Mehmet YILDIRIM, Recep USTAALİOĞLU, Ilgaz DOĞUSOY, Hatice DEMİRBAĞ

Primer spontan pnömotoraksın cerrahi tedavisinde aksiller torakotomi ile video yardımlı torakoskopik cerrahinin karşılaştırılması

Amaç: Bu çalışmada primer spontan pnömotoraksın cerrahi tedavisinde video yardımlı torakoskopik cerrahi ile aksiller torakotomi sonuçları karşılaştırıldı. Çalışma planı: Ocak 2009 - Aralık 2015 tarihleri arasında Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi Göğüs Cerrahisi Kliniği ile Kadıköy ve Kozyatağı Acıbadem Hastanelerinde primer spontan pnömotorakslı olan ve ameliyat edilen toplam 199 hasta (178 erkek, 21 kadın; ort. yaş 21.3±7.1 yıl; dağılım 13-35 yıl) geriye dönük olarak incelendi. Hastaların 48’ine aksiller torakotomi, kama rezeksiyon, apikal plörektomi ve doku yapıştırıcısı uygulanır iken, 151’ine video yardımlı torakoskopik cerrahi, kama rezeksiyon, apikal plörektomi ve doku yapıştırıcısı uygulandı. İki grup yaş, cinsiyet, uzun süre analjezik kullanım miktarı, ameliyat süresi, hastanede kalış süresi, nüks, komplikasyon ve mortalite oranları açısından karşılaştırıldı. Bulgular: Hastalar bir yıl süreyle takip edildi. Hiçbir hastada mortalite gözlenmedi. Ameliyat tipine göre hastaların yaş ve cinsiyet dağılımları, ameliyat sonrası hastanede kalış süreleri, nüks oranları ve komplikasyon oranları açısından istatistiksel olarak anlamlı bir farklılık görülmedi. Ancak, ameliyat süresi yardımlı torakoskopik cerrahi yapılan hastalarda daha uzundu. Sonuç: Video yardımlı torakoskopik cerrahi daha az ağrı ve daha yüksek hasta memnuniyeti ile ilişkilidir ve günlük aktivitelere daha kısa sürede dönüş yapılmasına olanak sağlar. Çalışma sonuçlarımıza göre, video yardımlı torakoskopik cerrahinin, daha az invaziv olması ve daha iyi görüş açısı sağlaması gibi avantajları sayesinde, aksiller torakotomiye kıyasla daha uygun olduğu kanaatindeyiz.

A comparison of axillary thoracotomy versus video-assisted thoracoscopic surgery in the surgical treatment of primary spontaneous pneumothorax

Background: This study aims to compare the results of video-assisted thoracoscopic surgery and axillary thoracotomy in the surgical treatment of primary spontaneous pneumothorax.Methods: Between January 2009 and December 2015, a total of 199 patients (178 males, 21 females; mean age 21.3±7.1 years; range 13 to 35 years) with primary spontaneous pneumothorax who were operated at Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Thoracic Surgery and Kadikoy and Kozyatagi Acibadem hospitals were retrospectively analyzed. Of these patients, 48 underwent axillary thoracotomy, wedge resection, apical pleurectomy, and tissue adhesives, while 151 were administered video-assisted thoracoscopic surgery, wedge resection, apical pleurectomy, and tissue adhesives. Both groups were compared in terms of age, gender, the amount of long-term analgesic use, duration of surgery, length of hospitalization, recurrence, complication, and mortality rates.Results: The patients were followed for one year. No mortality was observed in any patient. There was no significant difference in the age and gender distributions of the patients, postoperative length of hospital stay, recurrence rates, and complication rates according to the type of operation. However, the duration of operation was longer in the video-assisted thoracoscopic surgery patients.Conclusion: Video-assisted thoracoscopic surgery is associated with less pain and higher patient satisfaction and allows returning to daily activities in a shorter time period. Based on our study results, we suggest that video-assisted thoracoscopic surgery is more suitable, compared to axillary thoracotomy, owing to its advantages, such as being less invasiveand providing a better angle of view.

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