Böbreğin hidatik kist hastalığı

Burak ÖZKAN, Bülent ALICI, Şefik ÇİTÇİ, Oktay DEMİRKESEN, Özgür SANCAKLI

Özet

Büyüyen hidatik kist, yaptığı basınç ile birlikte böbreğe zarar verebilmektedir, aynı zamanda böbrek rüptürü, kistin infeksiyonu, retroperitoneal hemoraji ve perirenal hidatik yayılım gibi komplikasyonlara neden olmaktadır. Diğer tarafta ise cerrahiye bağlı komplikasyonlar da gözardı edilmemelidir. Cerrahi planlanmadan önce yayılım ve buna bağlı gelişebilecek şiddetli anafilaksi reaksiyonları değerlendirilmelidir; hastalığın medikal tedavisi cerrahi tedaviye göre realistik bir tedavi seçeneği olmamakla birlikte adjuvan tedavi olarak yada cerrahi yapılması uygun olmayan hastalarda alternatif tedavi seçeneğini oluşturmaktadır. Perkütan kist drenajı ve alkol instillasyonu ise uygun durumlarda, minimal invaziv tedaviler içinde gelecek vaat eden ancak daha fazla deneyim gerektiren bir seçenektir.

Abstract

Background and Design.- Cystic hydatic disease is a parasitic infestation caused by the larval form of Echinococcus granulosus. it is endemic in parts of Africa, Latin America, Mediterranean and Turkey. Hydatic cysts are mostly evident in'the liver and lungs, while renal involvement is rare, comprising only 2% to 4% of cases.Renal hydatid disease mimicked other disease's. The combination of clinical history, imaging studies and serological, urine investigation yielded a reliable pretreatment diagnosis in only 50 % of cases and a presumptive diagnosis in 71%. Among imaging studies computerized tomography was the most valuable diagnostic examination.;Moderate eosinophilia was found in half of the cases while a third of cases had scoleces in the urine.Renal sparing approach should be intended when preoperative diagnosis of hydatidosis has been considered. Renal conservative surgery is possible>ven for large lesions. Cystectomy is the simplest technique and can be followed safely by pedicled omentoplaşty to treat residuel cavity. Nephrectomy is also electively performed for large lesions when the cyst causes tissue damage by pressure atrophy and in cases with evident communication with the urinary tract. The risk of surgical spillage and severe allergic reaction to the cyst should be considered. Also, a renal preserving strategy may fail. However, medical management of disease is far from being a realistic option to surgery and should be conceived as adjuavant therapy or an alternative for poor surgical candidates.