Clinical effect of minimally invasive duodenum preserving pancreatic head resection for benign and pre-malignant lesions of pancreatic head / 中华外科杂志

Objective: To examine the clinical effect of minimally invasive duodenum preserving pancreatic head resection(DPPHR) for benign and pre-malignant lesions of pancreatic head. Methods: The clinical data of patients with diagnosis of benign or pre-malignant pancreatic head tumor were retrospectively collected and analyzed,all of them underwent laparoscopic or robotic DPPHR between October 2015 and September 2021 at Division of Gastrointestinal and Pancreatic surgery,Zhejiang Provincial People's Hospital. Thirty-three patients were enrolled with 10 males and 23 females. The age(M(IQR)) was 54(32) years old(range: 11 to 77 years old) and the body mass index was 21.9(2.9)kg/m2(range: 18.1 to 30.1 kg/m2). The presenting symptoms included abdominal pain(n=12), Whipple triad(n=2), and asymptomatic(n=19). There were 7 patients with hypertension and 1 patient with diabetes mellitus. There were 19 patients who were diagnosed as American Society of Anesthesiologists class Ⅰ and 14 patients who were diagnosed as class Ⅱ. The student t test,U test, χ2 test or Fisher exact test was used to compare continuous data or categorized data,respectively. All the perioperative data and metabolic morbidity were analyzed and experiences on minimally invasive DPPHR were concluded. Results: Fourteen patients underwent laparoscopic DPPHR,while the rest of 19 patients received robotic DPPHR. Indocyanine green fluorescence imaging was used in 19 patients to guide operation. Five patients were performed pancreatico-gastrostomy and the rest 28 patients underwent pancreaticojejunostomy. Pathological outcomes confirmed 9 solid pseudo-papillary neoplasms, 9 intraductal papillary mucinous neoplasms, 7 serous cystic neoplasms, 6 pancreatic neuroendocrine tumors, 1 mucous cystic neoplasm, 1 chronic pancreatitis. The operative time was (309.4±50.3) minutes(range:180 to 420 minutes),and the blood loss was (97.9±48.3)ml(range:20 to 200 ml). Eighteen patients suffered from postoperative complications,including 3 patients experienced severe complications(Clavien-Dindo Grade ≥Ⅲ). Pancreatic fistula occurred in 16 patients,including 8 patients with biochemical leak,7 patients with grade B pancreatic fistula and 1 patient with grade C pancreatic fistula. No one suffered from the duodenal necrosis and none perioperative death was occurred. The length of hospital stay was 14(7) days (range:6 to 87 days). The follow-up was 22.6(24.5)months(range:2 to 74 months). None suffered from recurrence or metastasis. During the follow-up,all the patients were free of refractory cholangitis. Moreover,in the term of endocrine dysfunction,no postoperative new onset of diabetes mellitus were observed in the long-term follow-up. However,in the view of exocrine insufficiency,pancreatic exocrine insufficiency and non-alcoholic fatty liver disease (NAFLD) was complicated in 2 and 1 patient,respectively,with the supplement of pancreatic enzyme,steatorrhea and weight loss relieved,but NAFLD was awaited to be seen. Conclusions: Minimally invasive DPPHR is feasible and safe for benign or pre-malignant lesions of pancreatic head. Moreover,it is oncological equivalent to pancreaticoduodenectomy with preservation of metabolic function without refractory cholangitis.

A study on the anatomy of the transcorpus callosal ventricle approach to the thalamic region using the mi- croscope and neuroendoscope / 中国神经精神疾病杂志

Objective To investigate the anatomic landmarks during the exposure of thalamus via the transcorpus callosal ventricle approach between microscope and endoscope to provide an anatomic foundation for clinical application. Methods The transcorpus callosal ventricle approach to expose the thalamus was simulated in selected 6 (12 sides) red and blue latex-perfused cadaver head specimens. The anatomic structures of four stages-interhemispheric, septum pellu?cidum cavity, lateral ventricle and third ventricle were examined by microscope and endoscope and relevant anatomic date was obtained during the process. Results Both microscope and endoscope could show the anatomic structures clear?ly during the interhemispheric and septum pellucidum cavity stages. The major landmarks of the interhemispheric cavity included callosal margin artery, cingulate sulcus, pericallosal artery and corpus callosum, and landmarks of septum pellu?cidum cavity included the septum pellucidum and body of fornix. Lateral ventricle stage-the major landmarks contained foramen of monro, septum vein, thalamus striatum vein, choroid plexus, body of fornix and body of caudate nucleus. The blind field under microscope such as anterior part of frontal horn (25.7mm±1.7mm vs. 14.2mm±1.2mm, P<0.05), lateral part (1/3) (12.1mm ± 0.7mm vs. 7.0mm ± 0.9mm, P<0.05) and posterior part (2/5) (28.8mm ± 1.4mm vs. 18.7mm ± 1.4mm, P<0.05) of thalamus could be made up by endoscope. Third ventricle stage-neither microscope nor endoscope could show the medial part of thalamus effectively due to the restriction of fornix and internal cerebral vein. Conclusions The anatomic landmarks can be identified during the exposure of thalamus via the transcorpus callosal ventricle approach. The coordination of microscope and endoscope can be helpful to identify eloquent structures and make up blind surgical field.