Postoperatif Safra Fistülleri ve ERCP (İki Olgunun Sunumu)

Öz

Anahtar Kelimeler

• -

Postoperatif Safra Fistülleri ve ERCP (İki Olgunun Sunumu)

Öz

Safra kanalı yaralanmaları kolesistektomi sonrası hastaların morbidite ve mortalite artışına neden olan ciddi komplikasyonlardandır. Cerrahi tedaviye ihtiyaç duyulan safra kanalı yaralanmaları % 11 oranında mortaliteye neden olur. En sık görülen yaralanmalar sistik kanal güdüğünden kaynaklanan yaralanmalardır. Safra kanalı yaralanması olan hastalarda öncelikle endoskopik tedaviler denenmelidir. ERCP yaralanmanın tipini belirlemeye yardım ederken sfinkterotomi ve/veya stentleme yapılarak da kanal içi basıncı azaltılır ve fistülün kapanması hızlandırılır. Ancak çepeçevre yaralanmalarla birlikte seyreden olgularda endoskopik tedaviler yarar sağlamaz ve hepatojejunostomi gibi ciddi cerrahi işlemlere ihtiyaç duyulur

Anahtar Kelimeler

• Safra kanalı yaralanması, kolesistektomi, ERCP, stentleme

Kaynakça

1. Zhang JM, Yu SA, Shen W, Zheng ZD. Pathogenesis and treatment to postoperative bile leakage: report of 38 cases. Hepatobiliary Pancre- at Dis Int. 2005; 4(3): 441-444.
2. The Southern Surgerons Club. A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med. 1991; 324(16): 1073-1078.
3. Khan MH, Howard TJ, Fogel EL, Sherman S, McHenry L, Watkins JL, Canal DF, Lehman GA. Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center. Gas- trointest Endosc. 2007; 65(2):247-252.
4. Rauws EAJ, Gouma DJ. Endoscopic and surgical management of the bile duct injury after laparoscopic cholecystectomy. Best Practice and Research Clinical Gastroenterology. 2004; 18 (5): 829-846.
5. Kaffes AJ, Hourigan L, De Luca N, Byth K, Williams SJ, Bourke MJ. Impact of endoscopic in- tervention in 100 patients with suspected postchol- ecystectomy bile leak. Gastrointest Endosc. 2005; 61(2): 269-275.
6. Woods MS, Traverso LW, Kozarek RA, Tsao J, Rossi RL, Gough D, Donohue JH. Character- istics of biliary tract complications during lapa- roscopic cholecystectomy: a multi-institutional study. Am J Surg. 1994; 167(1): 27-33.
7. Kern KA. Medicolegal analysis of bile duct injury during open cholecystectomy and abdomi- nal surgery. Am J Surg. 1994; 168(3): 217-222.
8. Moossa AR, Easter DW, Van Sonnenberg E, Kocatepe Tıp Dergisi, Cİlt 9 No: 3, Eylül 2008 Casola G, D’Agostino H. Laparoscopic injuries

9. to the bile duct. A cause for concern. Ann Surg. 1992; 215(3): 203-208.
10. Duperier T, Brody F, Felsher J, Walsh RM,
11. Rosen M, Ponsky J. Predictive factors for suc
12. cessful laparoscopic splenectomy in patients with
13. immune thrombocytopenic purpura. Arch Surg. 2004; 139(1): 61-66.
14. Strasberg SM, Callery MP, Soper NJ. Lapa
15. roscopic hepatobiliary surgery. Prog Liver Dis. 1995; 13: 349-380.
16. Malik AM, Laghari AA, Talpur AH, Khan
17. A. Iatrogenic biliary injuries during laparoscopic
18. cholecystectomy. A continuing threat. Int J Surg. 2008; 6(5): 392-395.
19. Li JH, Liu HT. Diagnosis and management
20. of cystic duct leakage after laparoscopic cholecys- tectomy: report of 3 cases. Hepatobiliary Pancreat Dis Int. 2005; 4(1): 147-151.
21. Brugge WR, Rosenberg DJ, Alavi A. Diag- nosis of postoperative bile leaks. Am J Gastroen- terol. 1994; 89(12): 2178-2183.
22. Ragozzino A, De Ritis R, Mosca A, Iacca- rino V, Imbriaco M. Value of MR cholangiography in patients with iatrogenic bile duct injury after cholecystectomy. AJR Am J Roentgenol. 2004; 183(6): 1567-1572.
23. De Palma GD, Iuliano GP, Puzziello A, Man- fredini S, Masone S, Persico G. Biliary leaks af- ter laparoscopic cholecystectomy. Results of the endoscopic treatment. Minerva Chir. 2002; 57(2): 123-127.
24. Resim 3: Safra kanalı yaralanmalarında tedavi algoritması