The impact of resection margin status within 1 mm clearance of portal and superior mesenteric vasculature on the prognosis of patients of pancreatic head adenocarcinoma undergoing pancreatoduodenectomy / 中华普通外科杂志

Objective:To evaluate the impact of resection margin status within a cut-off 1 mm clearance of cancer on the groove of portal/superior mesenteric vein and/or the top end of the uncinate process bordering on the superior mesenteric artery in pancreatic head adenocarcinoma patients after pancreatoduodenectomy.Methods:The clinical, pathological and followup data of 113 pancreatic head adenocarcinoma patients undergoing pancreatoduodenectomy with or without vascular graft replacement were retrospectively analyzed.Results:Univariate analysis showed that resection margin 1mm clearance, postoperative adjuvant chemotherapy, T staging, N staging, TNM staging (AJCC), gender, and maximum tumor diameter were risk factors for survival . Multivariate analysis showed that surgical margin 1mm clearance, postoperative adjuvant chemotherapy, and gender were independent prognostic factors. In resection margin >1 mm group(83 cases), the mean survival time was 19.04 months, and the 1-year, 2-year, and 3-year survival rates were 78%, 50%, and 25%, respectively. In resection margin ≤1 mm group(30 cases), the mean survival time was 9.42 months, and the 1-year, 2-year and 3-year survival rates were 61%, 20% and 0, respectively. There was statistical significance between the two groups in survival time ( P=0.018). Conclusion:Resection margins 1 mm clearance of cancer off portal vein/superior mesenteric vein and superior mesenteric artery is independent prognostic factors in pancreatic head adenocarcinoma patients undergoing pancreatoduodenectomy.

Clinical efficacy of different treatment methods for chronic pancreatitis based on M-ANNHEIM system / 中华消化外科杂志

Objective:To evaluate the clinical efficacy of different treatment methods for chronic pancreatitis based on M-ANNHEIM system.Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 177 patients with chronic pancreatitis from two medical centers between July 2008 and July 2018 were collected, including 95 in the Sichuan Provincial People′s Hospital and 82 in the West China Hospital of Sichuan University. There were 100 males and 77 females, aged (49±5)years, with a range from 29 to 72 years. The M-ANNHEIM system was used to decide clinical stages of chronic pancreatitis. Patients in different clinical stages received drug, endoscopic or surgical treatment. Observation indicators: (1) general data and follow-up of patients; (2) treatment of patients in asymptomatic stage; (3) treatment of patients in stage Ⅰ; (4)treatment of patients in stage Ⅱ; (5) treatment of patients in stage Ⅲ; (6) treatment of patients in stage Ⅳ; (7) aggravation and new-onset of diabetes; (8) complications. Follow-up using outpatient examination, telephone, mail, and Sojump was performed to collect data for M-ANNHEIM system up to December 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the AVONA. Repeated measurement data were analyzed using repeated ANOVA. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Results:(1) General data and follow-up of patients: there were 11, 72, 55, 31, and 8 patients with chronic pancreatitis classified as asymptomatic stage, stage Ⅰ, stage Ⅱ, stage Ⅲ, stage Ⅳ of M-ANNHEIM system before treatment. Of the 177 patients, 49, 49, and 79 patients underwent drug, endoscopic and surgical treatment, respectively. All the 177 patients were followed up for (2.4±0.5)years. (2) Treatment of patients in asymptomatic stage: 11 patients in asymptomatic stage underwent drug treatment. The M-ANNHEIM score was 1.91±0.21 before treatment, and 1.27±0.14, 1.73±0.19, 2.09±0.16 at 1 month, 12 months, 24 months after treatment, respectively. (3) Treatment of patients in stage Ⅰ: of the 72 patients in stage Ⅰ, 13 underwent drug treatment, 26 underwent endoscopic treatment, and 33 underwent surgical treatment. The M-ANNHEIM score of patients undergoing drug treatment was 8.11±1.05 before treatment, and 6.31±0.31, 7.69±0.24, 10.00±0.23 at 1 month, 12 months, 24 months after treatment, respectively. The M-ANNHEIM score of patients undergoing endoscopic treatment was 8.42±0.93 before treatment, and 5.13±0.25, 6.89±0.20, 8.27±0.24 at 1 month, 12 months, 24 months after treatment, respectively. The M-ANNHEIM score of patients undergoing surgical treatment was 8.13±0.77 before treatment, and 4.79±0.15, 5.42±0.22, 7.76±0.20 at 1 month, 12 months, 24 months after treatment, respectively. There was no significant difference in M-ANNHEIM score before treatment between patients receiving different treatments ( F=1.23, P>0.05). For patients in M-ANNHEIM stage Ⅰ, at 1 month after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=2.94, 4.98, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=1.26, P>0.05). At 12 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=2.43, 5.99, 4.80, P<0.05). At 24 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=4.61, 6.29, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=1.63, P>0.05). (4) Treatment of patients in stage Ⅱ: of the 55 patients in stage Ⅱ, 8 underwent drug treatment, 15 underwent endoscopic treatment, and 32 underwent surgical treatment. The M-ANNHEIM score of patients undergoing drug treatment was 12.61±1.16 before treatment, and 11.63±0.26, 12.57±0.30, 14.50±0.27 at 1 month, 12 months, 24 months after treatment, respectively. The above indicators of patients undergoing endoscopic treatment was 12.42±1.43, 8.47±0.24, 11.07±0.21, 11.93±0.30, respectively. The above indicators of patients undergoing surgical treatment was 12.53±1.22, 8.78±0.15, 9.94±0.21, 11.00±0.24, respectively. There was no significant difference in M-ANNHEIM score before treatment between patients receiving different treatments ( F=1.38, P>0.05). For patients in M-ANNHEIM stage Ⅱ, at 1 month after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=8.37, 8.48, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=1.13, P>0.05). At 12 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=4.13, 8.48, 3.33, P<0.05). At 24 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=5.61, 6.83, 2.26, P<0.05). (5) Treatment of patients in stage Ⅲ: of the 31 patients in stage Ⅲ, 9 underwent drug treatment, 8 underwent endoscopic treatment, and 14 underwent surgical treatment. The M-ANNHEIM score of patients undergoing drug treatment was 17.25±0.89 before treatment, and 17.11±0.35, 18.44±0.41, 17.33±0.44 at 1 month, 12 months, 24 months after treatment, respectively. The above indicators of patients undergoing endoscopic treatment was 17.38±1.06, 15.00±0.53, 16.50±0.33, 16.88±0.44, respectively. The above indicators of patients undergoing surgical treatment was 17.63±1.06, 14.64±0.34, 16.00±0.35, 16.57±0.33, respectively. There was no significant difference in M-ANNHEIM score before treatment between patients receiving different treatments ( F=1.19, P>0.05). For patients in M-ANNHEIM stage Ⅲ, at 1 month after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=3.37, 4.82, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=0.59, P>0.05). At 12 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=3.63, 4.48, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=0.95, P>0.05). At 24 months after treatment, there was no significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=0.73, 1.41, 0.55, P>0.05). (6) Treatment of patients in stage Ⅳ: 8 patients in stage Ⅳ underwent drug treatment. The M-ANNHEIM score of patients was 17.94±0.59 before treatment, and 18.01±0.34, 17.54±0.19, 17.34±0.26, 17.88±0.43 at 1 month, 6 months, 12 months, 24 months after treatment, respectively. (7) Aggravation and new-onset of diabetes: of 49 patients undergoing endoscopic treatment, 17 had diabetes before treatment, 5 had aggravated diabetes and 11 had new-onset of diabetes after treatment. Of 79 patients undergoing surgical treatment, 31 had diabetes before treatment, 21 had aggravated diabetes and 7 had new-onset of diabetes after treatment. There were significant differences in the aggravation and new-onset of diabetes between the two groups ( χ2=2.07, 2.04, P<0.05). (8) Complications: 49 patients undergoing drug treatment had no treatment related complications. Of 49 patients undergoing endoscopic treatment, 4 patients with stent related complications were cured after replacing stent under endoscopy, 6 patients had acute pancreatitis, 2 had gastrointestinal bleeding including 1 patient was cured after endoscopic hemostasis, other patients with complications were improved after symptomatic and supportive treatment. Of 79 patients undergoing surgical treatment, 17 had pancreatic leakage (including 11 of biochemical leakage, 5 of grade B pancreatic leakage, and 1 of grade C pancreatic leakage), 3 had postoperative gastroparesis, 3 had intraabdominal infection, 1 had deep venous thrombosis, 2 had hemorrhage of which 1 combined with grade C pancreatic leakage was improved after open hemostasis and 1 was improved after interventional treatment, other patients with complications were improved after symptomatic and supportive treatment. Conclusions:For chronic pancreatitis, individualized treatment should be formulated according to the different stages. M-ANNHEIM score system can be used the evaluate clinical efficacies of drug treatment, endoscopic treatment, and surgical treatment.

Clinical efficacy of radical resection with individualized surgical approach for borderline resectable pancreatic head carcinoma / 中华消化外科杂志

Objective To explore the clinical efficacy of radical resection with individualized surgical approach for borderline resectable pancreatic head carcinoma.Methods The retrospective descriptive study was conducted.The clinicopathological data of 54 patients with borderline resectable pancreatic head carcinoma who underwent radical resection with individualized surgical approach in the West China Hospital of Sichuan University from January 2015 to January 2018 were collected.There were 37 males and 17 females,aged from 37 to 73 years,with a median age of 59 years.For venous type borderline resectable pancreatic head carcinoma,surgery for pancreatic head carcinoma and (or) pancreatic head and neck carcinoma was performed via inferior mesenteric vein,and surgery for pancreatic uncinate process carcinoma was performed via inferior colon artery.For arterial type borderline resectable pancreatic head carcinoma,surgery for pancreatic head carcinoma and (or) pancreatic head and neck carcinoma was performed via medial uncinate artery,and surgery for pancreatic uncinate process carcinoma was performed via left posterior artery.Observation indicators:(1) surgical situations;(2) postoperative complications;(3) postoperative pathological examination;(4) follow-up.Patients were followed up by outpatient examination or telephone interview once every 3 months to detect survival up to March 2019.Measurement data with normal distribution were represented by Mean ± SD.Measurement data with skewed distribution were represented by M (range),and count data were represented by absolute numbers or percentage.Kaplan-meier method was used to draw the survival curve and calculate the survival rate.Results (1) Surgical situations:all the 54 patients underwent expanded pancreatoduodenectomy combined with superior mesenteric vein/portal vein (SMV/PV) resection,including 15 via inferior mesenteric vein,20 via inferior colon artery,12 via medial uncinate artery,and 7 via left posterior artery.The operation time was (320± 83)minutes,and the volume of intraoperative blood loss was (865±512) mL.(2) Postoperative complications:of 54 cases,28 had postoperative complications,including 13 with grade 1 Clavien-Dindo complications,12 with grade 2 ClavienDindo complications,3 with grade 3 or above Clavien-Dindo complications.One of the 28 patients with postoperative complications died and 27 were improved after symptomatic and supportive treatment.(3) Postoperative pathological examination:of 54 patients,31 had R0 resection and 23 had R1 resection.In the 23 patients with R1 resection,5 underwent surgery via the inferior mesenteric vein (4 with involvement of pancreatic anterior surface,1 with involvement of both pancreatic anterior and posterior surface),9 underwent surgery via the inferior colon artery (2 with involvement of both pancreatic anterior and posterior surface,2 with involvement of superior mesenteric artery margin,2 with involvement of pancreatic posterior surface,2 with involvement of pancreatic anterior surface,1 with involvement of superior mesenteric artery margin and pancreatic posterior surface),5 underwent surgery via the medial uncinate process artery (2 with involvement of superior mesenteric artery margin,2 with involvement of both pancreatic anterior and posterior surface,1 with involvement of pancreatic neck transected margin),and 4 underwent surgery via the left posterior artery (3 with involvement of superior mesenteric artery margin,1 with involvement of both pancreatic anterior and posterior surface).Of 54 patients,16 had no positive lymph nodes,26 had 1-3 positive lymph nodes,and 12 had 4 or more positive lymph nodes.The tumor diameter was (3.20±0.14)cm.There were 48 of 54 patients with nerve infiltration,41 with superior mesenteric vein and/or portal vein infiltration,and 11 with vascular thrombus.There were 17 of 54 patients with high differentiation and medium differentiation,and 37 with low differentiation and undifferentiation.(4) Follow-up:54 patients were followed up for 1-42 months,with a median time of 19 months.The 1-,3-year overall survival rate was 78.0％,11.4％.Condusion As for the borderline resectable pancreatic head cancer,individualized and customized surgical approach according to the location of tumor and the relationship with blood vessels is helpful to standardize the radical resection and avoid R2 resection.

Clinical efficacy of pancreaticoduodenectomy combined with venous resection via inferior mesenteric vein pathway for resectable pancreatic cancer / 中华消化外科杂志

Objective To investigate clinical efficacy of pancreaticoduodenectomy combined with venous resection via inferior mesenteric vein (IMV) pathway for resectable pancreatic cancer with superior mesenteric vein (SMV) and / or anterior wall of portal vein (PV) involvements.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 38 resectable pancreatic cancer patients who underwent pancreaticoduodenectomy with venous resection via IMV pathway in the West China Hospital of Sichuan University between January 2013 and January 2017 were collected.The tumors of 25 patients were BR-PV type (simplex SMV and / or PV involvements),and tumors of 13 patients were BR-A type (SMV,celiac trunk and / or hcpatic artcry involvements).The pancreaticoduodenectomy via IMV pathway was the same as traditional surgery in organs resection and lymph node dissection,the difference was cutting off the pancreas at a junction between IMV and splenic vein when using IMV pathway.Observation indicators:(1) intraoperative and postoperative situations;(2) results of postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to January 2018.Measurement data with skewed distribution were described as M (range).The survival curve was drawn by the Kaplan-Meir method,and Log-rank test was used for survival analysis.Results (1)Intraoperative and postoperative situations:38 patients underwent intraoperative segmental resection of PV and / or SMV,including 30 with end-to-end anastomosis in situ and 8 with artificial vessel interposition anastomosis.Two of 38 patients were intraoperatively combined with common hepatic artery resection and end-to-end anastomosis in situ.There was no intraoperative celiac trunk resection.The operation time and volume of intraoperative blood loss of 38 patients were respectively 320 minutes (range,280-520 minutes) and 530 mL (range,420-650 mL).The incidence of total complications (Clavien-Dindo Ⅲ and above) of 38 patients was 18.4％ (7/38),and some patients were combined with multiple complications,including 6 with pulmonary infection,4 with pancreatic fistula (B and C grade),4 with intra-abdominal infection,3 with delayed gastric emptying,2 with postoperative bleeding and 2 with venous thrombosis.Five patients were cured by postoperative symptomatic treatment,and 2 with postoperative bleeding died of worsened condition after reoperation.The mortality at 90 days postoperatively and duration of hospital stay were respectively 5.3％(2/38) and 12 days (range,9-52 days).(2) Results of postoperative pathological examination:the R0 resection rate of 38 patients was 81.6％ (31/38).The R0 resection rate of 25 patients in BR-PV type was 92.0％ (23/25),and resection margin of pancreatic leading edge ＜ 1 mm was in 2 patients without R0 resection;R0 resection rate of 13 patients in BR-A type was 8/13,and resection margin of pancreatic leading edge ＜ 1 mm was in 2 patients and resection margin of SMV ＜ 1 mm was in 4 patients (1 margined with resection margin of multiple sites ＜ 1 mm) of patients without R0 resection.The resection margins of pancreatic trailing edge,venous cut edge and pancreatic cut edge in patients with BR-PV type and BR-A type were more than and equal to 1mm.The venous infiltration rate in patients with BR-PV type and BR-A type was respectively 100.0％ (25/25) and 9/13.(3) Follow-up and survival situations:38 patients were followed up for 6-40 months,with a median time of 15 months,and survival time was 18 months (range,6-40 months).The survival time and 1-,2-and 3-year cumulative survival rates were respectively 23 months (range,8-40 months),89.5％,33.1％,22.1％ in 25 patients with BR-PV type and 16 months (range,6-25 months),83.9％,16.8％,0 in 13 patients with BR-A type.The tumor-free survival time and 1-and 2-year cumulative tumor-free survival rates were respectively 15 months (range,5-30 months),63.0％,7.5％ in patients with BR-PV type and 9 months (range,4-18 months),11.5％,0 in patients with BR-A type.Conclusion For resectable pancreatic cancer with SMV and / or anterior wall of PV involvements,pancreaticoduodenectomy combined with venous resection via IMV pathway could avoid injury of SMV and / or PV,and increase negative rates of venous and pancreatic resection margins.

Current status and controversies in the management of borderline resectable pancreatic cancer / 中华消化外科杂志

The borderline resectable pancreatic cancer is high a controversial hotspot in the field of pancreatic surgery,and the controversy mainly focuses on definition and treatment.Five famous experts and their teams in pancreatic surgery discussed present situation and dilemmas in treatment of borderline resectable pancreatic cancer based on clinical experiences.Professor Hao Chunyi has reviewed and analyzed origin of the definition and treatment model of borderline resectable pancreatic cancer,and proposed that high-level pancreatic disease center and multidisciplinary collaboration diagnosis and treatment may be the best choice for resectable pancreatic cancer.Professor Liu Xubao suggested surgical treatment for most of borderline resectable pancreatic cancer,and whether or not tumor invades adjacent blood vessels and invasion level will be used to decide direct surgery or neoadjuvant therapy.Professor Sun Bei proposed 6 causes,and direct surgery may be more realistic and feasible option for borderline resectable pancreatic cancer.Professors Liang Tingbo and Bai Xueli recommended that neoadjuvant therapy should be performed due to defeat hiding micrometastasis lesions and reduce tumor burden,and there was a higher R0 resection rate and lower lymph node metastasis rate after neoadjuvant therapy,meanwhile,it can also increase cure rate and is benefited to survival.

Analysis of research progresses on pancreatic cystic neoplasms of the 103rd annual meeting of American College of Surgeons / 中华消化外科杂志

Pancreatic cystic neoplasm is a general term for a large class of pancreatic tumors,including mucinous cystic neoplasm,serous cystic neoplasm,and pancreatic intraductal papillary mucinous neoplasm.Due to the limitations of the current techniques in differential diagnosis and disease staging,different centers have great discrepancies in their treatment.The 103rd annual meeting of American College of Surgeons (ACS)as a grand meeting in the field of surgery bringed together a large number of clinical research results every year.Therefore,authors selected and reviewed contents about pancreatic cystic neoplasm,with a view to provide new ideas in terms of its management and further research.

Recent advance in surgical treatment of pancreatic neuroendocrine tumors / 中华内分泌外科杂志

Pancreatic neuroendocrine tumors (P-NETs) are a group of heterogeneous tumors,including functional and nonfunctional ones.With the enhancement of clinicians' awareness about this disease and the improvement of imaging diagnostic techniques,the incidence of P-NETs has obviously increased in the past years.Based on the mitotic counting and Ki-67 positive index,the grading classification is of great value for the diagnosis,treatment and even prognosis of P-NETs.P-NETs are a group of malignant tumors with inert biological behaviors,whose surgical resection rate and long-term survival is much better than those of pancreatic ductal adenocarcinoma.P-NETs have different malignant potentials.Clinicians need to develop a comprehensive treatment plan in combination with the patient's symptoms,tumor grading classification and TNM staging information.Surgery is the only curable way to cure P-NETs.Even if radical resection is not suitable,palliative surgery may alleviate the patients,symptoms,and even prolong their survival time.According to the tumor location,size,quantity,degree of grading,local invasion and distant metastasis,different surgical procedures should be selected.

Circular RNA in human disease and their potential clinic significance / 中华医学遗传学杂志

Circular RNAs (circ RNAs) are a novel type of RNA that, unlike linear RNAs, form a covalently closed continuous loop and are highly represented in the eukaryotic transcriptome. They share a stable structure, high expression and often exhibit tissue/developmental-stage-specific expression. Emerging evidence indicates that circRNAs might play important roles in human disease, such as cancer, neurological disorders and atherosclerotic vascular disease risk. The huge potentials of circRNAs are recently being discovered from the laboratory to the clinic. CircRNAs might be developed as a potential novel and stable biomarker and potential drugs used in disease diagnosis and treatment. Here, we review the current understanding of the roles of circRNAs in human disease and their potential clinic significance in disease.

Pancreatic neuroendocrine tumor: diagnosis and treatment / 中华内分泌外科杂志

Pancreatic neuroendocrine tumor (p-NET) is a kind of neoplasm originating from neuroendocrine cell of pancreas.The morbidity of p-NET increased 5 times in the past 40 years and threatened people's life.However,the key points of diagnosis and treatment for p-NET are still unclear.There were no special and easy blood tests or imaging scanning for p-NET.The TNM classification remains controversial.Surgery is the most effective method to cure p-NET.But we still need to clarify which is the best time or method for surgery.In this review,we try to answer above questions based on our experiences and studies.

The near future and the forward curative effect of Autologous islet transplantation in the treatment of chronic pancreatitis / 中华内分泌外科杂志

Chronic pancreatitis (CP) is a kind of disease with the sustainable and irreversible damage of the tissue structure and function of pancreas,which may be caused by alcohol,gene,gallstone,metabolism,deformity and other factors.The clinical manifestations are intractable abdominal pain and disorder of the internal and external secretion of pancreas.At present,the main purpose of the treatment for chronic pancreatitis is to relieve patients' pain,and to maintain the secretion function of pancreas as far as possible.The main surgical procedures for chronic pancreatitis includes the pancreatic resection,nerve block and decompression drainage of the pancreatic duct.In recent years,people hve paid more attenntion to the whole pancreas resection combined autologous transplantation due to retaining some functions of the islet cells.After whole pancreas resection combined autologous transplantation,the abdominal pain will relieve and the life quality will improved significantly.At the same time,it will effectively reduce the occurrence of pancretogenic diabetes since the surgery retains some function of the islet cells.

Survival analysis of patients with insulinoma after different surgical procedures / 中华内分泌外科杂志

Objective To compare the survival conditions of patients with insulinoma after enucleation of insulinoma or partial resection of pancreas.Methods The clinical data of 99 patients with insulinoma,treated with surgery from May.2003 to Aug.2015 were retrospectively analyzed.Of the 99 patients,38 received enucleation of insulinoma alone and 61 received partial resection of pancreas.The overall data were analyzed by SPSS 21.0 software.Results Average survival of patients after enucleation of insulinoma (103.3 months) was longer than that of patients after partial resection of pancreas (77.5 months),and the difference had statistical significance (P=0.006).The difference of the incidence of most chronic or temporary complications had no statistical significance between the two groups (P＞0.05),except for new-onset diabetes (P=0.004).Conclusion Enucleation of insulinoma should be firstly recommended for patients with insulinoma in suitable size,which can provide patients with better survival condition.

A study on the pathological type and surgical therapy of chronic pancreatitis / 中华普通外科杂志

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.

Clinical efficacy of pancreaticoduodenectomy with vein resection via inferior mesenteric vein for tumors in the head and neck of pancreas / 中华消化外科杂志

Objective To investigate the clinical efficacy of pancreaticoduodenectomy with vein resection (PD + VR) via inferior mesenteric vein(IMV) for tumors in the head and neck of pancreas.Methods The clinical data of 62 patients who underwent modified PD + VR for tumors in the head and neck of pancreas at the West China Hospital of Sichuan University between January 2006 to December 2013 were retrospectively analyzed.Twenty-eight patients undergoing Whipple procedure via inferior mesenteric vein were allocated to the WATIMV group,and 34 patients with pancreatic transection as central pancreatectomy undergoing PD + VR were allocated to the c-PD + VR group.The operation time,volume of intraoperative blood loss,rate of patients with intraoperative blood loss ＞ 800 mL,rate of intraoperative blood transfusion,length of vein resection,R1 resection rate,site of positive margin,incidence of complications,classification of complications and duration of postoperative hospital stay were compared between the 2 groups.Patients were followed up via outpatient examination and telephone interview till December 2014.Count data of ratio and proportion were compared by the chi-square test.Measurement data with normal distribution were presented as (x) ± s and analyzed by independent sample t test.Results All the 62 patients underwent operation successfully without perioperative death.The operation time,rate of intraoperative blood transfusion,length of vein resection,incidence of complications,incidence of grade 1,2,3,4,5 complication,duration of postoperative hospital stay were (325 ± 50) minutes,35.7 ％ (10/28),(25 ± 5) mm,46.4％ (13/28),14.3％ (4/28),17.9％ (5/28),14.3％ (4/28),0,0,(15 ± 7) days in the WATIMV group,and (346 ± 97) minutes,58.8％ (20/34),(24 ±5)mm,50.0％ (17/34),14.7％ (5/34),23.5％ (8/34),8.8％ (3/34),0,2.9％ (1/34),(19 ± 11) days in the c-PD + VR group,respectively,showing no significant difference between the 2 groups (t =0.866,x2 =3.283,t =0.647,x2 =0.078,1.883,t =1.666,P ＞ 0.05).The volume of intraoperative blood loss,rate of patients with intraoperative blood loss ＞ 800 mL,R1 resection rate,rate of positive margin in pancreas and retroperitoneal positive margin were (534 ± 277) mL,46.4％ (13/28),3.6％ (1/28),0,3.6％ (1/28) in the WATIMV group,and (796 ± 567) mL,67.6％ (23/34),23.5％ (8/34),8.8％ (3/34),14.7％ (5/34) in the c-PD + VR group,respectively,showing significant differences between the 2 groups (t =2.374,x2 =2.839,4.929,6.507,P ＜ 0.05).Fifty-nine patients were followed up for 15.2 months (range,8.0-23.0 months) with a follow-up rate of 95.2％ (59/62).No patient was complicated with portal vein thrombosis during the follow-up.Conclusion WATIMV is safe and feasible for treatment of tumors in the head and neck of pancreas,helping to improve radical resection rate of carcinoma and operation safety.

Comparison between biliary tract intraductal papillary mucinous neoplasm and intraductal papillary mucinous neoplasm of the pancreas / 中华肝胆外科杂志

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.

Perioperative complications and recent results of Frey procedure in the treatment of chronic pancreatitis / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the perioperative complications and recent results of the Frey procedure in the treatment of chronic pancreatitis.</p><p><b>METHODS</b>Between February 2009 and September 2012, 104 patients with chronic pancreatitis underwent the Frey procedures. This study included 91 male and 13 female patients, with a mean age of (49 ± 11) years (range, 16 to 75 years). The most common symptoms were abdominal pain in 97 patients, diarrhea in 10 patients, obstructive jaundice in 5 patients, and 5 patients had no symptoms. Nine patients had history of pancreatic surgery.</p><p><b>RESULTS</b>There was no mortality. Perioperative complications occurred in 25 patients (24.0%), included pancreatic fistula in 7 patients, delayed gastric emptying in 15 patients, bleeding in 2 patients, abdominal infection in 1 patient, pulmonary infection in 2 patients, delayed healing incision in 4 patients, and pancreatic pseudocyst in 1 patient with reoperation. Seventeen patients with preoperative hyperamylasemia had a higher risk of intranperative hemorrhea and perioperative complications rates. At a mean follow-up of (29 ± 13) months, 8 patients had missed, 2 patients had died, and 3 patients was proved to be coexisted with pancreatic carcinoma. Among 87 patients with abdominal pain, 58 patients (66.7%) have complete pain relief and 23 patients (26.4%) have substantial pain relief. However, among 5 patients without abdominal pain, 2 had recurrent abdominal pain now. Seven of 17 patients with diabetes mellitus aggravated, and new onset of diabetes mellitus was observed in 10 patients. In addition, impaired glucose tolerance was developed in 13 patients. Among 10 patients with diarrhea, the symptom of 4 patients got worse. Thirty-one patients (33.7%) newly developed exocrine insufficiency, included 12 patients treated by patients oral administration of pancreatin and 19 patients only treated by diet control. Ten patients was readmitted and 5 patients underwent reoperation, included 1 patient of pancreatic pseudocyst, 3 patients of chronic pancratitis coexisted with pancreatic carcinoma, and 1 patient of chronic pancratitis with abdominal pain and obstructive jaundice.</p><p><b>CONCLUSIONS</b>Frey procedure in the treatment of chronic pancreatitis is a safe technique with low mortality and morbidity rates, but indication should be strictly controlled and pancreatic tumorigenesis should be alerted.</p>

Diagnosis and treatment of 13 cases of autoimmune pancreatitis / 中华内分泌外科杂志

Objective To investigate and summarize the clinical characteristic of autoimmune pancreati-tis(AIP).Methods Clinical data of 13 patients with AIP, admitted to the West China Hospital from 2009 to 2013, were retrospectively analyzed .Results The median age of the 13 patients was 48 years old.The main clinical manifestations included epigastric pain or discomfort (8 cases), obstructive jaundice(7 cases)and weight loss(10 cases).Diffuse enlargement of pancreas and localized pancreatic enlargement were observed in 6 cases, pseudocyst and pancreatic stones were observed in 1 case.Dilation of pancreatic duct was found in 4 cases.Bili-ary stricture and thickened wall of bile duct were detected in 8 cases, dilated gallbladder with delayed enhance-ment of the thickened wall in 7 cases, retroperitoneal fibrosis surrounding the aorta in 1 case, abdominal lymph-adenopathy in 6 cases, stenosis of splenic vein in 4 cases, and Sjogren's disease and ulcerative colitis in 1 case. The positive rate of serum IgG, RF, ANA was 71.43%(5/7), 42.86%(3/7), and 42.86%(3/7), respec-tively.8 patients were misdiagnosed and underwent surgery .Steroid therapy was administered in all patients with satisfactory response.Conclusions AIP is a rare and autoimmune disease ,without speci? c symptoms,and often be misdiagnosed as pancreatic cancer or bile duct carcinoma .We must give more attention to AIP and keep pa-tients from undergoing unnecessary surgery .

Intrapancreatic pseudocysts after acute pancreatitis / 中华肝胆外科杂志

Objectives The study aims were to analyze the clinical features and to explore the management of intrapancreatic pseudocysts after acute pancreatitis.Methods A retrospective study was conducted on 151 patients who received surgical treatment from Dec,2008 to Feb,2012 after acute pancreatitis.Based on CT/MRI findings and clinical data,there were 17 patients with intrapancreatic pseudocysts (11.3％).The clinical manifestations,diagnoses and treatments for these 17 patients were retrospectively analyzed,and the outcome after operations were followed.Results For the 17 patients,obstructive jaundice was present in 3 patients,pancreatic portal hypertension (PPH) in 7,pseudoaneurysm in 2.All 17 patients underwent operation.The surgical procedures included internal drainage (n=8),external drainage (n=5),distal pancreatic resection with splenectomy (n=3),and local resection (n=1).All patients recovered after the operations.Conclusions Intrapancreatic pseudocysts after acute pancreatitis had a high incidence of local complication.The diagnosis of these pseudocysts was difficult.The treatment should be performed early for those patients who had developed complications.

Effects of two styles of pancreaticojejunostomy following pancreaticoduodenectomy on postoperative complications / 中华消化外科杂志

Objective To analyze postoperative complications of duct-to-mucosa pancreaticojejunostomy and side-to-end or end-to-end pancreaticojejunostomy following pancreaticoduodenectomy.Methods The clinical data of 342 patients who underwent pancreaticoduodenectomy at the West China Hospital of Sichuan University from June 2004 to May 2008 were retrospectively analyzed.All patients were divided into the duct-to-mucosa group (179 cases)and side-to-end or end-to-end group(163 cases)according to the styles of pancreaticojejunostomy.The relationship between the incidence and severity of postoperative complications of the 2 anastomotic styles were analyzed according to the Clavien grading system.The measurement data and the count data were analyzed using the t test or chi-square test.Results The overall complication rate was 48.8％(167/342),and the complication rate was 38.0％(68/179)in the side-to-end group and 60.7％(99/163)in the side-to-end or end-to-end group,with a significant difference between the 2 groups(x2=17.667,P ＜0.05).The incidences of grade Ⅱ and grade Ⅴ complications were 16.8％(30/179)and 1.1％(2/179)in the duct-to-mucosa group,which were significantly lower than 28.2％(46/163)and 5.5％(9/163)of the side-to-end or end-to-end group(x2=6.484,5.316,P ＜0.05).Conclusion Compared with side-to-end or end-to-end pancreaticojejunostomy,duct-to-mucosa pancreaticojejunostomy is a better style with a lower incidence of postoperative complication.

Surgical management of chronic pancreatitis / 中华消化外科杂志

Eighty percent of patients with chronic pancreatitis were presented with symptoms of intractable pain.Patients with chronic pancreatitis were at risk of losing the endocrine and exocrine function of the pancreas as the advance of the disease.The main objective of surgical management of chronic pancreatitis includes pain alleviation and pancreatic endocrine and exocrine function improvement.This paper analyzes the strategics of surgical procedure selcction and thc time,indication for surgical intervention.

Clinical efficacy of Frey and Beger procedures for chronic pancreatitis / 中华普通外科杂志

Objective To analyse clinical efficacy of Frey and Bger procedures for chronic pancreatitis. Methods Clinical data of seventy patients of chronic pancreatitis undergoing Frey (32 cases) and Beger Procedures (38 cases) in our hospital from January 1999 to June 2009 were retrospectively analyzed,the rate of pain relief and endocrine and exocrine function of the pancreas in longterm follow-up were compared with each other. Results Overall perioperative morbidity for Frey group and Beger group was 12. 5% and 7.9% respectively (P =0. 52); Total pain relief rate in long-term follow-up was 96. 8% and 94. 7% respectively (P =0. 57). Postoperative de novo diabetes mellitus was 12. 5% and 21% ( x2 = 0. 90, P = 0. 34), Rate of steatorrhea was 12. 5% and 18.6% respectively ( x2 = 0. 15, P =0. 70). Conclusions Frey and Beger procedures were equally effective in improving symptoms of chronic pancreatitis and there were no significant differences in perioperative morbidity, rate of pain relief and function of endocrine and exocrine of the pancreas.