目的 探讨胰头癌侵犯肠系膜上动脉时行根治性切除的可行性。方法 采用联合将受侵犯的肠系膜上动脉一并切除的胰十二指肠切除术，肠系膜上动脉断端与腹主动脉端侧吻合方式重建。 结果 患者术后恢复顺利，已随访14个月，仍存活。 结论 肠系膜上动脉侵犯的胰头癌仍可行扩大的胰十二指肠切除术，并可延长患者的生存时间和提高生活质量。
ObjectiveTo discuss the current status and progress of delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).MethodThe related researches about DGE after PD in recent year were searched and reviewed.ResultsThe etiology and pathogenesis of DGE had not yet been fully elucidated. There were various risk factors, such as the surgical trauma, advanced age, diabetes, and with other abdominal complications. The pylorus preserving PD didn’t increase the risk of DGE. The pylorus ring resection, anterior colon, Braun anastomosis, and minimally invasive surgery were beneficial for reducing DGE. Although there was no obvious progress in the treatment of DGE at home and abroad, the majority of patients could be cured by the symptomatic conservative treatment.ConclusionsPrevention is a main strategy for DGE after PD. Application of enhanced recovery after surgery might be a key to solve problem in clinical, but further research is needed.
【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.
ObjectiveTo evaluate the predictive value of the geriatric nutritional risk index (GNRI) for postoperative overall and severe complications after pancreaticoduodenectomy (PD) in the elderly patients with pancreatic cancer. MethodsThe clinical data of the elderly (65 years old or more) patients with pancreatic cancer underwent PD were retrospectively collected, who were admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from January 2017 to October 2021. The incidences of postoperative overall and severe complications (Clavien-Dindo grade Ⅲ–Ⅴ was defined as severe complications) were summarized. The univariate and multivariate logistic regression models were used to analyze whether GNRI was a risk factor for overall and severe complications after PD. The area under the receiver operating characteristic curve (AUC) was used to evaluate the ability of GNRI to distinguish whether overall or severe complications occurred after PD and to confirm the optimal threshold. Then the patients were assigned into a high nutritional risk group (greater than the optimal threshold) and low nutritional risk group (the optimal threshold or less) based on this. Simultaneously, the clinical outcomes of the two groups were compared. ResultsIn this study, 190 elderly patients with pancreatic cancer were enrolled, 95(50.0%) of whom developed complications, including 28(29.5%) cases of serious complications. The results of multivariate logistic regression model analysis showed that the decreased GNRI was a risk factor for the occurrence of overall and severe complications after PD for the elderly patients [OR(95%CI)=0.361(0.154, 0.848), P=0.019; OR(95%CI)=0.906(0.834, 0.983), P=0.018]. The AUC of GNRI for assessing the occurrence of overall and severe complications was 0.765 and 0.715, respectively, with the optimal critical values of 98 and 96, respectively. Compared with the low nutritional risk group, the high nutritional risk group had higher postoperative total hospitalization costs (Z=–2.37, P=0.019), higher occurrences of overall complications (χ2=44.61, P<0.001) and severe complications (χ2=29.39, P＜0.001). ConclusionsIn elderly patients with pancreatic cancer underwent PD, incidence of serious complications is not lower. GNRI has a good discriminative value in terms of postoperative overall and severe complications. When preoperative GNRI is 98 or less and GNRI is 96 or less, patients should be given early preoperative nutritional support treatment in time.
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。
Objective To explore the influencing factors of pancreatic fistula after pancreaticoduodenectomy (PD), and to compare the incidence of pancreatic fistula after pancreaticoduodenectomy with internal drainage of main pancreatic duct and external drainage according to the pancreatic fistula risk score (FRS) system, to provide the basis for the best drainage scheme in clinic. Methods The clinical data of 76 patients with PD who treated in the Affiliated Hospital of Xuzhou Medical University from January 2016 to December 2017 were analyzed retrospectively, to explore the risk factors of pancreatic fistula. Single factor analysis was based on group chi-square test or Fisher exact probability method, and multivariate analysis was based on unconditioned logistic regression model. According to the results of FRS, the difference of pancreatic fistula in different risk groups was explored. The statistical method was chi-square test. Results The incidence of pancreatic fistula after PD was 31. 5% in 76 patients.Univariate analysis showed that the diameter of the main pancreatic duct and the texture of the pancreas were the related factors affecting the occurrence of pancreatic fistula after PD (P<0.05), and the soft pancreas was the independent risk factor for the occurrence of pancreatic fistula after PD (OR=3.886, P=0.011). There was no significant difference in the incidence of postoperative pancreatic fistula between the internal drainage group and the external drainage group (P>0.05). There was no pancreatic fistula occurred in the patients with negligible risk. The incidence of postoperative pancreatic fistula in patients with high risk of external drainage group was only 12.5%, comparing with patients in internal drainage group (63.6%), the difference was statistically significant (P=0.026). There was no significant difference in the incidence of postoperative pancreatic fistula between patients in the external drainage group with moderate risk and low risk compared with the corresponding patients in the internal drainage group (P>0.05). Conclusions Pancreatic texture was an independent risk factor for pancreatic fistula after PD. External drainage maybe more effective than internal drainage in preventing pancreatic fistula after PD in patients with high risk of FRS.
ObjectiveTo review the recent research progress on prediction models for pancreatic fistula after pancreaticoduodenectomy and explore the potential application of prediction models in personalized treatment, aiming to provide useful reference information for clinical doctors to improve patient’s treatment outcomes and quality of life. MethodWe systematically searched and reviewed the literature on various prediction models for pancreatic fistula after pancreaticoduodenectomy in recent years domestically and internationally. ResultsSpecifically, the fistula risk score (FRS) and the alternative FRS (a-FRS), as widely used tools, possessed a certain degree of subjectivity due to the lack of an objective evaluation standard for pancreatic texture. The updated a-FRS (ua-FRS) had demonstrated superior predictive efficacy in minimally invasive surgery compared to the original FRS and a-FRS. The NCCH (National Cancer Center Hospital) prediction system, based on preoperative indicators, showed high predictive accuracy. Prediction models based on CT imaging informatics had improved the accuracy and reliability of predictions. Prediction models based on elastography had provided new perspectives for the assessment of pancreatic texture and the prediction of clinically relevant postoperative pancreatic fistula. The Stacking ensemble machine learning model contributed to the individualization and localization of prediction models. The existing pancreatic fistula prediction models showed satisfactory predictive efficacy, but there were still limitations in identifying high-risk patients for pancreatic fistula.ConclusionsAfter pancreaticoduodenectomy, pancreatic fistula remains a major complication that is difficult to overcome. The prevention of pancreatic fistula is crucial for improving postoperative recovery and reducing mortality rates. Future research should focus on the development and validation of pancreatic fistula prediction models, thereby enhancing their predictive power and increasing their predictive efficacy in different regional patients, providing a scientific basis for medical decision-making.
目的探讨保留幽门胰胃吻合式胰十二指肠切除术的临床应用价值。方法对36例壶腹周围癌患者在证实胃幽门、幽门上、下淋巴结及十二指肠球部未受侵犯的情况下，施行保留幽门胰胃吻合的胰十二指肠切除术，术后观察治疗效果，并进行随访。结果本组无手术死亡、胆胰瘘、出血等并发症发生。5例术后短期内有胃排空延迟症状，经处理后缓解，无吻合口溃疡和胆道返流症状。1、3、5年累计生存率分别为61.1%、25.0%和13.9%。结论本术式可降低胰十二指肠切除术的死亡率和并发症，1、3、5年生存率与Whipple手术相比无差异。