Four techniques in Whipple operation improved by the anthor in this article are as follow: ①the jejunum was pulled up to the area above transverse colon through the duodenal canal behide intestinal mesenteric radix. ②As Hofmeister’s method, the duodenojejunostomy or gastrojejunostomy was made through mesentery of transverse colon. ③The internal drainage tube inserted into the pancreatic duct was extended to about 25 to 30 cm. ④A silicon tube for feeding about 3 mm diameter was placed into distal jejudum through anterior wall of gastric antrum, pylorus and duodenojejunal anastomosis. The techniques and their advantages are elaborated in this paper.
目的 探讨胰十二指肠切除术后胰瘘引起腹腔大出血行外科治疗的可行性。方法 在343例行胰十二指肠切除术的患者中，2例术后发生严重的胰瘘伴有腹腔大出血，均再次手术行胰肠分离式桥式内引流术。结果 经术后支持治疗、持续腹腔冲洗、抑制胰酶分泌，治疗成功，顺利出院。术后随访18个月，没有胰管梗阻和脱落的迹象。患者没有发生糖尿病。结论 胰十二指肠切除术后胰瘘导致的腹腔大出血治疗非常困难，通过外科再手术行胰肠分离式桥式内引流术，取得成功，避免了复杂的全胰切除，挽救了胰腺功能，提高了患者的成功救治机会，改善了患者术后的生活质量。
Objective To summarize the experiences of middle pancreatectomy. Methods Eleven female and 4 male with a mean age of 49.4 years (23.8-73.1 years) who underwent middle pancreatectomy from January 2001 to October 2005 were collected. Eight patients with neuroendocrine tumor (non-function of 5 cases), 5 with serous cystadenomas and 2 with mucinous cystadenomas were included. The proximal apical end of pancreas was sutured, while distal end of pancreas was anastomosed to a Roux-en-Y jejunal loop. Results Mean operative time was 275 min (179-370 min), mean length of resected pancreas was 45 mm (30-60 mm) and max diameter of tumor was 23 mm (15-40 mm). Complication after operation was pancreatic fistula 〔4 cases (26.7%)〕, in which 3 cases (20.0%) had intraabdominal blood. The mean time of follow-up was 23 months (3 months-5 years). one patient was died of multiple organs failure for pulmonary infections in month 3 after operation, and the others were alive without novo-diabetes. Conclusion Middle pancreatectomy is an effective operation for benign and borderline tumors of neck and body of pancreas without a significant increase of postoperative morbidity.
Objective To assess the anal sphincteric function after intersphincteric resection for low rectal cancer by vectorial manometry. Methods Maximal anal pressure, vector volume, vector symmetric index and rectal anal inhibitory reflex were assessed in 16 patients underwent intersphincteric resection for low rectal cancer from 1999 to 2006. Thirty patients with low anterior resection for rectal cancer and another 30 healthy individuals were selected as control. Results The patients in intersphincteric resection group were subdivided into soiling group and defecation function good group. Maximal pressure, vector volume and vector symmetric index of the patients in soiling group and defecation function good group were significantly lower than those of the healthy and low anterior resection controls (P＜0.001). The maximal systole pressure, systole vector volume and vector symmetric index in soiling group were significantly lower than those in function good group (P＜0.001). The 25.0% patients in intersphincteric resection group had rectal anal inhibitory reflex， was significantly lower than that of the low anterior resection control group (93.3%, P＜0.001). Conclusion The maximal pressure and vector volume are compromised in patients underwent intersphincteric resection . The vectorial manometry can be an objective comprehensive tool for the evaluation of anal sphincter function in patients with intersphincteric resection.
目的 探讨胰十二指肠切除术中引流管的放置与术后管理的方法。方法回顾性分析88例胰十二指肠切除术后管理经验。结果 术后腹腔并发症的发生率为10.2%(9/88)，胃排空障碍发生率为3.4(3/88)%，其中保留幽门胰十二指肠切除术后胃排空障碍发生率为5.5%(3/55)。结论 胰十二指肠切除术后腹腔引流是预防术后并发症的重要方法，术中合理放置引流管，术后加强腹腔引流的管理，能减少术后并发症的发生。
Objective To research the effect of γ-radiation released from 103Pd radioactive stent on the expression of Fas gene and its relation with apoptosis of bile duct cancer cells lines. Methods The cancer cells of bile duct were dissociated into suspension in culture flasks, and the number of cells was counted by hemacytometry. The suspension was then stored in 2 ml freezing tubes in the density of 1×105/ml. They were set in two stents: general stent （general stent group） and 103Pd radioactive stent (103Pd stent group). The expression of Fas gene and apoptosis of bile duct cancer cells in general stent group and 103Pd stent group were analysed with immunohistochemistry technique and TUNEL method, respectively. Results The expression level of Fas gene in 103Pd stent group was significantly higher than that in general stent group （P＜0.05）, and the number of apoptotic cancer cells in 103Pd stent group was also significantly more than that in general stent group （P＜0.01）. Conclusion There is a correlation between the expression of Fas gene and the apoptosis of bile duct cancer cells, which means that 103Pd radioactive stent may increase the expression of Fas gene and promote the apoptosis of cancer cells. It may be helpful for the further study of treatment for bile duct cancer using 103Pd radiative stent.