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    Öğe
    Akciğer rezeksiyonu sonrası komplikasyonların önceden belirlenmesinde merdiven çıkma ve 6-dakika yürüme testlerinin yeri
    (2010) Alar, Timuçin; Ceylan, Kenan Can; Akdağ, Şencan; Olgaç, Güven
    Amaç: Akciğer rezeksiyonlarından sonra kaçınılmaz olarak olguların yaklaşık %25’inde, çoğu kardiyak veya solunumsal olmak üzere komplikasyon gelişir. Bu komplikasyonların sıklığının azaltılması, ancak bu açıdan yüksek risk taşıyan olguların önceden tahmin edilmesi ve gerekli önlemlerin alınmasıyla olanaklıdır. Bu yüzden preoperatif risklerin belirlenmesinde, kardiyovasküler ve solunum sistemlerinin birlikte değerlendirilmesine olanak sağlayan egzersiz testleri son yıllarda daha sık kullanılmaya başlanmıştır. Bu çalışmada merdiven çıkma ve 6-dakika yürüme testlerinin, postoperatif dönemde ortaya çıkabilecek komplikasyonları önceden belirlemedeki kestirim değerinin belirlenmesi amaçlandı. Gereç ve Yöntem: Bu prospektif çalışmaya, akciğer rezeksiyonu uygulanan 17’si(%68) erkek ve yaş ortalaması 53,1±18,3 (17-75) olan ardışık 25 olgu alındı. Tüm olgulara, standart spirometri ve arteriyel kan gazı analizleri sonuçlarına bakılmaksızın merdiven çıkma ve 6-dakika yürüme testleri uygulandı. Test öncesi ve sonrasında ölçülen dakika solunum sayısı, arteriyel kan basıncı, nabız dakika sayısı ve 6-dakika yürüme mesafeleri prospektif olarak veritabanına kaydedildi. Yirmi (%80) olgu akciğer kanseri nedeniyle opere edildi. Onbeş(%60) olguya lobektomi/bilobektomi, 8 olguya (%32) pnömonektomi ve diğer 2’sine (%8) ise kama rezeksiyon uygulandı. Postoperatif ilk 30 günde ortaya çıkan tüm kardiyopulmoner komplikasyonlar çalışmanın birincil sonucu olarak kabul edildi. Bulgular: Postoperatif dönemde 3’ü atelektazi, diğer 3’ü ise tedavi gerektiren hızlı ritimli atriyal fibrilasyon olmak üzere 6 (%24) hastada komplikasyon gelişti. Postoperatif komplikasyonlar ile cinsiyet, sistolik ve diyastolik kan basınçları, solunum ve nabız sayılarındaki değişiklikler arasında bir ilişki bulunamadı. Tek değişkenli analiz ile yapılan karşılaştırmalarda, komplikasyon gelişen olgu grubunda, 3. ve 5. dakika ortalama nabız sayılarının belirgin olarak daha yüksek olduğu saptandı (sırasıyla p=0,026 ve p=0,035). Çok değişkenli analiz ile, merdiven çıkma testi sonrası 3. dakika nabız sayısının 120’den çok, 5. dakika nabız sayısının 115’ten çok ve 6-dakika yürüme testi sonrası diyastolik kan basıncının ise 65 mmHg’den daha az olmasının postoperatif komplikasyon gelişimini önceden belirleyen bağımsız faktörler olduğu gözlendi (sırasıyla, ?=0,92 ve p<0,03; ?=0,91 ve p<0,04; ?=-0,88 ve p<0,05). Sonuç: Gerek solunum, gerekse kardiyovasküler sistem hastalıkları açısından düşük risk grubunda olmasına rağmen, çalışmamızdaki olguların yaklaşık dörtte birinde postoperatif komplikasyon gelişmesi, yüksek risk grubu olgularının preoperatif dönemde belirlenmesinin önemini daha da destekler niteliktedir. Bu yüzden, hem uygulama kolaylığı, hem de karmaşık cihazlar gerektirmemesi nedeniyle bu testlerin akciğer rezeksiyonu planlanmış düşük risk grubundaki hastalara da uygulanmasını öneririz.
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    Öğe
    How does the type of thoracotomy affect the patient quality of life? A short form-36 health survey study
    (Springer, 2014) Alar, Timucin; Ceylan, Kenan Can; Kaya, Seyda Ors; Sevinc, Serpil; Sigirli, Deniz; Ozcelik, Cemal
    We evaluated whether the quality of life was affected in patients who had undergone various types of thoracotomy using the Short Form-36 Health Survey. The patients who had undergone thoracotomy for diagnosis or treatment between January and September 2011 in the Thoracic Surgery Department were investigated to determine the effect of the type of thoracotomy on the quality of life using the Short Form-36 Health Survey. The patients were classified into three groups. In Group I, the latissimus dorsi and the serratus anterior had both been preserved, and there was no muscle dissection, in Group II the latissimus dorsi muscle had been dissected and only the serratus anterior muscle has been preserved, and in Group III both muscles had been dissected, and the standard posterolateral muscle dissection had been performed. A total of 101 patients comprising 64 males (63.37 %) and 37 females (36.63 %), with a median age of 38 years, were included in this study. There were significant differences in all quality of life subscales between Groups I and III and between Groups II and III. The patients in Group I had the highest scores, while the patients in Group III had the lowest scores. There were no significant differences in five of the eight Short Form-36 subscales and one of the two summary scores values between Group I and Group II in females. We investigated the effect of the type of thoracotomy on the patient quality of life using the Short Form-36 Health Survey, and found that the standard posterolateral thoracotomy had a marked adverse effect on the quality of life compared to muscle-sparing thoracotomy. We also found that it is possible to use thoracotomy with serratus preservation rather than muscle-sparing thoracotomy in cases with benign diseases where a large field of view is required, such as for decortication and pulmonary hydatid cysts, without any significant decrease in the quality of life, especially in females.
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    Öğe
    Is Acrylate Co-monomer (Glubran-2) Useful in the Prevention of Prolonged Air Leaks After Pulmonary Lobectomy?
    (Springer India, 2013) Alar, Timucin; Ceylan, Kenan Can; Duman, Elif; Usluer, Ozan; Basok, Oktay
    Many synthetic materials are being used in order to reduce the frequency of prolonged air leak (PAL) in thoracic surgical practice. This study presents our experience with the topical application of acrylate co-monomer (Glubran-2) as a synthetic tissue adhesive in an attempt to decrease troublesome postoperative air leaks in patients undergoing resection for non-small cell lung carcinoma. Of the 112 patients who had undergone resection for lung carcinoma, 69 patients having lobectomy or bilobectomy were included in this study. The application group (group A) consisted of 33 patients where a synthetic tissue adhesive (Glubran-2) was used and compared with the control group (group C, n=36) retrospectively. There was no difference between the groups regarding demographic details and operative variables. Both groups were compared in view to PAL, chest tube duration, in-hospital stay and hospital costs. There was no significant difference between group A (n=11, 33 %) and group C (n=6, 17 %) for the development of PAL (P=0.11). Hospital stay was 16.1 +/- 6.7 days in group A and 15.3 +/- 5.8 days in group C (P=0.66). The surgical cost was significantly higher in group A (is an element of 806 +/- 127) than the group C (is an element of 624 +/- 94) (P<0.001). There was no significant difference between the groups regarding overall hospital costs (P=0.41). In this study, the use of Glubran-2 following lung resection for non-small cell lung carcinoma did not decrease the incidence of PAL. Neither did it have a favorable effect concerning in-hospital stay nor did it decrease overall hospital costs while increasing surgical costs as expected.
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    Öğe
    The value of stair climbing and 6-minute walking tests in predicting complications following lung resection
    (Yerkure Tanitim & Yayincilik Hizmetleri A S, 2010) Alar, Timucin; Ceylan, Kenan Can; Akdag, Sencan; Olgac, Guven
    Objective: Approximately 25% of patients undergoing lung resection inevitably develop postoperative complications, most of which are being cardiopulmonary in origin. Frequency of these complications can only be reduced by predicting such cases that carry higher risk and taking preventive measures accordingly. Thus, exercise tests that allow evaluation of both respiratory and cardiac performance are being carried out more frequently in recent years. The purpose of this study was to evaluate the value of both stair climbing and 6-minute walking tests in predicting postoperative complications. Material and methods: Twenty-five consecutive patients in whom 17 (68%) of them were male with a mean age of 53,1 +/- 18,3 and undergoing lung resection were enrolled in this prospective study. All cases also underwent stair climbing and 6-minute walking tests irrespective of the results of their conventional spirometry or arterial blood gas analysis. Measurements of respiratory rate, systemic blood pressure and pulse rates before and at 1, 3, 5 and 10th minutes after both tests and 6-minute walking distance were recorded in a prospective database. Twenty (80%) patients were operated for carcinoma of the lung. Fifteen patients (60%) underwent lobectomy, 8 (32%) pneumonectomy and 2 (8%) wedge resection. Any cardiopulmonary complication occurring within the first 30 days after operation was considered as primary outcome of the study. Results: Six patients (24%) developed complications in the postoperative period. Of them, 3 patients had atelectasis and other 3 patients experienced fast atrial fibrillation requiring treatment. Development of a postoperative complication was not related to either gender, changes in systolic and diastolic blood pressures or breathing and pulse rates. Univariate analysis revealed that the mean heart rates at 3rd and 5th minutes were significantly higher (p=1,026 and p=0,035, respectively) in patients with complications. Heart rates of >120 min-1 and >115 min-1 at 3rd and 5th minutes after stair climbing test and a diastolic blood pressure of <65 mmHg at the end of 6-minute walking test were found to be good independent predictors for the development of a post-resection complication in a multivariate analysis (beta= 0,92 and p< 0.03; beta= 0,91 and p<0.04; beta=-0,88 and p< 0,05, respectively). Conclusions: Although our study population was in a low risk group for cardiovascular and pulmonary diseases, quarter of all patients developed a postoperative cardio-pulmonary complication, thus emphasizing the importance of exercise testing in the detection of higher risk patients. Due to ease of their application and lack of need for sophisticated equipment, we therefore recommend these two tests to be performed even for low risk patients undergoing lung resection.