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Značaj izbora resekcionih procedura u lečenju karcinoma Vaterove papile u Tis, T1 T2 stadijumu

The importance of choice in the treatment of resection procedures of carcinoma of the papilla vater in Tis,T1 and T2 stage

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2015
Disertacija652.pdf (2.372Mb)
Slavenko_Ostojic_Izvestaj_Komisije_MDF.pdf (47.23Kb)
Author
Ostojić, Slavenko R.
Mentor
Knežević, Srbislav
Committee members
Peško, Predrag
Bilanović, Dragoljub
Jurišić, Vladimir
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Abstract
Uvod.Ampula Vateri je kompleksna funkcionalna struktura koja se formira zajedničkim ušćem pankreasnog i bilijarnog završnog voda. U ovoj regiji javljaju se različiti benigni i maligni tumori, a najčešći su adenokarcinomi. U serijama autopsija incidenca je u rasponu od 0,028% do 0,040% što čini 6 do 8% svih periampularnih tumora i manje od 3% svih digestivnih neoplazmi. Specifično biološko ponašanje, koje uslovljava izraženiji lokalni rast a manje izraženo limfno širenje, daje im značajno bolju prognozu u odnosu na karcinome pankreasa i distalnog holedohusa. Ovakva biološka svojstva, uz ranije otkrivanje tumora, omogućavaju stopu resektabilnosti i do 90%. Aktuelni prikazi navode ukupne stope petogodišnjeg preživljavanja od 30 do 67 %. Iako je DP standardna procedura kod pacijenata sa malignim tumorima papile Vateri, ona je još uvek povezana sa značajno visokim morbiditetom i mortalitetom. Uprkos stalnom razvoju savremene hirurške tehnike i danas su stope komplikacija nakon DP od 35 do 4...5 %. Osnovni nedostatak LR je visoka stopa recidiva. Različite studije prikazuju stopu recidiva nakon LR od 25 do 45 % u intervalu od 12 do 36 meseci. Zato je neophodna precizna preoperativna procena i detaljna analiza svih prognostičkih faktora kako bi se sprovela optimalna hirurška metoda lečenja. Cilj U ovoj studiji želimo da ispitamo prognostičke faktore u lečenju ampularnih karcinoma u ranim stadijumima, i damo doprinos u izboru optimalne hirurške procedure. Pacijenti i metode Sprovedena studija obuhvatila je 109 pacijentata operisanih u periodu od 01.01.1999. godine do 31.12. 2008. godine na Klinici za digestivnu hirurgiju- Prva hirurška klinika KCS. U studiju su uključeni pacijenti kod kojih su patohistološki dokazani adenokarcinomi porekla ampule Vateri, bez udaljenih metastaza, isključivo tretirani resekcionim procedurama. LR ili DP je sprovedena kod pacijenata gde je endoskopski utvrđen tumor promera do 20mm i koji na osnovu ENDO US pregleda nije infiltrisao tkivo pankreasa (pT1/T2)...

INTRODUCTION The ampulla of Vater is a complex functional structure formed by the union of the pancreatic duct and the common bile duct. Various benign and malignant tumors can occur in this region, the most common are adenocarcinomas. They may arise from pancreatic, biliary epithelium or epithelium of common channel. In the autopsy series, incidence is in the range of 0.028% to 0.040% which is 6 to 8% of all periampullar tumors and less than 3% of the digestive system neoplasms. Specific biological behavior, which causes stronger local growth and less pronounced lymphatic dissemination, gives them a significantly better prognosis than carcinomas of the pancreas and distal common bile duct. Such biological properties, with earlier detection of tumors, enabling resectability rate and up to 90%. The current state displays the total five-year survival rates of 30-67%. Although the DP standard procedure in patients with malignant tumors of the ampulla of Vater, it is still associated with ...a significantly higher morbidity and mortality. Despite the constant development of modern surgical techniques and today the rates of complications after DP 35-45%. The main disadvantage of LR is a high rate of recurrence. Different studies show the rate of recurrence after LR from 25 to 45%, in the range from 12 to 36 months. Objectives Ampula of Vater’s, with its strategic location and its remarkable predisposition to the development tovarious malignant tumors, makes this region very challenging for surgery. In this study we want to examine the prognostic factors in the treatment of carcinoma of the ampulla of Vater in early stages, and contribute to the choice of optimal surgical procedure...

Faculty:
University of Belgrade, School of Medicine
Date:
16-07-2015
Keywords:
papilla Vateri / ampulla of Vater / karcinom / Duodenopankreatektomija / lokalna resekcija / carcinom / duodenopancreatectomy / local resection
[ Google Scholar ]
URI
http://nardus.mpn.gov.rs/handle/123456789/5013
http://eteze.bg.ac.rs/application/showtheses?thesesId=2659
https://fedorabg.bg.ac.rs/fedora/get/o:10756/bdef:Content/download
http://vbs.rs/scripts/cobiss?command=DISPLAY&base=70036&RID=47572495

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