Köpeklerde pnömonektomi sonrası farklı bronş kapatma tekniklerinin karşılaştırılması
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Date
2006
Authors
Salcı, Hakan
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Publisher
Uludağ Üniversitesi
Abstract
Köpeklerde sağ ve sol pnömonektomi sonrası bronş güdüğünün kapatılmasında farklı üçtekniğin (dikiş, stapler ve dikiş + doku flebi) bir aylık süre içinde histopatolojik iyileşme ve bronkoplevral fistül (BPF) komplikasyonu yönünden karşılaştırılması amaçlandı.Çalışmada yaklaşık 20 kg ağırlığında, ortalama bir yaşlı toplam 27 adet (n=27) melez ırk köpek kullanıldı. Bu köpeklerin 18 tanesi (n=18) histopatolojik inceleme ve 9 tanesi (n=9)oluşan komplikasyon yönünden değerlendirildi. Köpekler iki gruba ayrılarak, Grup I'de (GI),(n=9) sağ pnömonektomi, Grup II'de (GII), (n=9) sol pnömonektomi operasyonları yapıldı. GI ve GII kendi arasında üç alt gruba ayrılarak sağ ve solda eşit sayıda pnömonektomi operasyonu olacak şekilde Alt grup I'de (D), (n=6) bronş güdüğü yatay ?U? ve basit ayrı dikişle, Alt grup II'de (ST), (n=6) bronş güdüğü stapler ile ve Alt grup III'de (DDF), (n=6)bronş güdüğü dikiş + doku flebi (m. interkostalis eksternus-internus) ile kapatıldı. Postoperatif birinci ayda köpekler sakrifiye edildikten sonra bronş güdüğü çıkarıldı vehistopatolojik olarak incelendi. Postoperatif komplikasyonlar klinik, radyolojik ve postmortem bulgular ele alınarak değerlendirildi. Alt gruplar arasında biyoistatistik analizler histopatolojik inceleme yönünden Fisher'in Kesin Ki Kare testi ile ve BPF komplikasyon yönünden Pearson Ki Kare Testi ile yapıldı.Klinik muayenede general amfizem ve spontan ölüm görülmesi, postmortem olarak bronş güdüğünün açıklığı ve radyolojik olarak kapalı pnömotoraks görülmesi BPF tanısını doğruladı. BPF komplikasyonu (n=5) alt gruplara göre D'de 2, ST'de 1 ve DDF'de 2 adet olarak belirlendi. Diğer komplikasyonları (n=4) perioperatif kardiak arrest (n=1), postoperatif solunum (n=1) ve dolaşım yetmezliği (n=1) ve postoperatif idiopatik ölüm (n=1) oluşturdu. Biyo istatistik sonuçlarına göre histopatolojik inceleme yönünden D ile DDF (p=1.00; p>0.05)ve ST ile DDF (p=1.00; p>0.05) arasında 0.05 anlamlılık düzeyinde herhangi bir anlamlı bir fark bulunmadı. Benzer şekilde D, ST ve DDF alt grupları arasında BPF oluşumu yönünden 0.05 anlamlılık düzeyinde istatistiksel olarak anlamlı bir fark bulunmadı (p=0.945; p>0.05).Histopatolojik inceleme ve BPF komplikasyonu yönünden biyo istatistik sonuçlar göz önüne alındığında alt gruplar arasında herhangi bir anlamlı fark olmaması bronş kapatılmasında dikiş, stapler ve dikiş +doku flebi kullanılmasının histopatolojik iyileşme ve BPF komplikasyonu yönünden birbirine üstünlük sağlamayacağını göstermiştir.
The Comparison of Different Bronchial Closure Techniques FollowingPneumonectomy in DogsThe aim of this study was to compare three different bronchial closure techniques (suture,stapler and suture + tissue flap) with regard to histological healing and bronchopleural fistulaformation during one month period following right and left pneumonectomy in dogs.Twenty-seven dogs of mixed breed, of 1 year-old and with approximately 20 kg bodyweight were used in this study. Eighteen dogs and 9 dogs were evaluated forhistopathological healing and bronchopleural fistula formation, respectively. Dogs wereseparated into two groups: right pneumonectomy was performed in Group I (GI) (n=9) andleft pneumonectomy was performed in Group II (GII) (n=9). GI and GII were separated intothree subgroups and all subgroups had undergone equal numbers of pneumonectomyoperations. Bronchial stumps were closed with vertical ?U? suture and simple interruptedsuture technique in Subgroup I (D) (n=6). In Subgroup II (ST) (n=6) and Subgroup III (DDF)(n=6) bronchial stumps were closed with stapler and suture + tissue flap (m.intercostalisexternus-internus), respectively. After one month, dogs were sacrificed, bronchial stumpswere removed and examined histopathologically. Postoperative complications were evaluatedbased on the clinical, radiological and postmortem findings. Fisher?s Chi square test andPearson Chi square test were used for the analysis of difference between subgroups withregard to histopathologic evaluation and BPF complication, respectively.BPF was diagnosed based on the clinical findings of general emphysema and spontaneousexitus letalis, radiological finding of closed pneumothorax, and postmortem observation of thefistula formation of the bronchial stump. Two BPF complications were seen in D and DDF,and only one BPF complication was seen in ST subgroups. Other complications includedperioperative cardiac arrest (n=1), postoperative respiratory compromise (n=1), cardiac failure(n=1) and postoperative idiopathic exitus letalis (n=1). According to the statical analysisresults, there was no difference between D and DDF (p=1.00; p>0.05), and between ST andDDF (p=1.00; p>0.05) regarding histopathologic healing. Similarly, no significant differencewas observed between D, ST and DDF groups on BPF complication (P=0.945; p>0.05).Taking the results of the statistical analysis on histopathologic healing and BPFcomplication into consideration, there was no significant difference between the groups. Theresult suggests that suture, stapler and suture + tissue flap techniques do not have any majoradvantage over each other in bronchial stump closure in terms of histopathologic healing andBPF complication.Key words: Dog, pneumonectomy, bronchial closure
The Comparison of Different Bronchial Closure Techniques FollowingPneumonectomy in DogsThe aim of this study was to compare three different bronchial closure techniques (suture,stapler and suture + tissue flap) with regard to histological healing and bronchopleural fistulaformation during one month period following right and left pneumonectomy in dogs.Twenty-seven dogs of mixed breed, of 1 year-old and with approximately 20 kg bodyweight were used in this study. Eighteen dogs and 9 dogs were evaluated forhistopathological healing and bronchopleural fistula formation, respectively. Dogs wereseparated into two groups: right pneumonectomy was performed in Group I (GI) (n=9) andleft pneumonectomy was performed in Group II (GII) (n=9). GI and GII were separated intothree subgroups and all subgroups had undergone equal numbers of pneumonectomyoperations. Bronchial stumps were closed with vertical ?U? suture and simple interruptedsuture technique in Subgroup I (D) (n=6). In Subgroup II (ST) (n=6) and Subgroup III (DDF)(n=6) bronchial stumps were closed with stapler and suture + tissue flap (m.intercostalisexternus-internus), respectively. After one month, dogs were sacrificed, bronchial stumpswere removed and examined histopathologically. Postoperative complications were evaluatedbased on the clinical, radiological and postmortem findings. Fisher?s Chi square test andPearson Chi square test were used for the analysis of difference between subgroups withregard to histopathologic evaluation and BPF complication, respectively.BPF was diagnosed based on the clinical findings of general emphysema and spontaneousexitus letalis, radiological finding of closed pneumothorax, and postmortem observation of thefistula formation of the bronchial stump. Two BPF complications were seen in D and DDF,and only one BPF complication was seen in ST subgroups. Other complications includedperioperative cardiac arrest (n=1), postoperative respiratory compromise (n=1), cardiac failure(n=1) and postoperative idiopathic exitus letalis (n=1). According to the statical analysisresults, there was no difference between D and DDF (p=1.00; p>0.05), and between ST andDDF (p=1.00; p>0.05) regarding histopathologic healing. Similarly, no significant differencewas observed between D, ST and DDF groups on BPF complication (P=0.945; p>0.05).Taking the results of the statistical analysis on histopathologic healing and BPFcomplication into consideration, there was no significant difference between the groups. Theresult suggests that suture, stapler and suture + tissue flap techniques do not have any majoradvantage over each other in bronchial stump closure in terms of histopathologic healing andBPF complication.Key words: Dog, pneumonectomy, bronchial closure
Description
Keywords
Köpekler, Pnömonektomi, Bronş kapatılması, Dogs, Pneumonectomy, Bronchial closure
Citation
Salcı, H. (2006). Köpeklerde pnömonektomi sonrası farklı bronş kapatma tekniklerinin karşılaştırılması. Yayınlanmamış doktora tezi. Uludağ Üniversitesi Sağlık Bilimleri Enstitüsü.