الاتصالات الكيسية الصفراوية في كيسات الكبد المائية تشخيص وتدبير
Abstract
شملت الدراسة 47 مريضاً لديهم اتصال كيسي صفراوي من أصل 213 مريضاً أي بنسبة 22.38 %. عولجوا في قسم الجراحة بمشفى الأسد الجامعي باللاذقية بين عامي 1992 و 2007.
يمكن التنبؤ بوجود اتصال كيسي صفراوي بواسطة مشعرات مهمة : ارتفاع في مستويات ALP، GGT، TB،DB و قطر الكيسة < 10 سم، والكيسات المتعددة والناكسة. تم توزيع مرضى الدراسة إلى 3 مجموعات حسب زمن تشخيص الاتصال الكيسي الصفراوي بالنسبة للجراحة. التدابير الجراحية التي اتبعت خياطة الناسور + رأب الثرب + نزح قناة الصفراء (T-tube). تم علاج التسريب الصفراوي بعد الجراحة علاجاً محافظاً.و تم إجراء الـ ERCP عند تشكل الناسور عالي النتاج أو استمراره لأكثر من 3 أسابيع.بلغت نسبة المضاعفات بعد الجراحة 60.2 % مع حالتي وفاة. متوسط الإقامة في المشفى أطول عند حدوث الاتصال الكيسي الصفراوي، وهذا يزيد من نسبة المراضة والوفيات بعد الجراحة وبالتالي من المهم جداً تشخيصه قبل الجراحة وفي أثنائها ليكون العلاج ناجعاً.
The study included 47 patients who had CBC among 213 patients who had Hydatid Liver cysts (rate 22.38%) and had been admitted and treated in department of Surgery in Assad Hospital in Lattakia between 1992 and 2007. CBC can be predicted by important predictors: elevation of ALP, GGT, TB, DB values, Eosinophils count, cyst diameter >10 cm and recurrent and multi cysts. The study patients were divided into 3 groups according to the time of CBC diagnoses for surgery. The treatment of postoperative biliary leakage was conservative. ERCP was done when a high output fistula happens or when it remains for more than 3 weeks. 60.2 % was the average of postoperative complication and two patients died. The main hospital stay was longer in CBC. This increases postoperative morbidity and mortality. So CBC diagnosis during surgery is very important to have useful treatment.
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