PANKREAS YARALANMALARI

Kliniðimizde son 14 yýl içinde pankreas yaralanmasý nedeni ile tedavi edilen 67 hasta yaþ, cins, travmanýn sebebi, pankreatik yaralanmanýn derecesi, ilave organ yaralanmasýnýn olup olmamasý, uygulanan aperatif iþlemler, postoperatif komplikasyonlar ve mortaliteyi etkileyen faktörler yönünden incelendi. Hastalarýn 56'sý (%83.5) erkek olup, ortalama yaþ 24 idi. Pankreas yaralanmalarýnýn sebebi 48 hastada kunt travma, 10 hastada ateþli silah yaralanmasý, 9 hastada ise kesici-delici alet yaralanmasý idi. Hastalarýn 39'una periton lavajý ve 3'üne parasentez ile intraabdominal kanama tanýsý kondu. Ameliyat esnasýnda pankreastaki harabiyet Smego sýnýflamasýna göre yapýldý. Buna göre 44 hasta Grade I, 12 hasta Grade II, 10 hasta Grade III ve 1 hasta Grade IV olarak deðerlendirildi. En sýk görülen ilave organ yaralanmalarý sýrasý ile dalak, karaciðer ve mide idi. Pankreasa yönelik olarak basit drenaj, primer onarým, distal pankreatektomi gibi cerrahi iþlemler uygulandý. Postoperatif en sýk görülen komplikasyon yara enfeksiyonu olmuþtur. Bu seride 9 hasta kaybedilmiþ olup, en önemli mortalite sebebi ilave organ yaralanmalarýnýn yol açtýðý multipl organ yetmezliðidir. Bu çalýþmanýn sonucunda izole pankreas yaralanmalarýnýn nadir görüldüðü, morbidite ve mortaliteyi etkileyen en önemli faktörün ilave organ yaralanmalarýnýn olduðu tesbit edildi. Ayrýca intraabdominal kanama nedeni ile ameliyata alýnan hastalarda, pankreas yaralanmasýnýn kolaylýkla gözden kaçabileceði akýlda tutularak, eksplorasyonun çok dikkatli bir þekilde yapýlmasý gerekir.

PANCREATIC INJURIES

67 patients who have been treated in our clinic in the last 14 years was studied in terms of age, sex, traumatic cause, grade of traumatic injury, associated organ injury, operative procedures used, post operative complications and factors affecting mortality. The 56 (%83.5%) of the subjects were male and avarage age was 24. The cause of pancreatic injuries was blunt abdominal trauma in 48 patients, gunshot wounds in 10 and stab wounds in 9. As 39 patients were diagnosed as peritoneal lavage and 3 as paracentesis, the rest were diagnosed by physical examining, laboratory and ultrasonographic findings. Pancreatic damage was classified according to Smego classification. As a result of this, 44 patients were found Grade I, 12 Grade II, 10 Grade III and 1 Grade IV. The common associated organic injuries were liver, spleen and stomach, respectively. On pancreas, surgery operations such as simple drainage, primer repair and distal pancreatectomy were carried out. Postoperative wound infection was the most common complication. 9 patients died and the most important mortality reason was found as the associated organ injuries. Apart from this, pancreatic exploration should be carried out very carefully considering that in the patients who were operated on because of abdominal bleeding, injuries might be easily missed.