Kronik Pankreatit Tanı ve Tedavi Yaklaşımları
Özet
Kronik pankreatit, pankreasta fibrozis ve inflamasyona bağlı olarak endokrin ve ekzokrin fonksiyon bozukluklarıyla seyreden kronik ve ilerleyici bir hastalıktır. En sık 35-55 yaş aralığındaki erkeklerde gözlenen bu tablonun temel etiyolojik faktörü, vakaların %70-80’inden sorumlu olan aşırı alkol kullanımıdır. Hastalığın en yaygın klinik semptomu epigastriumda başlayıp sırta yayılan şiddetli karın ağrısıdır; buna zamanla zayıflama, steatore ve diabetes mellitus eşlik eder. Tanı aşamasında kontrastlı batın tomografisi ilk tercih edilen yöntemlerden biri olup, erken evrelerde ve kanal yapılarının incelenmesinde MRCP, EUS ve sekretin stimülasyon testi gibi spesifik fonksiyon testlerinden yararlanılır. Kronik süreçte hastalarda psödokist oluşumu, safra kanalı tıkanıklığı ve duktal adenokarsinom gibi malignite gelişme riski önemli ölçüde artmaktadır. Tedavi yaklaşımı öncelikle diyet düzenlemeleri, pankreatik enzim replasmanı ve ağrı kontrolünü içeren semptomatik medikal destekten oluşur. Ancak, medikal tedaviye yanıt vermeyen şiddetli ağrı, narkotik bağımlılığı, organ obstrüksiyonları veya kanser şüphesi varlığında Whipple, Beger veya Puestow gibi rezektif veya dekompresyon amaçlı cerrahi yöntemlere başvurulur.
Chronic pancreatitis is a progressive inflammatory disease characterized by irreversible fibrosis and the impairment of endocrine and exocrine pancreatic functions. Most commonly observed in men aged 35-55, the primary etiological factor is chronic alcohol abuse, which accounts for 70-80% of all cases. The most prevalent clinical manifestation is severe epigastric abdominal pain radiating to the back, which is frequently accompanied by significant weight loss, steatorrhea, and diabetes mellitus over time. Diagnosis primarily relies on contrast-enhanced abdominal computed tomography (CT), while MRCP, EUS, and specific pancreatic function tests like the secretin stimulation test are utilized in early stages and for detailed ductal evaluation. The chronic course significantly elevates the risk of severe complications, including pseudocyst formation, biliary obstruction, and pancreatic ductal adenocarcinoma. Management mainly comprises symptomatic medical support, including dietary modifications, pancreatic enzyme replacement therapy, and pain control. However, in cases of intractable pain, narcotic dependency, complications, or suspicion of malignancy, surgical interventions—classified as resective procedures like Whipple and Beger or decompressive procedures like Puestow—are required to improve quality of life.
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