RESUMEN
Early complications, which have had occurred in 154 patients, operated for neuroendocrine pancreatic tumors (NET), were analyzed. Operative interventions on pancreatic gland were performed in 138 (87.1%) patients, including the resectional interventions --in 82 (59.4%), and the organ-preserving--in 56 (40.6%). The external pancreatic fistula formation have had constituted the most frequent complication. In accordance to data of univariate and multivariate analysis done, investigating impact of prognostic factors of the operations performed on the postoperative surgical complications occurrence, the most significant factor in organ-preserving operations is the distance from the tumor to pancreatic duct, and in the resectional operations--low density of pancreatic tissue. Application of the elaborated diagnostic-treatment algorithm have permitted to reduce trustworthy a general rate of complications in the patients, operated on for the pancreatic NET, from 36.8 to 15%, in the resectional operative interventions--from 30 to 11.3%, and in the organ-preserving--from 44.4 to 21%.
Asunto(s)
Tumores Neuroendocrinos/cirugía , Pancreatectomía/métodos , Fístula Pancreática/patología , Neoplasias Pancreáticas/cirugía , Complicaciones Posoperatorias/patología , Adulto , Manejo de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Tumores Neuroendocrinos/patología , Páncreas/patología , Páncreas/cirugía , Fístula Pancreática/etiología , Neoplasias Pancreáticas/patología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Experience of surgical treatment of 6 patients for synchronous and 9 metachronous metastases of nonfunctioning neuroendocrine pancreas tumors (NEPT) in the liver was presented. In 14 (93.3%) patients made R0 resection. In 5 patients due synchronous metastases the combination intervention on pancreas and liver was performed, in one limited to the removal of the primary tumor. Regarding synchronous metastasis in 8 patients resection of the liver, in 1 multivisceral resection was performed. NEPT G2 stage diagnosed in 13 (86.7%) patients, neuroendocrine carcinoma G3 in 2 (13.3%). Indications for surgical treatment of metastatic NEPT is resectable forms of the disease and the appearance of metastases is not earlier than 6 months after the first operation.
Asunto(s)
Procedimientos Quirúrgicos Endocrinos/métodos , Hepatectomía/métodos , Neoplasias Hepáticas/cirugía , Tumores Neuroendocrinos/cirugía , Neoplasias Pancreáticas/cirugía , Humanos , Hígado/patología , Hígado/cirugía , Neoplasias Hepáticas/secundario , Tumores Neuroendocrinos/patología , Páncreas/patología , Páncreas/cirugía , Neoplasias Pancreáticas/patología , Reoperación/métodos , Reoperación/estadística & datos numéricos , Factores de TiempoRESUMEN
In 2009-2013 yrs in 7 patients, suffering insulin-producing pancreatic tumors, the ASVS-test was conducted, the result of which was compared with data of standard methods of investigation, including abdominal ultrasound, computer tomography and magnetic resonance imaging. The insuloma enucleation was performed in 3 patients, distal subtotal pancreatectomy with splenectomy--in 1 and the completed total pancreatectomy--in 1. The ASVS-test conduction is indicated in patients with diagnosed hyperinsulinism while impossibility to perform a topic diagnosis of insulinoma, in accordance to data of other noninvasive methods of diagnosis.
Asunto(s)
Gluconato de Calcio , Hiperinsulinismo/diagnóstico , Insulinoma/diagnóstico , Páncreas/cirugía , Neoplasias Pancreáticas/diagnóstico , Adulto , Anciano , Gluconato de Calcio/administración & dosificación , Femenino , Humanos , Hiperinsulinismo/complicaciones , Hiperinsulinismo/patología , Hiperinsulinismo/cirugía , Infusiones Intraarteriales , Insulina/sangre , Insulinoma/complicaciones , Insulinoma/patología , Insulinoma/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Páncreas/patología , Pancreatectomía , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Esplenectomía , Tomografía Computarizada por Rayos XRESUMEN
The results of laparoscopic treatment were analyzed in 9 patients, suffering pancreatic insulinoma, in the clinic in 2008-2012 yrs. Tumoral enucleation was performed in 6 patients, distal pancreatic resection--in 3. In 1 (11.1%) patient postoperative external pancreatic fistula have developed. All the patients are alive. Laparoscopic treatment of the patients, suffering insulinoma is effective and secure.
Asunto(s)
Hiperinsulinismo/etiología , Insulina/metabolismo , Insulinoma/cirugía , Laparoscopía/métodos , Neoplasias Pancreáticas/cirugía , Adulto , Endosonografía , Femenino , Humanos , Hiperinsulinismo/metabolismo , Hiperinsulinismo/cirugía , Secreción de Insulina , Insulinoma/complicaciones , Insulinoma/diagnóstico , Insulinoma/metabolismo , Imagen por Resonancia Magnética , Masculino , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/metabolismo , Tomografía Computarizada Espiral , Resultado del TratamientoRESUMEN
The results of diagnosis and treatment in 2004-2012 yrs period of 79 patients, suffering nonfunctioning neuroendocrine pancreatic tumors (NNPT), were analyzed. Effective diagnostic tactic while preoperative predilection on the NNPT presence for the diagnosis verification was proposed, permitting to determine the optimal method of surgical treatment, to introduce organpreserving and laparoscopic interventions, to widen indications for surgery for the NNPT extended forms.
Asunto(s)
Biomarcadores de Tumor/genética , Antígeno Ki-67/genética , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirugía , Cromogranina A/genética , Femenino , Humanos , Masculino , Mitosis , Clasificación del Tumor , Pancreatectomía , Neoplasias Pancreáticas/clasificación , Neoplasias Pancreáticas/diagnóstico por imagen , Radiografía , Estudios RetrospectivosRESUMEN
Results of treatment of 25 patients with combined injuries of bile ducts and the common hepatic artery in performing cholecystectomy were studied. In 19 (73.1%) patients the injuries were noted during open and in 7 (26.9%) patients during laparoscopic cholecystectomy. The patients needed multimodal strategy of treatment with reference to the time when the diagnosis was made and to the characteristics of clinical course. Positive results of treatment were obtained in 84.6% of cases, lethality made up 3.9%.
Asunto(s)
Conductos Biliares/lesiones , Colecistectomía/efectos adversos , Arteria Hepática/lesiones , Complicaciones Intraoperatorias , Adulto , Anciano , Colecistectomía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The results of treatment of 56 patients, in whom in 1984-2010 yrs, while performing cholecystectomy, a biliary duct injury have occurred, were analyzed, including 26 (main group)--with combined injury of biliary ducts and brunches of common hepatic artery, 30 (control group)--with isolated complete biliary ducts. High hepaticojejunostomy have constituted the main method of operation in a control group. In the main group in 2 patients there were attempts made to restore the arterial blood flow with subsequent performance of reconstructive intervention on biliary ducts. In 16 (61.5%) patients, due to adequate collateral blood supply presence, the bile outflow was restored using hepaticojejunostomy formation, and in 8 (30.8%)--hepatic resection of various volume was needed, because of hepatic abscesses formation. The results of treatment of patients in these groups have differed not essentially, while applying differentiated approach (positive results were achieved in 93.3 and 84.6% of patients, accordingly). So, in patients with combined injury of biliary ducts and branches of hepatic artery, while performance of cholecystectomy, it is necessary to apply multimodal tactics of treatment, taking into account the peculiarities of clinical course.
Asunto(s)
Conductos Biliares/lesiones , Colecistectomía/efectos adversos , Arteria Hepática/lesiones , Traumatismo Múltiple/cirugía , Adulto , Anciano , Conductos Biliares/cirugía , Colecistectomía Laparoscópica/efectos adversos , Femenino , Hepatectomía/métodos , Arteria Hepática/cirugía , Humanos , Yeyunostomía/métodos , Circulación Hepática , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/etiología , Traumatismo Múltiple/mortalidad , Resultado del TratamientoAsunto(s)
Neoplasias Pancreáticas/cirugía , Vipoma/cirugía , Humanos , Laparoscopía/métodos , UcraniaRESUMEN
Outcomes of pancreatoduodenectomies performed during the period from 1996 to 2008 in 110 patients with malignant diseases of pancreaticoduodenal zone and complicated forms of chronic pancreatitis with predominant changes of the pancreatic head were presented. Age of patients ranged from 17 to 73 years, on average (52.0 +/- 9.97) years. Primary aspects of pancreatoduodenal complex dissection and technique of reconstructive stage of the procedure are given. Use of transplantational technologies allowed significant decrease in complications total rate from 30.3 to 18.2%, and pancreatic anastomosis insufficiency one--from 24.2 to 5.2%. Total duration of the procedure decreased from (510.7 +/- 66.12) to (352.9 +/- 50.05) min, intraoperative blood loss--from (860.6 +/- 167.59) to (480.4 +/- 163.61) ml and postoperative hospital stay - from (30.12 +/- 24.32) to (18.2 +/- 9.98) days. After the operation all the patients are alive.
Asunto(s)
Neoplasias del Sistema Biliar/cirugía , Neoplasias Duodenales/cirugía , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/métodos , Pancreatitis Crónica/cirugía , Adolescente , Adulto , Anciano , Anastomosis Quirúrgica/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreaticoduodenectomía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Técnicas de Sutura , Resultado del Tratamiento , Adulto JovenAsunto(s)
Anastomosis en-Y de Roux/métodos , Laparoscopía/métodos , Seudoquiste Pancreático/cirugía , Pancreatoyeyunostomía/métodos , Adulto , Endoscopía del Sistema Digestivo , Femenino , Humanos , Seudoquiste Pancreático/diagnóstico por imagen , Seudoquiste Pancreático/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ucrania , UltrasonografíaRESUMEN
The experience of pancreaticoduodenal resection performance in 110 patients in 1996-2008 yrs was presented. The comparative analysis of the operations results was conducted between 49 patients, in whom standard methods were applied (I group), and 61 patients, who were operated on, using transplantation technologies (II group). Transplantation technologies application have permitted to reduce essentially the postoperative pancreatitis occurrence--from 30.6 to 9.8% and pancreatic fistula formation--from 18.3 to 4.9%. After the operation all the patients are alive.
Asunto(s)
Trasplante de Páncreas/métodos , Fístula Pancreática/prevención & control , Pancreaticoduodenectomía/métodos , Pancreatoyeyunostomía/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fístula Pancreática/epidemiología , Fístula Pancreática/etiología , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Pancreatoyeyunostomía/efectos adversos , Pancreatitis Crónica/cirugía , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenAsunto(s)
Enfermedades de los Conductos Biliares/cirugía , Conductos Biliares/lesiones , Conductos Biliares/cirugía , Colecistectomía Laparoscópica/efectos adversos , Anastomosis Quirúrgica , Enfermedades de los Conductos Biliares/etiología , Enfermedades de los Conductos Biliares/patología , Conductos Biliares/patología , Colecistectomía/efectos adversos , Constricción Patológica/etiología , Constricción Patológica/cirugía , Humanos , Reoperación , Resultado del TratamientoRESUMEN
The results of observation and treatment of 137 patients with choledocholithiasis complicated acute cholangitis are presented. The estimated scale APACHE II is adopted for the state severity of patients with choledocholithiasis and cholangitis sigh determination are examined. With multivariant correlative-regression analysis the most informative factors are determined, its grade estimation are carrying out. Optimal treatment tactics depended from state severity is definited. It permits to improve the treatment results owing to decrease of postoperative complications frequency, duration of patients therapy in hospital.
Asunto(s)
Colangitis/cirugía , Coledocolitiasis/cirugía , APACHE , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Colangitis/complicaciones , Colangitis/diagnóstico , Coledocolitiasis/complicaciones , Coledocolitiasis/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Resultado del TratamientoRESUMEN
There were analyzed the results of treatment of 65 patients, in whom unintended injury of biliary ducts occurred while performance of laparoscopic cholecystectomy in 1993-2005 yrs, including 9 patients, operated in the clinic and 56--in other hospitals. For correction of intraoperatively revealed injuries of biliary ducts there were formated bilio-biliary anastomosis, cholecystoenteroanastomosis--in 1, hepaticojejunoanastomosis end to side (in 2), "high" hepaticojejunoanastomosis (in 5). If the injuries were revealed more lately, application of two-staged treatment was needed in majority of cases. Miniinvasive intervention, as the definitive method of correction, was applied in 11 patients with small injury of biliary ducts, insufficiency of the gallbladder stump sutures due to residual choledocholithiasis, and also as an additive manipulation in the treatment of complete injury of biliary ducts--in 23. Postoperative mortality was 1.5%, and in late period--1.5%.
Asunto(s)
Conductos Biliares/lesiones , Conductos Biliares/cirugía , Colecistectomía Laparoscópica/métodos , Complicaciones Intraoperatorias , Procedimientos de Cirugía Plástica/métodos , Adulto , Anciano , Anastomosis Quirúrgica , Femenino , Humanos , Yeyuno/cirugía , Hígado/cirugía , Masculino , Persona de Mediana EdadRESUMEN
Results of treatment of 47 patients with cholangiogenic hepatic abscess were analyzed. Clinical, laboratory and special methods of investigation were applied for diagnosis. The authors consider ultrasound investigation (USI), computer tomography and the abscess puncture under the USI control with subsequent cytological and bacterial control the decisive methods in diagnosis of hepatic abscess. In complex of treatment of patients miniinvasive technologies were applied--the abscess puncture, its cavity drainage under USI control transcutaneus transhepatic cholangiostomy, endoscopic papillosphincterotomy with lithotripsy and nasobiliary drainage, according to indications. Efficacy of the abscess cavity sanation, using miramistinum and decasan, was proved. In general therapy the directed transport of medicines was applied.