Muhammed DAĞKIRAN

Şilöz fistül tedavisinde oktreotidin başlangıç tedavisi olarak etkinliği

Amaç: Bu çalışmanın amacı boyun diseksiyonu sonrasında düşük yada yüksek akımlı şilöz fistül (ŞF) gelişen hastalarda başlangıç tedavisi olarak kullanılan ve somatostatin analoğu olan oktreotidin etkinliğinin araştırılmasıdır.Gereç ve Yöntem: Çalışmaya 2010-2019 yılları arasında boyun diseksiyonu yapılan ve sonrasında şilöz fistül gelişen 21 hasta dahil edildi. Bütün hastaların konservatif tedavisine oktreotid başlangıç tedavisi olarak eklendi. Hastaların yaşı, cinsiyeti, boyun diseksiyonu için cerrahi endikasyonları, boyun diseksiyonu tipi, ŞF’ ün kaç gün sürdüğü ve kaç gün oktreotid aldığı, 24 saatte ki şilöz sıvı miktarı, toplam hastanede yatış süreleri ve tedaviye bağlı ortaya çıkan komplikasyonlar değerlendirildi.Bulgular: İki hastada sağ, 19 hastada ise sol tarafta ŞF izlendi. Hastaların %52.3 ünde (11/21) intraoperatif ŞF fark edildi. On üç hasta düşük akımlı, 8 hastada yüksek akımlı ŞF vardı. Düşük akımlılarda %100 (13/13), yüksek akımlılarda %62.5 (5/8), toplamda ise %85.71 (18/21) tedavi başarısı izlendi. Yüksek akımlı ŞF’ü olan 3 hastaya cerrahi tedavi gereksinimi oldu. Cerrahi tedaviye gerek duyulmadan oktreotid alan hastalarda ortalama fistül kapanma süresi 4.2 gün olarak bulundu. İstatiksel olarak oktreotid tedavisi ile kontrol sağlanan grup ile cerrahi gerektiren grup arasında sadece düşük akımlı veya yüksek akımlı ŞF olması arasında anlamlı fark bulundu.Sonuç: Çalışmamız göstermiştir ki oktreotidin hem düşük akımlı hem de yüksek akımlı ŞF kontrolünde başlangıç tedavisi olarak konservatif tedaviye dahil edilmesi başarılı sonuçlar sağlamaktadır.

Anahtar Kelimeler:

Boyun diseksiyonu, Somatostatin

Efficacy of octreotide as initial therapy in the treatment of chylous fistula

Purpose: The aim of this study was to investigate the efficacy of octreotide used as initial treatment in patients with low or high flow chylous fistula (CF) after neck dissection.Materials and Methods: Twenty-one patients who underwent neck dissection between 2010-2019 and developed chylous fistula were included in this study. Octreotide was added to the conservative treatment of all patients as initial treatment. Age, gender, surgical indications for neck dissection, type of neck dissection, the duration of CF and octreotid treatment, the amount of chylous fluid in 24 hours, total hospitalization time and treatment-related complications were evaluated.Results: Two patients had CF on the right side and 19 patients on the left side. Intraoperative CF was detected in 52.3% (11/21) of the patients. Thirteen patients had low-flow and 8 patients had high-flow CF. Treatment success was 100% (13/13) in low flow, 62.5% (5/8) in high flow, and 85.71% (18/21) in total. Three patients with high-flow CF required surgical treatment. Mean duration of fistula closure was 4.2 days in patients receiving octreotide without surgical treatment. Only to be low-flow or high-flow CP was found as a statistically significant between the group that CP controlled with octreotide treatment and the group required surgery.Conclusion: Our study showed that the addition of octreotide to conservative treatment as an initial treatment in both low-flow and high-flow CF provided successful results.

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