Malign plevral efüzyonlarda hızlı plöredezin başarısının değerlendirilmesi
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Tarih
2018
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info:eu-repo/semantics/embargoedAccess
Özet
Giriş ve Amaç: İleri evre maligniteleri olan hastalarda malign plevral efüzyonlar önemli bir sorun teşkil etmektedir. Bu hastaların yaklaşık %50’sinde hastalık süreci içinde malign plevral efüzyon meydana gelmektedir. Malign plevral efüzyonlu olgularda uygulanan terapötik torasentez ve tekrarlayan plevral effüzyon gelişimini önlemeye yönelik lokal sklerozan tedaviler en sık uygulanan palyatif tedavi yöntemleridir. Biz çalışmamızda, malign plevral efüzyonlarda sklerozan ajan olarak talk pudra kullandık. Günümüzde, plörodez amacıyla en sık kullanılan sklerozan ajanlar talk, iodopovidon, tetrasiklin, doksisiklin ve bleomisindir. Çalışmamızda hızlı plöredez tekniğinin ve talk pudra etkinliğini değerlendirmeyi amaçladık. Materyal ve Metod: Çalışma Dicle Üniversitesi Tıp Fakültesi Göğüs Cerrahisi Anabilim Dalında Ocak 2010 ile Aralık 2016 tarihleri arasında malign plevral efüzyon nedeniyle ince çaplı kateter yoluyla steril talk pudra kullanılarak plöredezis veya hızlı plöredezis yapılan 53’ü erkek 43’ü kadın olmak üzere toplam 96 hasta retrospektif olarak çalışmaya alındı. Taburcu edilen hastalara nefes darlığı veya göğüs ağrısının tekrar başlaması durumunda tekrar kliniğimize başvurmaları, şikayetlerinin olmaması durumunda ise 1. ayın sonunda kontrole gelmeleri söylendi. Bulgular: Malign plevral efüzyon saptanan ve ince çaplı katater yoluyla plöredezis yapılan 96 hasta incelendi. Bu olgulardan 53'üne ince çaplı kateterden 4 gr steril talk pudra uygulanarak plöredezis yapıldı (Grup-I), 43’üne ince çaplı kateterden 4 gr steril talk pudra uygulanarak hızlı plöredezis uygulandı(Grup-II). Olgularımızın yaş ortalaması 59,48 (23 - 104) idi. Plöredez (grup-I) grubu olguların 28’i erkek, 25'i kadın, hızlı plöredez (grup-II) grubu olguların 25’i erkek, 18’i kadındı. Grup I de 30 (% 56,6) hastada tam cevap, 12 (% 22,6) hastada parsiyel yanıt olmak üzere toplam 42 (% 79,2) hastada başarı sağlanırken, 11 hasta (% 20,8) başarısız kabul edildi. Grup II de ise olguların 18’inde (% 41,9) tam cevap, 14 (% 32,6) hastada parsiyel cevap olmak üzere toplam 32 (% 74,4) hastada başarı sağlanırken 11 hasta (% 25,6) başarısız kabul edildi (Tablo 8). İstatiksel olarak Grup-I ve Grup-II olguların başarı oranları arasında anlamlı fark saptanmadı (p>0,05). Tartışma ve Sonuç: Plöredezin küçük çaplı kateter kullanılarak hızlı plöredez tekniği ile yapılması, işlemin etkinliğini değiştirmemekte, hatta hastaların hastanede kalış sürelerini kısaltarak yaşam kalitelerini artırmakta ve maliyeti azaltmaktadır. Küçük çaplı kateter kullanılarak steril talk pudra ile yapılan hızlı plöredez güvenilir ve etkili bir yöntemdir.
Introduction and objectives: Malignant pleural effusions are an important problem in patients with advanced stage malignancies. Approximately 50% of these patients develop malignant pleural effusion in the disease process. Therapeutic thoracentesis and local sclerosing treatments to prevent recurrent pleural effusion are the most commonly used palliative treatment methods for malignant pleural effusions. In our study, we used talcum powder as a sclerosing agent in malignant pleural effusions. At present, the most commonly used sclerosing agents for pleurodesis are talc, iodopovidone, tetracycline, doxycycline and bleomycin. We aimed to evaluate the rapid pleurodesis technique and talcum powder activity in our study. Materials and Methods: Study A total of 96 patients, 43 male and 53 female, who underwent pleurodesis or rapid pleurodesis using sterile talc powder through thin-film catheter due to malign pleural effusion between January 2010 and December 2016, were enrolled retrospectively in Department of Thoracic Surgery of Dicle University Faculty of Medicine . Patients were referred to our clinic if they had a shortness of breath or chest pain, and if they had not complained, they were told to check in at the end of the first month. Results: A total of 96 patients with malignant pleural effusion who underwent pleurodesis via thin-wall catheter were studied. Pleurodesis was performed in 53 patients by applying a 4 gr sterile talc powder to a thin-film catheter (Group-I), rapid pleurodesis was performed in 43 patients by applying a 4-gauge sterile talc powder to the small-diameter catheter (Group-II). The mean age of our cases was 59.48 (23 - 104). Of the cases in the pleurodesis (group-I) group, 28 were males and 25 were females, 25 of the cases in the group of rapid pleurodesis (group-II) were male and 18 were female. In group I, total success was achieved in 42 (79.2%) patients, including 30 (56.6%) patients in complete response and 12 (22.6%) in partial response, while 11 patients (20.8%) were considered as unsuccessful. In Group II, 11 patients (25.6%) were accepted as unsuccessful, while 18 patients (41.9%) had complete response and 14 patients (32.6%) had partial response. Statistically, there was no significant difference between the success rates of Group I and Group II (p> 0,05). Conclusion: The use of pleurodesis with a pleurodesis technique using a small diameter catheter does not change the effectiveness of the procedure, but it also improves the quality of life and reduces the cost by shortening the length of hospital stay in patients. Rapid pleurodesis with sterile talcum powder using a small diameter catheter is a reliable and effective method.
Introduction and objectives: Malignant pleural effusions are an important problem in patients with advanced stage malignancies. Approximately 50% of these patients develop malignant pleural effusion in the disease process. Therapeutic thoracentesis and local sclerosing treatments to prevent recurrent pleural effusion are the most commonly used palliative treatment methods for malignant pleural effusions. In our study, we used talcum powder as a sclerosing agent in malignant pleural effusions. At present, the most commonly used sclerosing agents for pleurodesis are talc, iodopovidone, tetracycline, doxycycline and bleomycin. We aimed to evaluate the rapid pleurodesis technique and talcum powder activity in our study. Materials and Methods: Study A total of 96 patients, 43 male and 53 female, who underwent pleurodesis or rapid pleurodesis using sterile talc powder through thin-film catheter due to malign pleural effusion between January 2010 and December 2016, were enrolled retrospectively in Department of Thoracic Surgery of Dicle University Faculty of Medicine . Patients were referred to our clinic if they had a shortness of breath or chest pain, and if they had not complained, they were told to check in at the end of the first month. Results: A total of 96 patients with malignant pleural effusion who underwent pleurodesis via thin-wall catheter were studied. Pleurodesis was performed in 53 patients by applying a 4 gr sterile talc powder to a thin-film catheter (Group-I), rapid pleurodesis was performed in 43 patients by applying a 4-gauge sterile talc powder to the small-diameter catheter (Group-II). The mean age of our cases was 59.48 (23 - 104). Of the cases in the pleurodesis (group-I) group, 28 were males and 25 were females, 25 of the cases in the group of rapid pleurodesis (group-II) were male and 18 were female. In group I, total success was achieved in 42 (79.2%) patients, including 30 (56.6%) patients in complete response and 12 (22.6%) in partial response, while 11 patients (20.8%) were considered as unsuccessful. In Group II, 11 patients (25.6%) were accepted as unsuccessful, while 18 patients (41.9%) had complete response and 14 patients (32.6%) had partial response. Statistically, there was no significant difference between the success rates of Group I and Group II (p> 0,05). Conclusion: The use of pleurodesis with a pleurodesis technique using a small diameter catheter does not change the effectiveness of the procedure, but it also improves the quality of life and reduces the cost by shortening the length of hospital stay in patients. Rapid pleurodesis with sterile talcum powder using a small diameter catheter is a reliable and effective method.
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