Karaciğer Kist Hidatiğinin Cerrahi ve Perkütan Tedavi Sonuçlarının Karşılaştırılması

Yıl 2014, Cilt: 8 Sayı: 3, 141 - 145, 01.06.2014

Bilge Karabulut Gülşah Bayram Müjdem Nur Azılı Fatma Özcan Atilla Şenaylı Fatih Akbıyık Ervin Mambet Emrah Şenel Yusuf Ziya Livanelioğlu Tuğrul Tiryaki

Öz

ÖZETAmaç: Bu çalışmada kliniğimizde karaciğer kist hidatiği (KCKH) sebebi ile açık opere edilen hastalar ile girişimsel radyoloji ünitesinde perkütan yöntemle tedavi edilen hastaların tedavi sonuçlarının karşılaştırılması amaçlandı.Materyal ve Metod: 1997-2013 yılları arası KCKH nedeniyle tedavi edilen 114 hasta geriye dönük olarak incelendi. Hastalar demografik açıdan, geliş şikayetleri, kistin özellikleri ve işlemlerin komplikasyonları açısından incelendi. Bulgular: Hastalar yaşları 6 ila 16 yıl arasında olan 47 erkek (% 40.9), 67 kız (%58.3) olgudan oluşmaktaydı. Hastaların %49’u ağrı, %37.7’si karında şişlik ve 1 hasta ise tıkanma sarılığı şikayeti ile başvururken KCKH insidantel olarak 14 hastada (%12.3) tesbit edildi. KCKH 90 hastada (%79) tek iken 24 hastada 10’a kadar olan çoklu kist mevcuttu. Sadece karaciğer lokalizasyonlu kist 85(%74.6) hastada mevcutken 29 hastada (%25.4) ise en fazla akciğer olmak üzere karaciğerle beraber diğer organlarda da KH tutulumu vardı. Kistin çapı 3-16 cm arasında değişmekteydi. Açık opere olanlarda kist çapı ortalama 96 mm iken, perkütan tedavi uygulanan grupta ortalama çap 70 mm’di (p=0.001). Hastaların 82’sine (%72) açık operasyon, 32’sine (%28) perkütan tedavi uygulandı. Toplam 4 hastada nüks (açık opere), 3 kist enfeksiyonu (açık opere), 3 uzamış safra drenajı (1’i perkütan tedavi) tespit edilmiştir. Peroperatif safra kanalı ile ilişki açık opere olan 5 hastada görüldü. Açık opere edilenlerde başvuruda ağrı şikayeti daha az, kitle şikayeti fazla iken; PAİR grubunda bunun tam tersiydi (p=0.001). PAİR grubunda izole KCKH fazla iken KCKH’yla beraber akciğer kist hidatiği’i cerrahi grupta fazlaydı (p=0.002). Gruplar diğer parametreler açısından benzerdi.Sonuç: Perkütan tedavi minimal invaziv, skarsız, düşük morbidite ve mortalite oranlarına ve kısa hastanede kalış süresine sahip olması sebebiyle seçilmiş KCKH vakalarında öncelikle uygulanması gereken bir yöntem olmakla beraber komplike vakalarda (tip 2, 3b) açık cerrahi onarım düşünülmelidir.

Anahtar Kelimeler

Karaciğer Kist Hidatikleri, Pediatrik hasta, perkutan tedavi

Outcome Comparison of Liver Hydatid Cysts Following Surgical and Percutaneous Treatment

Öz

Objective: The aim of our study was to compare the outcomes of patients who had undergone surgery or percutaneous treatment for liver hydatid cyst (LHC) in our clinic. Material and Methods: A total of 114 patients treated for LHC between the years 1997 to 2013 were evaluated retrospectively from their fi les. Patients were evaluated in terms of demographic characteristics, complaints, cyst characteristics and complications.Results: There were 47 (41.2 %) males and 67 female (58.8%) aged between 6 and 16 years. The complaint was pain in 49% and abdominal swelling in 37.7%, while obstructive jaundice was present in 1 patient at the time of presentation. The cyst was found incidentally in 14 (12%) patients. Only one cyst was present in 90 patients (79%) and there were multiple cysts in 24 patients (maximum 10). The cyst was localized in the liver in 85 (74.6%) patients while there were other cysts, mostly in the lung in 29 (25.6%) patients. The cyst size was 3 to 16 cm. The mean cyst size in the patients undergoing surgery and percutaneous treatment was 96 mm and 70 mm respectively (p=0.001). Surgery was used in 82 (72%) patients and percutaneous treatment in 32 (28%). There were 4 recurrences (in the operated group), 3 cyst infections (in the operated group), and 3 prolonged biliary drainage cases (1 in the percutaneous treated group). Bile duct connection was seen in 5 patients who underwent open surgery. Abdominal swelling was more frequent than pain at presentation in the surgical group while the opposite was true for the percutaneous treatment group (p=0.001). The isolated LHC rate was higher in the PAIR (Puncture, Aspiration, Injection, Reaspiration) group than the operated group. The rate of LHC together with pulmonary cyst was higher in the surgical group (p=0.002). The groups were similar in terms of other parameters. Conclusion: Percutaneous treatment could be used as the primary treatment for LHC in selected cases as it is minimally invasive, does not cause scarring, and has a low morbidity and mortality rate and shorter hospitalization period, although surgical repair should be considered in complicated cases

Anahtar Kelimeler

Liver hydatid cyst in children, Percutaneous treatment

Kaynakça

• Tiryaki HT, Şenel E, Akbıyık F, Mambet E, Livanelioğlu Z, Atayurt HF. Karaciğer kist hidatik hastalıklı çocuk olgularda bilier sistem komplikasyonları daha mı az görülür? Türkiye Çocuk Hast Derg 2009; 3:34-9.
• Tiryaki T, Şenel E, Akbıyık F, Mambet E, Livanelioğlu Z, Atayurt H. Kist hidatik hastalıklı çocuklarda on yıllık deneyimimiz. Türkiye Çocuk Hast Derg 2008;2:19-25.
• Ammann RW, Eckert J. Cestodes. Echinococcus, Gastroenterol Clin North Am 1996;25:655-89.
• Anonymous. Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull WHO 1996;74:231-42.
• Akbulut S, Senol A, Sezgin A, Cakabay B, Dursun M, Satici O. Radical vs conservative surgery for hydatid liver cysts: Experience from single center. World J Gastroenterol 2010;16:953-9.
• Puliga A, Sulis R, Pala M, Sechi R, Pietrangeli M. Surgical treatment of hydatid liver cysts: 20 more years of experience. Chir Ital 2003;55:533-40.
• Kapan S, Turhan AN, Kalayci MU, Alis H, Aygun E. Albendazole is not effective for primary treatment of hepatic hydatid cysts. J Gastrointest Surg 2008;12:867-71.
• Todorov T, Vutova K, Mechkov G, Petkov D, Nedelkov G, Tonchev Z. Evaluation of response to chemotherapy of human cystic echinococcosis. Br J Radiol 1990; 63:523-31.
• Men S, Hekimoğlu B, Yücesoy C, Arda IS, Baran I. Percutaneous treatment of hepatic hydatid cysts: An alternative to surgery. AJR Am J Roentgenol 1999;172:83-9.
• Akhan O, Ozmen MN. Percutaneous treatment of liver hydatid cysts. Eur J Radiol 1999;32:76-85.
• Giorgio A, Di Sarno A, de Stefano G, Farella N, Matteucci P, Scognamiglio U, Giorgio V. Percutaneous treatment of hydatid liver cyst. Recent Pat Antiinfect Drug Discov 2009;4:29-36.
• Brunetti E, Kern P, Vuitton DA. Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010;114:1-16.
• Kahriman G, Ozcan N, Donmez H. Hydatid cysts of the liver in children: Percutaneous treatment with ultrasound follow-up. Pediatr Radiol 2011; 41:890-4.
• Kalyoncu AF, Selçuk ZT, Emri AS, Cöplü L, Sahin AA, Bariş YI. Echinococcosis in the Middle East and Turkey. Rev Infect Dis 1991;13:1028-9.
• Sayek I, Tirnaksiz MB, Dogan R. Cystic hydatid disease: Current trends in diagnosis and management. Surg Today 2004;34: 987-96.
• Donnellan WL. Hydatid cyst in children. Abdominal Surgery of Infancy and Children. Luxemburg: Harwood Academic Publishers, 64:19-25
• Yagci G, Ustunsoz B, Kaymakcioglu N, Bozlar U, Gorgulu S, Simsek A, et al. Results of surgical, laparoscopic, and percutaneous treatment for hydatid disease of the liver: 10 years experience with 355 patients. World J Surg 2005;29:1670-9.
• Brunetti E, Garcia HH, Junghanss T. International CE Workshop in Lima, Peru, 2009. Cystic echinococcosis: Chronic, complex, and still neglected. PLoS Negl Trop Dis 2011;5:e1146.
• Sayek I, Yalin R, Sanaç Y. Surgical treatment of hydatid disease of the liver. Arch Surg 1980;115:847-50.
• Yorganci K, Sayek I. Surgical treatment of hydatid cysts of the liver in the era of percutaneous treatment. Am J Surg 2002;184:63-9.
• Dziri C, Paquet JC, Hay JM, Fingerhut A, Msika S, Zeitoun G, et al. Omentoplasty in the prevention of deep abdominal complications after surgery for hydatid disease of the liver: A multicenter, prospective, randomized trial. French Associations for Surgical Research. J Am Coll Surg 1999;188:281-9.
• Demirbilek S, Sander S, Atayurt HF, Aydin G. Hydatid disease of the liver in childhood: The success of medical therapy and surgical alternatives. Pediatr Surg Int 2001;17:373-7.
• Akhan O, Ozmen MN, Dinçer A, Sayek I, Göçmen A. Liver hydatid disease: Long-term results of percutaneous treatment. Radiology 1996;198:259-64.
• Khuroo MS, Dar MY, Yattoo GN, Zargar SA, Javaid G, Khan BA, et al. Percutaneous drainage versus albendazole therapy in hepatic hydatidosis: A prospective, randomized study. Gastroenterology 1993;104:1452-9.
• Shams-Ul-Bari, Arif SH, Malik AA, Khaja AR, Dass TA, Naikoo ZA. Role of albendazole in the management of hydatid cyst liver. Saudi J Gastroenterol 2011;17:343-7.
• Mueller PR, Dawson SL, Ferrucci JT, Jr, Nardi GL. Hepatic echinococcal cyst: Successful percutaneous drainage. Radiology 1985;155:627-8.
• Ben Amor N, Gargouri M, Gharbi HA, Ghorbel A, Golvan YJ, Hammou-Jeddi H, et al. Treatment of hepatic hydatid cyst in sheep by echographic puncture. Tunis Med 1986;64:325-31.
• Gargouri M, Ben Amor N, Ben Chehida F, Hammou A, Gharbi HA, Ben Cheikh M, et al. Percutaneous treatment of hydatid cysts (Echinococcus granulosus). Cardiovasc Intervent Radiol 1990;13:169-73.
• Khuroo MS, Zargar SA, Mahajan R. Echinococcus granulosus cysts in the liver: Management with percutaneous drainage. Radiology 1991;180:141-5.
• Rajesh R, Dalip DS, Anupam J, Jaisiram A. Effectiveness of puncture-aspiration-injection-reaspiration in the treatment of hepatic hydatid cysts. Iran J Radiol 2013;10:68-73.
• Gharbi HA, Hassine W, Brauner MW, Dupuch K. Ultrasound examination of the hydatic liver. Radiol 1981;139:459-63.
• Giorgio A, Calisti G, de Stefano G, Farella N, Scognamiglio U, Giorgio V. Percutaneous treatment of hydatid liver cysts: An update. Recent Pat Antiinfect Drug Discov 2012;7:231-6.
• Kabaalioğlu A, Ceken K, Alimoglu E, Apaydin A. Percutaneous imaging-guided treatment of hydatid liver cysts: Do long-term results make it a fi rst choice? Eur J Radiol 2006; 59:65-73.
• Celebi F, Balik AA, Salman AB, Oren D. Hydatid disease in childhood. Pediatr Surg Int 2002;18:417-9.