[Diagnosis and therapy of cancer of Vater's ampulla].
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Biomedical subjects
Publications and source records attributed to M A Kunda.
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The effectiveness of therapy of pancreato-biliary cancer in jaundice patients has been raised due to introduction of sparing slightly-invasive (percutaneous, transhepatic) procedures for suppression of choleostasis and restoring biliary return to intestine. Also, such measures as pancreato-digestive anastomosis, radical surgery to compensate jaundice-related functional and morphological disorders and changes in the liver as well as perfection of procedures of combined and radiation therapy were used.
Morphological investigations at the preoperative stage were performed in 94 patients. The morphological diagnosis was made on the basis of findings of duodenal biopsies, cytological investigations of the bile and aspirate from the Vater's papilla ampulla, endocholedochal and percutaneous biopsies with the express cytological monitoring. Recommendations are given on the programs of preoperative morphological diagnosis of carcinoma of Vater's papilla.
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The paper is concerned with comparative assessment of the efficacy of digital subtraction angiography and routine angiography in assessing tumor spreading in pancreatobiliary cancer. A combined method of digital subtraction angiography and cholangiography was developed and performed in 41 patients with pancreatobiliary cancer permitting maximum information on the topical location and spreading of a tumor process. The clinical importance of the obtained results permitted recommending simultaneous digital subtraction angiography and cholangiography in patients with hepatobiliary cancer.
Treatment of 46 patients with mechanical jaundice of the inflammatory-calculous and tumorous nature is described. In 26 patients with external drainage of the bile ducts the cytological investigation of 3-5 morning portions of bile was performed. The lavage fluid was studied in 4 cases. On the basis of the findings of these cytological investigations carcinoma was diagnosed in 20 of 24 patients with tumorous processes (83.3%). A comparison of data obtained by histological and cytological investigations in 19 patients operated upon was made.
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The authors make an analysis of the operative treatment of 525 patients with cancer of the hepato-biliary and pancreatoduodenal zones. The distal, central and proximal obturations of bile ducts were found which determined the indications to formation of various bilio-digestive anastomoses. The operation of choice for distal obturation is a wide areflux cholecystogastrostomy with the use of blanket suture with the chromium-coated catgut. In the central and proximal obturation the precision suture with an atraumatic suture material and magnifying optics are recommended.
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The study was undertaken to enhance the efficiency of diagnosis of pancreatobiliary cancer complicated by jaundice by using the potentialities of currently available instrumental studies at most. The data of examination of 256 patients with this disease are presented. Based on diagnostic findings, the authors have constructed a diagnostic model of precision recognition of cancer of the extrahepatic bile ducts, pancreatic head, Vater's papilla.
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