Karaciğer kist hidatiğinde cerrahi deneyimimiz ve morbiditeye etki eden faktörler
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Tarih
2016
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç Karaciğer kist hidatiği; E. Granulosus’un larva sestodlarının neden olduğu zoonotik bir hastalıktır. Günümüzde kist hidatik tedavisinde en geçerli yöntem hala cerrahi işlemlerdir. Kistin safra yollarına açılması en sık görülen komplikasyondur. Cerrahi sonrası gelişen safra fistülü, hastanede kalış süresinin artmasına neden olmaktadır. Bu çalışmada kistin yerleşim yeri, büyüklüğü, ameliyat öncesi labaratuvar değerleri, ameliyat esnasında kist kavitesi ile safra kanalları arasındaki ilişkinin varlığı ve yapılan ameliyat tipinin komplikasyon ile hastanede kalış süresi üzerine etkilerini irdelemeyi amaçladık. Hastalar ve Yöntem Kliniğimizde Mart 2005-Ocak 2010 tarihleri arasında karaciğer kist hidatiği nedeniyle opere edilen 100 hasta retrospektif olarak incelendi. Yaş, cinsiyet, kistlerin sayısı, yerleşim yeri ve büyüklüğü, evresi, sarılık öyküsü, ameliyat öncesi labaratuvar değerleri, uygulanan cerrahi yöntem ve intrakaviter safra kanalı mevcudiyeti, postoperatif komplikasyon ve hastanede kalış süreleri kaydedildi. Bulgular Hastaların 63’ü (%63) kadın ve 37’si (%37) erkekti. Yaş ortalaması 35.6 idi. Hastaların 95’inde karın ağrısı, 12’sinde ikter ve 8’inde palpabl kitle mevcuttu. En büyük kist çapı 30 cm iken en küçük kist çapı 4 cm idi. 100 hastada toplam 134 kist mevcuttu. 9 hastada intraabdominal yerleşimli ekstrahepatik kisthidatik mevcuttu. 13 hastaya ameliyat öncesi kolanjit ve tıkanma ikteri nedeniyle ERCP yapılmıştı. Hastaların 64’ünde sağ lobda, 17’sinde sol lobda, 17’sinde bilobüler, bir hastada kaudat lobda ve bir hastada da hem sağ hem kaudat lobda kist mevcuttu. Perforasyon nedeniyle 2 hasta acil olarak opere edilirken, diğer hastalar elektif koşullarda opere edildi. Parsiyel kistektomi+drenaj+kapitonaj 45 hastaya, parsiyel kistektomi+drenaj 32 hastaya, parsiyel kistektomi+drenaj+omentoplasti 11 hastaya uygulanmıştır. Periferik yerleşimli 5 hastaya total kist eksizyonu ve 7 hastaya laparaskopik drenaj yapılmıştır. İntraoperatif 48 hastada kist kavitesinin safra yolları ile ilişkili olduğu saptanmıştır. Koledok dilatasyonu ve kistin ana biliyer duktuslarla ilişkisi olması nedeniyle 15 hastaya T-tüp uygulanmıştır. Safra yolları ile ilişkili hastalardaki kist çapı ortalama 11.8 iken, safra yolları ile ilişkisi olmayanlarda ortalama 8.6 cm idi. Safra yolları ile ilişkili kist hidatik vakalarında operasyon öncesi AST, ALP ve GGT değerleri sırasıyla 75.19 U/L, 162 U/L, 196 U/L olup safrayolları ile ilişkili olmayan hastalarda ise sırasıyla; 69.70 U/L, 124 U/L, 114 U/L idi. Hastaların %43’ünde komplikasyon gelişti. Safra fistülü ve kavite enfeksiyonu en sık gelişen komplikasyon olup, 9 hastada safra fistülü spontan kapanırken 9 hastaya endoskopik sfinkterektomi uygulandı. Bir hastada safra fistülüne eşlik eden intestinal fistül nedeniyle cerrahi işlem uygulandı. Major komlikasyon gelişme oranı safra yolları ilişkili kisti olan vakalarda %50 iken; olmayan grupta %15.4 idi. (p<0.001). Safra yolları ile ilişkili kist hidatik vakalarında hastanede kalış süresi 17,48 gün iken; safra yolları ile ilişkili olmayan vakalarda 8,46 gündü. (p<0.001). Sonuç Kist çapı büyük, ameliyat öncesi AST, ALP ve GGT değerleri yüksek olan hastalarda kistin safra yolları ile ilişkili olma riski artmaktadır. Safra yolları ile ilişkili kist hidatiklerde major komplikasyon gelişme oranı ve hastanede kalış süresi anlamlı olarak artmaktadır. Kistin yerleşim yeri, evresi ve uygulanan cerrahi yöntemin komplikasyon ve hastanede kalış süresi üzerine etkisi saptanmamıştır. Anahtar Sözcük: Karaciğer Kist Hidatiği, Cerrahi Tedavi, Morbidite
Introduction Liver hydatid cyst is a zoonotic disease caused by the cestods of Echinoccosis granulosus larvae. Nowadays, the most valid treatment of hydatid cyst is stil surgery. The most common complication of the disease is opening of the cyst to the biliary tract and led to prolonged duration of hospital stay. In this study, we aimed to investigate the relation between cyst location, size, preoperative laboratory values and presence of intracavitary bile duct, and also the effects of surgical procedures on complications and the duration of hospital stay. Patients and Method Between March 2005 and January 2010, 100 patients who underwent surgery with the diagnosis of hydatid cyst in our department were investigated retrospectively. Age, gender, cyst number, cyst location and size, stage of disease, jaundice history, preoperative laboratory values, surgical procedures, presence of intracavitary bile duct, postoperative complications and duration of hospital stay were recorded. Results 63 (63 %) patients were female and 37 (37 %) patients were male. The average age was 35.6 years. Abdominal pain was present in 95 patients. 12 patients had jaundice and 18 patients had a palpable mass. The largest cyst diameter was 30 cm and the smallest one was 4 cm. 134 cysts were determined in 100 patients. Extrahepatic localized hydatid cysts in the abdomen were present in nine patients. Preoperative ERCP was performed to 13 patients because of cholangitis and obstructive jaundice. Cyst of the right lobe in 64 patients, the left lobe cyst in 17 patients, both the right and left lobe cyst in 17 patients, caudate lobe cyst in one patient and both caudate lobe and right lobe cyst in one patient were detremined. While two patients were operated on urgently because of perforation, the other patients were operated electively. Partial cystectomy + drainage + capitonnage was applied to 45 patients, partial cystectomy + drainage applied to 32 patients and partial cysterctomy+drainage+omental patch was applied to 11 patients. Seven patients were underwent laparoscopic cyst drainage and total cyst cyst excision was applied to five patients who had peripheral cyst. Intraoperatively, bile duct associated with cyst cavitary in 48 patients was found. T-tube was applied to 15 patients because of main bilary duct dilatation and the relationship with cyst and biliary duct. The avarage cyst size in the patients who had a cyst associated with bile duct was 11.8 cm and in the other patients was 8.6 cm. Preoperative AST, ALP and GGT values were 75.19 U/L, 162 U/L, 196 U/L in the patients who had biliary duct associated hydatid cyst and 69.70 U/L, 124 U/L and 114 U/L in the others, respectively. Complications were developed in 43% of patients. The most common complications were biliary fistula and cavitary infection. The biliary fistula was closed spontaneously in nine patients and endoscopic sphincterectomy was applied to the other nine patients. Surgical procedure was performed to a patient with the diagnosis of intestinal fistula associated with biliary fistula. The rate of major complication was 50% in the group with biliary duct associated cysts and 15.4% in the other group (p<0.001). The duration of hospital stay was 17.48 days in the group with biliary duct associated cysts and 8.46 days in the other group (p<0.001). Conclusion In the patients who have large cyst diameter or high values of AST, ALP and GGT levels, the risk of the presence of a cyst associated with bilary duct was increased. Major complication rates and the duration of hospital stay were increased significantly in patients with biliary duct associated cysts. Location of the cyst, stage of the disease and surgical technique had no effect on the duration of hospital stay and complications. Key Words: Cist Hydatid of Liver, Surgery treatment, Morbidity
Introduction Liver hydatid cyst is a zoonotic disease caused by the cestods of Echinoccosis granulosus larvae. Nowadays, the most valid treatment of hydatid cyst is stil surgery. The most common complication of the disease is opening of the cyst to the biliary tract and led to prolonged duration of hospital stay. In this study, we aimed to investigate the relation between cyst location, size, preoperative laboratory values and presence of intracavitary bile duct, and also the effects of surgical procedures on complications and the duration of hospital stay. Patients and Method Between March 2005 and January 2010, 100 patients who underwent surgery with the diagnosis of hydatid cyst in our department were investigated retrospectively. Age, gender, cyst number, cyst location and size, stage of disease, jaundice history, preoperative laboratory values, surgical procedures, presence of intracavitary bile duct, postoperative complications and duration of hospital stay were recorded. Results 63 (63 %) patients were female and 37 (37 %) patients were male. The average age was 35.6 years. Abdominal pain was present in 95 patients. 12 patients had jaundice and 18 patients had a palpable mass. The largest cyst diameter was 30 cm and the smallest one was 4 cm. 134 cysts were determined in 100 patients. Extrahepatic localized hydatid cysts in the abdomen were present in nine patients. Preoperative ERCP was performed to 13 patients because of cholangitis and obstructive jaundice. Cyst of the right lobe in 64 patients, the left lobe cyst in 17 patients, both the right and left lobe cyst in 17 patients, caudate lobe cyst in one patient and both caudate lobe and right lobe cyst in one patient were detremined. While two patients were operated on urgently because of perforation, the other patients were operated electively. Partial cystectomy + drainage + capitonnage was applied to 45 patients, partial cystectomy + drainage applied to 32 patients and partial cysterctomy+drainage+omental patch was applied to 11 patients. Seven patients were underwent laparoscopic cyst drainage and total cyst cyst excision was applied to five patients who had peripheral cyst. Intraoperatively, bile duct associated with cyst cavitary in 48 patients was found. T-tube was applied to 15 patients because of main bilary duct dilatation and the relationship with cyst and biliary duct. The avarage cyst size in the patients who had a cyst associated with bile duct was 11.8 cm and in the other patients was 8.6 cm. Preoperative AST, ALP and GGT values were 75.19 U/L, 162 U/L, 196 U/L in the patients who had biliary duct associated hydatid cyst and 69.70 U/L, 124 U/L and 114 U/L in the others, respectively. Complications were developed in 43% of patients. The most common complications were biliary fistula and cavitary infection. The biliary fistula was closed spontaneously in nine patients and endoscopic sphincterectomy was applied to the other nine patients. Surgical procedure was performed to a patient with the diagnosis of intestinal fistula associated with biliary fistula. The rate of major complication was 50% in the group with biliary duct associated cysts and 15.4% in the other group (p<0.001). The duration of hospital stay was 17.48 days in the group with biliary duct associated cysts and 8.46 days in the other group (p<0.001). Conclusion In the patients who have large cyst diameter or high values of AST, ALP and GGT levels, the risk of the presence of a cyst associated with bilary duct was increased. Major complication rates and the duration of hospital stay were increased significantly in patients with biliary duct associated cysts. Location of the cyst, stage of the disease and surgical technique had no effect on the duration of hospital stay and complications. Key Words: Cist Hydatid of Liver, Surgery treatment, Morbidity
Açıklama
Anahtar Kelimeler
Karaciğer kist hidatiği, Cist hydatid of liver, Cerrahi tedavi, Surgery treatment, Morbidite, Morbidity, Karaciğer, Liver, Karaciğer hastalıkları, Liver diseases
