RESUMO
Introducción: La pancreatitis aguda grave está asociada a una mortalidad de 10 a 30 % en centros hospitalarios especializados y representa 20 % de los diagnósticos de pancreatitis. Las indicaciones para tratamiento quirúrgico son necrosis infectada, necrosis persistente, pancreatitis fulminante o complicaciones agudas de la pancreatitis como hemorragia o perforación intestinal. Métodos: Estudio que incluyó pacientes intervenidos quirúrgicamente con el diagnóstico de pancreatitis aguda grave del 1 de enero de 2000 al 31 de diciembre de 2007. Resultados: Se analizaron los expedientes de 82 pacientes, 63.4 % fue del sexo masculino; la etiología más frecuente de pancreatitis fue la biliar, en 63.4 %. La morbilidad fue de 62.19 %; 35.36 % presentó complicaciones pulmonares, 15.85 % fístula enterocutánea y 10.9 % hemorragia. La mortalidad fue de 20.73 %. Todos los pacientes con pancreatitis aguda grave fueron tratados en la unidad de cuidados intensivos; la nutrición parenteral se indicó en pacientes con intolerancia a la vía oral e imposibilidad de colocar una sonda nasoyeyunal; como terapia antibiótica profiláctica se utilizó un carbapenémico. Las indicaciones quirúrgicas se limitaron a necrosis pancreática infectada, necrosis pancreática estéril persistente, pancreatitis aguda fulminante e hipertensión intraabdominal y complicaciones como perforación intestinal y sangrado. Conclusiones: En los pacientes con pancreatitis aguda grave se recomienda manejo por un equipo multidisciplinario en una unidad de cuidados intensivos; la nutrición parenteral y los antibióticos deben ser bien valorados y no utilizarlos en forma rutinaria, y una vez diagnosticada la pancreatitis grave su uso debe ser sistemático.
BACKGROUND: Severe acute pancreatitis has a reported mortality of 10-30% in specialized hospitals, representing 20% of patients diagnosed with acute pancreatitis. Indications for surgery are infected necrosis, necrosis persistent, fulminant pancreatitis or acute pancreatitis complications such as bleeding or intestinal perforation. METHODS: We studied patients diagnosed with pancreatitis from January 1, 2000 to December 31, 2007. RESULTS: We analyzed records of 82 patients, 63.4% were male and the most common etiology of pancreatitis was biliary in 63.4% of patients. Morbidity was 62.19%; 35.36% had pulmonary complications. In 15.85% of patients there was enterocutaneous fistula and 10.9% had bleeding. Mortality was 20.73%. In our hospital, all patients with severe acute pancreatitis are managed in the intensive care unit. Parenteral nutrition is only indicated in patients intolerant to oral feeding or with inability to place a nasojejunal tube. Use of antibiotics is based on carbapenem, and surgical indications are infected pancreatic necrosis, persistent sterile pancreatic necrosis, fulminant acute pancreatitis and abdominal hypertension, and complications such as intestinal perforation and bleeding. CONCLUSIONS: It is recommended that patients with severe acute pancreatitis are managed by a multidisciplinary team in an intensive care unit. The role of parenteral nutrition and antibiotics should be individualized.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pancreatite/cirurgia , Doença Aguda , Estudos Transversais , Hospitais , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Severe acute pancreatitis has a reported mortality of 10-30% in specialized hospitals, representing 20% of patients diagnosed with acute pancreatitis. Indications for surgery are infected necrosis, necrosis persistent, fulminant pancreatitis or acute pancreatitis complications such as bleeding or intestinal perforation. METHODS: We studied patients diagnosed with pancreatitis from January 1, 2000 to December 31, 2007. RESULTS: We analyzed records of 82 patients, 63.4% were male and the most common etiology of pancreatitis was biliary in 63.4% of patients. Morbidity was 62.19%; 35.36% had pulmonary complications. In 15.85% of patients there was enterocutaneous fistula and 10.9% had bleeding. Mortality was 20.73%. In our hospital, all patients with severe acute pancreatitis are managed in the intensive care unit. Parenteral nutrition is only indicated in patients intolerant to oral feeding or with inability to place a nasojejunal tube. Use of antibiotics is based on carbapenem, and surgical indications are infected pancreatic necrosis, persistent sterile pancreatic necrosis, fulminant acute pancreatitis and abdominal hypertension, and complications such as intestinal perforation and bleeding. CONCLUSIONS: It is recommended that patients with severe acute pancreatitis are managed by a multidisciplinary team in an intensive care unit. The role of parenteral nutrition and antibiotics should be individualized.
Assuntos
Pancreatite/cirurgia , Doença Aguda , Adulto , Estudos Transversais , Feminino , Hospitais , Humanos , Masculino , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: We undertook this study to compare the outcome of laparoscopic and open splenectomy in the treatment of hematological diseases. METHODS: This was a comparative study of two groups of patients. The study sample consisted of 37 patients divided into two groups: group I, open splenectomy (OS) and group II, laparoscopic splenectomy (LS). Twenty one consecutive patients with LS were compared to 16 randomized patients selected from clinical records of OS patients. General and specific variables were collected in Microsoft Access database and analyzed in SPSS for Windows statistical program. Statistical analysis was done. RESULTS: Of 25 women and 12 men (37.2 +/- 16.9 years old), 6 had autoimmune hemolytic anemia, 29 idiopathic thrombocytopenic purpura (ITP), and two had Evans syndrome. Patients with ITP had preoperative platelet count of 74.6 +/- 64.1/mm(3) and patients with autoimmune hemolytic anemia had a preoperative hemoglobin of 10.6 +/- 2.9 g/dl. Ten patients had co-morbidity. There were 16 OS and 21 LS. Size of spleen was 13.1 +/- 3.7 cm and weight was 178 +/- 115 g. Surgical time for OS was 69.3 +/- 21.7 min and for LS was 152.8 +/- 61.1 min (p <0.05). Operative bleeding for OS was 300 +/- 265 ml and for LS it was 265 +/- 198 ml (p >0.05). One patient in LS group had red cell transfusion and two in the same group had to be converted to OS to reassure hemostasis. Reoperations had to be done in the OS group, two to control bleeding and one with a left lobe hepatic hematoma. There was no mortality. Postoperative platelet count in patients with ITP increased to 246 +/- 159 and hemoglobin in patients with hemolytic anemia increased to 12.1 +/- 3.6 g (p <0.05). Hospital stay in OS was 5.06 +/- 3.6 days vs. 2.06 +/- 0.26 in LS (p <0.05). Patients in OS had 30.6 +/- 10.5 lost work days vs. 15.5 +/- 4.6 in LS group (p <0.05). CONCLUSIONS: It is possible to treat patients with hematological diseases with LS. LS is time-consuming compared to OS. Morbidity in LS may be less than in OS. Mortality may be zero. Hospital stay and postoperative lost work days are less in LS than with OS. LS may be the gold standard in treatment of patients with hematological diseases.