ABSTRACT
Objective:To study the feasibility, safety and efficacy using transperitoneal approach guided by puncture catheter on laparoscopic treatment of infectious necrotizing pancreatitis.Methods:The clinical data of 7 patients who underwent laparoscopic treatment of infectious necrotizing pancreatitis using the transperitoneal approach at Jin Hua Jinhua Hospital of Zhe Jiang Zhejiang University from June 2018 to March 2021 were retrospectively analyzed. There were 3 males and 4 females, with age of (49.6±9.4) years old (range 32-65 years old). The general data, operation time, intraoperative blood loss and other clinical data were collected. Hepatobiliary and pancreatic CT was reviewed 1 week after the operation to study the changes in size of lesion, double cannula position and effect of necrotic tissue removal.Results:All patients were treated with percutaneous puncture and drainage under ultrasonic guidance before surgery. The course of the disease before operation was 42-58 days. All patients successfully completed surgery, and 5 patients underwent cholecystectomy. No patients required conversion to open surgery. The operation time was 140-195 min, the intraoperative blood loss was 30-100 ml, the postoperative hospital stay was 28-42 days, the postoperative time to first passed flatus was 2-4 days. Routine hepatobiliary and pancreatic CT 1 week after the operation showed that the degrees of necrosis and infection of pancreas were significantly improved and the lesion cavity was reduced compared with those before the operation. One patient suffered from abdominal hemorrhage after operation. There were no other serious complications. All patients recovered well after 6 to 12 months follow-up.Conclusion:Laparoscopic treatment of infectious necrotizing pancreatitis by using the transperitoneal approach guided by puncture catheter was safe and feasible. The treatment had the advantages of less trauma and fast recovery, and it was especially suitable for patients with biliary pancreatitis.
ABSTRACT
Objective@#To explore the clinical efficacy of S-1 single agent adjuvant chemotherapy for the patients undergoing radical resection of extrahepatic biliary carcinoma.@*Methods@#The clinical data of 108 patients with extrahepatic biliary carcinoma receiving radical resection who were admitted from January 2014 to June 2017 were retrospectively analyzed. There were 62 males(57.4%)and 46 females(42.6%),with a median age of 59 years (range:26 to 79 years),10 cases(9.3%) in stage Ⅱ,85 cases(78.7%) in stage Ⅲ, and 13 cases (12.0%) in stage Ⅳ, 40 cases(37.0%) of hilar cholangiocarcinoma, 8 cases(7.4%) of middle cholangiocarcinoma, 25 cases (23.2%) of distal cholangiocarcinoma, 35 cases(32.4%) of gallbladder carcinoma.After radical resection of extrahepatic biliary carcinoma, 49 patients receiving S-1 single agent chemotherapy and 59 patients receiving non-special treatment were divided into the chemotherapy group and the operation group,respectively. All the dates of the patients were followed up and collected with the overall survival time,tumor-free survival time,1,2 and 3-year survival rate after operation,and the rate of major toxic reaction during chemotherapy of the chemotherapy group. Survival curve was drawn by the Kaplan-Meier method, and survival analysis was done using the Log-rank test.@*Results@#There were no significant differences in the general date of two groups(sex, age, tumor size, tumor site, TNM stages, degree of differentiation). The median overall survival time and the median tumor-free survival time in the chemotherapy group were 27 months and 21 months,respectively,and in the operation group were 21 months and 17 months,respectively. There were differences between the two groups in the overall survival rates(χ2=3.967,P<0.05) and the 2 and 3-year survival rate(63.3%,36.6%;41.6%,20.4%;χ2=4.510,P<0.05;χ2=6.143,P<0.05),but the 1-year overall survival rate (83.4%,79.7%)was not statistically significant(χ2=0.286,P>0.05). There were no significant differences in the tumor-free survival time,1,2 and 3-year tumor-free survival rate(77.6%,41.4%,33.1%;62.7%,30.9%,21.2%)between the two groups(χ2=0.876,P>0.05;χ2=0.252,P>0.05;χ2=1.571,P>0.05;χ2=3.323,P>0.05,respectively). The main toxic reaction during chemotherapy were dyspepsia(28.6%, 14/49), anemia(26.5%, 13/49), and leukopenia(22.5%, 11/49), all of which were mild.@*Conclusion@#S-1 single agent chemotherapy after radical reseetion of extrahepatic biliary carcinoma could effectly improve the survival of patients and all of the main toxic reaction during chemotherapy were mild.