Objective To evaluate the operative indication and results of pancreaticogastrostomy following pancreaticoduodenectomy. Methods A retrospective study was carried out on the cases of pancreaticoduodenectomy following pancreaticogastrostomy from Aug. 2005 to Feb. 2008 in Shanghai Tongji Hospital. Results During this period, 38 cases had undergone pancreaticogastrostomy with pancreaticoduodenectomy. The median operative time was (352.1±78.3) min. The median intraoperative blood transfusion was (911.3±601.4) ml. The median postoperative length of stay was (26.2±12.1) d. Postoperative morbidity was 21.1% (8/38) with no operative death. Pancreatic anastomotic leakage occurred in 1 patient. Delayed gastric emptying occurred in 2 patients. Incision infection occurred in 2 patients. Abdominal fluid collection occurred in 1 patient and pulmonary infection occurred in 2 patients. All of the complications were treated conservatively. Conclusion Pancreaticogastrostomy is a safer drainage procedure for the pancreatic stump after pancreaticoduodenectomy.
【Abstract】 Objective To investigate the preoperative and intraoperative evaluation and the operative methods of pancreaticoduodenectomy combined with resection of involved blood vessel. Methods The materials of 226 cases of carcinoma of head of pancreas, which were collected from January 2002 to June 2005, were assessed according to the T-grade evaluative method and were summarized into a more accurate method of preoperative and intraoperative evaluation and an operative method of the pancreaticoduodenectomy combined with vascular resection. The statistical analyses were performed by SAS 6.12 Stat software package with χ2 test for categorical data. Results The coincidence of every preoperative evaluations on pancreaticoduodenectomy with T-grade method were more than 85.00% and the accurate rate of evaluation on relationship between tumor and blood vessel was 80.97%. As the degree of T-grade increased, the proportion of requiring pancreaticoduodenectomy combined with vascular resection increased significantly as well (P＜0.001). All operations were smoothly done and the reconstruction of removed vascular took 12 to 46 minutes. The complication rate and the mortality rate of perioperative period were 19.61% and 1.96%, respectively. Conclusion With more practice, experience and the advanced imaging technology, it is possible for professional surgeon to evaluate more accurately on the pancreaticoduodenectomy combined with vascular resection by using the preoperative T-grade method. T-grade evaluative method is useful for operator to assess the indication accurately and to design the operative schedule reasonably. Accurate operational evaluation and careful operation are also important for pancreatoduodenectomy combined vascular resection.