36 aydan küçük pediatrik nakil hastalarında biliyer komplikasyonlar ve perkütan radyolojik girişimler
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Karaciğer Transplantasyonu kronik ve ciddi akut karaciğer yetmezliğinde önemli bir tedavi seçeneği olmakla birlikte birçok komplikasyonu da beraberinde getirebilmektedir. Transplantasyonun önemli komplikasyonlarından olan biliyer komplikasyonların tanı ve tedavisinde perkütan radyolojik girişimler önemli ve etkili bir tedavi seçeneğidir. Çalışmamızda karaciğer transplantasyonu yapılan 36 aydan küçük çocuk hastalarda gelişen biliyer komplikasyonları ve bu komplikasyonların yönetiminde perkütan radyolojik girişimlerin önemi ve etkinliğinin gösterilmesi amaçlanmıştır. Gereç ve Yöntem: İnönü Üniversitesi Turgut Özal Tıp Merkezi Karaciğer Nakil Enstitüsü'nde Ocak 2007-Ekim 2019 tarihleri arasında yaşları 36 aydan küçük 186 hastaya 191 nakil işlemi gerçekleştirildi. Yapılan incelemede; 39 hasta çeşitli nedenlerle çalışma dışında bırakıldı. Toplamda 147 hastaya yapılan 152 pediatrik nakil işlemine ait demografik veriler, cerrahi prosedürler, yapılan biliyer girişimler retrospektif olarak incelendi. Bulgular: 36 aydan küçük 152 nakil olgusunun 38'inde (%25) biliyer komplikasyon gelişmiş, 25'inde darlık, 9'unda kaçak, 4'ünde hem darlık hem de kaçak tanımlanmıştır. Bu hastaların 34'üne (%89.5) perkütan biliyer girişim yapılmış, kaçak gelişen 4 hastaya (%10.5) cerrahi tedavi uygulanmıştır. Bunun dışında 5 hastaya karaciğer enzim ve bilirubin yüksekliği nedeniyle PTK yapılmış, biliyer patoloji tespit edilmemiştir. Yapılan istatistiksel analizde cerrahi anastomoz şekliyle (DD,HJ) biliyer komplikasyon arasında anlamlı ilişki tespit edilmiştir. (p=0.001) Perkütan biliyer girişim yapılan hastalar kateterli median 2.8 ay (0.03-18.7 ay), katetersiz median 11.1 ay (0-89 ay) takip edildi. Darlık nedeniyle balon dilatasyon işlemi yapılan 23 hastanın 5'inde (%21.7) ortalama 5.4 ay (3.5-7,5) ay sonra darlık nüks etti ve balon dilatasyon işlemi tekrarlandı. Darlığı nüks eden hastalar ortalama 8.5 ay (1-22 ay), nüks görülmeyen hastalar işlem sonrası 30 ay (0-107 ay) semptomsuz takip edilmiştir. Sonuç: Perkütan biliyer girişim, karaciğer naklinden sonra biliyer komplikasyon tedavisinde yüksek başarı oranlarına sahip minimal invaziv tekniklerdir. Perkütan biliyer girişimin etkinliği, pediatrik karaciğer nakli sonrası biliyer komplikasyon tedavisindeki cerrahi müdahaleye benzerdir.
Purpose: Liver Transplantation is an important treatment option in chronic and severe acute liver failure, but it may cause many complications. Percutaneous radiological interventions are important and effective method in the diagnosis and treatment of biliary complications. In our study, we aimed to demonstrate the importance and effectiveness of biliary complications developing in patients under 36 months of liver transplantation and percutaneous radiological interventions in the management of these complications. Materials and Methods: Between January 2007-October 2019, 191 liver transplantations were performed in 186 patients under 36 months of age in our center. 39 patients were excluded for various reasons. Demographic data, surgical procedures and biliary interventions were analyzed retrospectively in 152 liver transplantation procedures at 147 patients. Results: Biliary complications developed in 38 (25%) of 152 liver transplantations (stenosis 25, leakage 9, both stenosis-leakage 4). PTC/PTBD was performed in 34 (89.5%) of 38 patients. 4 patients operated (10.5%) for leakage. Except these 34 patients, 5 patients underwent PTC due to elevated liver enzymes and bilirubin; biliary pathology wasn't detected. In statistical analysis, significant relationship was found between anastomosis (Duct-duct, hepaticojejunostomy) and biliary complicatioıns (p= 0.001). Patients who underwent PTC were followed with catheter for median 2.8 months (0.03-18.7), catheter-free for median 11.1 months (0-89). In 5 (21.7%) of 23 patients who underwent balloon dilatation, the stenosis relapsed after average of 5.4 months (3.5-7.5) and balloon dilatation was repeated. Patients with recurrence were followed up for an average of 8.5 months (1-22 months), and patients without recurrence were followed up for 30 months (0-107 months) without symptoms. Conclusion: Percutaneous biliary intervention are minimally invasive techniques with high success rates in the treatment of biliary complications after liver transplantation. The effectiveness of percutaneous biliary intervention is similar to surgical intervention in the treatment of biliary complications after pediatric liver transplantation.
Purpose: Liver Transplantation is an important treatment option in chronic and severe acute liver failure, but it may cause many complications. Percutaneous radiological interventions are important and effective method in the diagnosis and treatment of biliary complications. In our study, we aimed to demonstrate the importance and effectiveness of biliary complications developing in patients under 36 months of liver transplantation and percutaneous radiological interventions in the management of these complications. Materials and Methods: Between January 2007-October 2019, 191 liver transplantations were performed in 186 patients under 36 months of age in our center. 39 patients were excluded for various reasons. Demographic data, surgical procedures and biliary interventions were analyzed retrospectively in 152 liver transplantation procedures at 147 patients. Results: Biliary complications developed in 38 (25%) of 152 liver transplantations (stenosis 25, leakage 9, both stenosis-leakage 4). PTC/PTBD was performed in 34 (89.5%) of 38 patients. 4 patients operated (10.5%) for leakage. Except these 34 patients, 5 patients underwent PTC due to elevated liver enzymes and bilirubin; biliary pathology wasn't detected. In statistical analysis, significant relationship was found between anastomosis (Duct-duct, hepaticojejunostomy) and biliary complicatioıns (p= 0.001). Patients who underwent PTC were followed with catheter for median 2.8 months (0.03-18.7), catheter-free for median 11.1 months (0-89). In 5 (21.7%) of 23 patients who underwent balloon dilatation, the stenosis relapsed after average of 5.4 months (3.5-7.5) and balloon dilatation was repeated. Patients with recurrence were followed up for an average of 8.5 months (1-22 months), and patients without recurrence were followed up for 30 months (0-107 months) without symptoms. Conclusion: Percutaneous biliary intervention are minimally invasive techniques with high success rates in the treatment of biliary complications after liver transplantation. The effectiveness of percutaneous biliary intervention is similar to surgical intervention in the treatment of biliary complications after pediatric liver transplantation.
Açıklama
Anahtar Kelimeler
Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine
