AIM： TO analyze the factors influencing radical （R0） resection rate and surgical outcome for malignant tumor of the pancreatic body and tail. METHODS： The clinical and operative data and follow- up results of 214 ...AIM： TO analyze the factors influencing radical （R0） resection rate and surgical outcome for malignant tumor of the pancreatic body and tail. METHODS： The clinical and operative data and follow- up results of 214 pancreatic body and tail cancer patients were analyzed retrospectively. RESULTS： One hundred and twenty/214 pancreatic body and tail cancer patients underwent surgical treatment; the overall resection rate was 59.2% （71/120）, and the R0 resection rate was 40.8% （49/120）. Compared with non-R0 treatment, the patients receiving an R0 resection had smaller size tumor （P 〈 0.01）, cystadenocarcinoma （P 〈 0.01）, less lymph node metastasis （P 〈 0.01）, less peri-pancreatic organ involvement （P 〈 0.01） and earlier stage disease （P 〈 0.01）. The overall 1-, 3- and 5-year survival rates for pancreatic body and tail cancer patients were 12.7% （251197）, 7.6% （151197） and 2.5% （5/197）, respectively, and ductal adenocarcinoma patients had worse survival rates [15.0% （9/60）, 6.7% （4/60） and 1.7% （1/60）, respectively] than cystadenocarcinoma patients [53.8% （21139）, 28.2% （11139） and 10.3% （4139）] （P 〈 0.01）. Moreover, the 1-, 3- and 5-year overall survival rates in patients with RO resection were 55.3% （26/47）, 31.9% （15/47） and 10.6% （5/47）, respectively, significantly better than those in patients with palliative resection [9.5% （2/21）, 0 and 0] and in patients with bypass or laparotomy [1.2% （1/81）, 0 and 0] （P 〈 0.01）. CONCLUSION： Early diagnosis is crucial for increasing the radical resection rate, and radical resection plays an important role in improving survival for pancreatic body and tail cancer patients.展开更多
AIM:To evaluate safety and feasibility of microcoil embolization of the common hepatic artery under proper or distal balloon inflation in preoperative preparation for en bloc celiac axis resection for pancreatic body ...AIM:To evaluate safety and feasibility of microcoil embolization of the common hepatic artery under proper or distal balloon inflation in preoperative preparation for en bloc celiac axis resection for pancreatic body cancer.METHODS:Fifteen patients(11 males,4 females;median age,67 years) with pancreatic body cancer involving the nerve plexus surrounding the celiac artery underwent microcoil embolization.To alter the total hepatic blood flow from superior mesenteric artery(SMA),microcoil embolization of the common hepatic artery(CHA) was conducted in 2 cases under balloon inflation at the proximal end of the CHA and in 13 cases under distal microballoon inflation at the distal end of the CHA.RESULTS:Of the first two cases of microcoil embolization with proximal balloon inflation,the first was successful,but there was microcoil migration to the proper hepatic artery in the second.The migrated microcoil was withdrawn to the CHA by an inflated microballoon catheter.Microcoil embolization was successful in the other 13 cases with distal microballoon inflation,with no microcoil migration.Compact microcoil embolization under distal microballoon inflation created sufficient resistance against the vascular wall to prevent migration.Distal balloon inflation achieved the requisite 1 cm patency at the CHA end for vascular clamping.All patients underwent en bloc celiac axis resection without arterial reconstruction or liver ischemia.CONCLUSION:To impede microcoil migration to the proper hepatic artery during CHA microcoil embolization,distal microballoon inflation is preferable to proximal balloon inflation.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
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
目的探讨腹腔镜下Kimura法和Warshaw法两种保脾胰体尾切除术的围术期疗效与安全性。方法回顾性分析2017年8月至2023年8月于空军军医大学西京医院接受腹腔镜下保脾胰体尾切除术的133例患者临床资料,根据手术方式不同分为Kimura组(77例)和...目的探讨腹腔镜下Kimura法和Warshaw法两种保脾胰体尾切除术的围术期疗效与安全性。方法回顾性分析2017年8月至2023年8月于空军军医大学西京医院接受腹腔镜下保脾胰体尾切除术的133例患者临床资料,根据手术方式不同分为Kimura组(77例)和Warshaw组(56例),比较两组患者手术时长、术中出血量等围术期指标及术后胰瘘发生率、脾梗死等并发症发生情况。结果Kimura组和Warshaw组两组患者在手术时长[(215.8±64.8)min vs(193.5±77.6)min]、术中出血量[(194.2±53.7)mLvs(176.5±69.2)mL]、术后排气及禁食时间[2(1)d vs 3(1)d]、术后住院时间[9(4)d vs 8(3)d]等围术期指标及术后胰瘘(3例vs 4例)、脾梗死(0例vs 3例)、腹腔积液(3例vs 2例)、腹腔感染(2例vs 1例)等并发症发生情况方面比较差异均无统计学意义(P>0.05)。结论腹腔镜下Kimura法和Warshaw法两种保脾胰体尾切除术对于胰体尾良性及低度恶性肿瘤均是安全有效的手术方式,且围术期疗效相当。展开更多
文摘AIM： TO analyze the factors influencing radical （R0） resection rate and surgical outcome for malignant tumor of the pancreatic body and tail. METHODS： The clinical and operative data and follow- up results of 214 pancreatic body and tail cancer patients were analyzed retrospectively. RESULTS： One hundred and twenty/214 pancreatic body and tail cancer patients underwent surgical treatment; the overall resection rate was 59.2% （71/120）, and the R0 resection rate was 40.8% （49/120）. Compared with non-R0 treatment, the patients receiving an R0 resection had smaller size tumor （P 〈 0.01）, cystadenocarcinoma （P 〈 0.01）, less lymph node metastasis （P 〈 0.01）, less peri-pancreatic organ involvement （P 〈 0.01） and earlier stage disease （P 〈 0.01）. The overall 1-, 3- and 5-year survival rates for pancreatic body and tail cancer patients were 12.7% （251197）, 7.6% （151197） and 2.5% （5/197）, respectively, and ductal adenocarcinoma patients had worse survival rates [15.0% （9/60）, 6.7% （4/60） and 1.7% （1/60）, respectively] than cystadenocarcinoma patients [53.8% （21139）, 28.2% （11139） and 10.3% （4139）] （P 〈 0.01）. Moreover, the 1-, 3- and 5-year overall survival rates in patients with RO resection were 55.3% （26/47）, 31.9% （15/47） and 10.6% （5/47）, respectively, significantly better than those in patients with palliative resection [9.5% （2/21）, 0 and 0] and in patients with bypass or laparotomy [1.2% （1/81）, 0 and 0] （P 〈 0.01）. CONCLUSION： Early diagnosis is crucial for increasing the radical resection rate, and radical resection plays an important role in improving survival for pancreatic body and tail cancer patients.
文摘AIM:To evaluate safety and feasibility of microcoil embolization of the common hepatic artery under proper or distal balloon inflation in preoperative preparation for en bloc celiac axis resection for pancreatic body cancer.METHODS:Fifteen patients(11 males,4 females;median age,67 years) with pancreatic body cancer involving the nerve plexus surrounding the celiac artery underwent microcoil embolization.To alter the total hepatic blood flow from superior mesenteric artery(SMA),microcoil embolization of the common hepatic artery(CHA) was conducted in 2 cases under balloon inflation at the proximal end of the CHA and in 13 cases under distal microballoon inflation at the distal end of the CHA.RESULTS:Of the first two cases of microcoil embolization with proximal balloon inflation,the first was successful,but there was microcoil migration to the proper hepatic artery in the second.The migrated microcoil was withdrawn to the CHA by an inflated microballoon catheter.Microcoil embolization was successful in the other 13 cases with distal microballoon inflation,with no microcoil migration.Compact microcoil embolization under distal microballoon inflation created sufficient resistance against the vascular wall to prevent migration.Distal balloon inflation achieved the requisite 1 cm patency at the CHA end for vascular clamping.All patients underwent en bloc celiac axis resection without arterial reconstruction or liver ischemia.CONCLUSION:To impede microcoil migration to the proper hepatic artery during CHA microcoil embolization,distal microballoon inflation is preferable to proximal balloon inflation.
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.
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.
文摘目的探讨腹腔镜下Kimura法和Warshaw法两种保脾胰体尾切除术的围术期疗效与安全性。方法回顾性分析2017年8月至2023年8月于空军军医大学西京医院接受腹腔镜下保脾胰体尾切除术的133例患者临床资料,根据手术方式不同分为Kimura组(77例)和Warshaw组(56例),比较两组患者手术时长、术中出血量等围术期指标及术后胰瘘发生率、脾梗死等并发症发生情况。结果Kimura组和Warshaw组两组患者在手术时长[(215.8±64.8)min vs(193.5±77.6)min]、术中出血量[(194.2±53.7)mLvs(176.5±69.2)mL]、术后排气及禁食时间[2(1)d vs 3(1)d]、术后住院时间[9(4)d vs 8(3)d]等围术期指标及术后胰瘘(3例vs 4例)、脾梗死(0例vs 3例)、腹腔积液(3例vs 2例)、腹腔感染(2例vs 1例)等并发症发生情况方面比较差异均无统计学意义(P>0.05)。结论腹腔镜下Kimura法和Warshaw法两种保脾胰体尾切除术对于胰体尾良性及低度恶性肿瘤均是安全有效的手术方式,且围术期疗效相当。
