GKD Anest Yoð Bak Dern Derg. 2022; 28(4): 339-344 | DOI: 10.14744/GKDAD.2022.04875

Komplike Akciðer Hidatik Kistlerinde Cerrahi Tedavi Yöntemleri ve Sonuçlarý

Fatoþ Kozanlý¹, Mehmet Deðirmenci¹, Ahmet Karslýgil^2
1Kahramanmaraþ Sütçü Ýmam Üniversitesi Týp Fakültesi, Göðüs Cerrahisi Anabilim Dalý, Kahramanmaraþ, Türkiye
²Necip Fazýl Þehir Hastanesi, Kahramanmaraþ, Türkiye

Amaç: Pulmoner kist hidatik, Echinococcus granulosis’in neden olduðu parazitik bir enfestasyondur. Tüm ileri taný ve tedavi yöntemlerine raðmen morbidite %3,5–18, mortalite %0–2 arasýndadýr. Bu çalýþmada, komplike pulmoner kist hidatik hastalýðýnda kist rüptürü ile preoperatif/postoperatif komplikasyonlar arasýndaki iliþkiyi ve tedavi yöntemlerini tartýþarak mortalite ve morbiditenin azaltýlmasýna ilerleyen yýllardaki bilgi birikimi eþliðinde katký saðlanmasý amaçlandý.
Yöntem: Çalýþmada, 101 hastanýn dosyalarý geriye dönük olarak deðerlendirildi. Hastalarýn yaþý, cinsiyeti, kist hidatik sayýsý, rüptürü, semptomlarý, preoperatif ve postoperatif komplikasyonlarý, ameliyat tipi, hastanede kalýþ süreleri, takip süreleri ve mortalite oranlarý analiz edildi.
Bulgular: Ortalama yaþ 39,2±18,2 idi. Hastalarýn 35'inde (%34,6) preoperatif komplikasyon geliþti. Olgularýn 54'ünde (%53,5) kist rüptürü saptandý. Rüptür varlýðýnýn preoperatif/postoperatif komplikasyonlar, semptomlar, rezeksiyon tercihi ve hastanede kalýþ süresi ile yüksek oranda iliþkili olduðu bulundu. Ameliyat öncesi en sýk komplikasyon 18 (%17,8) olguda akciðer apsesi idi. Hastalarýn 30'unda (%29,7) ameliyat sonrasý komplikasyon görüldü. Relaps tespit edilmedi. Mortalite 2 (%1,9) olguda meydana geldi. Lobektominin preoperatif komplikasyonlarla iliþkili olduðu bulundu. Komplike hidatik kistler yüksek morbidite ve uzun hastanede kalýþ süresi ile iliþkilendirilmiþtir.
Sonuç: Pulmoner kist hidatik hastalýðýnýn küratif tedavisi cerrahidir. Komplike pulmoner kist hidatikte majör cerrahi ihtiyacý daha yüksektir. Kist rüptürü preoperatif/postoperatif komplikasyonlarla iliþkilidir. Komplike pulmoner kist hidatiði en erken zamanda, komplikasyonlar geliþmeden önce tedavi etmenin morbiditeyi, hastanede kalýþ süresini ve tedavi maliyetini azaltacaðýný umuyoruz.

Anahtar Kelimeler: Kapitonaj, kistik ekinokokkoz, kistotomi, hidatik hastalýk, pulmoner kist hidatik.

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Surgical Treatment Methods and Results in Complicated Pulmonary Hydatid Cyst

Fatoþ Kozanlý¹, Mehmet Deðirmenci¹, Ahmet Karslýgil^2
1Department of Thoracic Surgery, Kahramanmaraþ Sütçü Ýmam University Faculty of Medicine, Kahramanmaraþ, Türkiye
²Necip Fazýl City Hospital, Kahramanmaraþ, Türkiye

Objectives: Pulmonary cystic hydatidosis (PCH) is a parasitic infestation caused by Echinococcus granulosis. Despite all advanced diagnosis and treatment methods, morbidity is between 3.5 and 18% and mortality is between 0 and 2%. We aimed to contribute to the reduction of mortality and morbidity by discussing the relationship between cyst rupture and pre-operative/post-operative complications and treatment methods in complicated pulmonary hydatid disease with the knowledge gained in the following years.
Methods: The files of 101 patients were evaluated retrospectively. Patients’ age, gender, number of hydatid diseases, rupture, symptoms, pre-operative and post-operative complications, type of operation, length of hospital stay, follow-up periods, and mortality rates were analyzed. Results: The mean age was 39.2±18.2. There were pre-operative complications in 35 (34.6%) of the patients. Cyst rupture was detected in 54 (53.5%) of the cases. The presence of rupture was found to be highly correlated with pre-operative/post-operative complications, symptoms, preference for resection, and length of stay. The most common pre-operative complication was lung abscess in 18 (17.8%) cases. Post-operative complications were observed in 30 (29.7%) of the patients. No relapse was detected. Mortality occurred in 2 (1.9%) cases. Lobectomy was found to be associated with pre-operative complications. Complicated hydatid cysts were associated with high morbidity and prolonged hospital stay.
Conclusion: The curative treatment of pulmonary hydatid disease is surgery. The need for major surgery is higher in complicated PCH. Cyst rupture is associated with pre-operative/post-operative complications. We hope that treating PCH before complications develop will reduce morbidity, length of hospital stay, and therefore the cost of treatment.

Keywords: Capitonnage, cystic echinococcosis, cystotomy, hydatid disease, pulmonary hydatid cyst

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