ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb07002.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb07003.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb07004.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb07005.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb07006.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Upper abdominal symptoms after side‐to‐side choledochoduodenostomy (CDDY) may be attributed to stagnant bite, food and calculi pooling in the distal bile duct ‘sump’ with resultant biliary or pancreatic duct obstruction and sepsis. Endoscopic sphincterotomy (ES) provides a means of draining this sump. The aim of this study was to assess outcome following endoscopic retrograde choledochopancreatography (ERCP) and ES in patients with post‐CDDY symptoms. Eight such patients (M: F = 1:7) underwent ERCP between September 1981 and March 1987. Their median age was 60 years (range: 37–72 years) and the median period since CDDY was 11 years (range: 1–28 years). The median follow‐up after ERCP was 18 months (range: 14–94 months). Presenting symptoms comprised postprandial (one) or intermittent (seven) abdominal pain, cholangitis (three), pancreatitis (one) and jaundice (one). ERCP revealed bile duct abnormalities in four, consisting of filling defects alone (two), anastomotic narrowing with filling defects (one) and sclerosing cholangitis. ES was performed in seven, of whom three (all with filling defects at ERCP) remain asymptomatic and three are significantly improved. One had recurrent pancreatitis for which a sphincteroplasty and pancreatic duct septectomy was performed. ES was not performed in one because of technical difficulties (there being no subsequent improvement). It is concluded that, in patients with post‐CDDY biliary symptoms, endoscopic sphincterotomy relieves the symptoms by either producing drainage of the sump at the distal bile duct, or dividing a dysfunctionin

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb07007.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The clinical course of 143 patients with gallstone pancreatitis is reviewed. Thirty‐one patients (22%) had three or more positive prognostic factors on admission and 24 (77%) of these had a complicated course. Thirteen patients died, giving an overall mortality rate of 9%.Patients were divided into three groups on the basis of performance and liming of surgery. In group I (n= 56), surgery was undertaken during the first admission with acute pancreatitis; eight of these patients had a complicated course and three died. In group 2 (n= 40), biliary surgery was deferred to a subsequent admission: none of these patients died but 10 experienced further attacks of pancreatitis white awaiting reoperation. Group 3 patients (n= 47) did not undergo surgery; nine patients were diagnosed as having gallstone pancreatitis for the first lime at autopsy, five refused operation, seven were lost to follow‐up, six were deal! with by endoscopic sphincterotomy, and in 20 cases surgery was not considered appropriate because of general debility or advanced age.Despite the zero mortality rate in group 2, it is advocated that biliary surgery be carried out during the index hospital admission. Endoscopic sphincterotomy can now be considered as an alternative to cholecystectomy and duct clearance in the elderly and unfit, and may be used as a preliminary manoeuvre when severe acute pancreatitis fails to settle promptly on conservative managem

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb07008.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

A personal series of 50 major pancreatic resections has been reviewed to assess some issues of the operative decision in relation to a patient's expected outcome. An accurate histological diagnosis was not always available at the time of operation. At operation. 25 were thought to have invasive carcinoma of the pancreas and 14 to have ampullary carcinoma but the final histology demonstrated these diagnoses as accurate in 21 and 12 cases, respectively. The remaining 17 patients had a variety of histological findings which necessitated resection. Thirty‐eight per cent of patients had major postoperative morbidity resulting in a median postoperative slay of 21 days after a Whipple procedure and 28 days after total pancreatectomy. The perioperative mortality rate was 6%. The median survival was 12 months for patients with invasive pancreatic carcinoma, 37 months for patients with ampullary carcinoma and 19 months for the whole group; the 5‐year survival results were 13%, 40% and 25%. respectively. It is concluded that surgical resection of small pancreatic tumours is justified because some patients gain long‐term survival with an acceptable risk of perioperative mortality and because the exact diagnosis may not be established at the lime of su

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb07009.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Endocystectomy combined with omentoplasty has become an accepted technique in the treatment of hydatid disease of the liver. Its attractiveness lies in its simplicity, its low frequency of postoperative biliary fistula, and the lack of specific complications related to the omentoplasty itself. However, radiological appearances after this procedure may be confusing. Two patients with upper abdominal pain are described in whom the radiological appearances of a previous omentoplasty could not be distinguished from a recurrent hydatid cyst.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb07010.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

A retrospective analysis of 453 patients with carcinoma of the oesophagus and gastric cardia was carried out in order to identify the incidence, operative findings, and outcome of patients who underwent laparotomy only without a definitive procedure. Of 343 patients who underwent surgery. 81% had their tumours resected and 15% had a bypass procedure. The remaining 14 patients (4%) had an exploratory laparotomy alone. The incidence of performing a laparotomy only was 1.5% for patients with carcinoma of the thoracic oesophagus but was 14% for patients with tumour of the gastric cardia (P<0.001). The reasons for exploration alone in these 14 patients were advanced local disease (12). bilobar liver metastases (seven), extensive abdominal lymph node metastases (seven), peritoneal seedlings (six) and malignant ascites (four). All except one patient had more than one feature which led to the decision of exploration only. As the overall incidence of exploratory laparotomy was low, it would not be appropriate for all patients to undergo exhaustive and expensive investigations. Surgical exploration continues to be the only reliable method to determine the actual extent of disease and whether a definitive procedure is possible. However, patients with cancer of the cardia with clinical features of advanced disease might warrant additional evaluations as the incidence of exploratory laparotomy alone with minimal prior investigation is relatively high.

ISSN:0004-8682    

DOI:10.1111/j.1445-2197.1989.tb07011.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY