Is it sufficient to evaluate only preoperative systemic inflammatory biomarkers to predict postoperative complications after pancreaticoduodenectomy?

Postoperative morbidity and mortality rates are still very high among patients undergoing pancreaticoduodenectomy(PD).However,mortality rates secondary to morbidities that are detected early and well-managed postoperatively are lower among patients undergoing PD.Since early detection of complications plays a very important role in the management of these patients,many ongoing studies are being conducted on this subject.Recent endoscopic retrograde cholangiopancreatography and biliary drainage history of the patient study group is important for comparison of C-reactive protein(CRP),an inflammatory parameter evaluated in the retrospective study by Coppola et al published in the World Journal of Gastrointestinal Surgery and titled“Utility of preoperative systemic inflammatory biomarkers in predicting postoperative complications after pancreaticoduodenectomy:Literature review and single center experience”.Therefore,it may be more appropriate to compare CRP values in randomized patients.

Complications of modern pancreaticoduodenectomy:A systematic review and meta-analysis

Background:In the past decades,the perioperative management of patients undergoing pancreaticoduo-denectomy(PD)has undergone major changes worldwide.This review aimed to systematically determine the burden of complications of PD performed in the last 10 years.Data sources:A systematic review was conducted in PubMed for randomized controlled trials and ob-servational studies reporting postoperative complications in at least 100 PDs from January 2010 to April 2020.Risk of bias was assessed using the Cochrane RoB2 tool for randomized studies and the method-ological index for non-randomized studies(MINORS).Pooled complication rates were estimated using random-effects meta-analysis.Heterogeneity was investigated by subgroup analysis and meta-regression.Results:A total of 20 randomized and 49 observational studies reporting 63229 PDs were reviewed.Mean MINORS score showed a high risk of bias in non-randomized studies,while one quarter of the ran-domized studies were assessed to have high risk of bias.Pooled incidences of 30-day mortality,overall complications and serious complications were 1.7%(95%CI:0.9%-2.9%;I 2=95.4%),54.7%(95%CI:46.4%-62.8%;I 2=99.4%)and 25.5%(95%CI:21.8%-29.4%;I 2=92.9%),respectively.Clinically-relevant postopera-tive pancreatic fistula risk was 14.3%(95%CI:12.4%-16.3%;I 2=92.0%)and mean length of stay was 14.8 days(95%CI:13.6-16.1;I 2=99.3%).Meta-regression partially attributed the observed heterogeneity to the country of origin of the study,the study design and the American Society of Anesthesiologists class.Conclusions:Pooled complication rates estimated in this study may be used to counsel patients scheduled to undergo a PD and to set benchmarks against which centers can audit their practice.However,cautious interpretation is necessary due to substantial heterogeneity.

Surgical techniques to prevent delayed gastric emptying after pancreaticoduodenectomy

Background: Delayed gastric emptying(DGE) is one of the most common complications after pancreaticoduodenectomy(PD). DGE represents impaired gastric motility without significant mechanical obstruction and is associated with an increased length of hospital stay, increased healthcare costs, and a high readmission rate. We reviewed published studies on various technical modifications to reduce the incidence of DGE. Data sources: Studies were identified by searching Pub Med for relevant articles published up to December 2022. The following search terms were used: “pancreaticoduodenectomy”, “pancreaticojejunostomy”, “pancreaticogastrostomy”, “gastric emptying”, “gastroparesis” and “postoperative complications”. The search was limited to English publications. Additional articles were identified by a manual search of references from key articles. Results: In recent years, various surgical procedures and techniques have been explored to reduce the incidence of DGE. Pyloric resection, Billroth II reconstruction, Braun's enteroenterostomy, and antecolic reconstruction may be associated with a decreased incidence of DGE, but more high-powered studies are needed in the future. Neither laparoscopic nor robotic surgery has demonstrated superiority in preventing DGE, and the use of staplers is controversial regarding whether they can reduce the incidence of DGE. Conclusions: Despite many innovations in surgical techniques, there is no surgical procedure that is superior to others to reduce DGE. Further larger prospective randomized studies are needed.

Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

BACKGROUND Sarcopenia is a syndrome marked by a gradual and widespread reduction in skeletal muscle mass and strength,as well as a decline in functional ability,which is associated with malnutrition,hormonal changes,chronic inflammation,distur-bance of intestinal flora,and exercise quality.Pancreatoduodenectomy is a com-monly employed clinical intervention for conditions such as pancreatic head cancer,ampulla of Vater cancer,and cholangiocarcinoma,among others,with a notably high rate of postoperative complications.Sarcopenia is frequent in patients undergoing pancreatoduodenectomy.However,data regarding the effects of sarcopenia in patients undergoing pancreaticoduodenectomy(PD)are both limited and inconsistent.The PubMed,Cochrane Library,Web of Science,and Embase databases were screened for studies published from the time of database inception to June 2023 that described the effects of sarcopenia on the outcomes and complications of PD.Two researchers independently assessed the quality of the data extracted from the studies that met the inclusion criteria.Meta-analysis using RevMan 5.3.5 and Stata 14.0 software was conducted.Forest and funnel plots were used,respectively,to demonstrate the outcomes of the sarcopenia group vs the non-sarcopenia group after PD and to evaluate potential publication bias.RESULTS Sixteen studies encompassing 2381 patients were included in the meta-analysis.The patients in the sarcopenia group(n=833)had higher overall postoperative complication rates[odds ratio(OR)=3.42,95%confidence interval(CI):1.95-5.99,P<0.0001],higher Clavien-Dindo class≥Ⅲ major complication rates(OR=1.41,95%CI:1.04-1.90,P=0.03),higher bacteremia rates(OR=4.46,95%CI:1.42-13.98,P=0.01),higher pneumonia rates(OR=2.10,95%CI:1.34-3.27,P=0.001),higher pancreatic fistula rates(OR=1.42,95%CI:1.12-1.79,P=0.003),longer hospital stays(OR=2.86,95%CI:0.44-5.28,P=0.02),higher mortality rates(OR=3.17,95%CI:1.55-6.50,P=0.002),and worse overall survival(hazard ratio=2.81,95%CI:1.45-5.45,P=0.002)than those in the non-sarcopenia group(n=1548).However,no significant inter-group differences were observed regarding wound infections,urinary tract infections,biliary fistulas,or postoperative digestive bleeding.CONCLUSION Sarcopenia is a common comorbidity in patients undergoing PD.Patients with preoperative sarcopenia have increased rates of complications and mortality,in addition to a poorer overall survival rate and longer hospital stays after PD.

Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy

AIM: To establish a scoring system to predict clinicallyrelevant postoperative pancreatic fistula(CR-POPF)after pancreaticoduodenectomy(PD).METHODS: The clinical records of 921 consecutive patients who underwent PD between 2008 and 2013 were reviewed retrospectively. Postoperative pancreatic fistula(POPF) was defined and classified by the international study group of pancreatic fistula(ISGPF).We used a logistic regression model to determine the independent risk factors of CR-POPF and developed a scoring system based on the regression coefficient of the logistic regression model. The optimal cut-off value to divide the risk strata was determined by the Youden index. The patients were divided into two groups(low risk and high risk). The independent sample t test was used to detect differences in the means of drain amylase on postoperative day(POD) 1, 2 and 3. The optimal cut-off level of the drain amylase to distinguish CR-POPF from non-clinical POPF in the two risk strata groups was determined using the receiver operating characteristic(ROC) curves.RESULTS: Grade A POPF occurred in 106(11.5%)patients, grade B occurred in 57(6.2%) patients,and grade C occurred in 32(3.5%) patients. A predictive scoring system for CR-POPF(0-6 points) was constructed using the following four factors: 1 point for each body mass index ≥ 28 [odds ratio(OR) = 3.86;95% confidence interval(CI): 1.92-7.75, P = 0.00],soft gland texture(OR = 4.50; 95%CI, 2.53-7.98, P =0.00), and the difference between the blood loss and transfusion in operation ≥ 800 mL(OR = 3.45; 95%CI,1.92-7.75, P = 0.00); and from 0 points for a 5 mm or greater duct diameter to 3 points for a less than 2 mm duct(OR = 8.97; 95%CI: 3.70-21.77, P = 0.00). The ROC curve showed that the area under the curve of this score was 0.812. A score of 3 points was suggested to be the best cut-off value(Youden index = 0.485). In the low risk group, a drain amylase level ≥ 3600 U/L on POD3 could distinguish CR-POPF from non-clinicalPOPF(the sensitivity and specificity were 75% and85%, respectively). In the high risk group, the best cutoff was a drain amylase level of 1600(the sensitivity and specificity were 77 and 63%, respectively).CONCLUSION: A 6-point scoring system accurately predicted the occurrence of CR-POPF. In addition, a drain amylase level on POD3 might be a predictor of this complication.

Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy

BACKGROUND The available prediction models for clinically relevant postoperative pancreatic fistula (CR-POPF) do not incorporate both preoperative and intraoperative variables. AIM To construct a new risk scoring system for CR-POPF that includes both preoperative and intraoperative factors. METHODS This was a retrospective study of patients who underwent pancreaticoduodenectomy (PD) or pylorus-preserving PD (PPPD) between January 2011 and December 2016 at the First Affiliated Hospital of Soochow University. Patients were divided into a study (01/2011 to 12/2014) or validation (01/2015 to 12/2016) group according to the time of admission. POPF severity was classified into three grades: Biochemical leak (grade A) and CR-POPF (grades B and C). Logistic regression was used to create a predictive scoring system. RESULTS Preoperative serum albumin ≥ 35 g/L [P = 0.032, odds ratio (OR)= 0.92, 95% confidence interval (CI): 0.85-0.99], hard pancreatic texture (P = 0.004, OR = 0.25, 95%CI: 0.10-0.64), pancreatic duct diameter ≥ 3 mm (P = 0.029, OR = 0.50, 95%CI: 0.27-0.93), and intraoperative blood loss ≥ 500 mL (P = 0.006, OR = 1.002, 95%CI:1.001-1.003) were independently associated with CR-POPF. We established a 10-point risk scoring system to predict CR-POPF. The area under the curve was 0.821 (95%CI: 0.736-0.905) and the cut-off value was 3.5. Including drain amylase levels improved the predictive power of the model. CONCLUSION This study established a 10-point scoring system to predict CR-POPF after PD/PPPD using preoperative and intraoperative parameters. Ultimately, this system could be used to distinguish between high- and low-risk populations in order to facilitate timely interventions after PD.

Early enteral nutrition vs parenteral nutrition following pancreaticoduodenectomy: Experience from a single center

AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition (TPN) and early enteral nutrition supplemented with parenteral nutrition (EEN + PN).METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy (PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group (n = 87) and a TPN group (n = 253). Demographic characteristics, comorbidities, preoperative biochemical parameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed.RESULTS: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings (P &#x0003e; 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying (16.1% vs 6.7%, P = 0.016), pulmonary infection (10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection (18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time (9 d vs 5 d, P = 0.006), postoperative hospital stay (25 d vs 20 d, P = 0.055) and higher hospitalization expenses (USD10397 vs USD8663.9, P = 0.008), compared to those with TPN.CONCLUSION: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively.

Is routine drainage necessary after pancreaticoduodenectomy?

With the development of imaging technology and surgical techniques, pancreatic resections to treat pancreatic tumors, ampulla tumors, and other pancreatic diseases have increased. Pancreaticoduodenectomy, one type of pancreatic resection, is a complex surgery with the loss of pancreatic integrity and various anastomoses. Complications after pancreaticoduodenectomy such as pancreatic fistulas and anastomosis leakage are common and significantly associated with patient outcomes. Pancreatic fistula is one of the most important postoperative complications; this condition can cause intraperitoneal hemorrhage, septic shock, or even death. An effective way has not yet been found to avoid the occurrence of pancreatic fistula. In most medical centers, the frequency of pancreatic fistula has remained between 9% and 13%. The early detection and routine drainage of anastomotic fistulas, pancreatic fistulas, bleeding, or other intra-abdominal fluid collections after pancreatic resections are considered as important and effective ways to reduce postoperative complications and the mortality rate. However, many recent studies have argued that routine drainage after abdominal operations, including pancreaticoduodenectomies, does not affect the incidence of postoperative complications. Although inserting drains after pancreatic resectionscontinues to be a routine procedure, its necessity remains controversial. This article reviews studies of the advantages and disadvantages of routine drainage after pancreaticoduodenectomy and discusses the necessity of this procedure.

Influence of bile contamination for patients who undergo pancreaticoduodenectomy after biliary drainage

BACKGROUND The influence of bile contamination on the infectious complications of patients undergoing pancreaticoduodenectomy(PD)has not been thoroughly evaluated.AIM To evaluate the effect of preoperative biliary drainage and bile contamination on the outcomes of patients who undergo PD.METHODS The database of 4101 patients who underwent PD was reviewed.Preoperative biliary drainage was performed in 1964 patients(47.9%),and bile contamination was confirmed in 606 patients(14.8%).RESULTS The incidence of postoperative infectious complications was 37.9%in patients with preoperative biliary drainage and 42.4%in patients with biliary contamination,respectively.Patients with extrahepatic bile duct carcinoma,ampulla of Vater carcinoma,and pancreatic carcinoma had a high frequency of preoperative biliary drainage(82.9%,54.6%,and 50.8%)and bile contamination(34.3%,26.2%,and 20.2%).Bile contamination was associated with postoperative pancreatic fistula(POPF)Grade B/C,wound infection,and catheter infection.A multivariate logistic regression analysis revealed that biliary contamination(odds ratio 1.33,P=0.027)was the independent risk factor for POPF Grade B/C.The three most commonly cultured microorganisms from bile(Enterococcus,Klebsiella,and Enterobacter)were identical to those isolated from organ spaces.CONCLUSION In patients undergoing PD,bile contamination is related to postoperative infectious complication including POPF Grade B/C.The management of biliary contamination should be standardised for patients who require preoperative biliary drainage for PD,as the main microorganisms are identical in both organ spaces and bile.

胰十二指肠切除术后发生胃排空延迟的危险因素分析

目的探讨胰十二指肠切除(PD)术后发生胃排空延迟(DGE)的危险因素。方法对湖州市中心医院肝胆胰外科2021年6月至2023年11月期间行PD术治疗的102例患者的临床资料进行回顾性分析。采用单因素分析及多因素Logistic回归对导致DGE发生的危险因素进行分析。结果本组病例术后DGE发生率为45.10%(46/102),其中A级22例、B级14例、C级10例。DGE组(n=46)较无DGE组(n=56)术后住院时间明显延长[(25.7±9.5)d vs(16.2±3.9)d,P<0.001]。单因素分析显示,DGE发生与PD手术时间≥6 h及术后胰瘘(POPF)、腹腔出血、腹腔感染相关。多因素Logistic回归分析显示,POPF(A级,OR=6.280,95%CI 1.826-21.597,P=0.004;B级,OR=28.132,95%CI 2.800-282.611,P=0.005)为PD术后发生DGE的独立危险因素。Spearman秩分析显示,PD术后DGE等级与POPF等级呈正相关(r=0.569,P<0.001)。结论PD术后发生DGE主要与PD手术时间长及PD术后并发症相关。缩短PD手术时间、早期诊断并及时处理胰瘘、腹腔感染、腹腔出血等术后并发症可能有助于减少DGE发生率。

大网膜包裹胰肠吻合口预防胰十二指肠切除术后并发症有效性和安全性的Meta分析

目的系统评价大网膜包裹胰肠吻合口预防胰十二指肠切除术后并发症的有效性和安全性。方法本研究根据PRISMA指南完成。计算机检索中国知网、万方、维普、中国生物医学文献数据库、Cochrane Library、Pub Med、Embase和Web of Science等中英文数据库,从数据库建立至2022年11月有关大网膜包裹胰肠吻合口预防胰十二指肠切除术后并发症的临床研究,采用Stata 16和Review Manager 5.4进行Meta分析。结果纳入15项研究,共1830例患者。Meta分析结果显示:网膜包裹组术后胰瘘总体发生率较非网膜包裹组更低(OR=0.30,95%CI:0.22~0.41,P<0.001),亚组分析提示网膜包裹组B/C级术后胰瘘发生率较非网膜包裹组更低(OR=0.29,95%CI:0.21~0.39,P<0.001)。网膜包裹组相较于非网膜包裹组,术后胆漏(OR=0.30,95%CI:0.16~0.56,P<0.001)、术后出血(OR=0.35,95%CI:0.24~0.53,P<0.001)、胃排空障碍(OR=0.45,95%CI:0.31~0.64,P<0.001)、腹腔感染(OR=0.55,95%CI:0.40~0.75,P<0.001)、再次手术(OR=0.31,95%CI:0.18~0.54,P<0.001)、术后30天死亡(OR=0.42,95%CI:0.22~0.80,P=0.009)的发生率更低,开放饮食时间更早(MD=-0.98,95%CI:-1.84~-0.11,P=0.03)、术后住院时间更短(MD=-2.44,95%CI:-4.10~-0.77,P=0.004),两组手术方式在手术时间(MD=-13.68,95%CI:-28.31~0.95,P=0.07)及术中出血量(MD=-17.26,95%CI:-57.55~23.03,P=0.40)方面差异无统计学意义。结论网膜包裹可降低术后胰瘘、胆漏、出血、腹腔感染、胃排空障碍等术后并发症的发生率,改善患者预后,缩短住院时间,且不增加手术难度及手术时间。

预防性使用广谱抗菌药在减少胰十二指肠切除术后并发症中的价值探讨

目的 评价预防性使用广谱抗菌药在减少胰十二指肠切除术后并发症中的应用价值。方法 对2018年10月至2023年10月在广东医科大学附属医院接受胰十二指肠切除术的83名患者进行了回顾性分析。患者被分为观察组(接受预防性使用广谱抗菌药治疗,共40人)和对照组(接受预防性使用窄谱抗菌药治疗,共43人)。收集和分析两组患者的性别、年龄、体质指数、胰腺质地、胰管直径、术前黄疸、术前经皮经肝胆管引流(PTCD)和术前胆道支架植入等特征。比较两组的阳性胆汁培养率、感染指标(PCT、白细胞计数、CRP、术后发热),以及术后腹部感染、腹腔出血、迟延胃排空(DGE)、CRPOPF和切口感染的发生率等指标。分析两组的住院时间和费用差异。结果 术后第一天,两组术前的感染指标(PCT、白细胞计数、CRP)均高于术前水平,而组间相比,观察组的水平较低,差异均具有统计学意义。术后,观察组和对照组分别有3例、12例发热,差异具有统计学意义。同时,发热组和正常体温组之间的人口学特征无统计学差异(P>0.05)。而术中胆汁培养阳性率发热组要高于正常体温组(P<0.05)。此外,观察组的阳性胆汁培养率也要高于对照组。在术后并发症方面,切口感染、腹部感染、迟延胃排空(DGE)和腹腔出血的发生率在两组之间具有统计学差异,而其他术后并发症发生率无显著差异。观察组的住院时间较短,住院费用较低(P<0.05)。结论 预防性使用广谱抗菌药在减少胰十二指肠切除术后的并发症,包括切口感染、腹部感染、迟延胃排空(DGE)和腹腔出血方面有一定效果,并能改善患者的预后,缩短住院时间和减少住院费用。

宣肺利气法针刺联合经空肠营养管中药泵入在腹腔镜胰十二指肠切除术加速康复外科中的应用

目的宣肺利气法针刺联合经空肠营养管中药泵入在腹腔镜胰十二指肠切除术加速康复外科中的应用。方法回顾性分析宝鸡市人民医院肝胆外科2018年12月至2022年12月完全腹腔镜下胰十二指肠切除术62例,其中32例围手术期应用加速康复外科策略,并应用宣肺利气法针刺联合经空肠营养管中药泵入治疗,对照组30例使用加速康复外科策略。比较两组患者术后住院天数,术后并发症发生率,治疗总费用,术后肛门首次排气时间,术后下床活动时间,术后24小时应激与炎性反应指标。结果两组均成功完成LPD,两组一般资料差异无统计学意义(P>0.05),观察组在术后住院天数,术后并发症发生率,治疗总费用,术后肛门首次排气时间,术后下床活动时间,术后应激与炎性反应指标均明显优于对照组(P<0.05),其手术时间及术中出血量无差异(P>0.05)。结论宣肺利气法针刺联合经空肠营养管中药泵入可明显促进腹腔镜胰十二指肠切除术后患者恢复。

基于快速康复理念的临床护理路径在胰十二指肠切除术患者围手术期管理中的应用

目的探讨基于快速康复理念构建的临床护理路径在胰十二指肠切除术围手术期管理中的应用价值。方法选取2021年3月至2023年4月盐城市第一人民医院普外科行胰十二指肠切除术的38例患者为研究对象,按随机数字表法分为对照组和干预组,各19例。围手术期对照组实施常规护理,干预组实施基于快速康复理念的临床护理路径,对比两组术后恢复情况、术后并发症、预后情况、住院时间及住院费用。结果与对照组比较,干预组患者术后血清白蛋白水平明显增高,术后肛门排气时间、下床活动时间和术后住院时间明显短于对照组,住院费用明显低于对照组,并发症的总发生率、术后胰瘘、肺部并发症发生率也均低于对照组(均P<0.05)。结论基于快速康复理念的临床护理路径应用于胰十二指肠切除术患者围手术期管理中,能有效降低患者术后并发症发生率,促进快速康复。

加速康复外科在胰十二指肠切除术中应用安全性评价的Meta分析

目的胰十二指肠切除术是普外科最复杂的手术之一,本研究旨在评估加速康复外科在胰十二指肠切除术中应用的安全性及有效性。方法通过计算机系统检索中文数据库、外文数据库有关加速康复外科在胰十二指肠切除术中应用的文献,检索时间自1994年1月至2016年4月,由两位研究者对符合纳入标准的文献进行质量评价并提取数据。采用Stata12.0软件对手术后总并发症发生率、胰漏发生率、消化道排空障碍发生率进行分析,运用Begg秩相关检验及Egger线性回归法检验发表偏倚情况。结果加速康复外科组术后总并发症发生率低于传统组,差异有统计学意义[风险比(RR)=0.748,95%可信区间(95%CI):0.680~0.824,P<0.001],胰漏发生率的比较两组间差异无统计学意义(RR=0.894,95%CI:0.734~1.089,P=0.266),加速康复外科组消化道排空障碍发生率低于传统组,差异有统计学意义(RR=0.520,95%CI:0.400~0.670,P<0.001)。结论加速康复外科在胰十二指肠切除术中的应用是安全、有效的,但加速康复外科中的一些措施在胰十二指肠切除术中的应用仍需更多的循证医学证据支持。

Blumgart吻合在胰十二指肠切除术后胰瘘防治中的作用

目的评价Blumgart吻合方法对胰十二指肠切除术后胰瘘及其他并发症发生的影响。方法回顾南京医科大学附属南京医院2005年1月-2011年12月实施胰十二指肠切除术的190例患者的临床资料。将患者按照不同的吻合方式为3组:Blumgart吻合组(A组)55例,胰管空肠黏膜端侧吻合组(B组)65例,套入式吻合组(C组)70例。比较不同吻合方法术后胰瘘及其他并发症的发生率。各组并发症发生率的比较采用行×列χ2检验。结果全部患者均无围手术期死亡,术后并发症发生率为48.4%(92/190),其中A组为25.5%(14/55),B组为52.3%(34/65),C组为62.9%(44/70),3组比较差异有统计学意义(χ2=17.850,P<0.05)。术后胰瘘发生率20.5%(39/190),其中A组为5.5%(3/55),B组为20%(13/65),C组为32.9%(23/70)。在胰管内径<3 mm的患者中,不同吻合方式的患者胰瘘发生率差异有统计学意义(χ2=6.089,P<0.05),在≥3mm的患者时,不同吻合方式患者胰瘘的发生率差异无统计学意义(χ2=5.436,P>0.05)。结论 Blumgart胰肠吻合方法安全、简单、省时,明显降低胰瘘的发生率,值得推广。

不同胰肠吻合方式胰十二指肠切除术后胰瘘发生率比较

目的:分析不同胰肠吻合方式胰十二指肠切除术(pancreaticoduodenectomy,PD)后胰瘘发生情况,探讨胰瘘发生的主要原因。方法:总结我院1994年8月至2012年12月18年间540例胰十二指肠切除术后胰瘘的发生情况,按3种不同胰肠吻合方式进行分组,其中采用单纯套入吻合32例为A组;采用胰管空肠黏膜对端吻合363例为B组;套入加捆绑式胰肠吻合145例为C组,胰瘘的定义参照国际胰瘘研究组(ISGPF)诊断标准。结果:胰瘘总发生率为6.5%,其中A组为28.1%,B组为5.8%,C组为3.4%;总手术死亡率为2.0%,A组为21.9%,B组为0.8%,C组为0.7%,在发生胰瘘的病例中,A组主要为C级瘘,B、C组主要为A、B级瘘,胰瘘发生率A组与B组间差异显著(χ2=17.85,P=0.00),A组与C组间差异同样显著(χ2=18.65,P=0.00),B组与C组间差异无统计学意义(χ2=1.165,P=0.28)。结论:胰肠吻合方式的改进与完善以及熟练的手术技巧是降低胰瘘发生率的主要因素,加强手术前后综合治疗是防止胰瘘的重要保障。

根据胰管直径等因素选择不同胰肠吻合方式对患者术后恢复的影响

目的评价根据胰管直径等因素选择的不同胰肠吻合方式对患者术后恢复的影响,为胰肠吻合方式的选择决策提供依据。方法回顾性分析我院在2010年1月至2013年1月间行胰十二指肠切除术305例患者的临床资料。对于胰管直径≥3 mm的患者采用胰管空肠黏膜吻合(胰管空肠吻合组,120例);对于胰管直径<3 mm者,进一步比较胰腺残端与空肠管径的直径大小,若胰腺残端较粗大,且大于空肠管径者采用改良Child胰肠吻合(改良Child胰肠吻合组,80例),若胰腺残端直径小于空肠管径者选择捆绑式胰肠吻合(捆绑式胰肠吻合组,105例)。比较不同胰肠吻合方式术后并发症的发生率,评价临床疗效。结果胰管空肠黏膜吻合组胰管直径显著大于其他两组(P<0.05),改良Child胰肠吻合组胰腺残端直径明显大于捆绑式胰肠吻合组(P<0.05)。本组研究总体胰瘘发生率为11.1%(34/305)。比较三组患者术后胰瘘、腹腔出血、腹腔感染、消化功能异常、平均住院时间及术后死亡,差异无统计学意义(x2=1.51,2.78,1.16,3.75,1.94,F=2.13,P>0.05)。结论在行胰十二指肠切除术时,可以根据胰管直径、胰腺残端直径及空肠管径合理选择不同的胰肠吻合方式。

保留幽门十二指肠胰头切除术的临床疗效分析

目的对比保留幽门胰十二指肠切除术(PPPD)与传统胰十二指肠切除术(PD)两种手术的术中和术后情况,分析保留幽门胰十二指肠切除术的临床疗效。方法回顾性分析重庆市第三人民医院2010年1月至2013年12月,47例接受胰十二指肠切除术的壶腹周围癌和胰头癌患者的病历资料,根据手术方式的不同,分为PPPD组20例,PD组27例,比较两组患者的术中和术后情况。结果 PPPD组患者手术时间明显低于PD组(P<0.05);PPPD组术后并发症发生率、术后感染率明显低于PD组(P<0.05),其中胰漏、胆漏、胃肠漏、术后出血与PD组比较差异无统计学意义;两组患者病死率、术后胃排空延迟发生率差异无统计学意义(P>0.05)。结论 PPPD术式具有缩短手术时间、术后患者恢复快、并发症发生率低、住院时间短的优点,有助于迅速改善患者的营养状态,提高患者的术后生活质量,在治疗胰头癌及壶腹部周围癌具有广阔的应用前景。

不同胰肠吻合方式的临床疗效分析

目的探讨胰十二指肠切除术中3种不同胰肠吻合方式的临床疗效。方法回顺分析2005年1月～2010年4月施行过的76例胰十二指肠切除术，按照胰肠吻合方式的不同将其分为胰管对肠黏膜吻合组、改良Child吻合组及捆绑式吻合绀，分析各组的胰肠吻合时间、肛门排气时间、术后胰瘘卒、腹腔出血率、消化道出血率、消化吸收障碍率等指标。结果3组之间仅术后消化吸收功能障碍率有明显差异，胰管刘黏膜吻合组明显低于另2组，而其他相关指标各组间均无统计学差异。结论胰十二指肠切除术后早期并发症与胰肠吻合方式无关．而胰管对肠黏膜吻合可以以减少术后消化吸收功能障碍的发生，故值得临床推广。