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81.
Summary
Background. The median survival rate of patients with nonresectable periampullary cancer is not much longer than 6–12 mo. Nevertheless,
in most incurable patients palliative treatment is necessary, which has to focus on jaundice, pain, and prevention of gastric
outlet obstruction. Up to now, debate remains about how to best provide palliative treatment.
Method. The results of controlled clinical trials and large multicenter studies comparing operative biliary bypass and biliary stent
insertion in nonresectable pancreatic tumors are discussed in this review.
Results. The initial success rate in palliation of jaundice is similar after endoscopic stent insertion and biliary bypass operation
(range: 90–95%). Morbidity (range: 11–36% vs 26–40%) and 30-d mortality (range: 8–20% vs 15–31%) is higher after bypass operation,
whereas stent insertion is accompanied by a higher rate of hospital readmission and reintervention because of recurrent jaundice
(range: 28–43%) and a later gastric outlet obstruction (up to 17%).
Conclusion. Endoscopic biliary stent insertion should be performed if there is evidence of hepatic, peritoneal, or pulmonary
metastasis formation, in old patients with a high comorbidity, or if the patient has had several laparotomies. Combined biliary
and gastric operative bypass procedures should be performed in nonresectable periampullary carcinomas with accompanying gastric
outlet obstruction, in the absence of metastatic spread, if a locally advanced tumor is the only reason for incurability,
if exploratory laparotomy demonstrates an unresectable tumor, or if endoscopic treatment fails. 相似文献
82.
������Χ��Һ͵��������Ĺ�ϵ̽�� 总被引:1,自引:0,他引:1
目的 探讨壶腹周围憩室(PAD)与胆道疾病的关系以及内镜诊断PAD铁应用价值。方法 选择284例经内镜逆行胰胆管造影(ERCP)检查确诊合并有PAD的病人(PAD组)与同期经ERCP检查无PAD的病人(对照组)作为对照研究。胆道疾病根据病史,体征,结合实验室检查,B超,CT以及ERCP等确诊。结果 PAD组合并胆囊结石,胆总管结石,胆总管下端括约肌功能不良病人明显多于对照组,尤以胆总管结石增多为著(P<0.01)。结论 PAD与胆道疾病,尤其是胆管结石存在着密切关系,PAD可能是胆道疾病发生或复发的一个重要因素,对胆道疾病病人行ERCP检查以了解PAD与胆道的关系,从而选择合适的治疗方案,对提高胆道疾病的治愈率有重要意义。 相似文献
83.
十二指肠乳头旁憩室综合征影像学诊断价值的研究 总被引:12,自引:1,他引:11
目的 研究十二指肠乳头旁憩室 (PAD)综合征的影像学表现。对PAD进行分型和临床分级 ,提出合理的影像检查流程 ,以提高放射医师及临床医师对PAD综合征的影像诊断水平。资料与方法 回顾性分析经内镜证实的 117例PAD患者的临床及影像资料 ,分析PAD与胆胰管末端的位置关系。结果 117例中显示 119个PAD ,其中乳头上型 71个 ,乳头下型 17个 ;乳头开口于憩室内 (憩室内型 ) 10个 ,乳头开口于憩室边缘 (憩室缘型 ) 2 1个。以憩室内型、边缘型和乳头上型易引起胆胰系统症状。合并肝外胆管扩张者 (直径 >1.0cm) 77例 (占 6 5 .8% ) ,相应PAD直径明显大于胆总管不扩张者 (P <0 .0 1)。结论 ERCP结合PAD造影及MRCP都是显示PAD及其与胆总管下段解剖关系的有效的影像检查手段 ,是诊断PAD综合征的理想方法 ,值得临床推广应用 相似文献
84.
Yan-Yan Lin Yu-Dong Wang Ping Yue Xian-Zhuo Zhang Joseph W Leung Pan-Pan Jiao Man Yang Hai-Ping Wang Bing Bai Ying Liu Jin-Duo Zhang Hong-Bo Chen Wen-Bo Meng Xun Li 《World journal of gastroenterology : WJG》2021,27(4):358-370
BACKGROUNDA previous study showed that irrigation with 100 mL saline reduced residual common bile duct (CBD) stones, which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIMTo determine whether saline irrigation can improve CBD clearance after lithotripsy.METHODSThis prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large (> 1.2 cm) CBD stones. After occlusion cholangiography confirmed CBD stone clearance, peroral cholangioscopy (POC) was performed to determine clearance scores based on the number of residual stones. The amounts of residual stones spotted via POC were graded on a 5-point scale (score 1, worst; score 5, best). Scores were documented after only stone removal (control) and after irrigation with 50 mL and 100 mL saline, respectively. The stone composition was analyzed using infrared spectroscopy.RESULTSBetween October 2018 and January 2020, 47 patients had CBD clearance scores of 2.4 ± 1.1 without saline irrigation, 3.5 ± 0.7 with 50 mL irrigation, and 4.6 ± 0.6 with 100 mL irrigation (P < 0.001). Multivariate analysis showed that CBD diameter > 15 mm [odds ratio (OR) = 0.08, 95% confidence interval (CI): 0.01-0.49; P = 0.007] and periampullary diverticula (PAD) (OR = 6.51, 95%CI: 1.08-39.21; P = 0.041) were independent risk factors for residual stones. Bilirubin pigment stones constituted the main residual stones found in patients with PAD (P = 0.004).CONCLUSIONIrrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy, especially in patients with PAD and/or a dilated (> 15 mm) CBD. Pigment residual stones are soft and commonly found in patients with PAD. Additional saline irrigation may be required to remove retained stones. 相似文献
85.
Periampullary carcinoma is a rare malignant tumor of digestive system,and its accurate diagnosis is still difficult.From January 2007 to July 2012,12 patients with periampullary carcinoma had been admi... 相似文献
86.
十二指肠乳头旁憩室与胆胰疾病的关系 总被引:4,自引:0,他引:4
十二指肠乳头旁憩室因其特殊的解剖位置,其临床意义日渐受到重视。现就其病因、分类,与胆胰系统疾病的关系及内在机制进行探讨,并简述其临床表现及诊治。 相似文献
87.
目的探讨壶腹旁憩室综合征(Periampullary diverticula syndrome,PADS)的CT表现、诊断价值及分型。方法回顾性分析经内镜或手术证实的22例PADS患者的CT表现,所有患者均行螺旋CT扫描,并提出本病的CT分型。结果22例患者中,共22个憩室。表现为十二指肠降段内侧囊状含气影者13例,含气液平面7例,表现为液性囊状影2例。合并胆管结石11例(其中4例合并胆囊结石),胆囊结石5例,仅表现为肝外胆管轻度扩张4例,胆源性胰腺炎1例,胆管细胞癌1例。结论CT能清楚显示憩室及其胆胰系统并发症,是诊断PADS有效的影像检查方法。 相似文献
88.
《Pancreatology》2020,20(7):1534-1539
BackgroundPancreaticoduodenectomy (PD) plays an integral part in the management of pancreatic, periampullary and duodenal cancers, along with a few other pathologies of this region. Despite advances in surgery PD continues to have significant morbidity and noteworthy mortality. The aim of this study is to provide an in-depth report on the patient characteristics, indications and the outcomes of PD) in a tertiary cancer hospital in Pakistan.Materials and methodsThe study population included patients who underwent PD between January 1, 2014 and march 31, 2019, at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC) in Pakistan. The data was retrospectively analyzed from the Hospital Information System (HIS), which is a prospectively maintained patient electronic database of SKMCH&RC. Patient characteristics, procedural details and post-operative outcomes according to internationally accepted definitions were reported.ResultsA total of 161 patients underwent PD at our hospital in the study period at a median age of 53 years, ranging from 19 to 78 years. 62% of the patients were males while 37% were females. Jaundice was the most common presenting symptom (64.6%), followed by abdominal pain (26.7%). PD with pancreaticogastrostomy was performed in 110 patients (68.3%), while pancreaticojejunostomy was performed in the rest of the cohort. Surgical site infection (SSI) was observed in 64 patients (40%). The incidence of Pancreatic Fistula grade C based on the International Study Group on Pancreatic Fistula (ISGPF) definition was 7.45% (n = 12). The 30 days mortality rate was 3.1%. Median survival of the cohort was 21 ±1.13 months and disease-free survival was 16±2.62 months.ConclusionPD can be performed with acceptable morbidity and mortality in a resource constrained country, as long as it is undertaken in a high-volume center. This is in keeping with data published from other well-reputed international centers. 相似文献
89.
90.
Neuroendocrine tumors of the ampulla of Vater are extremely rare cause of extrahepatic biliary obstruction and further rarer cause of duodenal obstruction, and only a few cases have been reported in the literature. Herein we report a case of ampullary neuroendocrine tumor in a 75-year-old woman who presented with biliary obstruction and gastric outlet obstruction palliated with metal biliary and duodenal stenting with relief of jaundice and vomiting at 1 month of follow-up. 相似文献