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 investigate the experience in the treatment of splnic malignant tumors with laparoscopy. MethodsThe clinical data of 51 patients with splnic malignant tumor who underwent splenectomy between January 2009 and July 2015 were retrospectively reviewed. Patients were divided into two groups based on the surgical method: Open splenectomy (OS group, n=18) and laparoscopic splenectomy (LS group, n=33). The preoperative, intraoperative and postoperative data of the patients were collected and analysed, the differences of each index during perioperative period (general information), intraoperative data (operative time, estimated blood loss, the size of spleen, intraoperaive transfusion) and postoprative situation (hospital stays, the first oral intake, postoperative pancreatic fistula, rehaemorrhagia, abdominal infection or pulmonary infection and the like) were compared. ResultsLS group compared with OS group, the operative time of LS group was significantly shorter than that of OS group [(103.64±16.92) min vs. (144.44±31.10) min, P=0.000〕, the amount of bleeding of LS group [M (Q25, Q75): 60 (50, 100)〕was significantly less than the OS group [M (Q25, Q75): 150 (115, 210)〕, P=0.000. The hospitalization time of LS group was significantly shorter than the OS group [(13.61±9.91) d vs. (9.03±3.09) d, P=0.017〕, and the LS group has a lower indication of the postoprative complications of fever and pulmonary infection (P=0.010 and P=0.003). Conciusions Laparoscopic splenectomy is feasible in the treatment of splenic malignant tumors, the employment of laparoscopy can shorten the operative time, has the advantages of less bleeding, the shorten hospital stays, lower indication of postoprative complications, and being worthy of further popularization and application.
Objective To explore the feasibility and safety of Frey operation under laparoscopy in the treatment of chronic pancreatitis. Methods The clinical data of chronic pancreatitis patients who underwent laparoscopic Frey procedure in Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University from 2021-2023 were retrospectively analyzed. Results Eleven patients with chronic pancreatitis complicated with pancreatic duct stones were included in the study, 7 of whom had a history of diabetes and (or ) impaired glucose tolerance, suggesting that pancreatic endocrine function was impaired. The median diameter of the main pancreatic duct measured by imaging method was 8 mm (4–20mm). The median operative time was 188 min (120–368 minutes), and the total intraoperative bleeding volume was 50 mL (20–100 mL). Postoperative pancreatic fistula did not occur, one case of postoperative abdominal fluid accumulation and hypoproteinemia improved after symptomatic supportive treatment such as anti infection, acid and enzyme inhibition, and nutritional rehydration. Postoperative bleeding occurred in 3 cases, including 1 case of intestinal anastomotic bleeding, which was sutured again under emergency laparoscopic intestinal anastomosis to stop bleeding. The other two cases improved after conservative management such as blood transfusion, plasma, vitamin K, acid inhibition, enzyme inhibition and hemostatic drugs. The median postoperative hospitalization time was 7 days (4–18 days), and no patient mortality happened within 90 days after surgery. Conclusion Laparoscopic Frey operation is feasible and a relatively safe and effective method for the treatment of chronic pancreatitis.