Dergiler / Optimal Tıp Derg. / 1999 / Cilt: 12 - Sayı: 4
Tıkanma sarılıklarında cerrahi tedavi sonuçları: 42 vakanın analizi
- Dergi
- Optimal Tıp Derg.
- Sayfa
- 87–91
- DOI
- —
Özet
Özet: Cerrahi tedavinin etkinliğini araştırmak amacıyla 1995-1998 yılları arasında kliniğimizde tıkanma sarılığı nedeniyle öpere edilen 42 hastanın kayıtları retrospektif olarak incelendi. Hastalar; obstrüksiyonun nedeni, uygulanan cerrahi prosedür, aperatif ve postoperalif komplikasyonlar ile mortalite oranları açısından değerlendirildi. Hastalarımızın 24'ü(%57.14) kadın, 18'i(%42.85) erkekti. Yaş ortalaması 56(40-81) idi. Tıkanma nedeni, hastaların 22'sinde koledokolityazis, 4'ünde paraziter, 4'ünde pankreas başı kanseri, 8'inde safra kese, safra yolları kanseri idi. Birer hastada ınetastatik mide kanseri, papilla wateri kanseri, papilla stenozu ve iyatfojenik koledok yaralanması vardı.Koledokolitiazisli hastaların 9'una koledokoduodenostomi, l0'una koledokotomi ve T tüp drenajı, 3'üne ise papilloplasti yapıldı.Papilla fibrozisi olan bir hastaya papillotomiden sonra koledokoduodenostomi uygulandı. İyatrojenik ana hepatik kanal paralanması olan bir hastaya roux en Y hepatikojejunostomi yapıldı. Paraziter obstrüksüyonu olan hidatik kistli 3 hastaya koledokoduodenostomi yapıldı. Askarisli bir hastada hepatikojejunostomi anastomoz revizyonu yapıldı. Pankreas bası kanseri olan hastalarımızın tümüne Whipple operasyonu uygulandı. Metastatik mide kanserli hastaya gastroenterostomi ve koledokojejunostomi yapıldı. Safra kesesi, safra yollarına ait kanser bulunan 8 hastamızdan beşine 3.segment kolanjiyojejunostomi, diğer üçüne ise hepatikojejunostomi yapıldı Papilla kanserli bir hastamıza, koledokoduodenostomi yapıldı. Hastanede kalma süresi ortalama 13 gün(7-21), ortalama takip süresi 18 ay(2-34) idi. Kanser nedeniyle öpere edilen 14 hastamızdan ikisi postoperatif erken dönemde, üçü ise geç dönemde kaybedildi. Benign tıkanma ikterli 28 hastamızda mortalite olmadı.
Abstract
Summary: A retrospective study was planned to efficacy of surgical intervention in 42 patients that were operated for the relief of obstructive jaundice between 1995 and 1998 at department of surgery. Documents of patients were evaluated standpoint of etiological factors, surgical techniques, operative-postoperative complications and mortality rates. Of these patients were 24(57.14%) female and 18(42.85%) male. The ages of patients were ranged from 40 10 81 years (mean 56). As the indication of operations were choledocholithiasis (22), parasites (4), carcinoma of pancreatic head (4), carcinoma of gallbladder or biliary tract (8), metastasis of gastric carcinoma (1), carcinoma of ampulla voter (1) and iatrogenic injury ofcholedocus (1). Choledochoduedonostomy was performed on 9 patients, choledochotomy and T-tube drainage was performed on 10 patients, papilloplasty was performed on 3 of 22 patients with choledocholithiasis. Papillotomy and Choledochoduedonostomy were performed on a patient with papillary fibrosis. Roux en Y hepaticojejunostomy was performed on a patient with common biliary duct injury. There were 4 patients with biliary obstruction caused by parasites; choledochoduodonostomy was performed on 3 patients with hidatid disease, revision of hepaticojejunostomy anastomoses was performed on a patient with ascariasis. Whipple operation was performed on all of patients with carcinoma of pancreatic head. Gastroenterostomy and cholodochojejunostomy was performed on a patient with metastatic carcinoma of stomac. There were 8 patients with carcinoma of gallbladder or biliary tract. 3. segment cholangiojejunostomy was performed on 5 of them and hepaticojejunostomy was performed on others. Choledochoduedonostomv was performed on a patient with carcinoma of ampullae vater. Hospital stay days were approximately 13 days (7-21). Patients were followed up mean 18 months (2-34) postoperatively. 14 patients with malign obstructive jaundice were operated. 2 of them died early postoperative period and 3 patients died late postoperative period. There were not seen any mortality in 28 patients with benign obstructive jaundice.