardiectomy with VATS and 44 patients were operated on via anterolateral thoracotomy. These cases were evaluated with respect to age and gender distribution, etiology, operation type, operation time, quality and amount of the drained pericardial fluid, duration of intensive care unit (ICU) stay, chest tube drainage, duration of hospitalization, pathological diagnosis, complications, recurrence, cost, morbidity and mortality. Results: Significant differences were found in patients with or without malignancy. In malignant cases; no statistically significant differences were found with respect to age, gender, recurrence, operation times, or amount of drainage by the surgical technique (p>0.05). Statistically significant differences were found in favor of VATS with respect to duration of ICU stay, duration of hospitalization, drain extraction time and costs of the surgical technique (p0.05). Statistically significant differences were found in favor of VATS with respect to duration of hospitalization and drain extraction time by the surgical technique in this patients (p

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