ObjectiveTo summarize the research progress of correlation between pancreatic cancer and diabetes mellitus.MethodsRecent studies on the association between pancreatic cancer and diabetes mellitus were extensively reviewed, and relevant research results on the association between pancreatic cancer and diabetes mellitus were reviewed.ResultsPancreatic cancer had a particular association with diabetes. Patients with pancreatic cancer may develop new diabetes or worsen existing diabetes mellitus. About 50% of patients with pancreatic cancer had diabetes mellitus before diagnosis, suggesting a “dual causal relationship” between pancreatic cancer and diabetes mellitus. Long-term type 2 diabetes mellitus (T2DM) was one of the high risk factors for the occurrence and development of pancreatic cancer. T2DM may also increase the risk of pancreatic cancer due to hyperinsulinemia, adipokine, and other factors. Pancreatic cancer was one of the cause of diabetes mellitus at the same time, but its mechanism was not yet known, also needed to get a lot of information to understand the impact of long-term diabetes mellitus on the development of pancreatic cancer, as well as the reason of pancreatic cancer related to diabetes mellitus mechanism.ConclusionThe clear relationship between pancreatic cancer and diabetes mellitus has not been proved, and further research is needed to clarify the relationship between them.
Objective To discuss the methods of producing experimental models of chronic pancreatitis and their individual properties. Methods The recent literatures about experimental models of chronic pancreatitis were reviewed and analyzed. Methods of producing experimental models and their individual properties were summarized, and best models suitable for varied chronic pancreatitis were afforded. Results Diet, ligation of pancreatic duct, caerulein, dibutyltin dichloride (DBTC), arterial ligation, injecting microspheres into artery, and injection of pancreatic duct could induce different experimental models of chronic pancreatitis. Spontaneous chronic pancreatitis was induced by diet, chronic obstructive pancreatitis produced by ligation and injection of pancreatic duct, chronic relapsing pancreatitis evoked by caerulein, and chronic active pancreatitis made by arterial ligation and injecting microspheres into artery.Conclusion Different methods could induce models of chronic pancreatitis, which had their individual properties.
ObjectiveTo summarize of clinical application and progress of duodenum-preserving pancreatic head resection (DPPHR).MethodThe relevant literatures published recently at domestic and abroad about the clinical application and progress of DPPHR were collected and reviewed.ResultsFor the benign lesions, low-grade malignancies and borderline tumors of the head of pancreas, the DPPHR could achieve the same expected therapeutic effect as the classical pancreatoduodenectomy. The DPPHR could reserve the continuity of stomach and duodenum while resecting lesions and improve the symptoms of patients, reduce the reconstruction of digestive tract and the resection of pancreas and surrounding tissues as much as possible, and retain the pancreas-intestinal axis, which was more in line with the physiology of human beings.ConclusionsAt present, DPPHR is worthy of further development and promotion in department of pancreas surgery, but current studies only focus on occurrence of short-term complications after operation. Because patients with benign diseases of pancreatic head have better prognosis and longer survival time after operation, we should pay attention to the long-term complications such as diarrhea, anemia and reflux cholangitis. More clinical studies need in future to be demonstrated superiority of DPPHR in clinical efficacy and to evaluate occurrence of long-term complications and their impact on quality of life of patients with DPPHR by comprehensive analysis of multiple evaluation indicators.
Objective To investigate the main characteristics of intro-abdominal microbial infection and the risk factors for it after pancreaticoduodenectomy. Methods Clinical data of 200 patients underwent pancreaticoduodenectomy at the First Affiliated Hospital of Xinjiang Medical University from Sep. 2008 to Sep. 2013 were reviewed retrospectively to investigate the main characteristics of abdominal microbial infection after pancreaticoduodenectomy and risk factors for it. Results Of the 200 patients, cultures of drainage fluids were positive in 78 patients, and 42 of them(21.0%) met the diagnosis of intra-abdominal infection criterion. One hundred and eighty-five pathogenic strains were isolated totally, 64 strains of them(34.6%) were Gram positive cocci, 103 strains(55.7%) were Gram negative bacilli, and 18 strains (9.7%) were fungus. The top 5 kinds of bacteria in order were Staphylococcus aureus(31 strains), Pseudomonas aemginosa(28 strains), Escherichia co1i(22 strains), Klebsiella pneumoniae(18 strains), and Enterococcus faecium (14 strains). Most of the pathogens were resistant to broad-spectrum antibiotics. The resistance rate of Pseudomonas aeruginosa was 60.7%(17/28) to imipenem. Extended spectrum beta lactamases(ESBLs)-producing strains accounted for 22.7%(5/22) and 33.3%(6/18) in Escherichia coli and Klebsiella pneumoniae respectively. The detection rate of methicillin resistant staphylococcus aureus(MRSA) was 45.2%(14/31) in Staphylococcus aureus. Multivariate logistic regression analysis results showed that status of pancreatic fistula and pulmonary infection were the risk factors for intraabdominal infection, patients with high grade of pancreatic fistula(OR=16.252, P=0.003) and with pulmonary infection (OR=2.855, P=0.017) had higher incidence of intra-abdominal infection. Conclusion Gram negative bacilli is the main pathogenic bacteria of abdominal drainage fluids cultivation of microbiology after pancreaticoduodenectomy. Most of them have multi-drug resistance characteristic. Positive prevention and treatment of pancreatic fistula and pulmonary infection can reduce the incidence of intra-abdominal infection.
ObjectiveTo investigate the guiding value of preoperative imaging and intraoperative rapid pathology in the diagnosis and treatment of pancreatic cystic neoplasm (PCN).MethodsThe clinical data of 205 patients with PCN diagnosed by pathology from July 14, 2003 to July 31, 2018 were analyzed retrospectively. The precise and fuzzy diagnostic rate and misdiagnosis rate of PCN by preoperative imaging and intraoperative rapid pathology were analyzed.ResultsThe most commonly used preoperative imaging methods were ultrasound and CT, in 146 cases (82.95%) and 141 cases (80.11%), respectively. There were 54 cases (30.68%) with MRI. Of them, 47 cases were examined by single examination, 129 cases received combined examination, of which 123 cases (95.35%) were examined by ultrasound combined with CT. The precise and fuzzy diagnostic rate of PCN by ultrasound, CT, and MRI were 81.51% (119/146), 81.56% (115/141), and 87.04% (47/54), respectively. Comparison of ultrasound with CT and MRI showed statistical significance (χ2=47.747, P<0.001; χ2=11.873, P=0.018), but no significant difference was observed between CT and MRI (χ2=5.012, P>0.05). In 27 cases of false diagnosis by ultrasound, no obvious abnormality was found in 14 cases (51.85%), followed by misdiagnosis as pancreatic pseudocyst (11 cases, 40.74%). Of the 26 cases misdiagnosed as pancreatic cancer by CT, 57.69% (15 cases) were misdiagnosed as pancreatic cancer; 7 cases were misdiagnosed by MRI, 42.86% (3 cases) of patients were misdiagnosed as pancreatic cancer and pancreatic pseudocyst. Thirty-one cases were misdiagnosed by intraoperative rapid pathology, and most of them misdiagnosed as pancreatic pseudocyst (10 cases, 32.26%). The next was SPN misdiagnosed as pancreatic neuroendocrine tumor (7 cases, 22.58%). The precise and fuzzy diagnostic rates of PCN were 81.58% (124/152), 86.84% (132/152), and 97.37% (148/152) in preoperative imaging, intraoperative rapid pathology, and preoperative imaging combined with intraoperative rapid pathology, while the misdiagnostic rates were 18.42% (28/152), 13.16% (20/152), and 2.63% (4/152), respectively.ConclusionsIn preoperative imaging and intraoperative rapid pathological examination, it is possible that ultrasound could not find PCN lesions. CT and MRI are most likely to be misdiagnosed as pancreatic cancer. Intraoperative rapid pathological examination misdiagnosed as pancreatic pseudocyst is most common. Perfect preoperative imaging and rapid intraoperative pathology can improve the correct diagnosis rate of PCN and avoid unreasonable surgical intervention measures.
ObjectiveTo evaluate the predictive value of C-reactive protein/albumin ratio (CAR) for postoperative complications of pancreaticoduodenectomy (PD).MethodsThe clinical data of 134 patients with pancreaticoduodenectomy (PD) in the Department of Pancreatic Surgery of The First Affiliated Hospital of Xinjiang Medical University from 2015 to 2018 were retrospectively collected, including general conditions and postoperative complications. The predictive value of CAR was calculated.ResultsOf the 134 patients, 38 patients suffered from postoperative pancreatic fistula (POPF), 32 patients suffered from abdominal infection, 5 patients suffered from biliary fistula, 63 patients suffered from delayed gastric emptying (DGE), 13 patients suffered from post pancreatectomy hemorrhage (PPH), 8 patients suffered from wound infection, and 1 patient suffered from chyle leakage. There was no significant difference in general conditions such as gender, age, BMI, American Society of Anesthesiologists (ASA) score, tumor nature, tumor diameter, operative time, intraoperative blood loss, diabetes history, jaundice history, and drinking history (P>0.05), but the hospital stay in the complication group was longer than that of the non-complication group (P<0.05). The value of CAR in the pancreatic fistula and abdominal infection group were significantly higher than those in the non-complication group at 1 d, 3 d and 5 d (exclude 1 day after surgery on POPF), the difference was statistically significant (P<0.05). On the 3rd day after surgery, the sensitivity of CAR predicting POPF was 79.95%, the specificity was 86.46%; the sensitivity of predicting abdominal infection was 75.00%, the specificity was 81.37%, and the result was better than using procalcitonin (PCT) alone, but similar with C-reactive protein (CRP) alone or CRP+PCT.ConclusionPostoperative CAR can better predict POPF and abdominal infection after PD, and the effect is better than PCT alone.
ObjectiveTo investigate the age of patients can be the independence factor to affect the feasibility of pancreaticoduodenectomy. MethodsThe cases in the First Affiliated Hospital, Xinjiang Medical University from Feb. 2011 to Feb. 2015 were retrospectively analyzed, and divided into six groups according to age < 50, 50≤age < 60, 60≤age < 70, 70≤age < 75, 70≤age < 80, and≥80 years old. The complications, hospitalization days, and mortality rates for six groups were analyzed. ResultsThe differences in ASA classification (P < 0.001), hypertension (P < 0.001), coronary heart disease (P=0.001), diabetes mellitus (P < 0.001), heart failure (P=0.001), respiratory failure (P=0.037), postoperative hospitalization days (P=0.014), and delayed gastric emptying grade C (P=0.006) had statistical significance, and pancreatic fistula (P=0.058), postoperative bleeding (P=0.786), and mortality (P=0.125) of the different age groups had no significant difference. ConclusionAge is not the independent risk factor to affect the feasibility of pancreaticoduodenectomy, but the strictly preoperative comorbidities assessment is necessary.
Objective To summarize the experience of single center for radical antegrade modular pancreatosplenectomy (RAMPS) in the treatment of pancreatic body and tail cancer. Methods The clinical data of 52 patients with pancreatic body and tail cancer who underwent RAMPS surgery in the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2016 were retrospectively analyzed. Results All operations of the 52 patients were successfully completed, with no death during hospitalization and 30 days after surgery. The operative time was (463±137) min (198–830 min), the median of intraoperative blood loss was 400 mL (100–2 800 mL), of which 19 cases (36.5%) received intraoperative blood transfusion. The median of hospital stay was 19.5 days (7–58 days). After operation, 18 patients suffered from pancreatic fistula, 5 patients suffered from delay gastric emptying, 7 patients suffered from peritoneal effusion, 3 patients suffered from pleural effusion, 4 patients suffered from abdominal infection, 2 patients suffered from abdominal bleeding. Reoperations were performed in 2 patients. There were 51 patients were followed up for 3–35 months (the median of 18 months) with the median survival time were 16.2 months. During the follow-up period, 21 patients suffered from recurrence or metastasis, of which 8 patients died. The results of Cox partial hazard model showed that, surgical margin ［RR=3.65, 95% CI was (0.06, 5.11), P=0.026］ and adjuvant therapy ［RR=6.43, 95% CI was (1.51, 27.43), P=0.012］ were statistically related with prognosis, the prognosis of patients with negative surgical margin and underwent adjuvant therapy were better than those patients with positive surgical margin and didn’t underwent adjuvant therapy. Conclusions RAMPS is safe and feasible in the treatment of pancreatic body and tail cancer, and it may improve the R0 resection rate. RAMPS combins with adjuvant therapy can contribute to better prognosis.