Erken Postoperatif Komplikasyonlar
Özet
Göğüs cerrahisi ameliyatları sonrası erken postoperatif dönem, literatürde 24 saat ile 30 gün arasında tanımlanmakta olup birçok kritik komplikasyon riskini barındırır. En sık karşılaşılan ikinci komplikasyon olan uzamış hava kaçağı, KOAH hastalarında ve lobektomi süreçlerinde sık görülürken; atelektazi ise anestezi etkisi ve balgam retansiyonuna bağlı olarak üçüncü sırada yer alır. Cerrahi operasyonların ardından en yaygın görülen aritmi tipi %10-40 sıklıkla atriyal fibrilasyondur. En sık retorakotomi gerektiren erken komplikasyon ise kanama olup, mortalite oranı %15,7 seviyesindedir. Ayrıca perikardiyal defektlerden kaynaklanan ve %50-100 mortaliteye sahip kardiyak herniasyon ile nadir ama ölümcül olan pulmoner lober torsiyon da cerrahi sonrası acil müdahale gerektiren tablolardandır. Postoperatif pnömoni gelişiminde gram negatif bakteriler %70 oranında etkiliyken; torasik duktus yaralanması sonucu ortaya çıkan şilotoraks yönetiminde öncelikle konservatif diyet tedavisi, başarısızlık durumunda ise cerrahi ligasyon uygulanır. Son olarak, operasyon sahasındaki retraksiyon veya diseksiyona bağlı gelişebilen frenik ve laringeal sinir hasarları; diyafragma paralizisi, solunum sıkıntısı ve ses kısıklığı gibi ciddi morbiditelere yol açabilmektedir.
The early postoperative period in thoracic surgery, defined in the literature between 24 hours and 30 days, involves various critical complications. Prolonged air leak is the second most common complication, frequently occurring in COPD patients and lobe resections, while atelectasis ranks third due to anesthesia effects and sputum retention. Atrial fibrillation is the most common postoperative arrhythmia, appearing in 10-40% of cases. Hemorrhage stands as the leading early complication requiring re-thoracotomy, carrying a notable mortality rate of 15.7%. Furthermore, cardiac herniation through pericardial defects poses a high mortality risk of 50-100%, and rare but fatal pulmonary lobar torsion necessitates immediate surgical intervention. Postoperative pneumonia is predominantly caused by gram-negative bacteria in 70% of cases, whereas chylothorax, resulting from thoracic duct injury, is initially managed with conservative diets or surgical ligation if persistent. Lastly, injuries to the phrenic and recurrent laryngeal nerves caused by dissection or retraction can lead to significant morbidities such as diaphragmatic paralysis, respiratory distress, and persistent hoarseness.
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