Ömür BALLI, Okan AKHAN, Devrim AKINCI, Türkmen Turan ÇİFTÇİ

LENFOSELLERDE PERKÜTAN TEDAVİ: TEK VEYA ÇOK SEANS SKLEROTERAPİNİN ETKİNLİĞİNİN KARŞILAŞTIRILMASI

AMAÇ: Lenfosel tedavisinde perkütan trankateter skleroterapi tekniği uzun yıllardan beri ilk tedavi seçeneği olarak kullanılmaktadır. Bu prospektif randomize çalışmanın amacı tek veya çok seans etanol skleroterapisinin başarı oranlarını, güvenilirlik düzeyini, major ve minor komplikasyonlarını, kısa ve uzun dönem takip sonuçlarını karşılaştırmalı olarak değerlendirmektir.GEREÇ VE YÖNTEM: Ağustos 2002 – Şubat 2010 tarihleri arasında postoperatif semptomatik pelvik lenfoseli olan 19 hasta çalışmaya dahil edildi. Hastaların tamamı kadın olup, ortalama yaşları 52.5 (25-75) idi.BULGULAR: Hastalarda mevcut bulunan 26 lenfoselin 12 (%46) tanesine tek seans, 14 (%54) tanesine çok seans skleroterapi işlemi uygulandı. Tek seans işlem sonrası 3 (%25) lenfoselde rekürrens, çok seans sonrası ise 1 (%7) lenfoselde rekürrens ve 2 (%14) lenfoselde apse izlendi. 4 rekürren lenfosele çok seans skleroterapi, apselere ise perkütan kateter drenajı yapılıp, uygun antibiyotik verilerek tedavi edildi. Bu işlemlerle birlikte toplam 30 perkütan transkateter etanol skleroterapi işlemi gerçekleştirildi. Çok seans uygulanan hastalarda, ortalama kateterizasyon süresi 21 (4-55) gündü. Hastaların takip süresi ortalama 21 (1- 96 ay) aydı. İstatistiksel çalışmalarda tek veya çok seans skleroterapi teknikleri arasında anlamlı fark saptanmadı (p=0.270).SONUÇ: Lenfosel tedavisinde tek seans etanol skleroterapi işlemi ilk seçenek olarak etkin ve güvenilir olup, rekürrenslerde ise çok seans skleroterapi tercih edilebilecek tedavi yöntemidir.

Anahtar Kelimeler:

Lenfosel, etanol skleroterapi, tek veya çok seans

PERCUTANEOUS TREATMENT OF LYMPHOCELE: COMPARISON OF SINGLE AND MULTIPLE SESSIONS SCLEROTHERAPY

OBJECTIVE: Percutaneous transcatheter sclerotherapy technique has been used as a first- line theraphy for treatment of postoperative pelvic lymphocele for long years. The aim of this prospective-randomized study is to investigate and compare the therapeutic efficacy, reliability, major and minor complications, short and long-term results of single and multisession percutaneous transcatheter ethanol sclerotherapy.MATERIAL AND METHODS: Between August 2002 and February 2010, 19 patients who had postoperative symptomatic pelvic lymphocele were included in this study. All of them were female and the mean age of patients was 52.5 (range:25-75) years.RESULTS: 12 (46%) of them were treated with single-session of ethanol sclerotherapy and 14 (54%) of them were treated with multi-session of ethanol sclerotherapy. Recurrence developed in 3 (25%) lymphoceles treated by single-session and 1 (7%) lymphocele treated by multiple- session percutaneous transcatheter ethanol sclerotherapy. Also, abscess developed in 2 (14%) lymphoceles after multiple-session percutaneous transcatheter ethanol sclerotherapy. All of the recurrent lymphoceles were treated by multiple-session percutaneous transcatheter ethanol sclerotherapy and abscesses were treated by percutaneous catheter drainage with appropriate antibiotic medication. Totally, 30 sclerotherapy procedures were performed. The mean duration of percutaneous catheter drainage was 21 days (4–55 days). There was no statistically difference between single and multi-session techniques for sclerotherapy of lymphocele (p=0.270). The follow-up period ranged from 1 to 96 months (mean:21 months).CONCLUSIONS: As a result, the treatment of lymphocele with single-session sclerotherapy is a safe and effective procedure, however, in recurrent lymphoceles, multisession sclerotherapy may be the treatment of choice.

Keywords:

Lymphocele, ethanol sclerotherapy, single or multi-session,

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