2002 – 2011 ARASI
description
Transcript of 2002 – 2011 ARASI
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Adnan Sayar, Necati Çitak, Songül Büyükkale, Muzaffer Metin, M.Zeki
Günlüoğlu, Selda Kanbur, Adalet Demir, Atilla Gürses
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KARİNAL REZEKSİYON; TEKNİK VE PEROPERATİF HAVAYOLUNUN DEVAMLILIĞI AÇISINDAN TRAKEOBRONŞİAL CERRAHİNİN EN KOMPLİKE AMELİYATLARINDAN
DİKKATLİ HASTA SEÇİMİ, CERRAHİ DETAYLARDA DAHA DİKKATLİ OLUNMASI VE ANESTEZİ UYGULANMASINDA YENİ YÖNTEMLER
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2002 – 2011 ARASI
KARİNAL İNVAZYON NEDENİYLE KARİNAL REZEKSİYON VE REKONSTRÜKSİYON UYGULANAN MALİGN TÜMÖRLÜ 17 OLGU (%1.2)
OPERASYON TEKNİĞİ, KOMPLİKASYON, AMELİYAT ENDİKASYONLARI VE UZUN DÖNEM TAKİPLERİ
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16 ERKEK, 1 KADIN (YAŞ ORT. 51,25)
İKİSİ 2.PRİMER OLMAK ÜZERE 14 OLGU KÜÇÜK HÜCRE
DIŞI AKCİĞER KARSİNOMU (KHDAK),
3 OLGU ADENOİD KİSTİK KARSİNOM
TÜM OLGULARA SAĞ POSTEROLATERAL TORAKOTOMİ
TÜM KHDAK’LI OLGULARA MEDİASTİNOSKOPİ
KARİNAL SLEEVE PNÖMONEKTOMİ (n=8),
LOBEKTOMİYLE KOMBİNE KARİNA REZEKSİYONU VE
REKONSTRÜKSİYONU (n=8),
İZOLE KARİNA REZEKSİYONU VE REKONSTRÜKSİYONU
(n=1)
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Olgu Yaş/C pTNM RzkEk işlem
Trakeal rzk
Takip Morbidite
1.RÇ 65 / E T4N1(14) P -- 1 119-Sağ AF
2.AK 45 / E T4N0 UL PA 1.6 99-Sağ --
3 *.AŞ 57 / E T3N1(10) P -- 2 EX MI
4.AG 59 / E T4N1(11) UL -- 1 57-Sağ --
5**.MK 46 / E T4N1(11) P -- 2 53-Sağ --
6**.YK 46 / E T4N1(11) P -- 2 51-Sağ --
7.İK 50 / E T4N1(11) UL PA 1.2 22-Sağ --
8.MEŞ 70 / E T4N0 UL PA 1 17-Ex --
9.MK 46 / E T4N1(10) P VCS 2 15-Ex --
10.İA 59 / E T4N0 UL ArtSle 1,3 EX Pnömoni
11.RA 73 / E T4N0 UL PA 1,1 12 --
12.HK 55 / E T4N2(4R) P -- 1 5 Hemoraji
13.YS 55 / E T4N1(11) P -- 1,2 5 --
14.ŞK 58 / E T4N1(11) UL VCS 1,4 4 --
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Olgu Yaş/C pTNM RzkEk işlem
Trakeal rzk
Takip Morbidite
1.RÇ 65 / E T4N1(14) P -- 1 119-Sağ AF
2.AK 45 / E T4N0 UL PA 1.6 99-Sağ --
3 *.AŞ 57 / E T3N1(10) P -- 2 EX MI
4.AG 59 / E T4N1(11) UL -- 1 57-Sağ --
5**.MK 46 / E T4N1(11) P -- 2 53-Sağ --
6**.YK 46 / E T4N1(11) P -- 2 51-Sağ --
7.İK 50 / E T4N1(11) UL PA 1.2 22-Sağ --
8.MEŞ 70 / E T4N0 UL PA 1 17-Ex --
9.MK 46 / E T4N1(10) P VCS 2 15-Ex --
10.İA 59 / E T4N0 UL ArtSle 1,3 EX Pnömoni
11.RA 73 / E T4N0 UL PA 1,1 12 --
12.HK 55 / E T4N2(4R) P -- 1 5 Hemoraji
13.YS 55 / E T4N1(11) P -- 1,2 5 --
14.ŞK 58 / E T4N1(11) UL VCS 1,4 4 --
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Olgu Yaş/C pTNM RzkEk işlem
Trakeal rzk
Takip Morbidite
1.RÇ 65 / E T4N1(14) P -- 1 119-Sağ AF
2.AK 45 / E T4N0 UL PA 1.6 99-Sağ --
3 *.AŞ 57 / E T3N1(10) P -- 2 EX MI
4.AG 59 / E T4N1(11) UL -- 1 57-Sağ --
5**.MK 46 / E T4N1(11) P -- 2 53-Sağ --
6**.YK 46 / E T4N1(11) P -- 2 51-Sağ --
7.İK 50 / E T4N1(11) UL PA 1.2 22-Sağ --
8.MEŞ 70 / E T4N0 UL PA 1 17-Ex --
9.MK 46 / E T4N1(10) P VCS 2 15-Ex --
10.İA 59 / E T4N0 UL ArtSle 1,3 EX Pnömoni
11.RA 73 / E T4N0 UL PA 1,1 12 --
12.HK 55 / E T4N2(4R) P -- 1 5 Hemoraji
13.YS 55 / E T4N1(11) P -- 1,2 5 --
14.ŞK 58 / E T4N1(11) UL VCS 1,4 4 --
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Olgu Yaş/C pTNM RzkEk işlem
Trakeal rzk
Takip Morbidite
1.RÇ 65 / E T4N1(14) P -- 1 119-Sağ AF
2.AK 45 / E T4N0 UL PA 1.6 99-Sağ --
3 *.AŞ 57 / E T3N1(10) P -- 2 EX MI
4.AG 59 / E T4N1(11) UL -- 1 57-Sağ --
5**.MK 46 / E T4N1(11) P -- 2 53-Sağ --
6**.YK 46 / E T4N1(11) P -- 2 51-Sağ --
7.İK 50 / E T4N1(11) UL PA 1.2 22-Sağ --
8.MEŞ 70 / E T4N0 UL PA 1 17-Ex --
9.MK 46 / E T4N1(10) P VCS 2 15-Ex --
10.İA 59 / E T4N0 UL ArtSle 1,3 EX Pnömoni
11.RA 73 / E T4N0 UL PA 1,1 12 --
12.HK 55 / E T4N2(4R) P -- 1 5 Hemoraji
13.YS 55 / E T4N1(11) P -- 1,2 5 --
14.ŞK 58 / E T4N1(11) UL VCS 1,4 4 --
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Olgu
Yaş & cins
Tm tipi
Rzk tipi
Ek işlem
Trakeal uzunluk (cm)
Takip (ay)
Morbidite
R durumu
1*.YA 29 / E
ADN KSTK
UL -- 2.5 120 -- R1
2.KD 61 / EADN KSTK
P -- 1.2 66 -- R0
3*.Pİ 51 / KADN KSTK
C -- 1.5 52 -- R1
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Olgu
Yaş & cins
Tm tipi
Rzk tipi
Ek işlem
Trakeal uzunluk (cm)
Takip (ay)
Morbidite
R durumu
1*.YA 29 / EADN KSTK
UL -- 2.5 120 -- R1
Olgu Yaş/C pTNM RzkEk işlem
Trakeal rzk
Takip Morbidite
2.AK 45 / E T4N0 UL PA 1.6 99-Sağ --
4.AG 59 / E T4N1(11) UL -- 1 57-Sağ --
7.İK 50 / E T4N1(11) UL PA 1.2 22-Sağ --
8.MEŞ 70 / E T4N0 UL PA 1 17-Ex --
10.İA 59 / E T4N0 UL ArtSle 1,3 EX Pnömoni
11.RA 73 / E T4N0 UL PA 1,1 12 --
14.ŞK 58 / E T4N1(11) UL VCS 1,4 4 --
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Olgu
Yaş & cins
Tm tipi
Rzk tipi
Ek işlem
Trakeal uzunluk (cm)
Takip (ay)
Morbidite
R durumu
1*.YA 29 / EADN KSTK
UL -- 2.5 107 -- R1
Olgu Yaş/C pTNM RzkEk işlem
Trakeal rzk
Takip Morbidite
2.AK 45 / E T4N0 UL PA 1.6 99-Sağ --
4.AG 59 / E T4N1(11) UL -- 1 57-Sağ --
7.İK 50 / E T4N1(11) UL PA 1.2 22-Sağ --
8.MEŞ 70 / E T4N0 UL PA 1 17-Ex --
10.İA 59 / E T4N0 UL ArtSle 1,3 EX Pnömoni
11.RA 73 / E T4N0 UL PA 1,1 12 --
14.ŞK 58 / E T4N1(11) UL VCS 1,4 4 --
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Olgu
Yaş & cins
Tm tipi
Rzk tipi
Ek işlem
Trakeal uzunluk (cm)
Takip (ay)
Morbidite
R durumu
1*.YA 29 / EADN KSTK
UL -- 2.5 107 -- R1
Olgu Yaş/C pTNM RzkEk işlem
Trakeal rzk
Takip Morbidite
2.AK 45 / E T4N0 UL PA 1.6 99-Sağ --
4.AG 59 / E T4N1(11) UL -- 1 57-Sağ --
7.İK 50 / E T4N1(11) UL PA 1.2 22-Sağ --
8.MEŞ 70 / E T4N0 UL PA 1 17-Ex --
10.İA 59 / E T4N0 UL ArtSle 1,3 EX Pnömoni
11.RA 73 / E T4N0 UL PA 1,1 12 --
14.ŞK 58 / E T4N1(11) UL VCS 1,4 4 --
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Olgu
Yaş & cins
Tm tipi
Rzk tipi
Ek işlem
Trakeal uzunluk (cm)
Takip (ay)
Morbidite
R durumu
1*.YA 29 / EADN KSTK
UL -- 2.5 107 -- R1
Olgu Yaş/C pTNM RzkEk işlem
Trakeal rzk
Takip Morbidite
2.AK 45 / E T4N0 UL PA 1.6 99-Sağ --
4.AG 59 / E T4N1(11) UL -- 1 57-Sağ --
7.İK 50 / E T4N1(11) UL PA 1.2 22-Sağ --
8.MEŞ 70 / E T4N0 UL PA 1 17-Ex --
10.İA 59 / E T4N0 UL ArtSle 1,3 EX Pnömoni
11.RA 73 / E T4N0 UL PA 1,1 12 --
14.ŞK 58 / E T4N1(11) UL VCS 1,4 4 --
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Sağ üst lob kaynaklı trakeayı invaze eden sol ana bronşa doğru mukozal olarak yayılan tm
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Üst lobAlt
lob
özofagus
Trakea
Sol ana bronş
v.azigos
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trakea
Sol a
na b
r
Pulm arter
İnte
rmed
ier
br
Alt lob
Orta lo
b
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İnte
rmedie
r br
Üst lob br
karina
Endotrakeal tüp
trakea
Sol ana br
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Olgu
Yaş & cins
Tm tipi
Rzk tipi
Ek işlem
Trakeal uzunluk (cm)
Takip (ay)
Morbidite
R durumu
1*.YA 29 / EADN KSTK
UL -- 2.5 107 -- R1
Olgu Yaş/C pTNM RzkEk işlem
Trakeal rzk
Takip Morbidite
2.AK 45 / E T4N0 UL PA 1.6 99-Sağ --
4.AG 59 / E T4N1(11) UL -- 1 57-Sağ --
7.İK 50 / E T4N1(11) UL PA 1.2 22-Sağ --
8.MEŞ 70 / E T4N0 UL PA 1 17-Ex --
10.İA 59 / E T4N0 UL ArtSle 1,3 EX Pnömoni
11.RA 73 / E T4N0 UL PA 1,1 12 --
14.ŞK 58 / E T4N1(11) UL VCS 1,4 4 --
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Karinaya yakın sağ ana bronşun posteriorunda 13x5 mm.lik kitle
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TRAKEA
İNTER
MED
İE
R B
R
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SOL A
NA
BRONŞ
ÜST LO
B
BR
İNTERM
EDİER B
R
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İNTE
RM
EDİE
R B
R
SOL ANA
BRONŞ
SO
L AN
A
BRO
NŞ
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Olgu
Yaş & cins
Tm tipi
Rzk tipi
Ek işlem
Trakeal uzunluk (cm)
Takip (ay)
Morbidite
R durumu
1*.YA 29 / EADN KSTK
UL -- 2.5 107 -- R1
Olgu Yaş/C pTNM RzkEk işlem
Trakeal rzk
Takip Morbidite
2.AK 45 / E T4N0 UL PA 1.6 99-Sağ --
4.AG 59 / E T4N1(11) UL -- 1 57-Sağ --
7.İK 50 / E T4N1(11) UL PA 1.2 22-Sağ --
8.MEŞ 70 / E T4N0 UL PA 1 17-Ex --
10.İA 59 / E T4N0 UL ArtSle 1,3 EX Pnömoni
11.RA 73 / E T4N0 UL PA 1,1 12 --
14.ŞK 58 / E T4N1(11) UL VCS 1,4 4 --
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Sağ ana bronşu invaze etmiş, trakea ve karinaya uzanan adenoid kistik karsinom
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2005
2010
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20062006
20082008
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1
Olgu
Yaş & cins
Tm tipi
Rzk tipi
Ek işlem
Trakeal uzunluk (cm)
Takip (ay)
Morbidite
R durumu
3*.Pİ 51 / KADN KSTK
C -- 1.5 52 -- R1
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Karinal düzeyde yerleşen her iki ana bronşta %50’ye yakın daralmaya yol açan düzensiz vegetan lezyon
FOB: Trakea distalinden başlayıp ana karinayı tutan, her iki ana bronşa taşan, sağ sekonder karinaya dek uzanan vegetan polipoid kitle
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Olgu
Yaş & cins
Tm tipi
Rzk tipi
Ek işlem
Trakeal uzunluk (cm)
Takip (ay)
Morbidite
R durumu
2.KD 61 / EADN KSTK
P -- 1.2 47 -- R0
OlguYaş/C
pTNMRzk
Ek işlem
Trakeal rzk
TakipMorbidite
1.RÇ 65 / E T4N1(14) P -- 1119-Sağ
AF
3 *.AŞ 57 / E T3N1(10) P -- 2 EX MI
5**.MK 46 / E T4N1(11) P -- 2 53-Sağ --
6**.YK 46 / E T4N1(11) P -- 2 51-Sağ --
9.MK 46 / E T4N1(10) P VCS 2 15-Ex --
12.HK 55 / ET4N2(4R
) P -- 1 5 Hemoraji
13.YS 55 / E T4N1(11) P -- 1,2 5 --
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Olgu
Yaş & cins
Tm tipi
Rzk tipi
Ek işlem
Trakeal uzunluk (cm)
Takip (ay)
Morbidite
R durumu
2.KD 61 / EADN KSTK
P -- 1.2 47 -- R0
OlguYaş/C
pTNMRzk
Ek işlem
Trakeal rzk
TakipMorbidite
1.RÇ 65 / E T4N1(14) P -- 1119-Sağ
AF
3 *.AŞ 57 / E T3N1(10) P -- 2 EX MI
5**.MK 46 / E T4N1(11) P -- 2 53-Sağ --
6**.YK 46 / E T4N1(11) P -- 2 51-Sağ --
9.MK 46 / E T4N1(10) P VCS 2 15-Ex --
12.HK 55 / ET4N2(4R
) P -- 1 5 Hemoraji
13.YS 55 / E T4N1(11) P -- 1,2 5 --
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Aralık/2005 RIBL Skuamöz T2N1 3 kür KT Şubat/2008 Sağ ana bronştan
kaynaklanıp trakea lateral duvarda lümene protrüde vegetan kitle, sağ ana bronşu tama yakın tıkıyor ve distale geçilemiyor
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ORTALAMA 46 AY (MEDİAN 51 AY, 4-120)
TAKİP
ADENOİD KİSTİK KARSİNOM TANILI 2
OLGUYA METASTAZ İÇİN METASTAZEKTOMİ
MORTALİTE %11.7 (n=2)
MORBİDİTE %23.5 (n=4)
13 OLGU SAĞ-SAĞLIKLI
2 OLGU TAKİPTE EX
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Karinanın tümörlerinde bazen cerrahiden yüksek mortalite ve morbidite nedeniyle kaçınılabilmekte
T4 KHDAK için en geniş cerrahi deneyim; trakeal sleeve pnömonektomi ve kombine pulmoner ve karinal rezeksiyon / rekonstrüksiyon ile karinaya invaze tümörlerde
Mortalite %11-27’den %6’lara kadar geriledi;Dikkatli hasta seçimi, cerrahi detaylarda daha dikkatli olunmasıanastezi uygulanmasında yeni yöntemler
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DİKKATLİ HASTA SEÇİMİ VE PEROP UYGULANAN İYİ YÖNETİM İLE KARİNAL REZEKSİYON VE REKONSTRÜKSİYON, KABUL EDİLEBİLİR MORTALİTE VE İYİ UZUN DÖNEM TAKİP SONUÇLARIYLA GÜVENLE UYGULANABİLİR.