Revista de chirurgie, oncologie, radiologie, o.r.l., oftalmologie, stomatologie. Chirurgie最新文献

The authors analyse, retrospectively, the experience of the Clinic of Surgery III. Cluj-Napoca, in the indications and surgical methods for reintroducing the duodenum in the digestive circuit in the syndromes of the stomach operated for benign affections. Between 1974 and 1987, the duodenum was reinstated in the digestive circuit in 37 patients, operated previously for duodenal ulcer (32 cases), gastric ulcer (3 cases), syndrome of mesenteric clip (2 cases). The primary surgeries that led to the exclusions of the duodenum from the digestive tract were gastroenteroanastomosis in 4 cases, and the gastric resections with gastrojejunal anastomoses of the Billroth II type in 33 cases (Reichel-Polya in 28 cases. Hoffmeister-Finsterer in 3 cases, Roux in 2 cases). The reintroduction of the duodenum in the digestive circuit, based on clinical and paraclinical criteria, was indicated in anastomotic ulcer (in 17 cases), gastric ulcer following gastroenteroanastomoses (in 1 case), syndrome of afferent loop (in 11 cases), persistent "dumping" syndrome (in 8 cases), association of plurideficiency syndrome (in 54% of the cases). The way of reconstructing the duodenum was adapted to the type and correctness of the primary operation, to the dominant clinical syndrome and associated lesions to the biological background and possibilities offered by the intrasurgical situation: reconversion by direct gastroduodenal anastomosis after degastrogastrectomy was used in 31 cases, the indirect methods by transposition of the afferent loop (Soupault--Bucaille) in 4 cases, or of the afferent one (Henley)--1 case gastrography and segmentary enterectomy in 1 case. The postoperative complications appeared in 35.1% of case, with a mortality of 8.1%. The therapeutic results were good and very good in 89.3% of the cases. The authors insist on the importance of maintaining the duodenum in the digestive circuit, during the primary surgeries for preventing some severe postsurgical syndromes.

An observation is presented, of a female patient aged 62 years with a large abdominal tumour. Clinical and para-clinical examinations could not establish the organic origin of the formation. Surgery disclosed a giant tumour developed in a gastric diverticulum situated under the cardia. The patient had suffered for a long time with gastric symptoms and her antecedents included upper digestive haemorrhage which was attributed to gastric ulcer according to radiological examination. In retrospect it was established that the disturbances were determined by a gastric diverticulum, complicated by haemorrhage and which later on had become malignant. In spite of its extraordinarily large size the tumour was removed by total gastric resection, in an attempt to treat radically the cancer.

The paper reports on a method of closing the duodenal stump, with maintenance of the ulcerous crater by sectioning the duodenum at the level of penetration. At closure, the ventral duodenum wall is sutured at the arterio-superior circumference of the sclerous ring of the penetration with nonabsorbable suture. The in-pocketing is achieved by one or two bursae. The thickness of the pancreatic capsule offers enough stuff for such a closure by the sclerous-inflammatory process. The ulcerous crater is cured in several weeks by concentric epithelialization. Healings without major complications were obtained. The tardy results were good; in the case of repeated surgeries for other affections, the duodenal stump appeared supple, without pathological modifications. The method is good when, owing to the advanced stage of the disease, a more conservative intervention cannot be made, and after the resection, a duodenal stump at a deeply situated, penetrating ulcer has to be closed.

Intraoperative control of the main bile duct is compulsory during surgeries for acute cholecystitis. The surgical cholangiography is essential within the investigation means and methods. Starting from their own experience and the literature data, the authors establish the indicators for intraoperative cholangiography in acute cholecystitis with reference to the specific methodology.

The paper reports on a case of congenital cystic dilatation of the main bile duct in a female patient, 3 years old, with a clinical evolution of the disease from 2 years old. The anamnestic data corroborated with iv cholangiography and hepatobile echography specifies the clinical diagnosis that was intraoperatively confirmed. The case was solved by resection of the cystic bag, followed by hepatojejunostomy on the loop ablated "en Y" à la Roux.

The paper reports on the tardy results following conservative surgeries performed in 15 cases of transitional supravesical carcinomas (8 pyelocaliceal and 7 ureteral). In cases the surgery was necessary (patients with tumours developed on the conservative operation was made deliberately. a unique kidney, in uremia, infiltrative, highly anaplastic), and in 8 patients. Two years after the surgery, 80% of the patients were alive, after 3 years, 66%, after 4 years, 47%, and after 5 years, 33%. The conservative surgeries in the transitional pyelocaliceal carcinomas have deliberate indications for small, unique lesions, T0-T1 N0 M0 G1, technically easily accessible. For the ureteral tumours, the conservative surgeries may be extended to T3 lesions, but with N0 M0, observing the oncologic limits of exeresis in length, that permit the reconstruction of the urinary tract by a rational surgery.

The present paper reports on an observations of mechanical jaundice by a rare cystic tumour of the hepatic pedicle. Although the diagnosis of obstructive jaundice is sufficient as an operatory indication, a series of imaging methods were used for establishing the situs and the nature of the obstruction.

The authors present the experience of the clinic on a group of 26 patients admitted and operated in the Clinic of Surgery, the Colţea Hospital, during 1984-1987. The paper reports, in general, on the indications for biliary derivations and then specifies the morphopathological situations met intrasurgically. Their correlation with the indices of postsurgical morbidity (12.5%), postsurgical mortality (0.8%) and length of postsurgical survival (8.2 months) shows their efficiency.