KARACİĞER METASTAZLARININ DEĞERLENDİRİLMESİ VE CERRAHİ TEDAVİSİNDE İNTRAOPERATİF SONOGRAFİ

Year 2001, Volume: 2 Issue: 3, 9 - 13, 01.12.2001

Yelda Özsunar Dayanır Bjorn Skoldbye Alev Akdilli Kutsi Köseoğlu Can Z. Karaman

Abstract

Amaç:İntraoperatif sonografinin, karaciğer tümörlü hastalarda teknik uygulama koşullarını, tanı ve tedaviye olan katkısını ortaya koymak. Gereç ve Yöntem: Preoperatif inceleme yöntemlerine göre opere edilebilir olarak değerlendirilen 93 karaciğer metastazı olgusu sonografi ile incelenmiştir. Hastalar operasyondan önce ultrasonografi, bilgisayarlı tomografi, anjiografi ve bazı olgularda sintigrafi ile değerlendirilmiş olup; intraoperatif sonografi bulguları, preoperatif inceleme sonuçları ve cerrahi bulgular ile karşılaştırılmıştır. Bulgular:Operasyonun gidişi 37 olguda (%40) değişmiştir. Yeni bulgular nedeniyle 14 olguya (%15) ek cerrahi girişim gerekirken, 7 olguda (%8) operasyon küçültülmüş, 16 olgu (%17) inoperabl bulunarak operasyon sonlandırılmıştır. Cerrahi gidişin değişme nedenini 10 (%11) olguda sadece intraoperatif sonografi, 10 (%11) olguda sadece cerrahi bulgular, 17 (%18) olguda ise her ikisi oluşturmuştur. Sonuç:Karaciğer metastazlarının doğru evrelendirilerek gereksiz cerrahinin önlenmesinde intraoperatif sonografinin, duyarlığı yüksek ve etkin bir inceleme yöntemi olduğu sonucuna varılmıştır. Genel olarak, hastaların üçte birinde intraoperatif sonografi, operasyon gidişini değiştirdiğinden; özellikle karaciğer rezeksiyonu uygulanan merkezlerde intraoperatif karaciğer sonografisi, rutin uygulama olarak önerilmiştir.

Keywords

İntraoperatif sonografi, karaciğer metastazları, ultrasonografi

Intraoperative Sonography In Evaluation And Surgical Treatment of Liver Metastases

Abstract

Purpose: The aim of this study was to evaluate the impact of intraoperative ultrasonography, on surgical decision making in patients with liver metastases. The technique of intraoperative ultrasonography also was discussed. Materials and Methods: intraoperative ultrasonography of the liver was performed in 93 patients operated for liver metastases. The patients were evaluated preoperatively by ultrasonography, computed tomography and in some cases by scintigraphy. intraoperative ultrasonography findings were compared with the results of preoperative imaging, surgical findings and the findings at surgery. Results: The surgical procedures were altered in 37 patients (40%). The procedure was extended in 14 patients (15%) and reduced in 7 patients (8%). Sixteen patients (17%) were found inoperable. The reason for the surgical modification was intraoperative ultrasonography alone in 10 patients (11%), surgical findings alone in 10 patients (11%), and a combination of both in 17 patients (18%). Conclusion: intraoperative ultrasonography is a precise diagnostic tool for staging the operability of liver metastases. Thus, unnecessary surgical procedures can be avoided. Totally, intraoperative ultrasonography altered the preoperative plan in one third of the patients and therefore is recommended as a routine procedure in connection with major liver surgery.

Keywords

Intraoperative ultrasonography, liver metastases, ultrasonografi

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