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4.
Zhonghua Wai Ke Za Zhi ; 57(10): 14-18, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510727

RESUMO

Objective: To investigate the changes of surgical invitations on necrotizing pancreatitis in recent 14 years by reviewing single center data. Methods: One thousand and eighty patients with necrotizing pancreatitis who received surgical invitation were involved in the study.All the patients were treated at Department of Pancreatic Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2005 to December 2018. Six hundred and seventy-eight were males and 402 were females. The median (range) age of the study patients was 45 (20-76) years.The etiology of the disease was related to cholelithiasis in 335 cases(31.02%), hyperlipemia in 302 cases(27.96%), alcohol in 226 cases(20.93%), endoscopic retrograde cholangiopancreatography in 28 cases(2.59%), pregnancy in 50 cases(4.63%), idiopathic factors in 72 cases(6.67%) and other causes in 67 cases(6.20%). The patients were divided into two groups according to the time of admission. Group 1 included 1 475 patients that admitted from January 2005 to December 2010, and group 2 included 1 539 patients that admitted from January 2011 to December 2018. The surgical interventions, morbidity and mortality of the two group were compared, and χ(2) test was used for the statistical test. Results: Two hundred and sixty-six among the 1 080 cases were treated with drainage procedures because of the pseudocyst.One hundred and seventy-five drainage procedures were performed between January 2005 and December 2018, which account for 11.87%(175 /1 475) of all patients of necrotizing pancreatitis; 91 drainage procedures were performed between January 2011 and December 2018,which account for 5.91%(91/1 539) of all patients of necrotizing pancreatitis. Eight hundred and fourteen cases received surgical intervention for infection of necrotizing tissues. Of these cases, 410 cases received percutaneous catheter drainage(PCD) of retroperitoneal fluid or residual infection. Debridement of necrotic tissues was performed on 756 cases. Of these cases, 32 cases received minimal invasive retroperitoneal debridement with/without denotes video assistant,4 cases received transluminal endoscopic debridement, 21 cases received laparoscopic debridement, and 709 cases received open laparotic debridement.Three hundred and sixty-five cases were admitted to our institute during January 2005 to December 2010, and the other 391 cases were admitted to our institute from January 2011 to December 2018. Of the first period, all debridement were performed with open laparotic procedures. Of the second period,debridement were performed with open laparotic procedures and minimal invasive procedures. The average times of surgical invasion, morbidity of principal local complications and mortality of the two periods were 1.27 and 1.34,28.22%(103/365) and 29.92%(117/346),and 6.03%(23/365) and 6.91%(27/346), respectively. Conclusions: Minimal invasive procedures can be considered for debridement in patients with necrotizing pancreatitis in some selected conditions.The involvements of minimal invasive procedures in treatment of necrotizing pancreatitis don't decrease the morbidity of principal local complications and mortality in recent years. Rational surgical procedures and appropriate surgical timing are the keys to improve the efficacy of necrotizing pancreatitis.


Assuntos
Pancreatite Necrosante Aguda/cirurgia , Espaço Retroperitoneal/cirurgia , Adulto , Idoso , Desbridamento/métodos , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pseudocisto Pancreático/etiologia , Pseudocisto Pancreático/cirurgia , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/mortalidade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
Medicine (Baltimore) ; 98(27): e15856, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277088

RESUMO

RATIONALE: Duodenal obstruction (DO) sometimes induces the groove pancreatitis. However, the case of DO due to chronic pancreatitis in pancreas tail (CPPT) is extremely rare. Therefore, the managements of DO caused by CPPT have not been established yet. PATIENT CONCERNS: A 68-year-old man, who was under the treatment of chronic pancreatitis, presented to our hospital with nausea and abdominal pain. He was diagnosed as DO caused by CPPT. The Conservative treatment, including the nasogastric aspiration and intravenous infusion under the absence of food, was performed. The drainage fluid from naso-gastric tube had been more than 2000 ml per a day although continuing treatment for 14 days. Hence, we decided that the conservative therapy was failed and the surgical intervention was required. DIAGNOSIS: Computed tomography showed gastroduodenal expansion due to stenosis at the horizontal portion of the duodenum with increasing pancreatic pseudocyst. The contrast radiography of the duodenum showed severe stenosis around Treitz ligament. His pre-surgical diagnosis was DO due to CPPT through exclusion of other etiologies for DO such as annular pancreas, SMA syndrome, duodenal diaphragm and Crohn disease. INTERVENTION: Spleen preserving distal pancreatectomy (Warshaw operation) was performed with gastrojejunostomy. During surgery, marked redness and thickness of the mesenteric serosa around Treiz ligament were observed. His surgical findings were supported our preoperative prediction. OUTCOMES: The patient was successfully treated and discharged uneventfully after postoperative day 14. At the 9 months follow-up visit, the patient is still doing well without any symptoms. CONCLUSION: Combination of gastrojejunostomy and Warshaw operation is one of the ideal surgical procedures for patients of DO due to CPPT.


Assuntos
Obstrução Duodenal/cirurgia , Derivação Gástrica/métodos , Pancreatectomia/métodos , Pseudocisto Pancreático/cirurgia , Pancreatite Crônica/complicações , Idoso , Obstrução Duodenal/etiologia , Humanos , Masculino , Tratamentos com Preservação do Órgão , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/etiologia , Tomografia Computadorizada por Raios X
7.
Khirurgiia (Mosk) ; (7): 80-86, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355820

RESUMO

OBJECTIVE: To present the results of surgical treatment of patients with mediastinalpancreatogeniccysts (MPC). MATERIAL AND METHODS: There were 5 patients with MPC. RESULTS: Laboratory tests revealed increased blood amylase level by 1.5-2 times in 3 cases, urine diastase by 4-5 times - in 2 cases. Pleural effusion with amylase concentration in the fluid from 5680 to 48 640 units was diagnosed in 4 cases. CT data of preudocysts of pancreatic body and tail were obtained in 3 cases, head and body - in 2 patients. These cysts extended to posterior mediastinum through the hiatal orifice for about 3.5-40 cm. Three patients underwent VATS removal of pleural fragments, one - thoracotomy, lung decortication and MPC drainage through pleural cavity. Three patients underwent pancreatic drainage procedures (cystogastrostomy, pancreaticojejunostomy and external drainage of the cyst). A small pseudocyst has been successfully treated by conservative treatment with octreotide. CONCLUSION: MPC is a rare complication of pancreatitis and often associated with pleural effusion. CT and fluid amylase analysis are the main diagnostic measures. Surgical treatment includes VATS, destruction of pleural fragments and pleural drainage, cystogastrostomy, pancreaticojejunostomy or external drainage of pancreatic pseudocyst.


Assuntos
Doenças do Mediastino/cirurgia , Cisto Pancreático/cirurgia , Derrame Pleural/cirurgia , Drenagem , Humanos , Doenças do Mediastino/diagnóstico por imagem , Cisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/cirurgia , Derrame Pleural/diagnóstico por imagem
8.
Pan Afr Med J ; 32: 77, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223368

RESUMO

Pancreatic pseudocyst is a rare benign condition, in particular among children. It is an intra or extra pancreatic juice collection lacking of an epithelial lining. We conducted a retrospective study of 7 children whose medical record data were collected in the Department of Paediatric Surgery at the University Hospital Hassan II in Fez, over a period of 11 years, from 1 January 2005 to 31 December 2016. All children were male, their average age was 6.6 years (15 months - 12 years). An history of abdominal trauma was found in 4 cases, abdominal bloating, pain, vomiting and transit disorders were the primary reason for consultation. Clinical examination showed epigastric tenderness and an alteration of the general state in all cases. Abdominal ultrasound as well as abdominal CT scan helped to diagnose pancreatic pseudocyst before surgery. Six patients, out of a total of seven, underwent surgery; we opted for internal bypass (gastro-cystic anastomosis) in 4 cases, external bypass in 2 cases and therapeutic abstention in one case. Pancreatic pseudocysts are rare. Nevertheless, they are the most frequent (80% of pancreatic cystic lesions are pseudocysts and due to acute and/or chronic pancreatitis, pancreatic trauma or pancreatic ductal obstruction).


Assuntos
Traumatismos Abdominais/epidemiologia , Dor Abdominal/etiologia , Pseudocisto Pancreático/diagnóstico por imagem , Traumatismos Abdominais/complicações , Dor Abdominal/epidemiologia , Criança , Pré-Escolar , Hospitais Universitários , Humanos , Lactente , Masculino , Pseudocisto Pancreático/fisiopatologia , Pseudocisto Pancreático/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Vômito/epidemiologia , Vômito/etiologia
9.
Pediatr Surg Int ; 35(8): 861-867, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31161252

RESUMO

BACKGROUND: Peripancreatic fluid collection and pseudocyst development is a common sequela following non-operative management (NOM) of pancreatic injuries in children. Our purpose was to review management strategies and assess outcomes. METHODS: A multicenter, retrospective review was conducted of children treated with NOM following blunt pancreatic injury at 22 pediatric trauma centers between the years 2010 and 2015. Organized fluid collections were called "acute peripancreatic fluid collection" (APFC) if identified < 4 weeks and "pseudocyst" if > 4 weeks following injury. Data analysis included descriptive statistics Wilcoxon rank-sum, Kruskal-Wallis and t tests. RESULTS: One hundred patients with blunt pancreatic injury were identified. Median age was 8.5 years (range 1-16). Forty-two percent of patients (42/100) developed organized fluid collections: APFC 64% (27/42) and pseudocysts 36% (15/42). Median time to identification was 12 days (range 7-42). Most collections (64%, 27/42) were observed and 36% (15/42) underwent drainage: 67% (10/15) percutaneous drain, 7% (1/15) needle aspiration, and 27% (4/15) endoscopic transpapillary stent. A definitive procedure (cystogastrostomy/pancreatectomy) was required in 26% (11/42). Patients with larger collections (≥ 7.1 cm) had longer time to resolution. Comparison of outcomes in patients with observation vs drainage revealed no significant differences in TPN use (79% vs 75%, p = 1.00), hospital length of stay (15 vs 25 median days, p = 0.11), time to tolerate regular diet (12 vs 11 median days, p = 0.47), or need for definitive procedure (failure rate 30% vs 20%, p = 0.75). CONCLUSIONS: Following NOM of blunt pancreatic injuries in children, organized fluid collections commonly develop. If discovered early, most can be observed successfully, and drainage does not appear to improve clinical outcomes. Larger size predicts prolonged recovery. LEVEL OF EVIDENCE: III STUDY TYPE: Case series.


Assuntos
Traumatismos Abdominais/terapia , Tratamento Conservador/efeitos adversos , Drenagem/métodos , Pâncreas/lesões , Pancreatectomia/métodos , Pseudocisto Pancreático/cirurgia , Ferimentos não Penetrantes/terapia , Adolescente , Criança , Pré-Escolar , Endoscopia/métodos , Feminino , Humanos , Lactente , Masculino , Pseudocisto Pancreático/etiologia , Estudos Retrospectivos , Stents
10.
Gastrointest Endosc ; 90(3): 507-513, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31152738

RESUMO

BACKGROUND AND AIMS: Recently, a newly designed lumen-apposing metal stent (LAMS) with a conventional delivery system was developed. The purpose of this study was to evaluate the effectiveness and safety of a newly designed LAMS for EUS-guided drainage to treat symptomatic pancreatic pseudocysts. METHODS: This prospective multicenter cohort study included 34 patients with symptomatic pancreatic pseudocysts from 2016 to 2017. The patients underwent EUS-guided drainage with the newly designed LAMS (Niti-S SPAXUS; Taewoong Medical Co, Ltd, Ilsan, South Korea). Effectiveness outcome measurements included technical success rate, clinical success rate, successful stent removal rate, and procedural time. Safety outcome measurements included procedure and/or stent-related adverse events (AEs) and overall AEs. Patients were prospectively followed, and consecutive data were collected at discharge, at stent removal, and 20 days after stent removal. RESULTS: Thirty-four patients (mean age 51.7 ± 13.3 years, 26 men) were enrolled. The mean pseudocyst size was 9.23 ± 3.54 cm. The technical success rate was 97.1% (33/34). The clinical success rate was 94.1% (32/34). All stents were successfully removed. The mean procedural time from needle puncture to stent deployment was 10.3 ± 5.7 minutes. Four patients (11.8%) experienced procedure and/or stent-related AEs, including stent maldeployment (n = 1) and pseudocyst infection (n = 3). All patients completely recovered from the AEs. Bleeding caused by the stent or buried LAMS syndrome was not observed. No unplanned endoscopic procedures were required. CONCLUSIONS: This study showed that EUS-guided drainage using the newly designed LAMS is technically feasible and effective for the treatment of symptomatic pancreatic pseudocysts. (Clinical trial registration number: NCT02730663.).


Assuntos
Drenagem/métodos , Pseudocisto Pancreático/cirurgia , Stents , Adulto , Idoso , Estudos de Coortes , Endoscopia do Sistema Digestório/métodos , Endossonografia , Desenho de Equipamento , Feminino , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Cirurgia Assistida por Computador
13.
West Afr J Med ; 36(1): 80-82, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30924121

RESUMO

Pancreatic pseudocyst (PPC) complicating blunt and penetrating abdominal injury is well documented in paediatric age groups. In adults, PPC is often one of the sequelae of acute pancreatitis rather than trauma. Blunt abdominal trauma accounts for most documented cases of post-traumatic PPC. To the best of our knowledge, PPC following penetrating abdominal gunshot injury is a rare event. Laparoscopic drainage of PPC is fast gaining acceptance as the procedure of choice amongst experts as it offers many advantages and benefits of minimal access surgery to the patient. We report our experience and challenges with our first case of laparoscopic cystogastrostomy for a large post-traumatic PPC in a 24-yearold man who was diagnosed 8 months after laparotomy for a penetrating thoraco-abdominal gunshot wound. We also conduct a review of the literature on laparoscopic management of Pancreatic pseudocyst.


Assuntos
Drenagem/métodos , Gastrostomia/métodos , Laparoscopia , Pseudocisto Pancreático/cirurgia , Ferimentos por Arma de Fogo , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
14.
Medicine (Baltimore) ; 98(8): e14255, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813129

RESUMO

OBJECTIVE: This systematic review and meta-analysis aims to compare surgical and endoscopic treatment for pancreatic pseudocyst (PP). METHODS: The researchers did a search in Medline, EMBASE, Scielo/Lilacs, and Cochrane electronic databases for studies comparing surgical and endoscopic drainage of PP s in adult patients. Then, the extracted data were used to perform a meta-analysis. The outcomes were therapeutic success, drainage-related adverse events, general adverse events, recurrence rate, cost, and time of hospitalization. RESULTS: There was no significant difference between treatment success rate (risk difference [RD] -0.09; 95% confidence interval [CI] [0.20,0.01]; P = .07), drainage-related adverse events (RD -0.02; 95% CI [-0.04,0.08]; P = .48), general adverse events (RD -0.05; 95% CI [-0.12, 0.02]; P = .13) and recurrence (RD: 0.02; 95% CI [-0.04,0.07]; P = .58) between surgical and endoscopic treatment.Regarding time of hospitalization, the endoscopic group had better results (RD: -4.23; 95% CI [-5.18, -3.29]; P < .00001). When it comes to treatment cost, the endoscopic arm also had better outcomes (RD: -4.68; 95% CI [-5.43,-3.94]; P < .00001). CONCLUSION: There is no significant difference between surgical and endoscopic treatment success rates, adverse events and recurrence for PP. However, time of hospitalization and treatment costs were lower in the endoscopic group.


Assuntos
Drenagem/métodos , Endoscopia/métodos , Pseudocisto Pancreático/cirurgia , Redução de Custos , Drenagem/efeitos adversos , Drenagem/economia , Endoscopia/efeitos adversos , Endoscopia/economia , Humanos , Tempo de Internação/economia , Complicações Pós-Operatórias , Recidiva , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(3): e14179, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653165

RESUMO

Although endoscopic ultrasound (EUS)-guided transmural drainage of pancreatic fluid collections with metal stents is generally preferred over plastic stents, its superiority among different types of metal stents has not yet been well studied. We conducted this study to compare clinical outcomes and complications of a novel self-expanding biflanged metal stent (BFMS) and a traditional-shaped tubular metal stent (TMS) in treating pancreatic pseudocyst (PPC).This was a retrospective analysis on consecutive patients with PPC underwent EUS-guided transmural drainage with either TMS or BFMS in a single tertiary center with expertise in management of complex biliary and pancreatic problems. The technical and functional success rate, reintervention, complications, and recurrence rate were evaluated.From September 2013 to January 2018, 125 patients (66.4% male, median age 47 years) underwent EUS-guided transmural drainage for PPC. Among them, 49 used TMS and 76 used BFMS. All patients met the inclusion criteria that cyst diameter was >6 cm or the distance between cyst and stomach wall was shorter than 1 cm. There was no difference in technical success (98% vs 97.4%, P = 1.0) or functional success rate (87.8% vs 92.1%, P = .54) using 2 types of metal stents. However, more procedure related complications occurred in TMS than in BFMS group. TMS group had a much higher migration rate than BFMS group (14.6% vs 0, P = .001), even though there was no significant difference in bleeding, infection, or death rate between 2 groups. With similar clinical outcomes, TMS group required more additional plastic stent placement than BFMS group for better drainage.TMS and BFMS placement can both be considered as methods of endoscopic transmural PPC drainage with equal efficacy, whereas BFMS could be preferred for fewer complications or less need of additional plastic stent placement.


Assuntos
Drenagem/métodos , Endossonografia/métodos , Pseudocisto Pancreático/cirurgia , Stents/efeitos adversos , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Estudos de Coortes , Drenagem/efeitos adversos , Desenho de Equipamento/efeitos adversos , Desenho de Equipamento/métodos , Falha de Equipamento/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Metais/efeitos adversos , Pessoa de Meia-Idade , Pâncreas/patologia , Pâncreas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
BMC Gastroenterol ; 18(1): 143, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30285639

RESUMO

BACKGROUND: Pancreatic pseudocyst (PPC) is a common complication of acute and chronic pancreatitis. To our knowledge no study has systematically reported the risk factors for the formation, intervention and recurrence of PPC. Therefore, the present study aimed to investigate the potential risk factors for PPC, with regards to its formation, intervention and recurrence. METHODS: A database containing 5106 pancreatitis patients was retrospectively analyzed. As a result, a total of 4379 eligible patients were identified and divided into 2 groups: PPC group (group A, n = 759) and non-PPC group (group B, n = 3620). The PPC group was subdivided into 2 groups: intervention PPC (group C, n = 347) and resolution PPC (group D, n = 412). The differences in surgical complication and recurrence rates were compared among 347 PPC patients receiving different interventions, including surgical, endoscopic and percutaneous drainages. Furthermore, group C was subdivided into 2 groups: recurrent PPC (group E, n = 34) and non-recurrent PPC (group F, n = 313). All possible risk factors for PPC formation, intervention and recurrence were determined by multivariate regression analysis. RESULTS: In this study, PPC was developed in 17.3% (759/4379) of pancreatitis patients. The significant risk factors for PPC formation included alcoholic pancreatitis (OR, 6.332; 95% CI, 2.164-11.628; p = 0.031), chronic pancreatitis (CP) (OR, 5.822; 95% CI, 1.921-10.723; p = 0.006) and infected pancreatic necrosis (OR, 4.253; 95% CI, 3.574-7.339; p = 0.021). Meanwhile, the significant risk factors of PPC patients who received intervention were alcoholic pancreatitis (OR, 7.634; 95% CI, 2.125-13.558; p = 0.016), size over 6 cm (OR, 8.834; 95% CI, 2.017-16.649; p = 0.002) and CP (OR, 4.782; 95% CI, 1.897-10.173; p = 0.038). In addition, the recurrence rate in PPC patients treated with percutaneous drainage was found to be the highest (16.3%) among the three intervention groups. Furthermore, percutaneous drainage was the only risk factor of PPC recurrence (OR, 7.812; 95% CI, 3.109-23.072; p = 0.013) identified from this retrospective cohort study. CONCLUSIONS: Alcoholic pancreatitis and CP are the main risk factors for PPC formation and intervention, but not PPC recurrence. A higher recurrence rate is found in PPC patients treated with percutaneous drainage, as compared to endoscopic and surgical interventions.


Assuntos
Pseudocisto Pancreático/etiologia , Pancreatite/complicações , Doença Aguda , Adulto , Idoso , China , Drenagem , Endoscopia do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Pseudocisto Pancreático/cirurgia , Pancreatite/patologia , Pancreatite Alcoólica/complicações , Pancreatite Crônica/complicações , Recidiva , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária
20.
Medicine (Baltimore) ; 97(35): e12051, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30170417

RESUMO

RATIONALE: Pancreatic fistula occurs as a result of pancreatic duct disruption during acute pancreatitis. An external or pancreatico-cutaneous fistula is defined as a leakage of pancreatic secretion through an abdominal wound or previously inserted drain. If the extravasated pancreatic juice is walled-off by the fibrous or granulation tissue, a pseudocyst is formed. Fistulization of the pancreatic pseudocyst into the different surrounding hollow viscera is reported. However, we present a patient with spontaneous cutaneous fistulization of the pancreatic pseudocyst into the lumbar region successfully treated conservatively. Such an extremely rare presentation is only reported twice and thus highly unexpected during the follow-up of patients after recovery from acute pancreatitis. PATIENT CONCERNS: The patient presented with 5-days intermittent fever and a tender, fluctuant, and erythematous swelling of the left lumbar paravertebral region with black necrotic skin spot on the top of it. DIAGNOSES: Abdominal computed tomography scan revealed retroperitoneal pseudocyst originating from the pancreatic body and tail and extending to the left flank. INTERVENTIONS: Incision of the swelling evacuated dark amylase rich fluid. Colostomy disc and bag were applied to collect further spontaneous outflow of pseudocyst content. OUTCOMES: Symptoms instantly resolved and the patient was managed conservatively with ambulatory follow-up of the daily volume of fistula discharge. Over the next 37 days daily fistula output gradually reduced to nil with the spontaneous closure of the external skin fistula opening. LESSONS: Frequent follow-ups of patients after severe acute pancreatitis are necessary for early detection and timely successful treatment of pancreatic pseudocysts with such unusual and rare presentation.


Assuntos
Fístula Pancreática/etiologia , Pseudocisto Pancreático/complicações , Idoso , Feminino , Humanos , Fístula Pancreática/cirurgia , Pseudocisto Pancreático/cirurgia , Tomografia Computadorizada por Raios X
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