Momentul operator în pancreatita acută

Abstract

Introducere: Pancreatita acuta reprezinta o patologie cu evolutie impredictibila, cu potential letal, fiind insotita de o rata de mortalitate si morbiditate semnificativa. Managementul chirurgical al acestei patologii vizeaza faza tardiva de evolutie a bolii, in care riscul major este reperzentat de infectia necrozei pancreatice si peripancreatice. Literatura actuala arata ca abordul de tip interventional progresiv este asociata cu rezulatate: Corelarea momentului operator cu rata complicatiilor la pacientii cu pancreatita acuta. Materiale și metoda: Studiu retrospectiv, efectuat pe o perioada de 4 ani, in care au fost inclusi pacientii internati in Spitalul Clinic de Urgenta Bucuresti cu diagnosticul de pancreatita acuta, pentru care s-a practicat chirurgie deschisa sau minim invaziva. Rezultate obținute: Au fost inclusi 624 de pacienti diagnosticati cu pancreatita acuta din care in functie de gradul de severitate 44 pacienti (7%) au avut forma severa, 243 pacienti (39%) forma moderat severa si 337 pacienti (54%) forma usoara. In ceea ce priveste corelatia dintre momentul operator si gradul de severitate , pentru pancreatita acuta severa timpul mediu pana la interventia chirurgicala a fost de 26.43 zile, iar pentru pancreatita acuta moderat severa timpul mediu pana la momentul operator a fost de 9.8 zile. Mortalitatea pentru pacientii cu pancreatita acuta forma severa este una semnificativa, in proportie de 42%. Analiza curbelor de supravietuire corelate cu momentul operator au aratat faptul ca pacientii operati tardiv au avut o rata de supravietuire mai buna. Concluzii: Interventia chirurgicala efectuata in primele 28 zile se asociaza cu o rata semnificativa de complicatii si mortalitate. Managementul multidisciplnar al pacientilor cu pancreatita acuta, terapie intenziva asociata cu tehnici minim invazive, pot oferi timp pretios acestor pacienti, pentru a ajunge la momentul optim tratamentului chirugical.

Introduction: Acute pancreatitis is a potentially lethal disease with an unpredictable evolution, with a significant morbidity and mortality rate. Surgical management of this disease targets the late evolution phase, when there are major risks from the infection of pancreatic and peripancreatic necrosis. Modern literature reports that progressive interventional approach shows better clinical results. Objective: Correlation of surgery timing with morbidity rate in patients with acute pancreatitis. Material and method: Retrospective study which included patients with acute pancreatitis admitted and operated (open and minimally invasive procedures) in the București Clinical Emergency Hospital during a period of 4 years. Results: 624 patients with acute pancreatitis were included; distribution according to severity: severe form - 44 patients (7%), moderate severe - 243 patients (39%), and mild - 337 patients (54%). Regarding the correlation between the timing of surgery and severity – median time until surgery for severe acute pancreatitis was 26.43 days, and for moderate severe - 9.8 days. Mortality rate for patients with severe acute pancreatitis is significant and reached 42%. Survival curves analysis corelated to the timing of surgery unveiled that the patients with delayed surgery showed a better survival rate. Conclusion: Surgical intervention performed during the first 28 days is associated with a significant rate of morbidity and mortality. Multidisciplinary management of these patients, intensive care combine with minimally invasive techniques may offer precious time to these patients in order to reach the optimal surgery timing.