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Optimizing management of pancreaticopleural fistulas

World Journal of Gastroenterology 2011年第42期17卷 4696-4703页

作者： Marek Wronski maciej slodkowski Wlodzimierz Cebulski Daniel Moronczyk Ireneusz W Krasnodebski Department of General Gastroenterological and Oncological SurgeryMedical University of Warsaw

AIM:To evaluate the management of pancreaticopleural fistulas involving early endoscopic instrumentation of the pancreatic ***:Eight patients with a spontaneous pancre-aticopleural fistula underwent endoscopic retrograde cholang iopancreatography(ERCP) with an intentionto stent the site of a ductal disruption as the primarytreatment. Imaging features and management were evaluated retrospectively and compared with ***:In one case,the stent bridged the site of aductal disruption. The fistula in this patient closed with in3 wk. The main pancreatic duct in this case appearednormal,except for a leak located in the body of the pancreas. In another patient,the papilla of Vater couldnot be found and cannulation of the pancreatic ductfailed. This patient underwent surgical treatment. In the remaining 6 cases,it was impossible to insert a stentinto the main pancreatic duct properly so as to coverthe site of leakage or traverse a stenosis situated down-stream to the fistula. The placement of the stent failed because intraductal stones(n = 2) and ductal strictures(n = 2) precluded its passage or the stent was too short to reach the fistula located in the distal part of the pancreas(n = 2) . In 3 out of these 6 patients,the pancre-aticopleural fistula closed on further medical *** these cases,the main pancreatic duct was normalor only mildly dilated,and there was a leakage at the body/tail of the pancreas. In one of these 3 patients,additional percutaneous drainage of the peripancre atic fluid collections allowed better control of the leakageand facilitated resolution of the fistula. The remaining3 patients had a tight stenosis of the main pancreatic duct resistible to dilatation and the stent could not beinserted across the stenosis. Subsequent conservative treatment proved unsuccessful in these patients. Aftera failed the rapeutic ERCP,3 patients in our series developed superinfection of the pleural or peripancreatic fluid collections. Four out of

关键词：化管理手术治疗仪器管理十二指肠保守治疗二重感染胰管患者

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Synchronous occurrence of gastrointestinal stromal tumors and other primary gastrointestinal neoplasms

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World Journal of Gastroenterology 2006年第33期12卷 5360-5362页

作者： Marek Wronski Bogna Ziarkiewicz-Wroblewska Barbara Gornicka Wlodzimierz Cebulski maciej slodkowski Aleksander Wasiutynski Ireneusz W Krasnodebski Department of General andGastroenterological Surgery and Nutrition Warsaw University of Medicine ul. Banacha 1A 02-097 Warsaw Poland Department of Pathology WarsawUniversity of Medicine ul. Pawinskiego 7 02-106 Warsaw Poland

AIM: To review clinical and pathologic features of Gas-trointestinal stromal tumors (GISTs) occurring synchro-nously with other primary gastrointestinal ***: Twenty-eight patients with primary GIST were treated at our institution between 1989 and 2005. Clinical and pathologic records were reviewed. RESULTS: The gastrointestinal stromal tumor occurred simultaneously with other primary GI malignancies in 14% of all patients with GIST. The synchronous stromal tumors were located in the stomach and were incidentally found during the operation. The coexistent neoplasms were colon adenocarcinoma, gastric cancer (2 cases) and gastric ***: The synchronous occurrence of GISTs and other gastrointestinal malignancies is more common than it has been considered. The development of gastrointestinal stromal tumors and other neoplasms may involve the same carcinogenic agents.

关键词：胃肠基质肿瘤病理机制临床治疗

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