Çocuklarda torakoskopik girişimler
Küçük Resim Yok
Tarih
2003
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Önbilgi/amaç: Minimal invaziv cerrahi tekniklerin gelişmesi ile torakoskopik girişimler çocuklarda artan sıklıkta uygulanmaya başlamıştır. Kliniğimizde bu yöntemle tedavi edilen hastalar işlemin etkinliği ve komplikasyonları yönünden değerlendirilmiştir. Yöntem: Kliniğimizde iki yıl içinde 23 hastaya 24 torakoskopik girişim (17 sağ, 7 sol) uygulandı. Hastaların yaş ortalamaları 5 (7 ay-14 yıl) yıldı. İşlem uygulanan tarafta akciğeri söndürmek için kullanılan teknikler; karşı taraf ana bronşunun selektif entühasyonu, işlem uygulanan tarafta ana bronşun Fogarty balonu ile kapatılması veya plevral boşluğa 5-8 mmHg basınçlı CO2 verilmesiydi. Kullanılan port sayısı işleme göre 2-4 arasında değişti. İki hastada 10 mm, diğer hastalarda 5 mm çapında teleskop kullanıldı. İşlem sonrası 4 hastada iki, diğer hastalarda ise bir toraks tüpü plevral boşluğa yerleştirildi. Bulgular: Torakoskopi ile 14 ampiyem dehridmanı, 1 bronkoplevral fistül. ligasyonu, 4 parenkim biyopsisi, I travma eksplorasyonu, 2 mediastinal lenf bezi eksizyonu, I akciğer kisti eksizyonu ve l Heller özofagomyotomi gerçekleştirildi. Ortalama operasyon süresi 2.8 (0.5-6) saatti. Sadece I olguda (mediastinal lenfadenopati) kanama nedeni ile açık cerrahiye geçidi. Komplikasyon olarak 5 hastada işlem sonrası (4 ampiyem dehridmanı, l parenkim hiopsisi) bronkoplevral fistül gelişti ve uzun süre toraks tüpü ile drenaja gereksinim oldu (ortalama: 17, 11-21 gün). Bu hastalardan üçü konservatif tedavi ile iyileşirken, birinde torakotomi ileflstülün cerrahi olarak kapatılması gerekti, bir hastaya ise ikinci kez torakoskopi ve fistül ligasyonu uygulandı. Diğer 18 hastada ise operasyondan ortalama 3.8 (1-12) gün sonra toraks tüpleri çek'ildi. Sonuç: Torakoskopik cerrahi çocuklarda etkin ve güvenli bir şekilde uygulanabilir. Ancak, parenkim hasarının ağır olduğu olgularda, bronkoplevral fistül gelişimi girişim sonrası tüp torakostomi süresinin uzamasına neden olmaktadır.
Background/aim: Advances in minimally invasive surgical techniques has led to increasing use of thoracoscopic procedures in children. Patients who have been operated with this technique in our department were evaluated for the efficacy and the complications of thoracoscopic surgery. Method: Twenty three patients had 24 thoracoscopic procedures (17 right and 7 left) in the last two years. Mean age of the patients was 5 years (7 months-14 years). Selective intubation of contralateral main bronchus, obliteration of ipsilateral main bronchus by a Fogarty catheter or CO2 insufflation into the pleura! space with 5-8 mmHg pressure were the methods used to collapse the ipsilateral lung. Number of trocars used during the procedures ranged between 2 and 4. Ten-mm telescope was used in two patients while 5 mm was preferred for the remaining. In 4 patients, two drains were placed into the pleural space while the remaining patients had only one drain postoperatively. Results: Fourteen debridements for empvma, I bronchopleural fistula ligation, 4 parenchyma! biopsies, I exploration for thoracic trauma, 2 mediastinal lymph node biopsies, J resection of pulmonary cyst, and I Heller esophagomyotomy were performed. Mean operating time was 2.8 (0.5-6) hours. In only I patient (mediastinal lymphadenopathy), the operation was converted to a thoracotomy because of bleeding. There were 5 bronchopleural fistulas (4 debridements for empyema and I parenchinial biopsy) as a complication, and these patients required prolonged tube thoracostomy (mean 17; 11-21 days). Three of these patients healed with conservative measures while one required a second thoracoscopy and the other required a thoracotomy for closure of the fistula. Mean time for tube thoracostomy in the remaining 18 patients was 3.8 (1-12) days. Conclusion: Thoracoscopic surgery is safe and effective in children. However, postoperative chest tube drainage may he prolonged due tobronchopleural fistulas in patients with severe parencymal damage.
Background/aim: Advances in minimally invasive surgical techniques has led to increasing use of thoracoscopic procedures in children. Patients who have been operated with this technique in our department were evaluated for the efficacy and the complications of thoracoscopic surgery. Method: Twenty three patients had 24 thoracoscopic procedures (17 right and 7 left) in the last two years. Mean age of the patients was 5 years (7 months-14 years). Selective intubation of contralateral main bronchus, obliteration of ipsilateral main bronchus by a Fogarty catheter or CO2 insufflation into the pleura! space with 5-8 mmHg pressure were the methods used to collapse the ipsilateral lung. Number of trocars used during the procedures ranged between 2 and 4. Ten-mm telescope was used in two patients while 5 mm was preferred for the remaining. In 4 patients, two drains were placed into the pleural space while the remaining patients had only one drain postoperatively. Results: Fourteen debridements for empvma, I bronchopleural fistula ligation, 4 parenchyma! biopsies, I exploration for thoracic trauma, 2 mediastinal lymph node biopsies, J resection of pulmonary cyst, and I Heller esophagomyotomy were performed. Mean operating time was 2.8 (0.5-6) hours. In only I patient (mediastinal lymphadenopathy), the operation was converted to a thoracotomy because of bleeding. There were 5 bronchopleural fistulas (4 debridements for empyema and I parenchinial biopsy) as a complication, and these patients required prolonged tube thoracostomy (mean 17; 11-21 days). Three of these patients healed with conservative measures while one required a second thoracoscopy and the other required a thoracotomy for closure of the fistula. Mean time for tube thoracostomy in the remaining 18 patients was 3.8 (1-12) days. Conclusion: Thoracoscopic surgery is safe and effective in children. However, postoperative chest tube drainage may he prolonged due tobronchopleural fistulas in patients with severe parencymal damage.
Açıklama
Anahtar Kelimeler
Konu Ataması Yapılmamış
Kaynak
Pediatrik Cerrahi Derg.
WoS Q Değeri
Scopus Q Değeri
Cilt
17
Sayı
2
