Güncel Proktoloji: Anorektal Hastalıklar ve Modern Yaklaşımlar

guncelproktolojianorektalhastaliklarvemodernyaklasimlar-1-0-25kapak

PELVİK TABAN HASTALIKLARINDA TANISAL TESTLER

Dr. Muhammed Kadir YILDIRAK1
Dr. Emre Furkan KIRKAN2

1SBÜ Tıp Fakültesi, Ümraniye EAH, Genel Cerrahi Kliniği, İstanbul, Türkiye
2SBÜ Tıp Fakültesi, Ümraniye EAH, Genel Cerrahi Kliniği, İstanbul, Türkiye

ÖZET

Pelvik taban hastalıklarının doğru tanısı, anismus gibi fizyolojik bozukluklardan rektosel gibi anatomik defektlere kadar geniş bir yelpazeyi kapsayan bu hastalık grubu için büyük önem arz etmektedir. Kronik pelvik ağrı, fekal inkontinans ve konstipasyon gibi semptomlarla sıkça prezente olan bu hastalıklar, hastaların yaşam kalitesini önemli ölçüde etkilemektedir. Epidemiyolojik veriler, Amerika Birleşik Devletleri’nde kadınların yaklaşık %15,7’sinin en az bir pelvik taban hastalığından etkilendiğini, bu oranın yaşla birlikte %50’ye kadar çıktığını göstermektedir. Bu hastalıklar, koloproktoloji kliniklerine başvuran hastaların önemli bir kısmını oluşturduğundan, etkili tanı stratejileri bu hastalıkların yönetimi ve ilişkili psikososyal yükün azaltılması için gereklidir. Kapsamlı bir tanısal yaklaşım, detaylı bir hasta anamnezi ile başlar ve pelvik ağrı, uzun süren ıkınma, tam boşalamama hissi ve istemsiz dışkı kaçırma gibi semptomların tespitinde kritik öneme sahiptir. Bu süreçte, semptomların ciddiyetini ölçen ve klinik karar vermede rehberlik eden standardize skorlama sistemleri büyük rol oynamaktadır. Konstipasyonun değerlendirilmesinde Cleveland Klinik Florida Konstipasyon Skoru ve Roma III Kriterleri yaygın olarak kullanılırken, fekal inkontinansın şiddetini değerlendirmede Cleveland Klinik Florida Fekal İnkontinans Skoru (Wexner Skoru) ve St. Mark İnkontinans Skoru temel araçlardır. Bu skorlama sistemleri, semptomların tasnifi ve değerlendirilmesine olanak sağlamakta, ayrıca tedavi sürecinin yapılandırılmasına ola- nak tanımaktadır. Bu skorlama sistemlerini tamamlayıcı olarak, ileri tanı araçları da detaylı anatomik ve fonksi- yonel değerlendirmeler sunmaktadır. Yüksek çözünürlüklü anorektal manometri, anorektal basınçların hassas ölçümlerini sağlarken, endoanal ultrasonografi anal sfinkter kompleksini görüntülemede ve fekal inkontinans ile ilişkili defektlerin saptanmasında altın standarttır. Manyetik rezonans görüntüleme ise özellikle anatomik anormalliklerin olduğu karmaşık vakalarda tanı doğruluğunu artırır. Klinik bulguların bu tanı yöntemleri, skorlama sistemleri ve ileri görüntüleme teknikleri ile bütünleştirilmesi, kişiye özel tedavi planlarının geliştirilmesi açısından kritik öneme sahiptir. Bu çok yönlü yaklaşım, tanı doğruluğunun artmasını, hastalığın yönetiminin kolaylaşmasını ve hastaların sonuçlarının iyileştirilmesini sağlar.

Anahtar Kelimeler: Fekal inkontinans; Pelvik taban kusurları; Konstipasyon; Ultrasonografi; Manyetik rezonans görüntüleme

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