277. Die Pankreatogastrostomie beim Papillen-Carcinom

Abstract

Zusammenfassung. Von 1960Von -1980 wurden an der Chirurgischen Klinik der UniversitM Mfinchen 39 Patienten wegen maligner hormonaktiver Tumoren endokriner Organe operiert: 14 Patienten hatten ein medull/ires Schilddriisen-Carcinom, 5 ein Epithelk6rperchen-Carcinom, 7 ein malignes Insulinom, I ein malignes Gastrinom und 12 Patienten ein Nebennierencarcinom (Cushing-Syndrom n = 10, AGS n = 1, Ph/iochromocytom n = 1). Die Besonderheiten dieser malignen Tumoren liegen in der Tumoreigenschaft selbst, Hormonsekretion, chirurgischer und spezieller medikament6ser Therapie.Summary. Anastomosis of A. carotis and of N. ischiadicus of the rat were carried out by a microsurgical technique to compare the nonabsorbable suture material Ethilon and the absorbable Vicryl, both 0.2 metric. There were no suture insufficiencies with either sutured nerves or vessels. After 70-84 days the Vicryl sutures were completely absorbed. In nerve sutures Vicryl proved to be particularly superior to Ethilon, as the displacement of axons in the area of granuloma decreased with progressing absorption of the suture and thus also resulted in less renewed degeneration of the axons.

Pancreatogastrostomy as Reconstruction for Pancreatoduodenectomy: Review

“…With this increase in numbers have come more precise definitions of [11] 1952 2 0 0 Sames [12] 1952 1 0 0 Wells [13] 1952 3 0 1 Nanson [14] 1954 1 0 0 Walker [15] 1955 1 0 1 Silverstone [16] 1956 1 0 0 Millbourne [17] 1958 7 0 1 Pataky [18] 1959 1 0 0 Bracey [19] 1961 1 1 0 Hurwitz [20] 1967 6 0 0 Strauch [21] 1972 1 0 0 Mackie [23] 1977 28 1 2 Eggert [24] 1982 11 0 1 Telford [25] 1984 9 0 0 Flautner [26] 1985 25 0 0 Wynn [27] 1985 1 0 0 Kapur [28] 1986 31 0 2 Icard [29] 1988 17 0 0 Reding [30] 1988 49 0 0 Total 199 2 9 leakage (particularly PCF) and more comprehensive lists of complications. The incidence of leakage (PCF) for this period rose to 4.7% (29/614) (including the results of four groups with rates of 13-14%).…”

“…For the time period 1991-1997, the number of cases of PG described in this review more than doubled (Table 2). With this increase in numbers have come more precise definitions of [11] 1952 2 0 0 Sames [12] 1952 1 0 0 Wells [13] 1952 3 0 1 Nanson [14] 1954 1 0 0 Walker [15] 1955 1 0 1 Silverstone [16] 1956 1 0 0 Millbourne [17] 1958 7 0 1 Pataky [18] 1959 1 0 0 Bracey [19] 1961 1 1 0 Hurwitz [20] 1967 6 0 0 Strauch [21] 1972 1 0 0 Mackie [23] 1977 28 1 2 Eggert [24] 1982 11 0 1 Telford [25] 1984 9 0 0 Flautner [26] 1985 25 0 0 Wynn [27] 1985 1 0 0 Kapur [28] 1986 31 0 2 Icard [29] 1988 17 0 0 Reding [30] 1988 49 0 0 Total 199 2 9…”

“…The question of long-term pancreatic insufficiency has been raised by several authors [17,24,39,41]. The short life-span of most survivors of PD for pancreatic cancer makes the study group relatively small in most institutions.…”

“…Of the five patients surviving 2 to 4 years, there were two whose intragastric pancreatic enzymes fell to little or none. These authors did not perform mucosa-to-mucosa anastomosis [24]. Flautner et al (1985), in a series of 25 PGs described one patient with "bilious" drainage, one with "serous" drainage, and one hemorrhage from the pancreatic surface at 6 weeks after operation that was reoperated.…”

“…Postmortem examination indicated the pancreatic anastomosis to be intact [23]. Eggert and Teichmann (1982) described no PG leaks in 11 patients but had one case of pancreatitis that eventually led to splenic vein bleeding and reoperation with completion pancreatectomy, splenectomy, and closure of gastrotomy, all on the 45th day. A second patient died from portal vein thrombosis on the 13th day after operation.…”