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.
Objective To explore the effects of recombinant human growth hormone （rhGH） on senile patients after pancreaticoduodenectomy. MethodsFortysix patients were divided into the therapeutic group (rhGH, n=17) and control group (n=29). Both were treated with parenteral nutrition. In the therapeutic group, rhGH (8 u/d) was given hypodermically for 7 days. After operation the levels of albumin, prealbumin, transferrin, and immunoglobulin were measured. Postoperative fatigue syndrome and the average length of stay in hospital were observed too. ResultsAfter operation the levels of albumin, prealbumin, transferrin, and immunoglobulin in the therapeutic group were significantly higher than those of control group. The degree of postoperative fatigue syndrome in the therapeutic group was less than that of control group. The average length of stay in hospital was significantly shortened. Conclusion The early application of rhGH in senile patients after pancreaticoduodenectomy can enhance immune function, reduce the incidence of infection, promote the postoperative recovery, shorten the average length of stay in hospital,decrease the mortality, increase the safety of operation and improve the postoperative life quality of senile patients.
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 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
Objective To evaluate the effectiveness and safety of early enteral nutrition (EN) versus total parenteral nutrition (TPN) after pancreaticoduodenectomy (PD). Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CBM, VIP, CNKI were electronically searched to collect the randomized controlled trials (RCTs) about EN versus TPN after PD published from 2000 to March 2010. The quality of the included trials was assessed according to the inclusive and exclusive criteria, and the data were extracted and analyzed by using RevMan 5.0 software. Results A total of 4 RCTs involving 322 PD patients were included. The meta-analysis showed that the EN (the treatment group) was superior to the TPN (the control group) in the average postoperative hospital stay (MD= –2.34, 95%CI –3.91 to –0.77, Plt;0.05), the total incidence rate of complication (RR=0.75, 95%CI 0.57 to 0.99, P=0.04), the recovery time of enterocinesia (MD= –29.87, 95%CI –33.01 to –26.73, Plt;0.05) and the nutrition costs (MD= –30.51, 95%CI –35.78 to –25.24, Plt;0.05); there were no differences in mortality (RR=0.23, 95%CI 0.03 to 2.03, P=0.19), pancreatic leakage (RR=0.78, 95%CI 0.45 to 1.35, P=0.38), infectious complications (RR=0.71, 95%CI 0.43 to 1.18, P=0.19), non-infectious complications (RR=0.78, 95%CI 0.5 1 to 1.20, P=0.26) and postoperative serum albumin level (MD= –0.79, 95%CI –2.84 to 1.27, P=0.45). Conclusion Compared with total parenteral nutrition, the enteral nutrition used earlier after pancreatoduodenectomy shows significant advantages. But more reasonably-designed and double blind RCTs with large scale are expected to provide high quality proof.
Objective To analyze the difference in the incidence of postoperative pancreatic leakage and anasto-motic bleeding complications in various methods of pancreaticojejunostomy after pancreaticoduodenectomy （PD）. Methods The clinical data of 526 patients underwent pancreaticojejunostomy from January 2008 to September 2012 in this hospital were analyzed retrospectively. End-to-side “pancreatic duct to jejunum mucosa-to-mucosa” anastomosis （abbreviation：mucosa-to-mucosa anastomosis） was performed in 359 patients， which contained 149 patients with internal drainage， 130 patients with external drainage， and 80 patients with no drainage. End-to-side invaginated anastomosis was performedin 165 patients without drainage. In addition， side-to-side anastomosis was performed in 2 patients without drainage.Results There were 34 cases （6.46%） of pancreatic leakage， 8 cases （1.52%） of anastomotic bleeding in pancreaticoje-junostomy， and 32 cases of death （6.08%）. ① The pancreatic leakage rate of mucosa-to-mucosa anastomosis was signi-ficantly lower than that of end-to-side invaginated anastomosis 〔4.18% （15/359） versus 11.52% （19/165）， χ2=10.029， P=0.002〕. There was no significant difference of the anastomotic bleeding incidence between mucosa-to-mucosa anasto-mosis and end-to-side invaginated anastomosis 〔1.67% （6/359） versus 1.21% （2/165）， χ2=0.159， P=0.691〕. ② In the mucosa-to-mucosa anastomosis group， the pancreatic leakage rates in the ones with internal drainage and external drainage were lower than those in the ones without drainage， respectively （2.68% （4/149） versus 11.25% （9/80）， χ2=7.132， P=0.008；1.54% （2/130） versus 11.25% （9/80）， χ2=9.410， P=0.002）；which was no significant difference between the ones with internal drainage and external drainage 〔2.68% （4/149） versus 1.54% （2/130）， χ2=0.433， P=0.510〕. But there were no significant differences for both the pancreatic leakage 〔2.68% （4/149） versus 1.54% （2/130）， χ2=0.433， P=0.510〕and anastomotic bleeding incidence 〔2.68% （4/149） versus 1.54% （2/130）， χ2=0.433， P=0.510〕 between the ones with internal drainage and external drainage. Conclusions Mucosa-to-mucosa anastomosis has a lower pancreatic leakage incidence as compared with end-to-side invaginated anastomosis. However， there is no significant difference of the anast-omotic bleeding incidence. Internal or external drainage could reduce the incidence of pancreatic leakage， but have no obvious effect to the anastomotic bleeding incidence.
Objective To investigate the effect of the duct-to-mucosa anastomosis in invaginating end-to-side pancreaticojejunostomy. Methods A retrospective review was conducted for 200 patients treated with pancreaticoduod-enectomy （PD） between August 2005 and December 2012. Reconstruction of digestive tract in PD was done according to the method described by Child. The duct-to-mucosa anastomosis was applied in the invaginating end-to-side pancrea-ticojejunostomy. The outline of the anastomosis structures was as follows：anastomosis of pancreatic duct and jejunal mucosa， anastomosis of pancreatic and jejunal resection margin， and anastomosis of pancreas and jejunal seromuscular layer. A cilicone tube was put into the pancreatic duct and lead to the jejunum. The anastomotic stoma was covered with part of the omentum majus, and put a drainage tube under the anastomotic stoma. Results The operation went smoothly，and no deaths occurred during perioperative period. The surgical time was 280-420 min， the average time was （298±77） min. The pancreatic fistula were observed in 22 patients （11%）， including 17 patients in Grade A， 2 patients in Grade B， and 3 patients in Grade C. The other complications were observed in 19 patients， including 16 patients with addominal infection， 1 patient with bleeding from splenic vein， 1 patient with bleeding from ruptured of pseudoaneurysm at biliary intestinal anastomosis， 1 patient with abdominal abscess. Three patients with pancreatic fistula in Grade C were cured by reoperation, and the other patients with pancreatic fistula were cured by expectant treatment. Conclusions The duct-to-mucosa anastomosis in invaginating end-to-side pancreaticojejunostomy is a simple and safe procedure that has the advantage in reducing the incidence of the pancreatic fistula. Using omentum to cover the anastomotic could localize the diffusion of panreactic fistula， and reduce the incidence of serious complications caused by pancreatic fistula.
Objective To explore the situation and prevention of pancreaticoduodenectomy perioperative complications. Methods The clinical data of 111 cases of pancreaticoduodenectomy were retrospectively analyzed， and the possible factor of complications was analyzed. Results There were postoperative complications in 48 patients （43.2%）， which one kind complication occurred in 25 cases， two kinds in 15 cases， and three kinds or more in 8 cases. Four cases （3.6%） died after operation. Conclusions Pancreaticoduodenectomy is a higher risk surgery in abdominal operation. Strengthen perioperative prevention and treatment are important measures to reduce morbidity and mortality after pancreaticoduodenectomy.
Objective To investigate the application value of the binding pancreaticogastrostomy in pancreatico-duodenectomy. Methods The clinical data of 13 patients that performed pancreaticoduodenectomy with binding pancr-eaticogastrostomy from Jan. 2010 to Mar. 2013 in our hospital were retrospectively analyzed. The incidence of postoper-ative complications were counted. Results There was 1 patient with pancreatic stump bleeding after operation， and then recovered after conservative treatment. There was no patient with pancreatic fistula， bile fistula， delayed gastric empt-ying， and other complications after operation in whole group. Peritoneal fluid and amylase level in peritoneal fluid were gradually reduced or degraded after operation. The gastrointestinal function was recovered better. All patients were compl-etely cured. Conclusion The binding pancreaticogastrostomy in pancreaticoduodenectomy has its own unique advantage.It could be reduce the incidence of pancreatic fistula in postoperative patients by using binding pancreaticogastrostomy reasonably.
Objective To explore the feasibility of clinical application of hepatic artery （HA） or proper hepatic artery （PHA） anastomosing with superior mesenteric artery （SMA） and internal iliac vein （IIV） anastomosing with superior mesenteric vein （SMV） or portal vein （PV） in the extended pancreaticoduodenectomy combined with vascular resection．Methods The HA，PHA，SMA， SMV， PV， and IIV were dissected on 20 adult corpses， and the length， thickness，and lumen diameter of blood vessels were measured and compared with the results of multislice spiral CT scan，magnetic resonance angiography，or color Doppler in 25 patients with pancreatic head carcinoma．The extended pancreaticoduodenectomy was carried out on 5 patients of pancreatic head carcinoma with vascular invasion according to the mathcing results，and the reconstructions of HA or PHA with SMA and IIV with SMV or PV were performed．Results According to autopsy，HA-PHA was （5.50±1.50） cm in length，（0.20±0.01） mm in thickness，（5.02±1.32） mm in lumen diameter；and SMA was （4.00±1.00） cm in length，（0.21±0.01） mm in thickness，（6.05±1.06） mm in lumen diameter．The lumen diameter of left IIV，right IIV，and PV or SMV was （11.06±0.16） mm，（11.10±0.13） mm，and （11.56±0.20） mm，respectively．The thickness of left IIV，right IIV，and PV or SMV was （0.10±0.01） mm，（0.10±0.02） mm，and （0.10±0.02） mm，respectively．The multislice spiral CT scan，magnetic resonance angiography，color Doppler，and selective arteriography in vivo showed that the thickness and lumen diameter of HA-PHA and SMA were wider （0.1 mm and 0.3 mm） than those of the autopsy results，and there were no statistic significances （P＞0.05），but the length of HA-PHA was longer （1－2 cm） than that of SMA，and there was statistic significance （P＜0.05）. The survival of 5 patients with extended pancreaticoduodenectomy combined with PHA or SMA and IIV-PV/SMV resection and reconstruction was longer than that of palliative surgery patients or giving-up patients at the same period，and no long-term complications occurred．Conclusions The vascular invasion of pancreatic head carcinoma is not an absolute contraindication of radical pancreaticoduodenectomy．The survival of 5 patients with vascular invasion of pancreatic head carcinoma in this group is prolonged by extended pancreaticoduodenectomy combined with vascular resection and reconstruction as compared with palliative surgery group at the same period．HA，PHA，and IIV are the best autologous vascular alternative materials without more complications． Being familiar with regional anatomy will guide the surgeons in extended pancreaticoduodenectomy.