The use of subcutaneous jejunum blind loop in pancreatoduodenectomy / 中国普通外科杂志

Objective To improve the technique of pancreatoduodenectomy in order to facilitate the(management) of complications and direct observation on follow up.Methods Pancreatoduodenectomy and Child′s method of digestive tract reconstruction was performed in 42 paltents.A blind loop of jejunum 5 to 6 cm in length was constructed beyond the pancreatojejular anastomosis and it was fixed to the subcutaneous(tissue) of the adjacent abdominal wall.Results Thirty-two cases recovered uneventfully,and 10 cases had complications induding pancreatic and biliary leakage and hemorrhage.These complications were successfully treated under direct vision by choledochoscope passed into the blind jejunal loop.This method of observation was used for long-time follow up in 22 cases,and revealed ercurrent tumor(n=5),bile duct stricture(n=4) and bile duct ascariasis(n=1).Conclusions This operative method did not cause new(complications) and it can be combined with the traditional operation.Postoperatively,direct observation and management of leakage of pancreatojejular anastomosis and biliointestinal anastomosis and hemorrhage can be accomplished,and the anastomoses and pancreatic stump can be directly observed at followup.

Clinical analysis of postoperative complications of pancreatoduodenectomy in 139 cases / 中国普通外科杂志

Objective To analyse the causes of postoperative complications of pancreatoduodenectomy(PD) and study measures for prevention and treatment of the complications.Methods A retrospective study was carried out on the data of 139 cases of pancreatoduodenectomy performed during recent 3 years in our(hospital).They included 91 cases of radical resection operation and 43 cases of pancreatoduodenectomy(combined) with vascular resection.Results There were 38 cases(27.4%) occurred complications after PD,including 10 cases(7.2%) of upper gastrointestinal hemorrhage,4 cases(2.9%) of hemorrhage in the abdominal cavity,and 6(4.3%) cases of pancreatic leakage,4cases(2.9%) of bile duct leakage,3((2.2%)) cases of intra-abdominal infection,5 cases(3.6%) of pulmonary infection,and 6 cases((4.3%)) of functional delayed gastric emptying.Four cases died during the peri-operative period.The overall mortality rate were 2.9%.Conclusions The main complications after PD were hemorrhage,pancreatic leakage,bile duct leakage and intra-abdominal cavity infection.Meticulons operative technique,the selection of appropriate anastomoses technique,careful observation and timely aggressive management in the postoperative period are the key points to reduce postoperative morbidity and motality rate after PD.

Advances of preventing pancreatic fistula after pancreaticoduodenectomy / 中国普通外科杂志

Objective To explore the methods of decreasing pancreatic fistula rates after pancreaticoduodenectomy. Methods This paper was made on the review of recent literatures about preventing pancreatic fistula after pancreaticoduodenectomy. Results Pancreatic fistula is still one of the main common complications of pancreaticoduodenectomy. Pancreatic stamp is managed mostly by pancreato enteric or pancreato gastric anastomosis. Ligation of the pancreatic duct and total pancreatectomy have reduced gradully. It is still undertermined that perioperative somatostatin can prevent pancreatic fistula. Conclusions The key point of deteasing pancreatic fistula rate of pancreaticoduodenectomy is to master all sorts of ways in managing the pancreatic stump.

Analysis of post-pancreatoduodenectomy diarrhea:a report of 71 cases / 中国普通外科杂志

Objective To explore the etiology,mechanism and treatment of diarrhea after(pancreatoduodenectomy).Methods Based on the clinical data of 159 cases of pancreatoduodenectomy(performed) in the recent one and half years,the pathogenesis of post-pancreatoduodenectomy diarrhea was(analyzed) and the effect of different treatments was observed.Results Seventy-one cases had diarrhea,with an incidence of 44.7%.Tweenty-two cases had bacterial infection of the intestinal tract and 4 cases had fungus infection.The incidence of infection was 36.6%.In 64 cases diarrhea was relieved with effective treatment,accounting for 90.1% of all cases.Seven cases with chronic diarrhea had additional treatment with oral pancreatic enzyme and symptoms were relieved 2 weeks after treatment.Conclusions Diarrhea is frequently observed in patients after pancreatoduodenectomy,and the majority of them can be cured with(treatment) selected according to the pathogenesis.

Influencing factors of intra-abdominal infectious complications after pancreatoduodenectomy / 中国普通外科杂志

Objective To investegate the influencing factors of intra-abdominal infectious complications after pancreatoduodenectomy(PD). Methods The postoperative intra-abdominal infectious complications occurrence rate and the influencing factors after PD in 196 patients in recent 7 years were retrospectively analyzed.Results After PD,the rate of postoperative intra-abdominal infections was significantly higher than the rate of other complications. The rate of intra-abdominal infections in patients with near normal pancreatic remnent and with pulmonary infections were significantly higher than those in with harder pancreatic remnant and without pulmonary infections(P