Title Kirurško liječenje tumora repa gušterače s prikazom slučaja laparoskopske distalne splenopankreatektomije
Title (english) Surgical treatment of pancreatic tail tumors with a case study of laparoscopic distal splenopancreatectomy
Author Ivana Baotić
Mentor Jakov Mihanović (mentor)
Committee member Ivan Bačić (predsjednik povjerenstva)
Committee member Robert Karlo (član povjerenstva)
Committee member Jakov Mihanović (član povjerenstva)
Granter University of Zadar (Department of Health Studies) Zadar
Defense date and country 2024-10-03, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Surgery
Abstract Tumori gušterače nastaju u endokrinom ili egzokrinom dijelu žlijezde te se dijele se na benigne, potencijalno maligne i maligne tumore. Incidencija se povećava s dobi bolesnika, a svoj vrhunac doseže u sedmom desetljeću života. Većinom su novotvorine duži period asimptomatske što otežava njihovo pravovremeno otkrivanje i liječenje. Abdominalna bol tupog karaktera koja je izražena epigastrično te se širi prema leđima je jedan od najčešćih simptoma tumora gušterače. Distalna pankreatektomija je standardni kirurški postupak koji se upotrebljava u liječenju benignih, malignih i premalignih lezija tijela i repa žlijezde distalno (lijevo) od gornje mezenterične arterije i vene. Često uključuje splenektomiju zbog anatomske blizine i vaskularne povezanosti. Isto tako može se upotpuniti limfadenektomijom u slučaju maligne bolesti. Postupci očuvanja slezene se realiziraju očuvanjem perfuzije kroz slezensku venu i arteriju ili resekcijom slezenske arterije i vene zajedno s gušteračom, ali uz uspostavu kolateralnog krvotoka slezene putem kratkih želučanih arterija. Razvojem kirurških tehnika, minimalno invazivna kirurgija repa gušterače doživjela je procvat u liječenju novotvorina. Obuhvaća laparoskopsku i robotsku distalnu pankreatektomiju. Laparoskopska distalna pankreatektomija provodi se u općoj anesteziji preko četiri ili pet troakara. Predstavlja preferirani oblik kirurškog liječenja koji ima izražene prednosti poput smanjenja poslijeoperacijske boli i komplikacija, kraćeg trajanja hospitalizacije, manjeg gubitka krvi, ranijeg povratka prethodnim aktivnostima u odnosu na klasičnu distalnu pankreatektomiju. Upotreba robotskog sustava u posljednjem desetljeću predstavlja ultimativni način kirurškog liječenja malignih i benignih novotvorina gušterače. Njime se omogućuje izrazita preciznost pokreta korištenjem trodimenzionalnog i uvećanog vidnog polja što uvelike pomaže kirurškom timu koji izvodi zahvat. Poslijeoperacijsko praćenje i liječenje primarno je orijentirano na nadzor nad sekrecijom preko abdominalnog drena, protokol ubraznog oporavka što uključuje ranu mobilizaciju, rano hranjenje i povratak peristaltike te uočavanje i saniranje mogućih komplikacija. Poboljšanje ishoda kod liječenja malignih tumora gušterače ipak zaostaje za ostalim vrstama karcinoma unatoč napretku u adjuvantnoj terapiji i kirurškim tehnikama.
Abstract (english) Pancreatic tumors arise in the endocrine or exocrine part of the gland and are divided into benign, potentially malignant, and malignant tumors. The incidence increases with the patient's age, peaking in the seventh decade of life. Most tumors are asymptomatic for an extended period, which complicates their timely detection and treatment. Abdominal pain of dull character, expressed in the epigastric region and radiating towards the back, is one of the most common symptoms of pancreatic tumors. Distal pancreatectomy is a standard surgical procedure used to treat benign, malignant, and premalignant lesions of the body and tail of the pancreas distal to the upper mesenteric artery and vein. It often involves splenectomy due to anatomical proximity and vascular connectivity. Lymphadenectomy may also be performed in the case of malignant disease. Spleen-preserving procedures are realized by preserving perfusion through the splenic vein and artery or by resecting the splenic artery and vein together with the pancreas, but with the establishment of collateral circulation in the hilum of the spleen through the gastric vessels. With the development of surgical techniques, minimally invasive surgery of the pancreatic tail has flourished in treating tumors. This includes laparoscopic and robot-assisted distal pancreatectomy. Laparoscopic distal pancreatectomy is performed under general anesthesia using four or five ports (trocars). Typically, two large ports are used for camera and connecting devices, while two to three smaller ports are for surgical instruments. It represents a preferred form of surgical treatment with significant advantages such as reduced postoperative pain and complications, shorter hospitalization duration, less blood loss, and earlier return to previous activities compared to open distal pancreatectomy. The use of robotic systems in the last decade represents a modern approach to the surgical treatment of malignant and benign pancreatic tumors. It enables precise movements using three-dimensional and magnified field of view, greatly assisting surgical teams performing minimally invasive procedures. Postoperative monitoring and treatment primarily focus on controlling and managing drainage output, restoring peristalsis, and detecting and managing possible complications. Improvement in outcomes lags behind other types of carcinomas despite advances in adjuvant therapy and surgical techniques.
Keywords
tumor
distalna pankreatektomija
laparoskopska distalna pankreatektomija
robotska distalna pankreatektomija
splenopankreatektomija
Keywords (english)
tumor
distal pancreatectomy
laparoscopic distal pancreatectomy
robotic distal pancreatectomy
splenectomy
Language croatian
URN:NBN urn:nbn:hr:162:240756
Study programme Title: Nursing Study programme type: university Study level: graduate Academic / professional title: sveučilišni/a magistar/magistra sestrinstva (sveučilišni/a magistar/magistra sestrinstva)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2024-10-14 15:03:36