Emin KÖSE, Nilay Tuğba BAZ, Deniz TAZEOĞLU, Mehmet Emin GÜRBÜZ, Hasan TOK, Ayhan ÖZSOY, Servet Rüştü KARAHAN

Karaciğer hidatik kist cerrahisi sonrası oluşan safra fistülünün gelişimindeki risk faktörlerinin retrospektif analizi

Amaç: Karaciğer hidatik kist hastalığı Echinococcus granulosus’un neden olduğu, Türkiye’de yaygın görülen bir parazitozdur. Karaciğer kist hidatik cerrahisi sonrası en sık gelişen komplikasyon safra fistülüdür. Bu çalışmadaki amacımız safra fistülü gelişimini etkileyen değişkenleri ortaya koymak ve uygun tedavi seçeneklerini incelemektir.Yöntemler: Bu çalışmaya karaciğer kist hidatik cerrahisi uygulanmış olan 118 hasta dahil edildi. Hastalar safra fistülü gelişen (grup2) ve gelişmeyen (grup1) olarak iki gruba ayrıldı ve değişkenler analiz edildi: yaş, hematolojik ve karaciğer fonksiyon testleri ve kistin özellikleri (tip, kist boyutu, sayısı ve yerleşim yeri).Bulgular: 118 hastanın 19 (%16)’unda safra fistülü saptandı. Grup 2’de kist boyutu, lökosit, alkalin fosfataz ve g-Glutamin transpeptidaz değerleri tek değişkenli analiz sonucuna göre grup 1’den daha yüksekti (p=0,03, p=0,008, p=0,04, p=0,001). Çok değişkenli analiz sonucuna göre; safra fistülü gelişimine etki eden tek bağımsız değişken yalnızca kist boyutu olarak saptandı (olasılık oranı 0.03, 95% güven aralığı 0,002-0,06; p=0,03). İşlem karakteristik eğrisine göre, kist boyutlarının 100% duyarlılık, 100% özgüllük ve eşik değeri, sırasıyla 7,5 cm, 4,0 cm ve 14,6 cm olarak bulundu. (Eğrinin altındaki alan 0,67). Sonuç: Safra fistülünün tahmininde preoperatif kist boyutu önemli bir parametredir. Bizim çalışmamıza göre; kist boyutunun 7,5 cm’den büyük olması safra fistülü gelişimi için bir risk faktörüdür.

Anahtar Kelimeler:

Karaciğer kist hidatik hastalığı, safra fistülü, Echinococcus granulosus

Retrospective analysis of risk factors for development of biliary fistula after liver cyst hydatid surgery

Aim: Hepatic hydatidosis is common parasitosis in Turkey and caused by Echinococcus granulosus. Biliary fistula is the most common complication after liver hydatid cyst surgery. The aim of this study was to investigate an appropriate treatment strategy for patients whose biliary fistula might develop, by revealing variables that affect biliary fistula.Methods: A total of 118 patients who underwent liver hydatid cyst surgery were included in this study. The following variables were analyzed between patients with biliary fistula (group 2) and without fistula (group 1): Age, gender, hematologic and liver function tests, and features of the cysts (type, cyst size, number, and localization).Results: Cystobiliary fistula was detected in 19 (16%) of 118 patients. In-group 2, cyst size, white blood cell, alkaline phosphatase and g-Glutamyl transpeptidase levels were higher than group 1 on univariate analysis (p=0.03, p=0.008, p=0.04 and p=0.001, respectively). In the multivariate model, only cyst diameter remained as an independent predictor (odds ratio 0.03, 95% confidence interval 0.002 to 0.06; p=0.03) On the receiver operating characteristic curve, the 100% sensitive, 100% specific, and optimal cutoffs of the cyst diameter were 7.5 cm, 4.0 cm and14.6 cm, respectively (The area under the receiver operator characteristic curve was 0.67). Conclusion: Preoperative cyst size is a valuable parameter for predicting biliary fistula. Our study suggests that cyst size greater than 7.5 cm is a risk factor for biliary fistula.

Keywords:

Hydatid liver disease, Cystobiliary fistula, Echinococcus granulosus,

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