Akut kolesistitin ciddi bir komplikasyonu olan safra kesesi perforasyonunun klinik yönetimi: yüksek volümlü tek merkez sonuçlarımız

Tufan Gümüş; Ebubekir Korucuk; Erkan Güler; Tuğçe Türk; Alper Uğuz

doi:10.19161/etd.1524037

TR EN

Akut kolesistitin ciddi bir komplikasyonu olan safra kesesi perforasyonunun klinik yönetimi: yüksek volümlü tek merkez sonuçlarımız

Öz

Amaç: Safra kesesi perforasyonu akut kolesistitin(AK) morbidite ve mortalite oranlarını artıran en ciddi komplikasyonudur. Akut perfore kolesistit (APK) yönetiminde net bir algoritma olmamakla birlikte erken dönemde operasyona uygun olmayan hastalar konservatif takip edilebilmektedir.Çalışmamızda APK nedeniyle takip edilen hastaların sonuçlarını değerlendirerek klinik deneyimimizi sunmayı amaçladık. Gereç ve yöntem Çalışmaya Aralık 2018- Aralık 2023 yılları arasında AK nedeniyle kliniğimizde takip edilen 532 hasta dahil edildi. Safra kesesi perforasyonu olmayan hastalar dışlanarak 118 hastanın verileri retrospektif tarandı. Bulgular Hastaların 53(%44,9)’ü kadın, 65(%55,1) erkek idi. Ortalama yaş 67,7(23-93) idi. Hastaların 17(%14,4)’sine medikal tedavi,73(%61,9)’üne perkutan kolesistostomi (PK),15(%12,7)’ine PK uygulama sonrası operasyon ve 13(%11)’üne operasyon uygulandı. Operasyon uygulananların 13(%46,4)’ü interval dönemde, 15(%53,6)’i elektif opere edildi. Elektif operasyon planlanan hastalar ortalama APK tanısından 116 gün sonra opere edildi. Operasyon zamanlamasının yatış süresi, operasyon türü ve sağkalıma etkisi saptanmadı. Hastaların tedavi türleri ve laboratuar değerleri karşılaştırıldığında C-Reaktif Protein/Albumin (CRP/ALB) değerinin anlamlı olarak PK uygulananlarda daha yüksek olduğu görüldü(p=0,008). Hastaların 13(%11)’ü yatışında eksitus oldu. Eksitus olan hastaların yaş ortalaması 80,1 iken olmayanlarınki 66,1 olarak saptandı (p=0,0007). Bunların 11(%84,6)’ine PK uygulanırken 2(%15,4)’si yalnızca medikal tedavi ile takip edildi. Sonuç APK tanısı alan erken dönemde operasyona uygun olmayan hastalarda konservatif tedavi seçenekleri tercih edilebilmekte ancak PK uygulaması hastane yatış sürelerini uzatmaktadır. APK mevcut olan hastalarda hastaya spesifik tedavi tercihlerinin yapılmasının doğru olacağını düşünmekteyiz.

Anahtar Kelimeler

Clinical Management of Gallbladder Perforation, a Serious Complication of Acute Cholecystitis: Our High-Volume Single-Center Results

Abstract

Aim Gallbladder perforation is the most serious complication of acute cholecystitis (AC), increasing morbidity and mortality rates. Although there is no clear algorithm for managing acute perforated cholecystitis (APC), patients who are not suitable for surgery in the early period can be followed conservatively. Our study aimed to present our clinical experience by evaluating the results of patients who were followed up due to APC. materyals and Method The study included 532 patients followed up in our clinic due to AC between December 2018 and December 2023. Patients without gallbladder perforation were excluded, and the data of 118 patients were retrospectively reviewed. Results 53 (44.9%) of the patients were female, 65 (55.1%) were male. The mean age was 67.7 (23-93). 17 (14.4%) of the patients received medical treatment, 73 (61.9%) received percutaneous cholecystostomy (PC), 15 (12.7%) underwent surgery after PC, and 13 (11%) underwent surgery. 13 (46.4%) of those who underwent surgery were operated on in the interval period, and 15 (53.6%) were operated on electively. Patients who were planned for elective surgery were operated on an average of 116 days after the diagnosis of APC. No effect of the timing of the surgery on the length of stay, type of surgery, and survival was detected. When the treatment types and laboratory values of the patients were compared, it was seen that the C-reactive protein/Albumin (CRP/ALB) value was significantly higher in those who underwent PC (p=0.008). Thirteen (11%) of the patients died during hospitalization. The mean age of the patients who died was 80.1, while the mean age of those who did not was 66.1 (p=0.0007). While 11 (84.6%) underwent PK, 2 (15.4%) were only followed up with medical treatment. Conclusion Conservative treatment options can be preferred in patients diagnosed with APC who are not suitable for surgery in the early period, but PK application prolongs the hospital stay. We think making patient-specific treatment preferences in patients with APC would be correct. Keywords: Acute Cholecystitis, Acute Perforated Cholecystitis, Percutaneous Cholecystostomy, Cholecystectomy, Gallbladder

Keywords

Ethical Statement

Etik İnceleme Komitesi Beyanı: Bu çalışma Helsinki Deklarasyonu'na uygundur. Biz (tüm yazarlar) Derginin etik yayıncılıkla ilgili konulardaki pozisyonunu okuduğumuzu ve bu raporun bu yönergelerle tutarlı olduğunu teyit ediyoruz. Etik Kayıt numarası: 24-7T/89 Çalışma Ege Üniversitesi Genel Cerrahi Anabilim Dalı'nda yürütüldü ve etik kurul onayı 24-7T/89 alındı

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Details

Primary Language

Turkish

Subjects

Gastroenterology Surgery , General Surgery

Journal Section

Research Article

Authors

Tufan Gümüş
0000-0003-1861-8282
Türkiye

Ebubekir Korucuk
0000-0002-1272-6103
Türkiye

Erkan Güler ^*
0000-0003-0881-1003
Türkiye

Tuğçe Türk
0000-0002-3221-1764
Türkiye

Alper Uğuz
0000-0001-8127-5644
Türkiye

Publication Date

December 9, 2024

Submission Date

July 29, 2024

Acceptance Date

August 14, 2024

Published in Issue

Year 1970 Volume: 63 Number: 4

DOI

https://doi.org/10.19161/etd.1524037

IZ

https://izlik.org/JA76RW65WU

Cite

RIS / Bibtex

Vancouver

1.Tufan Gümüş, Ebubekir Korucuk, Erkan Güler, Tuğçe Türk, Alper Uğuz. Akut kolesistitin ciddi bir komplikasyonu olan safra kesesi perforasyonunun klinik yönetimi: yüksek volümlü tek merkez sonuçlarımız. EJM. 2024 Dec. 1;63(4):563-71. doi:10.19161/etd.1524037