Nisan 2011
Siddetli pankreatit ve tedavi yaklasimlari: Mevcut siniflamalar yeterli mi?
Severe pancreatitis and treatment approaches: Are current classifications sufficient?
- Ana Sayfa
- Sayılar
- Nisan 2011
- Siddetli pankreatit ve tedavi yaklasimlari: Mevcut siniflamalar yeterli mi?...
Özet
Giris ve Amaç: Akut nekrotizan pankreatit, akut pankreatitin en siddetli formudur ve pankreatitin seyri sirasinda parenkim nekrozunun gelistigi pankreatit tipidir. Bu çalismada akut nekrotizan pankreatit nedeniyle cerrahi ve konservatif tedavi uygulanan hastalar RANSON VE APACHE II skorlama sistemleri esliginde degerlendirilerek, morbidite ve mortaliteye etkili faktörler ve skorlama sistemlerinin tedavi yönetimindeki etkinligini arastirmayi amaçladik. Gereç ve Yöntem: Klinigimizde 2005-2010 yillari arasinda akut nekrotizan pankreatit tanisiyla takip ve tedavi uygulanan 39 hasta retrospektif olarak degerlendirildi. Hastalarin morbidite ve mortalite risk oranlari RANSON ve APACHE II skorlama sistemleri ile belirlendi. Bulgular: Operasyon uygulanan 13 hastadan 4?üne eksplorasyon + nekrozektomi, 6 hastaya drenaj kateteri yerlestirilmesi, 1 hastaya nekrozektomi + sol hemikolektomi + hartmann prosedürü, 1 hastaya nekrozektomi + sag hemikolektomi + lahey mikulicz prosedürü, 1 hastaya nekrozektomi + sag hemikolektomi + parsiyel ince barsak rezeksiyonu + ucuca anastomoz operasyonlari uygulandi. Opere olan hastalardan 10?u (%77) mortal seyrederken, toplam mortalite sayisi 17 (%44) olarak belirlendi. Yirmi iki (%56) hasta sifa ile taburcu edildi. Sonuç: Nekrotizan pankreatitli hastalarin tedavi yönetiminde ve cerrahi kararinin alinmasinda, sadece bilgisayarli tomografi ve skorlama sistemlerinden alinan degerlerle hareket etmektense hastalarin klinik durumunu ve vital bulgularini ön planda tutmanin daha yararli olacagi kanaatindeyiz.
Abstract
Background and Aims: Acute necrotizing pancreatitis is the most severe form of acute pancreatitis, and is the type of pancreatitis during which parenchymal necrosis develops. In this study, we aimed to investigate the factors that affect morbidity and mortality and the effectiveness of scoring systems on the management of treatment by evaluating patients with acute necrotizing pancreatitis in whom surgical and conservative treatments were applied. The RANSON and APACHE II scoring systems were used. Materials and Methods: Thirty-nine patients who were followed-up and treated in our clinic between 2005 and 2010 for acute necrotizing pancreatitis were retrospectively evaluated. Morbidity and mortality risk rates of patients were determined using the RANSON and APACHE II scoring systems. Results: Of 13 patients operated, 4 underwent exploration and necrosectomy operations, 6 placement of drainage catheter, 1 necrosectomy, left hemicolectomy and Hartmann procedure, 1 necrosectomy, right hemicolectomy and Lahey Mikulicz procedure, and 1 necrosectomy, right hemicolectomy, partial small bowel resection and tip-to-tip anastomosis. While 10 (77%) of the patients who were operated died, the total mortality was 17 (44%). Twenty-two (56%) patients were discharged from the hospital in good health. Conclusions: In patients with necrotizing pancreatitis, we believe it is more useful to first consider the clinical condition and vital signs of the patients rather than deciding the method of treatment and whether or not to operate only on the basis of computerized tomography and scoring systems.
