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Amaç: İnoperabl malign bilier obstrüksiyonlu hastalarda, perkütan transhepatik kolanjiyografi(PTK) sonrasında uygulanan perkütan bilier drenaj(PBD) ve metalik endoprotez uygulamalarının etkinliğini sunmayı amaçladık. Gereç ve Yöntem: Girişimsel radyoloji ünitemize 3 yıllık süre içerisinde refere edilen, malign tıkanma sarılığı olan inopere 44 hastaya, PTK sonrası PBD uygulandı. Altı olguya (%13,6) sadece eksternal bilier drenaj(EBD), 27 olguya (%61,4) sadece internal-eksternal bilier drenaj(İEBD), 11 olguya (%25) ise ortalama 6 gün (1-34 gün) sonra İEBD sonrası metalik stent uygulandı. Drenaj öncesi ve sonrası alınan ortalama total bilirubin(TB), ALP, ALT, AST, GGT değerleri karşılaştırıldı. Bulgular: Hastaların tümünde safra drenajı sağlanarak işlem başarıyla sonlandırıldı. PBD sonrası ilk 2 haftada 38 olgunun (%86) genel durumunda iyileşme, halsizlik ve kaşıntı gibi şikayetlerde azalma saptandı. Tüm hastalarda drenaj öncesi ve sonrası ortalama total bilirubin(TB) 19,41 ± 9,09 9,39 ± 15,34, ALP 701,27 ± 352,53 357,48 ± 268,70, ALT 122,45 ± 75,42 62,91 ± 61,90, AST 129,14 ± 84,31 94,93 ± 118,79, GGT 684,48 ± 428,83 322,39 ± 253,26 olarak hesaplandı ve işlem sonrası değerlerde anlamlı düşüş saptandı (p<0,050). Takipte toplam 10 hastada (%22,7) minör komplikasyonlar izlendi. Sonuç: İnoperabl malign tıkanma sarılıklı hastalarda yaşamı mümkün olduğunca uzatabilmek için hastanın hepato-renal yetmezliğe girmesini önlemek gereklidir. Perkütan biliyer drenaj ve biliyer endoprotez uygulamaları, bozulmuş olan hepatik fonksiyonları büyük ölçüde düzelterek hastanın genel durumunun iyileşmesine olanak sağlamaktadır. Bir başka cerrahi müdahale gerekmeden hızlı bir şekilde hastanın genel durumunu iyileştirmesi ve düşük komplikasyon oranları bu radyolojik girişimin değerini giderek artırmaktadır.
Purpose: In patients with inoperable malign bilier obstruction, we aimed to provide the effectiveness of the percutaneous bilier drainage (PBD) and metal endoprothesis applications applied after percutaneous transhepatic colanjiyography (PTK). Tools and Methods: Inopere, malignant blocking coat, which was referred to in our initiative radiology unit within 3 years, 44 patients, after PTK, were applied PBD. In six cases (13.6%), only external bilier drenage (EBD), 27 cases (61.4%), only internal-external bilier drenage (EBD), 11 cases (25%) and an average of 6 days (1-34 days) after IEBD, metal stent was applied. The average total bilirubin (TB), ALP, ALT, AST, GGT values taken before and after drainage were compared. Results: The process was successfully completed by providing gland drainage to all patients. In the first 2 weeks after PBD, a reduction in complaints, such as healing, impotence and swelling, was observed in the overall condition of 38 matures (86 percent). In all patients, the average total bilirubin (TB) before and after drainage was calculated as 19,41 ± 9,09; 9,39 ± 15,34, ALP; 701,27 ± 352,53; 357,48 ± 268,70, ALT; 122,45 ± 75,42; 62,91 ± 61,90, AST; 129,14 ± 84,31; 94,93 ± 118,79, GGT; 684,48 ± 428,83; 322,39 ± 253,26 and a significant decrease in post-treatment values (p<0,050). In the follow-up, a total of 10 patients (22.7%) were monitored with minor complications. The result: Inoperable malignant blockage is necessary to prevent the patient from getting into hepato-renal insufficiency in order to extend life as long as possible in patients. Percutaneous intestinal drenage and intestinal endoprothesis applications enable the general condition of the patient to improve by greatly improving the deteriorated liver functions. The rapid improvement of the general condition of the patient without the need for another surgical intervention and the low rates of complications increases the value of this radiological initiative.
Objective:We aimed to present the effectiveness of percutaneous transhepatic cholangiography, percutaneous biliary drainage and metallic endoprotesis applications in patients with inoperable biliary obstructions. Materials and Methods: Percutaneous transhepatic cholangiographies(PTC) and percutaneous biliary drainages (PBD) were performed in 44 patients with inoperabl malignant obstructive jaundice who had been hospitalized in the radiology department of our hospital over a three years period. Six patients (13.6%) underwent external biliary drainage(EBD), 27 patients (61.4%) underwent internal-external biliary drainage(I-EBD) and metallic stents were placed in 11 patients (25%) on average 6 days (1-34 days) after I-EBD. The mean total bilirubin(TB), ALP, ALT, AST, GGT values taken before and after drainage in all patients were compared. Results: Biliary drainage was technically successful in all patients.İn the first two weeks after biliary drainage, 38 cases (86%) had a general condition improvement, weakness and itching decreased. The mean TB;19,41 ± 9,09; 9,39 ± 15,34, ALP; 701,27 ± 352,53 ; 357,48 ± 268,70, ALT; 122,45 ± 75,42; 62,91 ± 61,90, AST; 129,14 ± 84,31; 94,93 ± 118,79, GGT; 684,48 ± 428,83; 322,39 ± 253,26 values taken before and after drainage in all patients were compared and a significant decrease was found in the post-procedure values (p<0,050). In the follow-up, minor complications were observed in 10 patients (22.7%). Conclusion: It is necessary to prevent inoperable patients from entering hepato-renal failure in order to prolong life time as much as possible. PBD and stent applications significantly improves impaired liver function, allowing the patients general condition improvement. Low complication rates and quickyl improving general condition of patients without need for another surgery gradually increase the value of this radiological intervention.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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