Akademska digitalna zbirka SLovenije - logo
ALL libraries (COBIB.SI union bibliographic/catalogue database)
  • Kontraktilnost žučnoga mjehura u bolesnika s totalnom gastrektomijom i limfadenektomijom : magistarski rad
    Horvat, Matjaž, 1964-
    Background. The kinetics of gallbladder is being influenced upon numerous neurological and humoral factors. The operative procedure for gastric cancer involves, besides removal of the organ, ... lymphadenectomy. Lymphadenectomy causes dissection of nerve fibers of hepatic plexus, which innervates gallbladder and extra hepatic biliary tract. Reconstruction after total gastrectomy excludes duodenum, which influences humoral part of gallbladder kinetics. The purpose of our study was to establish the influence of total gastrectomy with lymphadenectomy in patients with gastric cancer on the gallbladder kinetics. Based upon the evidence of changed gallbladder kinetics we could conclude that there is a greater possibility of gallstone formation and therefore a synchronous cholecystectomy would be justified. Respondents and methods. In the prospetive study using ultrasound (US), we measured gallbladder volumes at patients, preparing for surgical procedure of total gastrectomy, before and after the operation. Each patient had a measurement done in the starving state and after stimulatory meal in three 10 minutes intervals before and after the operation. We tried to standardize the US procedure and the stimulatory meal. Comparing the numeric data from different samples from the same persons we used Student-t test paired the sample for means in the Excel as well as in the SPSS 100 program. We considered p values < 0,05 statistically significant. Results. 30 patients with total gastrectomy were included in the study (19 males, 11 females, average age 65,27 years in an interval from 50 to 77). 28 patients had histopatological diagnosis of adenocarcinoma (21 with diffuse or mixed type and 7 with intestinal type after Lauren) and 2 patients had a histological diagnosis of Non Hodgkin lymphoma. In our group 27 patients out of 30 (90 %) showed an enlarged gallbladder volume (166 % on average) in the starving state after the operation (p<0,01). We noticed statistically significant differences not only in the starving state but as well after the stimulatory meals after 10, 20 and 30 minutes intervals (p<0,05 in all cases). Analyzing three patients who did not show gallbladder enlargement we found that two of them had big tumor simulating the starving state before the operation and the third one had a small inflamed gallbladder with no stone and the gallbladder wall could have been less stretchable. The contractility of gallbladder was assessed by the percentage of gallbladder volume compared to the initial state after the stimulatory meal. All patients show significant diminished contractility after 30 minutes of stimulatory meal (p=0,018). However a detailed look upon data reveals the real difference only in the first 10 minute interval (p=0,047) and a comparison of the next time intervals showed no significant differences (interval 10-20 min. p=0,21, and 20-30 min. p=0,39). Gallbladder kinetics with enlarged starving state volume does not say much about the amount of the bile derived in the gut. For that purposes we used a calculation of ejection fraction in a certain time interval. Comparing the ejection fractions in total (p=0,09) and during the 10, 20 and 30 minute intervals showed no statistical significant differences before and after operation (after 10 min. p=0,36; after 20 min. p=0,057; after 30 min. p=0,053). The amount of bile derived in the gut is comparable before and after the operation. Conclusion. Total gastrectomy with lymphadenectomy has an influence on the gallbladder tonicity and kinetics. Diminished gallbladder tonus after the operation causes enlargement of the gallbladder volume in the starving state which under greater bile stasis could lead to increased tendency of the bile stone formation. Important change in contractility has been noticed only in the firt 10 minute interval which could be attributed to a delay in hormonal response due to altered gut after the reconstruction. The amount of bile derived in the gut after the operation has no influence on postoperative digestion. Prophylactic cholecystectomy in patients undergoing total gastrectomy with lymphadenectomy with no obvious evidence of biliary pathology is therefore not necessary and would have no impact on the postoperative morbidity.
    Type of material - master's thesis ; adult, serious
    Publication and manufacture - Zagreb : [M. Horvat], 2004
    Language - croatian
    COBISS.SI-ID - 2440511

Library/institution City Acronym For loan Other holdings
Maribor General Hospital Maribor SBMB outside loan 1 cop.
loading ...
loading ...
loading ...

Shelf entry