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PubMed · 7064311

[Ampullar choledocholithiasis].

P N Napalkov·N N Artem'eva
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Abstract

Under observation were 111 patients with ampullar choledocholithiasis. Variants of the clinical course of choledocholithiasis are characterized. The most rational method for the surgical treatment of ampullar choledocholithiasis is the transduodenal transpapillary extraction of concrements from the major papillar followed by papillocholedochoplasty. In a number of cases papillocholedochoplasty was accompanied with additional creation of biliodigestive anastomosis and plasty of the opening of the pancreatic duct. Remote results of the operations on the major papilla of the duodenum are dependent on the amount of preoperative complications of ampullar choledocholithiasis and first of all pancreatitis.

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Ampulla of VaterDuodenal ObstructionFemaleGallstonesHumansMaleMethodsMiddle AgedEnglish AbstractJournal Article

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P N Napalkov, N N Artem'eva. 1982. [Ampullar choledocholithiasis].. https://pubmed.ncbi.nlm.nih.gov/7064311/

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Patterns of lymphatic spread of carcinoma of the ampulla of Vater.

BACKGROUND: The pattern of lymphatic spread of ampullary cancer is poorly documented. This pattern was clarified in order to define the rational extent of radical lymphadenectomy. METHOD: Thirty-nine consecutive patients who underwent pancreaticoduodenectomy with radical lymphadenectomy were included in the study. A total of 1447 lymph nodes dissected from the resected specimens was examined to detect the presence of metastatic foci. RESULTS: Twenty-one of the 39 patients had a total of 97 positive nodes. The sites of nodal involvement were the posterior pancreaticoduodenal (20 of 21 patients), inferior pancreaticoduodenal artery (IPDA; 12 of 21), anterior pancreaticoduodenal (three of 21), trunk of the superior mesenteric artery (three of 20), pericholedochal (three of 21), retroportal (two of 21), and para-aortic (three of five) regions. No metastases were found in the hepatic artery, cystic duct, perigastric, right coeliac, middle colic artery or right caval node groups. CONCLUSION: Ampullary cancer mainly spreads to the posterior pancreaticoduodenal node group, then to the IPDA node group, and finally to the para-aortic area. The rational extent of radical lymphadenectomy should include the pancreaticoduodenal, superior mesenteric, pericholedochal, retroportal and para-aortic nodes.

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