Atilla ŞENAYLI, Müjdem Nur AZILI, Ervin MAMBET, Gülşah BAYRAM, Emrah ŞENEL, Bilge KARABULUT, Fatih AKBIYIK, Yusf Ziya LİVANELİOĞLU, Turgut TİRYAKİ

Karaci̇ğer Ki̇st Hi̇dati̇ği̇ni̇n Cerrahi̇ ve Perkütan Tedavi̇ Sonuçlarının Karşılaştırılması

Amaç: Bu çalışmada, kliniğimizde karaciğer kist hidatiği (KCKH) sebebi ile açık opere edilen hastalar ile girişimsel rad- yoloji ünitesinde perkütan yöntemle tedavi edilen hastaların tedavi sonuçlarının karşılaştırılması amaçlandı. Gereç ve Yöntemler: 1997-2013 yılları arası KCKH nedeniyle tedavi edilen 114 hasta geriye dönük olarak incelendi.Hastalar demografik, geliş şikayetleri, kistin özellikleri ve işlemlerin komplikasyonları açısından incelendi.Bulgular: Hastalar yaşları 6 ila 16 yıl arasında olan47 erkek (% 41.2), 67 kız (%58.8) olgudan oluşmaktaydı. Hastala- rın %49u ağrı, %37.7si karında şişlik ve 1 hasta ise tıkanma sarılığı şikayeti ile başvururken, KCKH insidantel olarak14 hastada (%12.3) tesbit edildi. KCKH 90 hastada(%79) tek iken, 24 hastada 10a kadar olan çoklu kist mevcuttu.Sadece karaciğer lokalizasyonlu kist 85(%74,6) hastada mevcutken, 29 hastada (%25.4) ise en fazla akciğer olmaküzere karaciğerle beraber diğer organlarda da kist hidatik tutulumu vardı. Kistin çapı 3-16 cm arasında değişmekteydi.Opere olanlarda kist çapı ortalama 96 mm iken, perkütan tedavi uygulanan grupta ortalama çap 70 mmdi (p=0,001).Hastaların 82sine (%72) operasyon, 32sine (%28) perkütan tedavi uygulandı. Toplam 4 hastada nüks (opere), 3 kistenfeksiyonu (opere), 3 uzamış safra drenajı (1i perkütan tedavi) tespit edilmiştir. Peroperatif safra kanalı ile ilişki opereolan 5 hastada görüldü. Opere edilenlerdebaşvuruda ağrı şikayeti daha az, kitle şikayeti fazla iken; PAİR (Puncture,Aspiration, Injection, Reaspiration) grubunda bunun tam tersiydi (p=0,001). Perkütan tedavi grubunda, izole KCKH fazlaiken KCKHyla beraber akciğer kist hidatiği cerrahi grupta fazla idi (p=0,002). Gruplar diğer parametreler açısındanbenzerdi. Sonuç: Perkütan tedavi minimal invaziv, skarsız, düşük morbidite ve mortalite oranlarına ve kısa hastanede kalış sü- resine sahip olması sebebiyle seçilmiş KCKH olgularında öncelikle uygulanması gereken bir yöntem olmakla beraberkomplike olgularda açık cerrahi onarım düşünülmelidir.

Outcome Comparison of Liver Hydatid Cysts Following Surgical and Percutaneous Treatment

Objective: The aim of our study was to compare the outcomes of patients who had undergone surgery or percutaneoustreatment for liver hydatid cyst (LHC) in our clinic.Material and Methods: A total of 114 patients treated for LHC between the years 1997 to 2013 were evaluatedretrospectively from their files. Patients were evaluated in terms of demographic characteristics, complaints, cystcharacteristics and complications. Results: There were 47 (41.2 %) males and 67 female (58.8%) aged between 6 and 16 years. The complaint was painin 49% and abdominal swelling in 37.7%, while obstructive jaundice was present in 1 patient at the time of presentation.The cyst was found incidentally in 14 (12%) patients. Only one cyst was present in 90 patients (79%) and there weremultiple cysts in 24 patients (maximum 10). The cyst was localized in the liver in 85 (74.6%) patients while there wereother cysts, mostly in the lung in 29 (25.6%) patients. The cyst size was 3 to 16 cm. The mean cyst size in the patientsundergoing surgery and percutaneous treatment was 96 mm and 70 mm respectively (p=0.001). Surgery was used in82 (72%) patients and percutaneous treatment in 32 (28%). There were 4 recurrences (in the operated group), 3 cystinfections (in the operated group), and 3 prolonged biliary drainage cases (1 in the percutaneous treated group). Bile duct connection was seen in 5 patients who underwent open surgery. Abdominal swelling was more frequent than pain at presentation inthe surgical group while the opposite was true for the percutaneous treatment group (p=0.001). The isolated LHC rate was higher in thePAIR (Puncture, Aspiration, Injection, Reaspiration) group than the operated group. The rate of LHC together with pulmonary cyst washigher in the surgical group (p=0.002). The groups were similar in terms of other parameters.conclusion: Percutaneous treatment could be used as the primary treatment for LHC in selected cases as it is minimally invasive, does notcause scarring, and has a low morbidity and mortality rate and shorter hospitalization period, although surgical repair should be consideredin complicated cases.

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