TORAKOTOMÝ SIRASINDA OLUÞAN ÝATROJENÝK KOT FRAKTÜRLERÝ

Torakotomi sýrasýnda oluþabilen kot fraktürleri, akciðer rezeksiyonu uygulanan hastalarda çoðu kez postoperative morbiditeyi artýrmaktadýr. Bu çalýþma, farklý iki torakotomi sýrasýnda geliþen iatrojenik kot fraktürü insidansýný araþtýrmak için planlandý. Yaþlarý 51-69 arasýnda deðiþen 67 hasta iki gruba ayrýldý. 46 Hastada (Grup 1) standart posterolateral torakotomi (PLT) uygulanýrken, 21 olgu (Grup II) kas-kesimsiz vertikal torakotomi (VT) insizyonu ile açýldý. Her iki grupta, lobektomi yada "wedge"rezeksiyon yapýldý. Grupta yer alan yedi (%15.2) ve II.Gruptaki beþ (%23.8) hastada kot fraktürü geliþti. VT grubunda fraktür insidansý anlamlý derecede yüksek bulundu (p<0.05). Literatürde son zamanlarda sýkça önerilen kas-kesimsiz torakotomi sýrasýnda, kot fraktürü oluþumunu önlemek için büyük özen gösterilmesi gerekir.

IATROGENIC FRACTURE OF THE RIBS DURING THORACOTOMY

Inadvertent rib fracture, which may occur during thoracotomy, is often associated with an increased postoperative morbidity after pulmonary resections. This trial was planned to evaluate the occurrence of the iatrogenic rib fracture in two different types of thoracotomies. 67 patients, ranging in age 51-69, were divided into two groups. Standard posterolateral thoracotomy (PIT) was performed in 46 patients (Group I), whereas a muscle-sparing vertical thoracotomy (VT) incision was used in 21 patients (Group II). Lobectomy or a wedge resection was performed in both groups. Iatrogenic rib fracture was noted in seven patients (% 15.2) and in five patients (%28.3) in Group I and II, respectively. The incidence of fracture was significantly high (p < 0.05) in VT group. During muscle-sparing thoracotomy techniques, which are suggested more frequently in recent literature, great care should be taken to avoid this complication.