Asemptomatik preoperatif transaminaz yüksekliklerinde postoperatif prognoz kontrollü bir retrospektif çalışma
Yükleniyor...
Dosyalar
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Toplumda sık rastlanan fizik muayenesi normal ve sınırda artmış serum aminotransferaz düzeyleri olan asemptomatik hastalar için, altta yatan karaciğer hastalığının ameliyat riskini arttırabileceği şüphesi vardır 2006-2014 yılları arasında Trakya Üniversitesi Tıp Fakültesinde çeşitli ameliyatlar geçirecek hastalarda sınırda transaminaz yüksekliklerinin postoperatif dönemde prognozu etkileyen bir risk faktörü yaratıp yaratmadığını belirlemeyi amaçladık. Bu amaçla, preoperatif aspartat aminotransferaz ve / veya alanin aminotransferaz değerleri normalin üstünde (5 kattan daha az) olan göğüs cerrahisi, genel cerrahi ve ortopedi klinikleri tarafından opere edilen 66 hasta retrospektif incelendi. Hastaların pre-operatif; ve post-operatif erken 1, 2, 3, 4 gün ve geç dönem(30. günden sonraki) serum alanin aminotransferaz, aspartat aminotransferaz enzim düzeyleri ile alkalin fosfataz , gama-glutamil transferaz aktiviteleri kaydedildi. Ayrıca serum total bilirubin düzeyleri, albumin düzeyleri ve protrombin süreleri de karşılaştırıldı. Çalışmamızda normal fizik muayenesi ve 5 kattan daha az artmış karaciğer transaminaz seviyeleri olan asemptomatik hastalarda postoperatif dönemde istatiksel olarak anlamlı kötüleşme saptanmadı (p> 0.05). Buna karşın serum transaminaz seviyelerindeki non spesifik yükselmelerin geç dönemde kendiliğinden düştüğü saptandı. (p> 0.05) Anestetik ilaçların türü, cerrahinin tipi veya perioperatif komplikasyonların karaciğer fonksiyonlarını (p> 0.05) anlamlı derecede etkilemediği bulunmuştur. Altmış altı hastanın alındığı bu çalışmanın sonuçlarına göre,normal fizik muayene olan bir hastada eğer serum bilirubin, albumin ve pıhtılaşma testleri normal ve aminotransferaz enzimleri hafif artmış (iki ila beş kat) ise cerrahi riskteki artış gözardıedilebilecek kadar azdır. Ameliyattan sonra karaciğer testlerinin izlenmesi ve eğer yükseklik devam ediyorsa ise ileri tetkik gerekir.
abstract
Asymptomatic patients with a normal physical examination and abnormal liver test results (increased serum alanine aminotransferase/aspartate aminotransferase) are encountered frequently , raising concerns that they have underlying liver disease that may increase the risk of surgery. We aimed to determine whether this situation poses a risk factor for postoperative prognosis in preoperative patients undergoing various surgeries in Trakya Üniversity Medical Faculty between the years 2006-2014. For this purpose, we retrospectively analyzed 66 patients that the preoperative aspartate aminotransferase and/or alanine aminotransferase values with above normal (less than 5 times ) and operated by thoracic surgery, general surgery and orthopedic surgery clinics. Patients' pre-operative; and post-operative early 1st, 2nd, 3rd, 4th days and late ( After 30 days) serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase activities were recorded. Serum total bilirubin and albumin levels and prothrombin times were also compared. In our study, we did not observe any statistically significant worsening in serum transaminase levels in the postoperative period in asymptomatic patients with a normal physical examination and abnormal liver transaminase levels less than 5 times increse (p>0.05). In contrast, these nonspecific elevations in serum transaminase levels were spontaneously resolved in the late postoperative period (p<0.05). The type of anesthetic drugs, type of surgery, or any perioperative complications were not found to affect liver function significantly (p>0.05). In conclusion, according to results of this study that included 66 patients, if the serum bilirubin, albumin, and clotting tests are normal and the increase in aminotransferases is mild (two-fold to five-fold) in a patient with a normal physical examination, there is little, if any, increase in surgical risk. After surgery the liver tests need to be monitored; if persistently abnormal, a thorough evaluation should be performed.
abstract
Asymptomatic patients with a normal physical examination and abnormal liver test results (increased serum alanine aminotransferase/aspartate aminotransferase) are encountered frequently , raising concerns that they have underlying liver disease that may increase the risk of surgery. We aimed to determine whether this situation poses a risk factor for postoperative prognosis in preoperative patients undergoing various surgeries in Trakya Üniversity Medical Faculty between the years 2006-2014. For this purpose, we retrospectively analyzed 66 patients that the preoperative aspartate aminotransferase and/or alanine aminotransferase values with above normal (less than 5 times ) and operated by thoracic surgery, general surgery and orthopedic surgery clinics. Patients' pre-operative; and post-operative early 1st, 2nd, 3rd, 4th days and late ( After 30 days) serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase activities were recorded. Serum total bilirubin and albumin levels and prothrombin times were also compared. In our study, we did not observe any statistically significant worsening in serum transaminase levels in the postoperative period in asymptomatic patients with a normal physical examination and abnormal liver transaminase levels less than 5 times increse (p>0.05). In contrast, these nonspecific elevations in serum transaminase levels were spontaneously resolved in the late postoperative period (p<0.05). The type of anesthetic drugs, type of surgery, or any perioperative complications were not found to affect liver function significantly (p>0.05). In conclusion, according to results of this study that included 66 patients, if the serum bilirubin, albumin, and clotting tests are normal and the increase in aminotransferases is mild (two-fold to five-fold) in a patient with a normal physical examination, there is little, if any, increase in surgical risk. After surgery the liver tests need to be monitored; if persistently abnormal, a thorough evaluation should be performed.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Alanin Aminotransferaz, Asemptomatik, Karaciğer, Aspartat Aminotransferaz, Alanine Aminotransferase, Asymptomatic, Liver, Aspartate Aminotransferase
