A case of chronic pancreatitis treated by laparoscopic duodenum-preserving pancreatic head resection

Pancreaticoduodenectomy(PD) has long been used for chronic pancreatitis(CP), but greatly affects the postoperative quality of life. A new procedure called duodenum-preserving pancreatic head resection(DPPHR) has been introduced, and has little effect on the structure and function of the digestive system. With the development of minimally invasive surgical techniques, treatment of CP can be performed with laparoscopic DPPHR(LDPPHR). We present a case of CP that was successfully treated with LDPPHR. The postoperative pathological diagnosis was pancreatitis, demonstrating the feasibility of LDPPHR. We recommend this minimally invasive surgical method as preferred treatment for CP.

Preoperative 3D reconstruction and fluorescent indocyanine green for laparoscopic duodenum preserving pancreatic head resection:A case report

BACKGROUND Duodenum-preserving pancreatic head resection(DPPHR)is the choice of surgery for benign or low-grade malignant tumors of the pancreatic head.Laparoscopic DPPHR(LDPPHR)procedure can be improved by preoperative 3D model reconstruction and the use of intravenous indocyanine green fluorescent before surgery for real-time navigation with fluorescent display to guide the surgical dissection and prevention of from injury to vessels and biliary tract.CASE SUMMARY Here we report the successful short-and long-term outcomes after one year following LDPPHR for a 60-year lady who had an uneventful recovery and was discharged home one week after the surgery.CONCLUSION There was no bile leakage or pancreatic leakage or delayed gastric emptying.The histopathology report showed multiple cysts in the pancreatic head and localized pancreatic intraepithelial tumor lesions.The resected margin was free of tumor.

Quality of life after pancreatic surgery

BACKGROUND Pancreatic surgery is challenging owing to the anatomical characteristics of the pancreas.Increasing attention has been paid to changes in quality of life(QOL)after pancreatic surgery.AIM To summarize and analyze current research results on QOL after pancreatic surgery.METHODS A systematic search of the literature available on PubMed and EMBASE was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Relevant studies were identified by screening the references of retrieved articles.Studies on patients’QOL after pancreatic surgery published after January 1,2012,were included.These included prospective and retrospective studies on patients'QOL after several types of pancreatic surgeries.The results of these primary studies were summarized inductively.RESULTS A total of 45 articles were included in the study,of which 13 were related to pancreaticoduodenectomy(PD),seven to duodenum-preserving pancreatic head resection(DPPHR),nine to distal pancreatectomy(DP),two to central pancre-atectomy(CP),and 14 to total pancreatectomy(TP).Some studies showed that 3-6 months were needed for QOL recovery after PD,whereas others showed that 6-12 months was more accurate.Although TP and PD had similar influences on QOL,patients needed longer to recover to preoperative or baseline levels after TP.The QOL was better after DPPHR than PD.However,the superiority of the QOL between patients who underwent CP and PD remains controversial.The decrease in exocrine and endocrine functions postoperatively was the main factor affecting the QOL.Minimally invasive surgery could improve patients’QOL in the early Core Tip:This review summarizes and analyzes current research results on quality of life(QOL)after pancreatic surgery.The article covers the discussion and analysis of the QOL of various pancreatic surgeries.Which kind of surgical procedure has better QOL is controversial.The long-term benefits on QOL of minimally invasive surgery over open surgery are contro-INTRODUCTION The pancreas,located in the retroperitoneum,is a glandular organ with endocrine and exocrine functions.It can be divided into four main parts:Head,neck,body,and tail.Pancreatic surgery can be divided into pancreaticoduoden-ectomy(PD),duodenum-preserving pancreatic head resection(DPPHR),distal pancreatectomy(DP),central pancre-atectomy(CP),and total pancreatectomy(TP).Pancreatic surgery is challenging due to the organ’s complex anatomical structure,peripheral vascularity,and intractable postoperative complications.Following the standardization of surgical steps and improvements in relevant medical techniques and surgical instruments,the safety of pancreatic surgery has significantly improved.Perioperative morbidity,mortality,and other related indicators have become more acceptable.However,owing to the organ’s essential role in digestion,absorption,and blood glucose regulation,changes in the quality of life(QOL)of patients after pancreatic surgery have attracted the attention of surgeons.More patients with non-malignant pancreatic diseases are willing to undergo surgical treatment because of the acceptable safety.In this case,from the perspective of the patient postoperatively,the significance of rehabilitation reflects the traditional perioperative outcome and QOL[1].The QOL is a new concept that extends beyond health.Although there is no consensus on its conception[2],we can consider it a multi-dimensional architecture that incorporates objective and individual subjective views of aspects of one’s physical,psychological,and social well-being[3-5].It includes evaluating physical health,and many subscales,such as emotion,job,culture,family,sociability,economy,cognition,happiness,sex,and some symptoms[6].Since people have realized the importance of QOL,many QOL scales have emerged,including the European Organization for Research and Treatment of Cancer QLQ-C30,European Quality of Life 5-dimension,36-item Short,etc.However,it is challenging to follow up on patients’QOL once they are discharged from the hospital.Consequently,most relevant studies had small sample sizes or lacked long-term follow-up results.Moreover,a summary of studies on QOL after pancreatic surgery is lacking.This study assessed the QOL in patients who underwent PD,DPPHR,DP,CP and TP.We conducted this study to describe the existing findings on the QOL after pancreatic surgery to make it easier for surgeons and patients to decide on a surgical approach.In addition,we attempted to identify controversial results to encourage further targeted research.

Laparoscopic duodenum-preserving pancreatic head resection:a narrative review

Pancreatic surgery is one of the most complex and challenging fields in abdominal surgery associated with extensive surgical trauma,damage to adjacent organs,a long operation time and a high incidence of postoperative complications.Since the early 1990s,laparoscopic techniques have been applied to a growing number of pancreas surgeries,and great progress has been achieved in laparoscopic pancreaticoduodenectomy.As surgeons become proficient in laparoscopic pancreaticoduodenectomy techniques,laparoscopic techniques are gradually used in other pancreatic surgeries,such as laparoscopic distal pancreatectomies and laparoscopic duodenum-preserving pancreatic head resection(LDPPHR),which may benefit patients by reducing postoperative pain and hospital stays and providing a quick recovery to normal activity.Recently,a great number of literature have introduced LDPPHR.It is a good surgical method for benign and low-grade malignant tumors of the pancreatic head.Although LDPPHR is technically feasible,it is not yet generally practicable and limited to highly skilled endoscopic surgeons,and the long-term results after LDPPHR are still not well defined.This article aims to provide a literature review of LDPPHR to assess its feasibility,safety,postoperative recovery,and future outlook according to early experiences of this technique.

Surgical Treatment of Chronic Pancreatitis in Young Patients

The main treatment strategies for chronic pancreatitis in young patients include therapeutic endoscopic retrograde cholangio-pancreatography （ERCP） intervention and surgical intervention. Therapeutic ERCP intervention is performed much more extensively for its minimally invasive nature, but a part of patients are referred to surgery at last. Historical and follow-up data of 21 young patients with chronic pancreatitis undergoing duodenum-preserving total pancreatic head resection were ana- lyzed to evaluate the outcomes of therapeutic ERCP intervention and surgical intervention in this study. The surgical complications of repeated therapeutic ERCP intervention and surgical intervention were 38% and 19% respectively. During the first therapeutic ERCP intervention to surgical intervention, 2 patients developed diabetes, 5 patients developed steatorrhea, and 5 patients developed pancreatic type B pain. During the follow-up of surgical intervention, 1 new case of diabetes occurred, 1 case of stea- torrhea recovered, and 4 cases of pancreatic type B pain were completely relieved. In a part of young patients with chronic pancreatitis, surgical intervention was more effective than therapeutic ERCP in- tervention on delaying the progression of the disease and relieving the symptoms.

保留十二指肠胰头勺式切除术治疗慢性胰腺炎合并胰管结石的前瞻性研究

目的探讨保留十二指肠的胰头勺式切除术治疗慢性胰腺炎合并Ⅰ、Ⅲ型胰管结石患者的疗效。方法前瞻性分析2008年6月至2013年6月湖南省人民医院收治的55例慢性胰腺炎合并Ⅰ、Ⅲ型胰管结石患者的临床资料，按随机数字表法将患者分为经典组27例（行胰十二指肠切除术）和勺式组28例（行保留十二指肠的胰头勺式切除术）。经典组患者中慢性胰腺炎合并Ⅰ型胰管结石18例，合并Ⅲ型胰管结石9例。勺式组患者中慢性胰腺炎合并Ⅰ型胰管结石16例，合并Ⅲ型胰管结石12例。经典组患者行传统胰十二指肠切除术，消化道重建采用Child吻合，胰肠吻合采用胰腺空肠端侧套入式吻合，放置胰管支撑管。胆肠吻合采用空肠与胆总管端侧连续吻合。勺式组患者行保留十二指肠的胰头勺式切除术，作Kocher切口，游离十二指肠，采用“四边法”向胰头方向切开胰管。距离十二指肠边缘1cm处切除胰管前方的胰腺组织，暴露胰头部的各分支胰管，取尽结石，沟通主胰管。对合并Ⅲ型胰管结石的患者，必要时可剖开胰体尾部的胰管取石。消化道重建采用胰勺面空肠Roux—en—Y吻合术。采用门诊随访，随访时间截至2013年12月。计量资料采用t检验和Mann—WhitneyU秩和检验，计数资料采用矿检验。结果术中经典组2例患者改行保留十二指肠的胰头勺式切除术，勺式组1例患者改行胰十二指肠切除术。经典组实际施行手术人数为26例，勺式组为29例。所有患者围手术期无死亡，腹痛、腹泻等消化道症状多在术后2周左右得以改善。经典组患者手术时间为（7．5±1．6）h，出血量为（460±88）mL，术后住院时问为（18．0±3．5）d，住院费用为（7．8±2．1）万元，并发症发生率为19．2％（5／26）。勺式组患者手术时间为（4．0±1．0）h，出血量为（120±36）mL，术后住院时间为（9．5±2．9）d，住院费用为（3．9±1．2）万元，并发症发生率为3．4％（1／29）。两组患者在手术时间、出血量、术后住院时间、住院费用及并发症发生率等方面比较，差异均有统计学意义（t=9．358，11．365，6．325，8．647，x2=3．976，P〈0．05）。53例患者获得随访，中位随访时间为33个月（6个月至5年），随访期间无患者死亡。经典组患者中24例获得随访，其中2例患者术后仍有轻微腹痛，1例腹痛剧烈，诊断为胰肠吻合口处胰管开口狭窄，经再次手术切除部分胰体组织后缓解；19例合并糖尿病的患者中12例病情好转或血糖恢复正常。勺式组患者均获得随访，其中2例术后轻微腹痛，疼痛时间较为短暂，未行处理；22例合并糖尿病的患者中16例血糖恢复正常。结论对慢性胰腺炎并Ⅰ、Ⅲ型胰管结石的患者，保留十二指肠的胰头勺式切除术是较为理想的术式。

胰头部肿物局部切除后胰肠吻合治疗胰头部良性肿瘤

目的探讨胰头局部切除联合胰肠Roux-en-Y吻合修补胰腺创面在治疗胰头部良性肿瘤方面的价值。方法回顾性分析2006年11月至2013年10月北京大学第三医院收治的12例施行胰头局部切除联合胰肠Roux-en-Y吻合修补胰腺创面患者的临床资料。男性5例，女性7例；年龄21～65岁，平均42．3岁。12例胰头部肿瘤最大径3．0-4．8cm，肿瘤切除后胰腺创面最大径5．1-7．9cm，其中1例有明确主胰管损伤。结果术中病理证实黏液性囊腺瘤2例，胰岛素瘤2例，实性假乳头状瘤3例，无功能内分泌肿瘤5例。12例患者术后均未发生胰瘘。围手术期无死亡。随访24～108个月（其中4例随访超过5年），均未发现复发征象，生活质量好，无糖尿病发生。结论对于胰头部良性肿瘤，在病例选择适当时，胰头局部切除联合胰肠Roux-en-Y吻合修补胰腺创面是一种较好的选择。