Hasan ERDEM, Mehmet AZİRET, Süleyman ÇETİNKÜNAR, Kemal TEKEŞİN, Savaş BAYRAK, Hilmi BOZKURT, Edip BAYRAK, OKTAY İRKÖRÜCÜ

Ciddi Komorbiditesi olan Geriyatrik Akut Kolesistitli Hastalarda Perkütan Kolesistostominin Performansı

Amaç: Perkütan kolesistostomi (PK) yaşlı ve komorbiditesi yüksek akut kolesistitli (AK) hastalarda tedavi seçenekleri arasındadır. Ciddi komorbiditesi olan geriyatrik akut kolesistitli hastalarda PK'nin başarılı tedavi ve takibini sunmayı planladık. Gereç ve Yöntem: 2011 Kasım ve 2014 Ekim arasında, 65 yaş üstü ve PK yapılan akut kolesistitli hastalar retrospektif olarak incelendi. Hastaların yaş, cinsiyet, kolesistostomi endikasyonu, eşlik eden hastalık, hastanede kalış süresi, takip süresi, işlem sonrası drenaj miktarı, kültür sonuçları, başarı oranı, işleme bağlı komplikasyonlar ve PK sonrası yapılan medikal ve cerrahi tedaviler kaydedildi. Bulgular: Toplam 22 PK yapılan hasta çalışmaya dahil edildi ve çalışma hastane veri tabanı, hasta dosyaları ve ameliyat notları incelenerek retrospektif olarak yapıldı. Hastaların 9'u bayan, 13'ü erkekti ve ortalama yaş 76.5 yıldı. Ortalama takip süresi 28.2 ay, ortalama hastanede kalış süresi 7 gün ve ortalama dren kalma süresi 31.2 (29.2-36.2) gündü. Hastaların takiplerinin sonunda 18 hastaya (% 82) kateterin çıkarılması dışında ek işlem yapılmazken, 4 hastaya (18%) ileri tedavi yapıldı. Sonuç: Radder tarafından 1980 yılında PK işlemi ilk kez tariflenmesinden itibaren kullanımı giderek artmaktadır. Yüksek kardiyak ve pulmoner sorunları olan yaşlı hastaların tedavilerinde PK sıklıkla kullanılmaktadır. PK'ler yüksek riskli yaşlı hastalarda düşük maliyeti, hızlı etkili olması ve düşük komplikasyonlarıyla akut kolesistitli hastalarda, geçici veya kalıcı tedavi metodu olarak kullanılabilir.

The Performance of Percutaneous Cholecystostomy in Geriatric Patients with Acute Cholecystitis Accompanying Serious Comorbidities

Objective: A percutaneous cholecystostomy (PC) may be listed among the treatment options for cases of acute cholecystitis (AC) in geriatric patients with accompanying comorbidities. We report on geriatric patients with high rates of comorbidities and AC who underwent a successful PC treatment and received follow-up care. Material and Method: Patients who were diagnosed with AC, were over the age of 65 and underwent a PC because of operative comorbidities between November 2011 and October 2014 were examined retrospectively. Patients' age, gender, cholecystostomy indications, accompanying diseases, duration of stay in hospital, duration of follow-up, amount of drainage after the procedure, culture results, success of the procedure, complications related to the procedure and records of the surgical and medical treatments after PC were recorded. Results: A total of 22 patients who received a PC were enrolled in the study and retrospectively investigated using database information, patient files and operative notes. Nine of the patients were female, 13 were male and the mean age was 76.5 years. The mean follow-up period was 28.2 months; the length of hospital stay was 7 days; and the mean duration of drain was 31.2 (29.2-36.2) days. Definitive treatment was performed on 4 (18%) of the patients, while in 18 (82%) of the patients, catheter was removed without any additional procedures. Conclusion: The use of PC has increased since it was first described by Radder in 1980. In geriatric patients with high cardiac and pulmonary morbidity, a PC is often used for treatment. As a low cost, quickly effective, time-saving treatment method with low complication rates, PCs can be used as a temporary or definitive treatment method for cases of AC in high risk geriatric patients.

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