Laparoskopik kolesistektomi sonrasi kalinti koledok tasi olgularinin tani ve tedavisi
Management of retained bile duct stone (s) after laparoscopic choleystectomy
- Ana Sayfa
- Sayılar
- Laparoskopik kolesistektomi sonrasi kalinti koledok tasi olgularinin tani ve tedavisi...
Özet
Giris ve amaç: Laparoskopik kolesistektomi sonrasi kalinti koledok taslarinin tani ve tedavisi önemini korumaktadir. Bu çalismada laparoskopik kolesistektomi sonrasinda ortaya çikan kalinti koledok taslari nin tani ve tedavisi incelenmistir. Gereç ve yöntem: 1998-2004 yillari arasinda ardisik olarak laparoskopik kolesistektomi ameliyati uygulanan 226 hasta arasinda kalinti koledok tasindan süphelenilen 23 hastanin semptomlari, kanda alanin transferaz, aspartat transferaz, bilirubin ve alkalen fosfataz degerleri kaydedildi. Ultrasonografi ile koledok çapi degerlendirildi. Kalinti koledok tasi düsünülenlerde endoskopik retrograt kolanjiografi yapilarak tas saptananlarda sfinkterotomi yapildi. Bulgular: Hastalarin yaslari 18-79 yil (ortanca 58 yil), kadin erkek orani 4:1’dir. Hastalarin hastanede kalis süreleri 1-15 gün (ortalama 3 gün)’dür. Laparoskopik kolesistektomi sonrasi biliyer semptomlarla 7 gün ile 2 yil arasinda yeniden hastaneye basvuran 23 (%10) ve koledok tasi düsünülen 16 olguda alanin transferaz degerleri yüksek bulundu. USG’de koledok çapi 10 mm ve üzerinde olan, alanin transferaz degerleri ve bilirubin düzeyleri yüksek olan 12 olgudan 11’ine endoskopik retrograd kolanjiografi+ endoskopik sfinkterotomi yoluyla tas ekstraksiyonu yapildi. 1 olguya laparatomi yoluyla koledokotomi + tas ekstraksiyonu yapildi. Sonuç: Alanin transferaz yüksekligi, koledok çapinin 10 mm ve üzerinde olmasi kalinti koledok taslarinin saptanmasinda önemlidir ve tedavide endoskopik retrograd kolanjiografi ve endoskopik sfinkterotomi güvenilirdir.
Abstract
Background/aims: Retained choledochal stones after laparoscopic cholecystectomy are still a major problem. The present study investigated the management of retained choledochal stones after laparoscopic cholecystectomy. Materials and methods: Among 226 consecutive patients who underwent laparoscopic cholecystectomy between 1998 and 2004, symptoms, and alanine aminotransferase, aspartate aminotransferase, bilirubin and alkaline phosphatase values of patients with suspected retained choledochal stone were evaluated. Diameter of choledochus was assessed by abdominal ultrasonography. Patients with suspected choledochal stone underwent endoscopic retrograde cholangiography and sphincterotomy. Results: Female to male ratio was 4:1 and median age was 58 years (range, 18-79 years). Elevated alanine aminotransferase values were detected in 16 patients suspected of retained choledochal stone among 23 patients who had been referred to the hospital between 7 days and 2 years following laparoscopic cholecystectomy. Stone extraction was performed in 11 of 12 patients with choledochal diameter of ≥10 mm and with high alanine aminotransferase and bilirubin levels via endoscopic retrograde cholangiography + endoscopic sphincterotomy. Choledochotomy + stone extraction was performed in 1 case via laparotomy. Conclusions: High alanine aminotransferase and choledochal diameter of ≥10 mm are important parameters for determination of choledochal stones, and endoscopic retrograde cholangiography + endoscopic sphincterotomy is a safe and feasible treatment modality.
