【Abstract】 Objective To investigate the origin, prevention and treatment of postoperative complications and death rate after pancreaticoduodenectomy （PD）. Methods Retrospective study on the clinical materials of complications and death rate was done on 106 cases of PD performed in our hospital during July 1985 to December 2002. Results In this group, 37 cases (34.91%) had postoperative complications, and the incidence rate of severe complications was 19.81% (21/106), the death rate was 10.38% (11/106). Compared between the two groups with preoperative bilirubin gt;342 μmol/L and ≤342 μmol/L, the incidence of total complications increased evidently (P＜0.05), and the bleeding amount，infusion amount and operation time in those with complications or dead ones were evidently higher than those without complications (P＜0.05). Conclusion The safty and resectability of PD has improved evidently in recent years but good skills, careful operation, the experience of the operatior and careful perioperative treatment and nursing are of crucial importance to reduce the complications and death rate.
目的 探讨保留幽门的胰十二指肠切除术的手术疗效和手术并发症的发生率。方法 回顾性总结解放军第401医院肝胆外科自2004年4月至2010年6月期间所行的37例保留幽门的胰十二指肠切除术的手术体会，术后并发症发生情况，以及术后生存率。结果 本组患者总并发症发生率为18.9% （7/37），其中胃排空障碍1例， 胰瘘3例，肺部感染2例，切口感染1例。无胆瘘、十二指肠空肠吻合口漏、消化道应激性出血等并发症发生。37例患者全部获随访，随访时间为6～54个月，平均31.4个月。1年生存率为75.7% （28/37），2年生存率为56.3% （18/32），3年生存率为34.6% （9/26）。结论 保留幽门的胰十二指肠切除术不影响胰头癌、壶腹周围癌根治的彻底性，手术并发症低，术后恢复快，是一种安全有效的手术方式。
Objective To investigate the cause, treatment, and prognosis of the postpancreaticoduodenectomy hemorrhage (PPH) . Method A total of 779 patients who underwent pancreaticoduodenectomy at Fudan University Shanghai Cancer Center between January 2015 and December 2016 were enrolled, and the data of them were retrospectively analyzed. Results Sixteen patients (PPH group) suffered from PPH and 763 patients didn’t suffered from PPH (non-PPH group) of 779 patients. There was no significant difference in the age, gender, type of disease, operative time, blood loss, and ratio of blood transfusion between the 2 groups (P>0.05), but the incidences of pancreatic fistula and delayed gastric emptying, postoperative drainage time, hospital stay, and mortality were all higher or longer in PPH group compared with non-PPH group (P<0.001). Of the 16 PPH patients, early haemorrhage occurred in 3 patients (including 2 patients with gastrointestinal haemorrhage and 1 patient with intra-abdominal haemorrhage) and delayed haemorrhage occurred in 13 patients (including 6 patients with gastrointestinal haemorrhage and 7 patients with intra-abdominal haemorrhage). All the 3 patients with early haemorrhage were cured by surgery. Of the 13 patients with delayed haemorrhage, 5 patients were cured by radiological intervention, 2 patients were cured by endoscopic hemostasis, and 3 patients were cured by conservative treatment, but 3 patients with sentinel bleeding died after interventional embolization+surgery. Conclusions The mortality of PPH is high. Surgery is optimal to early haemorrhage and radiological intervention is optimal to delayed haemorrhage, including embolization or covered stent implantation. The sentinel bleeding should be given great attention.
目的 用保留十二指肠水平段的胰十二指肠切除术及Roux-Y同步吻合重建消化道的方法，达到降低手术并发症，促进患者恢复，提高其生存质量和时间。方法 在行胰十二指肠切除术时，保留十二指肠水平段、升段、屈氏韧带及空肠上段，用RouxY同步吻合的方法将胰、胆、胃、肠重建排列，术后胆肠吻合口不置T管及空肠不置造瘘管，腹腔置2 mm硅胶管用于灌洗。结果 28例中除2例切口裂开，行二期缝合外，均顺利恢复出院。平均住院25天。无胆、胰漏，无返流性胆管、胰管炎等。随访6个月~6年，1年生存24例（85.7%），3年生存15例（53.6%），5年生存5例（17.9%）。结论 保留十二指肠水平段，消化功能恢复快，不影响根治时相关淋巴结的廓清。用Roux-Y同步吻合重建消化道，并发症少。不置T管和空肠造瘘管，对患者侵扰小，恢复快，提高了患者生存率。
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.
ObjectiveTo investigate value of drainage fluid amylase content and other risk factors in predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after laparoscopic pancreaticoduodenectomy (LPD).MethodsThe clinical data of 166 patients who underwent LPD in this hospital from January 2017 to December 2019 were retrospectively analyzed. The independent risk factors of CR-POPF after LPD were analyzed. And the sensitivity and specificity of drainage fluid amylase content obtained on postoperative day 1 and 3 (Abbreviated as DFA1 and DFA3, respectively) in predicting CR-POPF by receiver operating characteristic (ROC) curve.ResultsA total of 166 patients underwent LPD were collected in this study. The CR-POPF occurred in 16 (9.6%) patients and all of them were grade B. The DFA1 (P=0.037), DFA3 (P<0.001), and positive bacterial culture of drainage fluid after operation (P=0.020) were the independent risk factors of CR-POPF after LPD (P<0.05) by the logistic regression multivariate analysis. The area under the ROC curve of the DFA1 and DFA3 in predicting CR-POPF was 0.880 [95%CI (0.812, 0.949)] and 0.912 [95%CI (0.853, 0.971)] respectively, and the corresponding best critical value was 3 925 and 939 U/L, and the sensitivity was 100% and 100%, specificity was 64.0% and 70.7%, respectively.ConclusionFor patients with DFA1>3 925 U/L, DFA3>939 U/L, and positive bacterial culture of drainage fluid after operation, preventive measures should be made to avoid CR-POPF.
目的 探讨捆绑式胰肠吻合术在预防胰十二指肠切除术后胰肠吻合口漏的可行性及临床应用价值。 方法 我院在2002年3月至2006年10月期间对32例胰十二指肠切除术患者采用捆绑式胰肠吻合术。结果 32例患者手术均顺利，无一例发生胰瘘，无手术死亡病例。 术后发生胆瘘2例，经腹腔引流治愈。结论 捆绑式胰肠吻合术操作简便，预防胰瘘效果可靠，值得推广。
ObjectiveTo evaluate the predictive value of pancreatic duct diameter and pancreatic gland thickness measured using preoperative CT imaging on pancreatic fistula(PF)following pancreaticoduodenectomy (PD). MethodsOne hundred and fifty-one patients who underwent PD consecutively from January 2013 to April 2014 were reviewed retrospectively. Associations between the gender, age and the pancreatic duct diameter and pancreatic gland thickness from preoperative CT imaging and PF were analyzed. The diagnostic values of the pancreatic duct diameter and pancreatic gland thickness in patients with PF were evaluate by receiver operating characteristic (ROC) analysis. The reliability analysis was done for the pancreatic duct diameter and pancreatic gland thickness by using the intraclass correlation coefficient (ICC). The Spearman rank correlation analysis was done between the pancreatic duct diameter and pancreatic gland thickness. Results①PF occurred in 46 cases (30.1%).②The gender and age were not associated with PF (Gender: χ2=1.698, P=0.193; Age: χ2=0.016, P=0.900). The pancreatic duct diameter and pancreatic gland thickness were associated with PF (Pancreatic duct diameter: OR=0.275, 95% CI 0.164-0.461, P=0.000; Pancreatic gland thickness: OR=1.319, 95% CI 1.163-1.496, P=0.000).③There was no correlation between the pancreatic duct diameter and the pancreatic gland thickness (rs=-0.120, P=0.145).④The area under curve of ROC was 0.814 (95% CI 0.745-0.883, P < 0.001) for the pancreatic duct diameter in predicting the PF, the sensitivity and specificity was 68.6% and 78.3% respectively when the best critical value was 3.5 mm. The area under curve of ROC was 0.762 (95% CI 0.674-0.849, P < 0.001) for the pancreatic gland thickness in predicting PF, the sensitivity and specificity was 63.0% and 85.7% respectively when the best critical value was 31 mm.⑤The ICC of the pancreatic duct diameter and pancreatic gland thickness was 0.984 and 0.992 respectively by two medical diagnostic measurement. ConclusionPancreatic duct diameter and pancreatic gland thickness measured using preoperative CT imaging might be useful in predicting PF following PD.
Objective To investigate the effect of the duct-to-mucosa anastomosis in invaginating end-to-side pancreaticojejunostomy. Methods A retrospective review was conducted for 200 patients treated with pancreaticoduod-enectomy （PD） between August 2005 and December 2012. Reconstruction of digestive tract in PD was done according to the method described by Child. The duct-to-mucosa anastomosis was applied in the invaginating end-to-side pancrea-ticojejunostomy. The outline of the anastomosis structures was as follows：anastomosis of pancreatic duct and jejunal mucosa， anastomosis of pancreatic and jejunal resection margin， and anastomosis of pancreas and jejunal seromuscular layer. A cilicone tube was put into the pancreatic duct and lead to the jejunum. The anastomotic stoma was covered with part of the omentum majus, and put a drainage tube under the anastomotic stoma. Results The operation went smoothly，and no deaths occurred during perioperative period. The surgical time was 280-420 min， the average time was （298±77） min. The pancreatic fistula were observed in 22 patients （11%）， including 17 patients in Grade A， 2 patients in Grade B， and 3 patients in Grade C. The other complications were observed in 19 patients， including 16 patients with addominal infection， 1 patient with bleeding from splenic vein， 1 patient with bleeding from ruptured of pseudoaneurysm at biliary intestinal anastomosis， 1 patient with abdominal abscess. Three patients with pancreatic fistula in Grade C were cured by reoperation, and the other patients with pancreatic fistula were cured by expectant treatment. Conclusions The duct-to-mucosa anastomosis in invaginating end-to-side pancreaticojejunostomy is a simple and safe procedure that has the advantage in reducing the incidence of the pancreatic fistula. Using omentum to cover the anastomotic could localize the diffusion of panreactic fistula， and reduce the incidence of serious complications caused by pancreatic fistula.