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Carlos Jiménez Romero Laura Alonso Murillo Paula Rioja Conde Alberto Marcacuzco Quinto Óscar Caso Maestro Anisa Nutu Isabel Pérez Moreiras Iago Justo Alonso 《Cirugía espa?ola》2021,99(6):440-449
IntroductionThere is controversy regarding the ideal pancreaticojejunostomy technique after pancreaticoduodenectomy. Many authors consider the external Wirsung stenting technique to be associated with a low incidence of fistula, morbidity and mortality. We analyse our experience with this technique.Patients and methodsA retrospective analysis of the morbidity and mortality of a series of 80 consecutive patients who had been treated surgically over a 6.5-year period for pancreatic head or periampullary tumors, performing pancreaticoduodenectomy and pancreaticojejunostomy with external Wirsung duct stenting.ResultsMean patient age was 68.3 ± 9 years, and the resectability rate was 78%. The texture of the pancreas was soft in 51.2% of patients and hard in 48.8%. Pylorus-preserving resection was performed in 43.8%. Adenocarcinoma was the most frequent tumor (68.8%), and R0 was confirmed in 70% of patients. Biochemical fistula was observed in 11.2%, pancreatic fistula grade B in 12.5% and C in 2.5%, whereas the abdominal reoperation rate was 10%. Median postoperative hospital stay was 16 days, and postoperative and 90-day mortality was 2.5%. Delayed gastric emptying was observed in 36.3% of patients, de novo diabetes in 12.5%, and exocrine insufficiency in 3. Patient survival rates after 1, 3 and 5 years were 80.2, 53.6 and 19.2%, respectively.ConclusionsAlthough our low rates of postoperative complications and mortality using external Wirsung duct stenting coincides with other more numerous recent series, it is necessary to perform a comparative analysis with other techniques, including more cases, to choose the best reconstruction technique after pancreaticoduodenectomy. 相似文献
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Lipoma of the uterus is a rare condition usually developing in postmenopausal women. Clinical symptoms and physical signs are similar to those found in leiomyomas. The histiogenesis of these lesions is still unclear. We report a case of a pure intramural lipoma of the uterus illustrating characteristic morphological and histological findings. Additional immunohistochemical studies underline the lipomatous but not leiomyomatous nature of the tumor. 相似文献
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Óscar Núñez Martínez Isabel Marquina Ibáñez Elena Ruiz Bravo-Burguillos Alfonso Encinas Sotillos José Carlos Erdozaín Sosa 《Gastroenterologia y hepatologia》2013
We describe the case of a female patient with a previous diagnosis of primary biliary cirrhosis (PBC) and chronic hepatitis B in inactive phase who developed increased transaminase levels with no evidence of hepatitis B virus reactivation while receiving ursodeoxycholic acid treatment. A liver biopsy showed changes compatible with overlapping autoimmune hepatitis (AIH). Budesonide treatment achieved normalization of transaminase levels. We provide a review of PBC and AIH overlap syndrome and discuss the particular features of this case that led us to this diagnosis, as well as the treatment provided. 相似文献
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