BRONŞİEKTAZİ TEDAVİSİNDE CERRAHİNİN YERİ: BRONŞİEKTAZİ ŞİDDET İNDEKSİ İLE ERKEN CERRAHİ KOMPLİKASYONLARIN ÖNGÖRÜLMESİ
Öz
Amaç: Bronşiektazi, büyük ve küçük hava yollarının geri dönüşümsüz olarak genişlemesi olarak tanımlanır. Bu çalışmada, anatomik rezeksiyon uygulanmış lokalize bronşiektazi tanılı hastaların retrospektif veri analizi yapılmıştır. Çalışmanın amacı, lokalize bronşiektazi hastalarında akciğer rezeksiyonu sonrası yaşam kalitesindeki iyileşmeyi belirlemektir.
Gereç ve Yöntem: 2001 ile 2019 yılları arasında 68 cerrahi hastanın değerlendirmesi yapılmıştır. Hastaların demografik verileri, preoperatif dönem Bronşiektazi şiddet indeksi (BŞİ) skoru hesaplanmış, postoperatif erken dönem sonuçlar ve uzun dönem cerrahi sonuçlar incelenmiştir. Bronşiektazi nedeniyle anatomik rezeksiyon geçiren hastalar çalışmaya dahil edilmiştir. Bronşiektazi dışında sebeplerle ölen hastalar ve takip süresinde verilerine ulaşılamayan hastalar çalışma dışı bırakılmıştır.
Bulgular: Ortalama yaş 26 olup, kadın ve erkek oranı arasında anlamlı fark izlenmedi. Pediatrik yaş grubu 17 yaş altı hastalar olarak kabul edildi ve 26 hasta bu grupta değerlendirildi.. Pediatrik grup 26 hastadan oluşmaktaydı. Her bir hasta için preoperatif BŞİ skoru hesaplandı. Yüksek oranda tekrar hastaneye yatış ve yüksek mortalite oranları beklenen yedi hastada, yüksek BŞİ skoruna rağmen ameliyat sonrası dönemde bu hastaların hiçbirinin bronşiektazi nedeniyle yeniden hastaneye yatışa ihtiyaç duymadığı görüldü. 14 hasta video yardımlı torakostopik cerrahi ile ve 54 hasta torakotomi ile opere edildi. Tüm hasta grubunda ortalama ameliyat sonrası hastanede kalış süresi 13 gün olup, VATS işlemi uygulanan hastalarda bu süre sekiz gün, açık cerrahi uygulanan hastalarda ise ortalama 14 gün olarak bulundu (p:0,167). Alt grup analizine göre, BŞİ skoru dokuz veya daha yüksek olan hastalarda postoperative erken komplikasyon oranlarının arttığı gözlemlendi (p:0,35).
Sonuç: Yüksek BŞİ skoruna sahip hastalarda bile, klinik parametreler uygunsa cerrahi güvenilir bir seçenektir. Bronşiektazi şiddet indeksi, ameliyat sonrası komplikasyonların tahmin edilmesinde öngörü değerine sahiptir. Hastalar multidisipliner merkezlerde değerlendirilmelidir. Cerrahi karar verme sürecinde deneyimli göğüs hastalıkları hekimleri ve göğüs cerrahlarına ihtiyaç vardır.
Anahtar Kelimeler
Bronşektazi göğüs cerrahisi VATS Bronşiektazi şiddet indeks skoru
Kaynakça
- Cole PJ. Inflammation: a two-edged sword-the model of bronchiectasis. Eur J Respir Dis Suppl 1986;147:6-15. google scholar
- Reynolds HY. President’s address: R.T.H. Laënnec, M.D.- -clinicopathologic observations, using the stethoscope, made chest medicine more scientific. Trans Am Clin Climatol Assoc. 2004;115:1-29. google scholar
- Barker AF, Bardana EJ Jr. Bronchiectasis: update of an orphan disease. Am Rev Respir Dis 1988;137(4):969-78. [Crossref] google scholar
- Chang AB, Masel JP, Boyce NC, Wheaton G, Torzillo PJ. Non-CF bronchiectasis: clinical and HRCT evaluation. Pediatr Pulmonol 2003;35(6):477-83. [Crossref] google scholar
- Fleshman KJ, Wilson JF, Cohen JJ. Bronchiectasis in Alaska Native children. Arch Environ Health 1968;17(4):517-24. [Crossref] google scholar
- Singleton R, Morris A, Redding G, Poll J, Holck P, Martinez P, Kruse D, et al. Bronchiectasis in Alaska Native children: causes and clinical courses. Pediatr Pulmonol 2000;29(3):182-7. [Crossref] google scholar
- Edwards EA, Asher MI, Byrnes CA. Paediatric bronchiectasis in the twenty-first century: experience of a tertiary children’s hospital in New Zealand. J Paediatr Child Health 2003;39(2):111-7. [Crossref] google scholar
- Gao YH, Guan WJ, Liu SX. Aetiology of bronchiectasis in adults: a systematic literature review. Respirology 2016;21(8):1376-83. [Crossref] google scholar
- Goeminne PC, Hernandez F, Diel R, Filonenko A, Hughes R, Juelich F, et al. The economic burden of bronchiectasis - known and unknown: a systematic review. BMC Pulm Med 2019;19(1):54. [Crossref] google scholar
- Phua HP, Lim WY, Ganesan G, Yoong J, Tan KB, Abisheganaden JA, Lim AYH. Epidemiology and economic burden of bronchiectasis requiring hospitalisation in Singapore. ERJ Open Res 2021;7(4):00334-2021 [Crossref] google scholar
- Pasteur MC, Bilton D, Hill AT. British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010;65Suppl1:i1-58. [Crossref] google scholar
- Halezeroğlu S, Okur E. Thoracic surgery for haemoptysis in the context of tuberculosis: what is the best management approach? J Thorac Dis 2014;6(3):182-5. google scholar
- Agasthian T. Results of surgery for bronchiectasis and pulmonary abscesses. Thorac Surg Clin 2012;22(3):333-44. [Crossref] google scholar
- Baysungur V, Dogruyol T, Ocakcioglu I, Misirlioglu A, Evman S, Kanbur S, et al. The Feasibility of Thoracoscopic Resection in Bronchiectasis. Surg Laparosc Endosc Percutan Tech 2017;27(3):194-6. [Crossref] google scholar
- Costa JC, Machado JN, Ferreira C, Gama J, Rodrigues C. The Bronchiectasis Severity Index and FACED score for assessment of the severity of bronchiectasis. Pulmonology 2018:S2173-5115(17)30154-9. google scholar
- Alban J, Kennedy K, Hulbert A, Lighter M, Pasquinelli M, Rubinstein I, et al. Surgery for early-stage lung cancer with video-assisted thoracoscopic surgery versus open thoracotomy: A narrative review. Semin Oncol 2022:S0093- 7754(22)00052-5. google scholar
- Imam JS, Duarte AG. Non-CF bronchiectasis: Orphan disease no longer. Respir Med 2020;166:105940. [Crossref] google scholar
- Guerra MS, Miranda JA, Leal F, Vouga L. Tratamento cirúrgico das bronquiectasias [Surgical treatment of bronchiectasis]. Rev Port Pneumol 2007;13(5):691-701. [Crossref] google scholar
- Corless JA, Warburton CJ. Surgery vs non-surgical treatment for bronchiectasis. Cochrane Database Syst Rev 2000;2000(4):CD002180. [Crossref] google scholar
ENHANCING SURGICAL OUTCOMES IN BRONCHIECTASIS: PREDICTING EARLY SURGICAL COMPLICATIONS WITH THE BRONCHIECTASIS SEVERITY INDEX
Öz
Objective: Bronchiectasis is defined as the irreversible dilation of the large and smaller airways. This study is a retrospective data analysis of patients with localized bronchiectasis who underwent anatomical resection at our institution. The aim of the study was to detect quality of life improvements after lung resection in localized bronchiectasis patients.
Material and Method: 68 patients were evaluated between the years 2001 and 2019. Patient demographics, pathological data, preoperative period, Bronchiectasis Severity Index (BSI) score, and long-term outcomes were reviewed. We selected patients who had undergone anatomical resection. Cases of unrelated deaths or of lost data during the follow-up period were excluded.
Result: The median age was 26, and the female and male ratio was nearly even. Pediatric patients are defined as individuals under the age of 17 and 26 patients were in the pediatric group. The preoperative BSI score was calculated on each patient. Seven patients had expected high readmission rates and high mortality rates, according to their high BSI score, but after the surgery period none of those patients needed to be re-hospitalized due to bronchiectasis. 14 patients had VATS procedures and 54 patients were operated on via thoracotomy. The average postoperative hospital stay was 13 days for all patient groups. Patients who had had VATS stayed in the hospital for eight days, but those who had had open surgery remained for 14 days (p=0.167). Based on the subgroup analysis, it was observed that patients with a severity score of nine or higher experienced increased complication rates (p=0.35).
Conclusion: Even for patients with a high BSI score, surgery is a reliable option if clinical parameters are compatible. BSI shows the predictive value of postoperative complications. Patients should be evaluated in multidisiplinary centers. In making surgical decisions, experienced pulmonologists and thoracic surgeons are needed so that the best time for surgery is decided upon.
Anahtar Kelimeler
Bronchiectasis thoracic surgery VATS Bronchiectasis severity index score
Kaynakça
- Cole PJ. Inflammation: a two-edged sword-the model of bronchiectasis. Eur J Respir Dis Suppl 1986;147:6-15. google scholar
- Reynolds HY. President’s address: R.T.H. Laënnec, M.D.- -clinicopathologic observations, using the stethoscope, made chest medicine more scientific. Trans Am Clin Climatol Assoc. 2004;115:1-29. google scholar
- Barker AF, Bardana EJ Jr. Bronchiectasis: update of an orphan disease. Am Rev Respir Dis 1988;137(4):969-78. [Crossref] google scholar
- Chang AB, Masel JP, Boyce NC, Wheaton G, Torzillo PJ. Non-CF bronchiectasis: clinical and HRCT evaluation. Pediatr Pulmonol 2003;35(6):477-83. [Crossref] google scholar
- Fleshman KJ, Wilson JF, Cohen JJ. Bronchiectasis in Alaska Native children. Arch Environ Health 1968;17(4):517-24. [Crossref] google scholar
- Singleton R, Morris A, Redding G, Poll J, Holck P, Martinez P, Kruse D, et al. Bronchiectasis in Alaska Native children: causes and clinical courses. Pediatr Pulmonol 2000;29(3):182-7. [Crossref] google scholar
- Edwards EA, Asher MI, Byrnes CA. Paediatric bronchiectasis in the twenty-first century: experience of a tertiary children’s hospital in New Zealand. J Paediatr Child Health 2003;39(2):111-7. [Crossref] google scholar
- Gao YH, Guan WJ, Liu SX. Aetiology of bronchiectasis in adults: a systematic literature review. Respirology 2016;21(8):1376-83. [Crossref] google scholar
- Goeminne PC, Hernandez F, Diel R, Filonenko A, Hughes R, Juelich F, et al. The economic burden of bronchiectasis - known and unknown: a systematic review. BMC Pulm Med 2019;19(1):54. [Crossref] google scholar
- Phua HP, Lim WY, Ganesan G, Yoong J, Tan KB, Abisheganaden JA, Lim AYH. Epidemiology and economic burden of bronchiectasis requiring hospitalisation in Singapore. ERJ Open Res 2021;7(4):00334-2021 [Crossref] google scholar
- Pasteur MC, Bilton D, Hill AT. British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010;65Suppl1:i1-58. [Crossref] google scholar
- Halezeroğlu S, Okur E. Thoracic surgery for haemoptysis in the context of tuberculosis: what is the best management approach? J Thorac Dis 2014;6(3):182-5. google scholar
- Agasthian T. Results of surgery for bronchiectasis and pulmonary abscesses. Thorac Surg Clin 2012;22(3):333-44. [Crossref] google scholar
- Baysungur V, Dogruyol T, Ocakcioglu I, Misirlioglu A, Evman S, Kanbur S, et al. The Feasibility of Thoracoscopic Resection in Bronchiectasis. Surg Laparosc Endosc Percutan Tech 2017;27(3):194-6. [Crossref] google scholar
- Costa JC, Machado JN, Ferreira C, Gama J, Rodrigues C. The Bronchiectasis Severity Index and FACED score for assessment of the severity of bronchiectasis. Pulmonology 2018:S2173-5115(17)30154-9. google scholar
- Alban J, Kennedy K, Hulbert A, Lighter M, Pasquinelli M, Rubinstein I, et al. Surgery for early-stage lung cancer with video-assisted thoracoscopic surgery versus open thoracotomy: A narrative review. Semin Oncol 2022:S0093- 7754(22)00052-5. google scholar
- Imam JS, Duarte AG. Non-CF bronchiectasis: Orphan disease no longer. Respir Med 2020;166:105940. [Crossref] google scholar
- Guerra MS, Miranda JA, Leal F, Vouga L. Tratamento cirúrgico das bronquiectasias [Surgical treatment of bronchiectasis]. Rev Port Pneumol 2007;13(5):691-701. [Crossref] google scholar
- Corless JA, Warburton CJ. Surgery vs non-surgical treatment for bronchiectasis. Cochrane Database Syst Rev 2000;2000(4):CD002180. [Crossref] google scholar
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Hizmetleri ve Sistemleri (Diğer) |
| Bölüm | ARAŞTIRMA |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Ocak 2024 |
| Gönderilme Tarihi | 17 Temmuz 2023 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 87 Sayı: 1 |
Kaynak Göster
Contact information and address
Addressi: İ.Ü. İstanbul Tıp Fakültesi Dekanlığı, Turgut Özal Cad. 34093 Çapa, Fatih, İstanbul, TÜRKİYE
Email: itfdergisi@istanbul.edu.tr
Phone: +90 212 414 21 61