ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ PHẪU THUẬT XUẤT HUYẾT TIÊU HÓA DO UNG THƯ HANG MÔN VỊ DẠ DÀY XÂM LẤN ĐẦU TỤY, DI, DII TÁ TRÀNG

Abstract

Bleeding distal gastric cancer  invading  DI,DII  duodenum and head of pancreas is a complication of distal gastric cancer. The lesions could be combination of  pyloric stenosis, perforgation to DI,DII of duodenum. The surgical management needed good technical skills of closing duodenum stump as well as making  ist drainage  in case of  closing stump dundenum dificulty. Study aims: To Evaluate the result of surgical management of bleeding distal gastric cancer that invade DI, DII duodenum and/or head of pancreas. Patient and methode: Retrospective study.All the patients who had bleeding distal gastric cancer invading the head of pancreas and/or DI, DII of Duodenum. Period: 1/2019-12/2020. Results: 8 patients,100% males,mean age 59,9; melena in 62,5%,  hematemesis and melena in 37,5%. Endoscopic results (preoperation) Pyloroantriccancer with stenosis in 75,0%. Pyloro-antriccancer invading DI, DII of Duodenum in 25,0%. Lesions (peroperation): 87,5% tumors invade DI, DII;12,5% of tumors invade the head of pancreas, 37,5% of tumors perforated into head of pancreas. Surgical methode: Subtotal gastrectomy   with interrupted closure of duodenal stump in 87,5% (DII lymph node dissection). Subtotal gastrectomy with Duodenal drainage in 12,5% (DII lymph node dissection). Complication postoperation: 1 patient had pancreatic necrosis and annastomotic leakage  that stopped with medical treatment (continous aspiration). There is no death per and post opeeration. Consclusion: We conclude that distal gastric bleeding cancer invading DI,DII Duodenum and head of pancreas are serious lesions that require  technical skills and good surgical method of duodenal stump closure as well as duodenal drainage in case of difficulty in its closure.