Author/Editor		Abramič, Pavle; Sever, Marko; Rakovec, Slavko
Title		Kirurško zdravljenje septičnih zapletov pankreatitisa
Translated title		Surgical management of the septically involved pancreatitis
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 66, št. 2
Publication year		1997
Volume		str. 81-4
Language		slo
Abstract		Background. Frequently, at the end of the first week after the beginning, the acute necrotizing pancreatitis (ANP) is septically involved. It is an incident, which is limited to the pancreatic gland itself or to the pancreas and its surrounding tissues, but when there is bacterial and/or toxic sepsis it affects the whole body. An exact rate prediction of the expected patients with the ANP in respect to all cases of the acute pancreatitis is not possible, because many cases with subclinical courses of the disease are not registered. Patients and methods. At the Surgical department for gastroenterology in Ljubljana all data of the patients with ANP, who needed any surgical intervention in the year 1994, were surveyed. Their incidency was compared to all pattients at the Clinical Centre in Ljubljana, where the acute pancreatitis was registered as a single diagnosis or as an accompanied diagnosis to the other diseases. The rate of the operated patients was 4.7%. Medical examinations, lab tests, and other diagnostic procedures give many precious data, but frequently at the operation the surgeon is confronted with a vaster decay than expected. During the operative procedure the specimens for bacteriologic analyses can be taken, and the necrectomy of the ANP or/and of the juxtapancreatic fat necrosis can be performed. Often the intraabdominal abscesses are localized far from the pancreatic gland, and they can be evacuated and drained suitably. Also the pancreatic region and even the whole peritoneal cavity can be washed out and the tubes for drainage should be set in such a way, that they suit also for the peritoneal dialysis after the operation, if necessary. So the conditions are made for recovery from the infection and from the disasterous disease. (Abstract truncated at 2000 characters.)
Summary		Izhodišča. Proti koncu prvega tedna akutnega nekrozantnega pankreatitisa (ANP) pride pogosto do zapletov zaradi bakterijske kontaminacije. V kliniki se to odraža kot vnetni proces, ki je lahko omejen samo na pankreas ali na pankreas in njegovo bližnjo okolico oziroma deluje s toksičnimi metaboliti in z bakterijsko sepso na ves organizem. Kako pogosto se pojavlja nekrozantni pankreatitis s septičnimi zapleti v odnosu na vse oblike pankreatitisa, ni možno natančno ugotoviti, ker pacienti z lahkim kliničnim potekom bolezni pogosto niti ne iščejo zdravniške pomoči. Bolniki in metode. Na Kirurški gastroenterološki kliniki v Ljubljani smo retrogradno pregledali dokumentacijo pacientov z akutnim pankreatitisom, ki so potrebovali kirurško pomoč v letu 1994. Številčno smo jih primerjali s pacienti celotnega Kliničnega centra, kjer je bila odpustna diagnoza akutni pankreatitis, ali pa je bil akutni pankreatitis le spremljajoča diagnoza poleg druge osnovne bolezni. Pogostnost operiranih primerov je bila 4,7%. Klinična slika, laboratorijske preiskave in drugi diagnostični postopki dajo sicer dragocene podatke o bolezni, vendar pogosto najde kirurg pri operaciji obsežnejši razpad, kot ga iz osnovnih podatkov pričakuje. Med kirurškim posegom je možno odvzeti vzorce kužnine za bakteriološko analizo in antibiogram ter odstraniti nekrotično tkivo pankreasa ali nekroze v njegovi okolici. Formirane abscese v trebušni votlini, ki so pogosto precej oddaljeni, je možno ustrezno izprazniti in drenirati. V času operacije lahko izperemo ložo pankreasa in trebušno votlino in namestimo ustrezno ležeče drenažne cevi tudi za morebitno pooperativno peritonealno dializo. Kirurški poseg naj bi ustvaril pogoje za umiritev okužbe in za ozdravitev. Abscese in kolekcije, ki ostanejo po akutnem pankreatitisu ali pa se razvijejo v kasnejši dobi, lahko zdravimo z ultrazvočno vodeno punkcijo, drenažo, če je to možno, ali s programirano operacijo itd. (Izvleček prekinjen pri 2000 znakih.)
Descriptors		PANCREATITIS SEPSIS RETROSPECTIVE STUDIES