Browsing by Author "Bulut, Erhan"

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    Komplike akciğer hidatik kistlerinin cerrahi tedavisinde drenaj bronşunun etkinliği
    (Tıp Fakültesi, 2015) Bulut, Erhan; Yüksel, Cabir; Tıp
    Pulmonary hydatid cyst (PHC) caused by Echinococcus granulosus is parasitic infection of the lung. It is commonly seen in our country. The main treatment of pulmonary hydatid cyst is surgery. Although there are many surgical options, the most common used method is cystotomy and capitonnage. In this study we aimed to demonstrate, especially in complicated cysts in case of leaving drainage bronchus there is no need to capitonnage. Also we examine postoperative complication ratio, chest tube removal time (duration of air leak), hospitalization time and radiological improvement. We analysed retrospectively 183 patients which were diagnosed pulmonary hydatid cyst, underwent surgery and followed radiologically in Ankara University Thoracic Surgery Department from January 2001 to June 2014. There were 92 male (50.3%) and 91 (49.7%) female patients with a mean age 37 (6-78). 13% of the patients were asymptomatic. The most frequent complaint was cough (27%). In the 183 patients we identified totally 322 cysts radiologically. The mean cyst number was 1 and the mean cyst dimension was 43mm. There were 25 giant cysts (>100 mm). In the 123 (67%) of the patients there was only single cyst. In the 142 (78%) of patients there were unilateral cysts. In the 41 (22%) of patients there were bilateral cysts. Among 183 patients in the 111 (61%) patients there were isolated pulmonary hydatid cysts, in the 70 (38%) patients there were liver hydatid cysts. In the 6 patients hydatid cysts were seen in spleen and 1 patient had intracranial hydatid cyst. Total 213 operations were done to 183 patients. 198 of these operations were thoracotomy. 13 of them were thoracophrenotomy. There was one sternotomy and one VATS. The mean operation time respectively was 141 min, 207 min, 240 min and 135 min. 152 patients underwent unilateral surgery, 30 patients underwent bilateral thoracotomy and 1 patient was done median sternotomy. 4 patients were performed bilateral thoracotomy at the same session, 26 patients were performed contralateral thoracotomy at different session average 2 months (1-4 months). Among the surgeries there were 178 cystotomy, 15 cystotomy and wedge resection, 3 cystotomy and decortications, 14 only wedge resection, 2 lobectomy and 1 pneumonectomy. The parenchymal resection rate was 14.5%. There was no complication in the 162 of operations (76%). There were minor complications in 43 operations (20%), major complication in 2 operations (1%), minor+major complication in 6 (3%) operations. Mortality was not seen. Relapse was seen only 6 of the operations (2.8%). From cystotomy used 213 operations (with or without capitonnage) 165 surgical operations (139 patients) were included to our study. Lung resections (pneumonectomy, lobectomy, wedge resection), decortications and thoracophrenotomies were excluded from the study. 165 operations were divided into 2 groups according to capitonnage: Group 1 Capitonnage, Group 2 Non-Capitonnage. Among these two groups there was no difference in the suppurated cyst ratio, mean operation time, minor and major complication ratio. In the Group 2 chest tube removal time was 3 days, whereas in the Group 1 it was 4 days. The difference of tube removal time between two groups was statistically significant (p:0.013). In the Group 2 postoperative hospital stay time was 6 days, whereas in the Group 1 the time was 7 days. The difference of hospital stay time between two groups was statistically significant (p: 0.008). After the two groups were compared, new groups were generated according to leaving drainage bronchus: Group 1A: Drainage bronchus with capitonnage, Group 1B: Non-Drainage bronchus with capitonnage, Group 2A: Drainage bronchus without capitonnage, Group 2B: Non-Drainage bronchus without capitonnage. With comparing these groups we did not find any statistical difference in postoperative hospital stay, suppurative cyst ratio, minor complication rate and non-complication rate. We found chest tube removal time was longer in the Group 1B but it was not statistically significant. Non complication ratio was highest in the Group 2A (%82) but it was not statistically significant. In the late period (first 6 months), the best radiological healing was seen in the Group 2A (68%), secondly in the Group 1A (63%), then in the Group 1B (28%) and the worst was Group 2B (13%) (p: 0.001). In the long period (12 months), the best radiological healing was seen in the Group 1A (95%), secondly in the Group 2A (93%), then in the Group 1B (60%) and the worst was Group 2B (50%) (p: 0.001). Bad radiologic healing was seen in the non-drainage bronchus groups (Group 1B, Group 2B). In the drainage bronchus group (Group 1A, Group 2A) we observed rapid radiological improvement, less air leakage, decreased minor complication ratio. We found similar hospital stay and major complication ratio. In this study we concluded that in the surgical treatment of the pulmonary hydatic cysts cystotomy and removal of germinative membrane is effective without capitonnage. Especially in the non-capitonnage groups for the expansion of the lung and drainage of the cavity, not closure of bronchial openings is more suitable. In the drainage bronchus groups radiological healing time was shorter and radiological healing ratio was better than non-drainage groups. In the future, we hope that the optimal surgical treatment of pulmonary hydatid cyst will be cystotomy and not closure of bronchial openings without capitonnage, just like 'SPONTANEOUS CURE'.