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。
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。
Objective To investigate the clinical value of " O”continuous biliary-enteric anastomosis combined with percutaneous transhepatic cholangial drainage (PTCD) in pancreaticoduodenectomy (PD). Methods The clinical data of 35 patients with PD who were admitted to Xinyang Central Hospital from June 2015 to June 2017 were retrospectively analyzed. Results All patients completed the " O” continuous biliary-enteric anastomosis combined with PTCD without perioperative death. ① The preoperative indwelling time of PTCD tube was (13.24±3.39) d, total bilirubin (TBIL) was (363.67±12.26) μmol/L on admission and (155.59±17.63) μmol/L on preoperative after PTCD, respectively. ② The operative time was (231.46±18.69) min, the intraoperative blood loss was (158.30±31.33) mL, the diameter of the hepatic ductal segment was (1.3±0.2) cm, and the duration of the " O” continuous biliary-enteric anastomosis was (7.31±1.52) min. ③ After surgery, the indwelling time of PTCD tube was (8.13±1.49) d, the hospitalization time was (27.31±5.49) d. Biliary leakage occurred in 1 case, pancreatic fistula occurred in 5 cases (3 cases of biochemical sputum and 2 cases of B-stage pancreatic fistula), abdominal infection occurred in 2 cases, pneumonia occurred in 3 cases, wound infection occurred in 2 cases. No postoperative biliary-enteric anastomosis stenosis, biliary tract infection, and intra-abdominal hemorrhage occurred. There was no laparotomy patients in this group and all patients were discharged. ④ All patients were followed-up for 180 days after surgery. No death, bile leakage, biliary-enteric anastomotic stenosis, biliary tract infection, pancreatic fistula, gastro-intestinal leakage, and abdominal infection occurred. One case of delayed gastric emptying and 2 cases of alkaline reflux gastritis were cured after outpatient treatment. Conclusions The preoperative PTCD can improve the preoperative liver function and increase the security of PD. " O” continuous biliary-enteric anastomosis is simple, safe, feasible, and has the function of preventing biliary-enteric anastomosis stenosis. For severe jaundice patients with blood TBIL >170 μmol/L, the " O” continuous biliary-enteric anastomosis combined with PTCD is an alternative surgical procedure for PD.
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.
ObjectiveTo investigate the occurrence and treatment of postoperative complications after laparoscopic laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD) or pancreaticoduodenectomy (LPD). MethodThe clinical data of 130 patients undergoing LPD from October 2010 to December 2015 in West China Hospital of Sichuan University were analyzed retrospectively. ResultsOf 130 patients, postoperative complications occurred in 55 cases, including 24 cases of pancreatic fistula, 14 cases of gastric emptying disorder, 3 cases of anastomotic bleeding, 6 cases of peritoneal infection, 1 case of bile leakage, 1 case of venous thrombosis, 1 case of chylous leakage, 5 cases of peritoneal effusion, without the occurrence of stress ulcer and incision complications. There were significant difference in the incidence of pancreatic fistula (P=0.025), gastric emptying disorder (P=0.034), anastomotic bleeding (P=0.020), and peritoneal infection (P=0.016) among prophase group, metaphase group, and the later stage group. ConclusionsThe most common complication after LPD is pancreatic fistula. With the improvement of surgical techniques and procedures, incidences of some postoperative complications decreases gradually.
Objective To investigate the risk factors and preventions of functional delayed gastric emptying (FDGE) after pylorus-preserving pancreatoduodenectomy (PPPD). Methods The clinical data of 41 patients after undergoing PPPD between 2003 and 2009 in this hospital were analyzed retrospectively.Results In all 41 cases, postoperative complications developed in 13 patients (31.7%), in which 7 patients developed FDGE (17.1%). The complications excluding FDGE (P=0.010) and diabetes (P=0.024) had remarkable relations with the FDGE in the univariate analysis; Compared with the non-FDGE patients, the albumin was declined obviously (P=0.020) while the serum direct bilirubin increased significantly (P=0.036) in the FDGE patients, while the development of FDGE had relation only with the albumin (P=0.039) and the complication of diabete (P=0.047) by the binary logistic regression analysis. Conclusion In the patients undergoing PPPD, preoperative control of the blood glucose, preoperative correction of hypoproteinemia and hyperbilirubinemia, and centralizing PPPD in high-volume have possibly positive significance for the prevention of FDGE.
ObjectiveTo study the predictability of dynamic prediction model of clinical pancreatic fistula in patients with or without pancreatic duct stent in laparoscopic pancreaticoduodenectomy (LPD).MethodsA total of 66 patients who underwent LPD in West China Hospital of Sichuan University from November 2019 to October 2020 were enrolled in the randomized controlled trial (registration number: ChiCTR1900026653). The perioperative data of the patients were collected in real time. The patients were divided into groups according to whether the pancreatic duct support tube was retained during the operation, and the probability prediction value was output according to the model formula. The specificity, sensitivity, accuracy, discrimination, and stability of the prediction results were analyzed.ResultsFor the group with pancreatic stent tubes, the specificity, sensitivity, and accuracy of the model at the model cut-off points on the postoperative day 2, 3 and 5 were 92.0%, 76.7% and 57.1%, 50.0%, 100% and 66.7%, and 88.8%, 78.8% and 61.3%, respectively. The areas under the ROC curve were 0.870, 0.956 and 0.702, respectively. The kappa values of the prediction result based on model cut-off point and cut-off point of ROC curve were 0.308, 0.582 and 0.744, respectively. Whereas for those who without the stent tube, the specificity, sensitivity, and prediction accuracy of the model on the postoperative day 5 were 66.7%, 100% and 72%, respectively. The area under curve at different time points were 0.304, 0.821, and 0.958, respectively. The kappa values at the last two time points were 0.465 and 0.449, respectively.ConclusionsFor patients with pancreatic duct support during LPD operation, the dynamic model of clinical pancreatic fistula can more accurately screen high-risk groups of clinical pancreatic fistula, and has better stability of prediction results. For patients without supporting tube, in the case of flexible adjustment of the boundary point, the model can also be more accurate screening on the 3rd and 5th days after operation.
ObjectiveTo evaluate clinical feasibility and safety of total laparoscopic pancreaticoduodenectomy (TLPD).MethodThe clinical data of 51 consecutive cases who underwent TLPD, admitted in this department of pancreatic surgery of the Affiliated Hospital of Xuzhou Medical University from August 2016 to August 2018, were analyzed retrospectively.ResultsThe TLPDs were successfully completed in the 51 patients. The operative time was (375.5±75.2) min, the pancreaticojejunostomy time was (45.2±8.3) min and bilioenteric anastomosis time was (25.6±7.5) min. The intraoperative blood loss was (337.8±164.4) mL. The length of surgical incision was (6.0±1.2) cm. The duration of flatulence was (3.5±1.0) d. The time for liquid diet was (5.2±2.1) d, the postoperative first ambulation time was (2.0±1.2) d. The duration of postoperative hospital stay was (14.8±5.3) d. The total postoperative complication rate was 34.3% (17/51), with 19.6% (10/51) of B or C postoperative pancreatic fistula and 9.8% (5/51) of bleeding. The postoperative pathology showed that there were 45 cases of malignant tumor and there was no positive incisal margin. The maximum tumor size was (2.8±1.2) cm and the number of lymph nodes harvested was 12.6±7.8. All the patients were followed up for 2–24 months with a median time of 17 months. The 1-year overall survival rate and progression-free survival rate of the patients with malignant tumors were 84.4% (38/45) and 77.8% (35/45), respectively.ConclusionTLPD is safe and feasible in cases of clinical practice under skilled hand and there are advantages such as faster postoperative recovery and shorter hospital stay.