Video-asistirana torakoskopska hirurgija (VATS) u sarkoidozom zahvaćenoj hilusnoj i medijastinalnoj limfadenopatiji
VATS u sarcoidozi
Sažetak
Sarkoidoza je multisistemsko, granulomatozno oboljenje nepoznate etiologije. U nastanku bolesti značajna je interreakcija genetskih i faktora spoljašnje sredine. Klinička slika varira od asimptomatskog do oblika sa nespecifičnim simptomima respiratornog trakta. Dijagnoza se postavlja na osnovu kliničke slike, radiografskog nalaza hilusne i/ili medijastinalne limfadenopatije sa ili bez prisustva fokalnih lezija u parenhimu pluća. Dijagnoza se potvrdjuje na osnovu histopatološkog nalaza nekazeoznog granuloma. Bronhoskopija sa biopsijom limfnih čvorova predstavlja standardni dijagnostički pristup. U poslednje vreme, video-asistirana torakoskopska hirurgija (VATS) je našla svoju primenu kao tehnika za lakši pristup promenama u medijastinumu u cilju preciznije histopatološke verifikacije. Primena VATS tehnike je posebno opravdana u situacijama kada nastupa iznenadno pogoršanje bolesti kod koje nije moguće standardnim dijagnostičkim procedurama dokazati uzrok. Prikazan je slučaj bolesnika starosti 67 godina sa radiografskim nalazom hilusne i medijastinalne limfadenopatije kao i fokalnim promenama na plućnom parenhimu. Ove promene se otkrivaju na rentgenografiji grudnog koša učinjenoj u sklopu preoperativne pripreme bolesnika za holecistektomiju. Bolesnik je bezuspešno podvrgnut višestrukoj bronhoskopiji, a histopatološki pregled dobijenih uzoraka ne ukazuju na sarkoidozom uzrokovanu limfadenopatiju. Zbog radiografske progresije limfadenopatije, pojave obostranog pleuralnog izliva sa fokalnim lezijama na plućnom parenhimu primenjuje se VATS tehnika. Histopatološkim pregledom dobijenih uzoraka limfnih čvorova medijastinuma i pleure potvrđuje se dijagnozu sarkoidoze pluća sa posledičnom hilusnom i medijastinalnom limfadenopatijom. Bolesniku se u terapiju uvode kortikosterodi, te nakon 4 meseca od postavljene dijagnoze nastupa značajna radiološka regresija. VATS metoda je efikasna u potvrdi dijagnoze sarkoidozom uzrokovane limfadenopatije medijastinuma vodeći računa o bezbednosti bolesnika.
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