Mediastinal kistik lezyonlar ve cerrahi tedavisi
Mediastinal cystic lesions and surgical treatment
Yazar: ALİ BİLAL ULAŞ
Danışman: DOÇ. DR. YENER AYDIN
Atatürk Üniversitesi / Tıp Fakültesi / Göğüs Cerrahisi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2015
Konu: Göğüs Kalp ve Damar Cerrahisi = Thoracic and Cardiovascular Surgery
Dizin: Cerrahi = Surgery ; Cerrahi tedavi = Surgical treatment ; Kistler = Cysts ; Mediastinal hastalıklar = Mediastinal diseases ; Mediastinum = Mediastinum

Özet:
Amaç: Bu çalışmada mediastinal kistik lezyonlar ve cerrahi tedavi sonuçlarını sunduk.
Materyal ve Metot: Kliniğimizde 1996 – 2015 yılları arasında mediastinal kist tanısıyla 65 olgu opere edildi. Olgular retrospektif olarak değerlendirildi.
Bulgular: Olguların 34'ü (%52.3) erkek ve 31'i (% 47.7) kadındı. Ortalama yaş 36.2±19.3 (iki gün-82 yaş) idi. Mediastinal kistler 24 olguda (%36.9) anterior-süperior mediasten, 23 olguda (%35.4) orta mediasten, 18 olguda (%27.7) posterior mediasten yerleşimliydi. Histopatolojik tipler; 17 bronkojenik kist, 15 hidatik kist, 12 perikardiyal kist, altı kistik teratom, dört enterik kist, dört timik kist, iki tiroid kisti, iki dermoid kist, birer vakada ductus torasikus kisti, lenfanjiom ve kistik lenfoma idi. Olguların 31'ine (%47.7) torakotomi, 24'üne (%36.9) VATS, yedisine (%10.8) sternotomi ile yaklaşılırken birer olguya mediastinotomi, mediastinoskopi ve servikal insizyon ile müdahale edildi. Torakotomi ile yapılan cerrahiler ortalama 125.7 ± 23.8 dakika sürerken VATS yapılan olguların ortalama süresi 89.8 ± 17.4 dakika idi. Torakotomi cerrahisi sonrası hastanede ortalama yatış süresi 8.3 ± 4.2 gün iken VATS sonrası 4.3 ± 1.2 gün idi. Postoperatif olguların beşinde komplikasyon (iki pnömotoraks, bir plevral effüzyon, bir şilotoraks, bir nüks) izlendi. Olguların hiçbirinde mortalite gözlenmedi.
Sonuç: Mediastinal kistlerde asıl tedavi cerrahidir. Torakoskopik yaklaşım hastanın cerrahi işlem süresini ve postoperatif hastanede yatış süresini önemli derecede azaltır. Mediastinal kistlerde açık cerrahilerin gün geçtikçe yerini minimal invaziv cerrahilere bırakacağını düşünüyoruz.

Anahtar Kelimeler: Mediasten, Kist, Cerrahi

Abstract:
Objective: In this study, we report mediastinal cystic lesions and surgical treatment results of them.
Materials and Methods: 65 cases were operated with the diagnosis of mediastinal cyst between 1996 and 2015 in our clinic. Patients were evaluated retrospectively.
Results: 34 (52.3%) patients were male and 31 (47.7%) patients were female. The mean age was 36.2±19.3 (two days-82 years). In 24 patients (36.9%) mediastinal cysts were in anterior-superior mediastinum, in 23 cases (35.4%) they were in middle mediastinum, in 18 cases (27.7%) cysts were in posterior mediastinum. As histopathological classification there were 17 bronchogenic cysts, 15 hydatic cysts, 12 pericardial cysts, six cystic teratomas, four enteric cysts, four thymic cysts, two thyroid cysts, two dermoid cysts, a ductus thoracic cyst, a lymphangioma and a cystic lymphoma. Thoracotomy was performed in 31 (47.7%) cases, VATS in 24 (36.9%) cases, sternotomy in seven (10.8%) cases, mediastinotomy in one case, mediastinoscopy in one case, cervical incision in one case. The mean duration of surgery performed by thoracotomy was 125.7 ± 23.8 minute while it was 89.8 ± 17.4 minute for patients who underwent VATS. After thoracotomy surgery, average length of stay in hospital was 8.3 ± 4.2 days while it is 4.3 ± 1.2 days for VATS. Postoperative we observed complications in five cases (two pneumothorax, pleural effusion, a chylothorax, a recurrence). None of the patients were observed for mortality.
Conclusion: The main treatment of mediastinal cysts is surgery. Thoracoscopic approach significantly reduces the duration of the patient's surgical procedure and length of postoperative hospital stay. We think open surgery for mediastinal cysts will leave its place gradually to minimally invasive surgery in future.

Key words: Mediastinum, Cyst, Surgery