Safra yolları taşı olgularında klinik deneyim
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Date
1991
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Uludağ Üniversitesi
Abstract
Uludağ Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı Kliniğinde, Ocak 1985-0cak 1990 tarihleri arasında ameliyat edilmiş 327 safra yolu taşı olgusu retrospektif olarak incelenmiştir. Olgularda ameliyat öncesi almış oldukları klinik ve ultrasonografik (US) tetkik bulguları ameliyat sırası almış oldukları tanılarla karşılaştırılmıştır. Ameliyat sırası yapılan kolanjiyografiler ve endikasyonları irdelenmiştir. Olgular 17 - 93 yaşlar arasında dağılmakta olup, ortalama yaş 50.9 ± 13.4 yıldır. Ameliyat öncesi konulan ön tanılarla ameliyat bulguları arasında % 8.8 yanılma olduğu görülmektedir. Bu değer içine akut karın tanısı konulan olgular da dahil olup, aynı zamanda klinik tanı patolojinin safra yollarında olduğunu göstermesine karşın kesin değerleri bildirilmeyen olgular da buna dahil edilmiştir. US bulguları safra yollarındaki patoloji göstermede % 98.8 sensitif, % 37.5 spesifik olarak bulunmuştur (testin güvenirliği % 97). Ameliyat sırasında kolanjiyografi ve koledok eksplorasyonu yapılması klasik endikasyonlarla cerrahın kararıyla olmuştur. Kolanjiyografi 56 olguda (% 17.1) gerçekleştirilmiştir. 49 akut kolesistit olgusunun 15'i (% 30.6) gangrene safra kesesi veya ampiyem gibi komplike olgulardır. Bunun yanında bunların 12'sine (% 80.0) kolesistektominin gerçekleştirebildiği görülmüştür. Olgularda mortalite 2 olguyla % 0.6'dır. Bunların hepsi akut olgular içinde olup, bu olgulardaki mortaliteyi % 4.0 olarak oluşturmaktadırlar.
Between January 1985 - January 1990, 327 consecutive cases which were operated for biliary tract stone disease are analysed retrospectively. Preoperative clinical and ultrasonographic findings are compared with the definite operative diagnosis. Operative cholangiographies and their indications are evaluated. The age distribution of the cases were between 17-93 years, and the mean age was 50.9 ± 13.4 years. In the 8.8 % of the cases the pre and preoperative diagnosis did not correlate. This value includes also the cases operated with the diagnosis of acute abdomen, and also the cases in which the clinical diagnosis was in favour of biliary tract pathology but the definite diagnostic values were not the same as preoperatively declared. The sensitivity of the ultrasonographic findings was 98 %, and the spesificity 37.5 %. Preoperative cholangiography was performed on 56 cases ( 17. 1 % ). The indication for preoperative cholangiography and exploration of the common biliary tract was done with surgeon in charge according to the classical rules. Complicated cases like gangrenous or empyematous gallbladder was found in 15 (30.6 %) of the 49 acute cholecystitis cases, and in 12 of them (80.0 %) cholecystectomy performed successfully. The total mortality rate was 0.6 % (21327 cases), but the mortality rate of the operated acute cholecystitis cases was found to be 4 %.
Between January 1985 - January 1990, 327 consecutive cases which were operated for biliary tract stone disease are analysed retrospectively. Preoperative clinical and ultrasonographic findings are compared with the definite operative diagnosis. Operative cholangiographies and their indications are evaluated. The age distribution of the cases were between 17-93 years, and the mean age was 50.9 ± 13.4 years. In the 8.8 % of the cases the pre and preoperative diagnosis did not correlate. This value includes also the cases operated with the diagnosis of acute abdomen, and also the cases in which the clinical diagnosis was in favour of biliary tract pathology but the definite diagnostic values were not the same as preoperatively declared. The sensitivity of the ultrasonographic findings was 98 %, and the spesificity 37.5 %. Preoperative cholangiography was performed on 56 cases ( 17. 1 % ). The indication for preoperative cholangiography and exploration of the common biliary tract was done with surgeon in charge according to the classical rules. Complicated cases like gangrenous or empyematous gallbladder was found in 15 (30.6 %) of the 49 acute cholecystitis cases, and in 12 of them (80.0 %) cholecystectomy performed successfully. The total mortality rate was 0.6 % (21327 cases), but the mortality rate of the operated acute cholecystitis cases was found to be 4 %.
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Keywords
Safra yolları, Taş olguları, Klinik deneyim, Biliary tracts, Clinical experience, Stone cases
Citation
Korun, N. vd. (1991). ''Safra yolları taşı olgularında klinik deneyim''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 18(1), 55-65.