Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection.How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment...Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection.How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment thereafter is an urgent clinical issue to be solved.Recent research standardized the definition of pancreatic fistula and stressed the correlation between POPF classification and patient prognosis.According to the literature,identification of the risk factors for pancreatic fistula contributed to lowering the rate of the complication.Appropriate management of the pancreatic stump and perioperative treatment are of great significance to reduce the rate of POPF in clinical practice.After the occurrence of POPF,the treatment of choice should be determined according to the classification of the pancreatic fistula.However,despite the progress and promising treatment approaches,POPF remains to be a clinical issue that warrants further studies in the future.展开更多
Despite the advance of diagnostic modalities, carcinoma in the body and tail of the pancreas are commonly presented at a late stage. With unresectable lesions, long-term survival is extremely rare, and surgery remains...Despite the advance of diagnostic modalities, carcinoma in the body and tail of the pancreas are commonly presented at a late stage. With unresectable lesions, long-term survival is extremely rare, and surgery remains the only curative option for pancreatic cancer. An aggressive approach by applying extended distal pancreatectomy with the resection of the celiac axis may increase the resectability and analgesic effect but great care must be taken with the arterial blood supply to the liver and stomach. Sometimes, accidental injury to the pancreatoduodenal artery compromises collateral blood flow and leads to fatal complications. Therefore, knowledge of any alternative restoration of the compromised collateral flow before surgery is essential. The present case report shows a patient with a pancreatic body cancer in whom the splenic, celiac, and common hepatic arteries were involved with the tumor, which extended almost to the root of the gastroduodenal artery. We modified the procedure by reanastomosis between the proper hepatic artery and middle colic artery without vascular graft. The postoperative course was uneventful, and the patient was discharged on post-operative day 19. The patient was immediately free of epigastric and back pain.展开更多
目的 :研究联合腹腔干的胰体尾切除(distal pancreatectomy with en bloc celiac axis resection, DP-CAR)对扩大根治局部进展期胰体尾癌的近期临床疗效,并探讨血管变异对DP-CAR术后并发症发生的影响。方法:回顾性研究43例行DP-CAR且术...目的 :研究联合腹腔干的胰体尾切除(distal pancreatectomy with en bloc celiac axis resection, DP-CAR)对扩大根治局部进展期胰体尾癌的近期临床疗效,并探讨血管变异对DP-CAR术后并发症发生的影响。方法:回顾性研究43例行DP-CAR且术后病理结果均为胰腺导管腺癌的病例,分析R0切除率和围术期手术并发症发生率、死亡率等,比较有无血管变异对术后并发症发生的影响。结果:本研究DP-CAR的R0切除率达81.4%,围术期死亡率为7.0%,并发症发生率为46.5%。腹腔血管变异8例。血管变异组与无血管变异组术后并发症发生率为3/8(37.5%)比17/35(48.6%),P=0.535,死亡率为1/8(12.5%)比2/35(5.7%),P=0.224,组间差异均无统计学意义。结论:DP-CAR具有一定的优越性,安全可行。血管变异对DP-CAR术后并发症发生无显著影响。展开更多
基金This work was supported by the National Natural Science Foundation of China(No.81472705).
文摘Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection.How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment thereafter is an urgent clinical issue to be solved.Recent research standardized the definition of pancreatic fistula and stressed the correlation between POPF classification and patient prognosis.According to the literature,identification of the risk factors for pancreatic fistula contributed to lowering the rate of the complication.Appropriate management of the pancreatic stump and perioperative treatment are of great significance to reduce the rate of POPF in clinical practice.After the occurrence of POPF,the treatment of choice should be determined according to the classification of the pancreatic fistula.However,despite the progress and promising treatment approaches,POPF remains to be a clinical issue that warrants further studies in the future.
文摘Despite the advance of diagnostic modalities, carcinoma in the body and tail of the pancreas are commonly presented at a late stage. With unresectable lesions, long-term survival is extremely rare, and surgery remains the only curative option for pancreatic cancer. An aggressive approach by applying extended distal pancreatectomy with the resection of the celiac axis may increase the resectability and analgesic effect but great care must be taken with the arterial blood supply to the liver and stomach. Sometimes, accidental injury to the pancreatoduodenal artery compromises collateral blood flow and leads to fatal complications. Therefore, knowledge of any alternative restoration of the compromised collateral flow before surgery is essential. The present case report shows a patient with a pancreatic body cancer in whom the splenic, celiac, and common hepatic arteries were involved with the tumor, which extended almost to the root of the gastroduodenal artery. We modified the procedure by reanastomosis between the proper hepatic artery and middle colic artery without vascular graft. The postoperative course was uneventful, and the patient was discharged on post-operative day 19. The patient was immediately free of epigastric and back pain.
文摘目的 :研究联合腹腔干的胰体尾切除(distal pancreatectomy with en bloc celiac axis resection, DP-CAR)对扩大根治局部进展期胰体尾癌的近期临床疗效,并探讨血管变异对DP-CAR术后并发症发生的影响。方法:回顾性研究43例行DP-CAR且术后病理结果均为胰腺导管腺癌的病例,分析R0切除率和围术期手术并发症发生率、死亡率等,比较有无血管变异对术后并发症发生的影响。结果:本研究DP-CAR的R0切除率达81.4%,围术期死亡率为7.0%,并发症发生率为46.5%。腹腔血管变异8例。血管变异组与无血管变异组术后并发症发生率为3/8(37.5%)比17/35(48.6%),P=0.535,死亡率为1/8(12.5%)比2/35(5.7%),P=0.224,组间差异均无统计学意义。结论:DP-CAR具有一定的优越性,安全可行。血管变异对DP-CAR术后并发症发生无显著影响。
