Trakya Üniversitesi Tıp Fakültesi Genel Cerrahi kliniğinde uygulanan açık ve laparoskopik kolesistektomilerin karşılaştırılması
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Tarih
2008
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info:eu-repo/semantics/openAccess
Özet
Bu çalışmamızda; kliniğimizde kolesistektomi uyguladığımız olguların morbidite ve mortalite oranlarının belirlenmesi ve mortalite ve morbiditeye etkisi olan faktörlerin ortaya konulması ve karşılaştırılması amaçlanmıştır. Ocak 2002 ve Haziran 2008 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı kliniğinde kolesistektomi uygulanan 802 (511 kadın, 291 erkek; ort. yaş 54,4; dağılım 14-89) hasta çalışmaya dâhil edildi. Hastalar uygulanan ameliyat tekniğine göre laparoskopik kolesistektomi uygulananlar (Grup I) ve açık kolesistektomi uygulananlar (Grup II) olmak üzere iki gruba ayrıldı. Grup I' de toplam 483, Grup II' de ise 319 hasta mevcuttu. Grup I ve Grup II arasında komplikasyonlar ve mortalite oranları açısından istatistiksel olarak anlamlı fark olmadığı tespit edildi (p>0,05). Dörtyüzseksenüç hastanın 24 (% 5)' ünde açığa geçildi. Açığa geçilme nedenleri içerisinde yapışıklıklar (% 4) ilk sırayı almaktadır. Gruplar arasında ağrı kesici gereksinimi açısından istatistiksel olarak anlamlı fark olduğu saptandı (p<0,05). Gruplar arasında hastanede kalış süreleri açısından istatistiksel olarak anlamlı fark olduğu saptandı (p<0,05). Öğretim üyeleri ve 4. 5. yıl asistanları tarafından gerçekleştirilen ameliyatlar arasında açığa geçilme oranları ve hastanede kalış süreleri açısından fark olduğu saptandı (p<0,05). Aspartat aminotransferaz değeri yüksek olarak tespit edilen hastaların postoperatif komplikasyon oranlarının daha yüksek olduğu saptandı (p<0,05). Akut kolesistit atağı geçiren hastaların açığa geçilme ve peroperatif komplikasyon oranları daha yüksek olarak tespit edildi (p<0,05). Sonuç olarak; açığa geçilme oranlarının operasyonu yapan kişinin cerrahi deneyimi ile yakından ilişkili olduğunu ve deneyim arttıkça açığa geçilme oranının azalacağını düşünüyoruz. Laparoskopi konusunda deneyim kazanmamızın yanı sıra kullanılan el aletleri ve videoskopik cihazlardaki teknolojik gelişmelerinde peroperatif komplikasyon oranlarındaki gerilemede etkili olduğu kanaatindeyiz.
The aim of this study was to find out the morbidity and mortality rates for the patients who underwent open or laparoscopic cholecystectomy, and to introduce and compare the factors of mortality and morbidity. We evaluated the data of 802 patients who were treated between January 2002 and June 2008 in Trakya University Medical Faculty Department of General Surgery, in Edirne. The male/female ratio was 511/291, the mean age was 54.4(14-89). Patients divided into two groups according to surgical technique, patients underwent laparoscopic cholecystectomy (Group 1) and patients underwent open cholecystectomy (Group 2). There were 483 patients in Group 1 and 319 patients in group 2. There was no statistically significant difference between two groups according to the complications and the mortality rate (p<0,05). In 24(5%) of 483 patients, conversion to the open cholecystectomy was documented. The most common reason of conversion to open cholecystectomy was adhesion formation (4%). There was a significant statistically difference between the groups according to the analgesic need (p<0,05). It was found that there was a significant difference between the groups according to the hospital stay (p<0,05). It was also found that there was a significant difference according to the hospital stay and the conversion rate to open surgery between operations performed by academic surgical staff or surgical residents in the fourth or fifth year (p<0,05). Postoperative complication rate was found to be higher for patients who had a increased AST levels (p<0.05). The conversion rate and the rate of postoperative complication were higher in patients who had acute cholecystitis previously. Finally, we suppose that conversion to open cholecystectomy is related to the experience of surgeon. With increasing experience in laparoscopic surgery the conversion rates will decrease obviously.
The aim of this study was to find out the morbidity and mortality rates for the patients who underwent open or laparoscopic cholecystectomy, and to introduce and compare the factors of mortality and morbidity. We evaluated the data of 802 patients who were treated between January 2002 and June 2008 in Trakya University Medical Faculty Department of General Surgery, in Edirne. The male/female ratio was 511/291, the mean age was 54.4(14-89). Patients divided into two groups according to surgical technique, patients underwent laparoscopic cholecystectomy (Group 1) and patients underwent open cholecystectomy (Group 2). There were 483 patients in Group 1 and 319 patients in group 2. There was no statistically significant difference between two groups according to the complications and the mortality rate (p<0,05). In 24(5%) of 483 patients, conversion to the open cholecystectomy was documented. The most common reason of conversion to open cholecystectomy was adhesion formation (4%). There was a significant statistically difference between the groups according to the analgesic need (p<0,05). It was found that there was a significant difference between the groups according to the hospital stay (p<0,05). It was also found that there was a significant difference according to the hospital stay and the conversion rate to open surgery between operations performed by academic surgical staff or surgical residents in the fourth or fifth year (p<0,05). Postoperative complication rate was found to be higher for patients who had a increased AST levels (p<0.05). The conversion rate and the rate of postoperative complication were higher in patients who had acute cholecystitis previously. Finally, we suppose that conversion to open cholecystectomy is related to the experience of surgeon. With increasing experience in laparoscopic surgery the conversion rates will decrease obviously.
Açıklama
Anahtar Kelimeler
Genel Cerrahi, General Surgery
