ObjectiveTo investigate the application of imbedding pancreaticojejunostomy in pure laparoscopic pancreaticoduodenectomy. MethodsEighty-five cases of laparoscopic pancreaticoduodenectomy in our hospital from May 2014 to December 2015 were analyzed retrospectively. According with inclusion criteria and exclusion criteria, 78 cases were investigated. They were divided into pancreatic duct-to-jejunum mucosa pancreaticojejunostomy group as controlled group (n=42) and imbedding pancreaticojejunostomy (technique of duct-to-mucosa PJ with transpancreatic interlocking mattress sutures) group as modified group (n=36). The rates of pancreatic fistula, abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, and incision infection were investigated as well as hospital stays and pancreaticojejunostomy time in two groups were compared. ResultsThe rate of pancreatic fistula especially B to C grade pancreatic fistula in the modified group was obviously lower compared with which in the controlled group (8.3% vs. 31.0%, P < 0.05), pancreaticojejunostomy time ofmodified group was significantly shortened [(35.6±12.4) min vs. (52.8±24.6) min, P < 0.05] and total operative time also shortened [(322.4±23.6) min vs. (384.2±30.2) min, P < 0.05). There were no significant difference of the rates of abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, ?incision infection, and hospital stays (P > 0.05)]. Conciusions The type of pancreaticojejunostomy has a significant impact on the rate of pancreatic fistula after laparoscopic pancreaticoduodenectomy. Imbedding pancreaticojejunostomy can decrease the rate of pancreatic fistula after operation, and shorten the pancreaticojejunostomy time and total operative time.
ObjectiveTo analyze and summarize the short-term effectiveness of total hip arthroplasty (THA) with a tapered, modular neck hip stem for developmental dysplasia of the hip (DDH). MethodsBetween October 2010 and May 2012, 28 patients (31 hips) with DDH and secondary osteoarthritis underwent THA with a tapered, modular neck hip stem. There were 2 males and 26 females, with an average age of 61 years (range, 47-77 years). The unilateral hip was involved in 25 cases and bilateral hips in 3 cases. According to the Crowe system, 22 cases were classified as Crowe type I, 8 as Crowe type Ⅱ, and 1 as Crowe type Ⅲ. At preoperation, the leg length discrepancy was (1.6±0.8) cm; the hip range of motion values were (76.1±12.8)° in flexion, (14.5±6.7)° in abduction, (9.0±4.5)° in adduction, (13.1±6.4)° in internal rotation, and (11.7±7.0)° in external rotation; and the Harris hip score was 44.7±11.1. ResultsFemoral neck fracture occurred in 2 cases (2 hips) during operation, which healed by fixed with steel wire. The incisions healed by first intention. No related complication occurred. The mean follow-up time was 20 months (range, 12-32 months). At last follow-up, the leg length discrepancy was significant decreased to (1.0±0.5) cm (t=-3.512, P=0.002). The hip range of motion values were (102.9±10.1)° in flexion, (32.9±6.0)° in abduction, (19.2±4.3)° in adduction, (34.4±4.2)° in internal rotation, and (32.3±5.1)° in external rotation, all showing significant differences when compared with preoperative values (P<0.05). The Harris hip score was significantly improved to 90.3±6.1 (t=21.263, P=0.000). The X-ray films showed no subsidence, loosening, or breakage in the other cases except 2 cases having subsidence (<2 mm) within 1 year. Heterotopic ossification occurred in 2 hips. ConclusionThe short-term effectiveness of THA with a tapered, modular neck hip stem for DDH is satisfactory. However, the medium and long-term effectiveness still need further follow-up.