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 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 analyze the risk factors for pancreatic fistula following pancreaticoduodenectomy. MethodThe clinical data of 150 patients underwent pancreaticoduodenectomy in this hospital from January 2011 to January 2014 were reviewed, and the potential factors for pancreatic fistular were evaluated by both univariate and multivariate analysis. ResultsThe incidence of pancreatic fistula was 12.7% (19/150). Univariate analysis results showed that the age, preoperative high bilirubin level, texture of the remnant pancreas, diameter of wirsung, operative time were associated with pancreatic fistula following pancreaticoduodenectomy (P < 0.05). Multivariate logistic regression analysis results revealed that the texture of the remnant pancreas, diameter of wirsung, and operative time were the inde-pendent risk factors (P < 0.05) for pancreatic fistula following pancreaticoduodenectomy. ConclusionsTexture of the remnant pancreas, diameter of wirsung, operative time are independent risk factors for pancreatic fistula following pancreaticoduodenectomy. Rich experience and skilled surgical procedures could effectively reduce the incidence of pancreatic fistula.
ObjectiveTo investigate the application of imbedding pancreaticojejunostomy in pure laparoscopic pancreaticoduodenectomy. MethodsEighty-five cases of laparoscopic pancreaticoduodenectomy in our hospital from May 2014 to December 2015 were analyzed retrospectively. According with inclusion criteria and exclusion criteria, 78 cases were investigated. They were divided into pancreatic duct-to-jejunum mucosa pancreaticojejunostomy group as controlled group (n=42) and imbedding pancreaticojejunostomy (technique of duct-to-mucosa PJ with transpancreatic interlocking mattress sutures) group as modified group (n=36). The rates of pancreatic fistula, abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, and incision infection were investigated as well as hospital stays and pancreaticojejunostomy time in two groups were compared. ResultsThe rate of pancreatic fistula especially B to C grade pancreatic fistula in the modified group was obviously lower compared with which in the controlled group (8.3% vs. 31.0%, P < 0.05), pancreaticojejunostomy time ofmodified group was significantly shortened [(35.6±12.4) min vs. (52.8±24.6) min, P < 0.05] and total operative time also shortened [(322.4±23.6) min vs. (384.2±30.2) min, P < 0.05). There were no significant difference of the rates of abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, ?incision infection, and hospital stays (P > 0.05)]. Conciusions The type of pancreaticojejunostomy has a significant impact on the rate of pancreatic fistula after laparoscopic pancreaticoduodenectomy. Imbedding pancreaticojejunostomy can decrease the rate of pancreatic fistula after operation, and shorten the pancreaticojejunostomy time and total operative time.
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 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 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 clinical value of the improved style of pancreatodeodenectomy. Methods Retrospective analysis the data of 111 cases of pancreatodeodenectomy. Forty-one cases of 111 cases were performed the modified Whipple pancreatic jejunal anastomosis， which reconstruction residual pancreatic duct jejunum into the intestinal mucosa sets of accurate end to side anastomosis type （modified group）. Another 70 cases were performed the conventional Whipple pancreatic jejunal anastomosis， which classic lines set into the pancreas jejunum anastomosis （conventional group）. The incidence rate of pancreatic fistula after operation were compared in two groups. Results The postoperative recovery in modified group was smooth， and there was no case of pancreatic fistula. Thirteen cases （18.57%） had pancreatic fistula in conventional group. The difference of incidence rate of pancreatic fistula between two groups was statistically significant （P＜0.05）. The difference in other complications such as gastrointestinal bleeding， delayed gastric emptying， biliary fistula， abdominal infection， lung infection， and wound infection were no statistically significant （P＞0.05）， and the difference of survival rate was also no statistically significant （P＞0.05） in two groups. Conclusions Pancreatic duct jejunum end to side into the mucous membrane of the mucosal anastomosis sets of pancreatodeodenectomy can significantly prevent pancreatic fistula， it is worth to promote the use in clinical work.
ObjectiveTo summarize the clinical characteristics of traumatic pancreatitis (TP) after pancreatic trauma and illustrate the experience of specialized treatment. MethodsClinical data of 73 patients with TP treated in our hospital from January 2008 to June 2014 were collected. The pancreatic injury location, grade, and TP pathogenic factors were analyzed, summarized the common problem and the regularity in TP course, and summarized the treatment strategy, methods of surgical intervention, operation key points and difficulties of TP. ResultsThe grade of pancreatic trauma in the all of patients was mainly to levels of 2, 3, and 4, the head of the pancreas injury accounted for 31.5% (23/73), cervical pancreatic body and tail injuries accounted for 68.5% (50/73). Fifty-nine patients were from other hospitals referral. The occurrence of TP peak period was 4-7 days after pancreatic trauma. Pancreatic fistula and uncontrolled peritoneal infection were the treatment difficulty of TP. It's the effective minimally invasive treatment methods for TP that percutaneous catheter drainage, pancreatic duct stent placement, and endoscopic abscess debridement. Forty-two patients with TP needed reoperations, and 19 cases underwent more than 2 times operation. ConclusionsBecause of the condition of TP is complex and changeable, and difficulty to treat, so the early definitive diagnosis and appropriate surgical strategy play a crucial role in the treatment of TP. Besides, professional team of pancreatic surgery has advantages in estimating patients' conditions, selecting and performing surgical interventions.