【Abstract】ObjectiveTo determine the risk factors associated with development of pancreatic fistula after pancreatoduodenectomy (PD). Methods The clinical data of 123 consecutive patients who underwent PD from Dec. 1994 to Dec. 2003 were analysed retrospectively. Results The incidence of pancreatic fistula was 11.4% (14/123). Univariate analysis showed history of upper abdominal operation, texture of pancreas, postoperative serum hemoglobin level, type of pancreatojejunostomy and diameter of pancreatic duct were significantly associated with pancreatic fistula after PD. Multivariate analysis using Logistic regression identified four variables as independent factors associated with the occurrence of pancreatic fistula: history of upper abdominal operation, texture of pancreas, postoperative serum hemoglobin level and type of pancreatojejunostomy. Conclusion History of upper abdominal operation, soft texture of pancreas, postoperative serum hemoglobin level less than 90 g/L and routine invaginated pancreaticojejunostomy are main risk factors associated with development of pancreatic fistula after PD.
ObjectiveTo explore risk factors for pancreatic fistula and severe pancreatic fistula (grade B and C) after distal pancreatectomy. MethodsOne hundred and fifty patients underwent distal pancreatectomy were collected and analyzed from January 2012 to December 2014 in this retrospective study,among which 61 cases were male,89 cases were female,age from 18 to 78 years old.The risk factors for pancreatic fistula and severe pancreatic fistula after distal pancreatectomy were analyzed by univariate and multivariate logistic regression analysis. ResultsIn these patients,136 cases were underwent laparotomy,8 cases were underwent total laparoscopic surgery,6 cases were underwent hand assisted laparoscopic surgery;39 cases were preserved spleen,111 cases were combined splenectomy.Technique for closure of the pancreas remnant,15 cases were used cut stapler (Echelon 60,EC60),77 cases were used cut stapler (Echelon 60,EC60) combined with manual suture,52 cases were underwent manual cut and suture,and 6 cases were underwent pancreatic stump jejunum anastomosis.The total incidence of complications was 36.0%(54/150),the postoperative hospitalization time was (9.1±6.2) d,the reoperation rate was 2.7%(4/150),the perioperative mortality was 0,the incidence of postoperative pancreatic fistula was 34.7%(grade B and C was 10.0%).In these patients with postoperative pancreatic fistula,the postoperative hospitalization time was (12.6±9.3) d,the reoperation rate was 7.7%(4/52).The results of the univariate and multivariate logistic regression analysis showed that the hypoproteinemia (OR=4.919,P<0.05) was the risk factor for pancreatic fistula after distal pancreatectomy,the malignancy (OR=4.125,P<0.05) was the risk factor for severe pancreatic fistula after distal pancreatectomy. ConclusionsIncidence of pancreatic fistula after distal pancreatectomy is related to hypoproteinemia before operation,it is needed to improve the nutritional status by nutrition treatment for reducing postoperative pancreatic fistula.If patient with malignancy has postoperative pancreatic fistula,it is likely to be severe pancreatic fistula.
ObjectiveTo explore the risk factors of intraabdominal complications (IACs), pancreatic fistula (PF), and operative death after pancreatoduodenectomy (PD), and to provide a theoretical basis in reducing the rates of them. MethodsClinical data of 78 patients who underwent standard PD surgery in The Third People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from Jun. 2003 to Nov. 2011 were collected to analyze the influence factors of IACs, PF, and operative death. ResultsThere were 29 cases suffered IACs (13 cases of PF included), and 6 case died during 1 month after operation. Univariate analysis results showed that IACs and PF occurred more often in patients with soft friable pancreas, diameter of main pancreatic duct less than 3 mm, preoperative biliary drainage, no pancreatic duct stenting, and without employment of somatostatin (P < 0.05), no influence factor was found to be related to operative death. Multivariate analysis results showed that patients with no pancreatic duct stenting (OR=1.867, P=0.000), soft texture of remnant stump (OR=1.356, P=0.046), and diameter of main pancreatic duct less than 3 mm (OR=2.874, P=0.015) suffered more IACs; PF was more frequent in patient with no pancreatic duct stenting (OR=1.672, P=0.030), soft texture of remnant stump (OR=1.946, P=0.042), and diameter of main pancreatic duct less than 3 mm (OR=1.782, P=0.002);no independent factor was found to have relationship with operative death. ConclusionsSoft texture of remnant stump, diameter of main pancreatic duct less than 3 mm, and no pancreatic duct stenting are independent risk factors that should be considered in indications for PD surgery.
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.
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 effect of sealing one-layer anastomosis in pancreaticojejunostomy in patients underwent pancreaticoduodenectomy. MethodsThe clinical data of 85 patients underwent pancreaticoduodenectomy in this hospital from January 2014 to May 2015 were collected. Of all the patients, 28 patients were underwent sealing onelayer anastomosis in pancreaticojejunostomy (sealing one-layer anastomosis group), 27 patients were underwent ductto-mucosa pancreaticojejunostomy (duct-to-mucosa anastomosis group), and 30 patients were underwent end-to-side invaginated pancreaticojejunostomy (end-to-side invagination group). The anastomosis time, time to pull out drainage tube, postoperative hospital stay, and incidence rate of postoperative pancreatic fistula were compared among these three groups. Results①The anastomosis time (min) of the sealing one-layer anastomosis group was significantly shorter than that of the duct-to-mucosa anastomosis group or end-to-side invagination group (12.51±2.96 versus 25.65±3.35, P < 0.05; 12.51±2.96 versus 23.73±5.27, P < 0.05).②The time to pull out drainage tube of the sealing one-layer anastomosis group was significantly shorter than that of the end-to-side invagination group (7.65±1.30 versus 11.15±3.47, P < 0.05).③The postoperative hospital stay had no statistical significances among these three groups (P > 0.05).④The incidence of pancreatic fistula was 3.57% (1/28), 7.41% (2/27), and 10.00% (3/30) among the sealing one-layer anastomosis group, duct-to-mucosa anastomosis group, and end-to-side invagination group respectively, which had no statistical differences among these three groups (P > 0.05). ConclusionSealing one-layer anastomosis in pancreaticojejunostomy might be a safe anastomosis, and it has advantages of simple operation and short operation time.
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 summarize the experiences of middle pancreatectomy. Methods Eleven female and 4 male with a mean age of 49.4 years (23.8-73.1 years) who underwent middle pancreatectomy from January 2001 to October 2005 were collected. Eight patients with neuroendocrine tumor (non-function of 5 cases), 5 with serous cystadenomas and 2 with mucinous cystadenomas were included. The proximal apical end of pancreas was sutured, while distal end of pancreas was anastomosed to a Roux-en-Y jejunal loop. Results Mean operative time was 275 min (179-370 min), mean length of resected pancreas was 45 mm (30-60 mm) and max diameter of tumor was 23 mm (15-40 mm). Complication after operation was pancreatic fistula 〔4 cases (26.7%)〕, in which 3 cases (20.0%) had intraabdominal blood. The mean time of follow-up was 23 months (3 months-5 years). one patient was died of multiple organs failure for pulmonary infections in month 3 after operation, and the others were alive without novo-diabetes. Conclusion Middle pancreatectomy is an effective operation for benign and borderline tumors of neck and body of pancreas without a significant increase of postoperative morbidity.
Objective To evaluate the application of a surgical method in pancreaticoduodenectomy. Methods All the 211 cases of purse-string invaginated pancreaticojejunostomy performed from Dec.1985 to Dec.2007 were reviewed. Firstly, an accordant plastic tube was put and fastened in main pancreatic duct, and pancreas was ligated at 2-3 cm apart from the pancreatic stump to let secretin flow far away. Furthermore, invaginated pancreaticojejunostomy was performed to get closer between pancreas and jejunum. Results Pancreatic fistula and perioperative death didn’t occur among these 211 cases. The complications included 2 cases of incision dehiscence, 4 cases of biliary fistula and 1 case of scission of superior mesentric artery. Conclusion Purse-string invaginated double-layer anastomosis of pancreaticojejunal would be feasible for pancreaticoduodenectomy preventing pancreatic fistula.
ObjectiveTo evaluate the various methods in prevention of pancreatic fistula after pancreaticoduodenectomy.MethodsThe literatures over the years related to prevention of pancreatic fistula were reviewed.ResultsManagement of the pancreatic stump following pancreaticoduodenectomy played the most important role in preventing pancreatic fistula. None of the methods of pancreatic stump had proved to be perfect in preventing pancreatic fistula, though pancreaticojejunostomy was the most widely practiced reconstruct strategy in varieties of option. For pancreaticojejunostomy and pancreaticogastrostomy, the rate of this complication was 12.3% and 11.1%,respectively. In recent years, a new procedure, bindingup pancreaticoduodenectomy, had shown a promise and excellent results in prevention of pancreatic fistula, the rate of fistula was 0 for consecutive 100 cases after pancreaticoduodenectomy.ConclusionBindingup pancreaticojejunostomy have a definite effect to avoid pancreatic fistula and be worthy of being recommended