ObjectiveTo summarize recent research advancement on radically surgical therapy of carcinoma of the body and tail of pancreas． MethodsRelevant literatures about radically surgical therapy of carcinoma of the body and tail of pancreas were collected and reviewed． ResultsRecent experimental researches indicated that distal pancreatectomy was the common used surgical way to treat carcinoma of the body and tail of pancreas. Besides， spleenpreserving distal pancreatectomy, distal pancreatectomy with en bloc celiac axis resection, and laparoscopic distal pancreatectomy were also the choices to the treatment of carcinoma of the body and tail of pancreas. ConclusionThe surgical way to treat carcinoma of the body and tail of pancreas has advanced for these years, but furthermore development requires more great efforts.
ObjectiveTo investigate the feasibility and safety of spleen-preserving distal pancreatectomy (SpDP), and to discuss the indications and techniques of SpDP. MethodsThe clinical data of seven patients underwent SpDP between January 2004 and December 2007 in Xinhua Hospital were analyzed retrospectively. ResultsOut of the seven cases, one case received the SpDP combined with partial splenic vessel resection, while the other cases received the SpDP with splenic vessel preservation. The operation time was (2.93±0.38) h and the intraoperative blood loss was (392.86±109.65) ml. Only one case suffered from pancreatic fistula, who finally recovered after medicine therapy and percutaneous drainage. There was no other complication or operative mortality. The postoperative platelet count was (273±43.76)×109/L and the postoperative hospital stay was (17.86±8.07) d. For six cases of patients, no recurrence and metastasis was found after the followup (49.2±14.4) months （30-72 months）. ConclusionSpDP is a safe and feasible procedure, which is worthy for selected cases such as benign neoplasm of the body and tail of the pancreas.
Four techniques in Whipple operation improved by the anthor in this article are as follow: ①the jejunum was pulled up to the area above transverse colon through the duodenal canal behide intestinal mesenteric radix. ②As Hofmeister’s method, the duodenojejunostomy or gastrojejunostomy was made through mesentery of transverse colon. ③The internal drainage tube inserted into the pancreatic duct was extended to about 25 to 30 cm. ④A silicon tube for feeding about 3 mm diameter was placed into distal jejudum through anterior wall of gastric antrum, pylorus and duodenojejunal anastomosis. The techniques and their advantages are elaborated in this paper.
Objective To study the clinical significance of central pancreatectomy in treatment of benign tumor of neck and body of pancreas. Methods The clinical data of 29 patients with benign tumor of pancreas were reviewed retrospectively in our hospital during the past 5 years. Results There was no perioperative death. Mean of operative time was （165±45） min （125-270min）， mean of blood loss was （173±88） mL （50-450mL）. The pathological diagnosis of all the patients were benign. Pancreatic fistula occurred in 10 patients. One patient with bleeding after operation was treated with another two operations. Twenty-one patients were followed-up with the time ranged from 3 months to 4 years （average 16 months）. There were no complications related to diabetes. Conclusion Central pancreatectomy is reasonable for patients with benign tumor of pancreas， it could well preserve the endocrine and exocrine function of pancreas， and improve the quality of life of patients.
Objective To summarize the experiences of middle pancreatectomy. Methods Eleven female and 4 male with a mean age of 49.4 years (23.8-73.1 years) who underwent middle pancreatectomy from January 2001 to October 2005 were collected. Eight patients with neuroendocrine tumor (non-function of 5 cases), 5 with serous cystadenomas and 2 with mucinous cystadenomas were included. The proximal apical end of pancreas was sutured, while distal end of pancreas was anastomosed to a Roux-en-Y jejunal loop. Results Mean operative time was 275 min (179-370 min), mean length of resected pancreas was 45 mm (30-60 mm) and max diameter of tumor was 23 mm (15-40 mm). Complication after operation was pancreatic fistula 〔4 cases (26.7%)〕, in which 3 cases (20.0%) had intraabdominal blood. The mean time of follow-up was 23 months (3 months-5 years). one patient was died of multiple organs failure for pulmonary infections in month 3 after operation, and the others were alive without novo-diabetes. Conclusion Middle pancreatectomy is an effective operation for benign and borderline tumors of neck and body of pancreas without a significant increase of postoperative morbidity.
ObjectiveTo explore the security and advantages of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for occupancy lesions in pancreatic body and tail. MethodsA total of 97 patients with occupancy lesions in pancreatic body and tail who underwent laparoscopic distal pancreatectomy in our hospital from June 2010 to August 2014 were collected retrospectively, and were divided into LSPDP group (n=60) and laparoscopic distal pancreatectomy with splenectomy (LDPS) group (n=37) according to the surgery, clinical effect was compared between the 2 groups. ResultsThe operations got well in all patients, no one died during perioperative period. The operation time was shorter in LSPDP group than that of LDPS group[(190.83±66.39) min vs. (224.46±83.23) min, P=0.030], but there was no significant difference between LSPDP group and LDPS group in the blood loss[45.35 mL vs. 54.92 mL], hospital stay[(8.38±4.06) d vs. (9.76±4.54) d], incidence of total postoperative complication[23.33% (14/60) vs. 13.51% (5/37)], and degree of postoperative complication (P>0.050). There were 86 patients were followed up for 3-54 months, with the median time of 18 months. For patients with tumor, no one suffered from recurrence, metastasis, and death during the follow-up period, and other patients with benign diseases had an excellent prognosis. ConclusionFor occupancy lesions in pancreatic body and tail, LSPDP is feasible and safe.
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 risk factors of postoperative anxiety in patients with pancreatic cancer undergoing total pancreatectomy. Methods A total of 31 patients who underwent total pancreatectomy for pancreatic cancer between July 2011 and December 2016 were collected and analyzed in this retrospective study. The patients’ postoperative Self-Rating Anxiety Scale scores were collected, and the exposure factors were analyzed to identify the risk factors of postoperative anxiety through univariate analysis and multiple logistic regression analysis by SPSS 21.0 statistical software. Results In the 31 patients, there were 17 males and 14 females, with an average age of (66.16±9.09) years, an average body mass index of (21.11±3.10) kg/m2, and an average postoperative hospital stay of (14.58±7.47) days. There were 23 patients (74.2%) with postoperative anxiety, and 30 patients (96.8%) with hyperglycosemia required insulin therapy. The total perioperative mortality was 3.2%. In the univariate analysis, age (P=0.012), smoking history (P=0.043), preoperative diabetes mellitus (P=0.012), postoperative bile leakage (P=0.043), and postoperative abdominal infection (P=0.026) were related factors of the postoperative anxiety. In the multiple logistic regression analysis, patients without preoperative diabetes was an independent risk factor of postoperative anxiety (P=0.013). Conclusions For patients undergoing total pancreatectomy, it is needed to pay attention to the patients’ postoperative psychological conditions and assess the postoperative anxiety, especially for those without preoperative diabetes. To improve the life quality and long-term survival of these patients, health education and psychological intervention are needed.
Objective To evaluate feasibility and clinical application value of laparoscopic spleen-preserving distal pancreatectomy (LSPDP). Method The clinical data of 17 patients underwent LSPDP from January 2015 to June 2017 in this hospital were retrospectively analyzed. Results The LSPDP was successfully completed in the 17 cases, with Kimura procedure and Warshaw procedure were performed in the 12 cases and 5 cases, respectively. The operative time was (218±60) min, the intraoperative blood loss was (136±114) mL, the time to get out of bed after surgery was (1.4±0.6) d, the postoperative fasting time was (2.0±0.8) d, and the postoperative hospital stay was (13.4±5.7) d. The rate of the postoperative pancreatic fistula was 17.6% (3/17). The spleen infarction occurred in the 2 cases following the Warshaw procedure. The pathologic examination showed that there were 2 patients with the serous cystadenoma, 7 patients with the mucinous cystadenoma, 3 patients with the solid pseudo-papillary tumor, 3 patients with the intraductal papillary mucinous cystadenoma neoplasm, and 2 patients with the insulinoma. All the patients were followed-up for 5 to 26 months (average 13 months), and the perigastric varice occurred in 1 patient, no recurrence or spleen infarction occurred during the following-up. Conclusion LSPDP is a safe, feasible and effective method with less injury and rapid recovery.
Objective To analyze the risk factors of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) and to explore the effective index of predicting POPF after DP. Methods The clinical data of 120 patients with pancreatic disease who were treated with DP in the Department of Tumor Surgery of Xuzhou Medical University from January 2010 to November 2017 were analyzed retrospectively. The influencing factors of POPF after DP were analyzed by non-conditional logistic regression. Results Of the 120 patients, 15 patients (12.5%) had clinically significant POPF, including 13 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula. The results of non-conditional logistic regression showed that, the soft pancreas and preoperative pancreatic CT value of the pancreas less than 40 Hu were the independent risk factors of POPF after DP (P<0.05). Conclusions Pancreatic texture and preoperative CT value are important factors influencing the occurrence of POPF after DP. Evaluating the preoperative CT value and intraoperative pancreatic texture can effectively predict the risk of POPF after DP.