Akut Kolesistitte Perkütan Kolesistostomi: Tek Merkez Deneyimi

Abstract

Giriş-Amaç: Akut kolesistit (AK) akut batın tablosu ile başvurularda sık bir nedendir. AK nedenleri arasında taş, safra çamuru, akalkuloz sebepler olabileceği gibi malignite hastalarında bazen basıya sekonder de gelişebilir. AK tedavisi çoğu zaman, medikal tedavi veya safra kesesi dekompresyonu sonrası cerrahidir. Ancak gerek akut enflamasyonu geriletmek gerekse de cerrahi yapılamayan yüksek komorbit hastalarda tedavi amaçlı safra kesesi drenajı için perkütan kolesistostomi işlemleri yapılmaktadır. Amacımız girişimsel radyoloji merkezimizde yapılan perkütan kolesistostomi yapılmış hastaları değerlendirmek, işlem etkinliğini, komplikasyonları araştırmak ve literatür ile karşılaştırmaktır. Yöntemler: Çalışmamız retrospektif bir arşiv çalışmasıdır. Nisan 2018-Ocak 2022 tarihleri arasında Girişimsel radyoloji birimimizde perkütan kolesistostomi uygulanmış ve takipleri merkezimizde yapılmış hastalar çalışmaya dahil edilmiştir. Hastalar yaş, cinsiyet, kateter çapı, ön tanı, işlem komplikasyonları, klinik veya yoğun bakım durumu açısından değerlendirilmiştir. Ayrıca perkütan kolesistostomi yapılmış hastalarda alınan ilk örneğin mikrobiyolojik inceleme sonuçları da değerlendirilmiştir. Bulgular: Girişimsel Radyoloji birimimizde perkütan kolesistostomi yapılan toplam 91 hasta (57 (%63) erkek, 34 (%37) kadın) çalışmaya dahil edilmiştir. Hastaların 68 ine (%75) transhepatik yol ile, 23 üne (%25) transperitoneal yol ile kateter takılmıştır. Hastaların ön tanıları değerlendirildiğinde; 81 (%89) hasta akut kolesistit, 5 (%5) hasta perkütan bilier drenaj yapılamayan veya yapılmasına rağmen efektif olmayan malignite hastası, 4 (%4) hasta hidropik-perfore kese, 1(%1) hasta amfizematöz kolesistit idi. İşleme bağlı 15 (%16) hastada komplikasyon gelişti. Bunlar sırasıyla 4 (%25) hastada kese içi hemoraji, 4 (%25) hastada işlem sonrası ağrıya bağlı hipotansiyon ve yoğun bakım ihtiyacı, 5 (%33) hastada kateter çıkması, 1 (%6) hastada safra kesesi komşuluğunda sızıntı, 1 (%6) hastada batın içi safra sızıntısı idi. Tartışma-Sonuç: Perkütan kolesistostomi akut kolesistit durumlarında, operasyon açısından yüksek riskli hastalarda ve yoğun bakım hastalarında minimal invaziv ve lokal anestezi altında yapılabilen oldukça etkin bir yöntemdir. Bu süreç hasta tedavi yönetiminde elektif cerrahiye geçişte köprü görevi görebilir ve bazı durumlarda cerrahiye alternatif tedavi seçeneği olarak düşünülebilir.

Keywords

• Kolesistit
• Perkütan Kolesistostomi
• Ultrason
• Bilier Drenaj
• Kateter

Percutaneous Cholecystostomy in Acute Cholecystitis: A Single Center Experience

Abstract

Introduction-Purpose: Acute cholecystitis (AC) is a common cause of acute abdominal presentation. The causes of AC may include stones, bile sludge, acalculus, and sometimes it may develop secondary to compression in malignant patients. The treatment of AC is usually medical treatment or surgery after gallbladder decompression. However, percutaneous cholecystostomy procedures are performed for therapeutic gallbladder drainage in patients with high comorbidities who cannot undergo surgery, both to reduce acute inflammation and to investigate the effectiveness of the procedure and its complications, and to compare it with the literature. Method: Our study is a retrospective archive study. Patients who underwent percutaneous cholecystostomy in our interventional radiology unit between April 2018 and January 2022 and whose follow-ups were performed in our center were included in the study. Patients were evaluated in terms of age, gender, catheter diameter, preliminary diagnosis, procedure complications, clinical or intensive care status. In addition, microbiological examination results of the first sample taken from patients who underwent percutaneous cholecystostomy were also evaluated. Results: A total of 91 patients (57 (%63) male, 34 (%37) female) who underwent percutaneous cholecystostomy in our interventional radiology unit were included in the study. Catheters were inserted transhepatic in 68 (%75) of the patients and transperitoneally in 23 (%25). When the preliminary diagnoses of the patients were evaluated; 81 (%89) patients had acute cholecystitis, 5 (%5) patients had malignancy in which percutaneous biliary drainage could not be performed or was ineffective despite being performed, 4 (%4) patients had hydropic-perforated sac, and 1 (%1) patient had emphysematous cholecystitis. Complications related to the procedure developed in 15 (%16) patients. These were, respectively, intravesical hemorrhage in 4 (25%) patients, hypotension and intensive care need due to postprocedural pain in 4 (25%) patients, catheter dislocation in 5 (33%) patients, leakage adjacent to the gallbladder in 1 (6%) patient, and intraabdominal bile leakage in 1 (6%) patient. Discussion-Conclusion: Percutaneous cholecystostomy is a highly effective method that can be performed minimally invasively and under local anesthesia in cases of acute cholecystitis, in patients at high risk for surgery, and in intensive care patients. This process can serve as a bridge to elective surgery in patient treatment management and can be considered as an alternative treatment option to surgery in some cases.

Keywords

• Cholecystitis
• Percutaneous Cholecystostomy
• Ultrasound
• Biliary Drainage
• Catheter.

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