Malign plevral efüzyonlarda tek port torakoskopik plöredez

Amaç: Malign plevral efüzyonda tek port üzerinden yapılan torakoskopik cerrahi (SITS) ile plörodezin etkinliğini değerlendirmek. Gereç ve Yöntemler: 2014 ila 2018 yılları arasında, Sağlık bilimleri Üniversitesi Antalya Sağlık Uygulama ve Araştırma Merkezinde malign plevral efüzyon nedeniyle tek port torakoskopik plöredez uygulanan hastaların medikal kayıtları tarandı. Hastaların 30’u (%54,5) erkek ve 25’i (%45,4) kadın olup, yaşları 35 ila 88 yaş (ort. 64 yaş) arasında değişmekteydi. Hastalara tek port üzerinden 4 gr asbestsiz steril talk insuflasyonu ile plöredez yapıldı. En az üç gün süre ile göğüs dreni takılı kalan hastalarda günlük drenaj miktarı 100 ml altına düşmesi ile drenleri çekildi. Drenleri çekilerek taburcu edilen hastalara ameliyat sonrası otuzuncu güne klinik değerlendirme ve son akciğer grafilerini görmek amacıyla poliklinik randevusu verildi. Ameliyat sonrası 30. günde kontrole gelen hastaların çekilen göğüs radyografileri değerlendirilerek, kontrol grafisinde o taraf plevral boşluğun dörtte birini doldurmayan mayisi olan hastalarda plöredez başarılı olarak kabul edildi. Bulgular: Hastalarda en sık malign plevral efüzyonu nedeni olarak küçük hücreli dışı akciğer kanserleri ve meme kanseri tespit edildi. En sık gözlenen belirti ve bulgular dispne, göğüs ağrısı ve radyolojik plevral sıvı bulgularıydı. Efüzyon 40 (%72,7) hastada sağ ve 15 (%27,2) hastada sol tarafta gözlendi. Hiçbir hastada intraoperatif mortalite gözlenmedi. Postoperatif komplikasyon oranı %10,9 (6 hasta) olup bunlar %1,8 (bir hasta) ile ateş ve %9,0 (5 hasta) göğüs ağrısı olarak belirlendi. Postoperatif drenaj süresi 3 ila 13 gün (ort. 3,36 gün) ve hastanede kalış süresi 3 ila 15 gün (ort. 5,6 gün) arasında değişmekteydi. Toplamda 55 hastanın 34’ünde (%61,8) plöredez başarısının sağlandığı görüldü. Sonuç: SITS ile talk plörodezis malign plevral efüzyonların tedavisinde etkili ve güvenli bir yöntemdir.

Single-port thoracoscopic talc pleurodesis for malignant pleural effusion

Aim: The aim of this study was to evaluate the efficacy of single-incision thoracoscopic surgery (SITS) talc pleurodesis formalignant pleural effusion.Material and Methods: We examined the medical records of all consecutive patients with malignant pleural effusion whounderwent single port thoracoscopic pleurodesis from 2014 to 2018 at the Health Sciences University Antalya Practiceand Research Center. There were 30 males (54.5%) and 25 females (45.4%), ranging in age from 35 to 88 years (mean age:64.0 years). Pleurodesis was achieved by insufflation of 4g of sterile asbestos-free talc; the chest tube was left in place aminimum of 3 days and was removed when fluid drainage was less than 100 ml/24 h. Patients were discharged the dayafter chest tube removal and a return visit was scheduled on the 30th post-operative day, for clinical evaluation and for anew chest radiograph. Pleurodesis was regarded as successful if the amount of the fluid on chest radiograph on the 30thpost-operative day showed a pleural effusion occupying less than one-fourth of the pleural space.Results: The main causes of malignant pleural effusion were non-small cell lung carcinoma and breast cancer. Majorsymptoms were dyspnea, chest pain and radiographic findings of pleural fluid. The effusion was on the right side in 40patients (72.7%) and on the left side in 15 (27.2%). There was no intraoperative mortality. The postoperative complicationrate was 10.9% (6 patients), and included fever in 1.8% (one patient) and chest pain in 9.0% (5 patients) of the patients.Duration of postoperative pleural drainage ranged between 3 and 13 days (mean: 3.36 days). The postoperative hospitalstay ranged from 3 to 15 days (mean: 5.6 days). A successful pleurodesis was achieved in 34 of 55 patients (61.8%).Conclusion: SITS talc pleurodesis is an effective and safe treatment for the management of malignant pleural effusion.

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