Akut kolesistitli hastalarda perkütan safra kesesi drenajı sonuçlarımız

Yıl 2019, , 127 - 132, 18.01.2019

Muhammet Arslan , Sinan Sözütok Serkan Akbulut , Bozkurt Gülek

https://doi.org/10.31362/patd.452868

Öz

Amaç

Cerrahisi yüksek riskli akut kolesistitli
hastalarda perkütan safra kesesi drenajı (perkütan kolesistostomi) işleminin
tekniğini, klinik etkinliğini ve komplikasyonlarını değerlendirmeyi amaçladık.

Gereç
ve Yöntem

Haziran 2015'ten Ocak 2017'ye kadar akut kolesistit
nedeniyle perkütan safra kesesi drenajı uygulanan toplam 58 hastanın (26 erkek,
32 kadın) elektronik kayıtları retrospektif olarak incelendi.

Bulgular

Perkütan safra kesesi drenajı işleminin 57
hastada (% 98,3) başarıyla uygulandığı görüldü. Dört hastada (% 6,9) majör
komplikasyon (peritonit ve kanama) meydana geldiği tespit edildi. Drenaj
kateterinin hastada kalma süresi ortalama 26,4 (1-55) gündü. Toplam 58 hastanın
35'inde (% 60,3) perkütan safra kesesi drenajından sonra 7 hafta içinde elektif
kolesistektomi işlemi gerçekleştirilmişti. Perkütan safra kesesi drenajı
işleminden sonra 30 gün içinde mortalite oranı % 10,3 (58 hastada 6'sı) olarak
bulundu.

Sonuç

Cerrahisi yüksek riskli akut kolesistitli
hastalarda perkütan safra kesesi drenajı etkili ve güvenli bir işlemdir. İşlem
minimal invaziv olup komplikasyon oranı düşüktür.

Anahtar Kelimeler

Akut kolesistit, Perkütan kolesistostomi, Komplikasyon, Safra kesesi drenajı

Percutaneous gallbladder drainage in acute cholecystitis patients

Öz

Purpose

To evaluate the procedural
technique, clinical efficacy and complications of percutaneous gall bladder
drainage (percutaneous cholecystostomy) for the treatment of acute
cholecystitis in high-risk patients.

Material and Methods

From June 2015 to January
2017, a total of 58 acute cholecystitis in high-risk patients (26 men, 32
women) who underwent percutaneous cholecystostomy were retrospectively
evaluated.

Results

Percutaneous cholecystostomy
was successfully performed in 57 patients (98.3%) with acute cholecystitis.
Major complications (peritonitis and hemorrhage) occurred in 4 patients (6.9%).
The average duration of catheter drainage was 26,4 days (range, 1-55 days).
Elective cholecystectomy was performed in 35 (60.3%) of 58 patients at 7 weeks.
In-hospital mortality rate was 10.3% (6 of 58 patients) in 30 days.

Conclusion

Percutaneous
cholecystostomy is an effective and safe procedure for high-risk patients with
acute cholecystitis.  The procedure is
minimally invasive, and the complication rate of percutaneous cholecystostomy
is low.

Anahtar Kelimeler

Acute cholecystitis, Percutaneous cholecystostomy, Complication, Gallbladder drainage

Kaynakça

• Referans1. Akıncı D, Akhan O, Ozmen M, Peynircioglu B, Ozkan O, Karcaaltıncaba M. Yüksek cerrahi riskli hasta grubunda perkütan safra kesesi drenajı sonuçları. Tani Girisim Radyol 2004;10:323-327.Referans2. Chou C K, Lee K C, Chan C C. et al. Early percutaneous cholecystostomy in severe acute cholecystitis reduces the complication rate and duration of hospital stay. Medicine (Baltimore) 2015;94(27):e1096.Referans3. Little M W, Briggs J H, Tapping C R. et al. Percutaneous cholecystostomy: the radiologist's role in treating acute cholecystitis. Clin Radiol 2013;68(7):654–660.Referans4. Akhan O, Akinci D, Oznen MV. Percutaneous cholecystostomy. Eur J Radiol 2002;43:229–236.Referans5. Stanek, A, Dohan, A, Barkun, J, et al. Percutaneous cholecystostomy: A simple bridge to surgery or an alternative option for the management of acute cholecystitis? The American Journal of Surgery (2018). https://doi.org/10.1016/j.amjsurg.2018.01.027 Referans6. Aytekin C. Perkütan Bilier Sistem Drenajları. Trd Sem 2015;3: 216-226.Referans7. vanSonnenberg E, D’Agostino HB, Casola G, Varney RR, Taggart SC, May SR. The benefits of percutaneous cholecystostomy for decompression of selected cases of obstructive jaundice. Radiology 1990;176:15-8. Referans8. Welschbillig-Meunier K, Pessaux P, Lebigot J, Lermite E, Aube Ch, Brehant O, et al. Percutaneous cholecystostomy for high-risk patients with acute cholecystitis. Surg Endosc 2005;19:1256-1259.Referans9. Loberant N, Notes Y, Eitan A, et al. Comparison of early outcome from transperitoneal versus transhepatic percutaneous cholecystostomy. Hepatogastroenterology 2010;57:12e7. Referans10. Overhagen H, Meyers H, Tilanus HW, et al. Percutaneous cholecystostomy for patients with acute cholecystitis and an increased surgical risk. Cardiovasc Intervent Radiol 1996;19:72e6.Referans11. Karakayali FY, Akdur A, Kirnap M, Harman A, Ekici Y, Moray G. Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis. Hepatobiliary Pancreat Dis Int 2014;13:316–322.Referans12. Chang YR, Ahn YJ, Jang JY, et al. Percutaneous cholecystostomy for acute cholecystitis in patients with high comorbidity and re-evaluation of treatment efficacy. Surgery 2014;155:615–622. Referans13. Zerem E, Omerovic S. Can percutaneous cholecystostomy be a definitive management for acute cholecystitis in high-risk patients? Surg Laparosc Endosc Percutan Tech 2014;24:187–191. Referans14. Zeren S, Bayhan Z, Koçak C, Kesici U, Korkmaz M, Ekici MF, Algın MC, Yaylak F. Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis: Percutaneous cholecystostomy. Ulus Travma Acil Cerrahi Derg 2017;23(6):501–506. Referans15. Miura F, Takada T, Kawarada Y, et al. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreatic Surg 2007;14:27–34. Referans16. Sanjay P, Mittapalli D, Marioud A, et al. Clinical outcomes of a percutaneous cholecystostomy for acute cholecystitis: a multicentre analysis. HPB (Oxford) 2013;15:511–516.Referans17. McKay A, Abulfaraj M, Lipschitz J: Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc 2012, 26 (5):1343-1351.Referans18. Winbladh A, Gullstrand P, Svanvik J, et al. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB 2009;11:183–193.Referans19. Nemcek AA, Jr, Bernstein JE, Vogelzang RL. Percutaneous cholecystostomy: does transhepatic puncture preclude a transperitoneal catheter route? J Vasc Interv Radiol 1991;2:543–547.