This study was conducted to explore the feasibility of partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of benign tumors of the pancreatic head(BTPH). From November 2006 to Febr...This study was conducted to explore the feasibility of partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of benign tumors of the pancreatic head(BTPH). From November 2006 to February 2009, four patients(three female and one male) with a mean age of 34.3 years(range: 21-48 years) underwent partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of BTPH(diameters of 3.2-4.5 cm) using small incisions(5.1-7.2 cm). Preoperative symptoms include one case of repeated upper abdominal pain, one case of drowsiness and two cases with no obvious preoperative symptoms. All four surgeries were successfully performed. The mean operative time was 196.8 min(range 165-226 min), and average blood loss was 138.0 m L(range: 82-210 m L). The mean postoperative hospital stay was 7.5 d(range: 7-8 d). In one case, the main pancreatic duct was injured. Pathological examination confirmed that one patient suffered from mucinous cystadenoma, one exhibited insulinoma, and two patients had solid-pseudopapillary neoplasms. There were no deaths or complications observed during the perioperative period. All patients had no signs of recurrence of the BTPH within a follow-up period of 48-76 mo and had good quality of life without diabetes. Partial pancreatic head resection with Roux-en-Y pancreatic jejunostomy is feasible in selected patients with BTPH.展开更多
BACKGROUND： Postoperative pancreatic fistula remains the most common complication of pancreaticoduodenectomy （PD） and is potentially lethal. It contributes significantly to prolonged hospitalization and mortality. ...BACKGROUND： Postoperative pancreatic fistula remains the most common complication of pancreaticoduodenectomy （PD） and is potentially lethal. It contributes significantly to prolonged hospitalization and mortality. In this study, we introduced a new technical approach, a modified Roux-en-Y reconstruction and evaluated its safety and feasibility. METHODS： We retrospectively reviewed the patients who had undergone PD with the modified Roux-en-Y reconstructive technique for periampullary malignancies from January 2011 to June 2012. The data on complications, hospital stay and outcomes after the modified Roux-en-Y reconstruction were analyzed. RESULTS： The reconstruction was performed in 171 patients, of whom 92 received pancreaticogastrostomy and 79 received pancreaticojejunostomy. The median duration of surgery was 4.0 hours （range 3.1-6.9） in all patients, and the median blood loss was 530 mL （range 200-2000）. Sixty-nine patients were subjected to transfusions, with a median transfusion volume of 430 mL （range 200-1400）. The median hospital stay of the patients was 14 days （range 11-38）. Their operative mortality was zero and overall morbidity was 18.1% （31 patients）. Only four patients （2.3%） developed pancreatic fistulas （grade A fistulas in two patients and grade B in two patients）; no patients developed grade C fistula. None of the patients developed bile reflux gastritis. CONCLUSIONS： The modified Roux-en-Y reconstruction, which isolates biliary anastomosis from pancreatic, gastric or jejunalanastomosis, is a safe, reliable, and favorable technique. But it needs further investigation in randomized controlled trials.展开更多
Objective: To investigate the procedure choice of pal-liative operation for carcinoma of the head of the pan-creas (CHP).Methods: The clinical data from 187 patients withCHP treated in the last 20 years were analyzed ...Objective: To investigate the procedure choice of pal-liative operation for carcinoma of the head of the pan-creas (CHP).Methods: The clinical data from 187 patients withCHP treated in the last 20 years were analyzed retro-spectively.Results: The operation mortality rate was 8.6%, themortality of hepatic duct-jejunostomy (HDJS) was nothigher than that of cholecystojejunostomy (CJS) (P>0.05). The postoperative relapse of jaundice and cholan-gitis was significantly lower than that of CJS (P<0.025), while the survival was apparently higher thanthat of CJS (P<0.01). The mortality of HJDS or CJSwith gastrojejunostomy (GJS) was not significantlyhigher than that of the simple procedure without GJS(P>0.05), whereas the survival was significantlyhigher than that of the simple procedure without GJS(P<0.01). The occurrence of duodenal obstructionafter HDJS or CJS was 29.3%.Conclusion: As a palliative operation, Roux-en-Y chole-dochojejunostomy especially in combination with pre-ventive gastrojejunostomy is strongly recommended.展开更多
The effects of different surgical procedures for late pancreatic head carcinoma without gas- tric outlet obstruction were explored in order to provide theoretical basis to select a suitable operation for these patient...The effects of different surgical procedures for late pancreatic head carcinoma without gas- tric outlet obstruction were explored in order to provide theoretical basis to select a suitable operation for these patients. The clinical data of 441 cases of late pancreatic head carcinoma without gastric outlet obstruction were retrospectively analyzed. All patients were divided into 4 groups based on different surgical procedures： group A （101 cases） subjected to Roux-en-Y cholecystojejunostomy; group B （133 cases） undergoing Roux-en-Y choledochojejunostomy; group C （83 cases） given Roux-en-Y chole- cystojejunostomy combined with gastrojejunostomy; group D （124 cases） receiving Roux-en-Y chole- dochojejunostomy combined with gastrojejunostomy. Therapeutic efficacy in each group was evaluated comparatively. Both groups B and D had a lower rate of postoperative obstructive jaundice than groups A and C separately （P〈0.05 for all）. The data of mean life span showed that both groups B and D had a lower survival rate than groups A and C separately （P〈0.05 for all）. The incidence of postoperative gas- tric outlet obstruction in groups A and B was higher than that in groups C and D separately （P〈0.05 for all）. The gastrojejunostomy had no impacts on the mean life span, and there was no statistically signifi- cant difference in complications, average hospital stay （days） and median survival among four groups （P〉0.05）. For the late pancreatic head carcinoma without gastric outlet obstruction, Roux-en-~ chole- dochojejunostomy is effective for the reduction of icteric index and the incidence of recurrent jaundice, also offers an opportunity for prolonged survival. Combined use of prophylactic Roux-en-Y gastrojeju- nostomy during surgical biliary drainage is safe for advanced pancreatic carcinoma with obstructive jaundice, which can decrease the incidence of postoperative gastric outlet obstruction, and has important implications for improving outcomes.展开更多
Nutritional therapy has an important role in the management of patient with severe acute pancreatitis.This article reviews the endoscopist's approach to manage nutrition in such cases.Enteral feeding has been clea...Nutritional therapy has an important role in the management of patient with severe acute pancreatitis.This article reviews the endoscopist's approach to manage nutrition in such cases.Enteral feeding has been clearly validated as the preferred route of feeding,and should be started early on admission.Parenteral nutrition should be reserved for patients with contraindications to enteral feeding such as small bowel obstruction.Moreover,nasogastric feeding is safe and as effective as nasojejunal feeding.If a prolonged course of enteral feeding(>30d) is required,endoscopic placement of feeding gastrostomy or jejunostomy tubes should be considered.展开更多
基金Supported by Capital Medical Science Development Funds of China,No.2009-3027
文摘This study was conducted to explore the feasibility of partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of benign tumors of the pancreatic head(BTPH). From November 2006 to February 2009, four patients(three female and one male) with a mean age of 34.3 years(range: 21-48 years) underwent partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of BTPH(diameters of 3.2-4.5 cm) using small incisions(5.1-7.2 cm). Preoperative symptoms include one case of repeated upper abdominal pain, one case of drowsiness and two cases with no obvious preoperative symptoms. All four surgeries were successfully performed. The mean operative time was 196.8 min(range 165-226 min), and average blood loss was 138.0 m L(range: 82-210 m L). The mean postoperative hospital stay was 7.5 d(range: 7-8 d). In one case, the main pancreatic duct was injured. Pathological examination confirmed that one patient suffered from mucinous cystadenoma, one exhibited insulinoma, and two patients had solid-pseudopapillary neoplasms. There were no deaths or complications observed during the perioperative period. All patients had no signs of recurrence of the BTPH within a follow-up period of 48-76 mo and had good quality of life without diabetes. Partial pancreatic head resection with Roux-en-Y pancreatic jejunostomy is feasible in selected patients with BTPH.
基金supported by grants from the National Natural Science Foundation of China (81272659, 81101621 and 81372353)
文摘BACKGROUND： Postoperative pancreatic fistula remains the most common complication of pancreaticoduodenectomy （PD） and is potentially lethal. It contributes significantly to prolonged hospitalization and mortality. In this study, we introduced a new technical approach, a modified Roux-en-Y reconstruction and evaluated its safety and feasibility. METHODS： We retrospectively reviewed the patients who had undergone PD with the modified Roux-en-Y reconstructive technique for periampullary malignancies from January 2011 to June 2012. The data on complications, hospital stay and outcomes after the modified Roux-en-Y reconstruction were analyzed. RESULTS： The reconstruction was performed in 171 patients, of whom 92 received pancreaticogastrostomy and 79 received pancreaticojejunostomy. The median duration of surgery was 4.0 hours （range 3.1-6.9） in all patients, and the median blood loss was 530 mL （range 200-2000）. Sixty-nine patients were subjected to transfusions, with a median transfusion volume of 430 mL （range 200-1400）. The median hospital stay of the patients was 14 days （range 11-38）. Their operative mortality was zero and overall morbidity was 18.1% （31 patients）. Only four patients （2.3%） developed pancreatic fistulas （grade A fistulas in two patients and grade B in two patients）; no patients developed grade C fistula. None of the patients developed bile reflux gastritis. CONCLUSIONS： The modified Roux-en-Y reconstruction, which isolates biliary anastomosis from pancreatic, gastric or jejunalanastomosis, is a safe, reliable, and favorable technique. But it needs further investigation in randomized controlled trials.
文摘Objective: To investigate the procedure choice of pal-liative operation for carcinoma of the head of the pan-creas (CHP).Methods: The clinical data from 187 patients withCHP treated in the last 20 years were analyzed retro-spectively.Results: The operation mortality rate was 8.6%, themortality of hepatic duct-jejunostomy (HDJS) was nothigher than that of cholecystojejunostomy (CJS) (P>0.05). The postoperative relapse of jaundice and cholan-gitis was significantly lower than that of CJS (P<0.025), while the survival was apparently higher thanthat of CJS (P<0.01). The mortality of HJDS or CJSwith gastrojejunostomy (GJS) was not significantlyhigher than that of the simple procedure without GJS(P>0.05), whereas the survival was significantlyhigher than that of the simple procedure without GJS(P<0.01). The occurrence of duodenal obstructionafter HDJS or CJS was 29.3%.Conclusion: As a palliative operation, Roux-en-Y chole-dochojejunostomy especially in combination with pre-ventive gastrojejunostomy is strongly recommended.
文摘The effects of different surgical procedures for late pancreatic head carcinoma without gas- tric outlet obstruction were explored in order to provide theoretical basis to select a suitable operation for these patients. The clinical data of 441 cases of late pancreatic head carcinoma without gastric outlet obstruction were retrospectively analyzed. All patients were divided into 4 groups based on different surgical procedures： group A （101 cases） subjected to Roux-en-Y cholecystojejunostomy; group B （133 cases） undergoing Roux-en-Y choledochojejunostomy; group C （83 cases） given Roux-en-Y chole- cystojejunostomy combined with gastrojejunostomy; group D （124 cases） receiving Roux-en-Y chole- dochojejunostomy combined with gastrojejunostomy. Therapeutic efficacy in each group was evaluated comparatively. Both groups B and D had a lower rate of postoperative obstructive jaundice than groups A and C separately （P〈0.05 for all）. The data of mean life span showed that both groups B and D had a lower survival rate than groups A and C separately （P〈0.05 for all）. The incidence of postoperative gas- tric outlet obstruction in groups A and B was higher than that in groups C and D separately （P〈0.05 for all）. The gastrojejunostomy had no impacts on the mean life span, and there was no statistically signifi- cant difference in complications, average hospital stay （days） and median survival among four groups （P〉0.05）. For the late pancreatic head carcinoma without gastric outlet obstruction, Roux-en-~ chole- dochojejunostomy is effective for the reduction of icteric index and the incidence of recurrent jaundice, also offers an opportunity for prolonged survival. Combined use of prophylactic Roux-en-Y gastrojeju- nostomy during surgical biliary drainage is safe for advanced pancreatic carcinoma with obstructive jaundice, which can decrease the incidence of postoperative gastric outlet obstruction, and has important implications for improving outcomes.
文摘Nutritional therapy has an important role in the management of patient with severe acute pancreatitis.This article reviews the endoscopist's approach to manage nutrition in such cases.Enteral feeding has been clearly validated as the preferred route of feeding,and should be started early on admission.Parenteral nutrition should be reserved for patients with contraindications to enteral feeding such as small bowel obstruction.Moreover,nasogastric feeding is safe and as effective as nasojejunal feeding.If a prolonged course of enteral feeding(>30d) is required,endoscopic placement of feeding gastrostomy or jejunostomy tubes should be considered.
