RezumatIntroducere: Hemoragia postoperatorie reprezintă una dintre cele mai semnificative complicaţii după duodenopancreatectomia cefalică. Scop: Studiul prezentat în acest articol analizează cazurile de hemoragie intralumenală de la nivelul anastomozei gastrojejunale mecanice secundară duodenopancreatectomiei cefalice. Material şi metodă: În perioada ianuarie 2012 -ianuarie 2017, 84 de rezecţii cefalo-pancreatice consecutive au fost efectuate de aceeaşi echipă chirurgicală. Procedeul preferat de reconstrucţie a fost Whipple (76 pacienţi). Anastomoza gastrojejunală a fost efectuată mecanic la toţi pacienţii, folosindu-se staplerul Panther liniar tip GIA. Clasificarea propusă de ISGPS a fost folosită pentru evaluarea severităţii hemoragiei. Rezultate: Din cei 84 de pacienţi, un număr de 7 cazuri de hemoragie intralumenală (8,33 %) a fost observat, în medie în ziua 4 postoperator. Relaparotomia a fost inevitabila în două cazuri. Trei pacienţi din subgrupul cu hemoragie intralumenală postpancreatectomie au decedat. În lotul studiat nu au fost înregistrate cazuri de hemoragie de la nivelul anastomozelor pancreatico-jejunală sau hepatico-jejunală. Concluzii: Anastomoza mecanică poate ridica controverse, sângerarea severă necesitând relaparotomie de urgenţă şi fiind corelată cu rate mari de mortalitate. Hemoragia intralumenală postduodenopancreatectomie rămâne o complicaţie importantă, al cărei management depinde de multipli factori şi care poate avea potenţial devastator.Cuvinte cheie: hemoragie, duodenopancreatectomie, management, mortalitate AbstractBackground: One of the most significant complications following pancreaticoduodenectomy is represented by postoperative hemorrhage. Aim: This study undertook an analysis of the cases that presented intraluminal bleeding of mechanical gastrojejunal anastomosis following pancreatico-
Introduction. Gastric cancer remains among the top three digestive diseases with the highest mortality rates in the world. Treatment of gastric cancer is multidisciplinary, gastric resection being essential for the best result. Anemia is one of the most common comorbidities present in patients diagnosed with gastric cancer. Materials and Methods. This is a retrospective analytical study over a period of 6 years (2014-2019). It is based on 114 consecutive gastric resections for cancer performed by a single team using exclusively resection and reconstruction stapling methods. The study aims to investigate a correlation between the presence of preoperative anemia and the incidence of postoperative morbidity and mortality. Results. Preoperative anemia was found in 70% of patients, with about half of these patients presenting with mild anemia. Most postoperative complications were grade I and II according to the Clavien Dindo scale. Anemia was correlated with an increase in infectious complications, anastomotic leaks and secondary peritoneal abscesses, pancreatic complications after multivisceral resection and length of hospital stay. Conclusions. Preoperative anemia is a risk factor that exposes the cancer patient to an increased incidence of life-threatening postoperative complications. In addition, it also extends the length of hospital stay and costs. Therefore, special attention should be paid to the identification and reduction of anemia before extensive gastric surgery in order to obtain the best possible therapeutic result.
RezumatVã prezentãm cazul unui pacient în vârstã de 93 de ani cu ocluzie intestinalã datorate unei tumori de colon descendent, cu ascitã carcinomatoasã şi determinãri secundare hepatice şi pulmonare. Având în vedere riscurile asociate unui act chirurgical la un astfel de bolnav cât şi imposibilitatea efectuãrii unei intervenţii curative, a fost montat un stent colonic metalic auto-expandabil. Evoluţia post-intervenţie a fost favorabilã, pacientul fiind externat 48 de ore mai târziu. Cancerul de colon stâng se diagnosticheazã în fazã ocluzivã în 8 pânã la 26 % din cazuri (1). Acesta, necesitã de cele mai multe ori o rezolvare imediatã chirurgicalã datoritã potenţialului risc de deces. Procedurile chirurgicale efectuate în regim de urgenţã asociazã rate crescute de morbiditate şi mortalitate (2). Astfel au fost dezvoltate alte modalitãţi de rezolvare ale acestor urgenţe chirurgicale. Stenturile colonice au fost raportate prima datã în literaturã de cãtre Dohmoto (3). Iniţial, folosirea stenturilor a fost gandita ca şi metoda finala de paleaţie (4). Ulterior sau folosit ca punte catre chirurgia programata minim invaziva (5).Cuvinte cheie: tumora de colon descendent, ocluzie intestinalã, stent colonic metalic auto-expandabil AbstractWe present the case of a 93-year-old patient with intestinal occlusion due to a descending colon tumor, with carcinomatous ascites and secondary liver and lung determinations. Considering the risks associated with a surgical act in such a patient and the impossibility of performing a curative intervention, a self-expanding metallic colonic stent was mounted. The post-intervention evolution was favorable, the patient being discharged 48 hours later. Left colon cancer is diagnosed in the occlusive phase in 8 to 26% of cases (1). It often requires an immediate surgical resolution due to the potential risk of death. Emergency surgery involves increased rates of morbidity and mortality (2). Thus, other ways of resolving these surgical emergencies have been developed. Colonic stents were first reported in the literature by Dohmoto (3). Initially, the use of stents was as the final method of palletising (4). Later, they were used as a bridge to minimally invasive programmed surgery (5).
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