Dergiler / Turkish Journal of Medical Sciences / 2012 / Cilt: 42 - Sayı: 4
Pankreas yaralanmalarında yandaş organ yaralanmaları, morbidite ve mortalite
- Sayfa
- 559–566
- DOI
- —
Özet
Amaç: Pankreasta duktal yaralanma ve yandaş organ yaralanmalarının morbidite ve mortaliteye etkisini araştırmak.Yöntem ve gereç: Ocak 2004-Ekim 2010 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalındakarın travmalarına bağlı pankreas yaralanması gelişen ve cerrahi uygulanan 26 olgu retrospektif olarak değerlendirildi.Bulgular: Yaralanmaların 21’i (% 80,8) penetran, 5’i (% 19,2) künt travmaya bağlı idi. Hastaların 6’sı (% 23,1) evre I,12’si (% 46,2) evre II, 5’i (% 19,2) evre III ve 3’ü (% 11,5) evre IV`den oluşuyordu. En sık yaralanan yandaş organ 13olgu (% 50) ile mide ve vasküler yapılardı. Dört olgu izole idi. Onsekiz olguya primer sütur, hemostaz ve drenaj, 5’inedistal pankreatektomi, 3’üne Roux-en-Y pankreatikojejunostomi uygulandı. Postoperatif en sık intraabdominal apse vepankreatik fi stül gelişti. Bu çalışmada 2 hasta vasküler yaralanmaya bağlı hemorajik şoktan, bir hasta da pankreatik fi stülebağlı sepsis ve çoklu organ yetmezliğinden olmak üzere toplam 3 (% 11,5) hastada mortalite gelişti.Sonuç: Karın yaralanmalarında nadir de olsa pankreas hasarı olabileceği akılda tutularak iyi bir eksplorasyon yapılmalıdır.Vasküler yaralanmaların eşlik ettiği yaralanmalarda erken dönemde mortalite artabilir. Duktal yaralanmaların olduğuhasta grubunda ise morbidite ve geç dönemde mortalite artabilir
Abstract
Aim: Pancreatic injuries are rarely seen due to the retroperitoneal location of the organ. Associated organ and vascular structures usually accompany injury. In this study, the effect of ductal injury and associated organ injuries on morbidity and mortality was investigated. Materials and methods: Between January 2004 and October 2010, 26 patients with abdominal trauma who developed pancreatic injury and underwent surgery at the Dicle University General Surgery Department were evaluated retrospectively. Results: Of the 26 patients, 20 were males (76.9%) and 6 (23.1%) were females. The mean age of the patients was 24.96 ± 9.4 (14-56) years. Of the injuries, 21 (80.8%) were related to penetrating trauma and 5 (19.2%) were related to blunt trauma. Of the patients, 6 (23.1%) were stage I, 12 (46.2%) were stage II, 5 (19.2%) were stage III, and 3 (11.5%) were stage IV The most commonly injured associated organs were the stomach (50%) and vascular structures. Eighteen patients underwent primary suturing, 5 underwent distal pancreatectomy, 3 underwent Roux-en-Y pancreaticojejunostomy., Common postoperative complications included intraabdominal abscess and pancreatic fistula. Mortality occurred in 3 (11.5%) patients, 2 of them due to hemorrhagic shock resulting from vascular injury and 1 of them as a result of fistula-induced sepsis and multi-organ failure. Conclusion: A good exploration should be done in all abdominal traumas, remembering that pancreatic injury could occur. Mortality may increase during the early period in patients who have vascular injuries. Morbidity and late mortality may increase in patients with ductal injuries.