ObjectiveTo investigate the effect of drained versus nondrained pancreaticojejunostomy on prevention of the pancreatic leakage after pancreaticoduodenectomy. MethodsSeventysix patients underwent the standard pancreaticoduodenectomy including resection of the distal stomach,common bile duct, the head of pancreas and the duodenum.Pancreaticenteric reconstruction was accomplished via either pancreaticojejunostomy by endtoside anastomsis or pancreaticojejunostomy by ducttomucosa anastomsis.The stented external drainage of pancreatic duct was used in 45 of 76 patients. ResultsPancreatic leakage was identified in 1 patient in the drained group consisting of 45 patients,in 7 patients in the nondrained group consisting of 31 patients, the incidence of pancreatic leakage in the drained group (2.2%) was significantly less than in the nondrained group (22.6%,P＜0.05).ConclusionComparing the incidences of pancreatic leakage from both groups,the authors believe that the stented external drainage of pancreatic duct can significantly reduce the incidence of pancreatic leakage after pancreaticoduodenectomy.
Objective To explore the risk factors and treatment associated with postoperative hemorrhage after pancreaticoduodenectomy. Methods The clinical data of 78 patients undergoing pancreatieoduodeneetomy from May 2009 to October 2011 were retrospectively analyzed in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Results The incidence of postoperative hemorrhage was 10.3％ （8/78）. Among these eight patients, intra-abdominal hemorrhage occurred in two cases （one case of early and delayed hemorrhage respectively）, and gastrointestinal hemorrhage occurred in 6 cases （one and five cases of early and delayed hemorrhage respectively）. Univarlate analysis showed that operative blood loss, postoperative celiac infection, pancreatic fistula, and pancreaticogastrostomy were significantly associated with postoperative hemorrhage. Multivariate analysis identified for vailables as independent factors associated with postoperative hemorrhage, namely, pancreaticogastrostomy, postoperative celiac infection, and pancreatic fistula. Conclusions Skillful operation, prevention of pancreatic fistula, and control celiac infection are important for reducing postoperative hemorrhage. Proper treatments should be used according to the site, onset, and severity of hemorrhage. To prevent its occurrence is the key of treatment.
Objective To explore the effects of recombinant human growth hormone （rhGH） on senile patients after pancreaticoduodenectomy. MethodsFortysix patients were divided into the therapeutic group (rhGH, n=17) and control group (n=29). Both were treated with parenteral nutrition. In the therapeutic group, rhGH (8 u/d) was given hypodermically for 7 days. After operation the levels of albumin, prealbumin, transferrin, and immunoglobulin were measured. Postoperative fatigue syndrome and the average length of stay in hospital were observed too. ResultsAfter operation the levels of albumin, prealbumin, transferrin, and immunoglobulin in the therapeutic group were significantly higher than those of control group. The degree of postoperative fatigue syndrome in the therapeutic group was less than that of control group. The average length of stay in hospital was significantly shortened. Conclusion The early application of rhGH in senile patients after pancreaticoduodenectomy can enhance immune function, reduce the incidence of infection, promote the postoperative recovery, shorten the average length of stay in hospital,decrease the mortality, increase the safety of operation and improve the postoperative life quality of senile patients.
ObjectiveTo introduce the method of laparoscopic pancreaticoduodenectomy through an arterial approach, and to evaluate the clinical value of this technique. MethodsThe clinical data of 19 patients with periampullary carcinoma, distal bile duct cancer, and early-stage pancreatic head carcinoma that underwent laparoscopic pancreaticoduodenectomy through an arterial approach in the Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen Memorial Hospital between September 2010 and July 2013 were retrospectively analyzed. The patients were followed-up until February 28, 2014. ResultsLaparoscopic pancreaticoduodenectomy were successfully performed in all 19 cases, there were no need to convert to open surgery. Open reconstruction was performed in 2 cases, and 17 cases underwent total laparoscopic reconstruction of the digestive tract. The duration of the operations ranged from 5-10.5 h(mean 6.3 h), and the intra-operative blood loss ranged from 170-430 mL(mean 250 mL). Post-surgical pathology detected a mean number of 13.7 lymph(9-21) nodes in all patients. No deaths occurred during the perioperative period. Complications were observed in 42.1%(8/19) of the subjects, including 5 cases with pancreatic fistula, 1 case with bile leak, 1 case with gastric emptying disorder, and 1 case with a gastroduodenal artery aneurysm. The mean length of hospital stay was 10.7 d(7-19 d). The mean followed-up period was 7.5 months(2-28 months), there were 6 patients died of tumor metastasis or recurrence during the followed-up. ConclusionLaparoscopic pancreaticoduodenectomy through an arterial approach simplifies pancreaticoduodenectomy and lymph node dissection procedures, and can completely remove lymph nodes.
ObjectiveTo evaluate the postoperative complications after pancreaticoduodenectomy with modified triple-layer(MTL) duct-to-mucosa pancreaticojejunostomy and with resection of jejunal serosa, analyse the risk factors of pancreatic fistula, and compare effects with two-layer(TL) duct-to-mucosa pancreaticojejunostomy. MethodsData on 184 consecutive patients who underwent the two methods of pancreaticojejunostomy during standard PD between January 1, 2010 and January 31, 2013 were collected retrospectively. The risk factors of pancreatic fistula were investigated by using univariate and multivariate analyses. ResultsA total of 88 patients received TL and 96 underwent MTL. Rate of pancreatic fistula for the entire cohort was 8.2%(15/184). There were 11 fistulas(12.5%) in the TL group and four fistulas(4.2%) in the MTL group(P=0.039). Body mass index, pancreatic texture, pancreatic duct diameter, and methods of pancreaticojejunostomy had significant effects on the formation of pancreatic fistula on univariate analysis. Multivariate analysis showed that pancreatic duct diameter less than 3 mm and TL were the significant risk factors of pancreatic fistula. ConclusionsMTL technique effectively reduced the pancreatic fistula rate after PD in comparison with TL, especially in patients with pancreatic duct diameter less than 3 mm.
Objective To summarize preliminary experience of laparoscopic pancreaticoduodenectomy for periampullary carcinoma. Method The clinical data of patients with periampullary carcinoma underwent laparoscopic pancreaticoduodenectomy from July 2016 to September 2016 in the Shengjing Hospital of China Medical University were analyzed retrospectively. Results Two patients underwent complete laparoscopic pancreaticoduodenectomy, 2 patients underwent laparoscopic resection and anastomosis assisted with small incision open. The R0 resection and duct to mucosa pancreaticojejunal anastomosis were performed in all the patients. The operative time was 510–600 min, intraoperative blood loss was 400–600 mL, postoperative hospitalization time was 15–21d, postoperative ambulation time was 6–7 d. Three cases of pancreatic fistula were grade A and all were cured by conservation. No postoperative bleeding, delayed gastric emptying, intra-abdominal infection, and bile leakage occurred. The postoperative pathological results showed that there was 1 case of pancreatic head ductal adenocarcinoma, 1 case of cyst adenocarcinoma of pancreas uncinate process, 1 case of papillary carcinoma of duodenum, and 1 case of terminal bile duct carcinoma. Conclusion The preliminary results of limited cases in this study show that laparoscopic pancreaticoduodenectomy has been proven to be a safe procedure, it could reduce perioperative cardiopulmonary complications, its exhaust time, feeding time, and postoperative ambulation time are shorter, but its operative complications could not be reduced.
Objective To investigate the effect of sarcopenia on postoperative complications in patients undergoing pancreaticoduodenectomy（PD）. Methods The data of 225 patients who underwent pancreaticoduodenectomy in the Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital) from March 2012 to February 2020 were retrospectively analyzed. The total area of the skeletal muscle was measured by CT images at the level of the third lumbar vertebra for the diagnosis of sarcopenia. The patients were divided into sarcopenia group and non-sarcopenia group. The clinical data and surgical complications were compared between the two groups to explore the relationship between sarcopenia and postoperative complications. Results Compared with the non-sarcopenia group, the patients in the sarcopenia group were older and had lower hemoglobin concentration, lower serum albumin concentration, and higher total bilirubin levels (P<0.05). The incidences of clinically relevant pancreatic fistula (grade B and C fistula), pulmonary infection, atelectasis and hypoxemia in the sarcopenia group were significantly higher than those in the non-sarcopenia group (P<0.05). The length of ICU stay and perioperative mortality in the sarcopenia group were significantly higher than those in the non-sarcopenia group (P<0.05). Multivariate analysis showed that sarcopenia, preoperative total bilirubin level, pancreatic duct diameter and pancreatic texture were independent risk factors for clinically relevant pancreatic fistula (P<0.05). Sarcopenia, intraoperative blood loss and postoperative abdominal infection were independent risk factors for pulmonary complications after PD (P<0.05). Conclusions Sarcopenia is an independent risk factor for increased incidence of clinically relevant pancreatic fistula and pulmonary complications after PD. Strengthening perioperative nutritional therapy and rehabilitation exercise in patients with sarcopenia is of great significance to reduce postoperative complications of PD.
ObjectiveTo evaluate the safety and efficacy of Roux-en-Y reconstruction with isolated pancreatico-jejunostomy after pancreaticoduodenectomy. MethodsSystematically literature search was performed through PubMed, EMBASE, Cochrane Library, Wanfang, VIP, and CNKI from the earliest to November 30, 2015. Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) comparing outcomes of Roux-en-Y reconstruction with isolated pancrea-ticojejunostomy and conventional pancreaticojejunostomy were searched. The data were applied meta-analysis by RevMan 5.3. ResultsSeven trials were involved, two RCTs including 367 patients and five CCTs including 431 patients. Meta-analysis result showed that there was no statistic significant difference in pancreas fistula between Roux-en-Y reconstruction with isolated pancreaticojejunostomy and conventional pancreaticojejunostomy. ConclusionRoux-en-Y reconstruction with isolated pancreaticojejunostomy after pancreaticoduodenectomy is not superior to conventional pancreaticojejunostomy regarding pancreatic fistula rate or other relevant outcomes.
ObjectiveTo investigate safety and effectiveness of laparoscopic pancreaticoduodenectomy (LPD) in municipal hospitals.MethodsThe clinic data of patients underwent pancreatoduodenectomy in the Leshan People’s Hospital from November 2017 to January 2020 were retrospectively analyzed. The patients were divided into LPD group and open pancreaticoduodenectomy (OPD) group according to the operation methods, and the indicators of perioperative safety and effectiveness of the two groups were compared.ResultsA total of 72 patients were enrolled in this study, including 30 patients in the LPD group and 42 patients in the OPD group. There were no significant differences in the age, gender, and other baseline indicators between the two groups (P>0.05). Although the operative time of the LPD group was longer than that of the OPD group (P<0.05), the intraoperative blood loss in the LPD group was significantly less than that in the OPD group (P<0.05), the postoperative hospital stay, postoperative exhaust time, and postoperative ambulation time in the LPD group were shorter than those in the OPD group (P<0.05). And there were no significant differences in the terms of intraoperative red blood cell transfusion, intraoperative blood transfusion rate, postoperative ICU hospitalization time, hospitalization expenses, overall complications and specific complications (except incision infection rate of LPD group was significantly lower than OPD group, P=0.031) between the two groups (P>0.05). There were no significant differences in the positive rate of resection margin, number of lymph node dissection, and positive rate of lymph node between the two groups (P>0.05).ConclusionLPD has the same safety and effectiveness as OPD in the perioperative period in municipal hospitals, and is more conducive to postoperative recovery of patients.
Objective To explore the clinical value of the improved style of pancreatodeodenectomy. Methods Retrospective analysis the data of 111 cases of pancreatodeodenectomy. Forty-one cases of 111 cases were performed the modified Whipple pancreatic jejunal anastomosis， which reconstruction residual pancreatic duct jejunum into the intestinal mucosa sets of accurate end to side anastomosis type （modified group）. Another 70 cases were performed the conventional Whipple pancreatic jejunal anastomosis， which classic lines set into the pancreas jejunum anastomosis （conventional group）. The incidence rate of pancreatic fistula after operation were compared in two groups. Results The postoperative recovery in modified group was smooth， and there was no case of pancreatic fistula. Thirteen cases （18.57%） had pancreatic fistula in conventional group. The difference of incidence rate of pancreatic fistula between two groups was statistically significant （P＜0.05）. The difference in other complications such as gastrointestinal bleeding， delayed gastric emptying， biliary fistula， abdominal infection， lung infection， and wound infection were no statistically significant （P＞0.05）， and the difference of survival rate was also no statistically significant （P＞0.05） in two groups. Conclusions Pancreatic duct jejunum end to side into the mucous membrane of the mucosal anastomosis sets of pancreatodeodenectomy can significantly prevent pancreatic fistula， it is worth to promote the use in clinical work.