Safra Yollarına Açılmış Hidatik Kist Olgularımız
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Dosyalar
Tarih
2007
Dergi Başlığı
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Cilt Başlığı
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Hidatik kistin safra yollarına rüptürü nadir rastlanan ciddi komplikasyonlardandır. Safra yolları ile bağlantısı tesbit edilen kistlerde tedavi yaklaşımı normal kiste göre çok değişmektedir. Kliniğimizde bu tip hastalarla karşılaştığımız durumlarda uyguladığımız tedavi yöntemlerini sunmak istedik. Gereç ve Yöntemler: Ocak 1985-Aralık 2005 tarihleri arasında kliniğimizde ameliyat edilen 640 (dökümanlarına ulaştığımız 475 olgu) karaciğer hidatik kisti olgusu içinde safra yollarına rüptüre olmuş 62 (% 13) olgunun dosyaları retrospektif olarak değerlendirildi ve uygulanan tedavi yöntemleri literatür bilgisi eşliğinde incelendi. Bulgular: Olguların 35'i erkek (% 56), 27'si kadın (% 44) olup, yaş ortalaması sırasıyla 39 (28-74) ve 44 (15-63) idi. Karaciğer dışı hidatik kiste rastlanmadı. Hidatik kist 48 olguda (% 77) sağ, 12 olguda (% 19) sol lobda ve 2 olguda bilateral yerleşimliydi. Sağ lobdaki bir olgu (2 adet kist) hariç diğerlerinde kist sayısı tek idi. 1 olgunun nüks olduğu ve 7 yıl önce ameliyat geçirdiği öğrenildi. Karın sağ üst kadran ağrısı ve duyarlılık en sık saptanan yakınma ve fizik muayene bulguları olarak belirlendi. Tanıda ultrasonografi (USG), karın tomografisi (BT) ve endoskopik retrograd kolanjiopankreatikografiden (ERKP) yararlanıldı. 5 olguda sfinkteratomi sonrasında klinik bulgularda iyileşme görüldü. Laparotomi yapılan olgularda safra drenajı için 35 olguda T-tüp drenajı, 8 olguda koledokoduodenostomi, 1 olguda hepatikojejunostomi, 12 olguya da safra fistülü ağzına primer sütür uygulandı. Ameliyat sonrasında 12 hastada yara infeksiyonu, 2 hastada da anastomoz kaçağı gelişti, mortalite görülmedi. Postoperatif yatış süresi ERKP ve sfinkterotomi yapılan olgularda anlamlı olarak düşüktü (p 0.05). Sonuç: Safra yollarına açılmış karaciğer hidatik kisti olgularında safra yolu drenajında T-tüp veya koledokoduodenostomi uygulaması ile düşük mortalite ve morbidite sağlanabilmektedir. Seçilmiş olgularda tanıda ve tedavide ERKP ve sfinkterotomi düşünülmesi gereken diğer tedavi seçeneğidir.
Purpose: Rupture of the hydatid cyst of the liver into bile ducts is a rare and serious complication of hepatic hydatid disease. Operative treatment of intrabiliary ruptured hydatid cysts has many differences to uncomplicated cysts. We report our experience, including surgical approach to the intrabiliary ruptured hydatid disease. Materials and Methods: Between January 1985 to December 2005, 640 patients with hydatid cysts of the liver underwent surgery, and 62 patients (13 %) with intrabiliary rupture of hepatic hydatid cysts were retrospectively reviewed. Results: Of 62 patients, 35 were men and 23 were women. Their average age was 39 (28-74) for men and 43 (15-63) for women. Biliary ruptured hydatid cysts were all in liver. The right lobe of the liver was involved in 48 patients (77 %), the left lobe in 12 (19 %) and both lobes in 2 patients. Each had only one cyst except one patient who had two cysts in two lobes. One patient had recurrent hepatic hydatid cyst who had been operated on 7 years ago. The most common clinical manifestations were right hypocondrial pain and tenderness in the right hypocondrium on physical examination. Methods used for diagnosis were ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography (ERCP). Five of the patients healed after ERCP and endoscopic sphincterotomy. In these patients common bile duct (CBD) was explored and it was drained by a T-tube in 35 patients, by a choledochoduodenostomy in 8 patients and hepaticojejunostomy in one patient. Bile fistula orifice was sutured in 12 patients. Twelve patients had wound infection and 2 patients had bile leak postoperatively. There was no mortality. Conclusion: The low mortality and morbidity rates in the treatment of intrabiliary rupture of hydatid cysts can be obtained with surgical intervention to CBD with T-tube drainage and choledochoduodenostomy. In selected cases ERCP and endoscopic sphincterotomy are adequate methods for diagnosis and treatment of intrabiliary ruptured hydatid cysts.
Purpose: Rupture of the hydatid cyst of the liver into bile ducts is a rare and serious complication of hepatic hydatid disease. Operative treatment of intrabiliary ruptured hydatid cysts has many differences to uncomplicated cysts. We report our experience, including surgical approach to the intrabiliary ruptured hydatid disease. Materials and Methods: Between January 1985 to December 2005, 640 patients with hydatid cysts of the liver underwent surgery, and 62 patients (13 %) with intrabiliary rupture of hepatic hydatid cysts were retrospectively reviewed. Results: Of 62 patients, 35 were men and 23 were women. Their average age was 39 (28-74) for men and 43 (15-63) for women. Biliary ruptured hydatid cysts were all in liver. The right lobe of the liver was involved in 48 patients (77 %), the left lobe in 12 (19 %) and both lobes in 2 patients. Each had only one cyst except one patient who had two cysts in two lobes. One patient had recurrent hepatic hydatid cyst who had been operated on 7 years ago. The most common clinical manifestations were right hypocondrial pain and tenderness in the right hypocondrium on physical examination. Methods used for diagnosis were ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography (ERCP). Five of the patients healed after ERCP and endoscopic sphincterotomy. In these patients common bile duct (CBD) was explored and it was drained by a T-tube in 35 patients, by a choledochoduodenostomy in 8 patients and hepaticojejunostomy in one patient. Bile fistula orifice was sutured in 12 patients. Twelve patients had wound infection and 2 patients had bile leak postoperatively. There was no mortality. Conclusion: The low mortality and morbidity rates in the treatment of intrabiliary rupture of hydatid cysts can be obtained with surgical intervention to CBD with T-tube drainage and choledochoduodenostomy. In selected cases ERCP and endoscopic sphincterotomy are adequate methods for diagnosis and treatment of intrabiliary ruptured hydatid cysts.
Açıklama
Anahtar Kelimeler
Cerrahi, karaciğer hidatik kisti, safra yollarına rüptür, hidatik kist, Liver hydatid cyst, cyst rupture into bile ducts, hydatic cyst
Kaynak
Ulusal Cerrahi Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
23
Sayı
4
Künye
Tekin, A., Küçükkartallar, T., Aksoy, F., Belviranlı, M., Çakır, M., Erenoğlu, B., (2007). Safra Yollarına Açılmış Hidatik Kist Olgularımız. Ulusal Cerrahi Dergisi, 23(4), 125-128.
