Ulus Travma Acil Cerrahi Derg. 2001; 7(2): 104-109

NEKROTÝZAN PANKREATÝT'ÝN CERRAHÝ TEDAVÝSÝNDE MORBÝDÝTE VE MORTALÝTEYÝ ETKÝLEYEN FAKTÖRLER

Cumhur Arýcý¹, Taner Çolak¹, Okan Erdoðan¹, Levent Döþemeci¹, Alihan Gürkan¹, Mehmet Öðüþ¹, Güner Öðünç¹
Akdeniz Üniversitesi Týp Fakültesi Genel Cerrahi Ad

Nekrotizan pankreatit (NP), akut pankreatitin en þiddetli formudur ve yüksek morbidite ve mortaliteye sahiptir. Bu retrospektif çalýþmada, Akdeniz Üniversitesi Týp Fakültesi Genel Cerrahi Kliniðinde Þubat 1993-Temmuz 2000 tarihleri arasýnda ameliyat edilen 11 hastanýn (17 erkek, 5 kadýn, yaþ ortalamasý 52.714) verilerini deðerlendirerek, kliniðimizin deneyimini aktarmak ve NP olgularýndaki cerrahi tedavisinde morbidite ve mortaliteye etki eden faktörleri tanýmlamayý amaçladýk. Hastalarýn tamamýnda preoperatif taný ve laparatomi endikasyonu klinik bulgulara (akut batýn ve eþlik eden sepsis, septik þok veya organ yetmezliði varlýðý) ek olarak abdominal Bilgisayarlý Tomografi ile konuldu ve çalýþmaya laparotomide pankreatik ve peripankreatik nekroz varlýðý ispatlanan olgular dahil edildi. Hastalarýn demografik verileri, klinik bulgularý, baþvuru anýndaki APACHE-II skoru, çoklu organ yetmezliði (ÇOY) ve lokorejyonel komplikasyonlarýn (IRK) morbidite ve mortalite ile olan iliþkisi araþtýrýldý. Ýstatistiksel yöntem olarak Fisher'in kesin Ki-kare testi kullanýldý ve p<0.05 deðeri anlamlý olarak kabul edildi. Yirmi-iki hastaya toplam 97 (1-23, ortalama 4.44.9) cerrahi giriþim uygulandý. Toplam 17 hastada (%77) LRK komplikasyon görüldü. En sýk geliþen komplikasyon intra-abdominal abse idi (15 hasta). Lokorejyonel komplikasyon geliþimi ile uzamýþ hastanede yatýþ süresi ve artmýþ cerrahi giriþim sayýsý arasýndaki iliþki anlamlý bulundu (p>0.05). Sekiz hasta (%36) eksitus oldu. Baþvuru anýndaki APACHE-II skoru 10 ve altýnda olan 7 hastada mortalite görülmedi. APACHE-II skorunun 10'nun üzerinde olduðu 15 hastadan 8'i öldü. Toplam 7 (%32) hastada çoklu organ yetmezliði geliþti ve bu hastalarýn 6'sý (%86) eksitus olurken, bu oran çoklu organ yetmezliði geliþmeyen hastalarda %13 olarak bulundu. Baþvuru anýndaki yüksek (> 10) APACHE-II skoru (p=0.02) ve tedavi sýrasýnda geliþen ÇOY(p = 0.002) ile mortalite arasýndaki anlamlý bulundu. Sonuç olarak NP'in cerrahi tedavisinde, baþvuru anýndaki APACHE-II skorunun > 10 olmasý ve hastanýn takibi sýrasýnda ÇOY geliþiminin mortaliteye etkili olabileceði, buna karþýn LRK geliþiminin hastanede kalýþ süresi ve cerrahi giriþim sayýsýný arttýrdýðý halde mortaliteyi etkilemediði sonucuna varýldý.

Anahtar Kelimeler: NEKROTÝZAN PANKREATÝT, ORGAN YETMEZLÝÐÝ, LOKO-REJYONEL KOMPLÝKASYONLAR

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THE FACTORS EFFECTING MORBIDITY AND MORTALITY IN SURGICAL TREATMENT OF SEVERE NECROTIZING PANCREATITIS

Cumhur Arýcý¹, Taner Çolak¹, Okan Erdoðan¹, Levent Döþemeci¹, Alihan Gürkan¹, Mehmet Öðüþ¹, Güner Öðünç¹
Akdeniz Üniversitesi Týp Fakültesi Genel Cerrahi Ad

Necrotizing Pancreatitis is the most severe form of acute pancreatitis with a high morbidity and mortality rates. In this retrospective study we report our experience with 22 patients (17 men, 5 women with a mean age of 52.714) who operated at Akdeniz University School of Medicine Department of General Surgery, from February 1993 to July 2000 and define the factors affecting the morbidity and mortality in surgical treatment of NP. Diagnosis of NP and decision of laparotomy was performed by clinical findings and contrast-enhanced abdominal computed tomography (CT). The patients with pancreatic and peripancreatic necrosis confirmed intraoperatively included to the study. All patients had required intensive care therapy. The relationship between mortality / morbidity and with demographic and clinical data of patients, APACHE II score, presence of multiple organ dysfunction (MOD), and local-regional complications (IRC) was examined. The Fischer Chi-Square test was used to evaluate statistical significance and p < 0.05 was accepted as meaningful. The mean number of reoperations were 4.44.9 (1 to 23). Local-regional complications were observed in 17 (77%) patients and mostly consisted of intra-abdominal abscess (15 patients). The overall hospital mortality rate was 36% (8 of 22 patients died). In the 7 patients with low APACHE-II score on admission (< or = 10) no mortality was encountered. Eight of 15 patients with high APACHE-II score (> 10) on admission were died. Multiple-organ dysfunction developed in 7 (32%) patients and 6 (86%) of them died. Two of the 15 patients (13%) died without MOD. In conclusion, poor outcome was associated with high APACHE-II score (> 10) on admission (p = 0.02), and progression of MOD (p=0.002) during the treatment. Local-regional complications increase the hospital stay and frequency of surgical interventions but these complications do not effect the mortality in negative manner in the surgical treatment of NP.

Keywords: NECROZITAN PANCREATITIS, ORGAN FAILURE, LOCO-REGIONAL

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ATIF KOPYALA