The effect of preoperative percutaneous transhepatic biliary drainage on postoperative short-term outcomes after pancreaticoduodenectomy / 中华肝胆外科杂志

ObjectiveTo evaluate the effect of preoperative percutaneous transhepatic biliary drainage (PTBD) on postoperative outcomes after pancreaticoduodenectomy.MethodsThe clinical data of 115 patients undergoing pancreatoduodenectomy between 2001 and 2009 were retrospectively analyzed.The diagnosis of periampullary cancer or cancer of the pancreatic head was confirmed histologically.The preoperative total bilirubin level was more than 100 μmol/L and there was no concomitant cholangitis.Forty-two patients underwent PTBD (PTBD group),and 73 were not drained (early operation group).The following parameters were analyzed:wound infection,intra-abdominal abscess,intra-abdominal or gastrointestinal bleeding,biliary or pancreatic leakage,gastroparesis,morbidity and mortality.The length of hospital stay and cost were also assessed.ResultsThe perioperative mortality and morbidity were 2.38％/54.76％ in the PTBD group and 2.74％/50.68％ in the early operative group,respectively.There were no significantly differences between these two groups.Similar results were obtained in biliary leak,pancreatic leak,intra-abdominal infection,wound infection and gastroparesis.The length of hospital stay and cost were significantly less in the early operation group than the PTBD group.ConclusionsPTBD had no beneficial effects on postoperative outcomes following pancreaticoduodenectomy.For distal biliary obstruction,PTBD should not be carried out routinely.

Effects of transcatheter arterial chemoembolization in combination with portal vein chemotherapy on survival of patients after resection of hepatocellular carcinoma / 中华肝胆外科杂志

Objective To study the value of transcatheter arterial chemoembolization (TACE)in combination with portal vein chemotherapy (PVC) after resection of hepatocellular carcinoma to prolong survival. Methods From January 2000 to July 2007, 168 patients with hepatocellular carcinoma (HCC) underwent tumor resection in our hospital. After operation, TACE in combination with PVC was performed in 48 patients (combined group), TACE alone in 26 (TACE group), PVC alone in 50 (PVC group) and none of the above in 44 (control group). All the patients were followed up for 17-96 months. The 1-, 3-and 5-year survival rates were compared among the 4 groups. Results Accumulative 1-, 3-and 5-year survival rates were higher in the combined and TACE groups than in PVC and control groups. Conclusion After resection of HCC, combined use of TACE and PVC is the same as TACE in prolonging patient survival. However, it is better than PVC alone and non-surgical procedure.