Analysis of Factors Influencing Morbidity and Mortality after Pancreaticoduodenectomy

PURPOSE: The surgical morbidity and mortality after a pancreaticoduodenectomy has been decreasing but still remains high. The most serious complications are pancreatic leakage, gastrointestinal or intra-abdominal hemorrhage, and an intraabdominal abscess. The less serious complications are delayed gastric emptying and wound problems. The aim of this study was to evaluate the risk factors for morbidity and mortality after a pancreaticoduodenectomy. METHODS: Among 90 patients who underwent pancreaticoduodenectomy from Feb. 1992 to Dec, 2000. 68 patients whose hospital records could be reviewed thoroughly were enrolled in this study. The postoperative morbidity and mortality after a pancreaticoduodenal resection were evaluated in terms of the patient's age, combined disease, laboratory values, biliary drainage, transfusion, types of pancreaticojejunostomy, pancreatic duct size, consistency, and the administration of octreotide. Univariate and multivariate analysis were performed with a chi-square test and multiple logistic regression test. RESULTS: Postoperative complications were observed in 43 cases (63.2%). Wound complications were noted in 13 cases (19.1%), gastric emptying disturbance in 10 cases (14.7%), bleeding in 9 cases (13.2%), an abscess in 4 cases (5.9%), and leakage in 22 cases (32.4%). Nine cases (13.2%) had died. The causes of death were sepsis due to leakage in 3 cases, bleeding in 3 cases, and others causes in 3 cases. Univariate analysis showed that diabetes mellitus was significantly (P<0.05) related to delayed gastric emptying. In multivariate analysis, transfusion was significantly (P<0.05) related to wound infections and mortality. Old age ( 65 years) was significantly related to leakage and delayed gastric emptying. CONCLUSION: Pancreaticoduodenectomy is still associated with a high mortality and morbidity rate even though there has been significant progress in the field of pancreatic surgery and postoperative follow-up. Old age and transfusions appeared to be the main risk factors for morbidity and mortality after a pancreaticoduodenectomy in this study. In addition to these factors, better anticipation and management of the postoperative complications is essential for improving the surgical outcome.

Hemostatic Effect of Endoscopic Hemoclip Method, Hypertonic Saline Epinephrine Injection Method and Their Combined Method for Bleeding Peptic Ulcer / 대한소화기내시경학회지

BACKGROUND: Bleeding peptic ulcer is the most common cause of upper gastrointestinal bleeding. Various different endoscopic hemostatic methods were introduced to treat bleeding peptic ulcer. Many studies reported the efficacy and comparision of various methods. Endoscopic injection therapy is the most comman method among them because it is inexpensive and easy in use. Complications of injection therapy such as aggravation of bleeding, tissue neerosis and perforation were repoted rarely. Recently endoscopic hemoclipping method is considered to be safe and effective hemostatic method for upper gastrointestinal bleeding. METHODS: During the period between January 1993 and August 1996, we have conducted clinical trial and retrospective analysis among 100 patients in whom active bleeding or visible vessel was identified. RESULTS: 1) Three groups was divided, Hemoclip group 26 cases, Hypertonic Saline Epinephrine(HSE) group 59 cases, Combination group 15 cases. 2) The sources of bleeding in Hemoclip group were gastric ulcer in 23 Cases and duodenal ulcer in 3 cases, and in HSE group, gastric ulcer in 44 case, duodenal ulcer 14 cases and stomal ulcer in one case, and in combination group, gastric ulcer in 10 cases, duodenal ulcer in 3 cases and stomal ulcer in two cases. HSE and combination method were performed more than Hemoclip method in duodenal ulcer(23.7% and 20.0% versus 11.5%). 3) As the stigmata of bleeding in Hemoclip and HSE and Combination group, spurting were seen in 5 cases and 3 cases and 4 cases, and oozing in 10 cases and 17 cases and 3 cases, and nonbleeding visible vessel in 11 cases and 39 cases and 8 cases, respectively. Hemoclip method was performed more than HSE method in active bleeding state(57.6% versus 33.9%). 4) Initial hemostasis was achieved in 24 cases(92.3%) in Hemoclip group and 52 cases(88.1%) in HSE group, 13 cases(86.7%) in Combination group. 5) The rebleeding developed in 1 case(4.2%) in Hemoclip group and 8 cases(15.4%) in HSE group and 1 case(7.6%) in Combination group, the emergent operation was undewent 2 cases(7.7%) in Hemoclip group and 10 cases(17.0%) in HSE group and 1 case(6.7%) in Combination group, respectively. 6) The death was noticed in 1 cases(3.9%) in Hemoclip group and 2 cases(3.4%) in HSE group and 2 case(13.3%) in Combination group, repectively. 7) Permanent hemostasis by only endoscopic treatment was achieved in 24 cases(92.3%) in Hemoclip group and 48 cases(81.4%) in HSE group, 12 cases(80.0%) in Combination group. 8) Complication was noticed only in HSE group, aggravation of bleeding in one case and hematoma in two cases. CONCLUSION: Hemoclip method was effective hemostatic method same as HSE injection method, and safe method weth low complication in bleeding peptic ulcer. We suggest more detail selection of endoscopic hemostatic method in variously individualized endoscopic features.

A Case of Small Cell Carcinoma of Gallbladder / 대한내과학회지

Carcinoma of the gallbladder is relatively rare malignancy usually found in an elderly, predominantly female population. Histologically, adenocarcinoma predominate, with only 10% to 15% being of other varieties(small cell carcinoma and others). Small cell carcinoma of the gallbladder is a rare lesion and predominantly a disease of older women with clinical history of stones. These tumors show an aggressive clinical course and death usually occurs with in a few months of the diagnosis. The diagnosis of small cell carcinoma should be based on cell morphology, histologic pattern and immunohistochemical study. Correct diagnosis is important not only because these tumors give rise to endocrine syndromes, but also because the chemotherapeutic approach to small cell carcinoma differs from that for adenocarcinoma.