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31.
超声内镜与CT对胰腺及壶腹部周围肿瘤的术前诊断价值 总被引:3,自引:0,他引:3
目的评估超声内镜(endoscopic ultrasonography,EUS)和CT对胰腺及壶腹部周围肿瘤的术前诊断价值。方法回顾性分析33例胰腺及壶腹部肿瘤患者术前EUS、CT资料,与手术探查及术后病理结果对照,从肿瘤大小、部位等角度筛选出影响EUS准确性的因素。结果 EUS在判断胰周脂肪浸润、胆管扩张、胰周脏器侵犯、血管侵犯等方面敏感性、特异性与CT的差异无统计学意义(P>0.05);EUS在胰管扩张及淋巴结转移方面的诊断价值优于CT(P=0.039和P=0.004); EUS判断胰周脂肪浸润和胰周脏器侵及的准确性与肿瘤大小有关(P=0.015和P=0.022),判断胰管扩张的准确性与肿瘤部位有关(P<0.001)。结论 EUS对胰腺及壶腹部周围肿瘤诊断的临床价值很高,结合CT检查有助于加强对患者术前评价的认识。 相似文献
32.
Ayman Zaki Azzam Ahmed Alqarni Tarek Mahmoud Amin 《Journal of the Egyptian National Cancer Institute》2018,30(2):77-79
Background
In spite of the advances in modern surgery, the outcome for patients suffering from pancreatic adenocarcinoma or periampullary adenocarcinoma is still bad. Recently, introperative radiotherapy (IORT) was introduced into the multimodality management approach to improve both tumor control and patient’ survival.Aim of work
To evaluate our initial experience in combined surgical resection and IORT, and to evaluate the feasibility of the application of IORT and its effect on morbidity, mortality and local recurrence.Patients and methods
This study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. Data were collected retrospectively. A total of six patients were included in the study, during the period from November 2013 to April 2017. All surgeries were done by the same surgeon.Results
The average age was 60?years (50–71). The patients were four males and two females. Five patients underwent complete surgical resection (pancreaticoduodenectomy) combined with IORT. One patient had locally advanced pancreatic tumor which was beyond surgical resection, for whom surgical bypass was done to overcome the biliary obstruction combined with IORT. Two patients died from disease progression and liver metastases. The remaining four patients survived without any evidence of local recurrence or metastases on follow-up.Conclusion
Application of IORT is safe and feasible. It can be applied without additional morbidities or mortalities. Although our results are satisfactory, yet they need to be applied on a larger number of patients with longer periods of follow-up to reach sound conclusions. 相似文献33.
34.
Most tumours in the head of the pancreas are adenocarcinomas of the exocrine pancreas. However, carcinomas located in the head of the pancreas may originate from the papilla of Vater, the distal part of the common bile duct, or the duodenum. Tumours of that region, within 2 cm of the greater duodenal papilla, have been usually described as periampullary neoplasms. Adenocarcinomas separated from the major duodenal papilla and located in the major pancreatic duct, common bile duct, or duodenum are identified as ductal pancreatic carcinomas, distal bile duct cholangiocarcinomas or duodenal carcinomas. Surgical treatment is the only chance for cure. Pancreatoduodenectomy is the procedure of choice. Regional lymphadenectomy and removal of at least 16 lymph nodes are necessary for optimal long-term outcomes. Indications for adjuvant chemotherapy remain controversial. This review evaluates the available data on the pathological assessment of periampullary tumours and discusses the controversies of therapeutic management, emphasising adjuvant treatment. 相似文献
35.
口服葡萄糖联合超声造影剂造影诊断壶腹部肿瘤及胆总管结石 总被引:2,自引:0,他引:2
目的探讨两种造影法结合对壶腹部肿瘤的超声诊断及临床应用价值。方法选择50例出现不同程度黄疸临床拟诊为壶腹部占位的患者,由二名医师分别采取口服葡萄糖造影法、静脉团注SonoVue造影剂造影法结合口服葡萄糖造影法检查,对比二名医师的超声诊断结果。结果单纯口服葡萄糖造影法诊断符合率为70.0%,两种造影法结合诊断符合率为89.8%。二者有统计学差异。结论在诊断壶腹部肿瘤中,葡萄糖超声造影法结合SonoVue造影剂造影法优于口服葡萄糖造影法的单独使用。 相似文献
36.
Hurtuk MG Devata S Brown KM Oshima K Aranha GV Pickleman J Shoup M 《American journal of surgery》2007,193(3):319-24; discussion 324-5
BACKGROUND: Long-term survival for duodenal adenocarcinoma is inconsistent in the literature, and the biology of duodenal adenocarcinoma is poorly understood. METHODS: One institution's experience with duodenal adenocarcinoma from 1984 to 2005 is reviewed. Clinicopathologic data were analyzed, and overall survival was estimated using Kaplan-Meier curves with log-rank test. RESULTS: Of the 52 patients, 35 (67%) underwent potentially curative surgery; 31 survived the postoperative period and were included in the analysis. Of these, the median survival was 34 months (range 6 to 186 months) compared with 13 months (range 1 to 24 months) for those not undergoing curative surgery (P < or = .001). Clinicopathologic factors favoring long-term survival were tumor size >3.5 cm (P < or = .001) and T-stage < or =4 (P = .014). CONCLUSIONS: Clinicopathologic factors important to survival in duodenal cancer are T4 tumor status and tumor size. Interestingly, larger tumors were less likely to be invasive, and patients with these tumors had improved survival. The biology of this cancer is poorly understood; therefore, aggressive resection for all duodenal adenocarcinomas is recommended for all patients medically fit to undergo resection. 相似文献
37.
Amit S Khithani David E Curtis Christos Galanopoulos Dhiresh Rohan Jeyarajah 《Obesity surgery》2009,19(6):802-805
Background The surgical management of periampullary lesions, status post-Roux-en-Y gastric bypass procedure (RYGBP), poses a challenge.
The strategy should focus on managing the gastric remnant.
Methods We propose a technique of managing the gastric remnant while doing a pancreaticoduodenectomy (PD) in a patient with a previous
RYGBP. From September 2005 to June 2008, two patients with a previous RYGBP underwent PD with a modified technique. The records
were reviewed with respect to preoperative, intraoperative, and postoperative data.
Results Both patients were operated for a carcinoma of the head of pancreas. Neither patient underwent a preoperative endoscopic ultrasound.
The operating times were 315 and 218 min. There was no mortality or morbidity seen. Neither patient was re-operated. The mean
length of stay was 6 days.
Conclusions The technique suggests an approach of managing the gastric remnant and preventing delayed gastric emptying which resulted
in a decreased length of hospital stay. 相似文献
38.
J.A. van der Zee C.H.J. van Eijck W.C.J. Hop H. van Dekken B.M. Dicheva A.L.B. Seynhaeve G.A. Koning A.M.M. Eggermont T.L.M. ten Hagen 《European journal of surgical oncology》2012
Background
Pancreatic cancer has a dismal prognosis. Attempts have been made to improve outcome by several 5-FU based adjuvant treatment regimens. However, the results are conflicting. There seems to be a continental divide with respect to the use of 5-FU based chemoradiotherapy (CRT). Furthermore, evidence has been presented showing a different response of pancreatic head and periampullary cancer to 5-FU based CRT. Expression of thymidylate synthase (TS) has been associated with improved outcome following 5-FU based adjuvant treatment in gastrointestinal cancer. This prompted us to determine the differential expression and prognostic value of TS in pancreatic head and periampullary cancer.Patients and methods
TS protein expression was studied by immunohistochemistry on original paraffin embedded tissue from 212 patients following microscopic radical resection (R0) of pancreatic head (n = 98) or periampullary cancer (n = 114). Expression was investigated for associations with recurrence free (RFS), cancer specific (CSS) and overall survival (OS), and conventional prognostic factors.Results
High cytosolic TS expression was present in 26% of pancreatic head tumours and 37% of periampullary tumours (p = .11). Furthermore, TS was an independent factor predicting favourable outcome following curative resection of pancreatic head cancer (p = .003, .001 and .001 for RFS, CSS and OS, respectively). In contrast, in periampullary cancer, TS was not associated with outcome (all p > .10).Conclusion
TS, was found to be poorly expressed in both pancreatic head and periampullary cancer and identified as an independent prognostic factor following curative resection of pancreatic head cancer. 相似文献39.
A 34-year-old woman presented with epigastric pain, nausea, and dyspepsia. Contrast-enhanced computerized tomography revealed a small mass in the duodenal wall mimicking a periampullary neoplasm and, at endoscopic examination, a periampullary submucosal tumor was suspected. The diagnosis of intramural duodenal diverticulum (IDD) was made by an x-ray barium meal that showed a finger-like sac filled with barium, the so-called “windsock sign.” IDD is a rare congenital abnormality caused by an anomalous process of recanalization of the primitive foregut. The intermittent filling and emptying of the IDD is responsible for epigastric pain, nausea, and vomiting. When IDD is symptomatic, surgical or endoscopic treatment is recommended. 相似文献
40.
Malik S Kaushik N Khalid A Bauer K Brody D Slivka A McGrath K 《Digestive diseases and sciences》2007,52(2):508-512
The finding of common bile duct (CBD) dilatation on abdominal imaging frequently results in additional testing. It has been
our impression that endoscopic ultrasound (EUS) evaluation of a dilated CBD is a low-yield examination in the setting of normal
serum liver enzymes. We therefore sought to evaluate the EUS yield in evaluating CBD dilatation in patients with normal as
compared to elevated serum liver enzymes. A retrospective review was performed to identify patients referred for EUS evaluation
of a dilated CBD in the absence of obvious pathology on prior imaging. Charts were reviewed for patient symptoms, presence
of elevated serum liver enzymes, imaging studies before EUS, and EUS findings. Exclusion criteria included clinical jaundice,
known biliary stricture, mass lesion or stone, and previously sphincterotomy and/or stent placement. Forty-seven patients
were identified: 32 with normal and 15 with elevated serum liver enzymes. There was no difference in mean CBD diameter between
these two groups (8.51 vs. 8.79 mm, p=0.854). Of the entire group, 15 patients had undergone prior magnetic resonance cholangiopancreatography (MRCP); an additional
7 patients had undergone prior endoscopic retrograde cholangiopancreatography (ERCP). EUS findings to explain CBD dilatation
were found more commonly in patients with elevated compared with normal serum liver enzymes (53% vs. 6%, p=0.001). Periampullary diverticula and choledocholithiasis were the most common findings; of 32 patients with normal serum
liver enzymes, one periampullary diverticulum and one CBD stone were found, respectively. The CBD stone had been missed by
prior MRCP examination. Of 15 patients with elevated serum liver enzymes, there were 3 cases of choledocholithiasis, 4 periampullary
diverticula, and 1 ampullary tumor. EUS should be the test of choice for further evaluation of CBD dilatation when index imaging
is normal. Although the EUS yield is low in cases of biliary dilatation in the setting of normal serum liver enzymes, its
preferential use would potentially avoid unnecessary MRCP and ERCP. 相似文献