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排序方式: 共有163条查询结果,搜索用时 15 毫秒
41.
Harish Lavu Jamie L. Knuth Marshall S. Baker Changyu Shen Nicholas J. Zyromski Max Schmidt Atilla Nakeeb Thomas J. Howard 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2008,10(6):491-497
Middle segment pancreatectomy (MSP) is a new operation where the advantages of parenchymal preservation are counterbalanced by a high postoperative complication rate and unease among surgeons with adopting a new technique. This study reviews our experience incorporating MSP into our clinical practice focusing on the initial 34 consecutive patients operated on by one surgeon at a single institution between 1998 and 2007. Patients were divided into early (initial 17 operations) and late (subsequent 17 operations) groups for analysis. Thirty-one reconstructions were by Roux-en-y pancreaticojejunostomy and three were by pancreaticogastrostomy. Using multiple linear regression and logistic regression, we found no significant differences in performance outcomes (operative time, blood loss, tumor size, margin negative resection rate, pancreatic fistula rate, hospital length of stay, postoperative complications, and hospital readmission rate) between our early and late experience even after adjusting for potential confounding variables (patient demographics, co-morbidities, neoplasm, pancreatitis). The pancreatic fistula rate in this series was 29.4% (10/34) and they were all International Study Group on Pancreatic Fistula (ISGPF) Grade A (60%) or B (40%). In summary, MSP is an operation with a flat learning curve and acceptable morbidity rate that can be safely incorporated as a parenchymal preserving option by pancreatic surgeons in their clinical practice. 相似文献
42.
Lu Bangyu Huang Yubin Cai Xiaoyong Huang Fei Li Jie Lu Wenqi Xu Jing Liu Zujun Yan Yihe Li Jianjun 《Frontiers of Medicine in China》2007,1(4):369-372
Laparoscopic pancreaticoduodenectomy (LPD) is a challenging operation to general surgeon. Up to date, only about 135 cases
have been reported, 16 cases in China, 119 cases outside China. The reconstruction of alimentary system is a key procedure
to ensure success of the whole surgery. It is worth investigating the methods of reconstruction in LPD. A retrospective study
is made to investigate the methods of reconstruction in LPD. We analyze 13 cases of LPD performed in our center. Child’s or
modified Child’s method was used to make the reconstruction in our practice. We tried three methods to make the anastomosis
of pancreaticojejunostomy, including end-to-end dunking binding pancreaticojejunostomy in two cases, end-to-end dunking pancreaticojejunostomy
using interrupted suture in two cases, and duct-to-jejunal end-to-side embedding pancreaticojejunostomy in nine cases. The
clinical data was collected and analyzed. Three of four patients, who underwent end-to-end pancreaticojejunostomy, had a little
pancreatic leakage, especially in the first case. None of other nine patients, who underwent duct-to-jejunal end-to-side embedding
pancreaticojejunostomy, was detected to have pancreatic leakage, and the operating time of these nine cases was less than
other four cases. Duct-to-jejunal end-to-side embedding pancreaticojejunostomy is a safe and efficient method of reconstruction
in LPD. 相似文献
43.
Obuective To evaluate the safety and feasibility of a new operative procedure called binding pancreaticojejunostomy (BPJ) for the preven-tion of pancreatic leakage after pancreatoduodenectomy(PD). Methods Binding pancreaticojejunostomy was perfomed in 100 patients from 1996 to 2000.During the operation,the cut end of the je-junum(3 cm) was everted,the everted mucosa of the jejunum was destroyed with carbolic acid .Meanwhile 3 cm long remnant of pancreas was isolated and sutured to 3 cm away form the jejunum cut end, care being taken not to penetrate the sero-muscular layer.Then,the everted jejunum was restituted to its nomal position and the remnant of the pancreas was naturally pushed into the jejunal lumen for 3 cm.Finally,the surface of pancreatic remnant was closely in contact with destroyed jejunal mucosa surface,and a piece of absorbable thread was used to bind circumferentially this jejunum and the pancreatic remnant together,so no gap existed between the jejunal mucosa and pancreatic remnant. Results No pancreatic leakage occurred in the 100 patients with BPJ. Conclusion Binding pancreaticojejunostomy procedure can effectively prevent the occurrence of anastomatic leakage and can be applied broadly. 相似文献
44.
目的探讨胰肠吻合术后腹腔引流液淀粉酶升高的发生时间及变化规律。方法前瞻性收集2008年2月至2011年12月泰兴市人民医院收治的28例胰腺疾病病人临床资料,胰腺切除手术由同一医疗组完成,采用相同胰肠吻合方法。术后分别连续采集胰肠、胆肠吻合口旁引流液,进行淀粉酶测定。同时测定血清、T管内胆汁淀粉酶。采用国际国内认可的胰瘘定义对结果进行评估。结果 28例病人中,术后腹腔引流液淀粉酶异常升高85.7%(24/28),其中早期升高型42.9%(12/28),迟发性升高型7.1%(2/28),再次升高型(M型)28.6%(8/28),持续升高型7.1%(2/28)。术后发生胰瘘(ISGPF)12例(42.9%),均为A级胰瘘。经吻合口造影证实无胰肠吻合口瘘。结论胰肠吻合术后腹腔引流液中淀粉酶升高比较常见,且有一定的规律性,这与术后胰实质胰液渗漏有关,仅少数病人可发展为具有临床意义的胰瘘。 相似文献
45.
46.
Book reviews in this article: The treatment of chronic pancreatitis commonly yields disappointing results. Patients with chronic pancreatitis and a dilated pancreatic duct can be treated by longitudinal pancreaticojejunostomy. In order to evaluate the procedure, 20 patients undergoing pancreaticojejunostomy were followed for a median time of more than 5 years. Their clinical characteristics and outcomes have been compared with a group of 43 patients with chronic pancreatitis and small pancreatic ducts. There were no differences between the two groups in the major epidemiological parameters, except that calcification in the gland was more frequently noted in those with large ducts. The operation of longitudinal pancreaticojejunostomy could be accomplished with an acceptable morbidity. There was one death in the postoperative period. Seventy-six per cent of patients were found to have benefited clinically at five years, compared with 48% of those with small duct disease. This difference was statistically significant. Patients who benefited were defined by four factors; they were carrying out their usual occupation at the time of surgery, they were not narcotic dependent at the time of surgery, they had a pancreatic duct width greater than 7 mm and, they had totally abstained from alcohol from before the operation to the time of follow-up. Longitudinal pancreaticojejunostomy probably remains the best surgical treatment for suitable patients with chronic pancreatitis. The operation should only be performed when the pancreatic duct is greater than 7 mm in width. In such patients the operation produces considerable improvement of pain with minimal metabolic disturbance. 相似文献
47.
Takehiko Furusawa Takai Kuroda Shinji Nakata Gengo Kaneko Shigeyuki Kawa Osamu Hasebe Masuo Tokoo 《Journal of Hepato-Biliary-Pancreatic Surgery》1995,2(3):279-283
The effectiveness of operation for pancreas divisum in patients who exhibit unexplained upper abdominal pain or recurrent
pancreatitis is often uncertain. Here we report a successful operation in a patient whose two dissected pancreas portions
were anastomosed with the looped jejunum. The patient was a 31-year-old woman who had suffered from continuous upper abdominal
pain and relapsing pancreatitis for 10 years. She had a history of excessive alcohol intake from the age of 19–25 years. When
she was 24 years old, endoscopic retrograde pancreatography had been performed, revealing pancreas divisum. Thereafter, various
treatments had been performed, endoscopic accessory papillotomy; the administration of an anti-secretagogue, a cholecystokinin
receptor antagonist; and cannulation of a stent tube into the dorsal pancreatic duct. Each of these treatments led to only
short-lived relief of the symptoms. When she was 31 years old, the following operation was performed: The pancreas was cut
off at the portal vein and the jejunum was pulled up via the retrocolic route; the two dissected pancreas portions were double-anastomosed
with the jejunum by an end-to-side procedure. The postoperative course has been smooth. Fifteen months after the operation,
the patient has gained 4 kg in weight and is symptom-free. 相似文献
48.
对15例壶腹部周围癌的患者实施胰十二指肠切除术,行胰肠吻合时,采用翻袖式空肠浆膜(肌)层胰腺吻合技术,术后无1例胰瘘发生。本术式改变了传统的胰肠吻合位置,将实际吻合部位远离胰肠断缘,对预防胰瘘效果显著。 相似文献
49.
50.
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。方法回顾分析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组,分析各组的胰肠吻合时间、肛门排气时间、术后胰瘘率、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,胰管对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减少术后消化吸收功能障碍的发生,故值得临床推广。 相似文献