RESUMEN
Possibilities of various diagnostic methods for biliary hypertension detection in chronic pancreatitis were analyzed. Biliary hypertension was revealed in 163 (31%) patients, suffering chronic pancreatitis. The laboratory investigations data, ultrasonographic investigation, computer tomography, endoscopic retrograde cholangiopancreatography, magnet-resonance cholangiopancreatography, intraoperative measurement of the biliary ducts width, intraoperative measurement of biliary pressure were applied for diagnosis. Endoscopic retrograde cholangiopancreatography, magnet-resonance cholangiopancreatography and intraoperative measurement of biliary pressure are considered the most sensitive methods for chronic pancreatitis diagnosis.
Asunto(s)
Conductos Biliares/fisiopatología , Colangiopancreatografia Retrógrada Endoscópica , Páncreas/diagnóstico por imagen , Pancreatitis Crónica/diagnóstico por imagen , Adulto , Anciano , Conductos Biliares/patología , Pancreatocolangiografía por Resonancia Magnética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Páncreas/patología , Páncreas/fisiopatología , Pancreatitis Crónica/patología , Pancreatitis Crónica/fisiopatología , Presión , Tomografía Computarizada por Rayos XRESUMEN
The results of treatment of 231 patients, suffering tumoral affection of pancreatic left anatomical segment in period of 2009-2013 yrs were analyzed. Individualized approach, using modern technologies, was applied. Radical operations were performed in 129 patients, ageing 14-81 yrs old, including pancreatic distal resections in various modifications, central resection and tumoral enucleation. Possibilities of the extended pancreatic resection performance were studied in conditions of tumoral invasion of adjacent organs, regional vessels, as well as impact of such interventions on postoperative complications and lethality rate. While performing pancreatic subtotal distal resection with simultant resection of affected main venous vessels and adjacent organs the operative intervention risk is enhanced, but possibilities of a radical operations performance in previously considered inoperable patients are expanding.
Asunto(s)
Adenocarcinoma/cirugía , Cistadenocarcinoma/cirugía , Páncreas/cirugía , Pancreatectomía/métodos , Neoplasias Pancreáticas/cirugía , Complicaciones Posoperatorias/prevención & control , Adenocarcinoma/irrigación sanguínea , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cistadenocarcinoma/irrigación sanguínea , Cistadenocarcinoma/mortalidad , Cistadenocarcinoma/patología , Femenino , Venas Hepáticas/patología , Venas Hepáticas/cirugía , Humanos , Masculino , Venas Mesentéricas/patología , Venas Mesentéricas/cirugía , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Metástasis de la Neoplasia , Páncreas/irrigación sanguínea , Páncreas/patología , Neoplasias Pancreáticas/irrigación sanguínea , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Estudios Retrospectivos , Riesgo , Análisis de SupervivenciaRESUMEN
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 TratamientoAsunto(s)
Cistoadenoma/diagnóstico , Cistoadenoma/cirugía , Pancreatectomía/métodos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirugía , Adolescente , Adulto , Anciano , Cistoadenoma/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/patología , Adulto JovenRESUMEN
Experience of surgical treatment of 241 patients with malignant tumor of duodenal major papilla in 1992-2005 yrs was analyzed. In 95 patients the treatment was conducted in two stages, the first of which have had included biliary decompression. There were analyzed 18 potential risk factors for postoperative complications occurrence. Preoperative biliary decompression conduction have had constituted one of the risk factors for postoperative complications occurrence. There were proposed strict recommendations concerning preoperative biliary decompression conduction in patients with malignant tumor of duodenal major papilla.
Asunto(s)
Ampolla Hepatopancreática/patología , Ampolla Hepatopancreática/cirugía , Conductos Biliares/cirugía , Neoplasias del Conducto Colédoco/patología , Neoplasias del Conducto Colédoco/cirugía , Descompresión Quirúrgica , Cuidados Preoperatorios , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Tasa de SupervivenciaRESUMEN
Results of treatment of 39 patients, to whom pancreatoduodenal resection was performed for periampullar zone tumour, were analyzed. Anemia, revealed before the operation, had constituted the factor, which trustworthily increased the postoperative complications occurrence risk. Therapeutic course, using recombinant erythropoietins, was conducted for correction of anemia in 7 patients. This had promoted the hemoglobin level raising, the risk of postoperative complications occurrence lowering, but did not influence the intraoperative blood loss severity and perioperative hemotransfusion volume.