Drenden Ölçülen Amilaz Değerleri Acil Splenektomi Sonrası İyatrojenik Pankreas Yaralanmasına Sekonder Pankreatik Fistül Gelişimini Öngörmede Faydalı mıdır?
Amaç: Künt/delici-kesici dalak travmalarının cerrahi tedavisinde splenektomi, hayat kurtarıcı olduğu ölçüde çeşitli komplikasyonları da beraberinde getiren major bir cerrahi girişimdir. Kullanılan cerrahi teknik açısından son derece standardize edilmiş bir prosedür olmakla beraber özellikle dalak hilusunun diseksiyonu ve bağlanması esnasında pankreas kuyruk yaralanmaları da görülebilmektedir. Bu çalışmada dalak hilus diseksiyonu sırasında iatrojenik pankreas yaralanması şüphesi durumunda serum ve dren amilaz değerlerninin pankreatik kaçak/fistül oluşumunu öngörmedeki başarısı incelendi.
ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?
Objective: Splenectomy is a major surgical intervention that brings several complications as well as saving life in the surgical treatment of blunt/penetrating spleen trauma. Although it is a highly standardized procedure in terms of the surgical technique used, pancreatic tail injuries can also be observed, especially during dissection and ligation of the splenic hilum. In this study, we investigated the possible helpful effects of the amylase levels of serum and drainage fluid when there was suspicion for pancreatic injury during splenic hilum dissection.
___
- 1. Dragomir M, Petrescu DGE, Manga GE, Călin GA, Vasilescu C. Patients after splenectomy: Old risks and new perspectives. Chirurgia (Bucur). 2016;111(5):393-9.
- 2. US Department of Health and Human Services, Evidence based management of sickle cell disease, Expert Panel Report 2014. Access date: 23 March 2020: http://scinfo.org/wpcontent/uploads/2014/09/NIH_Report.pdf.
- 3. Schilling RF. Risks and benefits of splenectomy versus no splenectomy for hereditary spherocytosis-A personal view. Br J Haematol. 2009;145 (6):728-32.
- 4. Kang JH, Park JS, Yu JS, Chung JJ, Kim JH, Cho ES et al. Prediction of pancreatic fistula after pancreatoduodenectomy by preoperative dynamic CT and fecal elastase-1 levels. PLoS One. 2017;12(5):e0177052.
- 5. Yang J, Huang Q, Wang C. Postoperative drain amylase predicts pancreatic fistula in pancreatic surgery: A systematic review and meta-analysis. Int J Surg. 2015;22(2):38-45.
- 6. Teixeira UF, Rodriguez PD, Goldoni MB, Sampaio JA, Fontes PRO. Early drain fluid amylase is useful to predict pancreatic fistula after pancreatoduodenectomy: lessons learned from a Southern Brazilian Center. Arq Gastroenterol. 2018;55(2):160-3.
- 7. McMillan MT, Soi S, Asbun HJ, Ball CG, Bassi C, Beane JD et al. Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy: a model for performance evaluation. Ann Surg. 2016;264(1):344-52.
- 8. Israel JS, Rettammel RJ, Leverson GE, Hanks LR, Cho CS, Winslow ER et al. Does postoperative drain amylase predict pancreatic fistula after pancreatectomy? J Am Coll Surg. 2014;218(1):978-87.
- 9. Lee CW, Pitt HA, Riall TS, Ronnekleiv-Kelly SS, Israel JS, Leverson GE et al. Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy. J Gastrointest Surg. 2014;18(4):1902-10.
- 10. Dos Santos LV, Lessa MAO, Lima JPSN, Haaland B, Lopes GL. Curative-ıntent surgery for pancreatic tumors: A review of procedures from the Brazilian National Health System. J Glob Oncol. 2016;3(2):37-42.