Karaciğer Kist Hidatiğinin Cerrahi ve Perkütan Tedavi Sonuçlarının Karşılaştırılması

Abstract

ÖZETAmaç: Bu çalışmada kliniğimizde karaciğer kist hidatiği (KCKH) sebebi ile açık opere edilen hastalar ile girişimsel radyoloji ünitesinde perkütan yöntemle tedavi edilen hastaların tedavi sonuçlarının karşılaştırılması amaçlandı.Materyal ve Metod: 1997-2013 yılları arası KCKH nedeniyle tedavi edilen 114 hasta geriye dönük olarak incelendi. Hastalar demografik açıdan, geliş şikayetleri, kistin özellikleri ve işlemlerin komplikasyonları açısından incelendi. Bulgular: Hastalar yaşları 6 ila 16 yıl arasında olan 47 erkek (% 40.9), 67 kız (%58.3) olgudan oluşmaktaydı. Hastaların %49’u ağrı, %37.7’si karında şişlik ve 1 hasta ise tıkanma sarılığı şikayeti ile başvururken KCKH insidantel olarak 14 hastada (%12.3) tesbit edildi. KCKH 90 hastada (%79) tek iken 24 hastada 10’a kadar olan çoklu kist mevcuttu. Sadece karaciğer lokalizasyonlu kist 85(%74.6) hastada mevcutken 29 hastada (%25.4) ise en fazla akciğer olmak üzere karaciğerle beraber diğer organlarda da KH tutulumu vardı. Kistin çapı 3-16 cm arasında değişmekteydi. Açık opere olanlarda kist çapı ortalama 96 mm iken, perkütan tedavi uygulanan grupta ortalama çap 70 mm’di (p=0.001). Hastaların 82’sine (%72) açık operasyon, 32’sine (%28) perkütan tedavi uygulandı. Toplam 4 hastada nüks (açık opere), 3 kist enfeksiyonu (açık opere), 3 uzamış safra drenajı (1’i perkütan tedavi) tespit edilmiştir. Peroperatif safra kanalı ile ilişki açık opere olan 5 hastada görüldü. Açık opere edilenlerde başvuruda ağrı şikayeti daha az, kitle şikayeti fazla iken; PAİR grubunda bunun tam tersiydi (p=0.001). PAİR grubunda izole KCKH fazla iken KCKH’yla beraber akciğer kist hidatiği’i cerrahi grupta fazlaydı (p=0.002). Gruplar diğer parametreler açısından benzerdi.Sonuç: Perkütan tedavi minimal invaziv, skarsız, düşük morbidite ve mortalite oranlarına ve kısa hastanede kalış süresine sahip olması sebebiyle seçilmiş KCKH vakalarında öncelikle uygulanması gereken bir yöntem olmakla beraber komplike vakalarda (tip 2, 3b) açık cerrahi onarım düşünülmelidir.

Keywords

• Karaciğer Kist Hidatikleri, Pediatrik hasta, perkutan tedavi

Outcome Comparison of Liver Hydatid Cysts Following Surgical and Percutaneous Treatment

Abstract

Objective: The aim of our study was to compare the outcomes of patients who had undergone surgery or percutaneous treatment for liver hydatid cyst (LHC) in our clinic. Material and Methods: A total of 114 patients treated for LHC between the years 1997 to 2013 were evaluated retrospectively from their fi les. Patients were evaluated in terms of demographic characteristics, complaints, cyst characteristics and complications.Results: There were 47 (41.2 %) males and 67 female (58.8%) aged between 6 and 16 years. The complaint was pain in 49% and abdominal swelling in 37.7%, while obstructive jaundice was present in 1 patient at the time of presentation. The cyst was found incidentally in 14 (12%) patients. Only one cyst was present in 90 patients (79%) and there were multiple cysts in 24 patients (maximum 10). The cyst was localized in the liver in 85 (74.6%) patients while there were other cysts, mostly in the lung in 29 (25.6%) patients. The cyst size was 3 to 16 cm. The mean cyst size in the patients undergoing surgery and percutaneous treatment was 96 mm and 70 mm respectively (p=0.001). Surgery was used in 82 (72%) patients and percutaneous treatment in 32 (28%). There were 4 recurrences (in the operated group), 3 cyst infections (in the operated group), and 3 prolonged biliary drainage cases (1 in the percutaneous treated group). Bile duct connection was seen in 5 patients who underwent open surgery. Abdominal swelling was more frequent than pain at presentation in the surgical group while the opposite was true for the percutaneous treatment group (p=0.001). The isolated LHC rate was higher in the PAIR (Puncture, Aspiration, Injection, Reaspiration) group than the operated group. The rate of LHC together with pulmonary cyst was higher in the surgical group (p=0.002). The groups were similar in terms of other parameters. Conclusion: Percutaneous treatment could be used as the primary treatment for LHC in selected cases as it is minimally invasive, does not cause scarring, and has a low morbidity and mortality rate and shorter hospitalization period, although surgical repair should be considered in complicated cases

Keywords

• Liver hydatid cyst in children, Percutaneous treatment

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