The optimal treatment of hydatid cyst of the liver: Radical surgery with a significant reduced risk of recurrence
Küçük Resim Yok
Tarih
2008
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Halen ülkemizde endemik olan kist hidatik tedavisine yaklaşım medikal tedavi ya da perkütan drenajdan çeşitli cerrahi prosedürlere kadar geniş bir spektrumu içermektedir. Biz bu yazıda kist hidatik yaklaşımında radikal cerrahi ile diğer konservatif girişimleri etkinlik yönünden karşılaştırdık. Yöntem: Mart 1994- Mart 2007 yılları arasında cerrahi girişimi uygulanan karaciğer kist hidatik hastaları retrospektif olarak analiz edildi. Demografik veriler, tanı yöntemleri, cerrahi prosedür, morbidite, mortalite ve geç dönem nüks oranları değerlendirildi. Hastalar tedavi açısından iki grupta incelendi: Grup A -radikal cerrahi, Grup B - konservatif tedavi. Bulgular: Hastalardan %93,8'ine (242/258) karaciğer yerleşimli kist hidatik nedeniyle cerrahi tedavi uygulandı. Bu hastalardan 221'i (%91,3) çalışmaya uygun bulundu. Hastalardan 123 tanesi kadın, 98 tanesi erkek ve tüm hastaların yaş ortalaması 51 (18-82 yıl) idi. Olguların hastaneye en sık (%45.6) başvuru şikayeti karın ağrısı olarak izlendi. Tanı metotlarında abdominal ultrasonografi ve tomografi önceliği (%61.8) gözlenirken %12 hastada manyetik rezonans görüntüleme de kullanıldı. Tedavi etkinliğinin değerlendirildiği Grup A'da 92, grup B'de 129 olgu incelendi. Genel nüks oranı % 15,3 olmakla birlikte bu oran konservatif cerrahi uygulanan olgularda (n=31) %24 (p<0.05) ve radikal cerrahi olgularında ise %3,4 olarak bulundu. Morbidite oranı da radikal cerrahi grupta anlamlı düşük bulundu. Sonuç: Konservatif yöntemler basit olabilmekle birlikte %35 oranlarında postoperatif komplikasyon (safra fistülü, rezidüel kavite ve nüks, kavite süpürasyonu) gözlenmektedir. Diğer yandan, radikal metotlar ise bizim çalışmamızda da görüldüğü gibi mükemmel sonuçlarla-minimal nüks riski ile (%3,2)- uygulanabilir. Çalışmamızın sonuçları doğrultusunda radikal cerrahi yöntemler özellikle anlamlı düşük nüks riski ve minimal komplikasyonlarla diğer cerrahi yöntemlere üstündür ve bu olgularda radikal cerrahi yapılabiliyorsa öncelikli olmalıdır.
Background/aims: the management of hydatid cyst of the liver, which is still endemic in Turkey, varies from medical treatment or percutaneous drainage to different surgical procedures. in this study, we aimed to compare the efficacy of radical surgical procedures and conservative interventions with respect to recurrence rates. Methods: Patients who underwent any type of surgical treatment between March 1994 and March 2007 due to liver cyst hydatid were retrospectively evaluated. Data collection included demographic variables, diagnostic methods, surgical procedures, and morbidity and mortality rates. Results: 242/258 (93.8%) patients with liver hydatid cyst underwent surgery, and the characteristics of 221 (91.3%) (123 female, 98 male) of these patients matched the criteria of the study. the mean age of the patients was 51 years (18-82 years). the diagnostic methods primarily included abdominal ultrasonography and computed tomography with a rate of 61.8% and magnetic resonance imaging in 12% of the patients. the patients were divided into two groups with respect to the treatment modality: Group A (n=92) - radical surgical treatment and Group B (n=129) - conservative surgery. the overall rate of recurrence was 15.3%. in Group B, this rate was 24% (n=31), whereas only 3.2% of the patients (n=3) in Group A had recurrence in the follow- up (p<0.05). the morbidity rate of the patients who underwent radical surgical modalities was also significantly lower. Conclusions: Although conservative surgical procedures are considered simpler and safer to perform, the rate of postoperative complications such as biliary fistula, residual cavity and recurrence, and cavity suppuration has been reported to be about 35%. on the other hand, radical surgery can be performed with low risk of recurrence (3.2%). We believe radical surgical procedures present a lower rate of recurrence and less morbidity, and thus should be the surgical treatment of choice for hepatic hydatid disease.
Background/aims: the management of hydatid cyst of the liver, which is still endemic in Turkey, varies from medical treatment or percutaneous drainage to different surgical procedures. in this study, we aimed to compare the efficacy of radical surgical procedures and conservative interventions with respect to recurrence rates. Methods: Patients who underwent any type of surgical treatment between March 1994 and March 2007 due to liver cyst hydatid were retrospectively evaluated. Data collection included demographic variables, diagnostic methods, surgical procedures, and morbidity and mortality rates. Results: 242/258 (93.8%) patients with liver hydatid cyst underwent surgery, and the characteristics of 221 (91.3%) (123 female, 98 male) of these patients matched the criteria of the study. the mean age of the patients was 51 years (18-82 years). the diagnostic methods primarily included abdominal ultrasonography and computed tomography with a rate of 61.8% and magnetic resonance imaging in 12% of the patients. the patients were divided into two groups with respect to the treatment modality: Group A (n=92) - radical surgical treatment and Group B (n=129) - conservative surgery. the overall rate of recurrence was 15.3%. in Group B, this rate was 24% (n=31), whereas only 3.2% of the patients (n=3) in Group A had recurrence in the follow- up (p<0.05). the morbidity rate of the patients who underwent radical surgical modalities was also significantly lower. Conclusions: Although conservative surgical procedures are considered simpler and safer to perform, the rate of postoperative complications such as biliary fistula, residual cavity and recurrence, and cavity suppuration has been reported to be about 35%. on the other hand, radical surgery can be performed with low risk of recurrence (3.2%). We believe radical surgical procedures present a lower rate of recurrence and less morbidity, and thus should be the surgical treatment of choice for hepatic hydatid disease.
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Turkish Journal of Gastroenterology
WoS Q Değeri
Scopus Q Değeri
Cilt
19
Sayı
1
