Müge YILDIRIM, Utku Mahir YILDIRIM, Umut ÖZYER

Akut kolesistit tedavisinde perkütan kolesistostomi: 10-yıllık tek merkez deneyimi

Amaç: Akut kolesistitli hastalarda ultrasonografi kılavuzluğunda perkütan kolesistostomi (PK) işleminin teknik başarısı, klinik sonuçları ve güvenilirliğini değerlendirmek.Gereç ve Yöntem: 2000-2011 yılları arasında akut kolesistit tanısı alan ve PK ile tedavi edilen hastaların kayıtları retrospektif olarak değerlendirildi. ASA skorları, beyaz küre değerleri, safra taşı varlığı, safra kültürleri, ek işlemler, elektif cerrahi, işleme bağlı komplikasyonlar ve mortalite değerlendirildi.Bulgular: Yaşları 31 ile 100 arası 127 hastaya (72 erkek, 55 kadın) PK kateteri ile tedavi yapıldı. İşlemin teknik başarısı %100, klinik başarısı % 86 bulundu. İşleme bağlı mortalite veya erken major komplikasyon izlenmedi. Minör komplikasyon oranı %7 (9/127) , geç major komplikasyon oranı %3 (4/127) olup 30 günde hastanede mortalite oranı %8 (10/127) bulundu. Altı hasta elektif kolesistektomi sonrası, 4 hasta da PK kateteri takılı durumda öldü. PK ile akalkülöz kolesistitli hastaların %74'ünde (17/23) tedavi sağlandı ve cerrahi yapılmadı. Akut taşlı kolesistitli hastaların % 58'inde (31/53) sadece PK ile tedavi yapıldı ve bunların %10'unda (3/31) takipte nüks kolesistit gelişti.Sonuç: Akut kolesistit hastalarında PK primer kolesistektomiye tercih edilmelidir. İşlem kolay yapılabilir bir işlem olup yüksek teknik ve klinik başarı ve düşük komplikasyon oranlarına sahiptir. Yüksek cerrahi riski olan hastalarda kesin tedavi sağlayabilen bir seçenek olarak kullanılabilir.

Anahtar Kelimeler:

Girişimsel radyoloji, ultrasonografi, akut kolesistit

Treatment with ultrasound guided percutaneous cholecystostomy in acute cholecystitis: 10-year a single-center experience

Purpose: Evaluating the technical success, clinical outcomes and safety of ultrasound-guided percutaneous cholecystostomy (PC) in patients with acute cholecystitis.Material and Methods: Medical records of patients diagnosed as acute cholecystitis and treated with PC from year 2000 to 2011 were retrospectively examined. ASA scores, leukocyte counts, gall stone presence, bile cultures, additional interventions, interval surgery, procedure-related complications and mortality were reviewed.Results: PC catheters were placed in 127 patients (72 male, 55 female) aged from 31 to 100 years. Technical success of the procedure was 100%. Clinical success was obtained in 86% of the patients. No procedure related mortality or early major complications were observed. Minor complication rate was 7% (9/127) and late major complication rate was 3% (4/127). Thirty day in-hospital mortality rate was 8% (10/127). Six patients died after interval cholecystectomy and 4 patients died before the operation. PC served as a definitive treatment in 74% (17/23) of the patients with acalculous cholecystitis. Fifty-eight percent (31/53) of the patients with acute calculous cholecystitis were treated only with percutaneous cholecystostomy and only 10% (3/31) had recurrent cholecystitis in follow up.Conclusion: PC can be preferred over primary cholecystectomy in acute cholecystitis patients. The procedure has high technical success, high clinical response and low complication rates. It can also serve as a definitive treatment option in patients with high surgical risk.

Keywords:

Interventional radiology ultrasonography, acute cholecystitis, cholecystectomy.,

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