Agustos 2018
Kopuk pankreatik kanal sendromu tani ve tedavisi: Tek merkez deneyimi
Diagnosis and treatment of disconnected pancreatic duct syndrome: Single center experience
- Ana Sayfa
- Sayılar
- Agustos 2018
- Kopuk pankreatik kanal sendromu tani ve tedavisi: Tek merkez deneyimi...
Türkiye Yüksek Ihtisas Egitim ve Arastirma Hastanesi, 2Gastroenteroloji Bölümü, Ankara
Özet
Giris ve Amaç: Kopuk pankreatik kanal sendromu pankreas kanalininbütünlügünün bozulmasiyla karakterizedir. Nadir görülen bu sendromönemli bir morbidite ve mortalite nedenidir. Biz bu çalismada klinigimiz-de kopuk pankreatik kanal sendromu tanisi olan hastalarin demografiközelliklerini, endoskopik retrograd kolanjiopankreatografi bulgularinive bu hastalarin aldiklari endoskopik tedavileri arastirdik. Gereç veYöntem: Bu çalisma Türkiye Yüksek Ihtisas Hastanesi GastroenterolojiKlinigi, Endoskopik Retrograd Kolanjiopankreatografi Ünitesinde Ocak2010-Ocak 2017 tarihleri arasinda kopuk pankreatik kanal sendromutanisi alan hastalarla yapildi. Kopuk pankreatik kanal senromlu hastalaretiyolojilerindeki nedenin pankreatit olup olmamasina göre ikiye ayrildi.Kanal rüptürü 10 hastada olmak üzere en sik pankreas boynunda izlendi. Kanal rüptürünün bas ve boyunda oldugu hastalar distal grup, gövde ve kuyrukta oldugu hastalar ise proksimal grup olarak tanimlandi.Bulgular: Toplam 17 hastada kopuk pankreatik kanal sendromu vardi.Bu hastalarin yas ortancasi 46 olup 14 hasta erkek, 3 hasta kadindi.Bu hastalara toplamda 27 endoskopik retrograd kolanjiopankreatografiseansi uygulandi. Etiyolojik neden olarak 9 hastada akut pankreatit, 2hastada kronik pankreatit, 4 hastada travma ve 2 hastada ise insülinomadan dolayi yapilan pankreatektomi etiyolojik neden olarak izlendi.Akut pankreatit öyküsü olan hastalarin 5 tanesi biliyer orjinliydi. 17 hastanin 15’inde psödokist, 1 hastada ise walled-off nekroz vardi. Kanalrüptürünün distalde ve proksimalde oldugu hastalar arasinda endoskopik retrograd kolanjiopankreatografi islem sayisi ve pankreatite yolaçan etiyolojik nedenler karsilastirildi ve anlamli bir farklilik bulunmadi(sirasiyla p=0,215, p=0,278). Sonuç: Çalismamizda literatürle uyumluolarak kopuk pankreatik kanal sendromlu hastalarda en sik etiyolojikneden olarak akut pankreatit izlendi. Hastalarimizin çogunda kopukpankreatik kanal sendromu boyun kisminda lokalize olup bu bulgu da literatürle uyumluydu. Bu sendroma uygun tani konulamamasi ve gereklitedavinin yapilamamasi hastalarin morbidite ve mortalitelerinde artisayol açacaktir.
Abstract
Background and Aims: Disconnected pancreatic duct syndrome ischaracterized by the disruption. of the pancreatic duct. Although thissyndrome is rare, it is an important cause of morbidity and mortality.Here we examined demographic characteristics, endoscopic retrogradecholangiopancreatography findings, and endoscopic treatment features of our patients with the diagnosis of disconnected pancreatic ductsyndrome. Materials and Methods: This study was performed in theEndoscopic Retrograde Cholangiopancreatography Unit of the TürkiyeYüksek Ihtisas Training and Research Hospital between January 2010and January 2017. Patients who receive a diagnosis of disconnectedpancreatic duct syndrome in an endoscopic retrograde cholangiopancreatography procedure were identified retrospectively. These patientswere divided into two groups based on the location of their etiologiccause of pancreatitis. Patients with ductal distribution at the head andneck of the pancreas were defined as the distal group, whereas thosewith ductal distribution at the body and tail were defined as the proximal group. Results: Overall, 17 patients (median age 46, 14 malesand 3 females) were included in the study. Twenty-seven endoscopicretrograde cholangiopancreatography procedures were performed inthese patients. Acute pancreatitis was the etiologic cause in 9 patients.Other etiologic causes were chronic pancreatitis in 2 patients, traumain 4 patients, and pancreatectomy in 2 patients. In acute pancreatitis,a biliary cause could be defined in 5 patients. Also, pseudocysts werediagnosed in 15 patients, whereas walled-off necrosis was diagnosedin 1 patient, and duct distribution was seen in the neck of the pancreasin 10 patients. The proximal and distal groups were not statisticallydifferent regarding both endoscopic retrograde cholangiopancreatography sessions and etiologic causes of pancreatitis (p=.215, p=.278,respectively).Conclusion: We found that acute pancreatitis is the mostcommon etiologic cause of disconnected pancreatic duct syndromeand duct distribution was common at the neck of the pancreas similarto the literature. Both inappropriate diagnosis and delayed therapy canlead to increased morbidity and mortality in these patients.
