RESUMEN
Pancreas and kidney transplantation is the treatment of choice for patients with type 1 diabetes mellitus and terminal renal insufficiency. Herein we have presented a series of 35 patients transplanted between 2002 and 2009 including periods before and after 2007 divided based on introduction of some technical aspects. In the first phase (learning period) we have noted complications related to pancreatic surgery with a morbidity among 12 of 18 patients (66.6%). In the second period (stabilization period), complications appeared in 6 out of 17 patients (35.2%; P < .028). The reoperation rate was 83.3% in the learning period and 23.5% in the stabilization period (P < .03). Seven transplantectomies were performed in the first period (P < .004). Five patients died, all of them in the learning group (P < .019). Changes in the technical aspects of the procedure were responsible for improved outcomes obtained among pancreas and kidney transplantations.
Asunto(s)
Trasplante de Riñón/métodos , Trasplante de Páncreas/métodos , Anastomosis Quirúrgica/métodos , Diabetes Mellitus Tipo 1/cirugía , Nefropatías Diabéticas/cirugía , Hemoglobina Glucada/análisis , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Soluciones Preservantes de Órganos , Trasplante de Páncreas/efectos adversos , Trasplante de Páncreas/mortalidad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Análisis de SupervivenciaRESUMEN
We present a study of 28 patients, treated for adenocarcinoma of Vater's ampulla. We emphasize the distinct behavior of each one of the peri-ampullar tumors, those which affect Vater's ampulla yielding the best prognosis. We gathered data regarding gender, age, clinical manifestations, and analytical data. The confirmatory diagnosis gives us 100% of CPRE cases. All of the patients were submitted to surgical treatment with anatomic pathological confirmation of the diagnosis, be it pre or postoperative. We practiced curative surgery in 57.2% of the cases and palliative in 42.8% of the cases. We observed postoperative complications in 17.8% of the patients and peroperative mortality in 3.5%. Actual survival of the series of patients for whom exeretic surgery was performed is significantly superior to that of the other patients.