Faruk KARATEKE, Ebru MENEKŞE, KORAY DAŞ, Sefa ÖZYAZICI, Selim SÖZEN, Hilmi BOZKURT, Safa ÖNEL, Mehmet ÖZDOĞAN

Pankreasın kistik neoplazilerinde tanı ve tedavi: 12 olgunun analizi ve literatür taraması

Amaç: Pankreasın kistik neoplazileri (PKN) tüm pankreas neoplazilerinin %1-5’ini oluşturur ancak son yıllarda pankreatik rezeksiyonların yaklaşık %30 kadarı PKN’ler nedeniyle yapılmaktadır. Bu çalışmada, kliniğimizde PKN ön tanısıyla ameliyat edilen hastaların klinik verileri eşliğinde PKN’de tanı, tedavi ve takip uygulamaları ile bunların sonuçları tartışılmıştır. Gereç ve yöntem: Ocak-2009 ile Şubat-2012 yılları arasında kliniğimizde PKN ön tanısı alan 12 hastanın demografik özellikleri, ameliyat öncesi bulguları, uygulanan cerrahi yöntemler, patoloji sonuçları, ameliyat sonrası komplikasyonlar ve uzun süreli takip sonuçları değerlendirildi. Bulgular: Hastaların 1’i erkek,11’i kadın ve ortalama yaşları 51,5 (19-73 arası) idi. Lezyonlar 4 hastada pankreas başında, 2 hastada gövdede ve 6 hastada kuyrukta yerleşmişti. Ortalama kist boyutu 5,1 cm (3-10 cm arası) idi. Dört hastaya pilor koruyucu pankreatiko-duodenektomi,7 hastaya subtotal pankreatektomi/distal pankreatektomi+splenektomi, 1 hastaya ise dalak koruyucu distal pankreatektomi yapıldı. Altı hastada doku tanısı seröz kistadenoma (SKA), 3 hastada müsinöz kistadenoma (MKA), 2 hastada müsinöz kistadenokarsinoma (MKAK), 1 hastada ise psödokist olarak rapor edildi. Postoperatif dönemdeki komplikasyon oranımız %33 idi. Hastaların ortalama takip süresi 18,4 ay (2-38 ay arası) olarak hesaplandı. Sonuç: PKN ön tanısı alan hastalarda malignite potansiyeli ve cerrahi riskler hasta bazında değerlendirilerek karar verilmelidir.

Diagnosis and treatment in cystic neoplasms of the pancreas: Analysis of 12 cases and review of the literature

Objectives: Cystic Neoplasms of the Pancreas (CNP) accounts for only 1-5% of all pancreatic neoplasms but in recent years approximately 30% of all pancreatic resections are performed for CNP. In this study we aimed to argue diagnosis, treatment and outcomes of the patients whom operated in our clinic for CNP. Materials and methods: The demographic character- istics, preoperative findings, surgical procedures, histopathological diagnosis, postoperative complications and long term follow-up outcomes of the CNP patients operated in our clinic between 2009 -Jan and 2012-Feb were evaluated. Results: One patient was male,11 patients were female and mean age was 51,5 years (19-73 years).Localiza- tions of the lesions were in the head of pancreas for 4 patients, in the body for 2 patients and in tail for 6 patients. Mean size of the cysts was 5.1 cm (3-10 cm).Pylorus-reserved pancreaticoduodenectomy for 4 patients, subtotal/ distal pancreatectomy + splenectomy for 7 patients and spleen reserved distal pancreatectomy was performed for 1 patient. Histopathological diagnosis was reported as serous cystadenoma in 6, mucinous cystadenoma in 3, mucinous cystadenocarcinoma in 2 and pseudocyst in 1 patient respectively. Postoperative complication rate was 33%. Mean follow-up time was 18.4 months (2-38 months). Conclusions: Management should be based upon on carefully weighting the malignant potential of a pancreatic cystic lesions and the risk of surgery.

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