Nisan 2008
Akut pankreatitli olgularimiz: Kilavuz önerilerinden ne kadar uzak?
Our patients with acute pancreatitis: How long away from guideline recommendatoins?
- Ana Sayfa
- Sayılar
- Nisan 2008
- Akut pankreatitli olgularimiz: Kilavuz önerilerinden ne kadar uzak?...
Özet
Giris ve Amaç: Akut pankreatit, yakin ve uzak organlari degisen derecelerde etkileyebilen pankreasin akut inflamatuvar hastaligidir. Hastaligin etiyolojik faktörleri cografik bölgeler arasinda önemli farkliliklar göstermektedir. Çalismamizda bölgemizdeki verilerin gün isigina çikarilmasi amaçlanmistir. Gereç ve Yöntem: Ocak 2003 ile Aralik 2006 tarihleri arasinda akut pankreatit tanisi ile izlenen hastalar retrospektif olarak incelendi. Hastalar cins, yas, etiyoloji, belirti, laboratuvar ve görüntüleme verileri, atagin siddeti, komplikasyon oranlari, mortalite oranlari ve tedavi yönünden degerlendirildi. Bulgular: Çalismaya alinan 62 hastadan 33’ü (%53.2) kadin, 29’u (%46.8) erkek olup, yas ortalamalari sirasiyla 46.1 ve 56,0 idi. Etiyolojik dagilim 29’unda (%46.8) biliyer, 8’inde (%12.9) hiperlipidemi, 1’inde (%1.6) hiperkalsemi, 1’inde (%1.6) alkol, 1’inde (%1.6) malignite idi. Yirmi iki (%35.5)’si idiopatik olarak kabul edildi. Biliyer pankreatitlerin 23’ü (%33.3) siddetli tipti. Biliyer nedenlilerin hepsine ilk 72 saat içinde ERCP yapildi. Hiperlipidemili hastalarin amilaz degerleri diger nedenlerden düsük saptandi. Idiopatik gruptakilerin 7 (%31.8)’si kadin, 15 (%68.2)’i erkekti. Bunlari n %31.8’inde pankreatit siddetli tipteydi. Siddetli pankreatit olgulari nda Ranson skoru, CRP düzeyi, albümin düzeyi ve hastane yatis süresi, hafif tipten anlamli olarak farkli idi. Tüm hastalara bilgisayarli tomografi çekildi. Ölen dört hastadan ikisinin etiolojisinde biliyer pankreatit mevcutken, ikisi idiopatik idi. Siddetli pankreatitlilerin 6’sina yapilan ince igne aspirasyonunda 4’ünde enfekte nekroz saptanarak genel cerrahi klinigine transfer edildiler. Toplamda mortalite orani %6.5 iken, siddetli tipte bu orani %22.2 saptandi. Kaybedilen hastalarin yas ortalamalari 65.5 idi. Toplam 16 (%25.8) hastada pulmoner, 4 (%.6.5) hastada multiorgan yetmezlik, 3 (%4.8) hastada lokal komplikasyonlar (apse, psödokist) tespit edildi. Sonuç: Akut pankreatit takibinde bilgisayarli tomografi incelemesi ve ERCP konusunda daha konservatif davranilmalidir. Idiopatik grup literatür verilerine kiyasla daha yüksek bulunmustur. Mortalite oranlari miz ve hastalara genel yaklasim algoritmimiz kilavuzlara paralel olmustur.
Abstract
Background and Aim: Acute pancreatitis is an inflammatory disease of the pancreas, with variable involvement of peripancreatic tissue or remote organ systems. The etiology of the disease shows significant differences among geographic areas. In our study we aimed to enlighten the data of our region. Methods: Between January 2003 and December 2006 hospitalized patient with acute pancreatitis were retrospectively examined. Patients were evaluated according to race, age, etiology, symptomatology, data of laboratory and imagination, severity of attack, proportion of complication, proportion of mortality and treatment. Results: Of the 62 patients included into the study 33 (53.2%) were women, 29 (46.8%) were men and their mean age was consecutively 46,1 and 56,0. Etiologic dispersal was 29 (46.8%) billiary, 8 (12.9%) hypertrigliseridemia, 1 (1.6%) hypercalcemia, 1 (1.6%) alcohol, 1 (1.6%) malignancy. Twenty-two (35.5%) patients were considered to be idiopathic. Twenty-three of billiary patients (33.3%) were severe type. All of the billiary pancreatitis patients were applicated ERCP in the first 72 hours. Amilaz levels of patients with hyperlipidemia were determined lower than the other causes. Seven (31.8%) of the idiopathic patients were women and 15 (68.2%) of them were men and 31.8 % of these were severe pancreatitis type. In severe pancreatitis cases Ranson’s score, CRP level, albumin level and duration of admission in the hospital were significantly different from mild acute pancreatitis. Computed tomography was taken in all the patients. While billiary pancreatit was present in two of the four patients death, two of them were idiopathic. In fine needle aspiration apllied in the six of severe patients infected necrosis was determined in four of them and they were transferred to surgary clinic. While mortality rate was 6.5% in total, in severe pancreatitis type this rate was determined as 22.2%. Mean age of the patients died was 65.5. In 16 (25.8%) patient in total pulmonary, in four of them (6.5%) multiorgans deficiency, in three of them (4.8%) local complication were determined. Conclution: In the management of acute pancreatitis it should be more conservative about computed tomography and ERCP. Idiopathic group has been determined higher compared with data. In our study our mortality rates and our general approachment algoritm has been compatible with guideline recommendation.
