Meltem ERGÜN, Ali Rıza KÖKSAL, Salih BOĞA, Mehmet BAYRAM, Engin ALTINKAYA, Osman ÖZDOĞAN, Hüseyin ALKIM, Canan ALKIM

Nazobiliyer drenaj halen etkin ve güvenilir bir yöntemdir: Şişli Etfal Hastanesi deneyimi

Giriş ve Amaç: Nazobiliyer drenaj, akut süpüratif kolanjit, safra yollarına açılmış kist hidatik ve postoperatif safra kaçaklarında endoskopik tedavi metodu olarak kullanılmaktadır. Biz de kliniğimizde nazobiliyer drenaj kateterinin etkinliği ve güvenilirliğini retrospektif olarak incelemeyi amaçladık. Gereç ve Yöntem:Ocak 2011 ile Aralık 2012 arasında Şişli Etfal Eğitim ve Araştırma Hastanesi Gastroentereoloji Kliniği Endoskopi ünitesinde nazobiliyer drenaj kateteri takılmış olan 22 hasta çalışmaya alındı. Hastaların demografik özellikleri, laboratuvar değerleri, hastalara yapılan işlemler, işlem sonrası klinik seyir ve işlem komplikasyonları retrospektif olarak değerlendirildi. Bulgular: Nazobiliyer drenaj kateteri 12-84 yaş arası (Ortalama 54,3 ±24,4) 22 hastaya (11 kadın) takılmıştır. Akut süpüratif kolanjit nedeniyle 11 hastaya, safra yollarına açılmış kist hidatik nedeniyle 4 hastaya, postoperatif kaçak nedeniyle 3 hastaya, eksternal safra kaçağı sebebiyle 2 hastaya ve hemobilia nedeniyle 2 hastaya nazobiliyer drenaj kateteri uygulaması yapılmıştır. Ortalama kateter kalış süresi 8,4±6,2 gün olup, bilirubin düzeyleri normalizasyonu da 4±0,6 günde gerçekleşmiştir. Hastaların tamamı nazobiliyer drenajın konforsuz bir tedavi şekli olduğunu ifade etseler de, hiçbirinde nazobiliyer kateter dislokasyonu gerçekleşmemiştir. Endoskopik retrograd kolanjiyopankreatografi işlemi ile ilişkili komplikasyon ve mortalite saptanmamıştır. Sonuç: Nazobiliyer drenaj akut süpüratif kolanjit, postoperatif safra kaçağı, safra yollarına açılmış kist hidatikte etkin ve güvenilir bir tedavi yöntemidir.

Anahtar Kelimeler:

Nazobiliyer drenaj, kolanjit, safra kaçağ

Nasobiliary drainage is still an effective and reliable treatment modality: Şişli Etfal Hospital experience

Background and Aims: Nasobiliary drainage is an established mode of treatment for acute suppurative cholangitis, bile leakage and biliary fistula. We retrospectively analyzed the safety and efficacy of nasobiliary drainage placement for biliary drainage in patients with acute cholangitis. Materials and Methods: Between January 2011 and December 2012, nasobiliary drainage was performed in 22 patients at Şişli Etfal Training and Education Hospital. The clinical characteristics, laboratory results, clinical outcomes, and complications were analyzed retrospectively. Results:Nasobiliary drainage was performed in 22 patients (11 female), and the mean age was 54,3±24,4 years (range, 12-84). Acute suppurative cholangitis (n=11), hydatid cyst with biliary communication (n=4), postoperative biliary leak (n=3), external biliary leakage (n=2), and hemobilia (n=2) were the main indications of nasobiliary drainage. The catheter was removed in 8,4±6,2 days, and time elapsed to normalization of total serum bilirubin levels was 4±0,6 days. There were no endoscopic retrograde cholangiopancreatography -related complications. Although it is not a comfortable treatment modality, there were no instances of displacement or kinking of the nasobiliary drainage.Conclusions: Biliary drainage by nasobiliary drainage is a safe and effective treatment in patients with severe cholangitis, postoperative bile leakage and bile fistula.

Keywords:

Nasobiliary drainage, cholangitis, biliary leakage,

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