Bahattin DALKILIÇ, Nuh Zafer CANTÜRK, Cihan YILDIRIR, Nihat Zafer UTKAN

Biliyer, Pankreatik ve Enterokutanöz Fistullerde Oktreotid Asetatın Etkisi

Amaç: Laparatomi sonrası oluşan enterokutanöz, bilier ve pankreatik fistül gastrointestinal sistemin istirahati ve parenteral beslenme gibi klasik tedaviler ya da buna ilaveten oktreotid ile tedavi edilebilmektedir. Oktreotidin subkutan uygulaması tüm olgularda fistül outputunu azalttığı bildirilmiştir. Yöntem: Bizde gastrointestinal sistemin istirahati ve parenteral beslenme gibi klasik yöntemler veya buna ilaveten oktreotid uygulanan hastalarımızı inceledik. Bulgular: Klasik tedavi ile spontan fistül kapanma süresi ortalama 37,57±7,06 gün ve hastanede kalış süresi ise 44,93±6,30 gün idi. Oysa bu değerler oktreotid ilave edilen tedavi grubunda ise 23,3±5,53 ve 32,85±6,32 idi. Fistül kapanma zamanı, hastanede kalış süresi ve debileri karşılaştırıldığında aralarında fark yoktu (p>0, 05). Cerrahi müdahele gereksinimi açısından gruplar arasında fark saptandı (p<0, 05). Sonuç: Sonuçlarımız oktreotidin gastrointestinal sekrasyonu azaltarak enterokütan fistüllerde iyileşmeyi kolaylaştırıcı bir ajan olduğunu düşündürmektedir.

Anahtar Kelimeler:

Fistül, oktreotid, Biliyer

Effects of Octreotid on Biliary, Pancreatic, and Enterocutaneous Fistulas

Objective: Enterocutaneous, biliary or pancreatic fistulas appearing after laparatomy are treated with the classical methods or these plus octreotid. It has been suggested that subcutaneous injections of octreotid diminish output from the fistula in all cases. Methods: We evaluated our patients who were treated by classical methods or those plus octreotid injection. Results: Spontaneous fistula closure occurred after 37.57±7. 06 days of treatment with classical treatment. The mean hospital stay was 44.93±6.30 days and bowel function was restored to normal. Those results for octreotid treatment were respectively 23.3±5.53 days and 32.85±6.32 days . When compared, fistula closure time, hospital stay period and flow rate were not statistically different between both groups (p>0.05) . Necessity of operation in both groups were significantly different (p<0. 05). Conclusion: Our preliminary results indicated that octreotid can promote healing of enterocutaneous fistula by inhibiting gastrointestinal secretions.

Keywords:

Fistula, octreotid, Effects,

PDF

___

Fazio VW, Coutsoflides T, Steiger E. Factors influencing the outcome of treatment of small bowel cutaneousfistula. World J Surg. 1983;7(4):481-488.
Geerdson JP, Pederson VM, KJaergard HK. Small bowel fistulas treated with somatostatin:Preliminary results. Surgery. 1986;100(5):881-885.
Aribal D, Bumin C, Koçak S, Karayalçın K, Ozden H. Enterokiltan fistill tedavisinde somatostatin analogu SMS 201-995 (Sandostatin) uygulaması.Klinik Araştırmalar Bülteni. 1992;16:18-19.
Curtin JP, Burt LL. Case report. Successuful treatment of small intestine fistula with somatostatin Analog. Gynecol Oncol. 1990;39(2):225-227. doi: 10.1016/0090-8258(90)90438-Q
Siteges-serra A, Jaurrietto E, Siteger-Creus A. Management of postoperative intestinocutanous fistula. The roles of parental nutrition and surgery. Br J Surg. 1982;69(3):147-150. doi: 10.1002/bjs.1800690310
Rose D, Yarkbrough MF, Canizaro PC, Lowry SF. One hundred and fourteen fistulas of the gastrointestinal tract treated with total parenteral nutrition. Surg Gynecol Obst. 1986;163(4):345-348.
Reosbeck PG. Somatostatin treatment of gastrointestinal fistulas. Australian New Zealand J Surg. 1984;54:465-467.
Harris AG. Enterocutaneous and panctreatic fistulas. Klinik Araştırmalar Bülteni. 1992;16:1-17.
Hollander LF, Meyer C, Avet D, Zeyer B. Postoperative fistulas of small intestine : therapeutic principles. World J Surg. 1983;7:474-480.
Townsend CM, Thompson JC. Smalı bowel fistulas, Scwartz SJ, Shires GY, Spencer FC. Principles of Surgery. 6th ed. (In ed) 1994; p:1181-1182.
Locatelli V. Pharmacological profile of octreotide. 'Lecture book '2nd World week of Professional Updating in Surgery and in Surgical and Oncological Disciplines. Montorsi M, Zennaro F (eds.), Imprim Monduzzi, Bologna, pp.1367-1370, 1990.
Mulvihücr S, Pappas TN, Passaro E, Debas HT. Thee use of somatostatin and its analogs in the treatment of surgical disorders. Surgery. 1986;100:467-475.
Lamberts SW. Therapeutic effects of somatostatin analogs. lsı Atlas sci. Pharmacol. SAS, 1988;1241:179-184.
Nubrola Badia JM, Martinez-Rodenas F, Gil Ml, Segura M, Sancho J, Stiges-Serra A. Treatment of 27 postoperative enterocutaneous fistulas with the long half life. Somatostatin analogue SMSD20ı-995. Am Surg. 1989;210:56-58.
Rosenberg L, Brown RA. Sandostatin in the management of nonendocrine gastrointestinal and pancreatic disorders. Preliminary study. Canad J Surg. 1991;34:223-229.
Gullo L, Biliotti G, Pezzilli P. Distefano M,Ancona M:Effect of octreotide (SMS 20ı-995) on meal stimulated pancreatic secretion in three patients with external pancreatic fistula. Am J Gastroenterol. 1991;86(7):892-894.
Tulassay Z, Gupta R, Fehervari l, Flautner L. Long acting somatostatin analogue in the treatment of external pancreatic fistulas. Am J Gastroenterol. 1990;85:1263.
Miranda-Ruiz R, Castañón-González J, Pérez CA, Arias E, Díaz M. Zárate A. Effect of a synthetic somatostatin analogue with delayed action (SMS 201-995) on the biliary expenditure in a patient with an external biliary tract fistula. Revista de gastroenterologia de Mexico. 1990;55(2):67-69.