ObjectiveTo assess the safety for removing nasogastric tube(NGT)within postoperative 24 h in Whipple pancreaticoduodenectomy (PD)patients. MethodsThe clinical data of 310 patients performed classic Whipple PD from January 2008 to March 2013 in this hospital were analyzed retrospectively. The patients were divided into early (≤24 h after operation)removing NGT group and late( > 24 h after operation)removing NGT group according to the time of NGT duration. The ratio of NGT reinsertion, time of solid diet tolerance, hospital stay, mortality, and major complications associated with PD were compared between two groups. Results①The demography and preoperative comorbidities characteristics were similar(P > 0.05).②There was no statistical difference of ratio of NGT reinsertion between two groups(P=0.450).③The differences of rates of major complications associated with PD and mortality were not statistically different(P > 0.05)by univariate analysis, but the rate of total complications in the early removing NGT group was significantly lower than that in the late removing NGT group (P=0.014)by multivariate analysis.④The average time of solid diet tolerance(P=0.013)and average hospital stay(P < 0.001)in the early removing NGT group were significantly shorter than those in the late removing NGT group. ConclusionFor patients comfort, NGT following PD should be removed as early as possible even immediately after extubation for selective patients.
ObjectiveTo explore risk factors for pancreatic fistula and severe pancreatic fistula (grade B and C) after distal pancreatectomy. MethodsOne hundred and fifty patients underwent distal pancreatectomy were collected and analyzed from January 2012 to December 2014 in this retrospective study,among which 61 cases were male,89 cases were female,age from 18 to 78 years old.The risk factors for pancreatic fistula and severe pancreatic fistula after distal pancreatectomy were analyzed by univariate and multivariate logistic regression analysis. ResultsIn these patients,136 cases were underwent laparotomy,8 cases were underwent total laparoscopic surgery,6 cases were underwent hand assisted laparoscopic surgery;39 cases were preserved spleen,111 cases were combined splenectomy.Technique for closure of the pancreas remnant,15 cases were used cut stapler (Echelon 60,EC60),77 cases were used cut stapler (Echelon 60,EC60) combined with manual suture,52 cases were underwent manual cut and suture,and 6 cases were underwent pancreatic stump jejunum anastomosis.The total incidence of complications was 36.0%(54/150),the postoperative hospitalization time was (9.1±6.2) d,the reoperation rate was 2.7%(4/150),the perioperative mortality was 0,the incidence of postoperative pancreatic fistula was 34.7%(grade B and C was 10.0%).In these patients with postoperative pancreatic fistula,the postoperative hospitalization time was (12.6±9.3) d,the reoperation rate was 7.7%(4/52).The results of the univariate and multivariate logistic regression analysis showed that the hypoproteinemia (OR=4.919,P<0.05) was the risk factor for pancreatic fistula after distal pancreatectomy,the malignancy (OR=4.125,P<0.05) was the risk factor for severe pancreatic fistula after distal pancreatectomy. ConclusionsIncidence of pancreatic fistula after distal pancreatectomy is related to hypoproteinemia before operation,it is needed to improve the nutritional status by nutrition treatment for reducing postoperative pancreatic fistula.If patient with malignancy has postoperative pancreatic fistula,it is likely to be severe pancreatic fistula.
Objective To explore the effect of Frey procedure on patients with chronic pancreatitis, and evaluate pain control as well as the quality of life (QOL) after Frey procedure. Methods The clinical data of 81 patients with chronic pancreatitis who underwent Frey procedure in West China Hospital of Sichuan University from January 2010 to January 2015 were retrospectively analyzed. Izbicki pain score and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) were used to assess pain and QOL respectively. Results The mean value of operative time were (252±70) minutes (180-430 minutes), the mean value of blood loss were (220±142) mL (100-550 mL), and the mean value of hospital stay were (14.1±4.9) days (8-36 days). After Frey procedure, delayed gastric emptying occurred in 4 patients, hemorrhage occurred in 1 patient, wound infection or fat liquefaction occurred in 6 patients, abdominal infection and pyoperitoneum occurred in 4 patients, and pancreatic fistula occurred in 3 patients. All of the patients were followed up for 4-60 months, and the median time were 28 months. During the follow up period, 11 patients developed diabetes and 10 patients developed steatorrhea, respectively. In addition, the pain related score, including frequency of pain attacks, visual analogue scale of pain, analgetic medication, inability to work, and total pain score, were significantly reduced after Frey procedure (P＜0.001). Moreover, all the functional scales of EORTC -QLQ-C30, except for cognitive function, were improved postoperatively (P ＜0.001). Regarding to the symptom scales, the score of fatigue, pain, loss of appetite, and loss of body weight were significantly lower after surgery (P＜0.050). The scores of QOL after surgery were higher than before surgery (P＜0.001). Conclusion Frey procedure results in good post-operative pain control and significant improvement in qol.