ObjectiveTo investigate predictive value of amylase level in intraperitoneal drainage fluid after pancreaticoduodenectomy (PD) for grade B and C pancreatic fistula (PF).MethodThe clinical data of 106 patients underwent PD in the First Affiliated Hospital of Xinjiang Medical University from June 2014 to June 2018 were retrospectively analyzed.ResultsTwenty-four cases (22.6%) had the PF after the PD, in which of 18 cases of grade A, 4 cases of grade B, and 2 cases of grade C. The age, tumor diameter, pancreatic texture, and main pancreatic duct diameter were associated with the PF after the PD by the univariate analysis (P<0.050), the main pancreatic duct diameter (OR=4.856, P=0.004) was its independent risk factor. The amylase levels of intraperitoneal drainage fluid on day 5, 7, and 10 after the PD could better predict the occurrence of PF (AUC was 0.910, 0.951, 0.948, respectively), especially which on day 10 after the PD could better predict the occurrence of grade B and C PF (AUC was 0.938).ConclusionElevated amylase levels in peritoneal drainage fluid on day 5, 7, and 10 after PD have better diagnostic effects on PF, especially which on day 10 after PD has a better diagnostic effect on grade B and C PF.
ObjectiveTo investigate the factors that affect the occurrence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP).MethodsThe clinical data of 114 patients underwent DP who were performed in the First Affiliated Hospital of Xinjiang Medical University from Jan. 2014 to Jun. 2019, were retrospectively analyzed.ResultsIn this group of 114 patients, 43 cases (37.7%) of POPF occurred after DP, including 19 cases of grade A (biochemical fistula), 21 cases of grade B, and 3 cases of grade C. The univariate analysis results showed that: BMI value, drinking history, preoperative plasma albumin level, postoperative plasma albumin level, postoperative neutrophil/lymphocyte ratio (NLR), preoperative and postoperative prognostic nutrition index (PNI) levels were significant different between the POPF group and non-POPF group (P<0.05). Multivariate analysis results showed that: preoperative plasma albumin>35 g/L [OR=0.115, 95%CI was (0.038, 0.348)], postoperative plasma albumin>35 g/L [OR=0.126, 95%CI was (0.031, 0.516)], and postoperative NLR value≤6.65 [OR=0.149, 95%CI was (0.048, 0.461)] were the influencing factors of POPF after DP. The area under curve of postoperative NLR was 0.731 [95%CI was (0.639, 0.824)]. ConclusionPreoperative and postoperative plasma albumin>35 g/L, as well as postoperative NLR ≤6.65 are protective factors for POPF after DP, and postoperative NLR can be used as a predictor of POPF.
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 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.
ObjectiveTo analyze the risk factors for delayed gastric emptying (DGE) after pancreaticoduodenec-tomy (PD). MethodsClinical data of 67 patients who underwent PD in our hospital from September 2012 to June 2014 were retrospectively analyzed. ResultsTwenty-two patients were complicated with DGE of the 67 patients (32.8%) after PD operation. Univariate analysis showed that, diabetes mellitus, the anastomosis methods for stomach and jejunum, and diameter of circular stapler were risk factors for postoperative DGE, the patients who complicated with diabetes mellitus, treated with the traditional Child plus Braun anastomosis method, and treated with 25 mm circular stapler had higher incidence of DGE than patients who didn't complicate with diabetes mellitus, treated with Roux-en-Y anastomosis method, and treated with 28 mm circular stapler (P<0.05). Logistic regression identified 2 variables as independent risk factors which were associated with postoperative DGE, namely, anastomosis methods for stomach and jejunum (OR=0.062,95% CI:0.009-0.407,P=0.004) and diameter of circular stapler (OR=0.135,95% CI:0.034-0.538,P=0.005). The patients who treated with traditional Child plus Braun anastomosis method and 25 mm circular stapler had higher incidence of DGE. ConclusionsThe incidence of DGE after PD is still high. The incidence of DGE could be reduced by using Roux-en-Y method to reconstruct digestive tract and 28 mm circular stapler during PD operation.