Karaciğer Kist Hidatik Hastalıklı Çocuk Olgularda Bilier Sistem Komplikasyonları Daha Mı Az Görülür ?

Yıl 2009, Cilt: 3 Sayı: 4, 34 - 39, 01.04.2009

H. Tuğrul Tiryaki Emrah Şenel Fatih Akbıyık Ervin Mambet Ziya Livanelioğlu Halil F. Atayurt

Öz

Amaç: Kist Hidatik (KH) hastalığı Echinococcus granulosus’a bağlı gelişen parazitik bir enfestasyondur. Olguların %50-70’inde karaciğer tutulumu olur. Karaciğer hidatik kistli olgularda en sık karşılaşılan komplikasyon, kistobilier ilişkinin olmasıdır. Çocuk karaciğer kist hidatikli olgularda, yüksek mortalite ve morbidite saptanan erişkin serileri ile karşılaştırıldığında, düşük komplikasyon oranları görülmektedir. Çalışmamızda karaciğer kist hidatikli çocuk olgularımızda saptadığımız komplikasyonlar değerlendirilerek literatürdeki erişkin serileri ile karşılaştırıldı.Metod: Karaciğer kist hidatikli 74 olgu geriye dönük olarak değerlendirildi. Hidatid kist tanısı tüm olgularda radyolojik incelemeler ile konuldu. Olgularımız ortalama 30 ay izlemde tutuldular.Bulgular: 2-15 yaş arasında (ortalama 9.5 yaş) 44 kız, 30 erkek olgu değerlendirmeye alındı. 74 olguda toplam 94 karaciğer hidatik kisti tedavi edildi. Serimizdeki olguların hiçbirinde ameliyat öncesi tıkanma sarılığı ve kolanjit bulguları saptanmadı. Üç olguda (%4) kist tekrarladı. Bir olguda (%1.3) uzamış safra drenajı ile karşılaşıldı. Dört olguda (% 5.4) 5 mm’nin altında safra yolu açıklığı gözlendi. Bir olgumuzda operasyon sırasında anaflaktik reaksiyon ile karşılaşıldı. Serimizde kaybedilen olgu olmadı.Sonuç: Erişkin serilerinin aksine komplike karaciğer kist hidatiği ile çocuk olgularda karşılaşmadık. Bu çalışmaya göre erişkinde karaciğer kist hidatiği hastalığı için belirlenen kist büyüklüğü, kistin lokalizasyonu gibi morbidite göstergeleri çocuk olgularda aynı şekilde morbiditeyi etkilemeyebilir. Bu nedenle çocuklarda özellikle bilier sisteme yönelik cerrahi girişimlerden kaçınılması vurgulanmak istenmiştir.

Anahtar Kelimeler

Hidatik kist, Bilier komplikasyon

IS THE BILIARY COMPLICATION REALLY SEEN LESSER IN CHILDREN WITH HYDATID LIVER DISEASE ?

Öz

Background: Hydatid disease (HD) is a parasitic infection caused by Echinococcus granulosus. The liver is involved in 50-70 % of the cases. Cystobiliary communication is the most common complication of hepatic hydatid cysts. Low frequency of the complications of liver hydatid disease is noted in children when compared to adult series with high mortality and morbidity.We present our experience of complications in childhood liver hydatid cyst disease and compare the results with adult series.Methods: Seventy four cases of HD have been evaluated retrospectively. The diagnosis of HD was made on the basis of radiologic imaging methods. The median follow-up period was 30 months.Results: There were 44 females and 30 males, age ranging from 2 to 15 years (mean 9.5 years). Overall 94 liver hydatid cysts in 74 patients were treated. Obstructive jaundice and signs of cholangitis were not noted preoperatively in our series. Recurrence of cyst was seen in three patients (4%). Prolonged bilier drainage was seen in one patient (1.3%). Four patients (5.4 %) of our series had biliary opening up tosize of 5 mm . Anaphlactic reaction was seen in one patient intraoperatively. There were no mortalities.Conclusion: Unlike adult series we did not encountered complicated cyst hydatid disease in childhood. Predictors of morbidity for liver hydatid cyst in adults like age, size of the cyst, location of the cyst are not valid predictors in children. Therefore surgeons must be avoid of surgical procedure in children especially at biliary system

Anahtar Kelimeler

Hydatid cyst, biliary complication

Kaynakça

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