Bilateral staged thoracotomy for multiple lung hydatidosis

Journal of Cardiothoracic Surgery

Fahri Oguzkaya¹  Omer Onal¹  Leyla Hasdıraz¹ 

[1] Department of Thoracic Surgery, Erciyes University Medical Faculty, Kayseri 38039, Turkey

关键词: Multiple cysts;    Thoracotomy;    Lung;    Hydatid disease;   

Others  :  825438
DOI  :  10.1186/1749-8090-8-121

 received in 2013-01-08, accepted in 2013-04-12,  发布年份 2013

【 摘 要 】

Background

Hydatid cyst disease is still a problem in many countries. Surgical removal is currently the generally accepted choice of treatment for lung hydatidosis. However, operating on bilateral widespread lung hydatidosis is still controversial. The aim of this retrospective study was to evaluate the results of surgical treatment in bilateral multiple hydatid disease of the lung.

Methods

In this study, we reviewed our experience in the surgical treatment of 17 (3.7%) patients with bilateral, and at least three, lung hydatid cysts. These 17 patients (8 male, 9 female), with an average age of 34.6 years (range 12–58 years), underwent bilateral staged thoracotomy.

Results

In total 105 lung cysts were removed from 17 patients who underwent staged thoracotomies. The mean count of cysts was 6.7 (range 3–20 cysts). Most of the cysts (38.2%) were located in the right lower lobe. The mean interval between thoracotomies was 4.2 (range 3–5) days. Two patients (11.7%) had cysts associated with hepatic hydatidosis and one (5.8%) had cysts associated with the spleen; they were treated via phrenotomy during thoracotomies. All cysts were removed without lung resection. We observed some complications such as prolonged air leaks (n = 2), atelectasis (n = 3) and empyema (n = 2). No further surgery was required for management of complications. The mean hospital stay was 9.3 days. (range 7–23 days). Oral albendazole was started on the 2nd post operative day after the first thoracotomy in the dose of 10–20 mg/kg and was continued for 3 months with a gap of 1 week after each 21 days. No recurrences or deaths occured during the follow-up period.

Conclusions

Although staged thoracotomy applied in 3–5 days after the initial thoracotomy increases the total hospital stay, it decreases the chance of possible complications can occur in cysts in the other lung when long intervals are preferred between the first and the second thoracotomy. In our experience, bilateral staged thoracotomy is an appropriate surgical option because morbidity rates are minimal and the hospital stay is acceptable for the treatment of bilateral widespread lung hydatidosis, even in patients who had a total of 20 hydatid cysts.

【 授权许可】

   
2013 Hasdıraz et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Burgos R, Varela A, Castedo E: Pulmonary hydatidosis: surgical treatment and follow up of 240 cases. Eur J Cardiothorac Surg 1999, 16:628-635.
• [2]Karaoglanoglu N, Kurkcuoglu IC, Gorguner M: Giant hydatid lung cysts. Eur J Cardiothorac Surg 2001, 19:914-917.
• [3]Morar R, Feldman C: Pulmonary hydatid cyst. Eur Respir J 2003, 21:1069-1077.
• [4]Doğan R, Yüksel M, Çetin G: Surgical treatment of the hydatid cyst of the lung: report on 1055 patients. Thorax 1989, 44:192-199.
• [5]El On J: Benzimidazole treatment of cystic echinococcosis. Acta Trop 2003, 85:243-252.
• [6]Falagas ME, Bliziotis IA: Albendazole for the treatment of human echinococcosis: a review of comparative clinical trials. Am J Med Sci 2007, 334(3):171-179.
• [7]De Rosa F, Lastilla MG, Franchi C: Advances of medical treatment of human hydatidosis. Recent Prog Med 1996, 87:346-352.
• [8]Albendazole JH: A review of anthelmintic efficacy and safety in humans. Parasitology 2000, 121:113-132.
• [9]Horton J: Albendazole in treatment of human cystic echinococcosis: 12 years of experience. Acta Trop 1997, 64:79-93.
• [10]Stamatakos M, Sargedi C, Stefanaki C: Anthelminthic treatment: An adjuvant therapeutic strategy against Echinococcus granulosus. Parasitol Int 2009, 58:115-120.
• [11]Matthew T, Martin L: Management of osteosarcoma pulmonary metastases. Seminars in Ped Surg 2006, 15:25-29.
• [12]Murat K, Canan D, Cagatay T: One-stage operation via median sternotomy and phrenotomy for bilateral lung and liver hydatid disease. Ind J Thorac Cardiovasc Surg 2005, 21:167-170.
• [13]Petrov DB, Terzinacheva PP, Djambazov VI: Surgical treatment of bilateral hydatid disease of the lung. Eur J Cardiothorac Surg 2001, 19:918-923.
• [14]Shehatha J, Alizzi J, FRACS: Thoracic hydatid disease; a review of 763 cases. Heart Lung Circ 2008, 17:502-504.
• [15]Cetin G, Dogan R, Yuksel M: Surgical treatment of bilateral hydatid disease of the lung via median sternotomy: experience in 60 consecutive patients. Thorac Cardiovasc Surg 1988, 36:114-117.
• [16]Gunes Y: New inhalation agents and hepatotoxicity. Archive 2011, 20:270-277.
• [17]Gomez R, Moreno E, Loinaz C: Diaphragmatic or transdiaphragmatic thoracic involvement in hepatic hydatid disease: surgical trends and classification. World J Surg 1995, 19:714-719.
• [18]Aribas OK, Kanat F, Gormus N, Turk E: Pleural complications of hydatid disease. J Thorac Cardiovasc Surg 2002, 123:492-497.