ABSTRACT
Objective To evaluate surgical therapies for chronic pancreatitis.Method The clinical data of 229 patients admitted for chronic pancreatitis during March 2009 to November 2013 in our hospital was retrospectively analyzed,different operation method and their clinical outcome were compared.Results Drainage operations or resection operations were made to all these 229 patients according to different types.57 patients underwent longitudinal pancreaticojejunostomy (LPJ procedure).118 patients received local resection of the head of pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure in 105 cases,Berne procedure in 6 cases,Beger procedure in 7 cases).7 patients received pancreaticoduodenectomy,21 patients received distal pancreas resection,26 patients received other procedures.Post-operative pain relief rate was 89.3％,overall morbidity was 19.6％.Conclusions In cases of chronic pancreatitis,different surgical types are adopted according to their individual indications.Operation in accordance with pathological types guarantees clinical outcome.
ABSTRACT
Objective To compare biliary tract intraductal papillary mucinous neoplasm (BT-IPMN) with intraductal papillary mucinous neoplasm of the pancreas (P-IPMN).Methods From January 2008 to December 2013,eleven (6.0％) cases of BT-IPMNs were retrospectively identified from a total of 182 biliary tract tumors resected in our institution,while 50 cases underwent surgery for P-IPMN.The mean age of the 11 BT-IPMN cases was 57.3 years (range 40 to 74 years).There were 8 men (73.0％).The mean age of the 50 P-IPMN cases was 57.4 years (range 33 to 85 years).There were 34 men (68.0％).The clinical features,radiologic findings,pathology,surgical strategies,and long-term follow up outcomes between the 2 groups of patients were analyzed.Results There was no significant difference between BT-IPMN and P-IPMN in the following aspects:mean age,sex ratios and clinical presentation [including the most common presenting symptom abdominal pain (73.0％ vs.68.0％),and elevated tumor markers (CEA and CA19-9)].The mean tumor size of BT-IPMN was significantly smaller than P-IPMN (1.7 vs.4.1 cm,P ＜ 0.05).Macroscopically visible mucin was detected in all the 11 patients basing on the original surgical reports.The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilatation (100％) and intraluminal masses (55.0％).Most cases (82.0％) involved the intrahepatic bile duct and hilum.For tumor clearance,we conducted left hepatectomy in most cases (64.0％).Only one patient underwent biopsy and choledochojejunostomy for multiple tumors involving the extrahepatic,right and left bile ducts.BT-IPMN was likely to have a higher risk of malignancy (55.0％ vs.44.0％) and poorer prognosis (median survival,57 vs.63 months),although there was no significant difference (P ＞ 0.05).The patient without tumor resection died of liver failure 22 months after palliative surgery.Conclusions BT-IPMNs are very rare and they had some similarity with P-IPMN.Complete resection of BT-IPMN is associated with good survival.