Semptomatik perikardiyal efüzyonların cerrahi tedavisinde VATS, subksifoid ve minitorakotomi perikardiyal pencerenin etkinliği

Amaç: Perikardiyal efüzyon potansiyel olarak ciddi morbidite ve mortalite nedenidir. Video-yardımlı torakoskopik cerrahi (VATS), subksifoid ve minitorakotomi perikardiyal pencere sıklıkla kullanılan cerrahi tedavi seçenekleridir. Bu çalışmanın amacı, semptomatik perikardiyal efüzyonun tedavisinde bu üç yöntemin sonuçlarını ve etkinliğini araştırmaktır. Yöntemler: Ekim 2007 ile Aralık 2011 tarihleri arasında Dr. Siyami Ersek Hastanesinde perikardiyal efüzyon nedeniyle ameliyat edilen 88 hasta cerrahi tedavi yöntemlerine göre [Grup 1 (VATS,n=24), Grup 2 (Subksifoid, n=28), Grup 3 (Minitorakotomi, n=36)] üç grup olarak çalışmaya alındı. Gruplar demografik bilgiler, etiyoloji, ameliyat sırası ve sonrasına ait veriler ve sonuçlar, nüks, takip bilgileri, morbidite, mortalite ve sağkalım yönünden incelendi ve mukayese edildi. Bulgular: 88 hasta (37 kadın, 51 erkek, ortalama yaşları 54,47±16,81) çalışmaya alındı. Gruplar cinsiyet dağılımı ve etiyoloji hariç benzer perioperatif özelliklere sahipti. Her üç cerrahi yöntem hastalar tarafından genel olarak iyi tolere edildi. Gruplar ameliyat mortalitesi, 30 günlük mortalite, tüm ameliyat sonrası komplikasyonlar, nüks ve sağkalım oranları yönünden benzer sonuçlara sahipti. Grup 3teki hastaların ameliyat süreleri belirgin olarak daha kısa idi (p

The efficacy of VATS, subxiphoid and minithoracotomy pericardial window for surgical management of symptomatic pericardial effusions

Objective: Pericardial effusion potentially cause significant morbidity and mortality. Pericardial window by videoassisted thoracic surgery (VATS), subxiphoid and minithoracotomy is available surgical treatment options. The aim of this study is to determine the efficacy and outcome of the three different methods for surgical management of symptomatic pericardial effusions. Methods: A retrospective study of patients operated for pericardial effusion between October 2007 to December 2011 at Dr. Siyami Ersek Hospital were divided into three groups according to surgical treatment d: Group 1 (VATS, n=24), Group 2 (Subxiphoid, n=28) Group 3 (Minithoracotomy, n=36). The groups were analyzed and compared using demographic information, operative and postoperative details and course, recurrence, follow-up data, morbidity, mortality and survival. Results: A total of 88 patients (37 women, 51 men, with mean age 54.47±16.81) underwent pericardial window were included in the study. The groups had similar perioperative characteristics except sex distribution and etiology. VATS, Subxiphoid and minithoracotomy pericardial window were well tolerated by patients, resulted in similar rates of mortality, 30-day mortality, overall postoperative complications, recurrence rates and survival. Operative time was significantly shorter in group 3 (p<0.01). Drained volume at operation and diagnostic value of pericardial biopsy significantly higher in group 3 (p<0.05, p<0.05). Patients undergoing Group 1 had a lower length of chest tube stay, intensive care unit stay and hospital stay but they did not reach to statistical significance (p>0.05). Group 2 had a significantly higher lenght of hospital stay (p<0.05). Conclusion: Minithoracotomy pericardial window provides rapid and definitive diagnosis and treatment for pericardial effusions of all causes acceptable morbidity rates. On the other hand, VATS and subxiphoid pericardial window should be performed in selected cases.

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