Kolelitiazisli Çocuk Olgularin Değerlendirilmesi: 10 Yıllık Tek Merkez Deneyimi

Öz

Son yıllarda risk faktörlerinde değişiklikler, tanı ve tedavi yöntemlerinde gelişmeler nedeni ile safra taşı tanısıyla izlenen hastaların demografik verileri, başvuru yakınmaları, görüntüleme bulguları, risk faktörleri, tedavi rejimleri ve tedaviye yanıtlarının değerlendirilmesi amaçlanmıştır. Eskişehir Osmangazi Üniversitesi’nde 2008-2018 yılları arasında kolelitiazis tanısı ile izlenen çocukların demografik özellikleri, aile öyküleri, altta yatan hastalıkları, ilaç kullanımları, semptomları, labaratuvar ve görüntüleme bulguları, uygulanan medikal ve cerrahi tedavi yöntemleri kaydedildi. Ursodeoksikolik asit (UDCA) tedavisini en az 6 ay süreyle alanlar tedavi açısından değerlendirmeye alındı ve taşın tamamen kaybolması tedaviye yanıt olarak kabul edildi. 79 çocuk [32 erkek (%40), 47 kız (%60); ortalama 8 yaş 10 ay] çalışmaya alındı. Hastalardan 39’unda (% 49.3) taş oluşumu için bir risk faktörü vardı: En sık obezite (%21.5), daha sonra ilaç (% 17.7, seftriakson) ve hemolitik hastalıklar (% 10.1, 4 herediter sferositoz, 1 G6PD eksikliği, 2 talasemi majör ve 1 orak hücreli anemi) tespit edildi. Hastaların %57’sinde biliyer semptomlar (sağ üst kadran-epigastrik ağrı, bulantı, kusma, sarılık, yağlı besin intoleransı) görülürken, % 43’ü ise asemptomatikti. Toplam 70 hastanın (%88) en az 6 ay UDCA tedavisi (15-20 mg/kg/gün) aldığı ve izlemde 41’inde (%58) taşın kaybolduğu görüldü. On üç hastaya (%16.4, ortalama yaş 145.7±40 ay) kolesistektomi uygulandı. Sonuç olarak çocuklarda kolelitiazisin %50’sinin nedeni belli olmadığı, en sık risk faktörünün obezite olduğu, puberte öncesi ve sonrası bulgularda farklılık olmadığı, sıklıkla semptomatik oldukları, UDCA yanıtlarının yüksek ve özellikle seftriaksona bağlı taşlarda daha belirgin olduğu görüldü.

Anahtar Kelimeler

• Kolelitizis,Kolesistektomi,Obezite,Ursodeoksikolik asit

Evaluation of Children with Cholelithiasis:10 Years of Single Center Experience

Öz

We aimed to evaluate demografic features, symptoms, imaging findings, risk factors, treatment modalities and response to treatment of children with cholelithiasis due to changes in risk factors and development in diagnosis and treatment methods in recent years. This retrospective study was conducted in Eskişehir Osmangazi University School of Medicine Pediatric Gastroenterology and Hepatology Department between January 2008 and December 2018. The ethics committee of Eskişehir Osmangazi University approved the study. Demografic features, symptoms, imaging findings, risk factors, treatment modalities and response to treatment of children with cholelithiasis were recorded. Patients who received UDCA teratment at least for 6 months were enrolled the study. Treatment responce was defined as dissolving of stone completely. Seventy nine children [32 (40%) boys, 47 (60%) girls; mean 8 years and 10 months] were enrolled the study. Among the 79 pediatric patients, 39 patients had at least 1 risk factor [ obesity (21.5%), lithogenic drug (17.7%) ve hemolytic disease (10.1%, 4 hereditary sferocytosis, 1 G6PD deficiency, 2 talassemia major ve 1 sickle cell anemia)]. Fifty seven per cent of patients have biliary symptoms (right upper quadrant pain, nause, vomiting, jaundice and intolerance with fatty meal) while 43% were asymptomatic. Seventy patients were received UDCA therapy at least 6 months and resolution of gallstone was seen in 41 (58%). Thirteen patients (16.4%, mean age 145.7±40 months) were treated by laparoscopic cholecystectomy. As a result, it was observed that 50% of cholelithiasis was not known in children, and the most common risk factor was obesity, and there was no difference between pre- and post-pubertal groups, and they were frequently symptomatic, and UDCA responses were higher and especially in ceftriaxone-dependent stones. 

Anahtar Kelimeler

• Cholelithiasis; obesity; ursodeoxycholic acid; cholecystectomy

Kaynakça

1. 1. Glenn F. 25-years experience in the surgical treatment of 5037 patients with nonmalignant biliary tract disease. Surg Gynecol Obstet. 1959;109:591–606.2. Wesdorp I, Bosman D, de Graaff A, Aronson D, van der Blij F, Taminiau J. Clinical Presentations and Predisposing Factors of Cholelithiasis and Sludge in Children, J Pediatr Gastroenterol Nutr. 2000;31(10):411–417.3. Svensson J, Makin E. Gallstone disease in children. Semin Pediatr Surg. 2012;21(3):255-65.4. Poffenberger C M, Gausche-Hill M, Ngai S, Myers A, Renslo R. Cholelithiasis and Its Complications in Children and Adolescents: Update and Case Discussion. Pediatr Emer Care 2012;28: 68-79.5. Strauss RG. Cholelithiasis in childhood. Am J Dis Child. 1969;117(6):689-92.6. Pokorny WJ, Saleem M, Gorman RB, Mcgill CW, Harberg FJ. Cholelithiasis and cholecystitis in childhood. Am J Surg. 1984;148(6):742-4.7. Debray D. Cholelithiasis in Infancy: a study of 40 cases. J Pediatr Gastroenterol. 1993;122(3):385-91.8. Tannuri CA, Gonçalves AJ, Velhote M, Gonlçalves ME, Tannuri U. Management of gallstone disease in children: a new protocol based on the experience of a single center. J Pedia Surg. 2012;47:2033-8.9. Bhasin S K, Gupta A, Kumari S. Evaluation and management of cholelithiasis in children: a hospital based study. Int Surg J. 2017;4(1):246-251.10. Corte C D, Falchetti, D, Nebbia, G, Calacoci, M, Pastore, M, Francavilla, R, Iorio, R. Management of cholelithiasis in Italian children: A national multicenter study. World J Gastroenterol. 2008;7;14(9):1383-8.11. Baran M, Appak Y C, Tümgör G, Karakoyun M, **Ozdemır T, Köylüoğlu G. Etiology and Outcome of Cholelithiasis in Turkish Children. Indian Pediatr. 2018 Mar 15;55(3):216-218.12. Gokçe S, Yıldırım M, Erdogan D. A retrospective review of children with gallstones: single-center experience from central Anatolia. Turk J Gastroenterol. 2014;25:46-5313. Bogue CO, Murphy AJ, Gerstle JT, Moineddin R, Danrman A. Risk factors, complications and outcomes of gallstones in children: a single centre review. J Pediatr Gastroenterol Nutr. 2010;50(3):303-8.14. Holcomb GW, Holcomb GW. Pediatric cholecystectomy: clinical significance of cases unrelated to hematologic disorders. Pediatr Gastroenterol Hepatol Nutr. 2015;18(2):115-20.15. Pollak HM, Reyes KC. Cholelithiasis in Childhood and adolescence. SA Med Journal. 1982;62:887-9. 16. Dooki MR, Norouzi A. Cholelithiasis in childhood: a cohort study in North of Iran. Iran J Pediatr. 2013;23(5):588-92. 17. Gamba PG, Zancan L, Muraca M, Vilei MT, Talenti E, Guglielmi M. Is there a place of medical treatment in children with gallstones? J Pediatr Surg 1997; 32: 476-478.