Hemoptizi olan ve hemoptizi olmayan hastaların cerrahi tedavi sonuçları

Yıl 2021, Cilt: 14 Sayı: 4, 892 - 898, 01.10.2021

Hakan Keskin , Hulya Dirol , Makbule Ergin

https://doi.org/10.31362/patd.864790

Öz

Amaç: Hemoptizi hastalarında uygulanan cerrahi girişimlerin artmış komplikasyon riski cerrahlar arasında yaygın bir endişedir. Bu nedenle burada hemoptizi olan tüberküloz hastalarının cerrahi sonuçlarını araştırdık.
Gereç ve yöntem: 1985-2018 yılları arasında cerrahi olarak tüberküloz tanısı alan hastalar retrospektif olarak incelendi. Hastalar iki gruba ayrıldı; hemoptizi olmayanlar (Grup 1) ve hemoptizi olanlar (Grup 2). Analiz yaş, cinsiyet, semptomlar, komorbiditeler, Pozitron Emisyon Tomografisi-Bilgisayarlı Tomografi (PET-CT) bulguları, cerrahi müdahaleler, perioperatif komplikasyonlar, hastanede kalış süreleri, hemoptizi nüksü ve Grup 1 ve 2'nin karşılaştırmasını içeriyordu.
Bulgular: Cerrahi olarak teşhis edilen akciğer tüberkülozu olan 541 hasta incelendi. Grup 1'de 448 hasta, Grup 2'de 93 hasta vardı. Grup 2'deki hastalar Grup 1'deki hastalara göre anlamlı olarak daha gençti (Grup 1 ortalama yaş 57,8±6,2, Grup 2 ortalama yaş 31,2±5,3, p<0,01). Her iki grupta da en sık komorbidite maligniteydi. Grup 2'de kavitasyon daha sıktı (Grup 1 92 (%20,5), Grup 2 79 (%84,9), p<0,01). Postoperatif komplikasyonlar ve hastanede kalış süresi her iki grupta benzerdi ve Grup 2'de hemoptizi rekürrensi yoktu. Grup 1'de perioperatif ölüm görülmezken Grup 2'de 3 (%3) hasta öldü.
Sonuç: Hemoptizi tanısı veya tedavisi için yapılan cerrahi girişim sonrası tüberküloz tanısı alan hastaların cerrahi morbidite ve mortalitesi, hemoptizi olmayan hastalardan anlamlı olarak farklı değildi.

Anahtar Kelimeler

Komplikasyonlar, Hemoptizi, Mycobacterium tuberculosis, Akciğer Tüberkülozu, Cerrahi

Surgical management outcomes of tuberculosis with hemoptysis and without hemoptysis

Öz

Objective: Increased complication risk of surgical interventions performed in patients with hemoptysis is a common concern among surgeons. Therefore, here, we investigated the surgical outcomes of tuberculosis patients with hemoptysis.
Materials and methods: Patients, between 1985 and 2018, diagnosed with tuberculosis surgically, were analyzed retrospectively. The patients were divided into two groups; those without hemoptysis (Group 1) and those with hemoptysis (Group 2). The analysis included age, gender, symptoms, comorbidities, Positron Emission Tomography-Computed Tomography (PET-CT) findings, surgical interventions, perioperative complications, lengths of hospital stay, recurrence of hemoptysis, and comparison of Group 1 and 2.
Results: 541 patients with pulmonary tuberculosis diagnosed surgically were analyzed. 448 patients were in Group 1 and 93 patients were in Group 2. The patients in Group 2 were significantly younger than the patients in Group 1 (Group 1 mean age 57.8±6.2, Group 2 mean age 31.2±5.3, p<0.01). The most frequent comorbidity was malignancy in both groups. Cavitation was more common in Group 2 (Group 1 92 (20.5%), Group 2 79 (84.9%), p<0.01). Postoperative complications and hospital stay length were similar in both groups and there was no hemoptysis recurrence in Group 2. There was no perioperative death in Group 1 while 3 (3%) patients died in Group 2.
Conclusion: The surgical morbidity and mortality of patients diagnosed with tuberculosis after the surgical intervention performed for the diagnosis or treatment of the hemoptysis were not significantly different from those of the patients without hemoptysis

Anahtar Kelimeler

Complications, Hemoptysis, Mycobacterium tuberculosis, Pulmonary tuberculosis, Surgery

Kaynakça

• 1. Albay A, Güney M, Tekin K, Kısa Ö, Sığ A. Pulmoner ve ekstrapulmoner örneklerde tüberkülozun erken tanısı ve rifampisin direncinin tespiti için geneXpert MTB/RIF testinin değerlendirilmesi. Cukurova Medical Journal 2016;41:548-53
• 2. Furin J, Cox H, Pai M. Tuberculosis. Lancet. 2019;393:1642–56
• 3. Zhang Y, Chen C, Jiang GN. Surgery of massive hemoptysis in pulmonary tuberculosis: immediate and long-term outcomes. J ThoracCardiovasc Surg. 2014;148:651-6.
• 4. Erdogan A, Yegin A, Gürses G, Demircan A. Surgical management of tuberculosis-related hemoptysis. Ann Thorac Surg. 2005;79:299-302.
• 5. Cortés-Julián G, Valencia LC, Ríos-Pascual S, de la Rosa-Abarroa MA, Guzmán-de Alba E. Complications of surgery for infectious lung cavities. Asian CardiovascThorac Ann. 2018;26:120-6.
• 6. Halezeroğlu S, Okur E. Thoracic surgery for hemoptysis in the context of tuberculosis: what is the best management approach? J Thorac Dis. 2014;6:182-5.
• 7. Evman S, Baysungur V, Alpay L, et al. Management and Surgical Outcomes of Concurrent Tuberculosis and Lung Cancer. ThoracCardiovasc Surg. 2017;65:542-5.
• 8. Reid MJA, Arinaminpathy N, Bloom A, Bloom BR, Boehme C, Chaisson R, et al. Building a tuberculosis-free world: The Lancet Commission on tuberculosis. Lancet. 2019;393(10178):1331-84.
• 9. Hilderbrandt J.W., Tarver R.D., Conces D.J., Jr., Broderick L.S., Patel N.H. Diagnostic case study: Rasmussen aneurysm. SeminRespir Infect. 1998;13:160–162.
• 10. Garay Stuart M. Pulmonary tuberculosis. In: N Rom William, Garay Stuart M., editors. Tuberculosis. second ed. Lippincott Williams & Wilkins; Philadelphia: 2004. p. 367.
• 11. Echazarreta A, Zerbini E, De Sandro J, et al. Biomedica. Tuberculosis and comorbidities in urban areas in Argentina. A gender and age perspective. Biomedica. 2018;15;38:180-8.
• 12. Dewan RK, PezzellaAT. Surgical aspects of pulmonary tuberculosis: an update. Asian Cardiovasc Thor Ann. 2016;24: 835-46.
• 13. Subotic D, Yablonskiy P, Sulis G, et al. Surgery and pleuro-pulmonary tuberculosis: a scientific literature review. J Thorac Dis. 2016;8: 474-85.
• 14. Mirsadraee M, Shafahie A, Reza Khakzad M, Sankian M. Value of the polymerase chain reaction method for detecting tuberculosis in the bronchial tissue involved by anthracosis. J BronchologyIntervPulmonol. 2014;21:131-4.
• 15. Lowe VJ, Fletcher JW, Gobar L, et al. Prospective investigation of positron emission tomography in lung nodules. J ClinOncol.1998;16:1075-1084.
• 16. Hashimoto Y, Tsujikawa T, Kondo C, et al. Accuracy of PET for diagnosis of solid pulmonary lesions with 18F-FDG uptake below thestandardized uptake value of 2.5. J Nucl Med. 2006;47:426-431.
• 17. Du Toit R, Shaw JA, Irusen EM, Von Groote-Bidlingmaier F, Warwick JM, Koegelenberg CFN. The diagnostic accuracy of integrated positron emission tomography/computed tomography in the evaluation of pulmonary mass lesions in a tuberculosis-endemicarea. S Afr Med. 2015;105:1049-1052.
• 18. Sathekge MM, Maes A, Pottel H, Stoltz A, Van de Wiele C. Dual time-point FDG PET/CT for differentiating benign from malignant solitary pulmonary nodules in a TB endemic area. S Afr Med J.2010;100:598-601.
• 19. Marfina GY, Vladimirov KB, Avetisian AO, et al. Bilateral cavitary multidrug- or extensively drug-resistanttuberculosis: role of surgery. European Journal of Cardio-Thoracic Surgery 53 2018;4:618–624.
• 20. Yun JS, Song SY, Na KJ, et al. Surgery for hemoptysis in patients with benign lung disease. J Thorac Dis. 2018;10:3532-8.