90 results on '"Gorin Ds"'
Search Results
2. [Endoscopic treatment of duodenal duplication cyst]
- Author
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Kriger Ag, L A Marinova, A. R. Kaldarov, Gorin Ds, and V I Panteleev
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Adult ,medicine.medical_specialty ,Nausea ,Duodenum ,Asymptomatic ,Epigastric pain ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Cyst ,Duodenoscopy ,Duodenal Diseases ,integumentary system ,business.industry ,General Medicine ,medicine.disease ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Vomiting ,030211 gastroenterology & hepatology ,Female ,medicine.symptom ,business ,Digestive System Abnormalities ,Rare disease - Abstract
Duodenal duplication cyst (DDC) is a rare form of intestinal malformation (2-12% of all gastrointestinal duplications). There are many difficulties in diagnosis and management of DDC. We present a case of successful endoscopic transluminal treatment of DDC in a 30-year-old female. She complained of epigastric pain, nausea and vomiting, weight loss of 5 kg over the past 3 months. Laparoscopic cholecystectomy for gallstone disease was performed 18 months prior to admission. Examination revealed a cyst 52×60?35 mm in descending part of duodenum. There was a calculus inside the cyst. Transluminal endoscopic cyst fenestration was performed. Histological examination confirmed DDC. According to control duodenoscopy data, cyst was collapsed. The patient remains asymptomatic three months after surgery. DDC is a rare disease of gastrointestinal tract, which should be differentiated first with choledochocele Todani type III and intraluminal duodenal diverticulum. Endoscopic treatment may be an adequate alternative to traditional interventions in some cases.Дупликационная киста (ДК) двенадцатиперстной кишки (ДПК) является редким вариантом кишечной мальформации (2—12% всех ДК желудочной-кишечного тракта). Диагностика и определение тактики лечения ДК ДПК существенно затруднена. Представляем случай эндоскопического лечения ДК ДПК у взрослой женщины с клинической картиной дуоденальной непроходимости.Клиническое наблюдение. Женщина 30 лет обратилась с жалобами на дискомфорт в эпигастральной области, тошноту и рвоту после еды, похудение на 5 кг за последние 3 мес. Из анамнеза известно, что за 18 мес до обращения пациентке выполнили лапароскопическую холецистэктомию по поводу желчнокаменной болезни. В ходе обследования выявлено кистозное образование нисходящей части ДПК размером 52×60×35 мм, в полости которого обнаружены конкремент и суживающее ее просвет образование. Выполнена операция — эндоскопическая фенестрация кистозной полости в просвет ДПК с гистологическим исследованием. Патологоанатомическая картина соответствовала ДК ДПК. При контрольной дуоденоскопии отмечена киста в спавшемся состоянии. Через 3 мес после операции жалобы у пациентки отсутствуют.ДК ДПК представляет собой редкое заболевание желудочно-кишечного тракта, дифференцировать которое в первую очередь следует с кистой холедоха 3-го типа по Todani и внутрипросветным дивертикулом ДПК. Эндоскопическое лечение, выполненное нами в данном наблюдении, в некоторых случаях может являться адекватной альтернативной традиционным вмешательствам.
- Published
- 2021
3. [Combination of intraductal papillary mucinous neoplasm with other cystic pancreatic tumors]
- Author
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Kriger Ag, Gorin Ds, V I Panteleev, and A. R. Kaldarov
- Subjects
Pathology ,medicine.medical_specialty ,Pancreatic Intraductal Neoplasms ,Malignancy ,03 medical and health sciences ,0302 clinical medicine ,Cystadenoma, Mucinous ,medicine ,Neoplasm ,Humans ,Pancreas ,Mucinous cystadenoma ,Cystic Tumor ,Intraductal papillary mucinous neoplasm ,business.industry ,General Medicine ,medicine.disease ,Solid pseudopapillary tumor ,Pancreatic Neoplasms ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business ,Neoplasms, Cystic, Mucinous, and Serous ,Carcinoma, Pancreatic Ductal - Abstract
Cystic tumors of the pancreas are uncommon entities. Synchronic occurrence of intraductal papillary mucinous neoplasm (IPMN) and other pancreatic tumors is extremely rare. Two patients with this diagnosis are reported in the manuscript. Cystic tumors of the pancreas can rarely occur in various combinations while malignancy potential of each neoplasm may be different. Surgery depends on localization and type of each tumor and must be determined individually.Кистозные опухоли поджелудочной железы (ПЖ) являются редкими образованиями. Синхронное поражение ПЖ внутрипротоковой папиллярной муцинозной опухолью (ВПМО) с другими опухолями встречается крайне редко. Представлено 2 клинических наблюдения.Кистозные опухоли ПЖ в редких случаях могут возникать в самых различных сочетаниям, при этом потенциал злокачественности каждой из них может быть различным. Объем операции зависит от локализации, типа и характера каждой опухоли и должен определяться индивидуально.
- Published
- 2021
4. [Predicting of pancreatic fistula after pancreatoduodenectomy]
- Author
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Yu.S. Galchina, Kriger Ag, Berelavichus Sv, Gorin Ds, A. R. Kaldarov, A V Glotov, D. V. Kalinin, and G V Galkin
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Logistic regression ,Extracorporeal ,Pancreaticoduodenectomy ,03 medical and health sciences ,Pancreatic Fistula ,0302 clinical medicine ,Pancreatectomy ,Risk Factors ,medicine ,Humans ,Pancreas ,Histological examination ,business.industry ,General Medicine ,medicine.disease ,Prognosis ,Surgery ,Pancreatic Neoplasms ,medicine.anatomical_structure ,Bile Duct Neoplasms ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Pancreatitis ,030211 gastroenterology & hepatology ,business ,Abdominal surgery - Abstract
Identifying the opportunity of objective prognosis of pancreatic fistula emergence after pancreatoduodenectomy.In the department of abdominal surgery in 2016-2019, 177 pancreatoduodenectomies for pancreatobiliary tumors were performed. 4 risk factors were identified: type of tumor, preoperative CT with an accumulation coefficient in the pancreas of more than 1, soft pancreas, the number of functioning acinar structures identified during intraoperative histological examination. Statistical data processing and predictive modeling were performed using a binary logistic regression model.Clinically significant pancreatic fistula was developed in 47 (26,6%) patients. Risk indicators for the occurrence of pancreatic fistula depending on the presence or absence of risk factors were obtained. Groups of patients were identified that require various preventive and therapeutic measures aimed to treat postoperative pancreatitis and its consequences.Predicting the pancreatic fistula emergence allows to take timely preventive and therapeutic measures, both minimal and aggressive (early extracorporeal detoxification, pancreatectomy), which may lead to complications. Well-reasoned pancreatectomy and extracorporeal detoxification is a surgeon's defense in an insured case or legal conflict.Определение возможности прогнозирования возникновения панкреатического свища (ПС) после панкреатодуоденальной резекции (ПДР).В отделении абдоминальной хирургии НМИЦ хирургии им. А.В. Вишневского в 2016—2019 гг. выполнено 177 ПДР по поводу опухолей панкреатодуоденальной зоны. Факторами риска возникновения ПС считали 4 параметра: характер исходного заболевания, предоперационную КТ поджелудочной железы (ПЖ) с коэффициентом накопления более 1, мягкую структуру ПЖ, определяемую клинически во время операции, и количество функционирующих ацинарных структур, выявленных при интраоперационном гистологическом исследовании. Статистическую обработку полученных данных и предиктивное моделирование проводили с использованием бинарной логистической регрессионной модели.Клинически значимый ПС после операции развился у 47 (26,6%) больных. Получены показатели риска возникновения ПС в зависимости от наличия или отсутствия факторов риска. Выделены группы больных с вероятностью возникновения ПС: менее 30, 30—60 и более 60%, требующие проведения профилактических и лечебных мер, направленных на купирование послеоперационного панкреатита и его последствий.Прогнозирование вероятности возникновения ПС позволяет своевременно предпринять превентивные и лечебные меры — как минимальные, так и агрессивные (ранняя экстракорпоральная детоксикация, панкреатэктомия), несущие в себе угрозу осложнений; аргументированное определение показаний к последним является залогом защиты хирурга при возникновении страхового случая или юридического конфликта.
- Published
- 2020
5. [Contrast-enhanced computed tomography in evaluation of pancreatic stump volume in pancreaticoduodenectomy]
- Author
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E.V. Kondratyev, G V Galkin, Kriger Ag, G.G. Karmazanovsky, Yu.S. Galchina, and Gorin Ds
- Subjects
Pancreatic parenchyma ,medicine.medical_specialty ,medicine.medical_treatment ,Contrast Media ,Computed tomography ,030230 surgery ,Pancreaticoduodenectomy ,03 medical and health sciences ,Pancreatic Fistula ,0302 clinical medicine ,Risk Factors ,Medicine ,Pancreatic structure ,Humans ,Pancreas ,Retrospective Studies ,Pancreatic duct ,medicine.diagnostic_test ,business.industry ,Pancreatic Ducts ,General Medicine ,Organ Size ,medicine.disease ,medicine.anatomical_structure ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Radiology ,business ,Tomography, X-Ray Computed ,Pancreatic stump - Abstract
To analyze the role of contrast-enhanced computed tomography in evaluation of pancreatic stump volume for prediction of significant pancreatic fistula.A retrospective analysis enrolled 99 patients. Patients were divided into 2 groups depending on the course of postoperative period and development of clinically significant pancreatic fistula. The first group included 24 patients (25%) with clinically significant postoperative pancreatic fistula. The second group included 75 patients (75%) without postoperative complications. Pancreatic structure, pancreatic parenchyma thickness (mm), pancreatic duct diameter (mm) and volume of pancreatic stump (cmThe risk of postoperative pancreatic fistula is 10 times higher in case of soft structure of the pancreas, 1,7 times higher in decrease of pancreatic duct diameter, 9,3 times higher in increased volume of residual pancreatic parenchyma, 8.6 times higher in increase of pancreatic parenchyma thickness.Contrast-enhanced computed tomography is valuable for preoperative evaluation of the volume of residual pancreatic parenchyma and identification of patients with high risk of postoperative pancreatic fistula.Определение возможностей КТ с контрастным усилением в оценке объема культи поджелудочной железы (ПЖ) для прогнозирования развития клинически значимого панкреатического свища (ПС).Ретроспективно отобрано 99 пациентов. Пациенты разделены на 2 группы в соответствии с течением послеоперационного периода и развитием клинически значимого ПС. В 1-ю группу вошли 24 (25%) больных с развитием клинически значимого ПС, во 2-ю — 75 (75%) больных с неосложненным течением послеоперационного периода.По данным дооперационной КТ с контрастным усилением оценивали структуру дистального отдела железы, толщину железы, диаметр панкреатического протока, объем культи ПЖ.Риск развития ПС возрастает при «мягкой» структуре железыКТ с контрастным усилением позволяет оценить объемы культи ПЖ на дооперационном этапе для выделения группы повышенного риска развития ПС.
- Published
- 2020
6. [Duodenopancreatectomy for pancreatic tumors - pros and cons]
- Author
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A. R. Kaldarov, Kriger Ag, M V Dvukhzhilov, A V Glotov, Gorin Ds, D. V. Kalinin, Berelavichus Sv, V Yu Zektser, G.G. Karmazanovsky, and V I Panteleev
- Subjects
medicine.medical_specialty ,business.industry ,Locally advanced ,Acinar cell carcinoma ,General Medicine ,030230 surgery ,Neuroendocrine tumors ,medicine.disease ,Pancreaticoduodenectomy ,Pancreatic Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Renal cell carcinoma ,030220 oncology & carcinogenesis ,medicine ,Humans ,In patient ,Radiology ,Mucinous Tumor ,Pancreas ,Distal pancreatectomy ,business ,Digestive System Surgical Procedures - Abstract
To optimize surgical treatment of multiple and advanced pancreatic tumors.There were 852 patients with various pancreatic tumors for the period 2011 - September 2019. Duodenopancreatectomy (DPE) was performed in 18 patients. Locally advanced ductal adenocarcinoma was diagnosed in 10 patients, acinar cell carcinoma - in 1 patient, multiple neuroendocrine tumors - in 4 cases, intraductal papillary mucinous tumor - in 2 patients, multiple metastases of renal cell carcinoma - in 1 patient. This procedure was avoided in 9 patients who underwent alternative operations: pancreatoduodenectomy (PDE) with pancreatic body resection for intraductal papillary mucinous tumor - 5 cases, two-stage (2) and one-stage (1) distal pancreatectomy and PDE for multiple neuroendocrine tumors - 2 patients, simultaneous pancreatic head resection and distal pancreatectomy for multiple metastases of renal cell carcinoma - 1 patient.Postoperative complications occurred in 14 patients after DPE (77.8%) and in 5 patients after alternative operations (55.5%). Alternative procedures in patients with neuroendocrine tumors, intraductal papillary mucinous tumors and metastases of renal cell carcinoma ensured radical surgical treatment. These patients did not need for insulin replacement therapy and enzyme drugs.Strict adherence to oncological canons and differentiated approach in patients with multiple neuroendocrine tumors, metastases of renal cell carcinoma and intraductal papillary mucinous tumors are essential to avoid DPE in some cases in favor of alternative operations.Цель исследования - оптимизация хирургического лечения при множественных и распространенных опухолях поджелудочной железы (ПЖ). Материал и методы. Оперированы 852 больных различными опухолями ПЖ за период 2011 г. - сентябрь 2019 г. Дуоденопанкреатэктомия (ДПЭ) произведена 18 больным, из них у 10 была местнораспространенная протоковая аденокарцинома ПЖ, у 1 - ацинарно-клеточная карцинома, у 4 - множественные нейроэндокринные опухоли (НЭО), у 2 - внутрипротоковая папиллярная муцинозная опухоль (ВПМО), у 1 - множественные метастазы почечно-клеточного рака. Избежать этой операции удалось у 9 больных, которым выполнили альтернативные операции: панкреатодуоденальную резекцию (ПДР) с резекцией тела ПЖ при ВПМО у 5, двухэтапные (у 2) и одномоментная (у 1), дистальные резекции ПЖ и ПДР при множественных НЭО у 2, одномоментную резекцию головки и дистальную резекцию ПЖ при множественных метастазах почечно-клеточного рака у 1. Результаты. Послеоперационные осложнения отмечены у 14 (77,8%) больных, перенесших ДПЭ, и у 5 (55,5%) больных после альтернативных операций. Пациентам с НЭО, ВПМО и метастазами почечно-клеточного рака, у которых удалось избежать ДПЭ, обеспечили радикальное хирургическое лечение, они не нуждались в заместительной инсулинотерапии и приеме ферментных препаратов. Вывод. Строгое соблюдение онкологических канонов в сочетании с разумным подходом к тактике лечения больных множественными НЭО и метастазами почечно-клеточного рака, ВПМО позволяет в ряде случаев избежать выполнения ДПЭ путем выполнения альтернативных операций.
- Published
- 2019
7. [Complex treatment of patient with chronic pancreatitis]
- Author
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Kriger Ag, S. A. Budzinsky, Gorin Ds, and M A Zakharova
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Calculi ,03 medical and health sciences ,Necrosis ,Pancreatic Fistula ,0302 clinical medicine ,Pancreatectomy ,Pancreatitis, Chronic ,Medicine ,Humans ,Surgical treatment ,Pancreas ,Pancreatic duct ,business.industry ,Open surgery ,Pancreatic Ducts ,Pancreatic Diseases ,General Medicine ,medicine.disease ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Pancreatitis ,030211 gastroenterology & hepatology ,Pancreatic Cyst ,business - Abstract
Chronic pancreatitis complicated by pancreatic duct stones and pancreatic hypertension, post-necrotic cysts and fistulas requires surgical treatment. There are various procedures from minimally invasive to advanced pancreatectomy. Endoscopic interventions and radical open surgery allow to achieve good results. Successful complex treatment of patient with chronic pancreatitis is presented in this report.Лечение больных хроническим панкреатитом, осложненным вирсунголитиазом и панкреатической гипертензией, постнекротическими кистами, панкреатическими свищами, требует хирургических методов их устранения. Существует широкий спектр вмешательств, от миниинвазивных до обширных резекционных операций, позволяющих устранить имеющиеся проблемы. Последовательное применение эндоскопических вмешательств и радикального хирургического лечения позволяет добиться хороших результатов. В настоящем сообщении представлен вариант успешного комплексного лечения больного хроническим панкреатитом.
- Published
- 2018
8. Diagnostic and treatment of the intraductal papillary mucinous tumor of pancreas
- Author
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Vetsheva Nn, A. G. Krieger, V I Panteleev, Berelavichus Sv, A V Glotov, G. G. Karmazanovskiy, A. R. Kaldarov, and Gorin Ds
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Biliary fistula ,Pancreatic Intraductal Neoplasms ,Magnetic resonance imaging ,General Medicine ,Explorative laparotomy ,medicine.disease ,Pancreaticoduodenectomy ,Metastasis ,Pancreatic Neoplasms ,Pancreatectomy ,medicine.anatomical_structure ,Carcinoma ,Humans ,Medicine ,Mucinous Tumor ,Radiology ,Radical surgery ,business ,Pancreas - Abstract
Adjustment of diagnostics and management of the surgical treatment of patients with intraductal papillary mucinous tumor of pancreas.From 2012 to 2018, 45 patients with intraductal papillary mucinous tumor were observed. During the observation the ultrasound examination, contrast-enhanced computed tomography and magnetic resonance tomography with contrast were used. In 29 cases radical surgery was performed, nonradical in 1 case; case follow-up is chosen for 15 patients.Intraductal papillary mucinous tumor was diagnosed and the definition of the type of tumor was made on the base of 2 types of imaging methods. Intraductal papillary mucinous tumor type 1 was founded in 5 (11%), whereas intraductal papillary mucinous tumor type 2 was founded in 20 (44,5%) and intraductal papillary mucinous tumor type 3 was observed in 20 (44,5%) cases. Intraductal papillary mucinous tumor associated with carcinoma was observed in 16 cases. Pancreaticoduodenal resection was performed in 20, distal exsection of pancreas was performed in 4 cases (2 in open manner access, 2 in robot-assisted manner), pancreatic head resection was performed in 3 cases (1 in open manner access, 2 in laparoscopic access) and in 2 cases the duodenopancreatectomy was performed. Explorative laparotomy was performed in case of intraductal papillary mucinous tumor type 2 associated with mucilaginous carcinoma and miliary metastasis in the liver. Early postoperative complications were observed in 5 cases (16, 6%): biliary fistula (n=2), postoperative wound infection (n=2), arrosive hemorrhage type B in ISGPS (n=1, was treated in an X-ray endovascular manner). Case follow-up was chosen in 15 cases of intraductal papillary mucinous tumor over the course of 6 to 74 months and disease progression was not observed.Intraductal papillary mucinous tumor is a condition associated with high risk of malignant change and demands early disease detection. The treatment should be provided in medical centers that specialize in the pancreas deceases, where a full patient examination as well as a clear-eyed understanding of diagnostic information with the execution of desirable type of surgical intervention with the guaranty of achievement R0 condition can be offered.Цель исследования - оптимизация диагностики и тактики хирургического лечения больных внутрипротоковой папиллярной муцинозной опухолью (ВПМО) поджелудочной железы (ПЖ). Материал и методы. В 2012-2018 гг. наблюдали 45 больных с ВПМО. При обследовании использовали УЗИ, КТ и МРТ с контрастированием. Радикальные операции выполнены 29 больным, паллиативная - 1, динамическое наблюдение проводили за 15 пациентами. Результаты. Диагноз ВПМО и тип опухоли определены на основании 2 методов лучевой диагностики. ВПМО 1-го типа диагностирована у 5 (11%), 2-го типа - у 20 (44,5%), 3-го типа - у 20 (44,5%) пациентов. ВПМО, ассоциированная с карциномой, установлена у 16 больных. Панкреатодуоденальная резекция выполнена 20 больным, дистальная резекция ПЖ - 4 (2 - открытым, 2 - робот-ассистированным доступом), резекция головки ПЖ - 3 (1 - открытым, 2 - лапароскопическим доступом), дуоденопанкреатэктомия - 2 больным. Диагностическая лапаротомия произведена больному с ВПМО 2-го типа, ассоциированной со слизистой карциномой и милиарными метастазами в печени. Ранние послеоперационные осложнения возникли у 5 (16,6%) больных: желчный свищ у 2, нагноение послеоперационной раны у 2, аррозионное кровотечение типа В по ISGPS (остановлено рентгенэндоваскулярным способом) - у 1. Динамическое наблюдение за 15 больными с ВПМО в течение 6-74 мес не выявило прогрессирования заболевания. Заключение. ВПМО имеет высокий риск малигнизации, что требует ранней диагностики заболевания. Лечение следует проводить в центрах, специализирующихся на лечении заболеваний ПЖ, где есть возможность полноценного обследования пациентов, здравой оценки диагностической информации и выполнения оптимального вида хирургического вмешательства, обеспечивающего состояние R0.
- Published
- 2020
9. Prevention of pancreatic fistula after pancreatoduodenectomy
- Author
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Kriger Ag, A. R. Kaldarov, G V Galkin, and Gorin Ds
- Subjects
medicine.medical_specialty ,Logistic regression ,Gastroenterology ,Pancreaticoduodenectomy ,Pancreatic Fistula ,03 medical and health sciences ,0302 clinical medicine ,Gastrointestinal Agents ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Glucocorticoids ,Pancreas ,Frozen section procedure ,business.industry ,Incidence (epidemiology) ,General Medicine ,medicine.disease ,Pancreatic Neoplasms ,Somatostatin Analogue ,Biliary Tract Neoplasms ,Somatostatin ,Pancreatic fistula ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business ,Glucocorticoid ,Abdominal surgery ,medicine.drug - Abstract
Prospective randomized investigation of the efficiency of somatostatin analogues and glucocorticoids in pancreatic fistula prevention after pancreatoduodenectomy by using.In period from December 2018 till March 2020 78 patients underwent pancreatoduodenectomy for pancreatobilliary tumors in department of abdominal surgery of National Medical Research Center of Surgery named after A.V. Vishnevsky. Intraoperative frozen section investigation of pancreatic functioning acinar structures (FAS) was held for all patients. 38 patients had more than 40% of FAC and were related with high risk of pancreatic fistula (PF), while 40 patients with less than 40% FAC were included in low risk of PF group. In both groups patients were randomized to main and control subgroups. In main subgroup of high risk group patients combination of somatostatin analogues and glucocorticoids was used, while in control subgroup patients received only somatostatin analogue. In low risk of PF group patients of main subgroup preventively got somatostatin analogue, while control group patients had no specific prophylaxis of PF. To assess the effect of drug prophylaxis on the development of pancreatic fistula we used logistic regression models with the inclusion of the drug use factor as an independent variable.25 patients were included in main subgroup of high risk group. Clinically relevant pancreatic fistula (CRPF) developed in 14 (56%) cases. From 13 patients of control subgroup CRPF developed in 5 (38%) cases. In main subgroup of low risk group 18 patients were included and 3 (16%) of them had CRPF. In control subgroup were 22 patients and there were no cases of CRPF.In our series combination of somatostatin analogue and glucocorticoid didn't show efficiency in prevention of CRPF in high risk patients, although difference between subgroups wasn't statistically significant (Проспективное рандомизированное изучение эффективности профилактики послеоперационного свища (ПС) после панкреатодуоденальной резекции (ПДР) за счет применения аналогов соматостатина и глюкокортикоидов.В отделении абдоминальной хирургии НМИЦ хирургии им. А.В. Вишневского с декабря 2018 г. по март 2020 г. было выполнено 78 ПДР по поводу опухолей билиопанкреатодуоденальной области. Интраоперационно определялось количество функционирующих ацинарных структур (ФАС) в срезе поджелудочной железы (ПЖ). Более 40% ФАС выявлено у 38 больных, которые были отнесены к группе высокого риска развития ПС. Менее 40% ФАС обнаружено у 40 больных, которые составили группу низкого риска. Пациенты группы высокого риска были разделены путем рандомизации на основную и контрольную подгруппы. В основной подгруппе в качестве профилактики ПС использовали гидрокортизон и синтетические аналоги соматостатина. В контрольной подгруппе пациенты получали только синтетические аналоги соматостатина. В группе низкого риска возникновения ПС пациенты также были разделены путем рандомизации на основную подгруппу и контрольную. В основной подгруппе пациенты получали синтетические аналоги соматостатина. В контрольной подгруппе специфическая медикаментозная профилактика ПС не проводилась. Для оценки влияния медикаментозной профилактики на развитие ПС использовались логистические регрессионные модели с включением фактора применения препарата в качестве независимой переменной.В группе пациентов высокого риска ПС в основную подгруппу вошли 25 пациентов, клинически значимый ПС возник в 14 (56%) случаях, в контрольной подгруппе были 13 больных, из них клинически значимый ПС отмечен у 5 (38%). В группе пациентов с низким риском ПС в основную подгруппу были включены 18 больных; клинически значимый ПС возник у 3 (16%), в контрольную подгруппу вошли 22 пациента, у которых клинически значимого ПС зафиксировано не было.Комбинация глюкокордикоидов и аналогов соматостатина при высоком риске возникновения ПС после ПДР не снижает частоту развития ПС, лучшие результаты были достигнуты при изолированном применении аналогов соматостатина. У больных с низким риском возникновения ПС аналоги соматостатина не привели к сокращению количества ПС.
- Published
- 2020
10. [Intrapancreatic accessory spleen]
- Author
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Kriger Ag, A E Akhtanin, Gorin Ds, A. R. Kaldarov, and Berelavichus Sv
- Subjects
Male ,Pathology ,medicine.medical_specialty ,Accessory spleen ,Neuroendocrine tumors ,Choristoma ,Metastasis ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Pancreatectomy ,Robotic Surgical Procedures ,Pancreatic tumor ,medicine ,Humans ,business.industry ,Pancreatic Diseases ,General Medicine ,medicine.disease ,Pancreatic Neoplasms ,medicine.anatomical_structure ,Mri diagnosis ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Cell cancer ,Female ,Pancreas ,business ,Distal pancreatectomy ,Spleen - Abstract
Accessory spleen is the human growth anomaly, which appears in embryogenesis and frequently becomes an accidental finding during prophylactic medical examination. Pancreatic tail - the second frequent localization after the splenic hilus. Intrapancreatic accessory spleen can mimic the pancreatic tumor.To demonstrate case series of intrapancreatic accessory spleen in course of differential diagnostic with pancreatic neuroendocrine tumor and metastasis of renal - cell cancer.Three patients with intrapancreatic accessory spleen were observed in abdominal department #1 A.V.Vishnevsky Institute of Surgery, - two females and one male.Two patients were surgically treated: in the first case basing on preoperative anamnesis and diagnostic data diagnosis of renal - cell cancer metastasis was established, in the second case - nonfunctional pancreatic neuroendocrine tumor. In both cases robotic distal pancreatectomy was performed. There were no conversions. Postoperative recovery was accompanied by clinicaly not relevant pancreatic fistulas, which didn't increase length of hospitalization. In the third case during CT and MRI diagnosis of intrapancreatic accessory spleen was determined. Surgical treatment wasn't performed. Control examination showed an absence of dynamic of characteristics and growth.Described cases demonstrate difficulty of differential diagnostics of tumor - like mass. Neuroendocrine tumors, renal - cell cancer metastases, solid pseudopapillary neoplasms and accessory spleen can have similar CT-characteristics. In appearance of differential diagnostic difficulties minimally invasive surgical treatment has to be performed.Введение. Добавочная селезенка (ДС) - аномалия развития, которая возникает на этапе эмбриогенеза. ДС располагается в связках селезенки и реже - в хвосте поджелудочной железы (ПЖ). ДС в хвосте ПЖ может имитировать нейроэндокринную опухоль или метастаз почечноклеточного рака. Цель - обратить внимание на сложность диагностики ДС, располагающейся в паренхиме ПЖ. Материал и методы. Наблюдали 3 пациентов (2 женщины, 1 мужчина) с ДС в хвосте ПЖ. При обследовании применялись КТ и МРТ. Результаты. Оперировано 2 пациентов. У женщины 43 лет, перенесшей нефрэктомию по поводу почечноклеточного рака, диагностирован метастаз в хвосте ПЖ, у мужчины 61 года - нефункционирующая нейроэндокринная опухоль хвоста ПЖ. В обоих случаях выполнена робот-ассистированная дистальная резекция ПЖ с сохранением селезенки. Послеоперационный период у больных осложнился панкреатическим свищом, не повлиявшим на сроки пребывания в стационаре. Динамическое наблюдение в течение 4 лет проводится за пациенткой 38 лет, у которой по данным КТ и МРТ установлен диагноз ДС хвоста ПЖ. При контрольном обследовании динамики в размере и лучевых характеристиках ДС нет. Заключение. Дифференциальная диагностика ДС, расположенной в паренхиме хвоста ПЖ, является сложной задачей. Сходную рентгенологическую картину имеют нейроэндокринные опухоли, метастазы почечноклеточного рака, солидно-псевдопапиллярная опухоль. При возникновении диагностических затруднений следует склоняться к выполнению миниинвазивного хирургического вмешательства.
- Published
- 2018
11. [Endovascular procedures in pancreatic surgery]
- Author
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Gorin Ds, Kriger Ag, Varava Ab, A. V. Smirnov, A. Sh. Revishvili, Berelavichus Sv, A. A. Goev, and E. A. Akhtanin
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Blood Loss, Surgical ,030230 surgery ,Postoperative Hemorrhage ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Pancreatectomy ,medicine.artery ,Medicine ,Humans ,cardiovascular diseases ,Superior mesenteric artery ,Embolization ,Pancreas ,Aged ,Splenic Diseases ,Pancreatic duct ,business.industry ,Endovascular Procedures ,Angiography ,Pancreatic Diseases ,General Medicine ,Middle Aged ,medicine.disease ,Thrombosis ,Hemostasis, Surgical ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Regional Blood Flow ,030220 oncology & carcinogenesis ,Hemostasis ,Pancreatitis ,Female ,business ,Aneurysm, False - Abstract
To evaluate an effectiveness of endovascular techniques in pancreatic surgery.For the period 1995-2017 at Vishnevsky Institute of Surgery endovascular treatment (EVT) was applied in 51 patients with chronic pancreatitis complicated by false aneurysms (FA) and postoperative hemorrhage after pancreatectomy. Various methods of embolization and stenting were used in 24 and 11 cases respectively in order to exclude FA of celiac trunk and superior mesenteric artery from blood flow. Endovascular hemostasis for postoperative hemorrhage was carried out with embolization of damaged vessel in 11 patients. Stent-grafts were deployed in 5 patients with marginal defect of the wall of hepatic/superior mesenteric arteries.In all 35 patients with chronic pancreatitis complicated by false aneurysms EVT ensured thrombosis of the aneurysm's cavity. EVT was final in 14 patients with FA and absent communication with pancreatic duct. Radical surgical treatment was required after 7-10 days for FA communicated with pancreatic duct due to lysis of thrombotic masses by pancreatic enzymes. Spleen infarction was diagnosed in 3 patients. Two of them did not require treatment while 1 patient underwent splenectomy in view of splenic abscess. 1 patient died from liver cirrhosis followed by severe hepatic failure, death was not associated with bleeding. In 16 patients with post-pancreatectomy bleeding hemostasis was achieved in all cases with EVT. However, recurrent bleeding occurred in 2 patients who underwent successful redo endovascular intervention. Complications after EVT were observed in 2 patients: duodenal wall necrosis followed by fistula which was closed spontaneously (n=1); advanced intestinal infarction (n=1) followed by fatal outcome; pulsating hematoma within cubital fossa that required brachial artery ligation and autovenous bypass.EVT provides thrombosis of FAs of celiac trunk and superior mesenteric artery branches in patients with chronic pancreatitis, as well as hemostasis for postoperative bleeding after pancreatectomy.Цель исследования - оценить эффективность рентгеноэндоваскулярного лечения (РЭЛ) в хирургии поджелудочной железы. Материал и методы. За период 1995-2017 гг. в Институте хирургии им. А.В. Вишневского РЭЛ было использовано у 51 больного хроническим панкреатитом, осложненным ложными аневризмами (ЛА), и при послеоперационном кровотечении (ПКР) у больных, перенесших резекционные операции на поджелудочной железе. Для 'выключения' из кровотока ЛА бассейна чревного ствола и верхней брыжеечной артерии из 35 больных у 24 применяли различные методы эмболизации, у 11 - стентирование. Эндоваскулярный гемостаз при послеоперационном кровотечении обеспечивали эмболизацией аррозированного сосуда у 11 больных, а при наличии краевого дефекта стенки печеночных артерий или верхней брыжеечной артерии у 5 больных использованы стент-графты. Результаты. У всех 35 больных хроническим панкреатитом, осложненным ЛА, РЭЛ привело к тромбированию полости аневризмы. У 14 больных с ЛА, не имевших сообщения с протоком поджелудочной железы, рентгеноэндоваскулярное вмешательство явилось окончательным методом лечения. При наличии сообщения полости ЛА с протоком поджелудочной железы за счет воздействия панкреатического секрета тромботические массы в просвете аневризмы лизировались через 7-10 сут, что требовало радикального хирургического лечения к концу указанного срока. Инфаркт селезенки диагностирован у 3 больных, в том числе двум лечения не потребовалось, у одного выполнена спленэктомия в связи с абсцедированием. Умер один больной от печеночной недостаточности, обусловленной циррозом печени, смерть не была связана с кровотечением. У 16 больных при ПКР, возникшем после резекционных вмешательств на поджелудочной железе, РЭЛ обеспечило гемостаз. Однако у 2 больных возник рецидив кровотечения, которое было остановлено при повторном эндоваскулярном вмешательстве. Осложнения РЭЛ отмечены у 3 больных: у 1 - некроз стенки двенадцатиперстной кишки с формированием свища, который закрылся самостоятельно, у 1 - обширный инфаркт кишечника, больной умер; у 1 - пульсирующая гематома в области локтевого сгиба, потребовавшая перевязки плечевой артерии и выполнения плечелоктевого шунтирования аутовеной. Вывод. РЭЛ позволяет обеспечить тромбирование ЛА ветвей чревного ствола и верхней брыжеечной артерии у больных хроническим панкреатитом, а также добиться гемостаза при ПКР при резекционных операциях на поджелудочной железе.
- Published
- 2018
12. [Physical minimally invasive treatment of pancreatic insulinoma]
- Author
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A. R. Kaldarov, Berelavichus Sv, R. S. Dugarova, and Gorin Ds
- Subjects
Pancreatic Insulinoma ,medicine.medical_specialty ,business.industry ,Patient Selection ,General Medicine ,Phototherapy ,medicine.disease ,Gastroenterology ,Pancreatic Neoplasms ,Treatment Outcome ,Cryotherapy ,Internal medicine ,Catheter Ablation ,Medicine ,Humans ,Insulinoma ,business - Published
- 2018
13. [Intestinal fistula after anterior abdominal wall hernia repair with composite prosthesis]
- Author
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A. R. Kaldarov, Alyautdinov Rr, Gorin Ds, B Sh Gogiya, V. N. Matushevskaya, and A. G. Krieger
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Fistula ,General surgery ,Abdominal Wall ,General Medicine ,Prostheses and Implants ,030230 surgery ,Surgical Mesh ,Hernia repair ,medicine.disease ,Prosthesis ,Hernia, Ventral ,Surgery ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,Intestinal Fistula ,Humans ,business ,Herniorrhaphy - Published
- 2017
14. The mistakes in diagnosis of pancreatic intraductal papillary mucinous tumor
- Author
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M A Zakharova, A. V. Smirnov, Gorin Ds, and Kriger Ag
- Subjects
Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Anastomosis ,Pancreaticoduodenectomy ,Malignant transformation ,03 medical and health sciences ,0302 clinical medicine ,Pancreatitis, Chronic ,Carcinoma ,medicine ,Humans ,Diagnostic Errors ,Pancreatic duct ,business.industry ,Pancreatic Ducts ,General Medicine ,Pancreatic Intraductal Papillary-Mucinous Tumor ,medicine.disease ,Adenocarcinoma, Mucinous ,Carcinoma, Papillary ,Abdominal Pain ,Pancreatic Neoplasms ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Pancreatitis ,030211 gastroenterology & hepatology ,Radiology ,Neoplasm Recurrence, Local ,business ,Pancreas ,Carcinoma, Pancreatic Ductal - Abstract
It is presented surgical treatment of the patient with pancreatic intraductal papillary mucinous tumor who was under observation with diagnosis of chronic pancreatitis for a long time. Recurrent tumor with possible malignant transformation to carcinoma was suspected in 5 years after pancreaticoduodenectomy. It was supposed to perform pancreatic stump extirpation. Redo surgery did not reveal any tumor. The cause of recurrent pain was pancreatic duct obliteration at the level of anastomosis.Представлено наблюдение хирургического лечения и послеоперационного контроля пациента с внутрипротоковой папиллярно-муцинозной опухолью. Панкреатическая гипертензия, возникшая через 5 лет после выполненной панкреатодуоденальной резекции, расценена как рецидив опухоли. Интраоперационная оценка ситуации позволила выявить истинную причину гипертензии - стриктуру панкреатикоеюноанастомоза и избежать экстирпации культи поджелудочной железы.
- Published
- 2019
15. X-ray-negative pancreatic dust stones in patients with chronic pancreatiti
- Author
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Gorin Ds, Kriger Ag, M A Zakharova, and L A Marinova
- Subjects
Pancreatic duct ,medicine.medical_specialty ,business.industry ,X-Rays ,Pancreatic Ducts ,General Medicine ,medicine.disease ,Gastroenterology ,Calculi ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Pancreatitis, Chronic ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Humans ,Pancreatitis ,In patient ,business - Abstract
Diagnosis of chronic pancreatitis is not associated with any difficulties in patients with CT signs of pancreatic duct stones as a rule. However, 'classical' picture of chronic pancreatitis is usually absent in case of predominant protein matrix in the calculi. Two cases of X-ray-negative pancreatic dust stones in patients with protein stones of the pancreatic duct are reported.Диагностика хронического панкреатита у пациентов с КТ-признаками вирсунголитиаза, как правило, не вызывает трудностей. Однако при преобладании в составе конкрементов белкового матрикса классическая лучевая картина хронического панкреатита отсутствует. Представлены 2 случая рентгенонегативного вирсунголитиаза у пациентов с белковыми конкрементами протока поджелудочной железы.
- Published
- 2019
16. Quality of life as an efficiency index of surgical treatment of chronic pancreatitis
- Author
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Gorin Ds, Kriger Ag, M A Zakharova, E A Vorobyeva, and A. V. Smirnov
- Subjects
Adult ,Male ,medicine.medical_specialty ,03 medical and health sciences ,Pancreatectomy ,0302 clinical medicine ,Quality of life ,Interquartile range ,Pancreatitis, Chronic ,medicine ,Humans ,In patient ,Surgical treatment ,business.industry ,Eortc qlq c30 ,Mean age ,General Medicine ,Middle Aged ,medicine.disease ,Abdominal Pain ,Surgery ,Treatment Outcome ,Health Care Surveys ,030220 oncology & carcinogenesis ,Quality of Life ,Pancreatitis ,Female ,030211 gastroenterology & hepatology ,business ,Body mass index - Abstract
To evaluate quality of life in long-term postoperative period in patients with chronic pancreatitis.There were 31 (21 males and 10 females) patients with complicated forms of chronic pancreatitis who underwent surgery in 2015-2017. Mean age was 49 (44; 53) years, body mass index - 22.4 (20.4; 24) kg/mPhysical status value (SF-36) before surgery was 30.5 (24.8; 37.5), after surgery - 50.8 (46.7; 56.5). Mental status value was 30.2 (26.7; 36.4) prior to surgery and 53.8 (48.7; 57.3) after operation. Improvement of QoL (QLQ C30) from 29.17 (0; 50.0) before surgery to 75.0 (54.2; 83.3) after operation was observed. VAS-score of pain severity was 8 (8; 10) prior to surgery and 3 (2; 5) after surgery. Differences were significant (p0.05).Surgical treatment of complicated chronic pancreatitis significantly reduces pain and improves HR-QoL. However, recurrent symptoms of chronic pancreatitis in long-term period cannot be excluded due to short follow-up period (median less than one year). The further investigation is needed.Осложненные формы хронического панкреатита (ХП), проявляющиеся наличием вирсунголитиаза, панкреатической гипертензии, портальной гипертензии, дуоденальной непроходимости, механической желтухи и сопровождающиеся значительным болевым синдромом, снижают качество жизни и требуют хирургического лечения. Цель исследования - оценить качество жизни больных ХП в отдаленном послеоперационном периоде. Материал и методы. Проведен анализ качества жизни 31 (21 мужчина и 10 женщин) пациента, оперированного по поводу осложненных форм ХП в 2015-2017 гг. Средний возраст пациентов составил 49 (44; 53) лет, индекс массы тела - 22,4 (20,4; 24) кг/м
- Published
- 2019
17. Diagnosis and surgical treatment of duodenal tumors
- Author
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V I Panteleev, A. R. Kaldarov, Gorin Ds, and Kriger Ag
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Splenectomy ,Pancreaticoduodenectomy ,Whipple Procedure ,03 medical and health sciences ,0302 clinical medicine ,Duodenal Neoplasms ,medicine ,Humans ,Stromal tumor ,GiST ,medicine.diagnostic_test ,business.industry ,Esophagogastroduodenoscopy ,General Medicine ,Explorative laparotomy ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Adenocarcinoma ,Laparoscopy ,030211 gastroenterology & hepatology ,business - Abstract
To present the experience in diagnosis and surgical treatment of duodenal tumors.The study included 27 patients with different duodenal tumors: adenocarcinoma (AC, n=8), gastrointestinal stromal tumor (GIST, n=13), neuroendocrine tumor (NET, n=6). The examination included computed tomography (in 27 patients), magnetic resonance imaging (12), transcutaneous ultrasound (14), endosonography (16), esophagogastroduodenoscopy (16). All patients were operated. Conventional (18), laparoscopic (4), robot-assisted (4), endoscopic endoluminal (1) surgical interventions were performed. 17 patients were followed up from 8 months to 10 years (median 26 months).According to the instrumental diagnostic methods, duodenal tumors were verified in 19 cases. Five patients with AC underwent pancreaticoduodenectomy (Whipple procedure), 2 - palliative operations (bypass gastroenteroanastomosis), 1 - explorative laparotomy. Patients with GIST underwent 3 pancreaticoduodenectomies and 10 duodenectomies: traditional (4), laparoscopic (4) and robot-assisted (2) approaches. In case of NET 3 interventions via traditional approach (pancreaticoduodenectomy, duodenal resection, tumor enucleation), 1 endoscopic endoluminal operation, 2 robot-assisted operations (duodenal resection and duodenopancreatectomy, splenectomy, distal gastrectomy) were performed. Postoperative complications occurred in 10 (37%) patients. Postoperative mortality was absent. Long-term results were analyzed in 17 patients. All patients with GIST and NET are alive without disease progression. Two AC patients are alive from those who are available.Duodenal tumors are relatively rare. Radical surgical intervention in accordance with oncological principles is preferred for these patients. Organ-preserving procedures may be applied depending on morphological type of tumor. Examination and treatment of patients with duodenal tumors should be carried out in specialized surgical departments.Цель исследования - представить опыт диагностики и хирургического лечения опухолей двенадцатиперстной кишки (ДПК). Материал и методы. В исследование включены 27 больных с различными опухолями ДПК: аденокарцинома (АК) - 8, гастроинтестинальная стромальная опухоль (ГИСО) - 13, нейроэндокринная опухоль (НЭО) - 6. Из инструментальных методов диагностики применяли компьютерную томографию (выполнена 27 больным), магнитно-резонансную томографию (12), транскутанное ультразвуковое исследование (14), эндосонографию (16), эзофагогастродуоденоскопию (16). Все больные оперированы. Хирургические вмешательства осуществлялись традиционным доступом (18), лапароскопически (4), робот-ассистированно (4), эндоскопически эндолюминально (1). Оценка отдаленных результатов проведена 17 больным в сроки наблюдения от 8 мес до 10 лет (медиана 26 мес). Результаты. По данным инструментальных методов диагностики верифицировать опухоль ДПК удалось в 19 наблюдениях. При АК панкреатодуоденальная резекция (ПДР) выполнена 5 больным, паллиативные вмешательства (формирование обходных анастомозов) - 2, эксплоративная лапаротомия - 1. При ГИСО 3 больным выполнена ПДР, 10 - резекция ДПК: лапаротомным доступом - 4, лапароскопически - 4, робот-ассистированы - 2. При НЭО выполнено 3 вмешательства традиционным доступом: ПДР, резекция ДПК, энуклеация опухоли; 1 - эндоскопическим эндолюминальным способом, 2 робот-ассистированные операции (резекция ДПК и дуоденумпанкреатэктомия, спленэктомия, дистальная резекция желудка). Послеоперационные осложнения возникли у 10 (37%) из 27 больных. Летальных исходов не было. Оценка отдаленных результатов лечения у 17 больных показала, что больные, оперированные по поводу ГИСО и НЭО, живы, прогрессирования заболевания нет. Из 4 больных с АК, о которых удалось получить информацию, живы 2. Заключение. Опухоли двенадцатиперстной кишки встречаются относительно редко. Радикальное хирургическое вмешательство, выполненное с соблюдением онкологических принципов, является методом выбора в лечении данной категории больных. В зависимости от морфологического варианта опухоли возможно выполнение органосберегающих вмешательств. Обследование и лечение больных с опухолями ДПК должно осуществляться в условиях специализированного хирургического стационара.
- Published
- 2019
18. Intraductal papillary mucinous neoplasm of pancreas
- Author
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A. R. Kaldarov, Gorin Ds, V I Panteleev, and Kriger Ag
- Subjects
Pathology ,medicine.medical_specialty ,endocrine system diseases ,Pancreatic Intraductal Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Pancreatic IPMN ,Pancreatic tumor ,Pancreatic cancer ,medicine ,Humans ,Surgical treatment ,Cystic Tumor ,Intraductal papillary mucinous neoplasm ,business.industry ,Clinical course ,General Medicine ,Prognosis ,medicine.disease ,Pancreatic Neoplasms ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,030211 gastroenterology & hepatology ,Pancreas ,business - Abstract
Intraductal papillary mucinous neoplasm (IPMN) is the most common cystic pancreatic tumor. There are 3 ductal types of this tumor depending on localization. Several histological subtypes determine clinical course and prognosis. The problems of diagnosis, surgical treatment and follow-up are reviewed in several guidelines. Literature review devoted to pancreatic IPMN is presented in the article, the latest guidelines are compared.Внутрипротоковая папиллярная муцинозная опухоль (ВПМО) - наиболее распространенная кистозная опухоль поджелудочной железы. В зависимости от локализации и отношения опухоли к панкреатическому протоку ВПМО подразделяется на три типа. Выделяют несколько гистологических подтипов, при которых различаются течение заболевание и прогноз. Проблемы диагностики, хирургического лечения и наблюдения отражены в нескольких клинических рекомендациях. Приводим обзор литературы по поводу ВПМО и сравнение последних клинических рекомендаций.
- Published
- 2019
19. [Surgical treatment of patients with enteric fistulae]
- Author
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Ikramov Rz, E. A. Akhtanin, V. N. Matushevskaya, E A Sokolova, A R Caldarov, A. G. Krieger, B Sh Gogiya, Kubyshkin Va, Berelavichus Sv, and Gorin Ds
- Subjects
Male ,medicine.medical_specialty ,business.industry ,Treatment outcome ,MEDLINE ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgery ,Young Adult ,Treatment Outcome ,Intestine, Small ,Intestinal Fistula ,Medicine ,Humans ,Female ,Young adult ,business ,Surgical treatment ,Digestive System Surgical Procedures ,Retrospective Studies - Abstract
To create multidisciplinary diagnostic and curative approach to patients with intestinal fistulae.Additional nutritive support was applied in all patients preoperatively. 35 patients with intestinal fistulae were operated. Unformed and formed intestinal fistulae were observed in 10 and 25 patients respectively. Radical one-stage surgery was performed in 30 cases, two-stage - in 3 patients. Unformed fistulae opened into granulating wound were not eliminated in 2 patients.Postoperative complications were observed in 10 patients. 2 of them required re-intervention. There were no deaths.Возникновение кишечного свища после операций на органах брюшной полости является тяжелым осложнением. Больные со свищами нуждаются в мультидисциплинарном диагностическом и лечебном подходе. С целью предоперационной подготовки все больные получали дополнительную нутритивную поддержку. Оперированы 35 больных с тонкокишечными свищами. Несформировавшиеся тонкокишечные свищи были у 10 больных, сформировавшиеся - у 25. Радикальное одномоментное хирургическое лечение проведено 30 больным, двухэтапное хирургическое лечение - 3 больным; не удалось устранить несформировавшиеся свищи, открывавшиеся в гранулирующую рану, у 2 больных. В послеоперационном периоде у 10 больных были отмечены осложнения, у 2 из них потребовавшие повторного оперативного вмешательства. Летальных исходов не было.
- Published
- 2016
20. [Robot-assisted pancreatoduodenectomy]
- Author
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Kriger Ag, A. R. Kaldarov, Gorin Ds, E. A. Akhtanin, N. A. Karel’skaya, and Berelavichus Sv
- Subjects
Adult ,Male ,medicine.medical_specialty ,Conventional surgery ,Anastomosis ,Pancreaticoduodenectomy ,Lymphatic nodes ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,technology, industry, and agriculture ,Retrospective cohort study ,General Medicine ,Robotics ,Middle Aged ,Surgery ,body regions ,Pancreatic Neoplasms ,Dissection ,Treatment Outcome ,Great vessels ,Narcotic drugs ,Female ,business ,Cancer surgery ,Follow-Up Studies - Abstract
To compare the results of robot-assisted and conventional techniques of pancreatoduodenectomy.It was performed the retrospective investigation of results of robot-assisted and conventional pylorus-preserving pancreatoduodenectomy in 7 and 7 patients respectively.Duration of robot-assisted and conventional surgery was 460.71±119.77 and 288.57±62.2 minutes, volume of blood loss--414.28±285.36 and 400±163.30 ml respectively. Postoperative complications after robot-assisted technique were classified as Grade I according to Clavien-Dindo classification. Pancreatic fistulae were absent (ISGPF (2005)). Lower duration of abdominal drainage and opioid analgesia were observed. Also narcotic drugs were required by not all patients after robot-assisted surgery. Histological study revealed the large number of excised lymphatic nodes.Obvious advantage of robot-assisted operation was precision of great vessels and lymphatic nodes dissection, performing anastomoses. Robot-assisted pancreatoduodenectomy corresponds to all requirements inherent to radical cancer surgery.Цель - сравнение роботизированной и традиционной технологий при выполнении панкреатодуоденальной резекции. Материал и методы. Проведено ретроспективное исследование результатов робот-ассистированной пилоросохраняющей панкреатодуоденальной резекции (РА пПДР) у 7 и пПДР, выполненной традиционным (Тр) доступом также у 7 пациентов. Результаты. Длительность РА пПДР составила 460,71±119,77 мин, Тр пПДР - 288,57±62,2; объем кровопотери - 414,28±285,36 и 400±163,30 мл соответственно. Послеоперационные осложнения после РА пПДР классифицировались как Grade 1 по классификации Clavien-Dindo. Отсутствовали панкреатические свищи (ISGPF (2005)), отмечена меньшая продолжительность дренирования брюшной полости и терапии наркотическими анальгетиками, при этом назначение наркотических анальгетиков потребовалось не всем больным в группе РА пПДР. При гистологическом исследовании выявлено большее количество удаленных лимфатических узлов. Заключение. Очевидным преимуществом робот-ассистированного варианта операции являлась прецизионность выделения магистральных сосудов, лимфатических узлов, формирования анастомозов. РА ПДР соответствует всем требованиям, предъявляемым к радикальным онкологическим операциям.
- Published
- 2016
21. Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion
- Author
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Kriger Ag, A. V. Smirnov, Gorin Ds, G.G. Karmazanovsky, G V Galkin, A. Sh. Revishvili, A. F. Kharazov, and M. B. Raevskaya
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Portal vein ,030230 surgery ,Pancreaticoduodenectomy ,03 medical and health sciences ,Mesenteric Veins ,0302 clinical medicine ,Pancreatic cancer ,medicine.artery ,Humans ,Medicine ,Neoplasm Invasiveness ,Superior mesenteric artery ,Stage (cooking) ,Overdiagnosis ,Vein ,Retrospective Studies ,Portal Vein ,business.industry ,General Medicine ,medicine.disease ,Survival Analysis ,Mesenteric Arteries ,Surgery ,Pancreatic Neoplasms ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,business ,Pancreatic head cancer - Abstract
To evaluate the outcomes of pancreaticoduodenectomy with mesenteric-portal vein resection for pancreatic head cancer.Retrospective analysis included 124 patients with pancreatic head cancer for the period 2010-2017. Mesenteric-portal vein (MPV) invasion was diagnosed in 37 (29.8%) patients, tumor contact with superior mesenteric artery as a borderline resectable state was noted in 11 cases. All patients underwent pancreaticoduodenectomy with mesenteric-portal vein resection.Vein invasion was histologically confirmed in 19 (51.3%) out of 37 patients. At the same time, arterial invasion was absent in 11 patients with a borderline resectable tumor. CT-associated overdiagnosis of venous wall invasion was 6.4%, intraoperative overdiagnosis - 87.5%. R0-resection was achieved in 88.5% after conventional pancreaticoduodenectomy and in 78.4% after pancreaticoduodenectomy followed by MPV resection. Median survival was 17 months, 2-year survival - 41%. Among 11 patients with a borderline resectable tumor median survival was 11 months. Pancreaticoduodenectomy without vein resection was followed by 2-year survival near 68.1%. Differences were significant (p=0.02).Pancreaticoduodenectomy followed by MPV resection as the first stage of combined treatment of pancreatic head cancer is absolutely justified if circumferential involvement of the vein and contact with superior mesenteric artery or celiac trunk do not exceed 50%. Vein resection can provide R0-surgery in these cases.Цель исследования - оценить результаты панкреатодуоденальной резекции (ПДР) с резекцией мезентерико-портального сегмента (МПС) вен при раке головки поджелудочной железы (ПЖ). Материал и методы. За период 2010-2017 гг. проведен ретроспективный анализ результатов диагностики и лечения рака головки ПЖ у 124 больных. Прорастание опухоли в мезентерико-портальный сегмент (МПС) диагностировано у 37 (29,8%) больных, из них у 11 был контакт опухоли с верхней брыжеечной артерией - погранично резектабельное состояние. Всем больным выполнена ПДР с резекцией МПС вен. Результаты. Инвазия опухоли в вену при гистологическом исследовании подтвердилась у 19 (51,3%) из 37 больных. Прорастания опухоли в артерии у 11 больных с погранично резектабельной опухолью во время операций не обнаружено. Гипердиагностика прорастания опухоли в стенку вен при КТ составила 6,4%, интраоперационная - 87,5%. Хирургической радикальности (R0) удалось достичь у 88,5% после стандартной ПДР и у 78,4% после ПДР с резекцией МПС вен. Медиана выживаемости составила 17 мес, при этом 2-летняя выживаемость - 41%. Среди 11 больных с погранично резектабельной опухолью медиана выживаемости составила 11 мес. После ПДР без резекции вены двухлетняя выживаемость составила 68,1%. Различие в выживаемости оказалось статистически значимыми (p=0,02). Выводы. ПДР с резекцией МПС вен, как первый этап комбинированного лечения рака головки ПЖ, абсолютно оправдана при отсутствии циркулярного вовлечения в опухоль МПС вены и контакта опухоли с верхней брыжеечной артерией или чревным стволом более половины окружности сосуда. Резекция вены в этих случаях может обеспечить состояние R0.
- Published
- 2018
22. [Robot-assisted operations for non-organ retroperitoneal tumors]
- Author
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Kalinin Dv, Gorin Ds, A. I. Son, Kriger Ag, Ikramov Rz, and Berelavichus Sv
- Subjects
Leiomyosarcoma ,Adult ,Male ,medicine.medical_specialty ,Megaureter ,Bronchogenic cyst ,Operative Time ,Blood Loss, Surgical ,Paraganglioma ,Robotic Surgical Procedures ,Lymphangioma ,Outcome Assessment, Health Care ,medicine ,Humans ,Retroperitoneal Neoplasms ,business.industry ,Cysts ,Teratoma ,General Medicine ,Middle Aged ,medicine.disease ,Ureterocele ,Magnetic Resonance Imaging ,Retroperitoneal Neoplasm ,Surgery ,Tumor Burden ,body regions ,Leiomyoma ,Female ,Laparoscopy ,Radiology ,business ,Tomography, X-Ray Computed - Abstract
Robot-assisted operations for non-organ retroperitoneal tumors were performed in 20 patients. The biggest tumor's diameter was 160 mm, the smallest--32 mm, mean value was 79.1±37.8 mm. According to morphological investigation data lymphangioma was diagnosed in 4 (20%) patients, lipoma--in 3 (15%) cases, peritoneal cyst--in 2 (10%) patients. Solitary lymphatic node, teratoma, leiomyosarcoma, accessory stomach, bronchogenic cyst, adenogenous cancer, ureterocele, megaureter, schwannoma, leiomyoma, malignant paraganglioma were observed in 1 (5%) case respectively.Surgery duration was 138±55.9 min. Blood loss was 69±112.7 ml (range 0-500 ml). Intraoperative complications (bleeding) were diagnosed in 3 (15%) patients. There were no conversions. Robot-assisted variant has been demonstrated in case of non-organ retroperitoneal tumors with diameter not more than 100-120 mm.Цель - представить технику робот-ассистированных операций и результаты хирургического лечения больных с неорганными забрюшинными опухолями. Материал и методы. Робот-ассистированные операции по поводу неорганных забрюшинных опухолей (НЗО) выполнены 20 больным. Наибольший диаметр опухоли был 160 мм, наименьший - 32 мм, среднее значение составило 79,1±37,8 мм. На основании данных морфологического исследования лимфангиома была диагностирована у 4 (20%) больных, липома - у 3 (15%), киста брюшины - у 2 (10%), по 1 (5%) больному было с солитарным лимфатическим узлом, тератомой, лейомиосаркомой, энтерогенной кистой, бронхогенной кистой, аденогенным раком, уретероцеле, мегауретером, шванномой, лейомиомой, злокачественной параганглиомой. Результаты. Продолжительность операции составила 138±55,9 мин. Объем кровопотери 69±112,7 мл (от 0 до 500 мл). Интраоперационные осложнения (кровотечения) зафиксированы у 3 (15%) пациентов. Конверсий доступа не было. Робот-ассистированный вариант операции показан при НЗО размером не более 100-120 мм.
- Published
- 2015
23. Schwannoma of small pelvis and gluteal area
- Author
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Kriger Ag, Gorin Ds, A. R. Kaldarov, and A O Gushcha
- Subjects
Adult ,medicine.medical_specialty ,Dissection (medical) ,030230 surgery ,Schwannoma ,Small pelvis ,Pelvis ,03 medical and health sciences ,0302 clinical medicine ,Paraganglioma ,Humans ,Medicine ,Pelvic Neoplasms ,Buttocks ,medicine.diagnostic_test ,business.industry ,Dissection ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Tumor Burden ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Radiology ,Tomography, X-Ray Computed ,business ,Neurilemmoma - Published
- 2017
24. Surgical treatment of retroperitoneal masses
- Author
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P. I. Davydenko, Gorin Ds, Kriger Ag, A. R. Kaldarov, A. I. Son, D. V. Kalinin, E. A. Akhtanin, A. V. Smirnov, and Berelavichus Sv
- Subjects
Male ,Comparative Effectiveness Research ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,030232 urology & nephrology ,Russia ,Surgical methods ,03 medical and health sciences ,Retroperitoneal tumor ,Postoperative Complications ,0302 clinical medicine ,Robotic Surgical Procedures ,Blood loss ,Laparotomy ,medicine ,Humans ,Retroperitoneal Neoplasms ,Surgical treatment ,Laparoscopy ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,Patient Outcome Assessment ,Great vessels ,030220 oncology & carcinogenesis ,Female ,Radiology ,business - Abstract
To improve the results of treatment of patients with retroperitoneal tumors.The study included 83 patients with retroperitoneal tumors including 57 cases of benign tumors and 26 patients with malignancies. Laparotomy (Lt), robot-assisted (RA) and laparoscopic (Ls) techniques were used in 35, 34 and 14 patients respectively. Median tumor sizes in the largest dimension were 102 mm, 75 mm and 81.5 mm in Lt, RA and Ls groups respectively.Average time of surgery was 112.5 minutes in Lt-group, 140 min in RA group and 125 minutes in Ls group. Median blood loss was 125 ml, 50 ml and 50 ml in the same groups respectively. Conversion was performed in 1 patient during RA-surgery and in 7 patients during laparoscopy. Postoperative complications occurred in 6 patients after laparotomy and in 5 patients after RA-intervention. There were no deaths.Comprehensive evaluation of different surgical methods is necessary to achieve successful treatment of retroperitoneal tumors. Conventional approach is indicated for tumors over 10 cm while minimally invasive techniques are justified for tumors less than 10 cm. RA-interventions facilitates surgery for tumors located in difficult areas and small anatomical spaces as well as for neoplasms adjacent to great vessels.Введение. Неорганные забрюшинные опухоли (НЗО) - собирательная классификационная единица, объединяющая доброкачественные и злокачественные мезенхимальные новообразования, исходящие из забрюшинного пространства и не имеющие определенной органной принадлежности. Частота этих опухолей невелика и составляет 0,03-1,1%. Хирургическое вмешательство является основным в выборе тактики лечения. Цель - улучшить результат лечения больных с НЗО. Материал и методы. Оперированы 83 больных с НЗО. Доброкачественные опухоли были у 57 больных, злокачественные - у 26. Традиционным (Тр) лапаротомным методом оперированы 35 больных, робот-ассистированным (РА) - 34, лапароскопическим (Л) - 14 больных. Медиана размера опухоли в наибольшем измерении при Тр-методе составила 102 мм, при РА - 75 мм, при Л - 81,5 мм. Результаты. Длительность операции (медиана) при Тр-методе составила 112,5 мин, при РА - 140 мин, при Л - 125 мин. Медиана объема кровопотери при Тр-методе составила 125 мл, при РА - 50 мл, при Л - 50 мл. Конверсия при РА-методе потребовалась 1 раз, при Л - 7 раз. Послеоперационные осложнения возникли у 6 больных при Тр и у 5 больных при РА-методе. Летальных исходов не было. Вывод. Для достижения успешного хирургического лечения НЗО необходима оценка возможностей различных методов выполнения операции. Показанием к Тр-методу удаления НЗО является размер опухоли более 10 см, миниинвазивные методы оправданы и позволяют получить хорошие результаты при опухолях менее 10 см. РА-вариант вмешательства существенно облегчает выполнение операции при расположении опухоли в трудных для манипуляций областях и малых анатомических пространствах, в случае прилежания опухоли к магистральным сосудам.Введение. Неорганные забрюшинные опухоли (НЗО) — собирательная классификационная единица, объединяющая доброкачественные и злокачественные мезенхимальные новообразования, исходящие из забрюшинного пространства и не имеющие определенной органной принадлежности. Частота этих опухолей невелика и составляет 0,03—1,1%. Хирургическое вмешательство является основным в выборе тактики лечения. Цель — улучшить результат лечения больных с НЗО. Материал и методы. Оперированы 83 больных с НЗО. Доброкачественные опухоли были у 57 больных, злокачественные — у 26. Традиционным (Тр) лапаротомным методом оперированы 35 больных, робот-ассистированным (РА) — 34, лапароскопическим (Л) — 14 больных. Медиана размера опухоли в наибольшем измерении при Тр-методе составила 102 мм, при РА — 75 мм, при Л — 81,5 мм. Результаты. Длительность операции (медиана) при Тр-методе составила 112,5 мин, при РА — 140 мин, при Л — 125 мин. Медиана объема кровопотери при Тр-методе составила 125 мл, при РА — 50 мл, при Л — 50 мл. Конверсия при РА-методе потребовалась 1 раз, при Л — 7 раз. Послеоперационные осложнения возникли у 6 больных при Тр и у 5 больных при РА-методе. Летальных исходов не было. Вывод. Для достижения успешного хирургического лечения НЗО необходима оценка возможностей различных методов выполнения операции. Показанием к Тр-методу удаления НЗО является размер опухоли более 10 см, миниинвазивные методы оправданы и позволяют получить хорошие результаты при опухолях менее 10 см. РА-вариант вмешательства существенно облегчает выполнение операции при расположении опухоли в трудных для манипуляций областях и малых анатомических пространствах, в случае прилежания опухоли к магистральным сосудам.
- Published
- 2017
25. Risk factors and prevention of postoperative pancreatitis after pancreatectomy
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A V Glotov, Gorin Ds, E. A. Akhtanin, V. M. Zemskov, M N Kozlova, N. S. Shishkina, A. V. Smirnov, Berelavichus Sv, and Kriger Ag
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Gastroenterology ,Perioperative Care ,Piroxicam ,03 medical and health sciences ,Pancreatectomy ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Pancreatic tumor ,Pancreatitis, Chronic ,Lornoxicam ,Internal medicine ,medicine ,Humans ,Prospective cohort study ,Injections, Intraventricular ,Retrospective Studies ,Pancreatic duct ,business.industry ,General surgery ,Anti-Inflammatory Agents, Non-Steroidal ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Pancreatic Neoplasms ,Treatment Outcome ,medicine.anatomical_structure ,Pancreatitis ,Pancreatic fistula ,Female ,030211 gastroenterology & hepatology ,business ,medicine.drug - Abstract
to improve the results of pancreatic resections through decrease of postoperative pancreatitis incidence.It was analyzed 207 patients who underwent pancreatic surgery for pancreatic tumor (n=137) or chronic pancreatitis (n=70). 22 risk factors of postoperative pancreatitis were analyzed in 112 patients retrospectively. In prospective study of 95 patients the efficacy of lornoxicam to prevent postoperative pancreatitis was assessed. 68 parameters of immune state were studied to estimate effect of lornoxicam.Significant factors were mellow pancreatic parenchyma, tumoral disease, pancreatic duct diameter over 3 mm, pancreatric duct index over 0.2, body mass index over 27 kg/m2. Likelihood of postoperative pancreatitis was 40%, 63%, 74.3% and 88.9% if 2, 3, 4 and 5 factors were combined respectively. Preventive use of lornoxicam reduced significantly incidence of postoperative pancreatitis (p=0.042). Incidence of pancreatic fistula and arrosive bleeding was decreased insignificantly due to small number of observations.Assessment of significant risk factors and use of medical prevention are available to decrease likelihood of postoperative pancreatitis.Цель работы - улучшение результатов резекционных операций на поджелудочной железе за счет снижения частоты возникновения послеоперационного панкреатита (ПП). Материал и методы. Анализу подвергнуты результаты лечения 207 больных, которым выполнены резекционные радикальные операции по поводу различных опухолей поджелудочной железы (n=137) или хронического панкреатита (n=70). В ретроспективном исследовании у 112 больных изучено 22 фактора риска возникновения ПП. В проспективном исследовании у 95 больных изучена эффективность применения лорноксикама для профилактики ПП. Для оценки механизма действия лорноксикама изучено 68 показателей иммунного статуса пациентов, получавших препарат и леченных без его применения. Результаты. Статистически достоверными факторами оказались: мягкая паренхима поджелудочной железы, опухолевый характер заболевания, диаметр панкреатического протока менее 3 мм, индекс панкреатического протока менее 0,2, индекс массы тела более 27 кг/м2. В случае сочетания двух факторов риска вероятность ПП составила 40,0%, трех - 63,0%, сочетание четырех факторов приводило к ПП в 74,3%, пяти - в 88,9% наблюдений. Профилактическое использование лорноксикама позволило статистически достоверно (р=0,042) уменьшить частоту возникновения ПП, уменьшение частоты возникновения панкреатических свищей и аррозионного кровотечения было статистически недостоверным из-за небольшого количества наблюдений. Выводы. Оценка значимых факторов риска и использование медикаментозной профилактики ПП является одним из возможных способов уменьшения частоты его возникновения.
- Published
- 2016
26. Laparoscopic ileocecal resection for cecalangiodysplasia
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Gorin Ds, Kalinin Dv, Kriger Ag, A. V. Smirnov, and Berelavichus Sv
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medicine.medical_specialty ,Ileocecal Valve ,medicine.diagnostic_test ,business.industry ,General surgery ,General Medicine ,Middle Aged ,Ileocecal resection ,Cecal Diseases ,medicine.disease ,Angiodysplasia ,Surgery ,Ileocecal valve ,medicine.anatomical_structure ,medicine ,Humans ,Female ,Laparoscopy ,Laparoscopic resection ,Surgical treatment ,business ,Digestive System Surgical Procedures - Published
- 2015
27. Organic hyperinsulinism: radiological diagnostics and surgical treatment
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R. S. Dugarova, Gorin Ds, N. A. Karel’skaya, A. R. Kaldarov, A. G. Krieger, A. V. Smirnov, Berelavichus Sv, Vetsheva Nn, Lebedeva An, and D. V. Kalinin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Nesidioblastosis ,Moscow ,Endosonography ,Diagnosis, Differential ,03 medical and health sciences ,Pancreatectomy ,Postoperative Complications ,0302 clinical medicine ,Hyperinsulinism ,Laparotomy ,medicine ,Humans ,Insulinoma ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Hypoglycemia ,Pancreatic Neoplasms ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Radiology ,Differential diagnosis ,Tomography, X-Ray Computed ,business ,Blood sampling - Abstract
To optimize the diagnosis and surgical treatment of insulinoma and nesidioblastosis.42 patients with organic hyperinsulinism (OH) were operated. There were 39 cases of insulinoma including 2 patients with insulinoma combined with nesidioblastosis and 3 cases of nesidioblastosis alone. Preoperative ray imaging consisted of percutaneous, endoscopic and intraoperative sonography, contrast-enhanced computed tomography, magnetic resonance imaging (MRI). Functional test included arterial-stimulated blood sampling (ASBS). Laparotomy and robot-assisted techniques were used in 22 and 20 patients.Sensitivity was 62.0%, 76.9%, 83.3%, 87.5%, 94.8% and 100% in percutaneous sonography, CT, endoscopic sonography, MRI, intraoperative sonography and ASBS respectively. Postoperative complications were observed in 14 and 6 patients after conventional and robot-assisted surgery. 2 patients died. Overall mortality was 4.8%. None patient had recurrent hypoglycemic conditions in long-term postoperative period (mean follow-up 18.7 months).Comprehensive survey allowed to define the cause of OH. Minimally invasive organ-sparing surgery has satisfactory immediate and remote results in these patients.Введение. Цель работы - оптимизация диагностики инсулином и незидиобластоза и тактики хирургического лечения больных. Материал и методы. Оперированы 42 больных с органическим гиперинсулинизмом (ОГ). Пациентов с инсулиномами было 39 (из них у 2 имело место сочетание инсулиномы и незидиобластоза), незидиобластозом - 3. Дооперационная лучевая диагностика включала чрескожное, эндоскопическое и интраоперационное ультразвуковое исследование (УЗИ), компьютерную томографию (КТ) с болюсным усилением, магнитно-резонансную томографию (МРТ). Функциональная диагностика заключалась в использовании ангиографии с артериально-стимулированным забором крови (АСЗК). Из лапаротомного доступа оперированы 22 больных, робот-ассистированным методом - 20. Результаты. Чувствительность чрескожного УЗИ составила 62,0%, КТ - 76,9%, эндоУЗИ - 83,3%, МРТ - 87,5%, интраоперационное УЗИ - 94,8%, АСЗК - 100%. Послеоперационные осложнения после традиционных операций были у 14 больных, после робот-ассистированных - 6. Умерли 2 больных, общая летальность составила 4,8%. В отдаленном периоде при медиане наблюдения 18,7 мес рецидива гипогликемических состояний не отмечено ни у одного больного. Вывод. Комплексное обследование больных позволило добиться точной диагностики причины ОГ. Органосохраняющее хирургическое лечение таких больных с применением минимально инвазивных технологий обеспечило хорошие ближайшие и отдаленные результаты.
28. [Diagnosis and treatment of duodenal dystrophy in patients with chronic pancreatitis]
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Kriger Ag, Ya. I. Nerestyuk, A V Glotov, D. V. Kalinin, G. G. Karmazanovskiy, Gorin Ds, Vetsheva Nn, A. V. Smirnov, and Berelavichus Sv
- Subjects
Adult ,Male ,medicine.medical_specialty ,Ectopic pancreatic tissue ,Duodenum ,Gastroenterology ,Resection ,Endosonography ,Pancreaticoduodenectomy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Pancreatitis, Chronic ,Complete regression ,medicine ,Humans ,In patient ,Duodenal Diseases ,Pancreas ,Retrospective Studies ,business.industry ,Persistent pain ,Optimal treatment ,General surgery ,Dystrophy ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Treatment Outcome ,030220 oncology & carcinogenesis ,Pancreatitis ,030211 gastroenterology & hepatology ,Female ,business ,Tomography, X-Ray Computed - Abstract
to define optimal treatment of duodenal dystrophy in patients with chronic pancreatitis.515 patients with chronic pancreatitis have been treated for the period 2004-2015 in A.V.Vishnevsky Institute of Surgery. Duodenal dystrophy (DD) was diagnosed in 79 (15.3%) of them. The diagnosis was confirmed by sonography, CT, MRI and endosonography. 5 patients are under observation without surgery. 74 patients were operated after previous medical therapy during 39 months on the average. Pancreatoduodenectomy was performed in 36 patients. Organ-sparing interventions were applied in 34 cases including different duodenal resections in 20 patients and pancreatic head resections in different modifications in 14 cases. 4 patients underwent palliative surgery. Chronic pancreatitis and DD were verified by morphological analysis of specimens. Long-term results were estimated in 47 patients. Median follow-up was 49.9 months.X-ray diagnostics showed that DD was combined with chronic pancreatitis in 87.3% of cases while morphological analysis revealed 93.8%. Clinical signs of DD were caused by striated pancreatitis in 69.6% and ectopic pancreatic tissue in 30.4%. Clinical manifestations of DD did not depend on its cause and were presented by symptoms of chronic pancreatitis. Postoperative complications occurred in 25 (34.7%) patients. There were 33.5% of complications after pancreatoduodenectomy and 70% after duodenal resection. 1 patient died. Overall mortality was 1,3%. In long-term period complete regression of symptoms was observed in 66% of cases, significant improvement - in 32%, absence of the effect - in 2%.Medical therapy should be preferred for patients with DD and chronic pancreatitis. Surgery is indicated in case of persistent pain, complicated course of chronic pancreatitis and duodenal obstruction. Pancreatoduodenectomy and pancreatic head resection are preferred.Введение. Для обозначения кистозно-воспалительной трансформации стенки двенадцатиперстной кишки (ДПК) при хроническом панкреатите (ХП) используется термин 'дуоденальная дистрофия' (ДД). Патогенез этого состояния не изучен, а лечебная тактика не определена. Материал и методы. Обследованы 515 больных ХП, находившихся на лечении в Институте хирургии им. А.В. Вишневского в 2004-2015 гг. ДД была диагностирована у 79 (15,3%) больных. Диагноз установлен по данным УЗИ, КТ, МРТ и эндоУЗИ. Не оперированы и находятся под наблюдением 5 больных. Оперированы 74 пациента после консервативного лечения средней продолжительности (39 мес). Панкреатодуоденальная резекция (ПДР) произведена 36 больным. Органосохраняющие операции выполнены 34 больным: различные резекции ДПК - 20, резекция головки поджелудочной железы (ПЖ) в разных модификациях - 14. Паллиативные операции произведены 4 больным. Диагнозы ХП и ДД верифицированы при морфологическом исследовании операционного материала. Отдаленные результаты лечения изучены у 47 человек, медиана наблюдения составила 49,9 мес. Результаты. ДД сочеталась с ХП по данным лучевой диагностики у 87,3% больных, по результатам морфологического исследования - у 93,8%. Причиной клинической картины ДД в 69,6% наблюдений явился бороздчатый панкреатит, в 30,4% - эктопия ткани ПЖ. Клинические признаки ДД не зависели от причины ее возникновения и проявлялись симптомокомплексом, характерным для ХП. Послеоперационные осложнения развились у 25 (34,7%) больных: после ПДР - у 33,5%, после резекций ДПК - у 70% (умер 1 больной). Общая летальность составила 1,3%. При оценке отдаленных результатов полное исчезновение симптоматики отмечено у 66% человек, значительное улучшение - у 32%, отсутствие эффекта - у 2%. Выводы. Лечение больных, страдающих ХП и ДД, вначале должно быть консервативным. Хирургическое лечение показано при сохраняющейся боли и наличии осложнений ХП, нарушения проходимости ДПК. Операциями выбора являются панкреатодуоденальная резекция, резекции головки ПЖ.
29. [Enucleation of pancreatic tumors: a multiple-center study].
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Solodkiy VA, Kriger AG, Akhaladze GG, Goev AA, Goncharov SV, Gorin DS, Zagainov VE, Kuznetsov NS, Kuchin DM, Latkina NV, Lysanyuk MV, Maistrenko NA, Martirosyan TA, Romashchenko PN, Shuinova EA, and Yukina MY
- Subjects
- Humans, Pancreatectomy adverse effects, Pancreatectomy methods, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Pancreatic Fistula surgery, Treatment Outcome, Retrospective Studies, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications surgery, Neuroendocrine Tumors complications, Pancreatic Neoplasms pathology, Neuroectodermal Tumors, Primitive complications, Neuroectodermal Tumors, Primitive surgery
- Abstract
Objective: To evaluate the immediate results of enucleation of pancreatic neuroendocrine tumors (pNETs)., Material and Methods: The results of enucleation of pancreatic neuroendocrine tumors (pNETs) were analyzed in 95 patients between 2016 and 2021. Functioning tumors (mean size 16.8 mm) were found in 70 patients, non-functioning (mean size 25 mm) - in 25 patients. Intraparenchymal tumors were found in 48 people, extraorganic lesion - in 47 patients., Results: There were 262 patients with pNETs who underwent various surgeries between 2016 and 2021. Various resections were performed in 167 (63.8%) cases, enucleations - in 95 (36.2%) patients. Traditional surgical approach was used in 65 patients. Pancreatic fistula occurred in 21 patients (type B - 17, type C - 4), while arrosive bleeding occurred in 6 patients with unfavorable outcomes in 2 cases. Minimally invasive surgeries were performed in 30 patients. Eight patients with intraparenchymal tumors required conversion to open surgery. Type B pancreatic fistula occurred in 5 patients that led to arrosive bleeding in 2 cases (hemostasis was provided by endovascular method). Comparison of intraparenchymal and extraorgan tumors regarding the incidence of pancreatic fistula revealed odds ratio 5.26 (95% CI 1.5355; 18.0323, p =0.0041). Postoperative mortality was 2.1%., Conclusion: Enucleation is advisable for highly differentiated pancreatic neuroendocrine tumors up to 2 cm. Minimally invasive enucleation is indicated for extraorgan tumors. Intraparenchymal tumors significantly increase the risk of postoperative complications.
- Published
- 2023
- Full Text
- View/download PDF
30. [Pancreaticoduodenectomy - results and prospects (two-center study)].
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Solodky VA, Kriger AG, Gorin DS, Dvukhzhilov MV, Akhaladze GG, Goncharov SV, Panteleev VI, and Shuinova EA
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- Humans, Pancreaticoduodenectomy adverse effects, Pancreaticoduodenectomy methods, Pancreatic Fistula diagnosis, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Pancreaticojejunostomy adverse effects, Pancreaticojejunostomy methods, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications etiology, Gastroparesis complications, Gastroparesis surgery, Pancreatitis surgery
- Abstract
Objective: To summarize the results of pancreaticoduodenectomy (PD) for pancreatic tumors and complications of chronic pancreatitis regarding prediction and prevention of postoperative complications., Material and Methods: There were 336 PD procedures between 2016 and mid-2022 in two centers. We assessed the factors influencing specific postoperative complications (postoperative pancreatitis, pancreatic fistula, gastric stasis, arrosive bleeding). Several risk factors were distinguished: baseline pancreatic disease and tumor size, CT-signs of a «soft» gland, intraoperative assessment of the pancreas, number of functioning acinar structures. We assessed surgical prevention of pancreatic fistula via preserving adequate blood supply to the pancreatic stump. The last one is provided by extended pancreatic resection and reconstructive stage of surgery, i.e. Roux-en-Y hepatico- and duodenojejunostomy with isolation of pancreaticojejunostomy on the second loop., Results: Postoperative pancreatitis underlies specific complications after PD. The risk of pancreatic fistula in case of postoperative pancreatitis increases by 5.3 times compared to patients without pancreatitis. Postoperative pancreatic fistula is more common in patients with T1 and T2 tumors. According to univariate analysis, only pancreatic fistula significantly affects the risk of gastric stasis. Among 336 people who underwent PD, pancreatic fistula occurred in 69 patients (20.5%), gastric stasis - in 61 (18.2%), pancreatic fistula complicated by arrosive bleeding - in 45 (13.4%) patients. Mortality rate was 3.6% ( n =15)., Conclusion: Modern prognostic criteria are valuable to predict specific complications after PD. A promising way to prevent postoperative pancreatitis can be extended pancreatic resection considering angioarchitectonics of the pancreatic stump. Roux-en-Y pancreaticojejunostomy is advisable to reduce aggressiveness of pancreatic fistula.
- Published
- 2023
- Full Text
- View/download PDF
31. [Non-occlusive mesenteric ischemia in reconstructive digestive tract surgery].
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Ruchkin DV, Okonskaya DE, Karmazanovsky GG, Kozlov VA, Rymar OA, and Gorin DS
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- Female, Humans, Ischemia diagnosis, Ischemia etiology, Ischemia surgery, Male, Necrosis surgery, Mesenteric Ischemia diagnosis, Mesenteric Ischemia etiology, Mesenteric Ischemia surgery, Plastic Surgery Procedures adverse effects, Shock, Septic
- Abstract
Objective: To analyze the mechanisms of non-occlusive mesenteric ischemia (NOMI) after digestive tract surgery., Material and Methods: NOMI occurred in 10 (0.4%) patients after reconstructive digestive tract surgery between 2015 and 2021. There were 4 women and 6 men aged 29-92 years (67 [60; 71]). Patients differed from each other in the nature of baseline disease and surgical approach. All patients underwent standardized surgical interventions. There were no intraoperative complications., Results: Median of surgery time was 372.5 (246.25; 548.75) min, blood loss - 450 (200; 725) ml. These parameters conformed to the type of surgery. There were no specific clinical signs of NOMI. Lactic acidosis (>4 mmol/L) occurred in 7 patients after 1-3 postoperative days. In 6 patients, fulminant NOMI developed after 1-2 postoperative days with subsequent multiple organ failure syndrome and septic shock. All patients underwent emergency redo surgery. Multivisceral gastrointestinal necrosis occurred in 5 patients, gastric conduit necrosis - 3, colon necrosis - 1, gastric stump necrosis - 1 patient. Mortality rate was 80%. Two patients survived., Conclusion: NOMI manifested as a septic shock in 60% of patients that was due to fulminant development of multivisceral necrosis after 1-2 postoperative days. Timely diagnosis of reversible NOMI in these cases was impossible. Extensive visceral necrosis in early postoperative period is probably associated with intraoperative critical ischemia of digestive organs.
- Published
- 2022
- Full Text
- View/download PDF
32. [A rare variant of pancreatic serous cystadenoma].
- Author
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Kriger AG, Gorin DS, Akhtanin EA, Glotov AV, and Panteleev VI
- Subjects
- Humans, Pancreas diagnostic imaging, Pancreas surgery, Pancreatectomy, Pancreaticoduodenectomy, Cystadenoma, Serous diagnosis, Cystadenoma, Serous surgery, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms surgery
- Abstract
The authors present a patient with serous cystadenoma of the pancreatic head. Atypical symptoms and CT data did not allow excluding pancreatic cancer. Thus, pancreaticoduodenectomy was performed.
- Published
- 2022
- Full Text
- View/download PDF
33. [Postoperative pancreatitis after pancreatoduodenectomy].
- Author
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Gorin DS, Kriger AG, Galkin GV, and Raevskaya MB
- Subjects
- Humans, Pancreas surgery, Pancreatic Fistula diagnosis, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Pancreaticoduodenectomy adverse effects, Pancreatitis diagnosis, Pancreatitis epidemiology, Pancreatitis etiology
- Abstract
Objective: Retrospective assessment of the influence of postoperative pancreatitis in development of pancreatic fistula., Material and Methods: The study included 173 patients after pancreatoduodenectomy performed between 2016 and 2019. Postoperative pancreatitis within the 1
st postoperative day was verified considering blood amylase > 125 U/L. Patients with postoperative pancreatitis ( n =36) were included in the main group, the control group consisted of 137 patients without pancreatitis. Postoperative pancreatic fistula was determined according to the ISGPS 2016 classification. Statistical analysis of the effect of postoperative pancreatitis on development of pancreatic fistula was carried out using relative risk and odds ratio with 95% confidence interval in both groups., Results: Postoperative pancreatitis occurred in 36 (20.8%) out of 173 patients after pancreatoduodenectomy. Pancreatic fistula occurred in 18 (50%) cases. Among 137 patients without postoperative pancreatitis, only 18 (13.1%) patients developed severe pancreatic fistula. Relative risk was 3.8 (95% CI 2.22-6.51, p <0.0001), odds ratio - 6.6 (95% CI 2.91-15.01, p <0.0001)., Conclusion: Postoperative pancreatitis significantly influences development of severe pancreatic fistula.- Published
- 2022
- Full Text
- View/download PDF
34. [Combination of intraductal papillary mucinous neoplasm with other cystic pancreatic tumors].
- Author
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Panteleev VI, Kaldarov AR, Gorin DS, and Kriger AG
- Subjects
- Cystadenoma, Mucinous diagnosis, Cystadenoma, Mucinous surgery, Humans, Pancreas surgery, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms surgery, Carcinoma, Pancreatic Ductal diagnosis, Carcinoma, Pancreatic Ductal surgery, Neoplasms, Cystic, Mucinous, and Serous diagnosis, Neoplasms, Cystic, Mucinous, and Serous surgery, Pancreas pathology, Pancreatic Intraductal Neoplasms diagnosis, Pancreatic Intraductal Neoplasms surgery
- Abstract
Cystic tumors of the pancreas are uncommon entities. Synchronic occurrence of intraductal papillary mucinous neoplasm (IPMN) and other pancreatic tumors is extremely rare. Two patients with this diagnosis are reported in the manuscript. Cystic tumors of the pancreas can rarely occur in various combinations while malignancy potential of each neoplasm may be different. Surgery depends on localization and type of each tumor and must be determined individually.
- Published
- 2021
- Full Text
- View/download PDF
35. [Pancreatic proinsulinoma].
- Author
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Kriger AG, Berelavichus SV, Gorin DS, Panteleev VI, Demidova VS, Davydenko PI, Varava AB, and Kaldarov AR
- Subjects
- Female, Humans, Hypoglycemia etiology, Insulin analysis, Male, Pancreas metabolism, Pancreas pathology, Pancreas surgery, Insulinoma complications, Insulinoma diagnosis, Insulinoma metabolism, Insulinoma surgery, Pancreatic Neoplasms complications, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms metabolism, Pancreatic Neoplasms surgery, Proinsulin biosynthesis
- Abstract
Objective: To report own experience in the treatment of patients with proinsulinoma., Material and Methods: There were 10 patients with increased proinsulin production and normal insulin level since 2017. Most of them were young women., Results: Fasting hypoglycemia in all patients was severe (up to 0.7 mmol/l). Clinical picture consisted of typical symptoms similar to those in insulinoma. The main difference in the course of proinsulinoma was the absence of weight gain in 7 patients and rapid weight loss (from 210 to 90 kg within 9 months) in 1 patient. All patients with proinsulinoma underwent surgery. In most cases, minimally aggressive surgery was performed., Conclusion: Proinsulinoma is an extremely rare endocrine-active neuroendocrine pancreatic tumor. Differential features of proinsulinoma are the absence of weight gain and normal insulin levels in the presence of hypoglycemia. Surgery is the only radical method of treatment.
- Published
- 2021
- Full Text
- View/download PDF
36. [Endoscopic treatment of duodenal duplication cyst].
- Author
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Panteleev VI, Marinova LA, Kaldarov AR, Gorin DS, and Kriger AG
- Subjects
- Adult, Duodenoscopy, Duodenum abnormalities, Duodenum surgery, Female, Humans, Digestive System Abnormalities diagnosis, Digestive System Abnormalities surgery, Duodenal Diseases congenital, Duodenal Diseases diagnosis, Duodenal Diseases surgery
- Abstract
Duodenal duplication cyst (DDC) is a rare form of intestinal malformation (2-12% of all gastrointestinal duplications). There are many difficulties in diagnosis and management of DDC. We present a case of successful endoscopic transluminal treatment of DDC in a 30-year-old female. She complained of epigastric pain, nausea and vomiting, weight loss of 5 kg over the past 3 months. Laparoscopic cholecystectomy for gallstone disease was performed 18 months prior to admission. Examination revealed a cyst 52×60?35 mm in descending part of duodenum. There was a calculus inside the cyst. Transluminal endoscopic cyst fenestration was performed. Histological examination confirmed DDC. According to control duodenoscopy data, cyst was collapsed. The patient remains asymptomatic three months after surgery. DDC is a rare disease of gastrointestinal tract, which should be differentiated first with choledochocele Todani type III and intraluminal duodenal diverticulum. Endoscopic treatment may be an adequate alternative to traditional interventions in some cases.
- Published
- 2021
- Full Text
- View/download PDF
37. Successful Surgical Treatment of a Patient with Synchronic Intraductal Papillary Mucinous Carcinoma and Solid Pseudopapillary Neoplasm of the Pancreas.
- Author
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Kriger AG, Gorin DS, Berelavichus SV, Panteleev VI, and Kaldarov AR
- Abstract
Intraductal papillary mucinous neoplasm (IPMN) and solid pseudopapillary neoplasm (SPN) are uncommon cystic tumors of the pancreas. The simultaneous occurrence of these 2 pancreatic neoplasms is extremely rare. We present a case of synchronous solid SPN and IPMN - carcinoma in a 44-year-old female patient. An uncommon surgical treatment was performed - pancreatoduodenectomy with the resection of the pancreas body, resection of the mesentericoportal trunk + distal pancreatectomy, and splenectomy. Part of the pancreatic tissue was preserved., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2020 by S. Karger AG, Basel.)
- Published
- 2020
- Full Text
- View/download PDF
38. [Predicting of pancreatic fistula after pancreatoduodenectomy].
- Author
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Gorin DS, Kriger AG, Galkin GV, Kalinin DV, Glotov AV, Kaldarov AR, Galchina YS, and Berelavichus SV
- Subjects
- Humans, Pancreas surgery, Pancreatectomy, Pancreatic Fistula etiology, Prognosis, Risk Factors, Bile Duct Neoplasms surgery, Pancreatic Fistula diagnosis, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy adverse effects
- Abstract
Objective: Identifying the opportunity of objective prognosis of pancreatic fistula emergence after pancreatoduodenectomy., Material and Methods: In the department of abdominal surgery in 2016-2019, 177 pancreatoduodenectomies for pancreatobiliary tumors were performed. 4 risk factors were identified: type of tumor, preoperative CT with an accumulation coefficient in the pancreas of more than 1, soft pancreas, the number of functioning acinar structures identified during intraoperative histological examination. Statistical data processing and predictive modeling were performed using a binary logistic regression model., Results: Clinically significant pancreatic fistula was developed in 47 (26,6%) patients. Risk indicators for the occurrence of pancreatic fistula depending on the presence or absence of risk factors were obtained. Groups of patients were identified that require various preventive and therapeutic measures aimed to treat postoperative pancreatitis and its consequences., Conclusion: Predicting the pancreatic fistula emergence allows to take timely preventive and therapeutic measures, both minimal and aggressive (early extracorporeal detoxification, pancreatectomy), which may lead to complications. Well-reasoned pancreatectomy and extracorporeal detoxification is a surgeon's defense in an insured case or legal conflict.
- Published
- 2020
- Full Text
- View/download PDF
39. [Contrast-enhanced computed tomography in evaluation of pancreatic stump volume in pancreaticoduodenectomy].
- Author
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Galchina YS, Karmazanovsky GG, Kondratyev EV, Gorin DS, Galkin GV, and Kriger AG
- Subjects
- Contrast Media, Humans, Organ Size, Pancreas pathology, Pancreatic Ducts diagnostic imaging, Pancreatic Ducts pathology, Pancreatic Ducts surgery, Pancreatic Fistula etiology, Retrospective Studies, Risk Factors, Tomography, X-Ray Computed, Pancreas diagnostic imaging, Pancreas surgery, Pancreatic Fistula diagnostic imaging, Pancreaticoduodenectomy adverse effects
- Abstract
Objective: To analyze the role of contrast-enhanced computed tomography in evaluation of pancreatic stump volume for prediction of significant pancreatic fistula., Material and Methods: A retrospective analysis enrolled 99 patients. Patients were divided into 2 groups depending on the course of postoperative period and development of clinically significant pancreatic fistula. The first group included 24 patients (25%) with clinically significant postoperative pancreatic fistula. The second group included 75 patients (75%) without postoperative complications. Pancreatic structure, pancreatic parenchyma thickness (mm), pancreatic duct diameter (mm) and volume of pancreatic stump (cm
3 ) were preoperatively analyzed considering contrast-enhanced computed tomography data., Results: The risk of postoperative pancreatic fistula is 10 times higher in case of soft structure of the pancreas, 1,7 times higher in decrease of pancreatic duct diameter, 9,3 times higher in increased volume of residual pancreatic parenchyma, 8.6 times higher in increase of pancreatic parenchyma thickness., Conclusion: Contrast-enhanced computed tomography is valuable for preoperative evaluation of the volume of residual pancreatic parenchyma and identification of patients with high risk of postoperative pancreatic fistula.- Published
- 2020
- Full Text
- View/download PDF
40. [Diagnostic and treatment of the intraductal papillary mucinous tumor of pancreas].
- Author
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Krieger AG, Karmazanovskiy GG, Panteleev VI, Gorin DS, Vetsheva NN, Berelavichus SV, Kaldarov AR, and Glotov AV
- Subjects
- Humans, Pancreas pathology, Pancreas surgery, Pancreatectomy adverse effects, Pancreatic Intraductal Neoplasms diagnostic imaging, Pancreatic Neoplasms diagnostic imaging, Pancreaticoduodenectomy adverse effects, Pancreatic Intraductal Neoplasms diagnosis, Pancreatic Intraductal Neoplasms surgery, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms surgery
- Abstract
Objective: Adjustment of diagnostics and management of the surgical treatment of patients with intraductal papillary mucinous tumor of pancreas., Material and Methods: From 2012 to 2018, 45 patients with intraductal papillary mucinous tumor were observed. During the observation the ultrasound examination, contrast-enhanced computed tomography and magnetic resonance tomography with contrast were used. In 29 cases radical surgery was performed, nonradical in 1 case; case follow-up is chosen for 15 patients., Results: Intraductal papillary mucinous tumor was diagnosed and the definition of the type of tumor was made on the base of 2 types of imaging methods. Intraductal papillary mucinous tumor type 1 was founded in 5 (11%), whereas intraductal papillary mucinous tumor type 2 was founded in 20 (44,5%) and intraductal papillary mucinous tumor type 3 was observed in 20 (44,5%) cases. Intraductal papillary mucinous tumor associated with carcinoma was observed in 16 cases. Pancreaticoduodenal resection was performed in 20, distal exsection of pancreas was performed in 4 cases (2 in open manner access, 2 in robot-assisted manner), pancreatic head resection was performed in 3 cases (1 in open manner access, 2 in laparoscopic access) and in 2 cases the duodenopancreatectomy was performed. Explorative laparotomy was performed in case of intraductal papillary mucinous tumor type 2 associated with mucilaginous carcinoma and miliary metastasis in the liver. Early postoperative complications were observed in 5 cases (16, 6%): biliary fistula (n=2), postoperative wound infection (n=2), arrosive hemorrhage type B in ISGPS (n=1, was treated in an X-ray endovascular manner). Case follow-up was chosen in 15 cases of intraductal papillary mucinous tumor over the course of 6 to 74 months and disease progression was not observed., Conclusion: Intraductal papillary mucinous tumor is a condition associated with high risk of malignant change and demands early disease detection. The treatment should be provided in medical centers that specialize in the pancreas deceases, where a full patient examination as well as a clear-eyed understanding of diagnostic information with the execution of desirable type of surgical intervention with the guaranty of achievement R0 condition can be offered.
- Published
- 2020
- Full Text
- View/download PDF
41. Proinsulin-Secreting Neuroendocrine Tumors of the Pancreas: A Single-Centre Experience.
- Author
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Kriger AG, Berelavichus SV, Kaldarov AR, Panteleev VI, Gorin DS, Dugarova RS, and Yukina MY
- Abstract
Background: Proinsulinoma is a neuroendocrine tumor (NET) of the pancreas that produces prohormone proinsulin. These tumors are very rare. In the literature, they are most often presented in the form of case reports., Materials and Methods: We studied 177 patients with NET of the pancreas who underwent surgical treatment in the A.V. Vishnevsky National Medical Research Centre of Surgery from January 2007 to December 2018., Results: Of 81 patients with organic hyperinsulinism caused by functioning NETs of the pancreas during the study period, 3 (3.7%) had a proinsulinoma; 2 were female; and 1 was male. None of them admitted to weight gain during this period, and their BMI was normal. All patients presented with Whipple's triad during the 72-h fast. Tumor-enucleating surgery was performed: one robot assisted, two laparotomies. A normal glucose level after treatment was achieved in all cases., Conclusion: In cases where clinical hypoglycemia is present, but the serum insulin level is within the normal range or even decreased, proinsulinoma should be suspected. For now, surgical resection remains the only effective method of treatment. Further investigation of pro-insulinomas is needed., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2019 by S. Karger AG, Basel.)
- Published
- 2019
- Full Text
- View/download PDF
42. Combination of laparoscopy and endoscopy as an option for treatment patients with gastric neuroendocrine tumors.
- Author
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Kriger AG, Gorin DS, Kaldarov AR, Berelavichus SV, Marinova LA, and Galkin GV
- Abstract
Background: Neuroendocrine tumors (NETs) are relatively rare neoplasms with the increasing survival due to the development of early diagnostics. There is no universal position in treatment and follow up of small (~20 mm) gastric NETs., Clinical Cases: Two female patients 51 and 66 y.o. with multiple gastric NETs <2 cm were observed in our department. In both cases treatment was performed by combination of two minimally invasive technologies: laparoscopy and gastroscopy. According to the localization of tumors in one case intraluminal gastric resection controlled by laparoscopy was performed. In the second case laparoscopic gastric resection with gastroscopy assistance was done., Discussion: There are two positions for surgical treatment of small NETs: to operate as the typical premalignant neoplasm or to make submucosa resections. We demonstrated combination of laparoscopy and gastroscopy as feasible approach with minimal risk of complications.
- Published
- 2019
- Full Text
- View/download PDF
43. [Intraductal papillary mucinous neoplasm of pancreas].
- Author
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Panteleev VI, Gorin DS, Kaldarov AR, and Kriger AG
- Subjects
- Humans, Pancreatic Intraductal Neoplasms pathology, Pancreatic Neoplasms pathology, Practice Guidelines as Topic, Prognosis, Pancreatic Intraductal Neoplasms diagnosis, Pancreatic Intraductal Neoplasms surgery, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms surgery
- Abstract
Intraductal papillary mucinous neoplasm (IPMN) is the most common cystic pancreatic tumor. There are 3 ductal types of this tumor depending on localization. Several histological subtypes determine clinical course and prognosis. The problems of diagnosis, surgical treatment and follow-up are reviewed in several guidelines. Literature review devoted to pancreatic IPMN is presented in the article, the latest guidelines are compared.
- Published
- 2019
- Full Text
- View/download PDF
44. [X-ray-negative pancreatic dust stones in patients with chronic pancreatiti].
- Author
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Zakharova MA, Gorin DS, Marinova LA, and Kriger AG
- Subjects
- Humans, Pancreatitis, Chronic complications, X-Rays, Calculi diagnostic imaging, Pancreatic Ducts diagnostic imaging, Pancreatitis, Chronic diagnostic imaging
- Abstract
Diagnosis of chronic pancreatitis is not associated with any difficulties in patients with CT signs of pancreatic duct stones as a rule. However, 'classical' picture of chronic pancreatitis is usually absent in case of predominant protein matrix in the calculi. Two cases of X-ray-negative pancreatic dust stones in patients with protein stones of the pancreatic duct are reported.
- Published
- 2019
- Full Text
- View/download PDF
45. [The mistakes in diagnosis of pancreatic intraductal papillary mucinous tumor].
- Author
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Gorin DS, Zakharova MA, Smirnov AV, and Kriger AG
- Subjects
- Abdominal Pain etiology, Adenocarcinoma, Mucinous diagnosis, Carcinoma, Papillary diagnosis, Humans, Pancreatic Ducts pathology, Pancreaticoduodenectomy, Pancreatitis, Chronic diagnosis, Reoperation, Carcinoma, Pancreatic Ductal diagnosis, Diagnostic Errors, Neoplasm Recurrence, Local diagnosis, Pancreatic Neoplasms diagnosis
- Abstract
It is presented surgical treatment of the patient with pancreatic intraductal papillary mucinous tumor who was under observation with diagnosis of chronic pancreatitis for a long time. Recurrent tumor with possible malignant transformation to carcinoma was suspected in 5 years after pancreaticoduodenectomy. It was supposed to perform pancreatic stump extirpation. Redo surgery did not reveal any tumor. The cause of recurrent pain was pancreatic duct obliteration at the level of anastomosis.
- Published
- 2019
- Full Text
- View/download PDF
46. [Duodenopancreatectomy for pancreatic tumors - pros and cons].
- Author
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Kriger AG, Karmazanovsky GG, Berelavichus SV, Gorin DS, Kaldarov AR, Panteleev VI, Dvukhzhilov MV, Kalinin DV, Glotov AV, and Zektser VY
- Subjects
- Digestive System Surgical Procedures methods, Humans, Pancreatic Neoplasms pathology, Pancreatic Neoplasms secondary, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy methods
- Abstract
Aim: To optimize surgical treatment of multiple and advanced pancreatic tumors., Material and Methods: There were 852 patients with various pancreatic tumors for the period 2011 - September 2019. Duodenopancreatectomy (DPE) was performed in 18 patients. Locally advanced ductal adenocarcinoma was diagnosed in 10 patients, acinar cell carcinoma - in 1 patient, multiple neuroendocrine tumors - in 4 cases, intraductal papillary mucinous tumor - in 2 patients, multiple metastases of renal cell carcinoma - in 1 patient. This procedure was avoided in 9 patients who underwent alternative operations: pancreatoduodenectomy (PDE) with pancreatic body resection for intraductal papillary mucinous tumor - 5 cases, two-stage (2) and one-stage (1) distal pancreatectomy and PDE for multiple neuroendocrine tumors - 2 patients, simultaneous pancreatic head resection and distal pancreatectomy for multiple metastases of renal cell carcinoma - 1 patient., Results: Postoperative complications occurred in 14 patients after DPE (77.8%) and in 5 patients after alternative operations (55.5%). Alternative procedures in patients with neuroendocrine tumors, intraductal papillary mucinous tumors and metastases of renal cell carcinoma ensured radical surgical treatment. These patients did not need for insulin replacement therapy and enzyme drugs., Conclusion: Strict adherence to oncological canons and differentiated approach in patients with multiple neuroendocrine tumors, metastases of renal cell carcinoma and intraductal papillary mucinous tumors are essential to avoid DPE in some cases in favor of alternative operations.
- Published
- 2019
- Full Text
- View/download PDF
47. [Diagnosis and surgical treatment of duodenal tumors].
- Author
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Kriger AG, Gorin DS, Panteleev VI, and Kaldarov AR
- Subjects
- Duodenal Neoplasms pathology, Humans, Laparoscopy, Pancreaticoduodenectomy, Treatment Outcome, Duodenal Neoplasms diagnosis, Duodenal Neoplasms surgery
- Abstract
Aim: To present the experience in diagnosis and surgical treatment of duodenal tumors., Material and Methods: The study included 27 patients with different duodenal tumors: adenocarcinoma (AC, n=8), gastrointestinal stromal tumor (GIST, n=13), neuroendocrine tumor (NET, n=6). The examination included computed tomography (in 27 patients), magnetic resonance imaging (12), transcutaneous ultrasound (14), endosonography (16), esophagogastroduodenoscopy (16). All patients were operated. Conventional (18), laparoscopic (4), robot-assisted (4), endoscopic endoluminal (1) surgical interventions were performed. 17 patients were followed up from 8 months to 10 years (median 26 months)., Results: According to the instrumental diagnostic methods, duodenal tumors were verified in 19 cases. Five patients with AC underwent pancreaticoduodenectomy (Whipple procedure), 2 - palliative operations (bypass gastroenteroanastomosis), 1 - explorative laparotomy. Patients with GIST underwent 3 pancreaticoduodenectomies and 10 duodenectomies: traditional (4), laparoscopic (4) and robot-assisted (2) approaches. In case of NET 3 interventions via traditional approach (pancreaticoduodenectomy, duodenal resection, tumor enucleation), 1 endoscopic endoluminal operation, 2 robot-assisted operations (duodenal resection and duodenopancreatectomy, splenectomy, distal gastrectomy) were performed. Postoperative complications occurred in 10 (37%) patients. Postoperative mortality was absent. Long-term results were analyzed in 17 patients. All patients with GIST and NET are alive without disease progression. Two AC patients are alive from those who are available., Conclusion: Duodenal tumors are relatively rare. Radical surgical intervention in accordance with oncological principles is preferred for these patients. Organ-preserving procedures may be applied depending on morphological type of tumor. Examination and treatment of patients with duodenal tumors should be carried out in specialized surgical departments.
- Published
- 2019
- Full Text
- View/download PDF
48. [Quality of life as an efficiency index of surgical treatment of chronic pancreatitis].
- Author
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Zakharova MA, Smirnov AV, Gorin DS, Vorobyeva EA, and Kriger AG
- Subjects
- Abdominal Pain etiology, Abdominal Pain surgery, Adult, Female, Health Care Surveys, Humans, Male, Middle Aged, Pancreatectomy, Pancreatitis, Chronic complications, Treatment Outcome, Pancreatitis, Chronic surgery, Quality of Life
- Abstract
Objective: To evaluate quality of life in long-term postoperative period in patients with chronic pancreatitis., Material and Methods: There were 31 (21 males and 10 females) patients with complicated forms of chronic pancreatitis who underwent surgery in 2015-2017. Mean age was 49 (44; 53) years, body mass index - 22.4 (20.4; 24) kg/m
2 . HR-QOL was determined using the questionnaires SF-36, QLQ EORTS C30, VAS. Postoperative control was made no earlier than 6 months after surgery. Median follow-up 11.5 months. The data were analyzed using non-parametric methods. Quantitative data are shown as median with interquartile range. Differences between quantitative values were determined using the Mann-Whitney test., Results: Physical status value (SF-36) before surgery was 30.5 (24.8; 37.5), after surgery - 50.8 (46.7; 56.5). Mental status value was 30.2 (26.7; 36.4) prior to surgery and 53.8 (48.7; 57.3) after operation. Improvement of QoL (QLQ C30) from 29.17 (0; 50.0) before surgery to 75.0 (54.2; 83.3) after operation was observed. VAS-score of pain severity was 8 (8; 10) prior to surgery and 3 (2; 5) after surgery. Differences were significant (p<0.05)., Conclusion: Surgical treatment of complicated chronic pancreatitis significantly reduces pain and improves HR-QoL. However, recurrent symptoms of chronic pancreatitis in long-term period cannot be excluded due to short follow-up period (median less than one year). The further investigation is needed.- Published
- 2019
- Full Text
- View/download PDF
49. [Current issues in pancreatic surgery].
- Author
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Revishvili AS, Kriger AG, Vishnevsky VA, Smirnov AV, Berelavichus SV, Gorin DS, Akhtanin EA, Kaldarov AR, Raevskaya MB, and Zakharova MA
- Subjects
- Humans, Pancreatectomy standards, Pancreatectomy statistics & numerical data, Pancreatic Diseases epidemiology, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications prevention & control, Referral and Consultation standards, Tertiary Healthcare standards, Hospitals, Special organization & administration, Hospitals, Special standards, Hospitals, Special statistics & numerical data, Pancreatectomy adverse effects, Pancreatectomy mortality, Pancreatic Diseases surgery
- Abstract
Aim: To present own experience of pancreatic surgery and to analyze literature data for this issue., Material and Methods: We have analyzed work of abdominal surgery department over the last 5 years. Moreover, MEDLINE and RSCI databases regarding surgical treatment of pancreatic diseases were assessed., Results: There were 456 pancreatectomies. Postoperative complications arose in 176 (38.6%) patients, 11 patients died (2.4%). According to world data, mortality after pancreatectomy reaches 10%. Only creation of specialized centers is proven way to improve the outcomes., Conclusion: Current medical assistance for pancreatic disease may be only achieved in specialized centers with large number of various pancreatic procedures. The organization of such centers is required throughout the country and certain accreditation criteria should be developed for this purpose. Targeted routing of patients to specialized pancreatology centers will be able to reduce incidence of diagnostic, tactical and technical errors.
- Published
- 2018
- Full Text
- View/download PDF
50. [Endovascular procedures in pancreatic surgery].
- Author
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Revishvili AS, Kriger AG, Gorin DS, Varava AB, Goev AA, Berelavichus SV, Smirnov AV, and Akhtanin EA
- Subjects
- Aged, Aneurysm, False diagnosis, Aneurysm, False etiology, Aneurysm, False surgery, Angiography methods, Female, Humans, Male, Middle Aged, Pancreas surgery, Pancreatic Diseases complications, Regional Blood Flow, Splenic Diseases etiology, Splenic Diseases surgery, Treatment Outcome, Blood Loss, Surgical prevention & control, Endovascular Procedures adverse effects, Endovascular Procedures methods, Hemostasis, Surgical methods, Pancreas blood supply, Pancreatectomy adverse effects, Pancreatectomy methods, Pancreatic Diseases surgery, Postoperative Hemorrhage diagnosis, Postoperative Hemorrhage etiology, Postoperative Hemorrhage prevention & control
- Abstract
Aim: To evaluate an effectiveness of endovascular techniques in pancreatic surgery., Material and Methods: For the period 1995-2017 at Vishnevsky Institute of Surgery endovascular treatment (EVT) was applied in 51 patients with chronic pancreatitis complicated by false aneurysms (FA) and postoperative hemorrhage after pancreatectomy. Various methods of embolization and stenting were used in 24 and 11 cases respectively in order to exclude FA of celiac trunk and superior mesenteric artery from blood flow. Endovascular hemostasis for postoperative hemorrhage was carried out with embolization of damaged vessel in 11 patients. Stent-grafts were deployed in 5 patients with marginal defect of the wall of hepatic/superior mesenteric arteries., Results: In all 35 patients with chronic pancreatitis complicated by false aneurysms EVT ensured thrombosis of the aneurysm's cavity. EVT was final in 14 patients with FA and absent communication with pancreatic duct. Radical surgical treatment was required after 7-10 days for FA communicated with pancreatic duct due to lysis of thrombotic masses by pancreatic enzymes. Spleen infarction was diagnosed in 3 patients. Two of them did not require treatment while 1 patient underwent splenectomy in view of splenic abscess. 1 patient died from liver cirrhosis followed by severe hepatic failure, death was not associated with bleeding. In 16 patients with post-pancreatectomy bleeding hemostasis was achieved in all cases with EVT. However, recurrent bleeding occurred in 2 patients who underwent successful redo endovascular intervention. Complications after EVT were observed in 2 patients: duodenal wall necrosis followed by fistula which was closed spontaneously (n=1); advanced intestinal infarction (n=1) followed by fatal outcome; pulsating hematoma within cubital fossa that required brachial artery ligation and autovenous bypass., Conclusion: EVT provides thrombosis of FAs of celiac trunk and superior mesenteric artery branches in patients with chronic pancreatitis, as well as hemostasis for postoperative bleeding after pancreatectomy.
- Published
- 2018
- Full Text
- View/download PDF
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