2 research outputs found
Surgical treatment of Barrett's esophagus with complications
Catedra de Chirurgie Nr 4, Universitatea de Stat de MedicinÄ Či Farmacie ,,Nicolae TestemiČanuā, IMSP Spitalul Clinic
Republican "Timofei MoČneaga", ChiČinÄu, Republica Moldova, Al XIII-lea Congres al AsociaČiei Chirurgilor āNicolae Anestiadiā Či
al III-lea Congres al SocietÄČii de Endoscopie, Chirurgie miniminvazivÄ Či Ultrasonografie āV.M.GuČuā din Republica MoldovaIntroducere: Formele asimptomatice de Esofagul Barret (EB) asociat cu displazie determinÄ Ć®n timp un risc anual de pĆ¢nÄ la 60% de
dezvoltare a adenocarcinomului esofagian, dar Či mai frecvent a complicaČiilor acute precum ulcere esofagiene, hemoragii digestive
superioare (HDS) sau dezvoltarea Ć®n timp a stenozelor cicatriceale. Tratamentul complicaČiilor determinate de EB reprezintÄ intervenČii
chirurgicale laborioase ce au o mortalitate Ć®naltÄ Či o supravieČuire la 5 ani de pĆ¢nÄ la 15%.
Material Či metode: Un studiu clinic pe serii de cazuri de 62 de bolnavi care au fost diagnosticaČi Či trataČi Ć®n clinica de chirurgie nr 4
pentru EB pe parcursul a 20 de ani. ComplicaČii ale EB Ć®n lotul de cercetare au fost atestate Ć®n 22 cazuri (35,4%).
Rezultate: Din lotul complicaČiilor Ć®n 9 cazuri (56%) a fost atestat un adenocarcinom pe fundalul metaplaziei intestinale, 6 cazuri
esofag Barrett cu HGD, stenozele au constituit 4 cazuri (40%), iar HDS pe fundalul ulcerului Barrett 3 cazuri (19%). Ćn 100% cazuri
acestea au necesitat intervenČii chirurgicale rezective, de substituČie a esofagului. Ćn 48% din cazuri am utilizat stomacul, Ć®n 27%
au fost efectuate esofagoplastii cu intestin subtire Či Ć®n 25% cu colonul. ComplicaČii postoperatorii au fost apreciate Ć®n 34% cazuri
(dehiscenČa de anastomoze, fistule), Ć®n 5 cazuri (31%) a fost necesarÄ etapizarea intervenČiei chirurgicale prin aplicarea primarÄ a unei
gastrostome, durata medie de spitalizare a constituit 16 zile, iar mortalitate postoperatorie 25%.
Concluzii: Complicatile EB deČi nu au o incidenČÄ Ć®naltÄ, acestea reprezintÄ forme evolutive grave cu un prognostic nefavorabil,
necesitÄ frecvent intervenČii chirurgicale laborioase Či au o mortalitate Ć®naltÄ.Introduction: The asimptomatic forms of BE associated with dysplasia determine a risk up to 60% of evolution into esophageal
adenocarcinoma, even more frequent acute complications such as superior digestive hemorrhage or later cicatricial stenosis. The
treatment of complications determined by BE represent laborious surgical interventions with a high mortality rate and a 5 year survival
rate of 15%.
Material and methods: A study comprised of 62 patients, that were diagnosed and treated in Department Nr.4 of Surgery during the
last 20 years. Complications of BE in the surveyed batch were determined in 22 cases (35,4%).
Results: From the batch with complications, 9 cases (56%) with adenocarcinoma as a result of intestinal metaplasia, 6 cases of
Barrett's esophagus with HGD, stenosis - 4 cases (40%), SDH as a consequence of Barrett ulcer ā 3 cases (19%). All of them required
surgical treatment of esophageal substitution. In 48% stomach was used, in 27 % esophagoplasty with small intestine, 25 % with
colon. Postoperative complications occurred in 34 % (anastomotic dehiscence, fistulae), 5 cases (31%) needed split surgery, first
being performed the gastrostomy. The average length of hospital stay was 16 days, postoperative mortality ā 25%.
Conclusions: Even though the complications of BE are rare, they represent severe forms of evolution with an unfavorable outcome
that necessitates complicated surgeries with a high mortality rate