Canlı vericili karaciğer nakli sonrası donör biliyer komplikasyonlarında perkütan radyolojik tedavi
Küçük Resim Yok
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Canlı vericili karaciğer nakli (CVKN) sonrasında donörlerde görülen biliyer komplikasyonlarda perkütan radyolojik tedavi yöntemlerini ve başarılarını değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu retrospektif çalışma Malatya İnönü Üniversitesi Bilimsel Araştırma ve Yayın Etiği Kurulu'nun 2019/5-23 karar no'lu izni ile gerçekleştirilmiştir. İnönü Üniversitesi Turgut Özal Tıp Merkezi Karaciğer Nakil Enstitüsü'nde Mayıs 2009-Aralık 2018 tarihleri arasında toplam 1839 CVKN gerçekleştirilmiş olup hepatektomi yapılan vericiler retrospektif olarak değerlendirilmiştir. Vericilerde gelişen biliyer komplikasyonlar Modifiye Clavien-Dindo sınıflamasına göre sınıflandırılmıştır. Biliyer komplikasyonların tedavisinde hastalara USG eşliğinde perkütan drenaj, endoskopik biliyer drenaj (ERKP), perkütan biliyer drenaj (PTK/PTBD) ve cerrahi tedavi uygulanmış olup perkütan tedavi uygulanan hastalar değerlendirildi. Bulgular: 1839 vericinin 121'nde (%6.57) girişimsel tedavi gerektirecek (Clavien derece III ve IV) komplikasyon gelişmiştir. Bu hastalardan 51'ne USG eşliğinde perkütan drenaj yapılmış olup 30'unda ek tedavi uygulanmamış ve minör safra kaçağı olarak kabul edilmiştir. 17'si perkütan drenaj tedavisinin yeterli olmadığı hastalar olmak üzere toplam 83 hastaya ERKP yapılmış olup 53'nde endoskopik tedavi başarılı olmuştur. Toplamda 12'si verici, 2'si ise hepatektomisi tamamlanmamış verici adayı olan 14 hasta PTK/PTBD'ye yönlendirilmiş, bu hastaların 8'i tedavi edilmiştir. 2'sinde eşlik eden otonom safra yolu olup perkütan yerleştirilen kateterler kılavuzlığunda opere edilmiştir. 4 hastada oklüde segment geçilememiş olup perkütan yerleştirilen kateterler içerisinden intaoperatif olarak kılavuz tel gönderilerek ameliyata dahil olunmuştur. 2 hasta ise hepatiko-jejunostomi sonrası perkütan tedavi edilmiştir. Sonuç: PTK/PTBD'nin USG eşliğinde perkütan drenaj ve endoskopik tedaviyi tamamladığı, bazı hastalarda cerrahi gereksinimini ortadan kaldırdığı ve cerrahi yapılacak hastalarda da tedaviye kılavuzluk ettiği dikkat çekmektedir. Anahtar kelimeler: donör, biliyer komplikasyon, perkütan radyolojik tedavi
Purpose: We aimed to evaluate percutaneous radiological treatment modalities and success in biliary complications that occur in donors for living donor liver transplantation (LDLT). Materials and Methods: This retrospective study was performed with permission of Malatya Inonu University Research and Publication Ethics Board decision number 2019/5-23. A total of 1839 LDLTs were performed in Inonu University Turgut Özal Medical Center Liver Transplantation Institute between May 2009 and December 2018. Hepatectomy donors were evaluated retrospectivly. Biliary complications in donors were classified according to Modified Clavien-Dindo classification. In the treatment of biliary complications, US-guided percutaneous drainage, endoscopic biliary drainage (ERCP), percutaneous biliary drainage (PTC/PTBD) and surgical treatment were applied and treated by percutaneous radiologycal treament donors were evaluated. Results: Of the 1839 donors, 121 (6.57%) required invasive treatment (Clavien grade III and IV) complications. Of thesee, 51 patients underwent US-guided percutanous drainage and 30 donors who accepted as minor biliary leakage received no additional teratment. İncluding 17 patients with percutaneous drainage therapy, 83 patients underwent ERCP. 53 of thesee, ERCP was successful. A total of 14 patients, 12 of whom donors and 2 of whom aborted donors underwent PTC/PTBD. 8 of thesee were terated successfully. 2 of thesee 8 patients had also autonomic bile tract and were operated under the guidance of placed percutaneous catheters. In 4 patients, the occlusal segment could not be passed and the guide wire was inserted in the percutaneous catheters intraoperatively by the interventional radiologyst. 2 patients were treated percutaneously afte hepatico-jejunostomy. Conclusion: It is noteworthy that PTC/PTBD completes the USG-guided percutaneous drainage and endoscopic treatment; while eliminating the need for surgery in some patients and guides treatment in patients undergoing surgery. Keywords: donor, biliary complication, percutaneous radiologycal treatment
Purpose: We aimed to evaluate percutaneous radiological treatment modalities and success in biliary complications that occur in donors for living donor liver transplantation (LDLT). Materials and Methods: This retrospective study was performed with permission of Malatya Inonu University Research and Publication Ethics Board decision number 2019/5-23. A total of 1839 LDLTs were performed in Inonu University Turgut Özal Medical Center Liver Transplantation Institute between May 2009 and December 2018. Hepatectomy donors were evaluated retrospectivly. Biliary complications in donors were classified according to Modified Clavien-Dindo classification. In the treatment of biliary complications, US-guided percutaneous drainage, endoscopic biliary drainage (ERCP), percutaneous biliary drainage (PTC/PTBD) and surgical treatment were applied and treated by percutaneous radiologycal treament donors were evaluated. Results: Of the 1839 donors, 121 (6.57%) required invasive treatment (Clavien grade III and IV) complications. Of thesee, 51 patients underwent US-guided percutanous drainage and 30 donors who accepted as minor biliary leakage received no additional teratment. İncluding 17 patients with percutaneous drainage therapy, 83 patients underwent ERCP. 53 of thesee, ERCP was successful. A total of 14 patients, 12 of whom donors and 2 of whom aborted donors underwent PTC/PTBD. 8 of thesee were terated successfully. 2 of thesee 8 patients had also autonomic bile tract and were operated under the guidance of placed percutaneous catheters. In 4 patients, the occlusal segment could not be passed and the guide wire was inserted in the percutaneous catheters intraoperatively by the interventional radiologyst. 2 patients were treated percutaneously afte hepatico-jejunostomy. Conclusion: It is noteworthy that PTC/PTBD completes the USG-guided percutaneous drainage and endoscopic treatment; while eliminating the need for surgery in some patients and guides treatment in patients undergoing surgery. Keywords: donor, biliary complication, percutaneous radiologycal treatment
Açıklama
Anahtar Kelimeler
Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine
