Çocuklarda ön mediasten tümörlerinde torakoskopik girişimler
Küçük Resim Yok
Tarih
2005
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Torakoskopinin çocuklarda sık kullanıldığı alanlardan biri de mediastinal kitlelerin tanı ve tedavisidir. Bu çalışmada ön mediastinal kitle nedeniyle torakoskopik girişim uyguladığımız hastalar sunulmuştur. Yöntem: Kliniğimizde ön mediastinal kitle tanılı 6 hastaya toplam 7 torakoskopik girişim uygulandı. Hastaların yaş ortalamaları 11,3 (7-16) yıldı. İşlem uygulanan tarafta akciğeri söndürmek için kullanılan teknikler, kontralateral ana bronşun selektif entübasyonu, ipsilateral ana bronşun Fogarty balonu ile kapatılması veya plevral boşluğa 5-8 mmHg basınçlı CO2 gazı verilmesiydi. Olguların hepsinde 3 adet trokar ve işlem sırasında 5 mm teleskop (0-derece) kullanıldı. Altı işlem sonrası trokar giriş yerlerinden birinden geçirilen toraks tüpü plevral boşluğa yerleştirildi, bir girişim sonrası ise toraks tüpü kullanılmadı. Bulgular: Biyopsi işlemi 4 hastada primer tanı amaçlı, 2 hastada ise tedavi sonrası kalıntı kitlenin değerlendirilmesi amacıyla uygulandı. Torakoskopik yaklaşım ile 4 olguda insizyonel, 2 olguda eksizyonel biyopsi yapıldı. İnsizyonel biyopsi uygulanan bir hastada kemoterapi sonrası kitle küçülmekle birlikte kalıntı doku saptanması nedeniyle ikinci kez torakoskopi uygulandı ve kitle tam olarak çıkarıldı. Hastaların hiçbirinde torakotomiye geçiş gerekmedi. Ameliyat sonrası hiçbir hastada komplikasyon gelişmedi ve operasyondan ortalama 1,6 (1-3) gün sonra toraks tüpleri çekildi. Primer tanı amaçlı alınan örneklerin patolojik incelemeleri; indiferansiye küçük yuvarlak hücreli malign habis tümör (n=1) ve Hodgkin Lenfoma (n=3) olarak yorumlandı. Torakoskopik girişim öncesi tedavi görmüş ve kalıntı kitle nedeniyle sekonder biyopsi/rezeksiyon uygulanmış olan olgularda ise patoloji sonucu benign selim histoloji (n=3) olarak rapor edildi. Sonuç: Torakoskopik cerrahi, çocuklarda ön mediasten kitlelerinde uygulanabilen etkili ve güvenli bir yöntemdir. Torakoskopik yaklaşım ile tanı için yeterli doku örnekleri alınabilir veya kitle tam olarak çıkartılabilir.
Aim: Thoracoscopy is frequently performed in pediatric patients for the diagnosis or treatment of mediastinal masses. In this study, we present our experience with thoracoscopic surgery in patients with anterior mediastinal tumors. Method: A total of 7 thoracoscopic procedures were performed in 6 children. Mean age of patients was 11.3 (7-14) years. Selective intubation of contralateral main bronchus, obliteration of ipsilateral main bronchus by a Fogarty catheter or CO2 insufflation into the pleural space with 5-8 mmHg pressure were the methods used to collapse the ipsilateral lung. Three trocars and 5 mm 0-degree telescope were used in all procedures. After 6 procedures, a chest tube was inserted through one of the trocar tracts while no drain was used after 1 procedure. Results: The biopsies (4 insicional, 2 excisional) were performed for a primary histologic diagnosis in 4 children and for the assesment of residual masses persisted after therapy in the remaining 2 patients. A second thoracoscopy and total resection of the mass was performed in a patient biopsied previously, and whose tumour shriked but not completely disappeared after chemotherapy. Conversion to thoracotomy was not required in any of the procedures and no postoperative complication was observed. The mean number of chest tube days was 1.6 (1-3). The histologic diagnosis of the tumors biopsied for a primary diagnosis were undifferentiated small round cell malign tumor (n=1) and Hodgkin Lymphoma (n=3). The pathologic examination revealed benign histology in residual tumors persisted after cessation of therapy (n=3). Conclusion: Thoracoscopic surgery in the treatment of children with anterior mediastinal tumors can be efficacious and safe. Mediastinal masses can be biopsied and resected by thoracoscopy alone.
Aim: Thoracoscopy is frequently performed in pediatric patients for the diagnosis or treatment of mediastinal masses. In this study, we present our experience with thoracoscopic surgery in patients with anterior mediastinal tumors. Method: A total of 7 thoracoscopic procedures were performed in 6 children. Mean age of patients was 11.3 (7-14) years. Selective intubation of contralateral main bronchus, obliteration of ipsilateral main bronchus by a Fogarty catheter or CO2 insufflation into the pleural space with 5-8 mmHg pressure were the methods used to collapse the ipsilateral lung. Three trocars and 5 mm 0-degree telescope were used in all procedures. After 6 procedures, a chest tube was inserted through one of the trocar tracts while no drain was used after 1 procedure. Results: The biopsies (4 insicional, 2 excisional) were performed for a primary histologic diagnosis in 4 children and for the assesment of residual masses persisted after therapy in the remaining 2 patients. A second thoracoscopy and total resection of the mass was performed in a patient biopsied previously, and whose tumour shriked but not completely disappeared after chemotherapy. Conversion to thoracotomy was not required in any of the procedures and no postoperative complication was observed. The mean number of chest tube days was 1.6 (1-3). The histologic diagnosis of the tumors biopsied for a primary diagnosis were undifferentiated small round cell malign tumor (n=1) and Hodgkin Lymphoma (n=3). The pathologic examination revealed benign histology in residual tumors persisted after cessation of therapy (n=3). Conclusion: Thoracoscopic surgery in the treatment of children with anterior mediastinal tumors can be efficacious and safe. Mediastinal masses can be biopsied and resected by thoracoscopy alone.
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Çocuk Cerrahisi Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
19
Sayı
2
