RESUMEN
UNLABELLED: Cholangiocarcinomas have been often met in daily practice. Biliar tract neoplasmas are the most important group in adenomas and papillomas. There is the medical and social problem with cancer patients because they call doctor too late when cancer changes reach a high level and only paliative procedures are recommended. In the most cases the prothesis implanted by ERCP and surgical digestive bypasses are applied. AIM OF THE STUDY: was to evaluate some therapeutic methods in paliative treatment applied in patients with biliary tract cancer. MATERIAL AND METHODS: From 01.2003 to 12.2007 (5 years experience) in 4 departments of general surgery and departments of digestive tract diseases the medical treatment of 430 patients with biliary tract cancer was analyzed. All patients were divided into 3 groups: G1--prosthesis by ERCP; G2--percutaneously, transhepatic drainage of biliary tract; G3--surgical digestive bypass. RESULTS: G1 techniques were applied in 75 patients, G2 in 14 cases and G3 in 74 cases. In the last group of patients the following procedures have been performed: triple bypass (TB) in 45 cases (62%), choledochoduodenostomy (ChD) in 7 cases (9%), gastroenterostomy (GE) in 10 patients (13%) and laparotomy with Kehr drainage in 12 patients (16%). The number of complications in G1 group was observed in 31%, in G2--42%, and in G3--63%. 30 days death rate was 14% in G1, 28% in G2 and 18% in G3. Over 12 months survival rate was in G1, 3 months in G2 and 15 months in G3. Differences are statistically sagnificant (p < 0.05). CONCLUSIONS: From all applied methods of paliative treatment the best results were noticed in surgical digestive bypass and implantation of prosthesis by ERCP. After surgical treatment survival rate was higher, but the number of complications was higher in relation to another methods.
Asunto(s)
Neoplasias del Sistema Biliar/terapia , Procedimientos Quirúrgicos del Sistema Biliar/métodos , Colangiocarcinoma/terapia , Cuidados Paliativos/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Sistema Biliar/mortalidad , Colangiocarcinoma/mortalidad , Colangiopancreatografia Retrógrada Endoscópica , Coledocostomía , Drenaje , Femenino , Estudios de Seguimiento , Gastroenterostomía , Humanos , Laparotomía , Masculino , Persona de Mediana Edad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
UNLABELLED: Cholecystolithiasis is a serious problem of contemporary medicine. The most common operations in gastroenterologic surgery are gallbladder operations because of calculosis. The most common complications after gallbladder operations are bleeding from site of the gallbladder and bile leakage, but the most serious complication is a bile ducts injury. THE AIM: The assessment of complications quantity after cholecystectomy due to cholecystolithiasis. Observation of operation's profile changes during last 10 years. MATERIAL AND METHODS: From January 1997 to December 2006 in Department of Surgery in MSWiA Hospital in Lodz and in Departments of Surgery in Leczyca and Piotrkow Trybunalski 6845 cholecystectomy were made including 4215 laparoscopic operations. RESULTS: Complications were observed in 12.6% patients. Suppuration of the wound and postoperative hernias occurred more often after classic operations, in the other hand blood and bile leakage from site of the gallbladder were more often observed after laparoscopic operations. The ratio of complications after classic operations to laparoscopic operations was about 15.4% to 6.1%. Conversion was made in 11.5%. During first 5 years conversion was made in 17.6%, in the next 5 years average number of complications drop to 5.4%. CONCLUSIONS: Nowadays laparoscopic cholecystectomy is a standard procedure in symptomatic and asymptomatic cholecystolithiasis. It's a safe operation, burden with a little amount of complications made during acute as well as chronic course of disease. Laparoscopic technique requires a lot of care and in the event of operator's doubts should be replace with classic operation.