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 investigate the application value of the binding pancreaticogastrostomy in pancreatico-duodenectomy. Methods The clinical data of 13 patients that performed pancreaticoduodenectomy with binding pancr-eaticogastrostomy from Jan. 2010 to Mar. 2013 in our hospital were retrospectively analyzed. The incidence of postoper-ative complications were counted. Results There was 1 patient with pancreatic stump bleeding after operation， and then recovered after conservative treatment. There was no patient with pancreatic fistula， bile fistula， delayed gastric empt-ying， and other complications after operation in whole group. Peritoneal fluid and amylase level in peritoneal fluid were gradually reduced or degraded after operation. The gastrointestinal function was recovered better. All patients were compl-etely cured. Conclusion The binding pancreaticogastrostomy in pancreaticoduodenectomy has its own unique advantage.It could be reduce the incidence of pancreatic fistula in postoperative patients by using binding pancreaticogastrostomy reasonably.
ObjectiveTo assess the safety for removing nasogastric tube(NGT)within postoperative 24 h in Whipple pancreaticoduodenectomy (PD)patients. MethodsThe clinical data of 310 patients performed classic Whipple PD from January 2008 to March 2013 in this hospital were analyzed retrospectively. The patients were divided into early (≤24 h after operation)removing NGT group and late( > 24 h after operation)removing NGT group according to the time of NGT duration. The ratio of NGT reinsertion, time of solid diet tolerance, hospital stay, mortality, and major complications associated with PD were compared between two groups. Results①The demography and preoperative comorbidities characteristics were similar(P > 0.05).②There was no statistical difference of ratio of NGT reinsertion between two groups(P=0.450).③The differences of rates of major complications associated with PD and mortality were not statistically different(P > 0.05)by univariate analysis, but the rate of total complications in the early removing NGT group was significantly lower than that in the late removing NGT group (P=0.014)by multivariate analysis.④The average time of solid diet tolerance(P=0.013)and average hospital stay(P < 0.001)in the early removing NGT group were significantly shorter than those in the late removing NGT group. ConclusionFor patients comfort, NGT following PD should be removed as early as possible even immediately after extubation for selective patients.
ObjectiveTo systematically review the efficacy and safety of enhanced recovery after pancreaticoduodenectomy surgery (ERAS).MethodsPubMed, EMbase, The Cochrane library, CBM, CNKI and VIP databases were electronically searched to collect clinical controlled trials of comparing ERAS and the traditional rehabilitation management in patients who received pancreaticoduodenectomy from inception to March 31st, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.2 software.ResultsA total of 12 non-randomized historical controlled trials involving 2 588 patients were included. The results of meta-analysis showed that ERAS shortened postoperative hospital stay (MD=–5.44, 95%CI –7.73 to –3.15, P<0.000 01) and the time to the first passage of flatus (MD=–1.40, 95%CI –2.60 to –0.20,P=0.02), reduced the rate of postoperative complication (OR=0.61, 95%CI 0.52 to 0.72, P<0.000 01), pancreatic fistula (OR=0.81, 95%CI 0.66 to 0.99,P=0.04) and delayed gastric emptying (OR=0.49, 95%CI 0.38 to 0.63, P<0.000 01). However, there was no significant difference in incidences of biliary fistula, abdominal cavity infection, wound infection and postoperative pulmonary infection between two groups.ConclusionsThe application of ERAS in pancreaticoduodenectomy is effective and does not increase postoperative complication. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo analyze the risk factors for pancreatic fistula following pancreaticoduodenectomy. MethodThe clinical data of 150 patients underwent pancreaticoduodenectomy in this hospital from January 2011 to January 2014 were reviewed, and the potential factors for pancreatic fistular were evaluated by both univariate and multivariate analysis. ResultsThe incidence of pancreatic fistula was 12.7% (19/150). Univariate analysis results showed that the age, preoperative high bilirubin level, texture of the remnant pancreas, diameter of wirsung, operative time were associated with pancreatic fistula following pancreaticoduodenectomy (P < 0.05). Multivariate logistic regression analysis results revealed that the texture of the remnant pancreas, diameter of wirsung, and operative time were the inde-pendent risk factors (P < 0.05) for pancreatic fistula following pancreaticoduodenectomy. ConclusionsTexture of the remnant pancreas, diameter of wirsung, operative time are independent risk factors for pancreatic fistula following pancreaticoduodenectomy. Rich experience and skilled surgical procedures could effectively reduce the incidence of pancreatic fistula.
ObjectiveTo summarize the prevention method for pancreatic fistula following pancreaticoduodenec-tomy. MethodLiteratures related to the prevention methods for postoperative pancreatic fistula at home and abroad in recent years were retrieved and summarized. ResultsThe pancreatic fistula was a common complication following pancreaticoduodenectomy. It was mainly caused by preoperative continuous high jaundice, selection of intraoperative anastomosis, and early postoperative pancreatic juice secretion. Trypsinogen was activated by alkaline intestinal juice and then the nearby tissue was digested. Pancreatic juice flowed into abdominal cavity to digest the tissue, then caused serious complications or even death. Through the prevention of drugs, preoperative biliary drainage and intraoperative anastomosis, etc., the incidence of postoperative pancreatic fistula was slightly decreased. ConclusionThe prevention for postoperative pancreatic fistula is an integrated process, and it needs to be ran through the whole perioperative period.
Objective To evaluate the operative indication and results of pancreaticogastrostomy following pancreaticoduodenectomy. Methods A retrospective study was carried out on the cases of pancreaticoduodenectomy following pancreaticogastrostomy from Aug. 2005 to Feb. 2008 in Shanghai Tongji Hospital. Results During this period, 38 cases had undergone pancreaticogastrostomy with pancreaticoduodenectomy. The median operative time was (352.1±78.3) min. The median intraoperative blood transfusion was (911.3±601.4) ml. The median postoperative length of stay was (26.2±12.1) d. Postoperative morbidity was 21.1% (8/38) with no operative death. Pancreatic anastomotic leakage occurred in 1 patient. Delayed gastric emptying occurred in 2 patients. Incision infection occurred in 2 patients. Abdominal fluid collection occurred in 1 patient and pulmonary infection occurred in 2 patients. All of the complications were treated conservatively. Conclusion Pancreaticogastrostomy is a safer drainage procedure for the pancreatic stump after pancreaticoduodenectomy.
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.
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.
ObjectiveTo investigate the role of laparoscopic pancreaticoduodenectomy (LPD) for periampullary carcinoma. MethodsThis is a retrospective review of all periampullary carcinomas consecutively performed between January 2013 and January 2016 in Zhejiang Provincial People's Hospital. ResultsFifty-one patients underwent LPD. Conversion to open procedure was required in three cases. The operative time was (370±104) min, The estimated blood loss was (220.7±180.9) mL. Five cases had binding pancreaticogastric anastomosis, the other patients underwent duct to mucosa pancreaticojejunal anastomosis. Post operatively hospital stay was (14.6±11.2) days. The represented morbidity including pancreatic fistula (9 cases), postoperative intraperitoneal bleeding (2 cases), postoperative gastrointestinal bleeding (2 cases), delayed gastric emptying (4 cases), and bile leakage (4 cases). All patients underwent R0 resection. Postoperative pathological results: pancreatic adenocarcinoma: 28 cases, duodenal papillary adenocarcinoma: 12 cases, common bile duct adenocarcinoma: 11 cases. Conciusions LPD has been proven to be a safe procedure. Our LPD approach can improve the effectiveness of lymphadenectomy. It combined with resection of portal vein can improve the R0 resection rate of periampullary adenocarcinoma and is associated with better survival of those patients.