.: ORİJİNAL ARAŞTIRMA
Primer Spontan Pnömotoraksta İlk Epizot Sonrası Nüksü Öngörmede Etkili Risk Faktörleri: Tanımlayıcı Çalışma
Risk Factors for Predicting Recurrence After the First Episode of Primary Spontaneous Pneumothorax: Descriptive Study
Turkiye Klinikleri Arch Lung. 2024;23(2):31-5
doi: 10.5336/archlung.2024-105789
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Primer spontan pnömotoraksın (PSP) ilk atağından sonra, ortalama nüks oranı %30 olarak rapor edilmiştir. Çocuklarda bu oran %50 ila %60 arasında görünmektedir. Bu çalışmanın amacı, ilk atak sonrası nüksün önlenmesi için cerrahi tedaviden fayda görebilecek hastaların seçiminde yararlı olabilecek nüks öngörücü faktörlerin belirlenmesidir. Gereç ve Yöntemler: Çalışmaya, Ağustos 2020 ile Haziran 2023 tarihleri arasında göğüs cerrahi kliniğimizde PSP nedeniyle yatarak tedavi uygulanan 112 hasta dâhil edildi. Tüm hastaların yaş, cinsiyet, boy, ağırlık, beden kitle indeksi, sigara içme öyküsü, pnömotoraks tarafı, pnömotoraksın miktarı, toraks bilgisayarlı tomografi (BT) bulguları ve uygulanan tedavi yöntemleri kaydedildi. Bulgular: Ortalama yaş 21,1±1,7 (14-34) yıldı. Hastaların 93'ü (%83) erkekti. Toraks BT değerlendirmesinde distrofik şiddet skoru 60 (%53,5) hastada sıfır iken, 21 (%18,7) hastada düşük değerli, 31 (%27,6) hastada ise yüksek değerdeydi. Nüks gelişimi ile sigara kullanımı (p=0,035), pnömotoraks miktarı (p=0,003) ve toraks BT'de distrofik şiddet skoru (p=0,024) arasında istatistiksel olarak anlamlı fark vardı. Nüks gelişimi ile yaş (p=0,065), cinsiyet (p=0,145), boy (p=0,895), beden kitle indeksi (p=0,123), pnömotoraks tarafı (p=0,768) ve tedavi şekli (p=0,540) arasında istatistiksel olarak anlamlı ilişki yoktu. Sonuç: PSP'nin ilk atağında sigara içme hikayesi, yüksek pnömotoraksın miktarı ve BT'de yüksek dereceli distrofik şiddet skoru, ipsilateral nüks gelişimi ile önemli ölçüde ilişkiliydi. Risk faktörleri daha ileri çalışmalarla netleştirilirse, erken video yardımlı toraks cerrahi ile hastanede kalış süreleri ve PSP nüksü azaltılabilir.
Anahtar Kelimeler: Primer spontan pnömotoraks; nüks; risk faktörleri
Amaç: Primer spontan pnömotoraksın (PSP) ilk atağından sonra, ortalama nüks oranı %30 olarak rapor edilmiştir. Çocuklarda bu oran %50 ila %60 arasında görünmektedir. Bu çalışmanın amacı, ilk atak sonrası nüksün önlenmesi için cerrahi tedaviden fayda görebilecek hastaların seçiminde yararlı olabilecek nüks öngörücü faktörlerin belirlenmesidir. Gereç ve Yöntemler: Çalışmaya, Ağustos 2020 ile Haziran 2023 tarihleri arasında göğüs cerrahi kliniğimizde PSP nedeniyle yatarak tedavi uygulanan 112 hasta dâhil edildi. Tüm hastaların yaş, cinsiyet, boy, ağırlık, beden kitle indeksi, sigara içme öyküsü, pnömotoraks tarafı, pnömotoraksın miktarı, toraks bilgisayarlı tomografi (BT) bulguları ve uygulanan tedavi yöntemleri kaydedildi. Bulgular: Ortalama yaş 21,1±1,7 (14-34) yıldı. Hastaların 93'ü (%83) erkekti. Toraks BT değerlendirmesinde distrofik şiddet skoru 60 (%53,5) hastada sıfır iken, 21 (%18,7) hastada düşük değerli, 31 (%27,6) hastada ise yüksek değerdeydi. Nüks gelişimi ile sigara kullanımı (p=0,035), pnömotoraks miktarı (p=0,003) ve toraks BT'de distrofik şiddet skoru (p=0,024) arasında istatistiksel olarak anlamlı fark vardı. Nüks gelişimi ile yaş (p=0,065), cinsiyet (p=0,145), boy (p=0,895), beden kitle indeksi (p=0,123), pnömotoraks tarafı (p=0,768) ve tedavi şekli (p=0,540) arasında istatistiksel olarak anlamlı ilişki yoktu. Sonuç: PSP'nin ilk atağında sigara içme hikayesi, yüksek pnömotoraksın miktarı ve BT'de yüksek dereceli distrofik şiddet skoru, ipsilateral nüks gelişimi ile önemli ölçüde ilişkiliydi. Risk faktörleri daha ileri çalışmalarla netleştirilirse, erken video yardımlı toraks cerrahi ile hastanede kalış süreleri ve PSP nüksü azaltılabilir.
Anahtar Kelimeler: Primer spontan pnömotoraks; nüks; risk faktörleri
ABSTRACT
Objective: The average recurrence rate after the first episode of primary spontaneous pneumothorax (PSP) has been reported to be 30%. In children, this rate appears to be between 50% and 60%. The aim of this study was to identify predictive factors for recurrence that may be useful in selecting patients who may benefit from surgical treatment to prevent recurrence after the first episode. Material and Methods: The study included 112 patients who underwent inpatient treatment for PSP in our thoracic surgery clinic between August 2020 and June 2023. Age, sex, height, weight, body mass index, smoking history, side of pneumothorax, amount of pneumothorax, chest computed tomography (CT) findings, and treatment modalities were recorded. Results: Mean age was 21.1±1.7 (14-34) years. 93 (83%) of the patients were male. The dystrophic severity score was zero in 60 patients (53.5%), low in 21 patients (18.7%), and high in 31 patients (27.6%). There was a statistically significant difference between the development of recurrence and smoking (p=0.035), the amount of pneumothorax (p=0.003), and the dystrophic severity score on chest CT (p=0.024). There was no statistically significant correlation between recurrence and age (p=0.065), gender (p=0.145), height (p=0.895), body mass index (p=0.123), side of pneumothorax (p=0.768) and treatment modality (p=0.540). Conclusion: A history of smoking at the first episode of PSP, a high amount of pneumothorax and a high grade dystrophic severity score on CT were significantly associated with the development of ipsilateral recurrence. If the risk factors are clarified by further studies, early video assisted thoracoscopic surgery may reduce the length of hospital stay and PSP recurrence.
Keywords: Primary spontaneous pneumothorax; recurrence; risk factors
Objective: The average recurrence rate after the first episode of primary spontaneous pneumothorax (PSP) has been reported to be 30%. In children, this rate appears to be between 50% and 60%. The aim of this study was to identify predictive factors for recurrence that may be useful in selecting patients who may benefit from surgical treatment to prevent recurrence after the first episode. Material and Methods: The study included 112 patients who underwent inpatient treatment for PSP in our thoracic surgery clinic between August 2020 and June 2023. Age, sex, height, weight, body mass index, smoking history, side of pneumothorax, amount of pneumothorax, chest computed tomography (CT) findings, and treatment modalities were recorded. Results: Mean age was 21.1±1.7 (14-34) years. 93 (83%) of the patients were male. The dystrophic severity score was zero in 60 patients (53.5%), low in 21 patients (18.7%), and high in 31 patients (27.6%). There was a statistically significant difference between the development of recurrence and smoking (p=0.035), the amount of pneumothorax (p=0.003), and the dystrophic severity score on chest CT (p=0.024). There was no statistically significant correlation between recurrence and age (p=0.065), gender (p=0.145), height (p=0.895), body mass index (p=0.123), side of pneumothorax (p=0.768) and treatment modality (p=0.540). Conclusion: A history of smoking at the first episode of PSP, a high amount of pneumothorax and a high grade dystrophic severity score on CT were significantly associated with the development of ipsilateral recurrence. If the risk factors are clarified by further studies, early video assisted thoracoscopic surgery may reduce the length of hospital stay and PSP recurrence.
Keywords: Primary spontaneous pneumothorax; recurrence; risk factors
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