Pancreaticogastroanastomoza după DPC 371<strong>Jurnalul</strong> <strong>de</strong> <strong>Chirurgie</strong> (Iaşi), 2012, Vol. 8, Nr. 4[26]. Mortalitatea în acest grup a fost <strong>de</strong>3,3% (20/614), iar rata fistulelor pancreaticea fost <strong>de</strong> 4,8% (29/614) [26]. Doar trei<strong>de</strong>cese din acest grup au fost legate <strong>de</strong>anastomoza pancreaticogastrică, 1 din cauzahemoragiei, 2 din cauze septice.Acestea sunt rezultatele unei metaanalizerealizate <strong>de</strong> Mason [26] pe cazurile<strong>de</strong> PGA între 1946 şi 1997.După 1997, tehnica a <strong>de</strong>venit mult mairăspândită, studiile prospective nereuşindînsă să <strong>de</strong>monstreze superioritatea ei înraport cu PJA [27].În cazul loturilor studiate, dimensiunearedusă a acestora şi lipsa <strong>de</strong> omogenitate aindicaţiilor pentru DPC nu permit extragereaunor concluzii în favoarea PGA, dar oferă odovadă a eficienţei acestei tehnici chiar şiîntr-un centru cu volum relativ mic <strong>de</strong>intervenţii. Indiferent <strong>de</strong> metoda aleasăpentru a efectua anastomoza pancreatică,acestui timp al intervenţiei trebuie să i seacor<strong>de</strong> cea mai mare atenţie, tehnica fiindrealizată cu cea mai mare grijă [28]CONCLUZIICele două spitale în care s-a efectuatstudiul nu sunt centre cu „volume” mari <strong>de</strong>ceea ce explică valorile relativ mari alemortalităţii şi morbidităţii postoperatorii.În ceea ce priveşte principalacomplicaţie a DPC, fistula pancreatică,aceasta s-a întâlnit numai la cazurile dinLotul II cu PJA. Analiza statistică aevi<strong>de</strong>nţiat că apariţia fistulei pancreatice afost influenţată doar <strong>de</strong> tipul <strong>de</strong> anastomozăpancreatică, anastomoza cu stomaculreprezentând un factor <strong>de</strong> protecţie.CONFLICT DE INTERESEAutorii nu <strong>de</strong>clară niciun conflict <strong>de</strong>interese.BIBLIOGRAFIE1. Cattell RB. A technic for pancreaticoduo<strong>de</strong>nalresection. Surg Clin North Am. 1948; 28: 761-775.2. Johnson CD. Pancreaticogastrostomy afterresection of the pancreatic head. In: Beger HG,Buchler M, Malfertheiner P, editors,Standards in Pancreatic Surgery. Berlin:Springer; 1993. p. 663-681.3. Watson K. Carcinoma of the ampulla of Vater:successful radical resection. Br J Surg. 1944;31: 368-3734. Traverso LW, Longmire WP. Preservation ofthe pylorus in pancreaticoduo<strong>de</strong>nectomy. SurgGynecol Obstet. 1978; 146: 959-9625. Herman RE. Current approaches to surgery inpancreatic cancer: panel discussion. Am JSurg. 1978; 135: 188-1896. Crile G. The advantages of bypass operationsover radical pancreatoduo<strong>de</strong>nectomy in thetreatment of pancreatic carcinoma. SurgGynecol Obstet. 1970; 130: 1049-10537. Howard JM. Pancreaticoduo<strong>de</strong>nectomy: 41consecutive Whipple resections without anoperative mortality. Ann Surg. 1968; 168: 629-6408. Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD,Kaufman HS, Coleman J. One hundred andforty-five consecutive pancreaticoduo<strong>de</strong>nectomieswithout mortality. Ann Surg.1993; 217: 430-4359. Tre<strong>de</strong> M, Schwall G, Saeger HD. Survivalafter pancreatoduo<strong>de</strong>nectomy: 118 consecutiveresections without an operative mortality. AnnSurg. 1990; 211: 447-45810. Watson K. Carcinoma of the ampulla of Vater:successful radical resection. Br J Surg. 1944;31: 368-37311. Popescu I, Dumitraşcu T. Duo<strong>de</strong>nopancreatectomiacefalică – trecut, prezent şiviitor. Chirurgia. 2011; 106(3): 287-296.12. Popescu I, David L. Duo<strong>de</strong>nopancreatectomiacefalică prin abord posterior. Enciclopedia <strong>de</strong><strong>Chirurgie</strong>. Bucureşti: Editura Celsius 2006; 1.13. Moldovanu R. Clasificarea rezecţiilorpancreatice. <strong>Jurnalul</strong> <strong>de</strong> chirurgie (Iaşi). 2007;3(2): 177-179.14. Miron A, Ar<strong>de</strong>lean M. Anastomozapancreatico-digestivă după duo<strong>de</strong>nopancreatectomiacefalică. Chirurgia. 2007;101(2): 149-155.15. Ionescu M, Stroescu C, Barbuta C.Duo<strong>de</strong>nopancreatectomia cefalică - operaţie <strong>de</strong>rutinã? Chirurgia. 2003; 98(2): 103-108.16. Tripodi AM, Sherwin CF. Experimentaltransplantation of the pancreas into thestomach. Arch Surg. 1934; 28: 345–356.17. Person EC, Glenn F. Pancreaticogastrostomy,experimental transplantation of the pancreasinto the stomach. Arch Surg. 1939; 39: 530–550.18. Aranha GV, Hodul PJ. Zero Mortality after152consecutive Pancreatoduo<strong>de</strong>nectomieswith Pancreaticogastrostomy. J Am Coll Surg.2003; 197(2):223-23119. Waugh JM, Clagett OT. Resection of theduo<strong>de</strong>num and head of pancreas forcarcinoma. An analysis of thirty cases.Surgery. 1946; 20: 224–232.
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