Tratamento cirúrgico das bronquiectasias

Surgical treatment of bronchiectasis

 

Miguel S Guerra¹

José António Miranda¹

Francisco Leal¹

Luís Vouga¹

 

Resumo

A prevalência das bronquiectasias diminuiu significativamente nas últimas décadas, principalmente nos países desenvolvidos. Contudo, a ressecção cirúrgica é ainda a alternativa terapêutica para um número significativo de doentes em alguns países, tais como Portugal. Entre 1994 e 2004, operámos 51 doentes com bronquiectasias (29 mulheres e 22 homens), com idades compreendidas entre os 4 e os 65 anos (média=38,6 anos). A duração média dos sintomas foi de 4,8 anos e a indicação cirúrgica foi: insucesso do tratamento médico (49,1%), hemoptises (23,5%), massa pulmonar (17,6%) e abcesso (9,8%). Foram realizadas 7 pneumectomias, 3 bilobectomias, 36 lobectomias e 5 segmentectomias. Não houve mortalidade operatória e ocorreram complicações major em 8 doentes (15,7%). O follow-up foi possível em 45 doentes (88,2%) durante uma média de 3,4 anos: 35 (77,7%) ficaram assintomáticos após a cirurgia, 7 (15,6%) melhoraram dos sintomas e 3 (6,7%) ficaram na mesma ou pioraram. Apesar dos antibióticos de largo espectro actualmente disponíveis, o insucesso do tratamento médico foi a principal indicação cirúrgica de doentes com bronquiectasias. A cirurgia melhorou os sintomas na maioria dos doentes e esteve associada a um baixo risco de morbi-mortalidade.

 

Palavras-chave: Bronquiectasias, cirurgia, resultados, complicações, morbilidade, mortalidade.

 

Abstract

While the prevalence of bronchiectasis has decreased significantly over recent decades in developed countries, resection for bronchiectasis still plays an important part in thoracic surgery practice in some countries, such as Portugal. Between 1994 and 2004, 51 patients (29 female and 22 male) with a mean age of 38.6 years (range 4-65 years) underwent pulmonary resection for bronchiectasis. Mean duration of symptoms was 4.8 years. Surgery was indicated because of unsuccessful medical therapy in 25 patients (49.1%), haemoptysis in 12 (23.5%), lung mass in 9 (17.6%) and lung abscess in 5 (9.8%). The surgical treatment was pulmonectomy in 7 patients, bilobectomy in 3, lobectomy in 36 and segmentectomy in 5. There was no operative mortality. Complications occurred in 8 patients and the morbidity rate was 15.7%. Follow-up was complete in 45 (88.2%) patients with a mean of 3.4 years. Overall, 35 (77.7%) patients were asymptomatic after surgery, symptoms were improved in 7 (15.6%), and unchanged or worse in 3 (6.7%). Unsuccessful medical therapy was still our main indication for surgery of bronchiectasis, despite aggressive antibiotic therapy. Surgical resection was performed with acceptable morbidity and morbidity and markedly improved symptoms in the majority of patients.

 

Key-words: Bronchiectasis, surgery, results, complications, mortality, morbidity.

 

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

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¹Serviço de Cirurgia Cardiotorácica / Cardiothoracic Surgery Unit

Centro Hospitalar de Vila Nova de Gaia, Porto, Portugal / Centro Hospitalar de Vila Nova de Gaia, Porto, Portugal

 

Correspondência / Correspondence to:

Miguel S. Guerra

Serviço de Cirurgia Cardiotorácica

Centro Hospitalar de Vila Nova de Gaia

Rua Conceição Fernandes

4434-502 Vila Nova de Gaia, Porto, Portugal

Tel: (+351) 227865100

Tlm: (+351) 933734217

Fax: (+351) 227865170

Email: migueldavidguerra@yahoo.com

 

Recebido para publicação/received for publication: 07.01.09

Aceite para publicação/accepted for publication: 07.05.10