ACUTE PANCREATITIS

Acute pancreatitis (AP) still remains as a disease with difficulties in diagnosis and treatment. Following diagnosis the distinction between acute edematous pancreatitis (AEP) and acute necrotising pancreatitis should be made. In a 3-year period between the years of 1992 and 1994, 11 cases of ANP and 22 cases of AEP, with a total of 33 cases of AP were evaluated in retrospective manner. The etiological factor was: 53% biliary causes, 30% unknown, 15% alcohol induced, and 9% diabetes mellitus. 9 cases of AEP and 9 cases of ANP (55%) were treated by conservative means. Out of 9 operated cases with ANP; 6 underwent debridement and drainage, 2 partial pancreatic resection and I triostomy. For AEP the morbidity rate was 9%, and the mortality rate was 0%; whereas, in ANP the morbidity was 72% and mortality was 64%. These rates are 30% and 21% consecutively for the AP series. Even the etiological factor is biliary early surgical intervention is not required, and the definitive surgery should be performed in the late phase. The surgical indication in ANP is determined by means of clinical, bacteriological and morphological data. We are in favour of debridement and drainage and if necessary reoperations or relaparotomies for the treatment of ANP.

AKUT PANKREATÝT

Akut pankreatit (AP) gerek taný gerekse de tedavide güçlükler gösteren bir hastalýktýr. Taný konulduktan sonra tedavi planý için akut ödematöz pankreatit (AÖP) ve akut nekrotizan pankreatit (ANP) ayýrýmý yapýlmalýdýr. 1992-1994 yýllarý arasýnda 3 yýllýk dönemdeki 11 "i ANP (%33), 22 'si AÖP (%67) olan 33 AP vakasý retrospektif olarak incelenmiþtir. Etyolojide %53 biliyer etkenler, %30 idiopatik etkenler, %15 alkol ve %9 oranýnda diabet sorumludur. 9'u AÖP'li 9'u ANP'li 18 vaka (%55) ameliyat edilmiþ, 13'ü AÖP'li 2'si ANP'li 15 vaka (%45) da konservatif olarak tedavi görmüþtür. Ameliyat olarak 9 ANP'li vakanýn 6'sýna debridman + loj drenajý, 2'sine parsiyel pankreatektomi, 1'ine de triostomi uygulanmýþtýr. AÖP'li vakalarýmýzda morbidite %9, mortalite %0; ANP'lilerde morbidite %72, mortalite %64'tür. Bu oranlar AP serimizde sýrasýyla %30 ve %21'dir. AÖP'lerde etken biliyer de olsa erken cerrahi endikasyon yoktur. Definitif biliyer cerrahi giriþim geç dönemde yapýlmalýdýr. ANP'lerde ise operasyon endikasyonu klinik, bakteriyolojik ve morfolojik verilere göre konur. ANP'de savunduðumuz cerrahi yöntem debridman + loj drenajý ve gerekiyor ise relaparotomi ya da relaparotomilerdir.