BACKGROUND: Pancreatic leakage after pancreaticoduodenectomy is associated with a morbidity and mortality. Different techniques have been used to make a safe anastomosis to the left pancreatic remnant. METHODS: We per...BACKGROUND: Pancreatic leakage after pancreaticoduodenectomy is associated with a morbidity and mortality. Different techniques have been used to make a safe anastomosis to the left pancreatic remnant. METHODS: We performed 'modified Child pancreatico jejunostomy' for 31 patients, by which end-to-end pancreaticojejunal anastomosis was made with a two-layer polypropylene continuous running suture. RESULTS: In the patients who underwent pancreaticojejunostomy, the average operative time was 14.2 minutes. There was no pancreaticoenterostomy leakage in all patients, and no deaths occurred. CONCLUSIONS: In pancreaticojejunostomy, pancreatic anastomosis is time-saving and free from complications. Thus it is an improvement of pancreaticojejunostomy.展开更多
Background: Few studies investigated biliary leakage after pancreaticoduodenectomy(PD) especially when compared to postoperative pancreatic fistula(POPF). This study was to determine the incidence of biliary leakage a...Background: Few studies investigated biliary leakage after pancreaticoduodenectomy(PD) especially when compared to postoperative pancreatic fistula(POPF). This study was to determine the incidence of biliary leakage after PD, predisposing factors of biliary leakage, and its management. Methods: We retrospectively studied all patients who underwent PD from January 2008 to December 2017 at Gastrointestinal Surgery Center, Mansoura University, Egypt. According to occurrence of postoperative biliary leakage, patients were divided into two groups. Group(1) included patients who developed biliary leakage and group(2) included patients without identified biliary leakage. The preoperative data, operative details, and postoperative morbidity and mortality were analyzed. Results: The study included 555 patients. Forty-four patients(7.9%) developed biliary leakage. Ten patients(1.8%) had concomitant POPF. Multivariate analysis identified obesity and time needed for hepaticojejunostomy reconstruction as independent risk factors of biliary leakage, and no history of preoperative endoscopic retrograde cholangiopancreatiography(ERCP) as protective factor. Biliary leakage from hepaticojejunostomy after PD leads to a significant increase in development of delayed gastric emptying, and wound infection. The median hospital stay and time to resume oral intake were significantly greater in the biliary leakage group. Non-surgical management was needed in 40 patients(90.9%). Only 4 patients(9.1%) required re-exploration due to biliary peritonitis and associated POPF. The mortality rate in the biliary leakage group was significantly higher than that of the non-biliary leakage group(6.8% vs 3.9%, P = 0.05). Conclusions: Obesity and time needed for hepaticojejunostomy reconstruction are independent risk factors of biliary leakage, and no history of preoperative ERCP is protective factor. Biliary leakage increases the risk of morbidity and mortality especially if concomitant with POPF. However, biliary leakage can be conservatively managed in majority of cases.展开更多
AIM: To analyze the risk factors for pancreatic leakage after pancreaticoduodenectomy (PD) and to evaluate whether duct-to-mucosa pancreaticojejunostomy could reduce the risk of pancreatic leakage.METHODS: Sixty-two p...AIM: To analyze the risk factors for pancreatic leakage after pancreaticoduodenectomy (PD) and to evaluate whether duct-to-mucosa pancreaticojejunostomy could reduce the risk of pancreatic leakage.METHODS: Sixty-two patients who underwent PD at our hospital between January 2000 and November 2003 were reviewed retrospectively. The primary diseases of the patients included pancreas cancer, ampullary cancer, bile duct cancer, islet cell cancer, duodenal cancer, chronic pancreatitis, pancreatic cystadenoma, and gastric cancer.Standard PD was performed for 25 cases, PD with extended lymphadenectomy for 27 cases, pylorus-preserving PD for 10 cases. A duct-to-mucosa pancreaticojejunostomy was performed for patients with a hard pancreas and a dilated pancreatic duct, and a traditional end-to-end invagination pancreaticojejunostomy for patients with a soft pancreas and a non-dilated duct. Patients were divided into two groups according to the incidence of postoperative pancreaticojejunal anastomotic leakage: 10 cases with leakage and 52 cases without leakage. Seven preoperative and six intraoperative risk factors with the potential to affect the incidence of pancreatic leakage were analyzed with SPSS10.0 software. Logistic regression was then used to determine the effect of multiple factors on pancreatic leakage.RESULTS: Of the 62 patients, 10 (16.13%) were identified as having pancreatic leakage after operation. Other major postoperative complications included delayed gastric emptying (eight patients), abdominal bleeding (four patients), abdominal abscess (three patients) and wound infection (two patients). The overall surgical morbidity was 43.5% (27/62). The hospital mortality in this series was 4.84% (3/62), and the mortality associated with pancreatic fistula was 10% (1/10). Sixteen cases underwent duct-to-mucosa pancreaticojejunostomy and 1 case (1/16, 6.25%) devel-oped postoperative pancreatic leakage, 46 cases underwent invagination pancreaticojejunostomy and 9 cases (9/46, 19.6%)developed postoperative pancreatic leakage. General risk factors including patient age, gender, history of jaundice,preoperative nutrition, pathological diagnosis and the length of postoperative stay were similar in the two groups.There was no statistical difference in the incidence of pancreatic leakage between the patients who received the prophylactic use of octreotide after surgery and the patients who did not undergo somatostatin therapy.Moreover, multivariate logistic regression analysis showed that none of the above factors seemed to be associated with pancreatic fistula. Two intraoperative risk factors,pancreatic duct size and texture of the remnant pancreas,were found to be significantly associated with pancreatic leakage. The incidence of pancreatic leakage was 4.88%in patients with a pancreatic duct size greater than or equal to 3 mm and was 38.1% in those with ducts smaller than 3 mm (P = 0.002). The pancreatic leakage rate was 2.94% in patients with a hard pancreas and was 32.1% in those with a soft pancreas (P = 0.004). Operative time,blood loss and type of resection were similar in the two patient groups. The incidence of pancreatic leakage was 6.25% (1/16) in patients with duct-to-mucosa anastomosis,and was 19.6% (9/46) in those with traditional invagination anastomosis. Although the difference of pancreatic leakage between the two groups was obvious, no statistical signific-ance was found. This may be due to the small number of patients with duct-to-mucosa anastomosis.By further analyzing with multivariate logistic regression,both pancreatic duct size and texture of the remnant pancreas were demonstrated to be independent risk factors (P= 0.007 and 0.017, OR = 11.87 and 15.45). Although anastomotic technique was not a significant factor,pancreatic leakage rate was much less in cases that underwent duct-to-mucosa pancreaticojejunostomy.CONCLUSION: Pancreatic duct size and texture of the remnant pancreas are risk factors influencing pancreatic leakage after PD. Duct-to-mum pancreaticojejunostomy,as a safe and useful anastomotic technique, can reduce pancreatic leakage rate after PD.展开更多
OBJECTIVE: To introduce a new reconstructional procedure to deerease the complications afterpancreaticoduodenectomy.METHODS: Separate internal drainage of bile and pancreatic fluid in pancreaticiduodenectomy wasperfor...OBJECTIVE: To introduce a new reconstructional procedure to deerease the complications afterpancreaticoduodenectomy.METHODS: Separate internal drainage of bile and pancreatic fluid in pancreaticiduodenectomy wasperformed in 256 patients. The digestive tract was reconstructed with Child method, with invaginatedpancreaticojejunostomy using a long silastic tube to drain pancreatic fluid internally, an end-to-sidecholedochojejunostomy and an end-to-side duodenojejunostomy or gastrojejunostomy. Gastrostomy drainagewas also performed.RESULTS: No complications of pancreatic leakage were found.CONCLUSION: The separate internal drainage of bile and pancreatic fluid plays an important role inpreventing pancreaticojejunal anastomotic leakage.展开更多
BACKGROUND As one of the major abdominal operations,pancreaticoduodenectomy(PD)involves many organs.The operation is complex,and the scope of the operation is large,which can cause significant trauma in patients.The o...BACKGROUND As one of the major abdominal operations,pancreaticoduodenectomy(PD)involves many organs.The operation is complex,and the scope of the operation is large,which can cause significant trauma in patients.The operation has a high rate of complications.Pancreatic leakage is the main complication after PD.When pancreatic leakage occurs after PD,it can often lead to abdominal bleeding and infection,threatening the lives of patients.One study found that pancreatic leakage was affected by many factors including the choice of pancreaticojejunostomy method which can be well controlled.AIM To investigate the choice of operative methods for pancreaticojejunostomy and to conduct a multivariate study of pancreatic leakage in PD.METHODS A total of 420 patients undergoing PD in our hospital from January 2014 to March 2019 were enrolled and divided into group A(n=198)and group B(n=222)according to the pancreatointestinal anastomosis method adopted during the operation.Duct-to-mucosa pancreatojejunostomy was performed in group A and bundled pancreaticojejunostomy was performed in group B.The operation time,intraoperative blood loss,and pancreatic leakage of the two groups were assessed.The occurrence of pancreatic leakage after the operation in different patients was analyzed.RESULTS The differences in operative time and intraoperative bleeding between groups A and B were not significant(P>0.05).In group A,the time of pancreatojejunostomy was 26.03±4.40 min and pancreatic duct diameter was 3.90±1.10 mm.These measurements were significantly higher than those in group B(P<0.05).The differences in the occurrence of pancreatic leakage,abdominal infection,abdominal hemorrhage and gastric retention between group A and group B were not significant(P>0.05).The rates of pancreatic leakage in patients with preoperative albumin<30 g/L,preoperative jaundice time≥8 wk,and pancreatic duct diameter<3 mm,were 23.33%,33.96%,and 19.01%,respectively.These were significantly higher than those in patients with preoperative albumin≥30 g/L,preoperative jaundice time<8 wk,and pancreatic duct diameter≥3 cm(P<0.05).Logistic regression analysis showed that preoperative albumin<30 g/L,preoperative jaundice time≥8 wk,and pancreatic duct diameter<3 mm were risk factors for pancreatic leakage after PD(odds ratio=2.038,2.416 and 2.670,P<0.05).CONCLUSION The pancreatointestinal anastomosis method during PD has no significant effect on the occurrence of pancreatic leakage.The main risk factors for pancreatic leakage include preoperative albumin,preoperative jaundice time,and pancreatic duct diameter.展开更多
BACKGROUND Post-operative pancreatic fistula(POPF)is the primary cause of morbidity following pancreaticoduodenectomy.Rates of POPF have remained high despite well known risk factors.The theory that hypoperfusion of t...BACKGROUND Post-operative pancreatic fistula(POPF)is the primary cause of morbidity following pancreaticoduodenectomy.Rates of POPF have remained high despite well known risk factors.The theory that hypoperfusion of the pancreatic stump leads to anastomotic failure has recently gained interest.AIM To define the published literature with regards to intraoperative pancreas perfusion assessment and its correlation with POPF.METHODS A systematic search of available literature was performed in November 2022.Data extracted included study characteristics,method of assessment of pancreas stump perfusion,POPF and other post-pancreatic surgery specific complications.RESULTS Five eligible studies comprised two prospective non-randomised studies and three case reports,total 156 patients.Four studies used indocyanine green fluorescence angiography to assess the pancreatic stump,with the remaining study assessing pancreas perfusion by visual inspection of arterial bleeding of the pancreatic stump.There was significant heterogeneity in the definition of POPF.Studies had a combined POPF rate of 12%;intraoperative perfusion assessment revealed hypoperfusion was present in 39%of patients who developed POPF.The rate of POPF was 11%in patients with no evidence of hypoperfusion and 13%in those with evidence of hypoperfusion,suggesting that not all hypoperfusion gives rise to POPF and further analysis is required to analyse if there is a clinically relevant cut off.Significant variance in practice was seen in the pancreatic stump management once hypoperfusion was identified.CONCLUSION The current published evidence around pancreas perfusion during pancreaticoduodenectomy is of poor quality.It does not support a causative link between hypoperfusion and POPF.Further well-designed prospective studies are required to investigate this.展开更多
AIM To compare efficacy and safety of endoscopic ultrasound (EUS)-guided and surgical drainage in pancreatic fluid collection management.METHODS Data were obtained retrospectively from January 2012 to December 2016.Pa...AIM To compare efficacy and safety of endoscopic ultrasound (EUS)-guided and surgical drainage in pancreatic fluid collection management.METHODS Data were obtained retrospectively from January 2012 to December 2016.Patients with pancreatic fluid collection were performed EUS-guided or surgical procedure.Main outcome measures including clinical efficiency,complication,duration of procedures,hospital stay and cost were analyzed.RESULTS Thirty-six patients were enrolled into the study,including 14 in endoscopic group while 22 in the surgical group.Twelve (86%) patients were treated successfully by endoscopic approach while 21 (95%) patients benefited through surgical procedure.Endoscopic treatment had higher recurrence and complication rates than surgery,resulting in more re-interventions.Meanwhile,duration of procedure,hospital stay and cost were significantly lower in endoscopic group.CONCLUSION Both approaches were effective and safe.EUS-guided approach should be the first-line treatment in mild and simple cases,while surgical approach should be considered as priority in severe and complex cases.展开更多
AIM: To analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy.METHODS: We retrospectively reviewed 172 consecutive patients who had undergone pancreatico-duodenectomy at Inha University Hospital...AIM: To analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy.METHODS: We retrospectively reviewed 172 consecutive patients who had undergone pancreatico-duodenectomy at Inha University Hospital between April 1996 and March 2006. We analyzed the pancreatic fistula rate according to the clinical characteristics, the pathologic and laboratory findings, and the anastomotic methods.RESULTS: The incidence of developing pancreatic fistulas in patients older than 60 years of age was 21.7% (25/115), while the incidence was 8.8% (5/57) for younger patients; the difference was significant (P = 0.03). Patients with a dilated pancreatic duct had a lower rate of post-operative pancreatic fistulas than patients with a non-dilated duct (P = 0.001). Other factors, including clinical features, anastomotic methods, and pathologic diagnosis, did not show any statistical difference. CONCLUSION: Our study demonstrated that pancreatic fistulas are related to age and a dilated pancreatic duct. The surgeon must take these risk factors into consideration when performing a pancre-aticoduodenectomy.展开更多
BACKGROUND: Postoperative pancreatic fistula (POPF) is a serious complication and results in prolonged hospitalization and high mortality. The present study aimed to evaluate the safety and effectiveness of total c...BACKGROUND: Postoperative pancreatic fistula (POPF) is a serious complication and results in prolonged hospitalization and high mortality. The present study aimed to evaluate the safety and effectiveness of total closure of pancreatic section for end-to-side pancreaticojejunostomy in pancreaticoduodenectomy (PD). METHODS: This was a prospective randomized clinical trial comparing the outcomes of PD between patients who un- derwent total closure of pancreatic section for end-to-side pancreaticojejunostomy (Group A) vs those who underwent conventional pancreaticojejunostomy (Group B). The primary endpoint was the incidence of pancreatic fistula. Secondary endpoints were morbidity and mortality rates. RESULTS: One hundred twenty-three patients were included in this study. The POPF rate was significantly lower in Group A than that in Group B (4.8% vs 16.7%, P〈0.05). About 38.3% patients in Group B developed one or more complications; this rate was 14.3% in Group A (P〈0.01). The wound/abdomi- nal infection rate was also much higher in Group B than that in Group A (20.0% vs 6.3%, P〈0.05). Furthermore, the average hospital stays of the two groups were 18 days in Group A, and 24 days in Group B, respectively (P〈0.001). However, there was no difference in the probability of mortality, biliary leakage,delayed gastric emptying, and pulmonary infection between the two groups. CONCLUSION: Total closure of pancreatic section for end-to- side pancreaticojejunostomy is a safe and effective method for pancreaticojejunostomy in PD.展开更多
AIM: To evaluate the effect of polypropylene mesh- reinforced pancreatojejunostomy on pancreatic leakage. METHODS: Seventeen consecutive patients with paraampullar malignancy received polyprolene mesh- reinforced panc...AIM: To evaluate the effect of polypropylene mesh- reinforced pancreatojejunostomy on pancreatic leakage. METHODS: Seventeen consecutive patients with paraampullar malignancy received polyprolene mesh- reinforced pancreatodudeonectomy and the Child’s method was used to rebuild the alimentary tract. RESULTS: The mean time of polyprolene mesh-reinforced pancreatojejunostomy was 22 min. Anastomosis could endure 30-500 cm H2O pressure during operation. All patients recovered without pancreatic leakage. CONCLUSION: Polyprolene mesh-reinforced pancreato- jejunostomy is a feasible and reliable procedure to prevent pancreatic leakage.展开更多
Objective: To analyze Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and inves-tigate the relationship between the major risk factors and Clavien-Dindo classification of c...Objective: To analyze Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and inves-tigate the relationship between the major risk factors and Clavien-Dindo classification of complications. Methods: The retrospective case-control study was adopted. The clinical data of 200 patients who underwent pancreatico-duodenectomy at the Third Affiliated Hospital of Inner Mongolia Medical University from January 2010 to June 2015 were collected. The patients underwent Whipple procedure or pylorus-preserving pancreaticoduodenectomy according to the tumor site. Observation indicators included: (1) postoperative complications using Clavien-Dindo classification;(2) univariate and multivariate analyses: patients' basic information, surgery-related factors, pancreas-related factors;(3) relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy. The chi-square test was applied to univariate analysis and categorical data. The comparison between groups was done by using independent samples nonparametric test (Kolmogorov-Smirnov Z), and multivariate analysis was done by using Logistic regression model. Results: (1) Postoperative complications: Of 200 patients, 122 underwent Whipple procedure and 78 underwent pylorus-preserving pancreaticoduodenectomy, including 6 cases combined with vascular reconstructions and 1 case with RFA of liver tumors. Ninety-eight patients had postoperative complications, including 41 patients with no less than 2 types of complications. After surgery, pancreatic fistula was detected in 80 patients, including 42 cases with grade A, 28 cases with grade B and 10 cases with grade C;incisional infection in 29 patients;gastric retention in 24 patients;intra-abdominal infection in 16 patients;intra-abdominal hemorrhage in 10 patients, including 8 patients receiving interventional treatment;biliary leakage in 7 patients and unplanned reoperation in 2 patients. Three patients were dead during hospitalization. The incidences of complications in grade Ⅰ, Ⅱ, Ⅲ (Ⅲ a and Ⅲ b), Ⅳ and Ⅴ of Clavien-Dindo classification were 28.00% (56/200), 13.00% (26/200), 5.00% (10/200), 1.50% (3/200) and 1.50% (3/200). (2) Univariate and multivariate analyses: The results of univariate analysis showed that body mass index (BMI) and pancreas texture were risk factors affecting complications after pancreaticoduodenectomy (χ2 = 6.483, Z = -3.189, p < .05). The results of multivariate analysis showed that BMI > 23.9 kg/m2 and soft pancreas were independent risk factors affecting complications after pancreaticoduodenectomy (OR = 2.044, 1.649, 95% confidence interval: 1.212-3.447, 1.194-2.275). (3) The relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy was analyzed. There were statistically significant differences between BMI or pancreas texture and Clavien-Dindo classification of complications after pancreaticoduodenectomy (χ2 = 13.897, 27.077, p < .05). Conclusions: Clavien-Dindo classification of complications after pancreaticoduodenectomy contributes to comprehensive com-parison and evaluation, and this type of classification in this study mainly refers to grade I and II. Reducing BMI and good management of pancreatic stump may improve Clavien-Dindo classification of complications after pancreaticoduodenectomy.展开更多
文摘BACKGROUND: Pancreatic leakage after pancreaticoduodenectomy is associated with a morbidity and mortality. Different techniques have been used to make a safe anastomosis to the left pancreatic remnant. METHODS: We performed 'modified Child pancreatico jejunostomy' for 31 patients, by which end-to-end pancreaticojejunal anastomosis was made with a two-layer polypropylene continuous running suture. RESULTS: In the patients who underwent pancreaticojejunostomy, the average operative time was 14.2 minutes. There was no pancreaticoenterostomy leakage in all patients, and no deaths occurred. CONCLUSIONS: In pancreaticojejunostomy, pancreatic anastomosis is time-saving and free from complications. Thus it is an improvement of pancreaticojejunostomy.
文摘Background: Few studies investigated biliary leakage after pancreaticoduodenectomy(PD) especially when compared to postoperative pancreatic fistula(POPF). This study was to determine the incidence of biliary leakage after PD, predisposing factors of biliary leakage, and its management. Methods: We retrospectively studied all patients who underwent PD from January 2008 to December 2017 at Gastrointestinal Surgery Center, Mansoura University, Egypt. According to occurrence of postoperative biliary leakage, patients were divided into two groups. Group(1) included patients who developed biliary leakage and group(2) included patients without identified biliary leakage. The preoperative data, operative details, and postoperative morbidity and mortality were analyzed. Results: The study included 555 patients. Forty-four patients(7.9%) developed biliary leakage. Ten patients(1.8%) had concomitant POPF. Multivariate analysis identified obesity and time needed for hepaticojejunostomy reconstruction as independent risk factors of biliary leakage, and no history of preoperative endoscopic retrograde cholangiopancreatiography(ERCP) as protective factor. Biliary leakage from hepaticojejunostomy after PD leads to a significant increase in development of delayed gastric emptying, and wound infection. The median hospital stay and time to resume oral intake were significantly greater in the biliary leakage group. Non-surgical management was needed in 40 patients(90.9%). Only 4 patients(9.1%) required re-exploration due to biliary peritonitis and associated POPF. The mortality rate in the biliary leakage group was significantly higher than that of the non-biliary leakage group(6.8% vs 3.9%, P = 0.05). Conclusions: Obesity and time needed for hepaticojejunostomy reconstruction are independent risk factors of biliary leakage, and no history of preoperative ERCP is protective factor. Biliary leakage increases the risk of morbidity and mortality especially if concomitant with POPF. However, biliary leakage can be conservatively managed in majority of cases.
文摘AIM: To analyze the risk factors for pancreatic leakage after pancreaticoduodenectomy (PD) and to evaluate whether duct-to-mucosa pancreaticojejunostomy could reduce the risk of pancreatic leakage.METHODS: Sixty-two patients who underwent PD at our hospital between January 2000 and November 2003 were reviewed retrospectively. The primary diseases of the patients included pancreas cancer, ampullary cancer, bile duct cancer, islet cell cancer, duodenal cancer, chronic pancreatitis, pancreatic cystadenoma, and gastric cancer.Standard PD was performed for 25 cases, PD with extended lymphadenectomy for 27 cases, pylorus-preserving PD for 10 cases. A duct-to-mucosa pancreaticojejunostomy was performed for patients with a hard pancreas and a dilated pancreatic duct, and a traditional end-to-end invagination pancreaticojejunostomy for patients with a soft pancreas and a non-dilated duct. Patients were divided into two groups according to the incidence of postoperative pancreaticojejunal anastomotic leakage: 10 cases with leakage and 52 cases without leakage. Seven preoperative and six intraoperative risk factors with the potential to affect the incidence of pancreatic leakage were analyzed with SPSS10.0 software. Logistic regression was then used to determine the effect of multiple factors on pancreatic leakage.RESULTS: Of the 62 patients, 10 (16.13%) were identified as having pancreatic leakage after operation. Other major postoperative complications included delayed gastric emptying (eight patients), abdominal bleeding (four patients), abdominal abscess (three patients) and wound infection (two patients). The overall surgical morbidity was 43.5% (27/62). The hospital mortality in this series was 4.84% (3/62), and the mortality associated with pancreatic fistula was 10% (1/10). Sixteen cases underwent duct-to-mucosa pancreaticojejunostomy and 1 case (1/16, 6.25%) devel-oped postoperative pancreatic leakage, 46 cases underwent invagination pancreaticojejunostomy and 9 cases (9/46, 19.6%)developed postoperative pancreatic leakage. General risk factors including patient age, gender, history of jaundice,preoperative nutrition, pathological diagnosis and the length of postoperative stay were similar in the two groups.There was no statistical difference in the incidence of pancreatic leakage between the patients who received the prophylactic use of octreotide after surgery and the patients who did not undergo somatostatin therapy.Moreover, multivariate logistic regression analysis showed that none of the above factors seemed to be associated with pancreatic fistula. Two intraoperative risk factors,pancreatic duct size and texture of the remnant pancreas,were found to be significantly associated with pancreatic leakage. The incidence of pancreatic leakage was 4.88%in patients with a pancreatic duct size greater than or equal to 3 mm and was 38.1% in those with ducts smaller than 3 mm (P = 0.002). The pancreatic leakage rate was 2.94% in patients with a hard pancreas and was 32.1% in those with a soft pancreas (P = 0.004). Operative time,blood loss and type of resection were similar in the two patient groups. The incidence of pancreatic leakage was 6.25% (1/16) in patients with duct-to-mucosa anastomosis,and was 19.6% (9/46) in those with traditional invagination anastomosis. Although the difference of pancreatic leakage between the two groups was obvious, no statistical signific-ance was found. This may be due to the small number of patients with duct-to-mucosa anastomosis.By further analyzing with multivariate logistic regression,both pancreatic duct size and texture of the remnant pancreas were demonstrated to be independent risk factors (P= 0.007 and 0.017, OR = 11.87 and 15.45). Although anastomotic technique was not a significant factor,pancreatic leakage rate was much less in cases that underwent duct-to-mucosa pancreaticojejunostomy.CONCLUSION: Pancreatic duct size and texture of the remnant pancreas are risk factors influencing pancreatic leakage after PD. Duct-to-mum pancreaticojejunostomy,as a safe and useful anastomotic technique, can reduce pancreatic leakage rate after PD.
文摘OBJECTIVE: To introduce a new reconstructional procedure to deerease the complications afterpancreaticoduodenectomy.METHODS: Separate internal drainage of bile and pancreatic fluid in pancreaticiduodenectomy wasperformed in 256 patients. The digestive tract was reconstructed with Child method, with invaginatedpancreaticojejunostomy using a long silastic tube to drain pancreatic fluid internally, an end-to-sidecholedochojejunostomy and an end-to-side duodenojejunostomy or gastrojejunostomy. Gastrostomy drainagewas also performed.RESULTS: No complications of pancreatic leakage were found.CONCLUSION: The separate internal drainage of bile and pancreatic fluid plays an important role inpreventing pancreaticojejunal anastomotic leakage.
基金Scientific Research Programme for Health Commission of Jiangxi Province,No.20204269.
文摘BACKGROUND As one of the major abdominal operations,pancreaticoduodenectomy(PD)involves many organs.The operation is complex,and the scope of the operation is large,which can cause significant trauma in patients.The operation has a high rate of complications.Pancreatic leakage is the main complication after PD.When pancreatic leakage occurs after PD,it can often lead to abdominal bleeding and infection,threatening the lives of patients.One study found that pancreatic leakage was affected by many factors including the choice of pancreaticojejunostomy method which can be well controlled.AIM To investigate the choice of operative methods for pancreaticojejunostomy and to conduct a multivariate study of pancreatic leakage in PD.METHODS A total of 420 patients undergoing PD in our hospital from January 2014 to March 2019 were enrolled and divided into group A(n=198)and group B(n=222)according to the pancreatointestinal anastomosis method adopted during the operation.Duct-to-mucosa pancreatojejunostomy was performed in group A and bundled pancreaticojejunostomy was performed in group B.The operation time,intraoperative blood loss,and pancreatic leakage of the two groups were assessed.The occurrence of pancreatic leakage after the operation in different patients was analyzed.RESULTS The differences in operative time and intraoperative bleeding between groups A and B were not significant(P>0.05).In group A,the time of pancreatojejunostomy was 26.03±4.40 min and pancreatic duct diameter was 3.90±1.10 mm.These measurements were significantly higher than those in group B(P<0.05).The differences in the occurrence of pancreatic leakage,abdominal infection,abdominal hemorrhage and gastric retention between group A and group B were not significant(P>0.05).The rates of pancreatic leakage in patients with preoperative albumin<30 g/L,preoperative jaundice time≥8 wk,and pancreatic duct diameter<3 mm,were 23.33%,33.96%,and 19.01%,respectively.These were significantly higher than those in patients with preoperative albumin≥30 g/L,preoperative jaundice time<8 wk,and pancreatic duct diameter≥3 cm(P<0.05).Logistic regression analysis showed that preoperative albumin<30 g/L,preoperative jaundice time≥8 wk,and pancreatic duct diameter<3 mm were risk factors for pancreatic leakage after PD(odds ratio=2.038,2.416 and 2.670,P<0.05).CONCLUSION The pancreatointestinal anastomosis method during PD has no significant effect on the occurrence of pancreatic leakage.The main risk factors for pancreatic leakage include preoperative albumin,preoperative jaundice time,and pancreatic duct diameter.
文摘BACKGROUND Post-operative pancreatic fistula(POPF)is the primary cause of morbidity following pancreaticoduodenectomy.Rates of POPF have remained high despite well known risk factors.The theory that hypoperfusion of the pancreatic stump leads to anastomotic failure has recently gained interest.AIM To define the published literature with regards to intraoperative pancreas perfusion assessment and its correlation with POPF.METHODS A systematic search of available literature was performed in November 2022.Data extracted included study characteristics,method of assessment of pancreas stump perfusion,POPF and other post-pancreatic surgery specific complications.RESULTS Five eligible studies comprised two prospective non-randomised studies and three case reports,total 156 patients.Four studies used indocyanine green fluorescence angiography to assess the pancreatic stump,with the remaining study assessing pancreas perfusion by visual inspection of arterial bleeding of the pancreatic stump.There was significant heterogeneity in the definition of POPF.Studies had a combined POPF rate of 12%;intraoperative perfusion assessment revealed hypoperfusion was present in 39%of patients who developed POPF.The rate of POPF was 11%in patients with no evidence of hypoperfusion and 13%in those with evidence of hypoperfusion,suggesting that not all hypoperfusion gives rise to POPF and further analysis is required to analyse if there is a clinically relevant cut off.Significant variance in practice was seen in the pancreatic stump management once hypoperfusion was identified.CONCLUSION The current published evidence around pancreas perfusion during pancreaticoduodenectomy is of poor quality.It does not support a causative link between hypoperfusion and POPF.Further well-designed prospective studies are required to investigate this.
文摘AIM To compare efficacy and safety of endoscopic ultrasound (EUS)-guided and surgical drainage in pancreatic fluid collection management.METHODS Data were obtained retrospectively from January 2012 to December 2016.Patients with pancreatic fluid collection were performed EUS-guided or surgical procedure.Main outcome measures including clinical efficiency,complication,duration of procedures,hospital stay and cost were analyzed.RESULTS Thirty-six patients were enrolled into the study,including 14 in endoscopic group while 22 in the surgical group.Twelve (86%) patients were treated successfully by endoscopic approach while 21 (95%) patients benefited through surgical procedure.Endoscopic treatment had higher recurrence and complication rates than surgery,resulting in more re-interventions.Meanwhile,duration of procedure,hospital stay and cost were significantly lower in endoscopic group.CONCLUSION Both approaches were effective and safe.EUS-guided approach should be the first-line treatment in mild and simple cases,while surgical approach should be considered as priority in severe and complex cases.
基金Supported by Inha University Research Funds of 2007
文摘AIM: To analyze the risk factors of pancreatic leakage after pancreaticoduodenectomy.METHODS: We retrospectively reviewed 172 consecutive patients who had undergone pancreatico-duodenectomy at Inha University Hospital between April 1996 and March 2006. We analyzed the pancreatic fistula rate according to the clinical characteristics, the pathologic and laboratory findings, and the anastomotic methods.RESULTS: The incidence of developing pancreatic fistulas in patients older than 60 years of age was 21.7% (25/115), while the incidence was 8.8% (5/57) for younger patients; the difference was significant (P = 0.03). Patients with a dilated pancreatic duct had a lower rate of post-operative pancreatic fistulas than patients with a non-dilated duct (P = 0.001). Other factors, including clinical features, anastomotic methods, and pathologic diagnosis, did not show any statistical difference. CONCLUSION: Our study demonstrated that pancreatic fistulas are related to age and a dilated pancreatic duct. The surgeon must take these risk factors into consideration when performing a pancre-aticoduodenectomy.
基金supported by grants from the Foundation of Mega Project of National Science and Technology(2016ZX10002020-009)Innovative Talent Project of Science and Technology of Henan Colleges(17HASTIT044)
文摘BACKGROUND: Postoperative pancreatic fistula (POPF) is a serious complication and results in prolonged hospitalization and high mortality. The present study aimed to evaluate the safety and effectiveness of total closure of pancreatic section for end-to-side pancreaticojejunostomy in pancreaticoduodenectomy (PD). METHODS: This was a prospective randomized clinical trial comparing the outcomes of PD between patients who un- derwent total closure of pancreatic section for end-to-side pancreaticojejunostomy (Group A) vs those who underwent conventional pancreaticojejunostomy (Group B). The primary endpoint was the incidence of pancreatic fistula. Secondary endpoints were morbidity and mortality rates. RESULTS: One hundred twenty-three patients were included in this study. The POPF rate was significantly lower in Group A than that in Group B (4.8% vs 16.7%, P〈0.05). About 38.3% patients in Group B developed one or more complications; this rate was 14.3% in Group A (P〈0.01). The wound/abdomi- nal infection rate was also much higher in Group B than that in Group A (20.0% vs 6.3%, P〈0.05). Furthermore, the average hospital stays of the two groups were 18 days in Group A, and 24 days in Group B, respectively (P〈0.001). However, there was no difference in the probability of mortality, biliary leakage,delayed gastric emptying, and pulmonary infection between the two groups. CONCLUSION: Total closure of pancreatic section for end-to- side pancreaticojejunostomy is a safe and effective method for pancreaticojejunostomy in PD.
文摘AIM: To evaluate the effect of polypropylene mesh- reinforced pancreatojejunostomy on pancreatic leakage. METHODS: Seventeen consecutive patients with paraampullar malignancy received polyprolene mesh- reinforced pancreatodudeonectomy and the Child’s method was used to rebuild the alimentary tract. RESULTS: The mean time of polyprolene mesh-reinforced pancreatojejunostomy was 22 min. Anastomosis could endure 30-500 cm H2O pressure during operation. All patients recovered without pancreatic leakage. CONCLUSION: Polyprolene mesh-reinforced pancreato- jejunostomy is a feasible and reliable procedure to prevent pancreatic leakage.
文摘Objective: To analyze Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and inves-tigate the relationship between the major risk factors and Clavien-Dindo classification of complications. Methods: The retrospective case-control study was adopted. The clinical data of 200 patients who underwent pancreatico-duodenectomy at the Third Affiliated Hospital of Inner Mongolia Medical University from January 2010 to June 2015 were collected. The patients underwent Whipple procedure or pylorus-preserving pancreaticoduodenectomy according to the tumor site. Observation indicators included: (1) postoperative complications using Clavien-Dindo classification;(2) univariate and multivariate analyses: patients' basic information, surgery-related factors, pancreas-related factors;(3) relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy. The chi-square test was applied to univariate analysis and categorical data. The comparison between groups was done by using independent samples nonparametric test (Kolmogorov-Smirnov Z), and multivariate analysis was done by using Logistic regression model. Results: (1) Postoperative complications: Of 200 patients, 122 underwent Whipple procedure and 78 underwent pylorus-preserving pancreaticoduodenectomy, including 6 cases combined with vascular reconstructions and 1 case with RFA of liver tumors. Ninety-eight patients had postoperative complications, including 41 patients with no less than 2 types of complications. After surgery, pancreatic fistula was detected in 80 patients, including 42 cases with grade A, 28 cases with grade B and 10 cases with grade C;incisional infection in 29 patients;gastric retention in 24 patients;intra-abdominal infection in 16 patients;intra-abdominal hemorrhage in 10 patients, including 8 patients receiving interventional treatment;biliary leakage in 7 patients and unplanned reoperation in 2 patients. Three patients were dead during hospitalization. The incidences of complications in grade Ⅰ, Ⅱ, Ⅲ (Ⅲ a and Ⅲ b), Ⅳ and Ⅴ of Clavien-Dindo classification were 28.00% (56/200), 13.00% (26/200), 5.00% (10/200), 1.50% (3/200) and 1.50% (3/200). (2) Univariate and multivariate analyses: The results of univariate analysis showed that body mass index (BMI) and pancreas texture were risk factors affecting complications after pancreaticoduodenectomy (χ2 = 6.483, Z = -3.189, p < .05). The results of multivariate analysis showed that BMI > 23.9 kg/m2 and soft pancreas were independent risk factors affecting complications after pancreaticoduodenectomy (OR = 2.044, 1.649, 95% confidence interval: 1.212-3.447, 1.194-2.275). (3) The relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy was analyzed. There were statistically significant differences between BMI or pancreas texture and Clavien-Dindo classification of complications after pancreaticoduodenectomy (χ2 = 13.897, 27.077, p < .05). Conclusions: Clavien-Dindo classification of complications after pancreaticoduodenectomy contributes to comprehensive com-parison and evaluation, and this type of classification in this study mainly refers to grade I and II. Reducing BMI and good management of pancreatic stump may improve Clavien-Dindo classification of complications after pancreaticoduodenectomy.