目的:探讨胰十二指肠切除术后胰瘘的原因及其预防。方法: 2003年1月至今,对46例行胰十二指肠切除术中采取胰管空肠吻合方式的病例资料进行回顾分析。结果: 46例患者行胰十二指肠切除术后无一例发生胰瘘。结论: 胰十二指肠切除术采取胰管空肠吻合方式可有效预防胰瘘的发生。
【Abstract】ObjectiveTo determine the risk factors associated with development of pancreatic fistula after pancreatoduodenectomy (PD). Methods The clinical data of 123 consecutive patients who underwent PD from Dec. 1994 to Dec. 2003 were analysed retrospectively. Results The incidence of pancreatic fistula was 11.4% (14/123). Univariate analysis showed history of upper abdominal operation, texture of pancreas, postoperative serum hemoglobin level, type of pancreatojejunostomy and diameter of pancreatic duct were significantly associated with pancreatic fistula after PD. Multivariate analysis using Logistic regression identified four variables as independent factors associated with the occurrence of pancreatic fistula: history of upper abdominal operation, texture of pancreas, postoperative serum hemoglobin level and type of pancreatojejunostomy. Conclusion History of upper abdominal operation, soft texture of pancreas, postoperative serum hemoglobin level less than 90 g/L and routine invaginated pancreaticojejunostomy are main risk factors associated with development of pancreatic fistula after PD.
ObjectiveTo summarize the clinical characteristics of traumatic pancreatitis (TP) after pancreatic trauma and illustrate the experience of specialized treatment. MethodsClinical data of 73 patients with TP treated in our hospital from January 2008 to June 2014 were collected. The pancreatic injury location, grade, and TP pathogenic factors were analyzed, summarized the common problem and the regularity in TP course, and summarized the treatment strategy, methods of surgical intervention, operation key points and difficulties of TP. ResultsThe grade of pancreatic trauma in the all of patients was mainly to levels of 2, 3, and 4, the head of the pancreas injury accounted for 31.5% (23/73), cervical pancreatic body and tail injuries accounted for 68.5% (50/73). Fifty-nine patients were from other hospitals referral. The occurrence of TP peak period was 4-7 days after pancreatic trauma. Pancreatic fistula and uncontrolled peritoneal infection were the treatment difficulty of TP. It's the effective minimally invasive treatment methods for TP that percutaneous catheter drainage, pancreatic duct stent placement, and endoscopic abscess debridement. Forty-two patients with TP needed reoperations, and 19 cases underwent more than 2 times operation. ConclusionsBecause of the condition of TP is complex and changeable, and difficulty to treat, so the early definitive diagnosis and appropriate surgical strategy play a crucial role in the treatment of TP. Besides, professional team of pancreatic surgery has advantages in estimating patients' conditions, selecting and performing surgical interventions.
ObjectiveTo evaluate the various methods in prevention of pancreatic fistula after pancreaticoduodenectomy.MethodsThe literatures over the years related to prevention of pancreatic fistula were reviewed.ResultsManagement of the pancreatic stump following pancreaticoduodenectomy played the most important role in preventing pancreatic fistula. None of the methods of pancreatic stump had proved to be perfect in preventing pancreatic fistula, though pancreaticojejunostomy was the most widely practiced reconstruct strategy in varieties of option. For pancreaticojejunostomy and pancreaticogastrostomy, the rate of this complication was 12.3% and 11.1%,respectively. In recent years, a new procedure, bindingup pancreaticoduodenectomy, had shown a promise and excellent results in prevention of pancreatic fistula, the rate of fistula was 0 for consecutive 100 cases after pancreaticoduodenectomy.ConclusionBindingup pancreaticojejunostomy have a definite effect to avoid pancreatic fistula and be worthy of being recommended
ObjectiveTo investigate the factors that affect the occurrence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP).MethodsThe clinical data of 114 patients underwent DP who were performed in the First Affiliated Hospital of Xinjiang Medical University from Jan. 2014 to Jun. 2019, were retrospectively analyzed.ResultsIn this group of 114 patients, 43 cases (37.7%) of POPF occurred after DP, including 19 cases of grade A (biochemical fistula), 21 cases of grade B, and 3 cases of grade C. The univariate analysis results showed that: BMI value, drinking history, preoperative plasma albumin level, postoperative plasma albumin level, postoperative neutrophil/lymphocyte ratio (NLR), preoperative and postoperative prognostic nutrition index (PNI) levels were significant different between the POPF group and non-POPF group (P<0.05). Multivariate analysis results showed that: preoperative plasma albumin>35 g/L [OR=0.115, 95%CI was (0.038, 0.348)], postoperative plasma albumin>35 g/L [OR=0.126, 95%CI was (0.031, 0.516)], and postoperative NLR value≤6.65 [OR=0.149, 95%CI was (0.048, 0.461)] were the influencing factors of POPF after DP. The area under curve of postoperative NLR was 0.731 [95%CI was (0.639, 0.824)]. ConclusionPreoperative and postoperative plasma albumin>35 g/L, as well as postoperative NLR ≤6.65 are protective factors for POPF after DP, and postoperative NLR can be used as a predictor of POPF.
目的 改进胰肠吻合缝合技术，预防胰瘘发生。方法 24例胰十二指肠手术，采用2-0或3-0嶶乔吸收缝线行套入式双层连续缝合加捆绑胰肠吻合术。结果 吻合时间平均18 min，均未出现胰肠吻合口漏，无手术死亡病例。结论 双层连续缝合加捆绑胰肠套入式吻合，操作简便、省时、并发症少，是胰肠吻合术的一种有效改进。
Objective To analyze the effect of inner diameter of pancreatic duct following pancreaticoduodenectomy on pancreatic fistula. Methods From January 1995 to December 2008, 256 patients underwent pancreaticoduodenectomy were divided into four groups based on the types of pancreaticojejunostomy: end-to-side “mucosa-to-mucosa” anastomosis group (n=115), end-to-end “mucosa-to-mucosa” anastomosis group (n=71), end-to-end invaginated pancreaticojejunostomy group (n=43) and pancreaticogastrostomy group (n=27). Alternatively, 238 patients were divided into two groups according to drainage ways: stenting tube for internal drainage group (n=132) and stenting tube for external drainage group (n=106). Furthermore, 233 cases were divided into three groups on the basis of inner diameter of pancreatic duct: ≤0.2 cm group (n=54), 0.2-0.4 cm group (n=93) and ≥0.4 cm group (n=76). Then, the incidence rate of pancreatic fistula of each group was compared. Results The incidence of pancreatic fistula was 8.20% (21/256). The incidence of pancreatic fistula for different types of pancreaticojejunostomy was as follow: end-to-side “mucosa-to-mucosa” anastomosis group (7.83%， 9/115), end-to-end “mucosa-to-mucosa” anastomosis group (7.04%, 5/71), end-to-end pancreaticogastrostomy invaginated group (13.95%, 6/43) and pancreaticogastrostomy group (3.70%, 1/27), in which there wasn’t significant difference in 4 groups （χ2=2.763，P=0.430）. There was no significant difference of the incidence of pancreatic fistula between stenting tube for internal drainage group (9.10%, 12/132) and stenting tube for external drainage group (8.49%, 9/106), χ2=0.126, P=0.722. The incidence of pancreatic fistula in ≥0.4 cm group, 0.2-0.4 cm group and ≤0.2 cm group was respectively 0, 15.05% (14/93) and 11.11%(6/54), and the difference was significant (χ2=12.009, P=0.002). No correlation was found between the incidence of pancreatic fistula of different inner diameter of pancreatic duct and the types of pancreaticojejunostomy (χ2=1.878， P=0.598). Conclusion The inner diameter of pancreatic duct is an important factor for postoperative pancreatic fistula. No relationship is found between the types of pancreaticojejunostomy and pancreatic fistula in this study.
Objective To investigate the effect of the duct-to-mucosa anastomosis in invaginating end-to-side pancreaticojejunostomy. Methods A retrospective review was conducted for 200 patients treated with pancreaticoduod-enectomy （PD） between August 2005 and December 2012. Reconstruction of digestive tract in PD was done according to the method described by Child. The duct-to-mucosa anastomosis was applied in the invaginating end-to-side pancrea-ticojejunostomy. The outline of the anastomosis structures was as follows：anastomosis of pancreatic duct and jejunal mucosa， anastomosis of pancreatic and jejunal resection margin， and anastomosis of pancreas and jejunal seromuscular layer. A cilicone tube was put into the pancreatic duct and lead to the jejunum. The anastomotic stoma was covered with part of the omentum majus, and put a drainage tube under the anastomotic stoma. Results The operation went smoothly，and no deaths occurred during perioperative period. The surgical time was 280-420 min， the average time was （298±77） min. The pancreatic fistula were observed in 22 patients （11%）， including 17 patients in Grade A， 2 patients in Grade B， and 3 patients in Grade C. The other complications were observed in 19 patients， including 16 patients with addominal infection， 1 patient with bleeding from splenic vein， 1 patient with bleeding from ruptured of pseudoaneurysm at biliary intestinal anastomosis， 1 patient with abdominal abscess. Three patients with pancreatic fistula in Grade C were cured by reoperation, and the other patients with pancreatic fistula were cured by expectant treatment. Conclusions The duct-to-mucosa anastomosis in invaginating end-to-side pancreaticojejunostomy is a simple and safe procedure that has the advantage in reducing the incidence of the pancreatic fistula. Using omentum to cover the anastomotic could localize the diffusion of panreactic fistula， and reduce the incidence of serious complications caused by pancreatic fistula.
ObjectiveTo investigate the role of local pancreatectomy for benign and low-grade malignant pancreatic tumors.MethodThe clinical data of 45 patients with benign and low-grade malignant pancreatic tumors who underwent local pancreatectomy from January 2014 to June 2019 in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were analyzed.ResultsForty-five patients underwent the local enucleation or resection with negative margin. The pathological results showed that there were 17 cases of solid pseudopapilloma, 5 cases of mucinous cystadenoma, 4 cases of serous cystadenoma, 10 cases of islet cell tumor, 5 cases of nonfunctional neuroendocrine tumor, 4 cases of congenital cyst. There were 6 cases of head of pancreas, 26 cases of body of pancreas, 8 cases of tail of pancreas, 5 cases of uncinate process. The tumor was 1.2 to 9.0 cm in diameter with an average of 3.2 cm. Among them, the diameter was more than 5.0 cm in 9 cases. The incidence of pancreatic fistula after operation was 57.8%, 65.4% was grade A fistula, 34.6% was grade B fistula, and no grade C fistula occurred. The incidence of abdominal infection was 13.3%, incidence of abdominal hemorrhage was 6.7%. There was no secondary diabetes mellitus and pancreatic endo- and exocrine dysfunction, and no death case.ConclusionsPancreatic enucleation for benign and low-grade malignant pancreatic tumors after strict preoperative evaluation can effectively preserve the pancreatic endocrine function of patients. Although the incidence of pancreatic fistula is high, it is mostly biochemical fistula, and the incidence of serious complications is low.