ObjectiveTo analyze risk factors of intraoperative massive hemorrhage in patients with pancreatitis-induced sinistral portal hypertension (SPH) and to explore its strategies of treatment.MethodsThe clinical data of patients with pancreatitis-induced SPH admitted to the West China Hospital of Sichuan University from January 2015 to March 2018 were retrospectively analyzed. The intraoperative massive hemorrhage was defined as the blood loss exceeding 30% blood volume. The factors closely associated with the intraoperative massive hemorrhage were analyzed by the forward logistic regression model.ResultsA total of 128 patients with pancreatitis-induced SPH were enrolled in this study, including 104 males and 24 females, with an average age of 47 years old and a median intraoperative bleeding volume of 482 mL. Among them, 93 patients with pancreatitis-induced SPH caused by the pancreatic pseudocyst after acute pancreatitis and 35 caused by the chronic pancreatitis. There were 36 patients with history of upper gastrointestinal bleeding and 46 patients with hypersplenism. Thirty-six patients suffered from the massive hemorrhage. Among them, 30 patients underwent the distal pancreatectomy concomitant with splenectomy, 1 patient underwent the duodenum- preserving resection of pancreatic head, and 5 patients underwent the pseudocyst drainage. The univariate analysis showed that the occurrence of intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH was not associated with the gender, age, body mass index, albumin level, upper gastrointestinal bleeding, hypersplenism, type of pancreatitis, course of pancreatitis, number of attacks of pancreatitis, size of spleen, maximum diameter of lesions in the splenic vein obstruction site, or number of operation (P>0.05), which was associated with the diameter of varicose vein more than 5.0 mm (χ2=19.83, P<0.01), the intraperitoneal varices regions (χ2=13.67, P<0.01), the location of splenic vein obstruction (χ2=5.17, P=0.03), the operation time (t=–3.10, P<0.01), or the splenectomy (χ2=17.46, P<0.01). Further the logistic regression analysis showed that the varicose vein diameter more than 5.0 mm (OR=6.356, P=0.002) and splenectomy (OR=4.297, P=0.005) were the independent risk factors for the intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH.ConclusionsSplenectomy and having a collateral vein more than 5.0 mm in diameter are independent risk factors for intraoperative massive blood loss in surgeries taken on patients with pancreatitis-induced SPH. Attention should be paid to dilation of gastric varices and choice of splenectomy.
ObjectiveTo summarize the diagnosis and treatment process of a patient who underwent laparoscopic local excision of duodenal papillary tumor, and to explore the safety and feasibility of this surgery. MethodThe clinicopathologic characteristics and surgical procedure of the patient with duodenal papillary neuroendocrine tumor admitted to the West China Hospital of Sichuan University in June 2021 were retrospectively analyzed. ResultsThe patient underwent the laparoscopic local excision of duodenal papillary tumor + in situ cholangiojejunostomy and pancreaticojejunostomy. The operation lasted about 3 hours, the blood loss was about 20 mL, and the patient exhausted on the 3rd day after the operation. On the 7th postoperative day, the gastric tube was pulled out and oral feeding was started. On the 8th day, the plasma drainage tube was pulled out and the patient was discharged smoothly. There was no duodenal fistula, bleeding, wound infection, and other complications. After 6 months of follow-up, the general condition of this patient was good, and no tumor recurrence or metastasis was found. ConclusionLaparoscopic local excision is an appropriate option for benign or low-grade malignancies involving the duodenal papillary tumor.