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??Delayed gastric emptying after pancreaticoduodenectomy??A single center retrospective ananlysis of risk factors ZHAO Zhan-qiang??WANG Long-xin??JIANG Hong-chi??et al. Department of Pancreatic and Biliary Surgery??the First Affiliated Hospital of Harbin Medical University??Harbin 150001??China
Corresponding author??TAN Hong-tao??E-mail??tanhongtao2013@163.com
Abstract Objective To analyze the risk factors for delayed gastric emptying(DGE) after pancreaticoduodenectomy(PD). Methods The clinical data of patients underwent PD in the First Affiliated Hospital of Harbin Medical University from January 2012 to August 2015 were collected. The factors influencing the development of DGE following PD were statistically analyzed by univariable and multivariable logistic regression analysis. Results The incidence of DGE was 9.9%(31/312). Univariable analysis indicated upper abdominal surgery??preoperative anemia(Hb<90 g/L)??PPPD??no Braun enteroenterostomy??no postoperative ICU stay??pancreatic fistula??postoperative hyperglycemia were risk factors for DGE. Multivariable analysis using logistic regression revealed that upper abdominal surgery??preoperative anemia(Hb<90 g/L)??PPPD??no Braun enteroenterostomy??no postoperative ICU stay??pancreatic fistula??postoperative hyperglycemia were independent risk factors(OR=13.991??12.145??3.831??3.128??3.463??5.361??3.048) for DGE. PPPD and postoperative hyperglycemia were independent risk factors of Grade B and C DGE(OR=7.318, 3.975). Conclusion For patients underwent PD??we recommend to apply PPPD reasonably??apply additional Braun enteroenterostomy procedure??control postoperative hyperglycemia and establish a multidisciplinary team will reduce the incidence of DGE.     

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??Analysis of the risk factors of hypoparathyroidism following total thyroidectomy ZHU Li-zhang, LI Peng, HAN Bin, et al. Department of Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
Corresponding author??WEI Wei, E-mail??rxwei1123@163.com
Abstract Objective To investigate the risk factors of transient hypoparathyroidism after total thyroidectomy and the clinical value of routine postoperative calcium supplementation. Methods The data of 237 patients performed total thyroidectomy in Peking University Shenzhen Hospital from January 2017 to October 2017 were analyzed retrospectively. All the patients were given calcium supplementation on the day of operation prophylactically. Meanwhile, PTH and Ca2+ were reexamined on the first day after operation. The clinical data of all the patients were collected and analyzed. Results (1) Among the patients, hypoparathyroidism was occurred in 139 cases (58.6%). Three cases (1.3%) were permanent hypoparathyroidism and 136 cases (57.3%) were transient hypoparathyroidism. (2) There was no significant difference in the incidence of transient hypoparathyroidism among different age, sex, and surgical pathway (P>0.05). (3) The scope of lymph node dissection, reoperation and whether the parathyroid glands were misdissection had statistical significance in the incidence of postoperative hypoparathyroidism (P<0.05). Conclusion (1) Wider lymphadenectomy, complicated surgery and incidental parathyroidectomy are the risk factors of transient hypoparathyroidism.(2) The detection of PTH on the first day after operation can predict postoperative hypoparathyroidism better than serum calcium. (3) Regular supplement of calcium and calctriol can avoid hypocalcemia effectively.     

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??Risk factors for anastomotic leakage after anterior resection for rectal cancer PAN Bo??ZHOU Jian-ping??DONG Ming. Department of Gastrointestinal Surgery??the First Hospital of China Medical University??Shenyang 110001??China
Corresponding author??DONG Ming??E-mail??dongming@cmu.edu.cn
Abstract Objective To explore the risk factors for anastomotic leakage after anterior resection for rectal cancer. Methods The clinical data of 262 patients who underwent anterior resection for rectal cancer in the Department of Gastrointestinal Surgery, the First Hospital to China Medical University from January 2014 to June 2018 were analyzed retrospectively. The association between the 31 variables and anastomotic leakage by univariate and multivariate logistic regression analyses were performed. Results Forty-one patients had anastomotic leakage which constituted 15.6% of total 262 patients who underwent anterior resection for rectal cancer. The results of univariate analyses revealed that??the number of distal rectal cut closure??P=0.040????anastomotic methods??P=0.030????perioperative blood transfusion??P<0.001????postoperative diarrhea??P<0.001?? were significantly associated with anastomotic leakage; Multivariate analyses found that: anastomotic methods??P=0.008????perioperative blood transfusion??P<0.001????postoperative diarrhea??P<0.001?? were significantly associated with anastomotic leakage independently. Conclusion In anterior resection of rectal cancer??reduce use frequency of anastomat stapler??avoid unnecessary perioperative blood transfusion??and pay attention to early postoperative diarrhea??it is helpful to reduce anastomotic leakage.     

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??Risk factors of pancreatic fistula after pancreaticoduodenectomy YANG Yin-mo. Department of Surgery??Beijing University First Hospital??Beijing 100034??China
Abstract Pancreaticoduodenectomy offers the only chance of curative resection for periampullary tumors??which is technically challenging and is accompanied by a substantial risk for postoperative complications. The most significant complication is pancreatic fistula which often causes infectious complications??hemorrhage??which makes it the leading risk factor for postoperative death. Risk factors for development of pancreatic fistula are now well known??and several technical modifications??which focus on the type of pancreatic anastomosis??duct stenting??somatostatin and analogues??have been suggested in prevention of pancreatic fistula. Although no one technique of pancreatic anastomosis has been shown to be superior in decreasing the rate of pancreatic fistula??meticulous attention to intraoperative details by surgeons is necessary to prevent pancreatic fistula.     

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??Risk factors analysis of bile duct injuries caused by laparoscopic cholecystectomy WANG Hong, LUO Jian-guan, LIANG Peng, et al. Department of Hepatobiliary Surgery, People’s Hospital of Liuyang City, Liuyang 410300, China
Corresponding author: WANG Hong, E-mail??wanghong810112@tom.com
Abstract Objective To analyze risk factors of bile duct injuries caused by laparoscopic cholecystectomy. Methods The clinical data of 4531 cases of laparoscopic cholecystectomy between October 1999 and December 2010 in People’s Hospital of Liuyang City were analyzed retrospectively. All influential factors were checked in chi square, and independent risk factors about bile duct injuries were analyzed simultaneously. Results Univariate analysis showed bile duct injuries were associated with gender, staging of inflammation, thickness of cholecyst wall by sonography, anatomy of Calot’s triangle and surgical experience (P??0.05). Anatomy of Calot’s triangle and surgical experience were independent risk factors of bile duct injuries, which was showed by multivariate unconditional Logistic regression analysis (P??0.05). Conclusion Anatomy of Calot’s triangle and surgical experience are independent risk factors of bile duct injuries.     

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??Risk factors for early postoperative complication after ileal/ileocecal resection for chronic radiation enteritis with small bowel obstruction GONG Jian-feng, ZHU Wei-ming, YU Wen-kui, et al. Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command PLA, Medical College of Nanjing University, Nanjing 210002, China
Corresponding author ??LI Ning, E-mail: liningrigs@yahoo.com.cn
Abstract Objective To identify the perioperative complication incidence and its risk factors in patients underwent ileal/ileocecal resection for chronic radiation enteritis (CRE) with small bowel obstruction. Methods Univariate and multivariate analysis of a retrospectively gathered database between June 2001 and December 2011 in Department of General Surgery, Nanjing General Hospital of Nanjing Military Command PLA were performed on a cohort of patients (n=158) underwent ileal/ileocecal resection for CRE obstruction at a single institution. Altogether, we analyzed 33 potential risk factors to identify significant influence on the postoperative outcome. Results Overall and major morbidity rates were 57.0% (90 patients) and 28.5% (45 patients), respectively. The mortality rate was 1.9% (3 patients). Univariate analysis determined that ASA score of not less than 3, anemia, low platelet level, long operation time, intraoperative transfusion, presence of radiation uropathy and proctitis and experience of surgeons were important risk factors for Grade ??-?? morbidity. Multivariate analysis found ASA score of not less than 3, anemia, intraoperative transfusion, low platelet level, radiation uropathy and surgeon’s experience as independent risk factors for Grade ??-?? morbidity. Conclusion The current study provides the first evidence of predictive risk factors for postoperative morbidity of ileal/ileocecal resection for CRE.     

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??Risk factors and treatment of pancreatic fistula after pancreaticoduodenectomy ZHANG Tai-ping??XIONG Guang-bing??DU Yong-xing??et al. Department of General Surgery??Peking Union Medical College Hospital??Chinese Academy of Medical Sciences??Beijing 100730??China
Corresponding author??ZHAO Yu-pei??E-mail??zhao8028@263.netAbstract Postoperative pancreatic fistula (POPF) is the most common complication after pancreaticoduodenectomy??which has significant impacts on curative effects and prognosis. Understanding the risk factors of POPF could contribute to the prevention and treatment of the complication. The contemporary surgical literature suggests the definite risk factors for POPF development are pancreatic texture, pancreatic duct diameter, pathologic type and surgeon experience. Although anastomostic methods of digestive tract reconstruction are regarded as the risk factors for POPF, the current evidences show no significant difference in POPF incidence irrespective of the methods of pancreatic anastomosis following pancreaticoduodenectomy. Reconstructive techniques and surgeon experience have been considered as statistically significant risk factors for POPF approved by the majority of researches. Therefore, the anastomosis quality is more important than the reconstruction type. The efficacious way to reduce the incidence of POPF is selecting the suitable and skilled technique for pancreatic anastomosis.     

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??The management of postoperative intra-abdominal hemorrhage after pancreaticoduodenectomy ZHANG Tai-ping??YANG Gang??ZHAO Yu-pei. Department of General Surgery??Peking Union Medical College Hospital??Peking Union Medical College??Beijing 100730??China
Corresponding author: ZHAO Yu-pei??E-mail??zhao8028@263.net
Abstract Intra-abdominal hemorrhage is one of the most serious postoperative complications after pancreaticoduodnectomy(PD). Due to urgent onset??quick change and severe consequences??it becomes a focus of clinical attention. Clarifying the time of onset??severity??cause and location of intra-abdominal hemorrhage of postoperative PD can help clinicians to choose accurate intervention time and therapy method. Early and mild hemorrhage can be treated conservatively??but reoperation is necessary if it’s severe. The outcome of late hemorrhage is serious, interventional treatment or reoperation should be taken as soon as possible. Meanwhile, clinicians should improve preoperative blood coagulation function, operate carefully and prevent postoperative complications actively, such as pancreatic fistula, to avoid intra-abdominal hemorrhage.     

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??A reoperation method for pancreatic fistula with hemorrhage after pancreaticoduodenectomy WU Wen-guang, WU Xiang-song, LI Mao-lan, et al. Department of General Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Corresponding author: LIU Ying-bin, E-mail: laoniulyb@163.com
Abstract Objective To evaluate a reasonable reoperation method for pancreatic fistula with hemorrhage after pancreaticoduodenectomy. Methods From May 2009 to December 2012, 143 cases of pancreaticoduodenectomy (PD) were performed in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Among them, 3 cases had pancreatic fistula with hemorrhage. Pancreatic juice external drainage, binding pancreaticojejunostomy, and binding pancreaticogastrostomy was performed in 1 case respectively for residual pancreatic reconstruction. Results Three cases had no serious complication and the first case underwent reoperation after 6 months for pancreatic juice internal drainage. Conclusion Binding pancreaticojejunostomy (pancreaticogastrostomy) describes a new binding anastomosis technique instead of direct suture for residual pancreatic reconstruction in reoperation, and is worthy of operating method for pancreatic fistula with hemorrhage after PD.     

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自1935年Whipple报告了胰十二指肠切除术(PD)以来，该术式已成为治疗胰头、壶腹周围恶性肿瘤及少数良性疾病的标准术式。PD切除脏器多，手术创伤大，并发症多，至今仍可称为腹部外科最复杂的手术之一。60余年中，外科医生对其进行了许多的改进，减少了并发症的发生，使总体手术死亡率降至5％以下。     

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目的 从临床经济学角度比较胰十二指肠切除术后肠内营养与肠外营养治疗费用的差别，评价早期肠内营养支持作用。方法 回顾分析1999年7月至2001年6月间32例胰十二指肠切除术后早期营养支持临床资料，其中早期肠内营养（EEN）组11例，术后第1天开始EEN支持；肠外营养组（TPN）21例。结果 术后平均住院日EEN组较TPN组为短（25.0天vs36.3天，P＜0.01），且平均费用明显少于TPN组（28368元vs40494元，P＜0.01）。并发症发生率EEN组虽少于TPN组，但无统计学差异（P＞0.05）。费用效果分析及敏感性分析提示EEN较TPN优越。结论 胰十二指肠切除术后EEN支持可减少并发症，并有更好的费用效果比。     

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胰十二指肠切除术后胆管炎 (ｃｈｏｌａｎｇｉｔｉｓｆｏｌｌｏｗｉｎｇｐａｎ ｃｒｅａｔｉｃｏｄｕｏｄｅｎｃｅｔｏｍｙ ,ＣＰＤ)是一个易被人们忽视的少见并发症。与常见的急性胆管炎相比 ,ＣＰＤ的症状较轻 ,加之接受了对机体影响较大的胰十二指肠切除术 (ＰＤ) ,故难以推测这些不适的感觉究竟是由何种原因所致。ＣＰＤ的确切发生率尚难以估计 ,常需对ＰＤ术后病人长期随访及仔细观察方可注意到它的存在。据美国哈佛医学院医疗中心的统计 ,其发病率为 5 % ;日本全国的统计资料显示 ,如将轻症ＣＰＤ包括在内 ,其发生率约为 3 0 %。国内…     

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??The present situation and prospect of pancreaticoduodenectomy ZHAO Yu-pei. Department of General Surgery??Peking Union Medical College Hospital??Peking Union Medical College??Beijing 100730??China
Abstract Pancreaticoduodenectomy is the standard procedure for the surgery of periampullary diseases??including cancer??precancerous lesions??and part of benign diseases. For decades??pancreaticoduodenectomy has developed continuously with the development of surgical technology and instruments so that surgical procedures have been standardized and the safety of pancreaticoduodenectomy has been improved. In recent years??laparoscopic pancreatoduicodenectomy and robotic pancreaticoduodenectomy has been carried out on clinic. In order to make sure the safety and quality of the operation and minimize postoperative complications??minimally invasive pancreaticoduodenectomy should be well evaluated and be carried out by a experienced surgeon in a high volume center. We can expect that laparoscopic pancreaticoduodenectomy and robotic pancreaticoduodenectomy will be more and more standardized and well developed with the constant development of surgical experience and technology in the future.     

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目的 确定创伤性失血性休克（ＨＴＳ）病人死亡和并发症发生的高危因素。方法 分析在创伤ＩＣＵ和急诊部（ＥＤ）内ＨＴＳ病人,确定病死率、感染、器官功能障碍（ＯＤ）的发生率和与此有关的预测指标。结果 １４３例ＨＴＳ病人２８％在入院后２ｈ内死亡,１０％死于２－２４ｈ６％在２４ｈ后死亡;５６％生存。生存〉２４ｈ病人４７％发生感染和２４％发生ＯＤ;最初２４ｈ内复苏时增加晶体液输入,病死率升高。结论 创伤失血致