Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head

Pancreaticoduodenectomy is often avoided in patients with portal or superior mesenteric venous involvement due to the perception that venous resection is complex, morbid, and carries a poor longterm survival. Our recent experience using state-of-the-art imaging and strict resection criteria show that venous reconstruction increases operative time, transfusion requirements, intensive care unit stay, and total hospital length of stay, but has no significant impact on operative morbidity rates, mortality rates, or the incidence of positive histologic margins. Kalpan-Meier life table analysis shows similar survival curves when compared to a contemporary cohort of patients who do not undergo venous reconstruction. Presented as an abstract at the Americas Hepato-Pancreatico-Biliary Association Meeting, Miami Beach, Florida, February 28–March 1, 2003.     

Huge cystic lymphangioma of the pancreas: report of a case

We report herein the case of a 33-year-old woman who presented with palpable abdominal swelling found to be caused by a huge lymphangioma of the pancreas. An abdominal computed tomographic (CT) scan showed a large multilocular cystic mass with water-dense contents, which was derived from the pancreatic head. A pancreaticoduodenectomy (PD) was performed because the tumor had invaded the duodenum. The resected tumor, which was 23 × 12 × 23 cm in size with 2 l of serous fluid, was pathologically diagnosed as a cystic lymphangioma. The endothelial cells lining the internal surface of the cystic spaces were immunohistochemically positive for factor VIII-R antigen and CD31. Our review of the literature revealed 45 reports of lymphangioma of the pancreas, including this one, but to the best of our knowledge this is only the fifth case that required a PD. Nevertheless, we recommend that a complete resection be performed to reduce the risk of recurrence. Received: April 3, 2000 / Accepted: March 6, 2001     

局部进展期胃癌或结肠癌联合胰十二指肠切除术：附15例报告

目的探讨局部进展期胃癌或结肠癌行胃癌或结肠癌切除联合胰十二指肠切除术的可行性及临床价值。方法回顾性分析2004年5月—2010年12月15例侵犯胰头十二指肠区域的局部进展期胃癌或结肠癌联合胰十二指肠切除术患者的临床资料,其中原发或复发胃癌12例,结肠癌3例。结果中位手术时间6 h(4～12 h),中位术后住院时间21 d(7～63 d)。并发症发生率为46.7%(7/15),再手术率为6.7%(1/15),病死率为6.7%(1/15)。中位生存期为23个月;1,2,3年累积生存率分别为62.2%,44.4%,22.2%。结论联合胰十二指肠切除术可作为局部进展期胃癌或结肠癌侵犯胰头十二指肠区域患者的治疗选择。该术式可延长部分患者的生存期。     

Frequency With Which Surgeons Undertake Pancreaticoduodenectomy Continues to Determine Length of Stay,Hospital Charges,and In-Hospital Mortality

Introduction This study was undertaken to determine changes in the frequency of, volume of, and outcomes after pancreaticoduodenectomy 6 years after a study denoted that, in Florida, the frequency and volume of pancreaticoduodenectomy impacted outcome. Methods Using the State of Florida Agency for Health Care Administration database, the frequency and volume of pancreaticoduodenectomy was correlated with average length of hospital stay (ALOS), in-hospital mortality, and hospital charges for identical periods in 1995–1997 and 2003–2005. Results Compared to 1995–1997, 88% more pancreaticoduodenectomy was performed in 2003–2005 by 6% fewer surgeons; the majority of pancreaticoduodenectomies were conducted by surgeons doing <1 pancreaticoduodenectomy every 2 months. In-hospital mortality rate did not decrease from 1995–1997 to 2003–2005 (5.1 to 5.9%); in-hospital mortality rate increased for surgeons undertaking <1 pancreaticoduodenectomy every 2 months (5.5 to 12.3%, p < 0.01). For 2003–2005, frequency with which pancreaticoduodenectomy is conducted inversely correlates with ALOS (p = 0.001), hospital charges (p = 0.001), and in-hospital mortality (p = 0.001). Conclusions In Florida, more pancreaticoduodenectomies are carried out by fewer surgeons. Mortality has not decreased because of surgeons infrequently performing pancreaticoduodenectomy. Most pancreaticoduodenectomies are still undertaken by surgeons who conduct pancreaticoduodenectomy infrequently with greater lengths of stay, hospital costs, and in-hospital mortality rates. To an even greater extent than previously documented, patients are best served by surgeons frequently performing pancreaticoduodenectomy. Presented at the 2007 Annual Meeting of the American Hepato-Pancreato-Biliary Association, April 19–22, 2007, Las Vegas, Nevada.     

Survival Rates and Cause of Death in 174 Patients with Chronic Pancreatitis

Background  The natural history after surgery for chronic pancreatitis is rarely reported. Methods  Between 1970 and 1999, 174 patients underwent surgery for chronic pancreatitis and were followed until December 2006. They were divided in four groups: (1) resection 62; (2) drainage 82; (3) external drainage 7; (4) non-pancreas-directed surgery 23. A second procedure was required by 25 patients and a third by four: group 1 = 6 + 0, group 2 = 10 + 2, group 3 = 3 + 1, group 4 = 6 + 1. Results  Hospital mortality was four of 174 (2.3%). Fifty-seven patients are alive; 49 of 170 developed cancer, and 38 died: lung (22), oral, pharynx, larynx (eight), esophagus, kidney, pancreas, colon, liver (two each), breast, stomach, mediastinum, prostate, melanoma, chronic myelogenous leukemia, squamous cancer of the auricle (one each), liver metastasis from unknown primary (two). Fifteen patients died of liver cirrhosis, 13 of myocardial infarction/decompensation, six of vascular problems, five each of acute renal insufficiency or cerebral diseases, four each of acute pancreatitis, accidental trauma, complications of diabetes, bronchopneumonia, and 19 of other causes. The overall 5-, 10-, 15-, 20-, 25-, and 30-year survival rate was 84.7, 65.6, 51.6, 38.0, 28.1, and 23.5. Conclusions  Incidence of pancreatic cancer was 1.2%. The high incidence of smoking cancers (18.8%) is explained by the smoking habits of almost 100% of our patients. Eliminating smoking and increasing tests on organs at risk may prolong survival. Grant support: This study has been supported by the Ministero dell’Università e Ricerca Scientifica (Cofin 2005060715_001), Rome, Italy.     

胰十二指肠切除术治疗壶腹周围癌疗效分析

目的：探讨壶腹周围癌的手术方式，方法：对１０５例壶腹周围癌患者行胰十二指肠切除术。结果：１、３、５年生存率分别为６６．６７％，４０．８５％，２５．００％。影响术后过 铲的主要因素有病程长短，肿瘤部位、大小；病理性质及组织来源，局部浸润和淋巴结转移状况。与患者的性别、年龄等因素无明显关系。结论：在进一步探讨手术方式的基础上，深入了解壶腹周围癌分子生物学行为，提高早期诊断水平，加强辅助治疗，有望提高     

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目的 对两种类型的捆绑式胰肠吻合术进行对比。方法 同期施行捆绑式胰吻合术Ⅰ型（同时施行空肠粘膜和胰腺缝合以及空肠断端与胰腺缝合等三项防漏步骤）35例（A组），与只行捆绑吻合的Ⅱ型手术49例（B组）进行对照观察。结果 两组都没有发生胰吻合口漏，没有手术死亡。术后随访，两组均无胰管扩张或胰腺外分泌功能不足的表现。完成吻合时间A组平均27min，B组平均16min。结论 捆绑式胰肠吻合术，相比之下Ⅱ型更加简单、省时，而且能够在吻合口完成后立即对它进行检测，可以避免捆绑过紧，从而无须插入胰管导管作为支撑。两种类型的捆绑式胰肠吻合术均可掌声用于胰十二指肠切除术，但是Ⅱ型应当成为首选方法。     

小口径吻合器胆肠吻合临床研究

目的：探讨小口径吻合器胆肠吻合在合并胆总管扩张壶腹部肿瘤胰十二指肠切除术中的应用。方法：2007年5月～2009年10月共30例伴胆总管扩张壶腹部肿瘤患者接受胰十二指肠切除术,其中16例行小口径吻合器胆肠吻合,其余14例采用常规方法吻合,分析其临床资料和病理结果,比较两组手术前后血清电解质、肝功能变化,手术时间,两组吻合口大小、吻合时间、吻合口狭窄发生率及胆道感染情况,手术后进食时间、住院时间和并发症发生情况。结果：全组无手术死亡及严重并发症发生。与常规术式组相比,观察组的胆肠吻合手术时间短,P=0.036,术后进食时间早,术后住院时间短,P=0.047,术后3个月胆管直径、胆漏发生率、吻合口狭窄发生率相当,两组间手术前后血钠、血钾、肝功能变化差异无统计学意义（P〉0.05）。结论：有胆管扩张的患者以小口径吻合器胆肠吻合同时不放置T管是安全可行的。     

经肝脏胆肠引流预防胰十二指肠切除术后吻合口瘘的临床研究

目的探讨经肝脏胆肠引流在预防胰十二指肠切除术后吻合口瘘中的疗效。方法 2009年5月至2011年5月共30例患者接受胰十二指肠切除术,其中16例行采用经肝脏胆肠引流,其余14例采用常规方法放置T管,分析其临床资料比较两组手术前后血清电解质、肝功能变化,手术时间,两组吻合口大小、吻合时间、吻合口狭窄发生率及胆道感染情况,手术后进食时间、住院时间和并发症发生情况。结果全组无手术死亡及严重并发症发生。与常规术式组相比,观察组的胆肠吻合手术时间小于对照组,术后引流管周围渗液明显减少,术后引流管拔除时间较早;两组术后进食时间,胆漏发生率、术后住院时间短,术后3个月胆管直径,吻合口狭窄发生率相当、两组间手术前后电解质及肝功能变化无明显差异。结论经肝脏胆肠引流可以有效预防吻合口瘘的发生。     

胰胃吻合术在胰十二指肠切除术中的应用

目的 探讨胰胃吻合术在胰十二指肠切除术中的应用效果.方法 对胰十二指肠切除术中应用胰胃吻合术的245例临床资料进行回顾性分析.结果 本组均行胰十二指肠切除胰胃吻合术.术后监测血糖4.0～6.9 mmol/L.术后胰漏发生率为0.82％,胃排空障碍发生率为0.82％,腹腔积液发生率为1.22％,腹部切口感染发生率为2.04％,病死率为1.22％.结论 胰胃吻合术是一种安全、可靠、有效的胰腺残端重建术式.