İntraabdominal Apselerin Görüntüleme Eşliğinde Perkütan Drenajı

Year 2019, Volume: 46 Issue: 1, 73 - 83, 03.03.2019

Çağrı Damar , Meltem Özdemir Baki Hekimoğlu

https://doi.org/10.5798/dicletip.534834

Abstract

Giriş: Çalışmanın amacı intraabdominal apselerin perkütan
drenajının fayda ve etkinliğini ortaya koymak; başarı, tekrarlama ve
başarısızlık oranlarını belirlemektir.

Yöntemler: Perkütan tedavi ugulanan 50 hastadaki (26 erkek,
24 kadın; yaş aralığı: 23-88; yaş ortalaması: 53) 58 apseyle ilgili
retrospektif analiz yapılmıştır. Apselerin drenajı ultrason ve floroskopi
kılavuzluğunda gerçekleştirilmiştir. 12 apsede (<5 cm) basit iğne (18 G, Chiba)
aspirasyon metodu, geri kalan diğer 46 apsede ise Seldinger yöntemiyle perkütan
kateter (6 F-14 F) drenajı uygulanmıştır.

Bulgular: Perkütan kateterizasyonların yaklaşık %49’u
(23/46) ilk haftada sonlandırılmıştır. Perkütan drenajda ilk girişimde elde
edilen başarı oranı % 63,7 (37/58)’ dir. Perkütan drenajı yapılan apselerde
rekürrens oranı %19 (11/58) bulunmuş olup bunların tümü ikincil girişimlerle
tedavi elde edilmiştir. Kümülatif başarı ve başarısızlık oranları sırasıyla
%82,8 (48/58) ve %5,2 (3/58) olarak belirlenmiştir. 7 apsede (%12)
temporizasyon ya da palyasyon sağlanmıştır. Temporizasyon-palyasyon sağlanan
apseler ile ikincil girişimlerle tedavi edilen tüm apseler dahil edildiğinde
başarı oranı %94,8 (55/58) ve başarısızlık oranı %5,2 (3/58) olarak
belirlenmiştir. Mortalite oranı ise %3,4 (2/58) bulunmuştur.

Tartışma ve Sonuç: Prosedürün minimal invaziv, kolay,
güvenli ve efektif oluşu, cerrahiye göre düşük komplikasyon oranları, ayrıca
genel anesteziye gerek duyulmaması nedenleriyle perkütan drenaj, intraabdominal
apse tedavisinde ilk seçenektir. Tedavide yüksek başarı oranları elde etmek
için, güvenli giriş rotası olan tüm intraabdominal apseler görüntüleme
eşliğinde perkütan drene edilmelidir.

Keywords

abdomen, apse, perkütan, drenaj

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