سارکناپ ناطرس

نایمیکح اضردمحمدیس رتکد یمومع یحارج صصختم ناطرس یحارج پیشولف

Types:

•

Neoplasms of the Endocrine Pancreas(25%)

• • • •

Neoplasms of the Exocrine Pancreas(75%)

75% arise within the head or uncinate process of the pancreas; l5 % are in the body, 10% are in the tail

Staging

Diagnosis & stage:

• • • • 7% percent of pancreas cancer cases are diagnosed while the cancer is still confined to the primary site (localized stage); 26% are diagnosed after the cancer has spread to regional lymph nodes or directly beyond the primary site 52% are diagnosed after the cancer has already metastasized (distant stage); and for the remaining l5% the staging information was unknown.

Diagnosis:

• • • • • • • • History & Ph Ex CT scan (the single most versatile and costeffective tool for the diagnosis) Sonography MRI Endosono LFT CA19-9 laparoscopy

Multislice, dynamic, contrast-enhanced CT with IV & oral contrast (pancreas protocol) • • • • • • • •

accuracy of CT scanning for predicting unresectable disease is about 90 to 95%

invasion of the hepatic or superior mesenteric artery, enlarged lymph nodes outside the boundaries of resection, ascites, and distant metastases (e.g., liver).

Invasion of the superior mesenteric vein or portal vein is not in itself a contraindication to resection as long as the veins are patent.

C T scanning is less accurate in predicting resectable diseas

When

all

of the current staging modalities are used, their accuracy in predicting resectability is reported to be about 80%. 98% when laparoscopy with US is used.

Paliative surgery:

• • • Jaundice & pruritus ; stent with ERCP, PTC drinage (choledochojejunostomy is the preferred approach) Duodenal obstruction (no bypass in the absence of signs or symptomes. Roux-en-Y limb with the gastrojejunostomy located 50 cm downstream or a loop of jejunum with a jejunojejunostomy to divert the enteric stream away from the biliary-enteric anastomosis ) Pain (celiac plexus nerve block)

Curative surgery

Technique:

• • • Complication rate: 31% pancreatic leakage rate: about 10% mortality rate for pancreaticoduodenectomy is <5% in "high volume" centers (where individual surgeons perform more than 15 cases per year)

• transpancreatic U-suture technique (Blumgart anastomosis)

1391(12m) 1392(10m) total

N.O.

leak mortality 16 4 (25%) 4(25%) 13 2(15%) 0(0%) 29 6(20%) 4(13%)