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Ductal adenocarcinoma of the pancreatic head:A focus on current diagnostic and surgical concepts

World Journal of Gastroenterology 2012年第24期18卷 3058-3069页

作者： Mehdi Ouassi Urs Giger Guillaume Louis Igor Sielezneff Bernard Sastre olivier farges Centre for Research in Oncology and Oncopharmacologie Aix Marseille University13005 MarseilleFrance Department of Oncologic and Digestive Surgery Timone Hospital13385 MarseilleFrance Department of Surgery Marienhospital HerneRuhr University Bochum44625 HerneGermany Department of Radiology Timone Hospital13385 MarseilleFrance Department of Hepato-Biliary Surgery Beaujon Hospital92110 ClichyFrance

Complete surgical resection still remains the only possibility of curing pancreatic cancer,however,only 10% of patients undergo curative *** resection currently remains the only method of curing patients,and has a 5-year overall survival rate between 7%-34% compared to a median survival of 3-11 mo for unresected *** surgery is a technically demanding procedure requiring highly standardized surgical ***,even in experienced hands,perioperative morbidity rates(delayed gastric emptying,pancreatic fistula etc.) are as high as 50%.Different strategies to reduce postoperative morbidity,such as different techniques of gastroenteric reconstruction(pancreatico-jejunostomy vs pancreatico-gastrostomy),intraoperative placement of a pancreatic main duct stent or temporary sealing of the main pancreatic duct with fibrin glue have not led to a significant improvement in clinical *** perioperative application of somatostatin or its analogues may decrease the incidence of pancreatic fistulas in cases with soft pancreatic tissue and a small main pancreatic duct(< 3 mm).The positive effects of external pancreatic main duct drainage and antecolic gastrointestinal reconstruction have been observed to decrease the rate of pancreatic fistulas and delayed gastric emptying,***,the concept of extended radical lymphadenectomy has been found to be associated with higher perioperative morbidity,but without any positive impact on overall ***,there is growing evidence that portal vein resections can be performed with acceptable low perioperative morbidity and mortality but does not achieve a cure.

关键词： Pancreatic adenocarcinoma, Pancreatic fis-tula Pancreatic surgery Venous resection

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Hepatic veins as a site of clot formation following liver resection

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World Journal of Gastroenterology 2011年第3期17卷 403-406页

作者： Emmanuel Buc Safi Dokmak Magaly Zappa Marie Helene Denninger Dominique Charles Valla Jacques Belghiti olivier farges Department of Hepato-Biliary Surgery Hpital BeaujonAssistance-Publique Hpitaux de ParisUniversity Paris 7 Department of Radiology Hpital Beaujon Assistance-Publique Hpitaux de ParisUniversity Paris 7 Department of Biological Hematology Hpital Beaujon Assistance-Publique Hpitaux de ParisUniversity Paris 7 Department of Hepatology Hpital BeaujonAssistance-Publique Hpitaux de ParisUniversity Paris 7

Pulmonary embolism occurs more frequently after hepatectomy than previously thought but is infrequently associated with peripheral deep vein thrombosis. In this paper, we report 2 cases of postoperative hepatic vein thrombosis after liver resection. Both patients had undergone major hepatectomy of a non-cirrhotic liver largely exposing the middle hepatic vein. Clots were incidentally found in the middle hepatic vein 4 and 17 d after surgery despite routine systemic thrombo-prophylaxis with low molecular weight heparin. Coagulation of the transition plan in a context of mutation of the prothrombin gene and inflammation induced biloma were the likely predisposing conditions. Clots disappeared following curative anticoagulation. We conclude that thrombosis of hepatic veins may occur after liver resection and is a potential source of pulmonary embolism.

关键词： Hepatectomy Hepatic veins Thrombosis Pulmonary embolism Anticoagulants

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