CE1 ve CE3a karaciğer kist hidatiklerinin perkütan tedavisinde modifiye Seldinger ve trokar yöntemlerinin karşılaştırılması

Yıl 2020, Cilt: 45 Sayı: 2, 588 - 594, 30.06.2020

Bekir Turgut Nahide Baran

https://doi.org/10.17826/cumj.675478

Öz

Amaç: Bu çalışmanın amacı, CE1 ve CE3a tipleri karaciğer kist hidatiklerinin perkütan tedavisinde kullanılan trokar ve modifiye Seldinger yöntemlerinin uzun dönem sonuçlarının karşılaştırılması oldu.
Gereç ve Yöntem: Ocak 2015 ve Haziran 2019 tarihleri arasında kateterizasyon yöntemi ile tedavi edilmiş olan, CE1 ve CE3a kist hidatik hastalarının verileri geriye dönük olarak tarandı. Kist tipi, kist boyutu, lokalizasyonu, uygulanan tedavi yöntemi, kateterizasyon süresi, hastanede yatış süresi verileri kayıt edildi. Takip ultrasonografi raporları değerlendirilerek takip süresi, kistin son kontroldeki boyutu, inaktivasyon süresi listelendi. Bu değişkenlerin tamamı modifiye Seldinger ve trokar yöntemlerinde ayrı ayrı listelendi ve istatistiksel olarak karşılaştırıldı.
Bulgular: Toplamda 126 CE1 ve CE3a hastanın verileri çalışmaya dahil edildi. Tedavide 36 hastada modifiye Seldinger yöntemi, 90 hastada trokar yöntemi uygulandı. Ortalama takip süresi 1185.36 ±426.02 gün oldu. Tedavi etkinliği modifiye Seldinger yönteminde %97.2, trokar yönteminde %97.7 oldu. Toplamda hastaların %2.3’ünde nüks görüldü. Modifiye Seldinger yöntemine kıyasla trokar yönteminde kateterizasyon ve hastanede yatış süresi anlamlı olarak düşük bulundu. Modifiye Seldinger yönteminde inaktivasyon süreci daha hızlı olmuştur.
Sonuç: Modifiye Seldinger ve trokar yöntemlerinin her ikiside CE1 ve CE3a karaciğer kist hidatik tedavisinde güvenle kullanılabilicek etkin tedavi yöntemleridir.

Anahtar Kelimeler

kist hidatik, CE1 ve CE3a hepatik kist hidatik, ekinokokus granulozus, trokar tekniği, modifiye Seldinger tekniği

Comparison of the modified Seldinger and trocar techniques in the percutaneous treatment of CE1 and CE3a hepatic hydatid cysts

Öz

Purpose: The aim of this study was to compare the long-term results of the trocar and modified Seldinger techniques used in the percutaneous treatment of type CE1 and CE3a hepatic hydatid cysts.
Materials and Methods: The data of the patients with CE1 and CE3a hydatid cysts, treated by the catheterization technique between January 2015 and June 2019 were reviewed retrospectively. Cyst type, cyst size and localization, treatment method applied, duration of catheterization and length of hospital stay were recorded. Follow-up period, cyst size at the last follow-up, and inactivation time were listed using the follow-up ultrasound reports. All of these variables were listed separately in the modified Seldinger and trocar techniques and compared statistically.
Results: The data of 126 CE1 and CE3a patients were included in the study. The modified Seldinger technique was used in 36 patients, and the trocar technique was used in 90 patients. The mean follow-up period was 1185.36 ± 426.02 days. The efficacy of the treatment was at the rate of 97.2% in the modified Seldinger technique and 97.7% in the trocar technique. In total, recurrence was seen in 2.3% of the patients. The duration of catheterization and length of hospital stay were found to be significantly lower in the trocar technique compared to the modified Seldinger technique. The inactivation process was faster in the modified Seldinger technique.
Conclusion: Both the modified Seldinger and trocar techniques are effective treatment modalities that can be used safely in the treatment of CE1 and CE3a hepatic hydatid cysts.

Anahtar Kelimeler

hydatid cysts, CE1 and CE3a hepatic hydatid cysts, echinococcus granulosus, trocar technique, modified Seldinger technique

Kaynakça

• Aydın Y, Çelik M, Ulaş AB, Eroğlu A. Transdiaphragmatic approach to liver and lung hydatid cysts. Turk J Med Sci. 2012;42(2): 1388-1393. doi:10.3906/sag-1204-22
• Altinel F, Tunçel D, Öztürk A, Açıkalın M. Alt Ekstremiteye Yayılım Gösteren Primer Intrakranial Kist Hidatik: Olgu Sunumu. Cukurova Medical Journal 2014;39:589-593 https://dergipark.org.tr/tr/pub/cumj/issue/4190/55138
• McManus DP, Zhang W, Li J, Bartley PB. Echinococcosis. Lancet 2003;362:1295–304. doi: 10.1016/S0140-6736(03)14573-4
• Kuş,M , Arer İ , Akkapulu N , Yabanoğlu H . "Karaciğer subkapsüler kist hidatik". Cukurova Medical Journal 2017;42:564-566 https://dergipark.org.tr/tr/pub/cumj/issue/26525/323994
• Yazıcı P, Aydın Ü, Ersin S, Kaplan H. Splenic Hydatid Cyst: Clinical Study. Eurasian J Med. 2007; 39: 25-27.
• Turgut AT, Akhan O, Bhatt S, Dogra VS. Sonographic Spectrum of Hydatid Disease. Ultrasound Quarterly 2008;24:17-29. doi: 10.1097/RUQ.0b013e318168f0d1.
• WHO Informal Working Group. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 2003;85:253–261 doi: 10.1016/s0001-706x(02)00223-1
• Bhutani N, Kajal P. Hepatic echinococcosis:A review. Ann Med Surg (Lond). 2018;36:99-105. doi: 10.1016/j.amsu.2018.10.032.
• Smego RA Jr, Sebanego P. Treatment options for hepatic cystic echinococcosis. Int J Infect Dis. 2005;9(2):69-76. doi: 10.1016/j.ijid.2004.08.001
• Bosanac ZB, Lisanin L. Percutaneous drainage of hydatid cyst in the liver as a primary treatment: review of 52 consecutive cases with long-term follow-up. Clin Radiol 2000;55:839–48. doi: 10.1053/crad.2000.0543
• Akhan O, Yildiz AE, Akinci D, Yildiz BD, Ciftci T. Is the adjuvant albendazole treatment really needed with PAIR in the management of liver hydatid cysts? A prospective, randomized trial with short-term follow-up results. Cardiovasc Intervent Radiol. 2014;37(6):1568–1574. doi:10.1007/s00270-014-0840-2
• Wen H, Vuitton L, Tuxun T, Li J, Vuitton DA, Zhang W, et al. Echinococcosis: Advances in the 21st Century. Clin Microbiol Rev.2019;32(2). pii: e00075-18. doi: 10.1128/CMR.00075-18.
• Akkapulu N, Aytac HO, Arer IM, Kus M, Yabanoglu H. Incidence and risk factors of biliary fistulation from hepatic hydatid cyst in clinically asymptomatic patients. Trop Doct. 2018;48(1):20-24. doi: 10.1177/0049475517717177.
• Demircan O, Baymus M, Seydaoglu G, Akinoglu A, Sakman G. Occult cystobiliary communication presenting as postoperative biliary leakage after hydatid liver surgery: are there significant preoperative clinical predictors?. Can J Surg. 2006;49(3):177–184.
• Kabaalioğlu A, Ceken K, Alimoglu E, Apaydin A. Percutaneous imaging-guided treatment of hydatid liver cysts: Do long-term results make it a first choice? European Journal of Radiology 2006;59(1):65–73. doi: 10.1016/j.ejrad.2006.01.014
• Popa AC, Akhan O, Petruţescu MS, Popa LG, Constantin C, Mihăilescu P, et al. New Options in the Management of Cystic Echinococcosis - A Single Centre Experience Using Minimally Invasive Techniques. Chirurgia (Bucur). 2018;113(4):486-496. doi: 10.21614/chirurgia.113.4.486.
• Giorgio A, de Stefano G, Esposito V, Liorre G, Di Sarno A, Giorgio V, et al. Long-term results of percutaneous treatment of hydatid liver cysts: a single center 17 years experience. Infection 2008;36(3):256–261. doi:10.1007/s15010-007-7103-y
• Atamanalp S, Polat P, Öztürk G, Aslan O.B. Cysto-Biliary Rupture in Hepatic Hydatid Disease: Magnetic Resonance Cholangiopancreatography and Endoscopic Retrograde Cholangiopancreatography Findings. Eurasian J Med. 2009; 41: 208-208.
• Ambregna S, Koch S, Sulz MC, Gruner B, Ozturk S, Chevaux JB, et al. A European survey of perendoscopic treatment of biliary complications in patients with alveolar echinococcosis. Expert Rev Anti Infect Ther. 2017;15:79–88. doi:10.1080/14787210.2017.1252260.
• Barosa R, Pinto J, Caldeira A, Pereira E. Modern role of clinical ultrasound in liver abscess and echinococcosis. J Med Ultrason. 2017;44(3):239-245. doi: 10.1007/s10396-016-0765-2.
• Villán González A, Pérez Pariente JM, Barreiro Alonso E. Obstructive jaundice secondary to a hepatic hydatid cyst. Rev Esp Enferm Dig. 2018 ;110(11):741-742. doi: 10.17235/reed.2018.5574/2018.
• Turan HG, Özdemir M, Acu R, Küçükay F, Özdemir FAE, Hekimoğlu B, et al. Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts. World J Radiol. 2017 ;9(11):405-412. doi: 10.4329/wjr.v9.i11.405.
• Kahriman G, Ozcan N, Dogan S, Karaborklu O. Percutaneous treatment of liver hydatid cysts in 190 patients: a retrospective study. Acta Radiol. 2017;58(6):676-684. doi: 10.1177/0284185116664226.
• Goktay AY, Secil M, Gulcu A, Hosgor M, Karaca I, Olguner M, et al. Percutaneous treatment of hydatid liver cysts in children as a primary treatment: long-term results. J Vasc Interv Radiol. 2005;16(6):831-9. doi: 10.1097/01.RVI.0000157777.33273.3B
• Balli O, Balli G, Cakir V, Gur S, Pekcevik R, Tavusbay C, et al. Percutaneous Treatment of Giant Cystic Echinococcosis in Liver: Catheterization Technique in Patients with CE1 and CE3a. Cardiovasc Intervent Radiol. 2019;42(8):1153-1159. doi: 10.1007/s00270-019-02248-z.
• Ozyer U. Percutaneous treatment of hepatic hydatid cysts is safe and effective with low profile single step trocar catheter. Acta Radiol. 2018;59(7):NP1-NP2. doi: 10.1177/0284185117719101.
• Macpherson CN, Bartholomot B, Frider B. Application of ultrasound in diagnosis, treatment, epidemiology, public health and control of Echinococcus granulosus and E. multilocularis. Parasitology 2003;127:21–35. doi: 10.1017/s0031182003003676