Atakan SAÇLI, Mehmet YILDIRIM, Savaş YAKAN, Ahmet Deniz UÇAR, Orkun SUBAŞI, Sedat TAN, Nurettin KAHRAMANSOY, Erkan OYMACI, Hilmi YAZICI

TOKYO 2013 REHBERİNE GÖRE AKUT KOLESİSTİT OLGULARIMIZIN DEĞERLENDİRİLMESİ

Giriş: Akut kolesistit, safra kesesinin genellikle safra taşı ile ilişkili olan akut, inflamatuvar bir hastalığıdır. Tanı ve tedavisinde ortak bir dil kullanılabilmesi için Tokyo 2013 (TG13) Rehberi düzenlenmiştir. Bu çalışmanın amacı akut kolesistit tanısıyla tedavi edilen hastaları TG13’e göre derecelendirmek, hastalara uygulanan tedavi yöntemlerini ve hastaların prognostik özelliklerini incelemektir. Gereç ve yöntem: Bu çalışma kliniğimizde akut kolesistit tanısıyla tedavi düzenlenen 100 hastanın geriye dönük taramasıyla demografik ve prognostik özelliklerini ortaya koymayı amaçlamaktadır. Hastalara yapılan ameliyatlar kaydedildi; yatış süreleri ve ek hastalıklar incelenirken, preop ve postop yatış süreleri, operasyon yöntemleri, açık ameliyata dönülüp dönülmediği, postop komplikasyon gelişip gelişmediği ve patoloji sonuçları incelendi. Bulgular: Murphy pozitifliği, sağ üst kadran hassasiyeti ve lökositoz belirgin pozitif saptanırken ateş ve c-reaktif protein (CRP) yüksekliği hastaların büyük kısmında tespit edilmedi. Grade 2 olgularda ateş ve CRP yüksekliği belirginken, Grade 1 olgularda çok düşük oranda saptandı; Grade 3 olgulardaysa saptanmadı. Tanıda USG'nin büyük oranda etkiliyken Grade 3 olguların %50'sinde ek görüntülemeye başvuruldu. Hastaların %57'si opere edilmişken, 57 hastanın 42'sinin ameliyatı laparoskopik tamamlandı. Patoloji sonuçlarında akut olarak raporlanan olguların Grade 3'e ilerledikçe belirginleştiği görüldü. Grade 3'e ilerledikçe postop morbidite artışı saptandı. Sonuç: Hastalar TG13'e göre ayrıştırıldığında ateş, CRP yüksekliği ve USG bulgularında istatistiksel anlamlı sonuç bulundu. CRP ve ateş yüksekliği inflamasyon belirteci olsa da, yükseklik saptanmaması tanıdan uzaklaştırmamalı, USG ile tablo örtüşmediğinde ek görüntüleme yöntemlerine başvurulmalıdır. Kolesistit şiddetinin artmasıyla postop morbidite artışından dolayı, Grade 3 olgular gereği halde yoğun bakımda monitorize izlenmelidir.

EVALUATION OF OUR CASES WITH ACUTE CHOLECYSTITIS ACCORDING TO TOKYO 2013 GUIDELINE

Introduction: Acute cholecystitis is an acute, inflammatory disease of the gallbladder that is usually associated with gallstones. The Tokyo 2013 Guideline has been arranged so that a common language can be used in diagnosis and treatment. The aim of this study was to evaluate patients treated with acute cholecystitis according to the TG13, to examine the treatment methods applied and the prognostic characteristics of the patients. Material and method: This study was conducted at our clinic with retrospective file scanning of 100 patients whose acute cholecystitis was diagnosed according to TG13 and treated. Aims to demonstrate the demographic and prognostic characteristics of patients classified according to TG13. Surgery techniques were recorded; preoperative and postoperative hospital stay, whether postoperative complications were developed and pathology results were examined. Patients were recorded as their co-morbidities. Results: Murphy positivity, Right upper quadrant (RUQ) tenderness, and leukocytosis were detected significantly positive; fever and CRP elevation were not detected in most of the patients. Fever and c-reactive protein (CRP) elevation were significantly higher in Grade 2 cases than in Grade 1, but not in Grade 3 cases. Abdominal USG was seemed to be effective in diagnosis, but additional imaging modalities were used in %50 of Grade 3 cases. Fifty-seven per cent %57 (Cümle başı rakamla başlamaz) of patients operated; 42 of 57 were made laparoscopically. Pathologic results were examined; it was observed that reported acute cases increased towards Grade 3 so as postoperative morbidity. Conclusion: There were significant results in fever, CRP and Abdominal USG. Although fever and CRP elevation are indicators of inflammation, clinician should not be removed from diagnosis whether level of fever and CRP are normal, and additional imaging methods should be used when there is discordance between patient and USG. Because of increased postoperative morbidity with increased cholecystitis severity, Grade 3 cases should be monitored in intensive care unit.

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