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CNAA / Theses / 2006 / June /

Tactics in diagnosis and surgical treatment of ampullary and majour duoadenal papilla

Author: Mutahar Qasem Mohsen Al-Ameer
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Scientific adviser: Vladimir Hotineanu
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific council:


The thesis was presented on the 28 June, 2006
Approved by NCAA on the 28 September, 2006


Adobe PDF document0.73 Mb / in romanian


CZU 616.361-006-07-089

Adobe PDF document 3.17 Mb / in romanian
131 pages


major duodenal papilla, mechanic jaundice, ampullary tumours


Over the period 2000-2005 in department of surgery, Clinical Republican Hospital, Institute of Oncology ( Republic of Moldova) and Al-Thurah Hospital ( Taizz, Republic of Yemen), 64 patients were operated with obstructive jaundice caused by ampullary - 42 (65,6%) and majour duodenal papilla tumours -22 (34,4%).Surgical treatment was merely palliative in the most cases.

The aim of the study was comparative evaluation of diagnosis and surgical treatment methods (palliative and radical) in ampullary and majour duodenal papilla tumours.

The presence of ampullary or majour duodenal papilla tumours was confirmed by the following methods of investigation: Ultrasound Investigation, Endoscopical Retrograde Cholangiopancreatography, Duodenoscopy, Laparoscopy, Computer Tomography, Nuclear Magnetic Imagistic, Percutaneal Transhepatical Cholangiography with Chiba needle.

US and CPGRE are the most effective methods in diagnosis and localization of ampullary and majour duodenal papilla tumours. Resecability was established by TC, RMN and laparoscopy. The preoperative biliary tract decompression was possible for 34 (53,12%), 30 cases by endoscopical decompression, 4 cases by percutaneous transhepatic drainage.Optimal results was obtained after radical operations and internal biliodigestive derivations : hepatico-jejunale, cholecysto-jejunale, excluded “Y” loop a la Roux. The limit of survival was between 14-20 months after Pancreaticoduodenectomy (Whipple Operation) and 13-15 months after internal biliodigestive derivations.

Our procedures of diagnosis and treatment had allowed to obtain good results and a low rate of lethality and mortality, with disappearence of ostructive jaundice at 52 (81,3%) patients.