Retrospective analysis of risk factors for development of biliary fistula after liver cyst hydatid surgery

Yıl 2019, , 45 - 48, 15.03.2019

Emin Köse , Nilay Tuğba Baz Deniz Tazeoğlu , Mehmet Emin Gürbüz Hasan Tok Ayhan Özsoy Servet Rüştü Karahan

https://doi.org/10.25000/acem.531385

Öz

Aim: Hepatic
hydatidosis is common parasitosis in Turkey and caused by Echinococcus granulosus.
Biliary fistula is the most common complication after liver hydatid cyst
surgery. The aim of this study was to investigate an appropriate treatment
strategy for patients whose biliary fistula might develop, by revealing
variables that affect biliary fistula.

Methods: A total of
118 patients who underwent liver hydatid cyst surgery were included in this
study. The following variables were analyzed between patients with biliary
fistula (group 2) and without fistula (group 1): Age, gender, hematologic and
liver function tests, and features of the cysts (type, cyst size, number, and
localization).

Results: Cystobiliary fistula was detected in
19 (16%) of 118 patients. In-group 2, cyst size, white blood cell,
alkaline phosphatase and g-Glutamyl transpeptidase levels were higher than
group 1 on univariate analysis (p=0.03, p=0.008, p=0.04 and p=0.001,
respectively). In the multivariate model, only cyst diameter remained as an
independent predictor (odds ratio 0.03, 95% confidence interval 0.002 to 0.06;
p=0.03) On the receiver operating characteristic curve, the 100% sensitive,
100% specific, and optimal cutoffs of the cyst diameter were 7.5 cm, 4.0 cm and14.6
cm, respectively (The area under the receiver operator characteristic curve was
0.67).

Conclusion: Preoperative cyst size is a valuable
parameter for predicting biliary fistula. Our study suggests that cyst size
greater than 7.5 cm is a risk factor for biliary fistula. 

Anahtar Kelimeler

Hydatid liver disease, Cystobiliary fistula, Echinococcus granulosus

Karaciğer hidatik kist cerrahisi sonrası oluşan safra fistülünün gelişimindeki risk faktörlerinin retrospektif analizi

Öz

Amaç: Karaciğer hidatik
kist hastalığı Echinococcus granulosus’un neden olduğu, Türkiye’de yaygın
görülen bir parazitozdur. Karaciğer kist hidatik cerrahisi sonrası en sık
gelişen komplikasyon safra fistülüdür. Bu çalışmadaki amacımız safra fistülü
gelişimini etkileyen değişkenleri ortaya koymak ve uygun tedavi seçeneklerini
incelemektir.

Yöntemler: Bu çalışmaya
karaciğer kist hidatik cerrahisi uygulanmış olan 118 hasta dahil edildi.
Hastalar safra fistülü gelişen (grup2) ve gelişmeyen (grup1) olarak iki gruba
ayrıldı ve değişkenler analiz edildi: yaş, hematolojik ve karaciğer fonksiyon
testleri ve kistin özellikleri (tip, kist boyutu, sayısı ve yerleşim yeri).

Bulgular: 118 hastanın 19 (%16)’unda safra fistülü
saptandı. Grup 2’de kist boyutu, lökosit, alkalin fosfataz ve g-Glutamin
transpeptidaz değerleri tek değişkenli analiz sonucuna göre grup 1’den daha yüksekti
(p=0,03, p=0,008, p=0,04, p=0,001). Çok değişkenli analiz sonucuna göre; safra
fistülü gelişimine etki eden tek bağımsız değişken yalnızca kist boyutu olarak
saptandı (olasılık oranı 0.03, 95% güven aralığı 0,002-0,06; p=0,03). İşlem
karakteristik eğrisine göre, kist boyutlarının 100% duyarlılık, 100% özgüllük
ve eşik değeri, sırasıyla 7,5 cm, 4,0 cm ve 14,6 cm olarak bulundu. (Eğrinin
altındaki alan 0,67).

Sonuç: Safra fistülünün
tahmininde preoperatif kist boyutu önemli bir parametredir. Bizim çalışmamıza
göre; kist boyutunun 7,5 cm’den büyük olması safra fistülü gelişimi için bir
risk faktörüdür.

Anahtar Kelimeler

Karaciğer kist hidatik hastalığı, safra fistülü, Echinococcus granulosus

Kaynakça

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