PERICYSTECTOMY FOR LIVER HYDATID CYST: SINGLE CENTER EXPERIENCE

Yıl 2020, Cilt: 83 Sayı: 3, 215 - 220, 29.06.2020

Kürşat Rahmi Serin Cem İbiş Yaman Tekant İlgin Özden

Öz

Objective: To analyze the results of total pericystectomy in hepatic hydatid disease. Material and Method: The data of patients who underwent total pericystectomy between 1999-2019 was evaluated. Results: Of 308 patients treated as in-patients, 32 (17 females-15 males) were found to have had total pericystectomy. Median age was 44 (range:17-73) years. Indications were: easily accessible anatomic location (20), albendazole toxicity (4), unresponsiveness to albendazol treatment (4), tumor suspicion (2), pregnancy (1) and nonadherence to albendazole use (1). Median cyst diameter was 75 mm (42-100), median cyst number was 1 (1-8). Fourteen patients had more than one cyst. Total pericystectomy alone was performed in 23 patients, while additional cysts were treated in a further 9. Of the 23 pericystectomy only patients, 18 received closed and 5 open pericystectomy. Median 36 minutes (12-78) Pringle clamping was performed in 10 patients. Median hospital stay was 6 days (1-60). Low output (<150 cc/day) bile fistula was seen in 3 patients, intraabdominal infection in 2 patients and superficial infection in 2 patients. No recurrence was observed during a median follow-up of 62 months (14-236) in 20 pericystectomy only patients. Conclusion: Pericystectomy can be performed with low morbidity and mortality in an experienced center. Recurrence risk is reduced in comparison with conservative surgery.

Anahtar Kelimeler

Echinococcus, hepatectomy, radical surgery, albendazol

KARACİĞER KİST HİDATİĞİNDE PERİKİSTEKTOMİ: TEK MERKEZ DENEYİMİMİZ

Öz

Amaç: Karaciğer kist hidatiğinde total perikistektomi uygulanan hastaların sonuçlarını irdelemek. Gereç ve Yöntem: 1999-2019 yılları arasında yatırılarak tedavi edilmiş hastaların verileri incelenerek, total perikistektomi yapılan hastalar çalışmaya dahil edilmiştir. Bulgular: Toplam 308 hastanın 32’sinde (17 kadın, 15 erkek, ortanca yaş 44 (17-73)) perikistektomi yapıldığı saptandı. Perikistektomi endikasyonları, ulaşımı kolay anatomik yerleşim (20), albendazol toksisitesi (4), albendazole cevapsız kist (4), kistik tümör kuşkusu (2), hamilelik (1) ve albendazol kullanımına uyumsuzluktu (1). Ortanca kist boyutu 75 mm (42-100), ortanca kist sayısı 1 (1-8) saptanırken, 14 hastada birden fazla kist vardı. Yirmi üç hastaya sadece total perikistektomi uygulanırken 9 hastada mevcut ek kistlere de drenaj uygulandı. Sadece perikistektomi uygulanan 23 hastadan 18’ine kapalı, 5’ine açık perikistektomi yapıldı. Perikistektomi sırasında 10 hastada ortanca 36 dk (12-78) Pringle klampajı uygulandı. Ortanca yatış süresi 6 gündü (1-60). Üç hastada düşük debili (<150 cc/gün) safra fistülü, 2 hastada karın içi enfeksiyon, 2 hastada da yüzeyel yara yeri enfeksiyonu gelişti. Sadece total perikistektomi yapılan ve ortanca 62 ay (14236) takip edilen 20 hastanın hiçbirisinde nüks gözlenmedi. Sonuç: Perikistektomi, deneyimli merkezde, seçilmiş hastalarda düşük morbidite ve mortalite ile uygulanmaktadır. Nüks riskinin de düşük olduğu gösterilmiştir.

Anahtar Kelimeler

Ekinokok, hepatektomi, radikal cerrahi, albendazol

Kaynakça

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