Prevention of pancreatic leakage after pancreaticoduodenectomy by modified Child pancreaticojejunostomy

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.

Biliary leakage following pancreaticoduodenectomy:Prevalence,risk factors and management

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.

Risk factors of pancreatic leakage after pancreaticoduodenectomy

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.

Prevention of pancreaticojejunal anastomotic leakage after pancreaticoduodenectomy with separate internal drainage of bile and pancreatic fluid

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.

Choice of operative method for pancreaticojejunostomy and a multivariable study of pancreatic leakage in pancreaticoduodenectomy

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.

Intraoperative pancreas stump perfusion assessment during pancreaticoduodenectomy:A systematic scoping review

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.

Novel and supplementary management of pancreatic fluid collections:Endoscopic ultrasound-guided drainage

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.

Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy

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.

Total closure of pancreatic section for end-to-side pancreaticojejunostomy decreases incidence of pancreatic fistula in pancreaticoduodenectomy

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.

Polypropylene mesh-reinforced pancreaticojejunostomy for periampullar neoplasm

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.

Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy

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.

胰管支架置入对急性胆源性胰腺炎患者预后及并发症的影响

目的分析急性胆源性胰腺炎(ABP)患者应用胰管支架置入治疗对预后及并发症的影响。方法选取2019年1月至2022年12月收治的300例ABP患者,按治疗方法不同分组,A组100例行鼻胆管引流治疗,B组100例行开腹胆总管探查联合T型管引流术治疗,C组100例行鼻胆管引流联合胰管支架置入治疗,对比3组肝功能、并发症、死亡率及恢复情况。结果B组术后总胆红素(TBIL)、天冬酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平低于A组(P<0.05);C组术后TBIL、AST、ALT水平低于A组和B组(P<0.05);B组恢复进食时间、体温恢复时间、住院时间较A组更短(P<0.05);C组恢复进食时间、腹痛消失时间、体温恢复时间及住院时间短于A组和B组(P<0.05);C组并发症发生率4.00%低于A组的12.00%(P<0.05);C组1.00%死亡率低于A组8.00%(P<0.05)。结论ABP患者应用胰管支架置入治疗,可有缩短患者恢复时间,有利于改善肝功能,死亡率低,且并发症少。

改进胰肠吻合法在3D腹腔镜胰十二指肠切除术中的应用

目的探讨改进胰肠吻合法在3D腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)胰肠吻合中的应用价值。方法2020年1月~2022年7月我科在62例3D LPD术中应用改进胰肠吻合方式:间断贯穿缝合胰腺断面,按“洪氏一针法”固定胰管内引流管,单针Prolene线对胰腺断面及空肠前后壁两层连续缝合。结果62例均施行3D腹腔镜下完成标本切除及消化道重建。手术时间(247.1±30.2)min,胰肠吻合时间(12.6±4.7)min,术中出血量(189±66)ml。术后住院时间(12.3±4.7)d。术后发生A级生化漏59例(95.2%),B级胰漏3例(4.8%);其他并发症:胃肠排空延迟4例(6.4%),胆漏3例(4.8%),腹腔感染1例(1.6%),术后出血1例(1.6%),术后肺部感染2例(3.2%)。术后病理:胰头癌13例,胰腺肉瘤1例,胰腺局灶导管上皮非典型增生1例,肿块性胰腺炎5例,胆管癌17例,胆管腺瘤1例,十二指肠癌11例,十二指肠间质瘤1例,十二指肠壶腹部癌10例,胰管黏液性乳头状瘤(主胰管型)1例,胃癌侵犯胰头部1例。术后1周腹部彩超检查均未发现胰腺残端周围包裹性积液。62例术后随访3~12个月,均无腹泻、急慢性胰腺炎、胰管结石等胰腺外分泌功能受阻碍的临床表现。结论在3D LPD术中采用改进胰肠吻合法进行胰肠吻合,操作简单,安全可靠,临床可复制性强。

毛细血管渗漏指数在急性重症胰腺炎合并急性肺损伤病人病情预测及预后评估中的价值

目的:探讨毛细血管渗漏指数(CLI)在急性重症胰腺炎(SAP)合并急性肺损伤(ALI)病人病情预测及预后评估中的价值。方法:选取78例SAP病人作为研究对象,根据是否合并急性肺损伤分为非ALI组40例和ALI组38例,根据病人入院28 d存活情况分为存活组45例和死亡组33例。分析SAP病人的临床基线资料;采用Pearson相关分析评价CLI与急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、改良CT严重程度指数(MCTSI)及乳酸的相关性;使用ROC曲线分析CLI对SAP合并ALI发生和28 d死亡风险的预测;采用Kaplan-Meier生存曲线分析不同CLI水平危险分层下的累积生存率。结果:ALI组病人C反应蛋白(CRP)、CLI、乳酸水平、MCTSI及APACHEⅡ评分均高于非ALI组(P<0.05~P<0.01);ALI组病人血清白蛋白(ALB)水平明显低于非ALI组(P<0.01)。存活组与死亡组性别差异无统计学意义(P>0.05);死亡组病人年龄、CRP、CLI、乳酸水平、MCTSI及APACHEⅡ评分均高于存活组(P<0.05~P<0.01);死亡组病人ALB水平明显低于存活组(P<0.01)。SAP病人入院时CLI与APACHEⅡ评分、MCTSI及乳酸均呈明显正相关关系(P<0.01)。CLI对预测SAP合并ALI和28 d死亡的ROC曲线下面积分别为0.802(95%CI:0.705~0.899)和0.758(95%CI:0.651~0.865);最佳截断值分别为0.517和0.394,对应的CLI为9.335和9.770,敏感度分别为84.20%和72.70%,特异度分别为67.50%和67.70%。基于9.552为最新最佳截断值进行Kaplan-Meier生存曲线分析,结果显示,CLI>9.552组的28 d累积生存率明显低于CLI≤9.552组(P<0.01)。结论:CLI可以早期预测SAP合并ALI的发生,并且在评估病人预后方面发挥重要价值,特别对于CLI>9.552的SAP病人其短期死亡风险更高,需要临床医生予以重点关注。

改良胰肠吻合法联合大网膜铺垫技术在胰十二指肠切除术中的应用

目的探讨改良胰肠吻合法联合大网膜铺垫技术在胰十二指肠切除术(PD)中的临床疗效。方法回顾性分析2017年1月至2023年1月行胰十二指肠切除术的临床资料,分为2组,改良组(n=33)行改良胰肠吻合法联合大网膜铺垫技术,其中21例为腹腔镜PD;传统组(n=32)开腹PD行传统的胰管-空肠黏膜的胰肠端侧吻合法,对比分析两组围术期指标及术后并发症发生情况。结果改良组胰肠吻合时间、术后住院时间、引流时间小于传统组(P<0.05);改良组发生B级胰瘘共2例(6.10%),显著低于传统组9例(28.13%),差异有统计学意义(P<0.05),但两组手术时间、术中出血量、生化漏、胃排空延迟、胆漏、腹腔感染、腹腔出血等并发症发生率差异无统计学意义(P>0.05)。结论改良胰肠吻合法联合大网膜铺垫技术相比传统吻合方法,可有效降低吻合难度,且安全有效。

急性胰腺炎并发毛细血管渗漏综合征的危险因素

目的探讨急性胰腺炎患者并发毛细血管渗漏综合征的发生率与危险因素。方法回顾性分析2015年5月至2022年3月贵州医科大学附属白云医院收治的515例急性胰腺炎患者的临床资料,分为并发毛细血管渗漏综合征组和无毛细血管渗漏综合征组,记录患者一般资料和实验室指标。采用单因素分析及二元Logistic多因素回归分析法分析急性胰腺炎并发毛细血管渗漏综合征的危险因素。结果515例急性胰腺炎患者中有53例(10.3%)并发毛细血管渗漏综合征。单因素分析结果显示,疾病严重程度、胰腺坏死、感染、SIRS、合并糖尿病、WBC、HB、HCT、PLT、ALT、AST、TBil、DBil、IBil、Cr、CRP、PCT、FIB、LDH、TP、ALB、NAPP是影响急性胰腺炎患者并发毛细血管渗漏综合征的相关因素(P<0.05)。Logistic多因素回归分析结果显示:病情严重程度(OR=0.129,95%CI:0.026~0.642)、ALB降低(OR=0.608,95%CI:0.514~0.719)、HCT升高(OR=1.264,95%CI:1.086~1.471)是急性胰腺炎患者并发毛细血管渗漏综合征的独立危险因素。结论重症胰腺炎、ALB、HCT是急性胰腺炎患者并发毛细血管渗漏综合征的独立危险因素。

胰十二指肠切除改良胰管空肠吻合预防胰瘘

目的:分析胰十二指肠切除术(PD)胰管空肠端侧粘膜对粘膜及胰管空肠套入式吻合方式,以其预防术后胰瘘发生。方法:2003年1月～2007年1月回顾性分析25例PD的临床资料,残胰的重建方式分别按胰管空肠粘膜对粘膜套入式端侧吻合,胰管支撑管胰液体外引流。结果:PD24例术后恢复顺利,未发生胰瘘;1例术后腹腔创面广泛渗血,多器官功能衰竭围手术期死亡,其余随访无远期并发症。结论:PD胰管空肠端侧粘膜对粘膜套入式吻合有明显避免胰瘘及并发症的发生,真正临床应用价值有待更大量的对照随机前瞻性大样本研究才能作出正确可靠的评价。

不同胰肠吻合方式的临床效果比较

目的:探讨端端胰肠套入式吻合、端侧胰管空肠黏膜吻合和捆绑式胰肠吻合的临床应用效果.方法:收集本院1999-02/2009-05行胰十二指肠切除术的患者资料157例,其中采用端端胰肠套入式吻合方式61例,端侧胰管空肠黏膜吻合方式66例,捆绑式胰肠吻合方式30例.分析患者胰肠吻合时间、术后并发症各指标、死亡率及住院时间.结果:端端胰肠套入式吻合时间、端侧胰管空肠黏膜吻合时间与捆绑式胰肠吻合组比较差异有统计学意义(35.85±4.73min,37.18±6.12min vs20.75±4.05min,均P<0.05).3组术后并发症各指标、死亡率及住院时间统计学上无差异.捆绑式胰肠吻合无1例发生胰漏.结论:3种方法均有良好的临床效果及较低的并发症.捆绑式胰肠吻合具有操作更方便、手术时间短、并发症少的优点,值得临床推广.

一种胆胰分流的重建方法在胰十二指肠切除术中的应用

目的探讨在胰十二指肠切除术中,一种胆胰分流的吻合方式运用于消化道重建的安全性和短期疗效。方法收集2007年1月至2012年5月在我院实施胰十二指肠切除术并以改良的四吻合口法行消化道重建的12例患者资料,对其进行回顾性分析。结果 12例患者行胆胰分流的重建术式后,发生2例胰漏(16.7%),1例胆漏(8.3%),2例出血(16.7%),没有出现1例胰漏合并胆漏患者,没有出现围手术期死亡病例。结论改良的消化道重建方法操作简便,遏制了胆胰液在其吻合口附近的激活,可作为提高手术安全性和患者生存率的参考术式。

全腹腔镜胰十二指肠切除术102例报告

目的探讨全腹腔镜胰十二指肠切除术(total laparoscopic pancreaticoduodenectomy,TLPD)的安全性及短期临床疗效。方法2015年12月至~2017年12月对102例胰管直径≥3mm恶性肿瘤行TLPD,术中完成标本整块切除后按照Child顺序进行腔镜下消化道重建,胰肠吻合采用胰管对空肠黏膜吻合。结果102例顺利完成TLPD。手术时间(427±159)min,术中出血量(294±107)ml,胰肠吻合时间为(36.1±14.7)min,淋巴结清扫数目(15.2±5.7)枚,R0切除率94.1%(96/102),术后进食流质饮食时间(5.5±2.6)d,术后ICU入住时间(3.5±2.3)d,术后住院时间(10.9±5.9)d。术后并发症发生率37.3%(38/102),其中A级胰漏发生率19.6%(20/102),B或C级胰漏发生率10.8%(11/102)。100例随访(11.4±4.7)月,术后6个月无瘤生存率90.0%(90/100),因肿瘤复发转移导致死亡13例(术后6~12个月死亡3例,13~24个月死亡8例,25~30个月死亡2例),肿瘤外因素死亡3例。结论对胰管直径≥3mm恶性肿瘤患者施行TLPD安全可靠,短期疗效满意。