| Abstract | Periampularni adenokarcinomi su maligni tumori koje se najčešće javljaju u pacijenata starije dobi. Uz duktalni adenokarcinom glave gušterače, pojmom periampularnog adenokarcinoma obuhvaćamo adenokarcinom papillae Vateri, adenokarcinom distalnog koledokusa i adenokarcinom duodenuma. Ovi se tumori liječe radikalnim operativnim zahvatom cefalične pankreatikoduodenektomije po Whipple-u. U ovom je diplomskom radu prikazana analiza pacijenata kojima je u razdoblju 1.1.2015. do 31.12.2019. dijagnoza pri otpustu bila jedan od periampularnih adenokarcinoma te pomnija analiza pacijenata koji su podvrgnuti operativnom zahvatu pankreatikoduodenektomije po Whipple-u. Cilj ovog diplomskog rada bio je utvrditi udio pacijenata s periampularnim adenokarcinomimom u ukupnom broju obuhvaćenih pacijenata, uvrditi dobno-spolnu raspodjelu, simptome, udio resektabilnih adenokarcinoma, udio pacijenata s pozitivnim limfnim čvorovima, udio R0 resekcija te učestalost pojavljivanja postoperativnih komplikacija. Rezultati pokazuju da je među pacijentima s periampularnim adenokarcinomima, 75,2% adenokarcinoma glave gušterače, 12,8% adenokarcinoma papile, 8,3% adenokarcinoma terminalnog koledokusa, 3,7% adenokarcinoma duodenuma. Prosječna dob pacijenata je 67,05 godina. Najčešći simptom je opstrukcijski ikterus (n = 70, 64,2%). Tumorski marker Ca 19-9 povišen je u 60,6% pacijenata. U 14 pacijenata (12,8%) bolest je u trenutku dijagnoze ograničena na primarno sijelo. Dvadeset sedam pacijenata (24,8%) ima proširenu bolest i podvrgnuti su palijativnim operativnim zahvatima, a njih 82 (75,2%) operativnom zahvatu pankreatikoduodenektomije po Whipple-u. Prosječna duljina hospitalizacije za pacijente koji su podvrgnuti operaciji po Whipple-u iznosila je 19 dana (medijan 15 dana). 55 pacijenata (67,1%) imalo je pozitivne limfne čvorove. U 79,3% učinjena je R0 resekcija. Utvrđena je učestalost postoperativnih komplikacija kako slijedi: DGE (n = 9; 11,0%), pankreatična fistula (n = 21; 25,6%), postoperativno krvarenje (n = 11; 13,4%), infekcija rane (n = 9; 11,0%).
Zaključujemo da su rezultati ovog rada u korelaciji s literaturom i rezultatima inozemnih studija. Postoji prostor za poboljšanje dostupnosti informacija o pacijentima između bolnica unutar RH radi adekvatnijeg praćenja pacijenata te ispitivanje mogućnosti laparaskopskog liječenja ove patologije. |
| Abstract (english) | Periampullary adenocarcinoma are malignancies that are most often seen in elderly patients. Along with ductal adenocarcinoma, term periampullary adenocarcinoma includes adenocarcinoma of Vater ampulla, distal choledochus adenocarcinoma and duodenal adenocarcinoma. These tumours are treated by radical surgical procedure called Whipple
pancreaticoduodenectomy. In this paper patients that had periampullary adenocarcinoma diagnosed between 1.1.2015 and 31.12.2019 are analysed and those who underwent Whipple pancreaticoduodenectomy are analysed in more details. The aim of this paper was to determine the portion of patient with periampullary adenocarcinoma within all analysed patients, age and sex distribution, symptoms, portion of resectable adenocarcinomas, portion of patients with positive lymph nodes, portion of R0 resections and frequency of postoperative complications. The result showed that among patients with periampullary adenocarcinoma, there is 75,2% pancreatic head adenocarcinoma, 12,8% adenocarcinomas of Vater ampulla, 8,3% of distal choledochus adenocarcinoma and 3,7% duodenal adenocarcinomas. Mean age was 67,05 years. Most common symptom is obstructive icterus (64,2%). Tumour marker Ca 19-9 was elevated in 60,6% patients. In 14 (12,8%) patients the tumour was limited to primary site when diagnosed. Twenty-seven patients (24,8%) had disease spread to other organs and underwent palliative surgical procedures. 82 (75,2%) of them underwent Whipple
pancreaticoduodenectomy. Mean hospitalization length was 19 days (median 15 days). 55 patients (67,1%) had positive lymph nodes. 79,3% patients had R0 resection. Frequency of postoperative complication was as it follows: 11,0% DGE, 25,6% pancreatic fistula, 13,4% postoperative bleeding and 11,0% wound infection. We can conclude that results of this paper are corelating with those from literature and foreign studies. The information sharing between hospitals of Croatia could improve and that would enable better patient follow-up. There is also a possibility to test laparoscopic surgical
treatment of this pathology. |
