Pankreas Cerrahisinin Hemorajik Komplikasyonları
Özet
Pankreas cerrahisi, mortalite oranları yüzde 5’in altına düşmüş olsa da yüzde 30-60 arasında seyreden yüksek postoperatif komplikasyon riskini barındırmaya devam etmektedir. Bu süreçte karşılaşılan en kritik ve hayati komplikasyonlardan biri, insidansı yüzde 3-10 arasında değişen postpankreatektomik kanamadır (PPK). Uluslararası Pankreas Cerrahisi Çalışma Grubu (ISGPS), bu kanamaları zamanlamasına (erken veya geç), şiddetine ve lokasyonuna göre Evre A, B ve C olarak sınıflandırmıştır. Cerrahi sonrasındaki ilk 24 saatte gelişen erken kanamalar genellikle teknik yetersizliklerden kaynaklanır ve relaparatomi ile yönetilir. Ameliyattan günler sonra veya taburculuk sonrasında ortaya çıkan geç dönem kanamalar ise anastomoz kaçakları, apse oluşumu ve vasküler erozyon gibi kompleks patofizyolojilere sahiptir ve yüzde 41’e varan yüksek mortalite oranlarına yol açabilir. Geç dönem kanamaların yönetiminde, hemodinamik duruma bağlı olarak kontrastlı BT, anjiyografi, embolizasyon, endoskopi veya sepsisin eşlik ettiği durumlarda acil laparotomi modaliteleri tercih edilmektedir.
Pancreatic surgery has achieved mortality rates below 5%, yet it maintains a high postoperative complication risk ranging between 30% and 60%. Among these, postpancreatectomy hemorrhage (PPH) stands out as a critical and life-threatening complication with an incidence of 3-10%. The International Study Group of Pancreatic Surgery (ISGPS) classifies these hemorrhages into Grades A, B, and C based on onset time (early or late), severity, and location. Early hemorrhage, occurring within the first 24 hours post-surgery, usually stems from technical limitations or coagulopathy and is primarily managed via relaparotomy. Conversely, delayed PPH, presenting days or even weeks after discharge, features a complex pathophysiology driven by anastomotic leaks, abscess formation, and vascular erosion, carrying a daunting mortality rate of up to 41%. The management of delayed PPH relies heavily on the patient's hemodynamic stability, utilizing diagnostic tools like contrast-enhanced CT, followed by targeted interventions such as angiography, embolization, endoscopy, or urgent laparotomy when accompanied by severe sepsis.
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