MINIMALNO INVAZIVNA TORAKOSKOPSKA HIRURGIJA KAO DIJAGNOSTIČKI I TERAPIJSKI PRISTUP KOD BILATERALNOG PNEUMOTORAKSA U TRUDNOĆI UZROKOVANOG LIMFANGIOLEIOMIOMATOZOM – PRIKAZ SLUČAJA

  • Željko Garabinović
  • Nikola Čolić
  • Jelena Vasić Madžarević
  • Milan Savić
DOI: https://doi.org/10.5937/smclk3-37604
Ključne reči: pneumotoraks, trudnoća, limfangioleiomiomatoza

Sažetak


Uvod: Limfangioleiomiomatoza (LAM) je retka bolest i uglavnom se javlja kod žena u generativnom periodu, kao i tokom trudnoće, dok je kod muškaraca opisano samo nekoliko pojedinačnih slučajeva. Javlja se u vidu sporadičnog oblika ili je povezana sa kompleksom tuberozne skleroze. Dijagnoza se može postaviti na osnovu nalaza kompjuterizovane tomografije grudnog koša visoke rezolucije (HRCT), ili je potrebna histopatološka analiza. U kliničke manifestacije bolesti spadaju: progresivna dispneja pri naporu, recidivantni pneumotoraks, hilotoraks, angiomiolipomi i limfangiomiomi.

Prikaz slučaja: Pacijentkinja stara 32 godine, u trećem tromesečju trudnoće, primljena je na našu kliniku nakon levostranog pneumotoraksa, verifikovanog na rendgenu grudnog koša. Početni tretman je uključivao eksuflaciju, a potom torakalnu drenažu levog pleuralnog kavuma. Zbog produženog gubitka vazduha kroz torakalni dren i poodmakle trudnoće, urađen je carski rez. Nakon porođaja, rendgenom grudnog koša, utvrđen je kompletni desnostrani pneumotoraks, koji je zahtevao torakalnu drenažu, kao i nedovoljno reekspandirano levo plućno krilo. Na učinjenom HRCT snimku zabeležene su cistično-bulozne promene u plućima, te je najpre sa leve, a potom i sa desne strane, torakohirurškim minimalno invazivnim pristupom, histopatološki verifikovana LAM, uz hirurško lečenje obostranog pneumotoraksa.

Zaključak: Pneumotoraks je česta komplikacija limfangioleiomiomatoze. Zbog visoke stope recidiva, treba izvršiti definitivnu ranu hiruršku intervenciju. Trenutne smernice preporučuju hemijsku pleurodezu i operaciju, za prvu epizodu pneumotoraksa. Prilikom lečenja pneumotoraksa u trudnoći treba primeniti adekvatnu terapijska proceduru, vodeći računa o bezbednosti trudnoće i porođaja.

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Objavljeno
2022/06/29
Broj časopisa
Vol. 3 Br. 2 (2022): Srpski medicinski časopis Lekarske komore
Rubrika
Prikazi slučajeva