Journals / Turkish Journal of Gastroenterology / 2007 / Cilt: 18 - Sayı: 1
İntrahepatik taş: Türkiye deneyimi
- Pages
- 28–32
- DOI
- —
Abstract
Background/aims: The aim of this study was to report our experience of hepatolithiasis, diagnosed in 55 patients between June 1995 and March 2003. Methods: Fifty-five patients who underwent endoscopic retrograde cholangiopancreatography for hepatolithiasis between June 1995 and March 2003 at our institution were evaluated. Diagnosis of hepatolithiasis was based on cholangiography, ultrasonography and computed tomography. Patients with hepatolithiasis were classified according to Tsunoda classification. Results: Fifty-five patients with hepatolithiasis (22 female, 33 male; mean age: 48.2 ±14.9, range: 22-83) were included in this study. The major causes of hepatolithiasis were previous bilio-digestive surgery and Caroli disease, with rates of 49% and 14.5%, respectively. While 37 of 55 patients (67.3%) presented with only intrahepatic lithiasis, 18 patients (32.7%) had intrahepatic lithiasis associated with common bile duct (16/18, 29%) or gallbladder (2/18, 3.6%) stones. According to Tsunoda classification, 4 patients were classified as type I, 32 type II, 9 type III and 10 type IV. Patients with types I and II had significantly better stone clearance rates in comparison to those with types III and IV (p<0.05). Complete eradication of stones in the patients with proximal strictures was significantly lower than in the patients with distal strictures (p<0.01). While complete clearance of stones was achieved in 22 cases (40%), incomplete clearance was achieved in 17 cases (30.9%) with endoscopic retrograde cholangiopancreatography . Mean number of endoscopic retrograde cholangiopancreatography procedures for clearance of stones was 4 (ranges: 1-9). Conclusion: The etiology of hepatolithiasis in our patients is similar to that observed in Western populations and endoscopic approach appears to be an effective alternative to surgery
Özet
Amaç: Kliniğimizde Haziran 1995- Mart 2003 yılları arasında intrahepatik taş tanısı alan 55 olguyu sunduk. Yöntem: Haziran 1995-Mart 2003 yılları arasında, intrahepatik taş nedeniyle endoskopik retrograde kolanjiopankreotografi yapılam 55 olgu değerlendirildi. ‹ntrahepatik taş tanısı abdominal ultrasonografi, kolanjiografi ve bilgisayarlı tomografi ile kondu. Tsunoda sınışamasına göre hastalar sınışandırıldı. Bulgular: Ellibeş (22 kadın, 33 erkek, ortalama yaş: 48.2 ± 14.9, sınırlar; 22-83) intrahepatik taş olgusu çalışmaya alındı. ‹ntrahepatik taşın en önemli nedenleri, geçirilmiş safra yolları cerrahisi ve Caroli hastalığıydı, sırasıyla %49, %14.5. Olguların 37 (%67.3)’sinde sadece intrahepatik taş varken, 18’inde (%32.7) intrahepatik taşla birlikte koledok (%29) ve safra kesesinde de (%3.6) taş vardı. Tsunoda sınışamasına göre 4 olgu tip I, 32 olgu tip II, 9 olgu tip III ve 10 olgu tip IV’dü. Tip I ve II’de taşları n tamamen temizlenme oranı tip III ve IV’e göre anlamlı olarak daha yüksekti (p<0.05). Proksimal darlıklarda başarı, distal darlıklara göre daha düşüktü (p<0.01). Endoskopik retrograde kolanjio-pankreotografi ile 22 (%40) olguda taşlar tamamen temizlenirken, 17 (%30.9) olguda kısmi başarı sağlandı. Taşların temizlenmesi için yapılan ortalama endoskopik retrograde kolanjiopankreotografi sayısı 4’tü (sınırlar; 1-9). Sonuç: Olgularımızda intrahepatik taş etyolojisi Batı toplumuna benzer iken, endoskopik yaklaşım cerrahi tedaviye alternatif gibi gözükmektedir.