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81.
82.
Akihiko Horiguchi S. Ishihara M. Ito Y. Asano T. Yamamoto S. Miyakawa 《Journal of hepato-biliary-pancreatic sciences》2010,17(4):523-526
Background/purpose
During a pancreatoduodenectomy (PD) it is important that the anatomy of the arcade of blood vessels in the head of the pancreas is fully understood before the surgery in order to reduce intraoperative bleeding. In most of the patients our group has treated, the inferior pancreaticoduodenal artery (IPDA), one of the efferent arteries of the head of the pancreas, has formed a short common trunk with the first jejunal artery (FJA). Thus, by first locating the origin of the FJA, it was easier to locate the IPDA. There are two ways to locate the IPDA: (1) by measuring the distance between the origin of the superior mesenteric artery (SMA) and that of the FJA; (2) by measuring the distance between the origin of the middle colic artery (MCA) and that of the FJA. Here, we report our measurements of both distances using three-dimensional (3D) models of arteries constructed with multidetector-row computed tomography (MD-CT) images and discuss which is the better measurement to determine the location of the IPDA during PD.Methods
A total of 140 patients underwent 64-MD-CT imaging to acquire early and late arterial phase scans. The distance between the origin of the SMA and that of the FJA and the distance between the origin of the MCA and that of the FJA origin were measured.Results
In patients whose IPDA formed either a common trunk with the FJA or arose directly from the SMA, the IPDA or the common truck was located in parallel with the SMA at a very short distance of approximately 18 mm from the MCA origin towards the center. The distance between the SMA origin and the IPDA was significantly longer (approximately 36 mm). Therefore, locating the MCA origin during PD helped determine the location of the IPDA. However, in patients whose anterior inferior pancreaticoduodenal artery (AIPDA) and posterior inferior pancreaticoduodenal artery (PIPDA) arose separately, the distance between the AIPDA origin and the MCA origin was approximately 18 mm, the distance between the AIPDA origin and the PIPDA origin was approximately 19 mm, and the distance between the PIPDA origin and the SMA origin was 19 mm. Thus, locating the SMA helped determine the location of the IPDA during PD in these patients.Conclusion
Based on our findings that the distance between the IPDA origin and the MCA origin was short, we have shown that it is effective to locate the MCA origin in order to determine the location of the IPDA. 相似文献83.
Satoshi Hirano Eiichi Tanaka Toshiaki Shichinohe Katsunori Saitoh Mikiya Takeuchi Naoto Senmaru On Suzuki Satoshi Kondo 《Journal of hepato-biliary-pancreatic sciences》2007,14(2):149-154
Pancreatoduodenectomy has been described as a possible treatment for gallbladder cancer that presents with evidence of direct invasion to the pancreas and/or the duodenum. This procedure does, however, carry a significantly higher morbidity and mortality if performed with a hepatectomy. An alternative procedure, therefore, of wedge resection of the invaded organ(s) was investigated in this study. On recognition of infiltration of the tumor into the pancreas and/or the duodenum, an en-bloc wedge resection of the organ(s) combined with the original tumor was the intended procedure. However, a pancreatoduodenectomy was performed if the tumor was not resectable by an attempted wedge resection. Operative and long-term outcomes were compared between patients who underwent wedge resection (n = 9) and pancreatoduodenectomy (n = 8). One patient in each group was incorrectly diagnosed preoperatively as having cancer invasion, as opposed to inflammatory changes, as recognized by subsequent histology. All tumors were excised with tumor-free pancreatic and duodenal margins. Postoperative complications occurred in one patient with wedge resection and four with pancreatoduodenectomy. One in-hospital death occurred in each group; one patient died with wedge resection of sepsis and one patient with pancreatoduodenectomy died of a pancreatic leak. No local recurrence occurred in either group. There was no difference in cumulative survival rates between the groups. Wedge resection was considered to be a feasible surgical procedure, in terms of morbidity, respectability, and long-term outcome. 相似文献
84.
Takehiro Okabayashi Michiya Kobayashi Isao Nishimori Takeki Sugimoto Saburo Onishi Kazuhiro Hanazaki 《Journal of hepato-biliary-pancreatic sciences》2007,14(6):557-563
Background/Purpose
Although the operative mortality and morbidity associated with pancreatoduodenectomy (PD) has been decreasing, pancreatic fistula remains a potentially fatal complication. The aim of this study was to identify risk factors and predictors of pancreatic fistula formation, and ways to prevent this in a consecutive series of PD patients in a single institution.Methods
The association between pancreatic fistula formation and various clinical parameters was investigated in 50 patients who underwent PD at Kochi Medical School from January 1991 through February 2006.Results
The incidence of pancreatic fistula in these patients was 28%. Multivariate analysis identified three independent factors correlated with the occurrence of pancreatic fistula: (1) absence of fibrotic texture of the pancreas examined intraoperatively (relative risk [RR], 1.6; 95% confidence interval [CI], 1.2–2.0; P = 0.01); (2) serum amylase concentration greater than 195?U/l (1.69 times the normal upper limit) on the first postoperative day (RR, 2.4; 95% CI, 1.0–5.7; P = 0.01); and (3) not having early postoperative enteral nutrition (RR, 3.2; 95% CI, 1.2–9.0; P = 0.004).Conclusions
Soft texture of the pancreas and increased serum amylase the day after PD are both risk factors with predictive value for pancreatic fistula. The incidence of fistula formation is reduced by early postoperative enteral nutrition.85.
86.
BackgroundOld age and frailty are predictors of early postoperative results after pancreatic surgery. We analysed the results of robotic and open pancreatoduodenectomy in elderly and frail patients.MethodsData from the local robotic pancreatoduodenectomy database were reviewed and matched with those from open operations during the same period (2014–2020). Both old age and frailty were used to determine any correlation with postoperative outcomes. Elderly patients were defined as patients aged 70 years or more, while frailty was classified according to the validated modified Frailty Index.ResultsA total of 118 pancreatoduodenectomies were included in the analysis: 65 (55.1%) robotic and 53 (44.9%) open. More than 50% of patients were frail. Overall, 7.6% of patients experienced grade IV Clavien-Dindo complications, and 3.4% died within 90 days after surgery. Frail patients experienced a similar rate of severe complications after robotic vs. open operations (5.3 vs. 11.6; p = 0.439) but earlier refeeding (3 days vs. 4 days; p = 0.006) and earlier drain removal (6 days vs. 7 days; p = 0.046) when operated on by a robotic approach. The oncological outcomes, including limphnodes retrieval, residual disease, recurrences, and survival, were not influenced by the surgical approach. Non-elderly patients also showed more benefits with the robotic approach (lower complication index, earlier refeeding, and drain removal).ConclusionsRobotic pancreatoduodenectomy is associated with risks of major complications that are comparable to those of open operation in frail patients. Some perioperative parameters (refeeding, drain removal) seem to favour robotics in frail patients and younger patients, although at the price of longer operating times. 相似文献
87.
Hitoshi Sekido Hiroshi Shimada Akira Nakano Itaru Endo Satoshi Fujii 《Journal of hepato-biliary-pancreatic sciences》1994,1(2):200-203
To curatively resect advanced bile duct carcinoma which spread from the hilus to the intrapancreatic bile duct and invaded the portal vein and the hepatic artery, left hepatic lobectomy, caudate lobectomy, hepatoduodenal ligamenteetomy, and pylorus-preserving pancreatoduodenectomy were performed. The hepatic artery was reconstructed by anastomosis of the middle colic artery to the right hepatic artery, and the portal vein was also reconstructed. Gastro-intestinal reconstruction was performed using Traverso's procedure. The patient had a relapsing liver abscess post-operatively and hospital stay was therefore prolonged. However, she was discharged. 3 months after the surgery. A histological study showed that this operation made it possible to remove the entire cancerous lesion in advanced bile duct carcinoma. 相似文献
88.
89.
The impact of pylorus-preserving pancreatoduodenectomy on surgical treatment for cancer of the pancreatic head 总被引:3,自引:0,他引:3
Pylorus-preserving pancreatoduodenectomy (PPPD) was reintroduced in 1978. This pylorus-preserving modification was designed
to minimize complications related to gastric resection, such as early satiety, marginal ulceration, and bile reflux gastritis,
as well as diarrhea and dumping. Since 1978, PPPD has been performed preferentially for benign and malignant diseases of the
periampullary region and pancreatic head. Some groups have argued against PPPD for cancer of the pancreatic head, because
the pylorus-preserving procedure is likely to compromise the field of resection and does not allow lymph node dissection of
the peripyloric and perigastric groups. However, comparative survival rates after PPPD have been the same as, or better than,
those with classic pancreatoduodenectomy, showing the rationale for PPPD as a radical resection procedure for cancer of the
pancreatic head. PPPD can be performed with low mortality. Delayed gastric emptying, which is the most common complication
in the immediate postoperative period after PPPD, is always transient. Many investigators have shown that body weight and
the majority of nutritional parameters are better than after PD. PPPD does not appear to cause any negative outcomes. We conclude
that PPPD is the surgical procedure of choice for cancer of the head of the pancreas.
Received: April 13, 2001 / Accepted: June 6, 2001 相似文献
90.
Masayuki Akita MD PhD Nobuaki Yamasaki MD Taiichiro Miyake MD Kazuya Mimura MD Eri Maeda MD Tohru Nishimura MD Koichiro Abe MD Akihito Kozuki MD Kunio Yokoyama MD PhD Hiroaki Kominami MD PhD Tomohiro Tanaka MD PhD Manabu Takamatsu MD PhD Kunihiko Kaneda MD PhD 《Journal of surgical oncology》2020,121(7):1126-1131