RESUMEN
An analysis of treatment of 584 patients with complicated forms of chronic pancreatitis operated during 2000-2100 years was carried out. Quality of life of postoperative patients was estimated according to a technique of calculations of modules EORTC QLQ-C30 and EORTC QLQ-PAN26. The indicators of quality of life have improved by 19.7% in performance of saving duodenal outflow of operations of pancreatic juice. Change of the surgical strategy has led to decreased number of postoperative complications by 4.6% and to satisfactory long-term results in 92.6% of the patients.
Asunto(s)
Enfermedades del Conducto Colédoco/cirugía , Descompresión/métodos , Dolor Postoperatorio , Pancreatectomía , Pancreatoyeyunostomía , Pancreatitis Crónica , Dolor Abdominal/etiología , Dolor Abdominal/fisiopatología , Adulto , Pérdida de Sangre Quirúrgica/prevención & control , Enfermedades del Conducto Colédoco/etiología , Enfermedades del Conducto Colédoco/fisiopatología , Femenino , Hemostasis Quirúrgica/métodos , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Dolor Postoperatorio/etiología , Dolor Postoperatorio/fisiopatología , Pancreatectomía/efectos adversos , Pancreatectomía/métodos , Pancreatoyeyunostomía/efectos adversos , Pancreatoyeyunostomía/métodos , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/fisiopatología , Pancreatitis Crónica/cirugía , Satisfacción del Paciente , Calidad de Vida , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
The experience of performance of pancreaticoduodenal resection (PDR) in 412 patients in 1998-2009 yrs for malignant periampullar tumors was analyzed. In 296 patients a standard PDR was done and in 116, with tumoral affection of distal part of common biliary duct and duodenal large papilla - pylorus-preserving PDR Individualized approach was used, exploiting modern technologies of pylorus-preserving PDR: saving gastroduodenal artery, selective ligation of right branch of dorsal pancreatic and lower pancreatoduodenal artery, dorsal and translateral surgical approaches usage. In 26 patients PDR was accomplished with resection of vessels. In 12 patients a no-touch procedure of PDR was applied. There were analyzed the results of application of modified extended lymphadenectomy while PDR performance. Complications had occurred in 29.5% patients, lethality was 2.7%. The survival indices had constituted at average 24 mo--in pancreatic tumors, 48 mo--in tumors of a distal part of common biliary duct and 72 mo--for localized in duodenal large papilla. Introduction of a new methods of PDR would permit to improve an early and late results of treatment.
Asunto(s)
Ampolla Hepatopancreática/cirugía , Neoplasias del Conducto Colédoco/cirugía , Neoplasias Duodenales/cirugía , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Ampolla Hepatopancreática/irrigación sanguínea , Neoplasias del Conducto Colédoco/irrigación sanguínea , Neoplasias Duodenales/irrigación sanguínea , Femenino , Humanos , Escisión del Ganglio Linfático/métodos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/irrigación sanguínea , Resultado del TratamientoRESUMEN
Experience of pancreaticoduodenal resection (PDR) performance in 81 patients in 2007-2008 yrs was summarized. There were studied up the risk of postoperative gastrostasis occurrence and factors, promoting such a risk lowering. In 24 patients (the main group) gastro- and duodenoenteroanastomosis were formatted in antecolic position, while in 57 (the control group) the gut continuity was restored according to standard method. Postoperative gastrostasis in a control group had occurred in 10 (17.5%) patients, while in the main group this complication was absent. Formation of gastro- and duodenoenteroanastomoses in antecolic fashion and absence of early postoperative complications are considered the factors, trustworthy influencing the risk of postoperative gastrostasis occurring. Application of a pylorus--preserving procedure of PDR had not promoted the risk of raising of postoperative gastrostasis occurrence.
Asunto(s)
Gastroparesia/prevención & control , Enfermedades Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Pancreaticoduodenectomía/métodos , Pancreatoyeyunostomía/métodos , Nutrición Enteral , Vaciamiento Gástrico/fisiología , Gastroparesia/epidemiología , Gastroparesia/etiología , Humanos , Intubación Gastrointestinal , Neoplasias Pancreáticas/cirugía , Índice de Severidad de la EnfermedadRESUMEN
The experience of application of shortly acting and durably acting preparations--analogues of somatostatin in complex therapy of various pancreatic diseases was summarized. There was established similar efficacy of the preparations in blockade of the pancreatic external secretion and the various duration of their inhibiting influence on the blood flow. The trustworthy differences in the complications frequency and lethality while application of various preparations--analogues of somatostatin were not revealed.
Asunto(s)
Fármacos Gastrointestinales/uso terapéutico , Octreótido/uso terapéutico , Páncreas , Enfermedades Pancreáticas , Péptidos Cíclicos/uso terapéutico , Somatostatina/análogos & derivados , Fármacos Gastrointestinales/administración & dosificación , Fármacos Gastrointestinales/efectos adversos , Humanos , Octreótido/administración & dosificación , Octreótido/efectos adversos , Páncreas/irrigación sanguínea , Páncreas/efectos de los fármacos , Páncreas/metabolismo , Enfermedades Pancreáticas/tratamiento farmacológico , Enfermedades Pancreáticas/metabolismo , Enfermedades Pancreáticas/cirugía , Péptidos Cíclicos/administración & dosificación , Péptidos Cíclicos/efectos adversos , Somatostatina/administración & dosificación , Somatostatina/efectos adversos , Somatostatina/uso terapéutico , Circulación Esplácnica/efectos de los fármacos , Resultado del TratamientoRESUMEN
Examination and treatment of 32 patients was done, in whom an acute necrotic pancreatitis was diagnosed. In 16 patients (the main group) ozonotherapy, according to scheme, elaborated in the clinic, was added to conventional treatment. The ozonotherapy application had permitted to reduce the rate of performance of "open" operative interventions. The cellular, humoral and local immunity improvement and biochemical indices normalization were noted. The stationary treatment duration was 21.4 days at average in the main group and 34.5 -- in a control one. The relaparotomy performance rate in the main group was lesser than in a control one.
Asunto(s)
Ozono/uso terapéutico , Pancreatitis Aguda Necrotizante/terapia , Adolescente , Adulto , Formación de Anticuerpos/efectos de los fármacos , Terapia Combinada , Femenino , Humanos , Inmunidad Celular/efectos de los fármacos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Peroxidación de Lípido/efectos de los fármacos , Masculino , Persona de Mediana Edad , Ozono/administración & dosificación , Pancreatitis Aguda Necrotizante/tratamiento farmacológico , Pancreatitis Aguda Necrotizante/inmunología , Pancreatitis Aguda Necrotizante/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
Basing on morphologic-anatomical peculiarities of extrahepatic biliary ducts (EBD) analysis the classification of their tumors was elaborated. The EBD portions borders were determined: the proximal, with predominant affection of right and left biliary duct, their branching; the central; the therminal; affection of common biliary duct ampulla and large duodenal papilla. Basing on the classification proposed, surgical tactics of the EBD tumors treatment was elaborated.
Asunto(s)
Neoplasias de los Conductos Biliares/clasificación , Neoplasias de los Conductos Biliares/diagnóstico por imagen , Conductos Biliares Extrahepáticos/diagnóstico por imagen , Adulto , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Extrahepáticos/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , UltrasonografíaRESUMEN
Experience of surgical treatment of 271 patients the extrahepatic biliary ducts tumor for the 1992-1999 yrs period is presented. Indirect signs of extrahepatic biliary ducts tumor were revealed in 84% of observations. Depending on the tumor localization the trustworthiness of the endoscopic retrograde pancreatocholangiography method had constituted from 79.8 to 96.4%. Correct diagnosis was established before the operation in 94.3% of patients. Radical operation was done in 93 (34.3%) of patients, including 22 with proximal localization of tumor, 13--with central one, 10--distal, 48--terminal. Palliative operation was performed in 178 patients, in 76 of them biliodigestive anastomosis was done. Total postoperative mortality was 14.8%.
Asunto(s)
Neoplasias de los Conductos Biliares/patología , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Extrahepáticos/patología , Conductos Biliares Extrahepáticos/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
There has been developed and adopted the author's method for surgical treatment of the retropancreatic cyst of the pancreas. The method involves a one-stage internal drainage of the cyst and pancreatic duct through cystoductopancreatojejunostomy on the isolated loop of the small intestine. Overall three patients have been operated on. The immediate and late results are good. The method is defended by the inventor's certificate.