Fatih Fakirullahoğlu, Gönül Dinler, Ayhan Gazi Kalaycı

Çocukluk çağında safra taşları: 60 olgunun geriye dönük incelenmesi Özgün Araştırma

Özet Amaç: Safra kesesinde taş nedeniyle izlenen çocuk hastaların geriye dönük olarak değerlendirilerek yaş cinsiyet dağılımları risk etmenleri klinik özellikleri ve hastalığın seyrinin belirlenmesi amaçlanmıştır Gereç ve Yöntem: Ultrasonografik olarak safra kesesinde taş saptanan ve yaşları 0 18 yıl arasında olan 60 hasta çalışmaya alınmıştır Bulgular: Hastaların 38 rsquo;i kız 63 3 olup ortalama yaşları 7 8 plusmn;5 1 yıl 0 25 18 yıl idi Otuz dört 56 7 hastada altta yatan risk etmeni belirlenirken 15 seftriyakson kullanımı altı hemolitik hastalık beş Down sendromu dört şişmanlık iki total parenteral beslenme ve sepsis birer enflamatuar bağırsak hastalığı ve kronik kolestatik karaciğer hastalığı 26 43 3 hastada herhangi bir risk etmeni saptanamamış ve idiyopatik olarak değerlendirilmiştir En az üç ay izlemi yapılabilen 46 olgunun nbsp; sekizinin 17 4 kolesistektomiye gittiği 16 rsquo;sında 34 8 taşın devam ettiği ve 24 rsquo;ünde 52 2 taşın kaybolduğu gözlenmiştir Seftriyaksona bağlı gelişen tüm taşların kaybolduğu izlenmiş ve bu olgular hariç tutulduğunda taşın kaybolma oranı 28 3 bulunmuştur Ursodeoksikolik asit tedavisi ile hastaların 69 2 rsquo;sinde yakınmaların düzeldiği izlenmiştir Beş olguda 8 3 safra taşı ile ilgili komplikasyonlar gözlenmiştir Çıkarımlar: Çocuklarda safra kesesi taşları eskiye oranla daha sık rastlanmaktadır Risk etmeni olarak ilk sırada seftriyakson kullanımı ikinci sırada da hemolitik hastalıklar gelmekte ancak olguların yaklaşık yarısı hala idiyopatik olarak kalmaktadır Özellikle risk grubundaki hastaların safra taşı ve komplikasyonları açısından yakın izlenmesi gereklidir Türk Ped Arş 2010; 45: 119 23 Anahtar sözcükler: Çocukluk çağı safra kesesi taşı safra taşı seftriyakson ursodeoksikolik asit

Anahtar Kelimeler:

Çocukluk çağı, safra kesesi taşı, safra taşı, seftriyakson, ursodeoksikolik asit

Gallstones in childhood: Retrospective analysis of 60 cases Original Article

Summary Aim: The purpose of this study was to documentation of the characteristics of children with cholelithiasis by means of age sex clinical manifestations and risk factors Material and Method: Sixty cases aged 0 18 years with ultrasonographic evidence of cholelithiasis were enrolled in the study nbsp; nbsp; Results: Mean age of the patients was 7 8 plusmn;5 1 years range: 0 25 18 years 38 63 3 of them were females Underlying risk factors were identified in 34 56 7 of cases 15 ceftriaxone use six hemolytic diseases five Down rsquo;s syndrome four obesity two total parenteral nutrition and sepsis one inflammatory disease and one chronic cholestatic liver disease No etiology could be found in 26 43 3 patients who were defined as idiopathic Of 46 patients who were followed at least for three months eight 17 4 had cholecystectomy 16 34 8 showed differences in stone size and the stones were resolved in 24 patients 52 2 When the cases related to ceftriaxone use were excluded the percentage of the disappaerance of the stones was found to be 28 3 Ursodeoxycolic acid was effective on resolution of symptoms in 69 2 of patients The complications of gallstones were recorded in five 8 3 patients Conclusions: Cholelithiasis is more common in children than previously thought The most common risk factors are ceftriaxone use and hemolytic diseases but about half of the cases are still idiopathic There is a need for close monitoring of patients in especially risk groups because of gallstone development and its complications Turk Arch Ped 2010; 45: 119 23 Key words: Childhood cholelithiasis ceftriaxone gallstones ursodeoxycolic acid

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