Karaciğer Hidatik Kisti Nedeniyle Cerrahi Uygulanan Olgularda Rekürrens Gelişimini Etkileyen Faktörlerin Değerlendirilmesi

Öz

Özet Giriş Hidatik hastalık, Echinococcus granulosus tarafından oluşturulan ciddi bir paraziter enfeksiyondur. En etkili tedavi yöntemi cerrahidir. Hastalığın nüksü, uzun dönem postoperatif dönemde önemli bir komplikasyondur. Bu çalışmada, karaciğer hidatik kisti nedeniyle ameliyat edilen olgularda nüks gelişimini etkileyen faktörlerin incelenmesi amaçlanmıştır. Gereç ve Yöntem Çalışmada, 2008–2014 yılları arasında karaciğer yerleşimli hidatik kist nedeniyle cerrahi tedavi uygulanan hastaların verileri incelenmiştir. Hastaların yaş, cinsiyet, serolojik test sonuçları, radyolojik inceleme bulguları, ASA skoru, uygulanan cerrahi teknik ve postoperatif komplikasyonları; hastane bilgi sistemi ve hasta dosyaları kullanılarak retrospektif olarak değerlendirilmiştir. Bulgular Toplam 166 karaciğer hidatik kisti hastası analiz edilmiştir. Çalışma grubunda 26 (%15,6) hastada nüks gelişmiş olup, bu hastaların 15’i (%9) kadındır. İndirekt hemaglütinasyon testi (IHAT) 96 (%65,8) hastada pozitif bulunmuştur. IHAT (+) hastaların %15,6’sında, çapı 10 cm’den büyük olan kistik lezyonu bulunan hastaların ise %20,0’sinde (n=8) nüks gelişmiştir. Kistik lezyon çapı, serolojik test sonuçları (IHAT), cinsiyet, yaş, Gharbi sınıflaması ve uygulanan cerrahi tekniğe bakılmaksızın nüks gelişimi arasında istatistiksel olarak anlamlı fark saptanmamıştır (p>0,05). Kırk dört (%26,5) hastada multipl kistik lezyon saptanmış olup, bu grupta nüks oranı %29,5 (n=13) olarak bulunmuştur. Bu oran, tek kistik lezyonu olan hastalara göre anlamlı derecede daha yüksektir (p<0,05). Radikal cerrahi uygulanan hastalarda nüks oranı, konservatif cerrahi uygulanan hastalara kıyasla anlamlı derecede daha düşük bulunmuştur (%5,9’a karşı %22,2; p<0,05). Tartışma ve Sonuç Hidatik kist cerrahisinde nüks, oldukça önemli bir sorundur. Multipl kisti bulunan hastalarda nüks oranı anlamlı derecede daha yüksektir. Benzer şekilde, radikal cerrahi girişimler konservatif yaklaşımlara kıyasla nüks gelişimini anlamlı şekilde azaltmaktadır. Bununla birlikte, radikal cerrahi girişimler daha fazla deneyim gerektirdiğinden daha seyrek uygulanmakta olup, bu durum yüksek nüks oranları ile ilişkili olabilir. Anahtar Kelimeler Hidatik kist, cerrahi, nüks, kist özellikleri.

Anahtar Kelimeler

• Hidatik kist
• cerrahi
• nüks
• kist özellikleri

Examination of Factors Affecting the Development of Recurrence in Operated Cases with Liver Hydatid Cysts

Öz

Abstract Introduction Hydatid disease is a serious parasitic infection caused by Echinococcus granulosus. The most effective treatment method is surgery. The recurrence of disease is an important long-term postoperative complication. The present study investigates the factors affecting recurrence in operated cases of liver hydatid cysts. Material and Methods The study examines the data who underwent surgical therapy for hydatid cysts with liver localization between 2008-2014. Age, gender, serological test results, radiological examination results, ASA score, operational technique, postoperative complications were reviewed retrospectively, making use of the hospital information system and the patient records. Results Total 166 patients with liver hydatid cysts were analyzed. Of the study group, recurrence developed in 26 (%15.6) patients and 15 (%9) patients were female. The indirect hemagglutination test (IHAT) was positive in 96 (%65.8) patients. Recurrence developed in 15.6% of the IHAT (+), 20.0% (n=8) of patients with a cystic lesion of >10cm. There was further no statistically significant difference between the diameter of cystic lesion, serological test results (IHAT), gender, age, Gharbi classification and recurrence development regardless of the type of surgical intervention (p>0.05). Multiple cystic lesions were identified in 44 (%26.5) patients and recurrence rate was 29.5% (n=13). The rate of recurrence in this group is significantly higher than patients with a single cystic lesion (p<0.05). Recurrence was observed to develop at a lower rate among patients undergoing radical surgery groups than conservative ones (5.9% v.s 22.2%, p<0.05). Discussion and Conclusion Recurrence is a very important issue in hydatid cyst surgery. Patients with multiple cysts having a significantly higher rate of recurrence. Likewise, radical surgical procedures reduce the development of recurrence rather than conservative ones, significantly. That said, radical surgical interventions are performed less frequently, as more experience is required, and this may be associated with the high recurrence rates. Keywords: Hydatid cyst, surgery, recurrence, cyst characteristics.

Anahtar Kelimeler

• Hydatid cyst
• surgery
• recurrence
• cyst characteristics

Kaynakça

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