Pancreatic fistula after duct-to-mucosa pancreaticojejunostomy / 中华普通外科杂志

Objective To investigate the risk factors for pancreatic fistula after duct-to-mucosa pancreaticojejuuostomy (PD). Methods The clinical data of 101 cases undergoing duct-to-mucosa PD in our hospital from January 1994 to January 2008 were reviewed retrospectively. Results The incidence of pancreatic fistula was 9.9% (10/101). Univariate analysis showed level of preoperative jaundice(χ2=5.814, P= 0.016) , duration of jaundice (χ2= 4.17, P = 0.041 ), texture of the remnant pancreas (χ2=5.286, P = 0.021 ), diameter of pancreatic duct (χ2= 4.165, P = 0.041 ), blood loss during operation (χ2=5.273, P=0.022) were significantly associated with pancreatic fistula after duct-to-mucosa PD. Multivariate analysis regression revealed that texture of the remnant pancreas (OR = 13.355, P = 0.023), level of preoperative jaundice (OR = 12.126, P = 0.006), blood loss during operation (OR = 5.92, P =0.032 ) were independent risk factors. Logistic regression equation was as following: P=1/[<1+e-(-6.378+2.592 texture of the remrant pancress + 2.495 level of preopetative jaundice + 1.778 blood loss during operative)>]. The accuracy of the logistic equation was 92.1%. Conclusion Texture of the remnant pancreas, level of preoperative jaundice, blood loss during operation were the independent risk factors for the occurrence of PD after duct-to-mucosa PD. Improvement of operative technique and reduction of blood loss can decrease the incidence of pancreatic fistula.

Analysis of risk factors for intra-abdominal infection after pancreaticoduodenectomy / 中国综合临床

Objective To study the risk factors for intra-abdominal infection after pancreaticoduodenecto-my. Methods Clinical data of 101 cases undergoing pancreaticoduodenectomy in our hospital from January 1994 to January 2008 were reviewed retrospectively. The risk factors were analyzed. Results The incidence of intra-abdomi-hal infection was 12.9% (13/101). Univariate analysis showed postoperative pancreatic,biliary and intestinal fistu-la,pulmonary infection,preoperative acute cholangitis and texture of the remnant pancreas were the risk factors for intra-abdominal infection(P<0.05). Multivariate Logistic regression revealed that postoperative pancreatic, biliary and intestinal fistula, pulmonary infection, preoperative acute cholangitis were independent risk factors (OR = 11.914,9.891 and 7.197 ) of intra-abdominal infection after pancreaticoduodenectomy. Conclusion Preventing and curing pancreatic ,biliary and intestinal fistula, pulmonary infection, preoperative acute cholangitis can decrease the incidence of intra-abdominal infection.

Are there other axillary lymph node metastasis than positive sentinel lymph nodes containing micrometnstmes and isolated tumor cells in patients with breast csncer / 中华普通外科杂志

Objective The purpose of this study was to assess the value of serial sectioning and immunohistoehemistry(IHC)for the diagnosis of senfinel lymph node(SLNs)metastases in patients with breast cancer,and to evaluate the significance of mierometastases and isolated tunlor cells(ITCs)in the SLNs. Methods Eighty pailents with clinically node-negative breast cancer underwent SLN biopsy with both99mTc-labeled sulfur colloid and iBosulfan blue dye for SLN identification.All SLNS and non-SLNs were evalnated with standard H&E stain and IHC analysis. Results SLNs were successfully identified in 78 of 80 patients(97.5%),the isotope/blue dye concordanee rate was 76.5%for all SLNs.Thirty two patients (41%)had histologically positive SLNs,and 13(40.6%)of these patients hod SLNS with micrometastatic disease.In 14(43.8%)of these patients,the SLNs were the only nodes involved.The sensitivity,specificity and accuracy of SLN biopsy in predicting axillary node stams were 96.9%,100%and 98.7%,reslaeetively.Patients with positive SLNs metastasis had a markedly higher proportion of non-SLNs metastases compared with those with only micrometastasis in the SLNS(78.9% vs 23.1%). Conclusions Serial sectioning and IHC ale sensitive methods for detecting breast cancer metastases in SLNS.The incidence of non-SLNs metastases is rather low in patients with SLNs that contain only micrometsstatic foci and ITCs.The prognostic significance and effect on surgical management of these occult disease have yet to be determined.

The diagnosis, treatment and clinicopathologic analysis on gastrointestinal neuroendocrine carcinomas / 中国普通外科杂志

Objective To investigate the clinicopathologic features of gastrointestinal neuroendocrine carcinomas. MethodsThe diagnosis and treatment results of 45 cases were studied, and clinicopathologic features and immunohistochemical expressions of NSE, Syn and CgA were detected.ResultsMicroscopically carcinomas were divided into three types: type Ⅰ(25 cases), type Ⅱ(10 cases) and type Ⅲ(10 cases). The histologic categories were correlated with lymph node metastasis significantly( P0.05). The 5-year survival rate for type Ⅰ, type Ⅱ and type Ⅲ was 70%, 65% and 52%, respectively.ConclusionsThe combination of NSE, Syn and CgA immunohistochemical stainnig is necessary for the diagnosis of gastrointestinal neuroendocrine carcinomas. The histologic classification is coincident with the requirement of clinical treatment and prognosis.