Çocukluk çağı kist hidatiklerinde cerrahi, perkütan radyolojik girişim ve benzimidazol tedavisi
Surgery, percutaneous radiological intervention and benzimidazole treatment in childhood hydatid cysts
Yazar: KAMURAN TUTUŞ
Danışman: PROF. DR. RECEP TUNCER
Çukurova Üniversitesi / Tıp Fakültesi / Çocuk Cerrahisi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2018
Konu: Klinik Bakteriyoloji ve Enfeksiyon Hastalıkları = Clinical Microbiology and Infectious Diseases ; Radyoloji ve Nükleer Tıp = Radiology and Nuclear Medicine ; Çocuk Cerrahisi = Pediatric Surgery
Dizin: Albendazol = Albendazole ; Benzimidazoller = Benzimidazoles ; Cerrahi = Surgery ; Cerrahi işlemler-operatif = Surgical procedures-operative ; Echinococcosis = Echinococcosis ; Echinococcus = Echinococcus ; Kistler = Cysts ; Çocuklar = Children

Özet:
Amaç: Çocuklarda kist hidatik sebebiyle cerrahi, perkütan ve benzimidazol tedavilerinde etkinliğin araştırılması.
Gereç ve Yöntem: Haziran 2002 ile Haziran 2016 arasında kist hidatik sebebiyle tedavi gören 91 çocuğun dosyası retrospektif incelendi. Hastalar; başvuru şikâyetleri, muayene bulguları, tanı yöntemleri, kistlerin yerleşim yeri, tip, boyut ve sayısı, tedavi yöntemleri, tedaviyi etkileyen faktörler, takip süreleri, bronş-safra fistülleri, kist rüptürü, komplikasyonlar ve yönetimi konularında değerlendirildi. Her bir organ ve organ ilişkisiz yerleşimler bir bölge olarak kabul edilip buna göre de kıyaslamalar yapıldı. İstatistiksel analizde IBM SPSS Statistics Versiyon 20.0 paket programı kullanıldı. 
Bulgular: En sık başvuru şikâyeti karın ağrısıydı. Karaciğer kistli 28/71, akciğer kistli 25/33 hastada muayenede patoloji vardı. Tanıda akciğer grafisi, tomografi ve manyetik rezonans görüntüleme kullanıldı. Seroloji 61/91 hastada pozitifti. Histopatolojik inceleme 75 hastada yapıldı. En sık tutulum karaciğerde, en fazla kist tipi Tip 1'di (49/71 hastada). 91 hastada 115 organ-bölge tutulumu vardı. Kist çapları ortalama 71,66±35,79 mm idi. Cerrahi 59, albendazol 41, perkütan tedavi 14 bölgeye uygulandı. Cerrahiyle 56/59, albendazolle 27/41, perkütan radyolojik girişimle 10/14 başarı sağlandı. Albendazol profilaksisi karaciğer cerrahisinde 29/29, akciğer cerrahisinde 19/21, perkütanda 11/14 hastaya uygulandı. En çok yapılan cerrahi işlem konservatif yöntem idi (52/59). Albendazol küçük kistlerde daha başarılıydı. Cerrahi uygulanan akciğer kistlerinin 19/23'ü bronş ilişkiliydi. Karaciğerde safra yoluyla ilişkili kistlerin 13/15'inde çap 75 mm'nin üstündeydi. Rüptür akciğer kistlerinde 12/33, karaciğerde 3/71 hastada vardı. Postoperatif hava kaçağında konservatif takip; safra drenajında endoskopik retrograd kolanjiopankreatografi, sfinkterotomi, biliyer stent ve cerrahi uygulandı. Takip süresi ortalama 40±28 aydı.
Sonuç: Kist hidatikte cerrahi halen en çok uygulanan ve en etkili tedavidir. Uygun vakalarda albendazol veya perkütan tedavi de etkilidir. En uygun tedavinin tespitinde başka prospektif çalışmalara ihtiyaç vardır.


Anahtar sözcükler: Albendazol, Cerrahi, Çocuk, Kist Hidatik, Perkütan Radyolojik Girişim

Abstract:
ABSTRACT
Surgery, Percutaneous Radiological Intervention and Benzimidazole Treatment in Childhood Hydatid Cysts
Aim: Investigation of the effectiveness of surgery, percutaneous radiological intervention and benzimidazole treatment for hydatid cyst in children.
Material and method: Between June 2002 and June 2016, patient file of 91 children, who were treated for cyst hydatid disease, were retrospectively reviewed. Patients were evaluated in terms of application complaints, physical examination findings, diagnostic methods, location, type, size and number of cysts, treatment methods, factors affecting treatment, follow up times, bronchial-bile fistulas, cyst rupture, complications and their management. Each organ and organ unrelated settlements were considered as a region and compared accordingly. All analyses were performed using IBM SPSS StatisticsVersion 20.0 statistical software package. 
Results: The most common complaint was abdominal pain. There were pathologic findings in 28 of 71 patients with liver cysts and 25 of 33 patients with lung cysts. Chest X-ray, tomography and magnetic resonance imaging were used in the diagnosis. Serology was positive in 61/91 patients. Histopathologic examination was performed in 75 patients. The most frequent involvement was seen in the liver and the cyst type was Type 1 (49/71 patients). There was 115 organ-region involvement in 91 patients. The mean diameter of the cysts was 71.66 ± 35.79 mm. Surgical treatment was applied in 59 regions, albendazole treatment in 41 regions and percutaneous treatment in 14 regions. Surgery was successful in 56 of 59 regions. Albendazole treatment was successful in 27 of 41 regions. Percutaneous radiological intervention was successful in 10 of 14 regions. Albendazole prophylaxis was applied to 29/29 patients in liver surgery, 19/21 patients in pulmonary surgery and 11/14 patients in percutaneous treatment. Conservative method (52/59) was used most commonly in surgery. Albendazole was more successful in small cysts. 19/23 of surgically treated lung cysts were associated with bronchi. In liver, 13/15 of bile-related cysts were bigger than 75 mm in diameter. Rupture was present in 12 of 33 lung cysts and 3 of 71 liver cyst patients. Follow-up was performed in case of air leak during postoperative period. When there is persistent external biliary fistula; endoscopic retrograde cholangiopancreatography, sphincterotomy, biliary stent and surgery were performed. The mean follow-up period was 40 ± 28 months.
Conclusion: Surgery is still the most effective and most commonly used treatment method for cyst hydatid disease. In appropriate cases albendazole or percutaneous treatment are also effective. Other prospective studies are needed to determine the most appropriate treatment.


Key Words: Albendazole, Child, Cyst Hydatid, Percutaneous Radiological Intervention, Surgery