Assuntos
Anastomose Cirúrgica/métodos , Jejunostomia/métodos , Jejuno/cirurgia , Fígado/cirurgia , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Humanos , Icterícia/diagnóstico , Icterícia/patologia , Laparoscopia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagem , RadiografiaRESUMO
Efficacy of endoultrasonography application in conditions of moderate risk for choledocholithiasis occurrence was estimated in 33 patients, in whom ultrasonography (US) did not reveal the common biliary duct concrements. Sensitivity, specificity, accuracy, positive and negative prognostic values of the method in suspicion for choledocholithiasis presence while US performance have had constituted 78.6, 94.7, 82.0, 98.2 and 54.5%; vs for endoultrasonography--100, 94.4, 97, 93.8 and 100% accordingly. Endoultrasonography constitutes a safe and highly effective method of investigation in patients in suspicion of the biliary ducts disease presence, it permits to reveal choledocholithiasis in significant part of patients after ineffective US. This diagnostic option permits to reduce the need for performance of diagnostic endoscopic retrograde cholangiopancreaticography.
Assuntos
Coledocolitíase/diagnóstico por imagem , Endossonografia/métodos , Bilirrubina/sangue , Coledocolitíase/sangue , Coledocolitíase/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
While doing pancreatic gland resection for cancer the lymphadenectomy is performed in volume, recommended on a congress of pancreatologists in Castelfranco-Venetto (standard, radical, extended radical) or in manuals of Japanese investigators (D1, D2). These classifications have got several shortages: terminological inaccuracies, lack of information, concerning the borders of the vegetative neural plexuses dissection etc. The authors have proposed a modified terminology and classification of lymphadenectomy, in accordance to which four types of lymphadenectomy are delineated: D1p, D2p, D3p, corresponding to lymphatic collectors N1, N2, N3, as well as D4p--complete excision of lymphatic nodes in all three regions while total pancreatectomy performance. The symbols 9n-dex/sin and 14n-dex/sin were recommended to name the lymph nodes of the ninth and fourteenth groups, indicating availability of the nervous plexuses dissection performance of right/left hemicircumference of vessels only. The retroperitoneal dissection borders and criterions for the lymphadenectomy volume choice were proposed.