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 age of patients can be the independence factor to affect the feasibility of pancreaticoduodenectomy. MethodsThe cases in the First Affiliated Hospital, Xinjiang Medical University from Feb. 2011 to Feb. 2015 were retrospectively analyzed, and divided into six groups according to age < 50, 50≤age < 60, 60≤age < 70, 70≤age < 75, 70≤age < 80, and≥80 years old. The complications, hospitalization days, and mortality rates for six groups were analyzed. ResultsThe differences in ASA classification (P < 0.001), hypertension (P < 0.001), coronary heart disease (P=0.001), diabetes mellitus (P < 0.001), heart failure (P=0.001), respiratory failure (P=0.037), postoperative hospitalization days (P=0.014), and delayed gastric emptying grade C (P=0.006) had statistical significance, and pancreatic fistula (P=0.058), postoperative bleeding (P=0.786), and mortality (P=0.125) of the different age groups had no significant difference. ConclusionAge is not the independent risk factor to affect the feasibility of pancreaticoduodenectomy, but the strictly preoperative comorbidities assessment is necessary.
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 evaluate the operative indication and results of pancreaticogastrostomy following pancreaticoduodenectomy. Methods A retrospective study was carried out on the cases of pancreaticoduodenectomy following pancreaticogastrostomy from Aug. 2005 to Feb. 2008 in Shanghai Tongji Hospital. Results During this period, 38 cases had undergone pancreaticogastrostomy with pancreaticoduodenectomy. The median operative time was (352.1±78.3) min. The median intraoperative blood transfusion was (911.3±601.4) ml. The median postoperative length of stay was (26.2±12.1) d. Postoperative morbidity was 21.1% (8/38) with no operative death. Pancreatic anastomotic leakage occurred in 1 patient. Delayed gastric emptying occurred in 2 patients. Incision infection occurred in 2 patients. Abdominal fluid collection occurred in 1 patient and pulmonary infection occurred in 2 patients. All of the complications were treated conservatively. Conclusion Pancreaticogastrostomy is a safer drainage procedure for the pancreatic stump after pancreaticoduodenectomy.
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.
Objective To explore the risk factors and treatment associated with postoperative hemorrhage after pancreaticoduodenectomy. Methods The clinical data of 78 patients undergoing pancreatieoduodeneetomy from May 2009 to October 2011 were retrospectively analyzed in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Results The incidence of postoperative hemorrhage was 10.3％ （8/78）. Among these eight patients, intra-abdominal hemorrhage occurred in two cases （one case of early and delayed hemorrhage respectively）, and gastrointestinal hemorrhage occurred in 6 cases （one and five cases of early and delayed hemorrhage respectively）. Univarlate analysis showed that operative blood loss, postoperative celiac infection, pancreatic fistula, and pancreaticogastrostomy were significantly associated with postoperative hemorrhage. Multivariate analysis identified for vailables as independent factors associated with postoperative hemorrhage, namely, pancreaticogastrostomy, postoperative celiac infection, and pancreatic fistula. Conclusions Skillful operation, prevention of pancreatic fistula, and control celiac infection are important for reducing postoperative hemorrhage. Proper treatments should be used according to the site, onset, and severity of hemorrhage. To prevent its occurrence is the key of treatment.
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.
ObjectiveTo summarize the application and the complications of pancreaticogastrostomy (PG) after pancreaticoduodenectomy(PD). MethodThe domestic and international publications involving the theory, methods, and clinical application of PG were retrieved and reviewed. ResultsPG was gradually concerned on the choice of the method of the digestive tract reconstruction after PD, in view of its advantages in theory and operation. The literatures about PG were increased in recent years. But the discussion of decreasing complications of PG after PD had yet to be unified. ConclusionsPG is one of the important operations of digestive tract reconstruction after PD. The factors of operator and patient should be comprehensively considered in the choice of PG.
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.