ABSTRACT
Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The retrospective case-control study was conducted.The clinicopathological data of 310 patients who underwent pancreaticoduodenectomy in the First Affiliated Hospital of Sun Yat-Sen University between January 2011 and December 2015 were collected.Observation indicators:(1) follow-up situations;(2) risk factors analysis of pancreatic fistula after pancreaticoduodenectorny.Follow-up using outpatient examination and telephone interview was performed to detect occurrence of pancreatic fistula and pancreatic fistula-induced rehospitalization or death up to June 2016.The univariate and multivariate analyses were respectively done using the chi-square test and logistic regression model.Results (1) Follow-up situations:310 patients were followed up for 6-60 months,with a median time of 31 months.During the follow-up,65 patients were complicated with pancreatic fistula,including 59 in grade B and 6 in grade C.Twenty-four patients received conservative treatment,and 41 received B ultrasound-guided catheter drainage.Of 65 patients,63 were improved and then discharged form hospital;2 in grade C of pancreatic fistula died of pancreatic fistula-related complications.(2) Risk factors analysis of pancreatic fistula after pancreaticoduodenectomy:univariate analysis showed that combined hypertension,cases with pancreaticoduodenectomy,operation time and pancreaticojejunostomy method were related factors affecting pancreatic fistula after pancreaticoduodenectomy (x2 =5.986,13.006,9.025,21.561,P＜0.05).The multivariate analysis showed that combined hypertension,operation time ＞ 6 hours and end-to-end telescopic pancreaticojejunostomy or biuding pancreaticojejunostomy were independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy (Odds ratio =2.465,1.880,2.719,6.190,95％ confidence interval:1.253-4.850,1.025-3.448,1.254-5.894,2.309-16.592,P＜0.05).Conclusion The combined hypertension,operation time ＞ 6 hours and end-to-end telescopic pancreaticojejunostomy or binding pancreaticojejunostomy are independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy.
ABSTRACT
Objective To investigate the security and validity of transabdominal preperitoneal prosthetic (TAPP) in treatment of incarcerated hernia.Methods One hundred and twenty-four patients with incarcerated hernia were divided into 2 groups by random pair method:observation group with treatment of laparoscopic reposition and TAPP (56 cases) and control group with treatment of open reduction and tension-free hernioplasty (68 cases).The operative time,hospital stay,bed time,hospital costs,recurrence rate and complication were compared between the 2 groups.Results All patients in observation group were received laparoscopic surgery successfully.The operation time,hospital stay,bed time in observation group were significandy shorter than those in control group [(37.52 ± 7.78) min vs.(44.23 ± 11.32) min,(4.53 ± 0.89) d vs.(6.85 ± 2.03) d,(9.30 ± 2.65) h vs.(12.63 ± 3.97) h],there were statistical differences (P ＜0.05).The hospital costs in observation group was significandy higher than that in control group [(9 324 ± 599) yuan vs.(7 203 ± 507) yuan],there was statistical difference (P ＜ 0.05).There was no statistical difference in complication rate between the 2 groups (P ＞ 0.05).Follow-up 1 year,there was no recurrence patient in observation group and 1 patient was recurrence in control group,there was no statistical difference between the 2 groups (P ＞ 0.05).Conclusions TAPP is safe and effective with advantages of mini-invasion,quicker recovery but more hospital costs in treatment of incarcerated hernia.The recurrence rate of TAPP is similar to tension-free hernioplasty.