Risk factors and managements of hemorrhage associated with pancreatic fistula after pancreaticoduodenectomy

BACKGROUND: Post-pancreaticoduodenectomy pancreatic fistula associated hemorrhage (PPFH) is one of the leading lethal complications. Our study was to analyze the risk factors and managements of hemorrhage associated with pancreatic fistula after pancreaticoduodenectomy, and to evaluate treatment options. METHOD: We analyzed 445 patients who underwent pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy and evaluated the relevance between clinical data and PPFH. RESULTS: The incidence of postoperative pancreatic fistula (POPF) was 27.42% (122/445), and the incidence of PPFH was 4.49% (20/445). Among the 20 patients with PPFH, 7 died and 13 were cured. Interventional angiographic therapy was performed for 10 patients and 5 were successfully treated. Relaparotomy was performed for 5 patients and 2 were successfully cured. Univariate logistic regression analysis indicated that several risk factors were related to PPFH: the nature of tumor (carcinoid/low-grade or high-grade malignancy), preoperative day 1. serum prealbumin, preoperative day 1 total bilirubin (TBIL), operative time, blood loss in the operation, operative method (vascular resection and revascularization), postoperative day 3 TBIL, biliary fistula, and the grade of POPF. The multivariate stepwise logistic regression analysis demonstrated that the nature of tumor and the grade of POPF were independently risk factors of PPFH. Receiver operating characteristic curve indicated that preoperative day 1 serum prealbumin level <173 mg/L and postoperative day 3 TBIL level.1.68.tmol/L were the risk factors of PPFH. CONCLUSIONS; The risk of PPFH was found to be increased with high potential malignancy and high grade of POPE Angiography-embolization is one of the major and effective therapies for PPFH. Extraluminal-intraluminal PPFH is more serious and needs more aggressive treatments.

Development characteristics and controlling factor analysis of the Neogene Minghuazhen Formation shallow water delta in Huanghekou area, Bohai offshore basin

Based on a combination of high resolution 3-D seismic, drilling and well logging and core data, this study focuses on describing the depositional features of the Neogene Minghuazhen Formation shallow water delta in Huanghekou area(HHKA), Bohai offshore basin and discussing the evolution and controlling factors of shallow water delta sandbody. An obvious meandering fluvial delta system developed in sequence 1(SQ1) of the Neogene in HHKA with thinner sandbody of distributary channels and poor development of mouth bar. The sequence texture obviously influences the vertical development and stacking pattern of sandbodies and controls the distribution of sandbodies in plain view as well. In shallow water lacustrine basins, relative topographic height difference leads to change of distribution of accommodation space, and sandbodies of distributary channels usually develop well in local low-lying areas where accommodation space increases. The delta is dominated by distributary channel sandbodies during the early period of base level rising. Sandbodies contact with each other in a lateral stacking pattern and are characterized by a fan shape in plain view. Distributary channels gradually narrow and tend to shift during the mid-late-period of base level rising, while the sandbodies are characterized by a net shape in plain view. During the period of base level slow falling, the multistory/multilateral channel sandbodies dominated the inner front of shallow-water delta and the delta sand dispersal distributes as a lobe shape.