ObjectiveTo understand the incidence and mechanism of posthepatectomy acute pancreatitis (PHAP) after liver resection, and to explore diagnosis, treatment, and preventive strategies to enhance prognosis for the patients with PHAP. MethodThe literature on studies relevant PHAP both domestically and internationally was retrieved and reviewed. ResultsThe incidence rate of PHAP was approximately 0.7% by the literature. The exact etiology was still unclear. According to the existing research results, it was speculated that the pathogenesis might be related to the portal vein congestion, reactive oxygen species, surgical trauma, and other factors. At present, there were no comprehensive guidelines for the diagnosis and treatment of PHAP after liver resection both domestically and internationally. The diagnosis was mainly based on the clinical manifestations, early signs and symptoms, biochemical examination and imaging evaluation. The treatment principle of the PHAP was similar to that of common acute pancreatitis. The symptomatic supportive treatment was performed for the patients with mild to moderate PHAP, while the surgical treatment and minimally invasive surgery were chosen for the severe PHAP. The best way prevented for PHAP was the preoperative comprehensive evaluation of patients, and quit smoking and drinking, and so on. The careful operation should be performed during the surgical process to minimize portal vein congestion and reduce reactive oxygen species in blood vessels.The blood biochemistry, hematuric amylase, pancreatic function, and relevant infection indicators should be closely monitored after surgery, and abdominal ultrasound should be repeated several times to achieve early identification and timely treatment. ConclusionsAlthough the incidence rate of PHAP is not high, it is a serious surgical complication. The prevention, early detection, and early treatment should be strengthened for PHAP, and we should focuse on earlier and more accurate prediction model in future.
Objective To compare the effect of three-dimensional visual (3DV) model, three-dimensional printing (3DP) model and computer-aided design (CAD) modified 3DP model in video-assisted thoracoscopic surgery (VATS) sublobular resection. MethodsThe clinical data of patients who underwent VATS sublobular resection in the Affiliated Hospital of Hebei University from November 2021 to August 2022 were retrospectively analyzed. The patients were divided into 3 groups including a 3DV group, a 3DP group and a CAD-3DP group. The perioperative indexes and the subjective evaluation of operators, patients and their families were compared. ResultsA total of 22 patients were included. There were 5 males and 17 females aged 32-77 (56.95±12.50) years. There were 9 patients in the 3DV group, 6 patients in the 3DP group, and 7 patients in the CAD-3DP group. There was no significant difference in the operation time, intraoperative blood loss, drainage volume, hospital stay time and postoperative complications (P>0.05). Among the seven subjective evaluations of surgeons, the CAD-3DP group was better than the 3DV group in the preoperative planning efficiency (P=0.008), intuitiveness (P=0.015) and doctor-patient communication difficulty (P=0.011); the CAD-3DP group was also better than the 3DP group in the overall satisfaction (P=0.008), preoperative planning difficulty (P=0.015) and efficiency (P=0.005). In the seven subjective evaluations of patients and their families, CAD-3DP group was better than the 3DP group in the understanding the vessel around the tumor (P=0.005), surgical procedure (P=0.007), program selection (P=0.010), and overall satisfaction (P=0.022). Both tumor size (P=0.013) and overall satisfaction were better than those of the 3DV group (P=0.033). ConclusionCAD-modified 3D printing model has certain advantages in pre-planning, intraoperative navigation and doctor-patient communication in the VATS sublobectomy.