Tubaovaryen Abse Olgularının Cerrahi Tedavisinin Değerlendirilmesi

Yıl 2016, Cilt: 7 Sayı: 27, 0 - 0, 30.09.2016

İlay Gözükara Oya Karapınar Ali Ulvi Hakverdi Kenan Serdar Dolapçıoğlu Arif Güngören

https://doi.org/10.17944/mkutfd.13834

Öz

Amaç: Kliniğimizde tubaovaryen abse nedeniyle cerrahi operasyon uygulanan hastaların klinik ve laboratuar bulgularını, uygulanan cerrahi yöntemleri ve sonuçlarını araştırmaktır.

Gereç ve Yöntem: Mustafa Kemal Üniversitesi Kadın Hastalıkları ve Doğum kliniğinde Ocak 2014 ve Mart 2016 yılları arasında tubaovaryen abse nedeniyle cerrahi uygulanan hastalar retrospektif olarak incelendi. Olguların klinik ve laboratuar özellikleri, uygulanan cerrahi yöntemler, komplikasyonları ve antibiyoterapi rejimleri kaydedildi.

Bulgular: Çalışmaya dahil edilen 19 olgunun ortalama yaşının 32,7 olduğu izlendi. Operasyon öncesi dönemde yapılan ultrasonografi ve bilgisayarlı tomografi sonuçlarına göre tubaovaryen abse kitlelerinin çapları ortalama 8,46 cm ve hastanede kalış süresi 8,5 gündü. Hastaların ortalama C reaktif protein (CRP) değeri 147mg/L ve olguların % 89,5'sinde (n=17) CRP 5'in üzerinde saptandı. Olgularda %47,7 (n=9) abse boşaltılması, %15,8 (n=3) salfenjektomi, %15,8 (n=3) total abdominal histerektomi ve bilateral salfingooferektomi ve %21,4 (n=4) unilateral salfingooferektomi uygulandı. Bir hasta cerrahi sonrası abse tekrarı ve sonrasında dissemine intravasküler koagulasyon gelişmesine sekonder kaybedildi. İki hastada intraoperatif barsak serozasında yaralanma oldu.

Sonuç: Tubaovaryen absenin cerrahi tedavisi hastanın fertilite isteği ve yaşına ek olarak operatörün becerisi ve deneyimine bağlı olarak değişmektedir. 

Kaynakça

• Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best practice & research Clinical obstetrics & gynaecology. 2009;23(5):667-78.
• Pedowitz P, Bloomfield RD. Ruptured Adnexal Abscess (Tuboovarian) with Generalized Peritonitis. American journal of obstetrics and gynecology. 1964;88:721-9.
• Vermeeren J, Te Linde RW. Intraabdominal rupture of pelvic abscesses. American journal of obstetrics and gynecology. 1954;68(1):402-9.
• Wiesenfeld HC, Sweet RL. Progress in the management of tuboovarian abscesses. Clinical obstetrics and gynecology. 1993;36(2):433-44.
• Rein DB, Kassler WJ, Irwin KL, Rabiee L. Direct medical cost of pelvic inflammatory disease and its sequelae: decreasing, but still substantial. Obstetrics and gynecology. 2000;95(3):397-402.
• Chappell CA, Wiesenfeld HC. Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clinical obstetrics and gynecology. 2012;55(4):893-903.
• Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstetrical & gynecological survey. 2009;64(10):681-9.
• Yang CC, Chen P, Tseng JY, Wang PH. Advantages of open laparoscopic surgery over exploratory laparotomy in patients with tubo-ovarian abscess. The Journal of the American Association of Gynecologic Laparoscopists. 2002;9(3):327-32.
• Murat KARAKULAK HGP, Yunus AYDIN, Bahadır SAATLI, Serkan GÜÇLÜ. EVALUATION OF THE CASES WITH TUBOOVARIAN ABSCESSES. DEÜ TIP FAKÜLTESİ DERGİSİ. 2008;22(1):9-13.
• Kaplan AL, Jacobs WM, Ehresman JB. Aggressive management of pelvic abscess. American journal of obstetrics and gynecology. 1967;98(4):482-7.
• Tanir HM, Hassa H, Ozalp S, Kaya M, Oge T. Pelvic abscess in intrauterine device users. The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception. 2005;10(1):15-8.
• Volkan TURAN ME, Özgür YENİEL, M. Coşan TEREK, Murat ULUKUŞ. Ege Üniversitesi Kadın Hastalıkları ve Doğum Kliniğinde Tuboovaryan Abselerin 5 Yıllık Değerlendirilmesi. Turkiye Klinikleri J Gynecol Obst 2009;19(6):349-53.
• Önder Kaplan MG, Murat Yüksel. Tuba ovarian abse: 61 olgunun deðerlendirilmesiSDÜ Týp Fak Derg 2012:19(2)/47-50. 2012.
• WHO website for STI treatment guidelines: http://www.who.int/hiv/pub/sti/en/STIGuidelines2003.pdf. (Accessed on November 08. 2011.
• Burkman R, Schlesselman S, McCaffrey L, Gupta PK, Spence M. The relationship of genital tract actinomycetes and the development of pelvic inflammatory disease. American journal of obstetrics and gynecology. 1982;143(5):585-9.
• Burkman RT. Intrauterine devices and pelvic inflammatory disease: evolving perspectives on the data. Obstetrical & gynecological survey. 1996;51(12 Suppl):S35-41.
• Landers DV, Sweet RL. Tubo-ovarian abscess: contemporary approach to management. Reviews of infectious diseases. 1983;5(5):876-84.
• Reljic M, Gorisek B. C-reactive protein and the treatment of pelvic inflammatory disease. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 1998;60(2):143-50.
• Miettinen AK, Heinonen PK, Laippala P, Paavonen J. Test performance of erythrocyte sedimentation rate and C-reactive protein in assessing the severity of acute pelvic inflammatory disease. American journal of obstetrics and gynecology. 1993;169(5):1143-9.
• Griesshammer M, Bangerter M, Sauer T, Wennauer R, Bergmann L, Heimpel H. Aetiology and clinical significance of thrombocytosis: analysis of 732 patients with an elevated platelet count. Journal of internal medicine. 1999;245(3):295-300.
• Heits F, Stahl M, Ludwig D, Stange EF, Jelkmann W. Elevated serum thrombopoietin and interleukin-6 concentrations in thrombocytosis associated with inflammatory bowel disease. Journal of interferon & cytokine research : the official journal of the International Society for Interferon and Cytokine Research. 1999;19(7):757-60.
• Perez-Medina T, Huertas MA, Bajo JM. Early ultrasound-guided transvaginal drainage of tubo-ovarian abscesses: a randomized study. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 1996;7(6):435-8.
• Reed SD, Landers DV, Sweet RL. Antibiotic treatment of tuboovarian abscess: comparison of broad-spectrum beta-lactam agents versus clindamycin-containing regimens. American journal of obstetrics and gynecology. 1991;164(6 Pt 1):1556-61; discussion 61-2.
• Sweet RL, Schachter J, Landers DV, Ohm-Smith M, Robbie MO. Treatment of hospitalized patients with acute pelvic inflammatory disease: comparison of cefotetan plus doxycycline and cefoxitin plus doxycycline. American journal of obstetrics and gynecology. 1988;158(3 Pt 2):736-41.
• An MM, Zou Z, Shen H, Zhang JD, Chen ML, Liu P, et al. Ertapenem versus piperacillin/tazobactam for the treatment of complicated infections: a meta-analysis of randomized controlled trials. BMC infectious diseases. 2009;9:193.
• Pelak BA, Citron DM, Motyl M, Goldstein EJ, Woods GL, Teppler H. Comparative in vitro activities of ertapenem against bacterial pathogens from patients with acute pelvic infection. The Journal of antimicrobial chemotherapy. 2002;50(5):735-41.
• Joiner KA, Lowe BR, Dzink JL, Bartlett JG. Antibiotic levels in infected and sterile subcutaneous abscesses in mice. The Journal of infectious diseases. 1981;143(3):487-94.
• Mingeot-Leclercq MP, Glupczynski Y, Tulkens PM. Aminoglycosides: activity and resistance. Antimicrobial agents and chemotherapy. 1999;43(4):727-37.
• Dewitt J, Reining A, Allsworth JE, Peipert JF. Tuboovarian abscesses: is size associated with duration of hospitalization & complications? Obstetrics and gynecology international. 2010;2010:847041.