| Abstract | UVOD: U uvodnom dijelu rada opisana je anatomija, fiziologija te patofiziologija žučnog sustava i ekskrecije žuči te kliničke manifestacije akutnog kolecistitisa. Za akutni kolecistitis istražili smo podatke iz dostupne literature o incidenciji, etiologiji, patofiziologiji, kliničkoj slici, mogućim komplikacijama te liječenju. Prilikom zbrinjavanja i liječenja bolesnika s akutnim kolecistitisom, istražili smo metode intervencijske radiologije uz najnovije smjernice kliničke prakse Tokyo Guidelines (TG13).
CILJ ISTRAŽIVANJA: Cilj istraživanja je utvrditi učinkovitost perkutane kolecistostome te drenaže apscesa jetre u bolesnika s umjerenim i teškim stupnjem akutnog kolecistitisa u KBC Split.
ISPITANICI I METODE: Ovom retrospektivnom studijom obuhvaćeno je 14 bolesnika čiji su se podaci iz digitalnih arhiva Kliničkog zavoda za dijagnostičku i intervencijsku radiologiju te arhiva povijesti bolesti i otpusnih pisama Klinika za kirurgiju i internu medicinu KBC Split koristili u istraživanju. Svim bolesnicima rađena je perkutana drenaža žučnog mjehura i/ili apscesa jetre uslijed akutnog kolecistitisa te su zabilježene eventualne komplikacije, mikrobiološki i laboratorijski nalazi, vrijeme do vađenja drena, ishod drenaže, podvrgavanje operativnom zahvatu, trajanje hospitalizacije te ishod liječenja.
REZULTATI: Na osnovu kliničkih i dijagnostičkih parametara, bolesnici su grupirani prema smjernicama TG13 o stupnju težine bolesti. Kod jednog je bolesnika klasificiran umjereni, II stupanj akutnog kolecistitisa, dok je kod ostalih klasificiran teški, III stupanj težine bolesti. Nakon podvrgavanja perkutanoj drenaži žučnog mjehura i/ili apscesa jetre, kod dvojice bolesnika zabilježene su blaže komplikacije. U svih bolesnika perkutana drenaža pokazala se kao učinkovita metoda liječenja akutnog kolecistitisa. Kod jednog je bolesnika zabilježen recidiv bolesti. Kod troje bolesnka učinjena je kolecistektomija. Smrtni ishodi nakon drenaže zabilježeni su kod dvije pacijentice, no uzrok smrti nije posljedica primjene metoda intervencijske radiologije već primarnih bolesti (karcinom žučnjaka; višeorgansko zatajenje).
ZAKLJUČAK: Naše istraživanje pokazalo je kako su obje metode, perkutana kolecistostoma i drenaža apscesa jetre, sigurni i minimalno invazivni načini liječenja bolesnika s umjerenim i teškim stupnjem akutnog kolecistitisa. |
| Abstract (english) | INTRODUCTION: In the introductory part of the paper describes the anatomy, physiology and pathophysiology of the biliary tract and bile excretion system, as well as clinical manifestations of the diseases. For acute cholecystitis we researched the available data from the literature on the incidence, etiology, pathophysiology, clinical presentation, possible complications and treatment. During the remediation and treatment of patients with acute cholecystitis , especially we have explored methods of interventional radiology, with the latest clinical practice guidelines, Tokyo Guidelines (TG13).
OBJECTIVES: The aim of this study was to determine the effectiveness of percutaneous choleystostomy and liver abscess drainage in patients with moderate and severe grade of acute cholecystitis at Clinical hospital centre Split.
PATIENTS AND METHODS: This retrospective study included 14 patients whose data, taken from a digital archive at the Department of interventional and diagnostic radiology, as well as from the archives of the history of the disease and discharge letters at the Departments of Surgery and Internal medicine at Clinical Hospital Center Split, used in the research. All patients undergo the percutaneous drainage of the gallbladder and/or an abscess of the liver due to acute cholecystitis. Possible complications, microbiological and laboratory findings, time of removing the drain, the outcome of the drainage, requiring of cholecystectomy, the duration of the hospitalization and treatment outcome were recorded.
RESULTS: On the basis of clinical and diagnostic parameters, patients are grouped according to the TG13 of severity grading for acute cholecystitis . One patient was classified as moderate, grade II acute cholecystitis, while the others were classified as severe, grade III acute cholecystitis. Two patients had mild complications following percutaneous cholecystostomy that didn´t require treatment. One patient had a relapse of the disease. Conditions at three of the patients required cholecystectomy. Two of the patients died few months after drainage, but the cause of death was not a result of the performing the methods of Interventional radiology. It is possible that the cause of death was the primary disease (cancer of the gallbladder; multiple organ failure).
CONCLUSION: Our research has shown that both methods, percutaneous cholecystostomy and liver abscess drainage, are safe and minimally invasive methods of treatment for patients with moderate and severe grade of acute cholecystitis. |
