부산대학교 도서관

Introduction Each surgical procedure has a certain risk of complications. Urological surgery, whether open or endoscopic, may be associated with visceral, vascular and thoracic complications. Along with technical and technological [...]
Objective: To present cases of thoracic complications that developed after urologic interventions and were treated in collaboration with thoracic surgery. Materials and Methods: Patients who were operated in the urology clinic at our hospital between January 2014 and December 2017 and required thoracic surgery consultation were retrospectively reviewed. Forty-two patients with pneumothorax, pleural effusion, hydropneumothorax and diaphragm injury were included in the study. Six patients, who had preoperative diaphragm invasion and underwent preoperative diaphragm incision, were excluded. Results: Tube thoracostomy (TT) was applied in only 5 patients who developed pneumothorax. Three patients with isolated pleural effusion were treated with TT and 3 with thoracentesis. All patients who developed hydropneumothorax were found to have undergone nephrectomy (3 left, 1 right). All patients with iatrogenic diaphragmatic injury were diagnosed perioperatively and all of these patients were nephrectomized (5 right, 1 left). All the patients underwent primary diaphragm repair and 5 patients underwent TT. The mean duration of tube drainage was 5.5[+ or -]2.1 (2-13) days. The mean length of hospital stay in patients who underwent percutaneous nephrolithotomy, nephroureterectomy, nephrectomy and prostatectomy with thoracic complications was 4.12[+ or -]1.08, 8.26[+ or -]2.87, 4.04[+ or -]1.23 and 4.17[+ or -]0.72 days, respectively. There was no significant difference in mean duration of hospital stay between patients with and without thoracic complications (p=0.729). Conclusion: Thoracic complications may develop after urological interventions. In particular, evaluation of chest pain in patients with right-sided percutaneous nephrolithotomy and nephrectomy by chest X-ray is important for early diagnosis. Keywords: Pneumothorax, Hydropneumothorax, Complication, Percutaneous Nephrolithotomy, Nephrectomy Amac: Bu calismada urolojik girisimler sonrasi torasik komplikasyon gelisen ve gogus cerrahisi-uroloji isbirligi ile tedavi edilen olgular sunuldu. Gerec ve Yontem: Ocak 2014 - Aralik 2017 tarihleri arasinda hastanemiz Uroloji Anabilim Dali tarafindan opere edilen ve gogus cerrahisi konsultasyonu istenilen olgular retrospektif incelendi. Calismaya pnomotoraks, plevral effuzyon, hidropnomotoraks ve diyafragma yaralanmasi saptanan 42 hasta dahil edildi. Operasyon oncesi diyafragma invazyonu saptanan ve peroperatif diyafragma insizyonu yapilan alti hasta calismadan cikarildi. Bulgular: Pnomotoraks gelisen hastalarin sadece 5'ine tup torakostomi (TT) uygulandi. Izole plevral effuzyon izlenen hastalarin 3'u TT, 3'u ise torasentez ile tedavi edildi. Hidropnomotoraks gelisen hastalarin tamamina nefrektomi (3 sol, 1 sag) uygulandigi goruldu. Iyatrojenik diyafragma yaralanmasi gelisen hastalarin tamamina perioperatif donemde tani kondu ve hastalarin tamami nefrektomi (5 sag, 1 sol) hastasi idi. Hastalarin tamaminda diyafragmanin primer onarimi yapildi, 5 hastaya TT uygulandi. Hastalarin ortalama dren kalis, suresi 5,5[+ or -]2,1 (2-13)/gundu. Toraks komplikasyonu gelisen hastalardan perkutan nefrolitotomi, nefroureterektomi, nefrektomi ve prostatektomi operasyonu geciren hastalarin ortalama hospitalizasyon sureleri, sirasiyla, 4,12[+ or -]1,08, 8,26[+ or -]2,87, 4,04[+ or -]1,23 ve 4,17[+ or -]0,72 gundu. Toraks komplikasyonu gelisen ve gelismeyen hastalarin ortalama hospitalizasyon sureleri arasinda anlamli bir farklilik yoktu (p=0,729). Sonuc: Urolojik girisimler sonrasi torasik komplikasyonlar gelisebilir. Ozellikle sag tarafli perkutan nefrolitotomi ve nefrektomi sonrasi gogus agrisi tarifleyen hastalarin akciger grafisi ile degerlendirilmesi erken tani icin onemlilik arz etmektedir. Anahtar Kelimeler: Pnomotoraks, Hidropnomotoraks, Komplikasyon, Perkutan Nefrolitotomi, Nefrektomi