Surgical treatment results of acute necrotising pancreatitis and affecting factors on mortality

Yıl 2012, , 500 - 504, 01.12.2012

İbrahim Aliosmanoğlu Mesut Gül Fırat Tekeş Ahmet Türkoğlu Burak Veli Ülger Ömer Uslukaya Abdullah Oğuz

https://doi.org/10.5799/ahinjs.01.2012.04.0209

Öz

Objectives: Acute necrotizing pancreatitis is a condition still with high morbidity and mortality which is associated with severe acute pancreatitis because parenchyma necrosis occurs during illness. Our aim in this study is to examine the factors affecting mortality in patients undergoing surgery because of acute necrotizing pancreatitis and present our surgical outcomes. Materials and methods: The clinical features, Ranson and APACHE II scores of 38 patients operated in clinic (2006-2012) for acute necrotizing pancreatitis were recorded retrospectively. Results: From the patients included in the study, 11 (28.9%) were male and 27 (71.1%) were female with an age average of 55.1±16.0 years. No relationship was found between age, C-reactive proteins, amylase and liver enzymes, pancreatitis etiology, complications seen after surgery and mortality (p>0.05). The effects of white blood cell values, width of necrosis area and the APACHE II and Ranson values upon admission on mortality were significant (p

Anahtar Kelimeler

Acute necrotizing pancreatitis, surgical treatment, mortality

Surgical treatment results of acute necrotising pancreatitis and affecting factors on mortality

Öz

Amaç: Akut nekrotizan pankreatit, seyri sırasında parankim nekrozu geliştiği için şiddetli akut pankreatit ile özdeşleşmiş, morbidite ve mortalitesi hala yüksek olan bir durumdur. Bu çalışmadaki amacımız akut nekrotizan pankreatit nedeniyle cerrahi uygulanan hastalarda mortaliteyi etkileyen faktörleri incelemek ve cerrahi tedavi sonuçlarımızı sunmaktır. Gereç ve yöntem: Kliniğimizde 2006-2012 yılları arasında akut nekrotizan pankreatit nedeniyle ameliyat edilen 38 hastanın özellikleri, Ranson ve APACHE II skorları retrospektif olarak kaydedildi. Bulgular: Çalışmaya dahil edilen hastaların 11\'i (%28.9) erkek, 27\'si (%71.1) kadın ve yaş ortalamaları 55.1±16.0 idi. Yaş, C-reaktif protein, amilaz ve karaciğer enzimleri, pankreatit etiyolojisi, ameliyat sonrası görülen komplikasyonlar ile mortalite arasında ilişki saptanamadı (p>0.05). Beyaz küre değerleri, nekroz alanının genişliği, başvuru anındaki APACHE II ve Ranson değerlerinin mortalite üzerindeki ilişkisi anlamlı idi (p

Anahtar Kelimeler

Akut nekratizan pankreatit, cerrahi tedavi, mortalite

Kaynakça

• Isaji S, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: surgi- cal management. J Hepatobiliary Pancreat Surg 2006;13(1):48-55.
• Dugernier T, Dewaele J, Laterre PF. Current surgical management of acute pancreatitis. Acta Chir Belg 2006; 106(2):165-71.
• Arıcı C, Colak T, Erdoğan O, et al. The factors effect- ing morbidity and mortality in surgical treatment of severe necrotizing pancreatitis. Ulusal Travma Derg 2001;7(2):104-9.
• Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W. Acute necrotizing pancreatitis: treatment strat- egy according to the status of infection. Ann Surg 2000; 232(5): 619-26.
• Ashley SW, Perez A, Pierce EA, et al. Necrotizing pan- creatitis: contemporary analysis of 99 consecutive cases. Ann Surg 2001;234(4):572-9.
• Beger HG, Isenmann R. Surgical management of necrotizing pancreatitis. Surg Clin North Am 1999;79(4):783-800.
• Wyncoll DL. The management of severe acute necro- tizing pancreatitis. Inten Care Med 1999;25(2):146-56.
• Farkas G, Marton J, Mandi Y,Szederkenyi E. Surgical strategy and management of infected pancreatic ne- crosis. BrJ Surg 1996;83(7):930-3.
• Oleynikov D, Cook C, Sellers B, Mone MC, Barton R. Decreased mortality from necrotizing pancreatitis. Am J Surg 1998;176(6):648-53.
• Bradley EL. A fifteen year experience with open drain- age for infected pancreatic necrosis. Surg Gynecol Obstet 1993;177(3):215-22.
• Van goor H, Sluiter WJ, Bleichrodt RP. Early and long term results of necrosectomy and planned re-explo- ration for infected pancreatic necrosis. Eur J Surg 1997;163(8):611-8.
• Rattner DW, Legermate DA, Lee MJ, Mueller PR, Warshaw AR. Early surgical debridment of symptom- atic pancreatic necrosis is benefical irrespective of in- fection. Am J Surg 1992;163(1):105-9.
• Norman J. The role of cytokines in the pathogenesis of acute pancreatitis. Am J Surg 1998;175(1):76-83.
• Gloor B, Reber HA. Effects of cytokines, and other inflammatory mediators on human acute pancreatitis. J Int Care Med 1998;13(2):305-12.
• Tenner S, Sica G, Hughes M, et al. Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology 1997;113(3):899-903.
• Rau B, Uhl W, Buchler MW, Beger HG. Surgi- cal treatment of infected necrosis. World J Surg 1997;21(2):155-61.
• Branum G, Galloway J, Hirchowitz W, Fendley M, Hunter J. Pancreatic necrosis: results of necrosec- tomy, packing, and ultimate closure over drains. Ann Surg 1998;227(6):870-7.
• Del Castillo CF, Rattner DW, Makary MA, Mostafavi A, McGrath D, Warshaw AL. Debridement and closed packing for the treatment of necrotizing pancreatitis Ann Surg 1998;228(5):676-84.
• Mier J, Leon EL, Castillo A, Robledo F, Blanco R. Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg 1997;173(2):71-5.
• Chaudhary A, Dhar P, Sachdev A, Agarwal AK. Surgical management of pancreatic necrosis pre- senting with locoregional complications. Br J Surg 1997;84(7):965-8.
• Triester SL, Kowdley KV. Prognostic factors in acute pancreatitis. J Clin Gastroenterol 2002; 34(2): 167-76.
• Tsiotos GG, Luque-de Leon E, Soreide JA, et al. Man- agement of necrotizing pancreatitis by repeated op- erative necrosectomy using a zipper technique. Am J Surg 1998;175(2):91-8.