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Öğe 196 Genel Cerrahi Uzmanının Kasık Fıtığına Yaklaşımları ile İlgili Anket Çalışması(2008) Kartal, Adil; Tekin, Ahmet; Vatansev, Celalttin; Tekin, Şakir; Belviranlı, Metin; Yol, Serdar; Aksoy, FarukAmaç: Anket çalışması kasık fıtıklarının onarımında Türkiye’deki genel cerrahların tecrübelerini analiz etmek için planlandı. Durum De?erlendirilmesi: Anket çalışmaları geri bildirimdeki yetersizlik nedeniyle araştırmacılar için zor yürütülmektedir. Bu konuda hekimlerin daha duyarlı olması bilime önemli katkılar sağlayacaktır. Yöntem: 2002 yılında Türkiye’deki 250 genel cerraha posta yoluyla bir anket (örneğin Lichtenstein veya diğer tekniklerin uygulanması ve kullanılan anestezi türünü içeren) gönderildi. Bulgular: 250 katılımcının 196’sından (%78) geri bildirim elde edildi. Bunlardan 128 cerrah (%65.3) kasık fıtığı onarımı için ilk tercih olarak Lichtenstein tekniğini kullanmaktaydı. Rutkow tekniği ve Bassini onarımı bunu takip etmekteydi. Cerrahların çoğunluğu genel anestezi kullanmaktaydı. Seroma ve hematom en sık bildirilen komplikasyonlardı. Sonuç: Özellikle Lichtenstein olmak üzere gerilimsiz meş tekniği primer ve nüks fıtıkların her ikisinde de tercih edilen tedavi yöntemiydi. Kasık fıtıklarının onarımında cerrahların yarıdan fazlası genel anesteziyi tercih etmekteydi. Hastaların çoğu ameliyat sonrası birinci günde hastaneden çıkartıldı.Öğe Akut Kolesistit İçin Erken Laparoskopik Kolesistektomi(2009) Tekin, Ahmet; Küçükkartallar, Tevfik; Belviranlı, Metin; Vatansev, Celalettin; Aksoy, Faruk; Tekin, Şakir; Kartal, AdilBACKGROUND The aim of this study was to assess the clinical results of treatment by laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. METHODS Between 1994 and 2006, LC was performed in 3876 patients in Selcuk University Meram Medicine Faculty. The clinical, biochemical, radiologic, and operative data of 182 (101 F, 81 M) consecutive patients with acute cholecystitis operated 3 days after the onset of symptoms were analyzed retrospectively to determine the complications and morbidity after operation. RESULTS The conversion rate was 31 (17.03%) in acute cholecystitis. Postoperative length of stay was found as 4 days in the successful LC group and 7 days in the conversion group. For acute cholecystitis, we found a statistical difference between the successful LC group and the conversion group in terms of length of postoperative hospitalization time and gallbladder wall thickness. We identified the following factors as associated with conversion: male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm. CONCLUSION LC is a safe approach in selected patients with acute cholecystitis. Male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm are associated with a higher risk of conversion to open surgery.Öğe Akut kolesistit için erken laparoskopik kolesistektomi(2009) Tekin, Ahmet; Küçükkartallar, Tevfik; Belviranlı, Metin; Vatansev, Celalettin; Aksoy, Faruk; Tekin, Şakir; Kartal, AdilAMAÇ: Bu çalışmada, erken laparoskopik kolesistektomi (LK) ile tedavi edilen akut kolesistitli (AK) hastaların klinik sonuçları değerlendirildi. GEREÇ VE YÖNTEM: Selçuk Üniversitesi Meram Tıp Fakültesi’nde Ocak 1994 ile Aralık 2006 yılları arasında 3876 hastaya LK yapıldı. Bunlardan 182 hastaya (101 kadın, 81 erkek) semptomların başlamasından itibaren ilk üç gün içinde kolesistektomi uygulandı. Hastaların dosyaları klinik, biyokimyasal, radyolojik ve ameliyat bulguları, ameliyat sonrası komplikasyon ve morbiditeye etkisini saptamak için geriye dönük olarak değerlendirildi. BULGULAR: Akut kolesistli olgularda açığa geçme oranı 31 (%17,03) idi. Ameliyat sonrası hastanede kalış süresi başarılı LK grubunda 4, açık kolesistektomiye geçilen grupta 7 gün olarak saptandı. Laparoskopik tamamlanan ve açığa geçilen kolesistektomi grupları arasında hastanede yatış süresi ve safra kesesi duvar kalınlığı yönünden istatistiksel olarak anlamlı fark bulundu. Çalışmamızda açığa geçme ile ilgili faktörler; erkek cinsiyeti, ultrasonografide perikolesistik sıvı gözlenmesi, gangrenöz tip kolesistit ve safra kesesi duvar kalınlığının 1 cm ve üzerinde olması idi. SONUÇ: LK, seçilmiş AK’li hastalarda güvenli bir yaklaşımdır. Erkek cinsiyeti, ultrasonografide perikolesistik sıvı gözlenmesi, gangrenöz kolesistitler ve safra kesesi duvar kalınlığının 1 cm ve üzerinde olması yüksek açık cerrahiye dönme riski ile beraberdir.Öğe Axillary Lymph Node Status in Multicentric Breast Tumors and Breast Tumors with Nipple Involvement(KARGER, 2012) Cakir, Murat; Tekin, Ahmet; Kucukkartallar, Tevfik; Vatansev, Celalettin; Aksoy, Faruk; Kartal, Adil; Tuncer, Fatma B.Background: Axillary lymph node dissection plays an important role in breast cancer management in terms of staging, prediction of prognosis, determination of adjuvant therapy, and local control of the primary tumor. The objective of this study was to evaluate the axillary lymph node involvement in multicentric breast tumors and breast tumors with nipple involvement in comparison with unifocal tumors. Patients and Methods: We reviewed the records of 267 patients with stage I or IIA disease. The rates of axillary lymph node metastasis (ALNM) in patients with unifocal tumors, multicentric tumors, or nipple involvement were compared. Results: 209 (78%) patients had unifocal tumors, 24 (8%) had multicentric tumors, and 34 (12%) had nipple involvement. The incidence of ALNM was 9.76% in patients with unifocal tumors, 24.84% in patients with multicentric tumors, and 36.71% in patients with nipple involvement. Hence, the incidence of ALNM was significantly higher in patients with nipple involvement or multicentric tumors than in patients with unifocal tumors. Conclusion: Our data suggest that compared to unifocal tumors, breast tumors with nipple involvement or multiple foci show a significantly higher incidence of ALNM which is a predictor of a poor prognosis.Öğe Comparison of Laparoscopic and Open Surgery Splenectomies Performed for Hematological Diseases(2012) Çakır, M.; Tekin, Ahmet; Küçükkartallar, T.; Vatansev, C.; Aksoy, Faruk; Kartal, AdilAim. Today most of the splenectomies performed for non-traumatic reasons are undertaken due to hematological diseases. In our study, our aim is to present the results of splenectomy cases that were applied laparoscopic and open surgery for benign hematological malignancies. Methods. We retrospectively examined 240 cases on whom splenectomy was performed in General Surgery Clinic at Meram Faculty of Medicine, Selcuk University between June 2002 and January 2011 because of hematological diseases in terms of age, gender, diagnosis, the presence of accessory spleen, operation method and duration, need for blood transfusion, duration of hospitalization, morbidity and mortality. Results. The mean age of the patients was 39 (17-74). 142 (59%) of the patients were female and 98 (41%) were male. Hundred forty of the splenectomies were performed with laparoscopic procedure, 100 were carried out with open method. Laparoscopic splenectomies were completed in 88 (50-140) minutes and those performed with open method took 52 (34-100) minutes to complete. On average, patients who were applied open surgery were discharged 5,7 days later, and those who had laparoscopic surgery were discharged 3 days later. The cases were followed for 44 (6-72) months on average. Conclusion. In hematological diseases, splenectomy is a distinguished treatment applied after medical treatment or if this treatment is inadequate. In hematological splenectomies, laparoscopic intervention is to be the primary choice.Öğe Comparison of mammography sensitivity after reduction mammoplasty targeting the glandular and fat tissue(AVES, 2015) Cakir, Murat; Kucukkartallar, Tevfik; Tekin, Ahmet; Selimoglu, Nebil; Poyraz, Necdet; Belviranli, Mehmet Metin; Kartal, AdilObjective: Mammography may have some limitations in the diagnosis and screening of breast cancer for women who have previously undergone breast reduction surgery. This study aimed to investigate how the structural defects in the breast tissue formed by postoperative changes are reflected on mammography. Material and Methods: The records of patients who had previously undergone breast reduction surgery and who were requested to undergo mammography for breast cancer screening by the general surgery clinic were retrospectively studied. The patients' ages, surgical procedures, postoperative follow-up periods, amount of removed material, and histopathological and mammographic results were studied. The patients were classified into 3 groups: those older than 40 years who underwent reduction mammoplasty targeting predominantly the glandular tissue (group 1), those younger than 40 years who underwent reduction mammoplasty targeting predominantly the fat tissue (group 2), and those older than 40 years who were diagnosed with breast hypertrophy and were not operated (group 3). Results: The mean follow-up period of the patients was 6 (2-10) years. The mean value of resected tissue was 1120 g (680-2070) in group 1 and 1220 g (720-1980) in group 2. The mean age at the time of surgery was 45 (40-70) years for group 1 and 35 (24-40) years for group 2. All patients in group 1 were classified in Breast Imaging-Reporting and Data System (BI-RADS) category 1-2; 28 patients in group 2 were classified in BI-RADS 1-2, 4 were classified in BI-RADS 3, and 8 were classified in BI-RADS 0. In group 3, 35 patients were classified in BI-RADS 1-2, 4 were classified in BI-RADS 3, and 1 was classified in BI-RADS 0. Conclusion: We believe that breast reduction surgery targeting predominantly the glandular tissue in patients older than 40 years increases mammographic sensitivity.Öğe Dalak Karaciğere Metastaz Oluşumunda Rol Oynuyor Mu?(1996) Yol, Serdar; Kartal, Adil; Gunjı, Yoshio; Isono, Kaichi[Abstract not Available]Öğe A different approach for sterilization of liver hydatid cysts(W J G PRESS, 2007) Tekin, Ahmet; Kucukkartallar, Tevfik; Kartal, Adil[Abstract not Available]Öğe Does Estrogen Cause Low Conversion Rates in Laparoscopic Cholecystectomies for Acute and Chronic Cholecystitis in Women?(2001) Kartal, Adil; Aksoy, Faruk; Vatansev, Celalettin; Şahin, Mustafa; Yılmaz, Osman; Belviranlı, Metin; Karahan, ÖmerLaparoscopic cholecystectomy is the preferred treatment for symptomatic cholelithiasis. Severe local inflammation and scar formation are commonly responsible for conversion to open surgery. Fibrosuppressive effects of estrogen on peritoneal inflammatory conditions could provide low, dense fibrosis or scar formation around the gallbladder and make laparoscopic cholecystectomy easier in women and we believe that male sex is a conversion factor in laparoscopic cholecystectomy.Öğe Early Hospital Readmission After Laparoscopic Cholecystectomy(LIPPINCOTT WILLIAMS & WILKINS, 2015) Simsek, Gurcan; Kartal, Adil; Sevinc, Baris; Tasci, Halil I.; Dogan, SerhatIntroduction:Laparoscopic cholecystectomy (LC) now has become the golden standard in the treatment of symptomatic gallstone cholecystitis.Aim:This retrospective analysis was conducted to clarify the reasons of early return to the hospital after discharge following a procedure like LC that has been frequently performed in daily surgical practice.Materials and Methods:This study covers 586 patients, who were called to follow-ups and thus evaluated, of 676 patients who had had LCs at Meram Medical School's General Surgery Clinic between January 2010 and May 2011.Findings:The rate of representation to the hospital during the early phase following LC was found to be 2.4% in our study. It was observed that 71% of returning patients had presented to the hospital with complaints of abdominal pain.Discussion:We believe that the rate of 2.4% early return to the hospital in our series is a bit high when all the complications are taken into consideration. This retrospective analysis, however, has shown that this rate can further be decreased by taking simple measures.Öğe Early laparoscopic cholecystectomy for acute cholecystitis(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2009) Tekin, Ahmet; Kucukkartallar, Tevfik; Belviranli, Metin; Vatansev, Celalettin; Aksoy, Faruk; Tekin, Sakir; Kartal, AdilBACKGROUND The aim of this study, was to assess the clinical results of treatment by laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. METHODS Between 1994 and 2006, LC was performed in 3876 patients in Selcuk University Meram Medicine Faculty. The clinical, biochemical, radiologic, and operative data of 182 (101 F, 81 M) consecutive patients with acute cholecystitis operated 3 days after the onset of symptoms were analyzed retrospectively to determine the complications and morbidity after operation. RESULTS The conversion rate was 31 (17.03%) in acute cholecystitis. Postoperative length of stay was found as 4 days in the successful LC group and 7 days in the conversion group. For acute cholecystitis, we found a statistical difference between the successful LC group and the conversion group in terms of length of postoperative hospitalization time and gallbladder wall thickness. We identified the following factors as associated with conversion: male gender, pericholecystic collection L seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm. CONCLUSION LC is a safe approach in selected patients with acute cholecystitis. Male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm are associated with a higher risk of conversion to open surgery.Öğe Effect of Laparoscopic Cholecystectomy on Platelet Aggregation(Springer Verlag, 2000) Yol, Serdar; Kartal, Adil; Çalışkan, Ümran; Tavlı, Şakir; Şahin, Mustafa; Bozer, MikdatThe purpose of this study was to investigate the effect of laparoscopic cholecystectomy on platelet function. We operated on 40 women with symptomatic gallbladder stone, 20 of whom (study group) underwent laparoscopic cholecystectomy and 20 of whom (control group) open cholecystectomy. Patients with a history of bleeding, abnormal platelet count, or systemic disorders and those who were on salicylates, heparin, or oral anticoagulants were excluded. Blood parameters were checked at the beginning and the end of the operation, including platelet aggregation using adenosine 5'-diphosphate (ADP), collagen, and ristocetin in a whole-blood aggregometer. Platelet aggregation,vas evaluated by percent aggregation. Platelet aggregation due to collagen and ristocetin increased significantly at the end of the operation in the study group (p < 0.001). Aggregation due to ADP did not differ significantly from the start to the end of the operation. Control group results did not show any differences. Although the clinical findings of aggregated platelet are not frequently observed in practice, we suggest that laparoscopy increases platelet aggregation.Öğe Effect of octreotide (Sandostatin 201-995) on bile flow and bile components(KLUWER ACADEMIC/PLENUM PUBL, 1999) Şahin, Mustafa; Kartal, Adil; Belviranlı, Metin; Yol, Serdar; Aksoy, Faruk; Ak, MehmetOctreotide (Sandostatin 201-995) has an inhibitory effect on gastric, intestinal, and pancreatic secretions and hepatic and splachnic blood flow. We examined the effects of octreotide on bile flow and bile components in 10 patients with T-tube choledochostomy. A Fogarty balloon catheter was inserted distal to the T-tube of these patients for measurement of bile flow and bile components. Bile samples were obtained to analyze bile acid, phospholipid, lipoprotein, and cholesterol, and bile flow measurements were performed every 15 min for a period of 90 min before study and after normal saline and octreotide administrations. While octreotide had an inhibitory effect on bile flow, the concentrations of bile acid, phospholipid, and lipoprotein in bile were increased with octreotide.Öğe The Effect of Tissue Environments on Primary Tumor Growth and Liver Metastasis in Mice Colon Adenocarcinoma(1996) Yol, Serdar; Gunjı, Yoshio; Kartal, Adil; Isono, Kaichi[Abstract not Available]Öğe Effectiveness of collagenase in preventing postoperative intra-abdominal adhesions(ELSEVIER SCIENCE BV, 2013) Cakir, Murat; Tekin, Ahmet; Kucukkartallar, Tevfik; Yilmaz, Huseyin; Belviranli, Metin; Kartal, AdilIntroduction: The purpose of this study is to investigate the effectiveness of Collagenase clastridiopeptidase an enzyme preparation used in enzymatic debridement in preventing adhesions brought about by peritoneal damage. Methods: The study covers a total of 40 rats in 4 groups each having 10 rats. Group 1: The control group. Group 2: Normal saline group. Group 3: Sterile Novuxol (R) group. Group 4: The group where the intraperitoneal and systemic effects of sterile Novuxol (R) were investigated. Adhesion frequency and grades were scored on the post-op 11th day according to Granat. Blood work including hemoglobin, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, and albumin level measurements were performed. Toxicity was investigated histopathologically through samples taken from the liver and the peritoneum from Group 4. Results: Adhesion frequency was found to be 80% on the right and 90% on the left for Group 1, while it was 50% on both left and right for Group 2, and 30% on the right and 10% on the left for Group 3. Adhesion stages were found to be 1: 2.35 +/- 1.42 for Group 1, 0.31 +/- 1.15 for Group 2, and 0.20 +/- 0.41 for Group 3. Adhesion stage of the Sterile Novuxol (R) Group was lower than all the other groups (p < 0.05). Biochemical and hematological parameters were similar in all groups (p > 0.05). Histopathological analysis revealed no hepatotoxicity. Conclusions: According to the results of our study, we believe that Sterile Novuxol (R) can be a good anti-adhesive agent considering its ease of use, non-toxicity, and effectiveness. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.Öğe The Effects of Splenic Artery Ligation in an Experimental Model of Secondary Hypersplenism(Royal College Surgeons Edinburgh, 2000) Şahin, Mustafa; Tekin, Şakir; Aksoy, Fatih; Vatansev, Hüsamettin; Şeker, Muzaffer; Avunduk, Mustafa Cihat; Kartal, AdilObjective: To induce hypersplenism in rats by splenic vein ligation and to investigate the effects of splenic artery ligation in this model. Background: Selective arterial embolisation and splenic artery ligation (SAI,) are used in the treatment of secondary hypersplenism in some medical centres but these methods are not common. Materials and Methods: Thirty male Saprague-Dawley rats were allocated to three groups (n=10). The first group underwent laparotomy, the second and third groups underwent laparotomy and splenic vein ligation. At the end of the third week, laparotomy was performed in the first and second groups and splenic artery ligation in the third group. Erythrocyte, leukocyte and platelet counts were performed weekly. At the end of the sixth week, the animals were sacrificed and the spleens were taken for histopathologic examination. Results: In the second and third groups, after splenic vein ligation, the erythrocyte and platelet counts mere significantly reduced at the end of the second week (p<0.01), In the second group, which underwent splenic vein ligation only, the levels remained low throughout the experiment. In the third group, after splenic artery ligation, there were rises in both erythrocyte and platelet counts; the levels were similar to the levels in the control group at three weeks after splenic artery ligation (p>0.05), No significant changes were observed in the leukocyte counts throughout the experiment (p>0.05), Conclusions: Splenic vein ligation successfully induces experimental secondary hypersplenism, This state can be ameliorated by splenic artery ligation.Öğe Enzymatic Debridement in Necrotizing Pancreatitis(INT COLLEGE OF SURGEONS, 2015) Cakir, Murat; Tekin, Ahmet; Kucukkartallar, Tevfik; Vatansev, Husamettin; Kartal, AdilMultiple organ failure and pancreatic necrosis are the factors that determine prognosis in acute pancreatitis attacks. We investigated the effects of collagenase on the debridement of experimental pancreatic necrosis. The study covered 4 groups; each group had 10 rats. Group I was the necrotizing pancreatitis group. Group II was the collagenase group with pancreatic loge by isotonic irrigation following necrotizing pancreatitis. Group III was the collagenase group with pancreatic loge following necrotizing pancreatitis. Group IV was the intraperitoneal collagenase group following necrotizing pancreatitis. The progress of the groups was compared hematologically and histopathologically. There was no difference among the groups regarding the levels of leukocyte, hemogram, and urea. The differences in AST levels between Group I and II; and differences in glucose, calcium, LDH, AST, and amylase between Group II and III; between Group II and IV; between Group I and III; and between Group I and IV were statistically significant (P < 0.05). There were statistically significant differences between Group II and III, and Group II and IV regarding edema, acinar necrosis, inflammatory cell infiltration, hemorrhage, and fat necrosis (P < 0.05). In conclusion, the collagenase preparation used in this experimental pancreatitis model was found to be effective in the debridement of pancreatic necrosis.Öğe Experiences in gamma probe-guided minimally invasive parathyroidectomy(2012) Erikoğlu, Mehmet; Tavlı, S. Şakir; Kartal, Adil; Ayhan, Barış; Çakır, Mehtap; Gönen, M. Sait; Sarı, OktayPrimer hiperparatiroidizmin %8090 nedeni tek bezde görülen paratiroid adenomudur. Son yıllarda ultrasonografi, Tc 99 M sesta MIBI ve gama prob gibi paratiroidleri lokalize edici tekniklerin kullanılması ile primer hiperparatiroidi tedavisinde minimal invaziv paratiroidektomi (MIP) başarıyla uygulanmaya başlanmıştır. Bu çalışmada son 4 yılda Selçuk Üniversitesi Meram Tıp Fakültesi Genel Cerrahi Kliniğinde primer hiperparatiroidi nedeniyle gama prob eşliğinde işaretleme ile minimal invaziv paratiroidektomi yapılan 14 hastanın analizi ve klinik özellikleri değerlendirildi. Hastalardan 10u kadın, 4ü erkek ve yaş ortalamaları 54,6 (39-74) idi. Operasyon öncesi ortalama Ca seviyeleri 11,7 mg/dl (10,1 13,3, normali: 8,9-10,3), fosfor seviyeleri 2,7 mg/dl (1,6-3,9, normali: 2,4-4,7) ve PTH 260,3 pg/ml (74,94 - 990,8 normali: 12-88) olarak ölçüldü. Hastaların kliniğimize başvuru şikâyetleri arasında baş ağrısı ve yaygın kemik ağrısı ön plandaydı. Tüm hastalara lokal anestezi ile birlikte sedasyon uygulandı. Sınırlı flep diseksiyonundan sonra strep kasları vertikal olarak açılarak adenoma ulaşıldı. Vasküler yapıları bipolar koter eşliğinde kesildi ve kapsülü zedelenmeden adenom çıkarıldı. Post operatif dönemde hastaların hastanede kalış süresi ort. 1,5 (1 ile 3 gün) gündü. Ortalama Ca seviyeleri 9,1 mg/dl, fosfor seviyeleri 3,2 mg/dl ve PTH ise 63,8 pg/ml olarak ölçüldü. Gama prob eşliğinde minimal invaziv paratiroidektomi; operasyonunun lokal anestezi ile yapılabilmesi, operasyon sonrası ağrının daha az olması ve düşük komplikasyon oranı ile günümüzde paratiroid cerrahisinde sık tercih edilen yöntemlerdendir.Öğe The Increase of Intra-Abdominal Pressure Can Affect Intraocular Pressure(HINDAWI LTD, 2015) Ece, Ilhan; Vatansev, Celalettin; Kucukkartallar, Tevfik; Tekin, Ahmet; Kartal, Adil; Okka, AndmehmetObjective. This study aims to explore the usage of intraocular pressure measurements as the early indicator of the increase in intra-abdominal pressure. Methods. In this prospective study, 40 patients undergoing elective surgery were included. Patients were divided into four groups of 10 patients. The control group (Group C) was not subjected to laparoscopic intervention. Laparoscopic surgery was, respectively, performed with an intra-abdominal pressure of 9, 12, and 15 mmHg in Groups L (low), M (medium), and H (high pressure). Intraocular pressure was measured binocularly in each patient at three different times (before, during, and end of surgery) using a contact tonometer. Results. Patients' gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, and operative times were not different among the groups. No complications occurred with either the surgery or measurement of intraocular pressure. Intubation was associated with a severe rise in IOP (P < 0.05). An increase in intraocular pressure was seen in groups M and H (P < 0.05). Conclusion. Intraocular pressure was increased in the groups with an intra-abdominal pressure of 12 mmHg or more. Measuring the intraocular pressure might be a useful method to estimate the intra-abdominal pressure.Öğe Karaciğer Rezeksiyonu Yapılan Olgularda Karşılaştığımız Komplikasyonlar(1999) Kartal, Adil; Belviranlı, Metin; Şahin, Mustafa; Vatansev, Celalettin; Karahan, Ömer; Tavlı, Şakir; Günel, ErginHastanemizde yapılan 24 hepatik rezeksiyon olgusunu retrospektif olarak incelemek, mortalite ve morbidite nedenlerini belirleyerek uygulanan tedavi sonuçlarını daha iyiye götürmek. Karaciğerin cerrahi hastalıklarının tedavisinde rezeksiyon artan bir sıklıkla uygulanmaktadır. Günümüzde karaciğer rezeksiyonları % 10'dan düşük bir mortalite ile başarılırken postoperatif komplikasyonlar hala yüksek (% 50 kadar) düzeyde seyretmektedir. 1988-1997 yılları arasında karaciğer rezeksiyonu yapılan 24 olgu retrospektif dosya kayıtlarından incelendi. Hastaların 14'ü (% 58.3) erkek, 10'u (% 41.7) kadındı. Erişkin hastaların yaş ortalaması 49 (28-73) idi. En sık yakınma ağrı ve kilo kaybı (% 41.6), en sık bulgu hepatomegali (% 66.6) olmuştur. On-dört hastaya sağ hepatik lobektomi yapıldı. Bunların histopatolojik tanıları 7 olguda hepatosellüler karsinom, 2 olguda hepatoblastom, 1 olguda Klatskin tümörü ve safra kesesi karsinomu, 3 olguda hemanjiom ve 1 olguda hidatik kist idi. Diğer olgulara segmentektomi (n9) ve subsegmentektomi (n1) yapıldı. Hepatosellüler karsinomun 3 olguda siroz zemininde geliştiği belirlendi. Bunlar Child A grubundaydı. Postoperatif geçici sarılık dışında 13 hastada (% 54.2) komplikasyon gelişti. En sık komplikasyon asit (n7), yara enfeksiyonu (n4), safra fistülü (n3), hepatosellüler karsinom nüksü (n4) ve plörezi (2) idi. Postoperatif erken mortalite bir olguda görüldü. Hastanede kalma süresi ortalama 13 (8-21) gündür. Kliniğimizde son yıllardaki gelişmelere paralel hepatik rezeksiyonlarda deneyim kazanıldığı ve deneyim arttıkça morbidite oranlarının da azaldığı görüldü. Ayrıca preoperatif titiz değerlendirmelerle karaciğer hastalıklarında gereksiz laparatomilerden ve mortalite artısından kaçınılabileceği kanısına varıldı.
