术前减轻黄疸对壶腹部癌行Whipple手术治疗效果的影响

目的:探讨术前减轻黄疸对壶腹部癌患者行Whipple手术治疗效果的影响。方法:回顾性分析2012年1月—2018年7月45例在Whipple手术术前行减轻黄疸治疗的壶腹部癌患者(减轻黄疸组)的临床资料,与同期34例行Whipple手术术前未行减轻黄疸治疗的壶腹部癌患者(未减轻黄疸组)的临床资料进行比较。比较两组患者术前、术中情况(手术时间、出血量、输血量)和术后并发症的差异。结果:减轻黄疸组患者治疗后总胆红素(TBil)、结合胆红素(DBil)、谷丙转氨酶(ALT)与治疗前比较差异有统计学意义(P<0.05)。两组R 0切除率比较差异无统计学意义(P>0.05)。减轻黄疸组手术时间、术中出血量、术中输血量优于未减轻黄疸组,差异均有统计学意义(P<0.05)。减轻黄疸组术后并发症发生率、胰漏发生率和胆漏发生率少于未减轻黄疸组,差异均有统计学意义(P<0.05)。结论:壶腹部癌患者行Whipple手术术前彻底减轻黄疸,可以缩短手术时间,减少术中出血量和术后并发症的发生。     

123例Whipple手术近期疗效的多因素分析

目的：探讨影响胰十二指局切除(Whipple)手术疗救的主要因素，以便临库作出必要的改进。方法：作分析我院369例壹腹周围癌行手术探查病例的相关资料；统计临库、手术和辅助检查等28项指标，以电脑应用软件作多种统计学分析。结果：手术切除123例，总切除率296％。原发疾病以壶腹癌(38％)多见，37％为管状腺癌，局部浸润占30％；手术采用Whippk式78例(63％)，Child式45例(37％)，86％的病人采用胆管、胰管双支架引流；围手术期死亡率为147％，并发率为32％；统计学分析证实影响Whipple手术疗效的4个主要因素为术中低血压持续时间、术前ALT水平、胰管处理方式及患的年龄。结论：早期诊断早期治疗、改进手术和围手术期处理是提高疗效的关键。     

Preservation of the pylorus in resection of the head of the pancreas

Pylorus preservation has been advocated to decrease the morbidity associated with the classical or standard pancreaticoduodenectomy. The proposed advantages are decreased incidence of peptic ulceration, dumping syndrome, and nutritional problems. However, after an initial period of enthusiasm for the procedure, it is now being found that marginal ulceration at the duodenojejunal anastomosis is encountered with increasing frequency. Delay in gastric emptying occurs frequently, with an overall incidence of 30%. With the availability of better pancreatic enzyme supplements, the current incidence of nutritional problems and weight loss after the standard Whipple procedure is unknown. Whether there is a difference in long-term survival after the two procedures performed for adenocarcinoma of the head of the pancreas is still debatable. A controlled trial is needed to answer many of these questions, and pylorus-preserving pancreaticoduodenectomy should be used cautiously until further data become available.     

Robotic pancreatoduodenectomy for a solid pseudopapillary tumor in a ten-year-old child

Background

Pancreatoduodenectomy (Whipple resection) in children is feasible though rarely indicated. In several pediatric malignancies of the pancreas, however, it may be the only curative strategy [1]. With the emergence of robotic pancreatoduodenectomy as at least a clinically equivalent alternative to open surgery [2], it remains to be determined whether the pediatric population may potentially benefit from this minimally invasive procedure. Here we present, for the first time, a video of setup and surgical technique of robotic pancreatoduodenectomy in a child.

Peri-operative blood transfusion and operative time are quality indicators for pancreatoduodenectomy

Background

Minimization of blood loss during pancreatoduodenectomy requires careful surgical technique and specific preventative measures. Therefore, red blood cell (RBC) transfusions and operative time are potential surgical quality indicators. The aim of the present study was to compare peri-operative RBC transfusion and operative time with 30-day morbidity/mortality after pancreatoduodenectomy.

Methods

All pancreatoduodenectomies (2005 to 2008) were identified using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). RBC transfusions and operative time were correlated with 30-day morbidity/mortality.

Results

Pancreatoduodenectomy was completed in 4817 patients. RBC transfusions were given to 1559 (32%) patients (1–35 units). Overall morbidity and mortality rates were 37% and 3.0%, respectively. Overall 30-day morbidity increased in a stepwise manner with the number of RBC transfusions (R =0.69, P < 0.01). Although RBC transfusions and operative times were not statistically linked (P =0.87), longer operative times were linearly associated with increased 30-day morbidity (R =0.79, P < 0.001) and mortality (R =0.65, P < 0.01). Patients who were not transfused also displayed less morbidity (33%) and mortality (1.9%) (P < 0.05).

Discussion

Peri-operative RBC transfusion after pancreatoduodenectomy is linearly associated with 30-day morbidity. Longer operative time also correlates with increased morbidity and mortality. Therefore, blood transfusions and prolonged operative time should be considered quality indicators for pancreatoduodenectomy.     

Leiomyosarcoma of the superior mesenteric vein: a diagnostic and therapeutic challenge

We report here a case of a very rare entity, a leiomyosarcoma of the mesentericoportal trunk, which was initially misdiagnosed as an unresectable pancreatic cancer invading the mesenteric vein, and which was finally treated by pancreatectomy with mesentericoportal reconstruction. The pitfalls of diagnosis and modalities of resection are discussed.