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.

Topical dimethyl sulfoxide and intralesional hyaluronidase administration for vinorelbine extravasation-induced rat skin injury / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effects of topical DMSO and intralesional hyaluronidase administration, used alone or in combination, on skin injury due to vinorelbine extravasation in rats.</p><p><b>METHODS</b>Skin injury due to vinorelbine extravasation was induced in the lower extremities of 30 SD rats, which were treated subsequently with topical DMSO, intralesional hyaluronidase, their combination, topical saline, and intralesional saline, with the rats without any treatment as the control. The wound area on 1, 4, 8, 12, 18, 24, 30 days and the time of healing were observed and compared.</p><p><b>RESULTS</b>The wound area on 1, 4, 8, 12, 18, and 24 days were significantly smaller in topical DMSO group than in topical saline and control groups (P<0.05), and so in intralesional hyaluronidase group than in intralesional saline and control groups (P<0.05), but there was no significant difference between single agent (hyaluronidase and DMSO) treatment group and the combined treatment group. The healing time was significantly shorter in topical DMSO and intralesional hyaluronidase groups than in topical and intralesional saline groups and control group ( 24.9-/+3.2 and 21.9-/+3.0 days vs 29.8-/+2.6, 28.6-/+4.1 and 30.6-/+3.0 days, P<0.01), but comparable between the two single agent groups and combined treatment group (23.3-/+3.8 days).</p><p><b>CONCLUSION</b>Intralesional hyaluronidase and topical DMSO application are effective therapies for skin damage due to vinorelbine extravasation, and their combination does not improve the therapeutic effect.</p>

The efficacies of hyaluronidase and hirudoid on skin extravasation damage caused by vinorelbine in rats / 肿瘤

Objective: To explore the preventive efficacy of local injection of hyaluronidase and topical administration of Hirudoid cream against skin damage caused by vinorelbine extravasation in rats. Methods: Vinorelbine was iv infused into the hinder limbs of SD rats to establish the extravasation model. The 48 rats were randomly divided into 6 groups. The model group received no treatment. The other five groups were given local injection of hyaluronidase, topical administration of Hirudoid cream, local injection of hyaluronidase plus topical administration of Hirudoid cream, local injection of normal saline (NS), or topical administration of normal saline, respectively. The lesion area and the healing time were observed and recorded on d 1, d 4, d 8, d 12, d 18, d 24, and d 30. Results: The lesions were cured by local injection of hyaluronidase on d 30. The lesion area were significantly reduced in hyaluronidase group compared with that in topical Hirudoid cream group, combined therapy group, local NS injection group, topical NS administration group, and the model group on d 1, d 4, d 8, d 12, d 18 and d 24 (P < 0.05). The healing time was significantly shorter in hyaluronidase group than that in other 5 groups [(21.9 ± 3.0) d vs (28.8 ± 3.5) d, (28.0 ± 2.9) d, (28.6 ± 4.1) d, (29.8 ± 2.6) d, and (30. 6 ± 3.0) d, P < 0.01]. Conclusion: Local injection of hyaluronidase is effective for skin damage caused by vinorelbine extravasation, but topical administration of Hirudoid cream is ineffective and combined therapy can not further improve the efficacy of hyaluronidase monotherapy.