The clinical analysis of autoimmune pancreatitis: a report of 21 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical feature, diagnostic and therapeutic experience of autoimmune pancreatitis (AIP).</p><p><b>METHODS</b>Twenty-one patients with AIP treated in the First Affiliated Hospital, Harbin Medical University from January 2006 to July 2014 were analyzed retrospectively. There were 15 men and 6 women among the 21 cases and the age ranged from 36 to 64 years. The characters of diagnosis and treatment of AIP were explored through clinical symptoms, imaging features, serologic test results, diagnostic treatment, and histopathologic characteristics.</p><p><b>RESULTS</b>All the patients showed obstructive jaundice and upper abdominal pain to different extents as major manifestations and the levels of serum IgG4, CA19-9, CEA were elevated in 16 cases (76.2%), 6 cases (28.5%) and 3 cases (14.2%), respectively. CT showed diffuse enlargement of the pancreas in 9 cases, localized pancreatic head enlargement in 3 cases and focally pancreatic mass in 9 cases. AIP was confirmed by extrapancreatic involvement, radiological and serological results plus biopsy in 11 cases (52.4%), interpretation of response to steroid in 3 cases (14.3%) and open laparotomy in 7 cases (33.3%). Surgery included choledochojejunostomy in 3 cases, cholecystojejunostomy in 1 case, pancreaticoduodenectomy in 2 cases and distal pancreatectomy combined with splenectomy in 1 case. The pathologic results displayed massive lymphocytes and plasma cells infiltration in the pancreatic tissues as well as parenchymal fibrosis. Except for 1 patient who had no symptom, the regular steroid therapy was performed (oral prednisone) and all the patients were cured. The follow-up time range was from 3 to 93 months, 4 cases (19.0%) were recurrent followed by the symptoms alleviated after the steroid was applied again.</p><p><b>CONCLUSIONS</b>AIP is rare and characterized by non-specific clinical manifestations so that the early diagnosis is difficult with a high misdiagnosis rate. The clinicians should strengthen the recognition of AIP and the definite diagnosis depends on the combination of clinical manifestations, radiological, serological and histopathological results so as to avoid the unnecessary operation.</p>

A prospective randomized controlled trial of pancreatic duct stent internal versus external drainage with pancreaticojejunostomy for the early curative effect after pancreaticoduodenectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of pancreatic duct stent internal versus external drainage with pancreaticojejunostomy on the early curative effect after pancreaticoduodenectomy (PD).</p><p><b>METHODS</b>The study was a prospective controlled trial. A total of 219 patients undergoing PD from January 2010 to March 2013 were randomly divided into external drainage group (n = 110) and internal drainage group (n = 109). The pancreatic duct stent was put in the jejunum during the operation in the internal drainage group, while that in the external drainage group was placed outside the body through the jejunum and abdominal wall. The intra-operative blood loss, operative duration, post-operative hospital stay, mortality rate, and the morbidity of pancreatic fistula as well as other complications were compared between the two groups.</p><p><b>RESULTS</b>Compared with internal drainage group, pancreatic duct stent external drainage obviously reduced the morbidity of pancreatic fistula (13.6% vs. 22.6%), delayed gastric emptying (10.0% vs. 27.5%), abdominal infection (6.4% vs. 19.3%), intestinal obstruction (8.2% vs. 20.2%) along with the overall complications (24.5% vs. 41.3%) after PD (χ(2) = 5.735 8 to 11.047 7, P < 0.05), and shortened the healing duration of pancreatic fistula ((11.5 ± 2.9) d vs. (20.1 ± 5.7) d, t = 5.07, P < 0.01), while there was no significant difference in the intra-operative blood loss, operative duration, post-operative hospital stay and mortality rate, etc between the two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Pancreatic duct stent external drainage can effectively reduce the morbidity of pancreatic fistula and the overall complications after PD, which is safe and feasible. The method is worthy of popularization and application clinically.</p>

The impact of blood transfusion on postoperative short-term results of pancreaticoduodenectomy: a comparative study on 356 patients / 中华肝胆外科杂志

Objective To study the impact of blood transfusion on postoperative complications of pancreaticoduodenectomy.Methods The medical data of 356 patients who underwent pancreaticoduodenectomy from January 2005 to December 2011 were retrospectively analyzed.242 patients in the transfusion group received blood transfusion while the remaining patients in the non transfusion group received no blood transfusion.Results The rates of pancreatic fistula and pulmonary infection,mean operative time,intraoperative blood loss,and hospital stay were 17.8％,16.5％,6.4 h,920.0 ml and 29.1 d in the transfusion group compared with 8.8％,6.1％,5.4 h,150.0 ml and 25.9 d in the non-transfusion group,respectively (P＜0.05).However,there were no significant differences between the two groups in the rates of biliary fistula,gastrointestinal and intraabdominal bleeding,delayed gastric emptying and death.Conclusions Patients undergoing pancreaticoduodenectomy in the non-transfusion group had significantly lower rates of pancreatic fistula and pulmonary infection,shorter operative time and hospital stay,and less intraoperative blood loss.This study suggested that a reduction in intraoperative blood loss by advanced instruments and techniques,with operations carried out by experienced pancreatic surgeons in specialized pancreatic center,could result in a significantly lower postoperative complication rate.

Diagnosis and treatment of postoperative gastroduodenal fistulas in patients with severe acute pancreatitis / 中华胰腺病杂志

Objective To investigate the etiologies, mechanisms, diagnosis and management of postoperative gastroduodenal fistulas in patients with severe acute pancreatitis (SAP). Methods The clinical data of 18 cases of postoperative gastroduodenal fistulas (PGF) in patients with SAP admitted in our hospital from Jan, 1996 to Dec, 2007 were analyzed retrospectively. Results Of 18 patients with SAP, 4 patients underwent cholecystectomy and common bile duct exploration, 4 patients underwent pancreatic debridement and open saucer-type drainage, 10 patients underwent pancreatic debridement and pancreas-bed mobilization, abdominal closed drainage. Duodenal fistula occurred in 12 patients (66.7%), gastric fistula occurred in 6 patients (33.3%). 14 patients (77.8%) developed gastroduodenal fistula within 3 weeks of surgery, and 4 patients developed gastroduodenal fistula after 3 weeks of surgery. 16 patients (88.9%) were cured with non-surgical management including drainage, antibiotics and abscess cavity douching. The average length of stay was 65 days. Two patients (11.1%) died of intra-abdominal hemorrhage and intra-abdominal infection complicated with abdominal compartment syndrome and multiple organ dysfunction syndromes, respectively. Conclusions SAP complicated with postoperative gaatroduodenal fistulas could be cured by appropriate non-surgical treatment.