Çocuklarda safra kesesi taşı: Klinik ve cerrahi bulguların değerlendirilmesi
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Date
2016
Authors
Aydın, Çetin
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Çocuklarda safra taşı hastalığının insidansında belirgin bir artış gözlenmektedir ve safra kesesi taşı çocukluk çağında önemli bir sağlık sorunu haline gelmiştir. Çocuklarda safra kesesi taşı ile ilgili erişkinlerin aksine yeterli çalışma ve klavuzlar yoktur. Halen tartışma konusu olan birçok noktada uzlaşmaya ihtiyaç olduğu görülmektedir. Biz de çocuklarda safra taşı ile ilgili risk faktörlerini ortaya koymak, semptomlar üzerine etkili faktörleri belirlemek ve çocuklarda safra taşı yönetimiyle ilgili kendi sonuçlarımızı ve deneyimlerimizi sunmayı amaçladık. Safra kesesi taşı nedeniyle kolesistektomi yaptığımız hastaların demografik özellikleri, anamnez bulguları, safra taşı risk faktörleri, ek hastalıkları, görüntüleme bulguları, laboratuar sonuçları, cerrahi bulguları, patoloji raporları, postoperatif takip sonuçlarını retrospektif olarak taradık. Safra kesesi taşı ile ilgili semptomlara, ciddiyet derecesine göre puan verilip her hasta için semptom skoru belirlendi ve değişik gruplar arasında semptom temelindeki farklılıklar karşılaştırıldı. Çalışmamızda 72'si kız 75 erkek olmak üzere 147 hasta vardı. Çocukluk çağında safra taşının erken çocuklukta erkek cinsiyette, adölesan dönemde ise kız cinsiyette daha fazla görüldüğü saptandı. Serimizde 35 (%23,8) asemptomatik, 112 (%76,2) semptomatik hasta vardı ve asemptomatik hastalarda risk faktörü daha fazla orandaydı. Hastalarımızn %54,4'ünde bir risk faktörü vardı ve en sık görülen risk faktörü hemolitik hastalıktı. Risk faktörü olmayan (idiyopatik) hastalarda semptom skor ortalaması daha yüksek saptandı. Ultrasonografik bulgularda hastaların %14,28'inde milimetrik, %44,9'unda da multiple taş varlığı saptandı. Milimetrik taşlı hastalarda semptom skoru ve pankreatit riski daha yüksekti. Hastalarımızın %96,6'sına laparoskopik kolesistektomi yapılmış ve komplikasyon oranı (%2,8) düşüktü. Türkiye'deki geniş serilerden biri olan çalışmamızda; son yıllarda safra kesesi taşı insidansında artış olduğu görüldü. Kızlarda ve ileri yaşta; Vücut Kitle İndeksi'nde (VKİ), safra taşı insidansında ve semptom şiddetinde artış olduğu görüldü. Daha küçük yaşlarda ise semptomların daha hafif olduğu saptandı. VKİ'nde artış kızlar için daha belirleyici bir risk faktörüydü. Asemptomatik hastalarda da uygun koşullarda laparoskopik kolesistektomi önermekteyiz. Çocuklarda safra kesesi taşı yönetimi ile ilgili eksiklerin giderilmesi için geniş serilerle daha fazla, çok merkezli ve çok boyutlu çalışmalara ihtiyaç olduğunu düşünmekteyiz.
The incidence of gallstones in pediatric population is increasing in recent years and it becomes a challenging problem in children. In opposition to adults, there is not enough studies or guidelines and consensus to manage this disease. We aimed to contribute our experience and results about risk factors that influences the symptoms and management. We report data of the patients with gallstones that experienced cholecystectomy. Demographic features, medical history, risk factors of gallstone, associated anomalies, results of radiologic examination and laboratory tests, operative findings, results of histopathological examination and follow up period were reviewed retrospectively. We classified the symptoms due to their severity with symptom scoring system and examined the differences between patients about the symptom scores. In our study, there were 147 patients, including 75 boy and 72 girl. It was detected that in toddler period the incidence of gallstones was more in boys and in adolescents, it was seen in girls. There were 35 (%23,8) asymptomatic, 112 (%76,2) symptomatic patients in our series and there was more risk factors in asymptomatic patients. 54.4% of our patients had a risk factor and the most common risk factor was hematologic disease. The average symptom scores were significantly higher in patients with idiopathic. In ultrasonographic findings; 14.28% of patients had millimeter stones and 44,9% of patients had multiple stones. In patients with millimetric stones; symptom scores and the risk of pancreatitis were higher. We performed laparoscopic cholecystectomy in 96,6 % of patients, complication rate (2.8%) is low. Our study is one of the larger data in Turkey; It appeared to be an increased incidence of gallstones in recent years. BMI (Body Mass Index), incidence of gallstones and the severity of symptoms were detected higher at older ages and in girls. At early childhood the symptom scores were less than scores that detected at older patients. Laparoscopic approach was the procedure that performed most of the cases. We think that multicentre studies with large patient groups that evaluate multiple factors are required to improve the management strategies of gallstone disease in children.
The incidence of gallstones in pediatric population is increasing in recent years and it becomes a challenging problem in children. In opposition to adults, there is not enough studies or guidelines and consensus to manage this disease. We aimed to contribute our experience and results about risk factors that influences the symptoms and management. We report data of the patients with gallstones that experienced cholecystectomy. Demographic features, medical history, risk factors of gallstone, associated anomalies, results of radiologic examination and laboratory tests, operative findings, results of histopathological examination and follow up period were reviewed retrospectively. We classified the symptoms due to their severity with symptom scoring system and examined the differences between patients about the symptom scores. In our study, there were 147 patients, including 75 boy and 72 girl. It was detected that in toddler period the incidence of gallstones was more in boys and in adolescents, it was seen in girls. There were 35 (%23,8) asymptomatic, 112 (%76,2) symptomatic patients in our series and there was more risk factors in asymptomatic patients. 54.4% of our patients had a risk factor and the most common risk factor was hematologic disease. The average symptom scores were significantly higher in patients with idiopathic. In ultrasonographic findings; 14.28% of patients had millimeter stones and 44,9% of patients had multiple stones. In patients with millimetric stones; symptom scores and the risk of pancreatitis were higher. We performed laparoscopic cholecystectomy in 96,6 % of patients, complication rate (2.8%) is low. Our study is one of the larger data in Turkey; It appeared to be an increased incidence of gallstones in recent years. BMI (Body Mass Index), incidence of gallstones and the severity of symptoms were detected higher at older ages and in girls. At early childhood the symptom scores were less than scores that detected at older patients. Laparoscopic approach was the procedure that performed most of the cases. We think that multicentre studies with large patient groups that evaluate multiple factors are required to improve the management strategies of gallstone disease in children.
Description
Keywords
Çocuk, Safra kesesi taşı, Laparoskopi, Kolesistektomi, Semptom skoru, Childhood, Gallstone, Laparoscopy, Cholecystectomy, Symptom score
Citation
Çetin, A. (2016). Çocuklarda safra kesesi taşı: Klinik ve cerrahi bulguların değerlendirilmesi. Yayımlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.