Ulus Travma Acil Cerrahi Derg. 2023; 29(11): 1248-1254 | DOI: 10.14744/tjtes.2023.75670

Akut kolesistitli yaþlý hastalarda gecikmiþ acil kolesistektomi ihtiyacýnýn göstergesi olarak kan parametrelerinin etkinliði

Mehmet Kubat¹, Serkan Þengül², Serdar Þahin^3
1Alanya Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Antalya, Tütkiye
²Alaaddin Keykubat Üniversitesi, Genel Cerrahi Ana Bilim Dalý, Antalya, Türkiye
³Ahi Evran Üniversitesi, Genel Cerrahi Ana Bilim Dalý, Kýrþehir, Türkiye

AMAÇ: Akut kolesistitli hastalarda erken kolesistektomi önerilmesine raðmen, konservatif tedaviyi takiben gecikmiþ kolesistektomi (DC) özellikle yaþlý eriþkin hastalarda oldukça tercih edilen bir yöntemdir. Bununla birlikte, bazý ciddi vakalar gecikmiþ acil kolesistektomi (OC) gerektirir. Bu çalýþ-ma, laboratuvar bulgularýnýn ve Tokyo þiddet sýnýflandýrmasýnýn (TokyoSC) yaþlý hastalarda OK ihtiyacý olanlarý ayýrt etme yeteneðini deðerlendirmeyi amaçladý.
GEREÇ VE YÖNTEM: Akut kolesistitli geriatrik hastalarýn baþvuru sýrasýndaki laboratuvar/radyolojik/klinik bulgularý ve TokyoSC geriye dönük olarak incelendi. DC ve OC gruplarý karþýlaþtýrýldý.
BULGULAR: 164 hastanýn yaþ ortalamasý 72.3±6.4 idi. Beyaz kan hücresi, nötrofil (NEU), olgunlaþmamýþ granülosit (IG), C-reaktif protein, nötrofil-lenfosit oraný (NLR) ve TokyoSC parametrelerinin tümü farklýlaþmada p < 0,001'de anlamlýydý. NLR'nin özgüllüðü %98 ve TokyoSC'nin duyarlýlýðý %98'dir.
SONUÇ: NLR, NEU, IG ve TokyoSC, akut kolesistit nedeniyle takip edilen yaþlý eriþkin hastalarda konservatif tedavi + DC planlanýrken OC ihtiyacý olan hastalarý ayýrt etmede etkiliydi. NLO >9.9 ve TokyoSC orta/yüksek ise yaþlý hastalarda konservatif tedavi + DC yerine erken kolesistektomi tercih edilmelidir.

Anahtar Kelimeler: Akut kolesistit, C-reaktif protein; kolesistektomi, nötrofil-lenfosit oraný; þiddet derecelendirmesi; yaþlý.

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Efficacy of blood parameters as indicators of the need for overdue urgent cholecystectomy in elderly patients with acute cholecystitis

Mehmet Kubat¹, Serkan Þengül², Serdar Þahin^3
1Department of General Surgery, Alanya Training and Research Hospital, Antalya-Türkiye
²Department of General Surgery, Alaaddin Keykubat University, Antalya-Türkiye
³Department of General Surgery, Ahi Evran University, Kýrþehir-Türkiye

BACKGROUND: Although early cholecystectomy is recommended for patients with acute cholecystitis, conservative treatment followed by delayed cholecystectomy (DC) is a highly preferred modality, especially in older adult patients. However, some severe cases require overdue urgent cholecystectomy (OC). This study aimed to evaluate the ability of laboratory findings and Tokyo severity classification (TokyoSC) to differentiate those with the need for OC among elderly patients.
METHODS: Laboratory/radiological/clinical findings of geriatric patients with acute cholecystitis on admission and TokyoSC were retrospectively analyzed. The DC and OC groups were compared.
RESULTS: The mean age of the 164 patients was 72.3±6.4 years. White blood cell, neutrophil (NEU), immature granulocyte (IG), C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), and TokyoSC parameters were all significant at P<0.001 in differentiation. NLR had a specificity of 98%, and TokyoSC had a sensitivity of 98%.
CONCLUSION: NLR, NEU, IG, and TokyoSC were effective in differentiating patients who needed OC while planning conservative treatment + DC for older adult patients who were followed up due to acute cholecystitis. If the NLR is >9.9 and TokyoSC is moderate/high, early cholecystectomy should be preferred instead of conservative treatment + DC in aged patients.

Keywords: Acute cholecystitis, aged; cholecystectomy; c-reactive protein; neutrophil-to-lymphocyte ratio; severity grading.

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