Pankreas Cerrahisinin Ekzokrin Komplikasyonları Ve Yönetimi
Özet
Pankreas cerrahisi, benign veya malign tümörler, kronik ve akut pankreatit ile pankreas travmalarının tedavisinde Whipple, santral ve total pankreatektomi gibi çeşitli operasyonlarla uygulanmaktadır. Bu cerrahi müdahaleler sonrasında kanama, gecikmiş mide boşalması, portal ven trombozu, biliyer kaçak ve anastomoz darlıkları gibi önemli komplikasyonlar gelişebilmektedir. En kritik fonksiyonel bozukluklardan biri olan postoperatif Pankreatik Ekzokrin Yetmezlik (PEY), parankim dokusu kaybı veya hormon salınımındaki aksaklıklar nedeniyle sindirim enzimlerinin yeterince üretilememesi sonucu ortaya çıkar. Klinik olarak karın ağrısı, şişkinlik, kilo kaybı ve steatore gibi semptomlarla kendini gösteren PEY, tanısal zorluklar barındırsa da MRCP ve sekretinli MRCP gibi noninvaziv yöntemlerle değerlendirilebilir. Tedavi süreci, hastanın antropometrik ölçümleriyle malnütrisyon tablosunun saptanmasını, ardından da diyet düzenlemeleri ile kombine edilen pankreatik enzim replasman terapisini kapsar.
Pancreatic surgery is utilized in treating benign or malignant tumors, chronic and acute pancreatitis, and pancreatic traumas through various procedures including Whipple, central, and total pancreatectomy. Following these surgical interventions, significant complications such as hemorrhage, delayed gastric emptying, portal vein thrombosis, biliary leakage, and anastomotic strictures may arise. One of the most critical functional impairments, postoperative Pancreatic Exocrine Insufficiency (PEI), occurs when digestive enzymes cannot be produced sufficiently due to parenchymal tissue loss or disruptions in hormone secretion. Clinically presenting with symptoms like abdominal pain, bloating, weight loss, and steatorrhea, PEI poses diagnostic challenges but can be evaluated using noninvasive methods like MRCP and secretin-stimulated MRCP. The management process encompasses determining the malnutrition status through anthropometric measurements, followed by pancreatic enzyme replacement therapy combined with dietary adjustments.
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