Çocuklarda Perkütan Kist Hidatik Tedavisi: Teknik Farklılıklar ve Uzun Dönem Takip Sonuçları

Amaç: Çocuklarda perkütan yöntemle kist hidatik tedavisinin etkinliğinin, güvenirliğinin ve uzun dönem takip sonuçlarının değerlendirilmesi, uygulanan perkütan girişim tekniklerinin farklılıklarının tartışılması amaçlandı. Gereç ve Yöntemler: Retrospektif olan çalışmamız hastanemiz akademik kurullundan onayı alınarak yapıldı. Çalışmaya, Ekim 2009 ve Nisan 2014 tarihleri arasında perkütan tedavi uygulanan WHO tip 1 ve 3a, toplam 60 kisti bulunan, 34 çocuk hasta (22 kız, 12 erkek; ortalama yaşları 9.1±3.2 yıl) dahil edildi. Çapı 6 cm’den küçük kistler “Puncture, Aspiration, Injection, Reaspiration” (PAIR) yöntemi ile, 6 cm’den büyük kistler kataterizasyon yöntemi ile (tek seansta veya kataterin serbest drenaja bırakılması şeklinde) tedavi edildi. Hastalar işlem sonrası 1. ay, ilk yıl 3 ayda bir, ikinci yıl 6 ayda bir ve sonra yıllık kontrollere çağrıldı. Bulgular: Çapı 6 cm’den küçük 32 kist PAIR yöntemi ile, 6 cm’den büyük 28 kist ise kateterizasyon yöntemi ile tedavi edildi. On altı kistte katater serbest drenaja bırakılırken, 12 kistte işlem sonunda kateter çekilerek tedavi tek seansta sonlandırıldı. Perkütan tedavi tüm kist hidatiklerde başarı ile sonuçladı. Ortalama volüm kaybı PAIR yönteminde %74.6, tek seans kateterizasyonda %78.7, serbest drenaja bırakılmış kateterizasyonda ise % 57.9’du. Tek-seans kateterizasyon en etkin yöntem olarak saptandı ve bunu sırasıyla kateterizasyon ve PAIR yöntemleri izledi (p<0.000). Ortalama hastanede kalış süresi PAIR ve tek seans kateterizasyon yöntemlerinde 16 saat, serbest drenaja bırakılmış kateterizasyon yönteminde ise 2.1 gündü. Ortalama takip süresi 93.6 aydı. Sonuç: Perkütan kist hidatik tedavisi oldukça etkin, başarılı ve güvenilir bir yöntemdir. Özellikle çocuklarda, tip 1 ve tip 3a kistlerde tercih edilmelidir. İşlem sırasında konforu, işlem sonrası ağrının azlığı, yüksek hasta uyumu nedeniyle tek seans kateterizasyon çocuklarda oldukça avantajlıdır.

Anahtar Kelimeler:

Çocuk, Kist hidatik, Perkütan tedavi

Percutaneous hydatic cyst treatment in children: Technical differences and long-term follow-up results

Purpose: To evaluate efficacy, safety and the long-term results of percutaneous imaging-guided treatment of hydatid cysts (HC) in children and to discuss the differences of applied percutaneous interventional techniques. Materials And Methods: Between October 2009 and April 2014, 34 children with type WHO-CE1 and CE 3a, 60 HC underwent percutaneous treatment (PT). For 32 cysts smaller than 6 cm in longest diameter the method of treatment was PAIR, for 28 cysts with diameters larger than 6 cm the method of treatment was catheterization. Catheter was leaved to free drainage in 16 cysts, out of which 12 was ended in single session. All patients were followed first month and every 3 months during the 1st year, every 6 months during the 2nd year, and after then yearly. Results: PT of HC was successful in all patients. Mean volume reduction was 74.6 % with PAIR, 78.7 % with single session catheterization, and 57.9 % in catheterization – free drainage methods. Mean of hospitalization periods were 16 hours for both of those patients treated with the PAIR technique, and single session catheterization, 2.1 days for the patients treated by catheterization – free drainage. The mean follow-up was 93.6 months. Conclusion: Percutaneous hydatid cyst treatment is a highly efficent, successful and safe procedure. PT should be prefered in WHO CE type 1 and 3a cysts especially in pediatrics. Performing the catheterization without keeping it in the cavity makes it advantegeous in pediatrics because of convenience of approach, low pain, high patient adherence, and short hospitalization period.

Keywords:

Children, Hydatic Cyst, Percutaneous Treatment,

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