RESUMEN
The modification of the reconstructive stage of gastropancreatoduodenal resection aims to increase the security of the pancreatojejunoanastomosis by minimizing the impact of such aggressive substances as bile and pancreatic juice. The modification represents the isolated pancreatojejunoanastomosis on the Roux-en-Y intestinal loop and gastro- and hepaticojejunoanastomoses on the second intestinal loop, separated with the use of the stub. Thus, the method allows the separate passage of pancreatic juice, bile and gastric contents, excluding their impact on other anastomoses. The described modification was performed in 6 patients. There were no cases of the anastomotic insufficiency. The mean hospital stay was 10,5 days. Thus. The method proved to be effective and safe, providing good initial results.
Asunto(s)
Anastomosis en-Y de Roux , Fuga Anastomótica , Reflujo Biliar , Duodeno/cirugía , Páncreas/cirugía , Neoplasias Pancreáticas/cirugía , Complicaciones Posoperatorias , Estómago/cirugía , Adulto , Anastomosis en-Y de Roux/efectos adversos , Anastomosis en-Y de Roux/métodos , Fuga Anastomótica/etiología , Fuga Anastomótica/prevención & control , Reflujo Biliar/etiología , Reflujo Biliar/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Páncreas/patología , Neoplasias Pancreáticas/patología , Pancreatoyeyunostomía/efectos adversos , Pancreatoyeyunostomía/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Resultado del TratamientoAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma no Hodgkin/radioterapia , Antibióticos Antineoplásicos/administración & dosificación , Antibióticos Antineoplásicos/uso terapéutico , Antineoplásicos Alquilantes/administración & dosificación , Antineoplásicos Alquilantes/uso terapéutico , Antineoplásicos Hormonales/administración & dosificación , Antineoplásicos Hormonales/uso terapéutico , Antineoplásicos Fitogénicos/administración & dosificación , Antineoplásicos Fitogénicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Clorambucilo/administración & dosificación , Clorambucilo/uso terapéutico , Terapia Combinada , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Doxorrubicina/administración & dosificación , Doxorrubicina/uso terapéutico , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Teleterapia por Radioisótopo , Dosificación Radioterapéutica , Factores de Tiempo , Vincristina/administración & dosificación , Vincristina/uso terapéuticoRESUMEN
Preoperative intraarterial chemotherapy was administered to 69 patients with gastric cancer. In 34 patients the tumor was localized in the antral portion, in 27 in the body of the stomach involving the proximal portion, and in 8 total involvement of the stomach was revealed. Left gastric artery was catheterized in 42 patients, right gastric-omental artery in 27. An original method of "loop" catheterization of celiac artery branches was used permitting a selective probing of gastric arteries proper. For prolonged intraarterial chemotherapy of gastric cancer adriablastin or farmorubicin were used in single dose 30 mg/M2, 5-fluorouracil in dose 500 mg/M2; the cytostatics were infused in 2-3 sessions. Immediate results of intraarterial chemotherapy were assessed by angiography and other instrumental methods of investigation, as well as intraoperatively and by morphometric analysis. In 62.4% of patients significant or total destruction of the tumor was attained, the volumic share of a viable tumor component being 0 to 2.1%. Altogether 95% of patients survived the follow-up of 2 to 30 months.