Opinions on several issues concerning radical pancreaticoduodenectomy for pancreatic head carcinoma / 中华肝胆外科杂志

According our practice of raical pancreaticoduodenectomy for pancretic head carcinoma and combined with these reviews, we suggested the active and palliative pancreaticoduodenectomy should be aviod. Skeletonization of hepatoduodenal ligament and the retroperitoneal resection should be the routine procedure in pancreticoduodenectomy, and at least invovle two regional lymph nodes. In addition, regardless of the metastase of No 13 lymph node, ristricted retroperitoneal resection for resectable pancretic carcinoma was needed. Exposured the superior mesenteric artery and distinguished inferior of uncinate process of pancrease with the artery, were the key point of the uncinate process of pancrease resection. Preoperative evaluation of angiography and other images, the ratio of activeness and combination with vessel resection would be improved. The style of pancreaticojejunostomy could be selected by the experience of the operator, we are apt to the double-deck invaginated pancreaticojejunostomy. Additionally, utilization of the electronic surgical workstation, should be careful and also need to accumulate more experience.

Epidermoid Cyst in Hepatoduodenal Ligament

A 39-year-old man was admitted to our hospital because of an intermittent, epigastric, abdominal pain and abdominal bloating. Magnetic resonance Cholangiopancreatography (MRCP) showed a 4x6 cm sized heterogenous cystic mass in the hilum of the liver. The mass seemed not to have originated from the liver, but was rather located at the anterior portion of the inferior vena cava and the caudate lobe, and superior to the head of the pancreas. The common bile duct (CBD) was displaced laterally by the mass, but the other biliary tree was normal. A presumptively diagnosed hematoma or high- protein mucous component filled cystic mass was later proved to be a large mass located in the hepatoduodenal ligament on laparotomy, and was completely removed by meticulous dissection. The histopathological diagnosis confirmed an epidermoid cyst.

Clinical Analysis of Injury of Bile Duct System during Operation for Gastric Cancer and Postoperative Changes of Liver Function Tests / 한국간담췌외과학회지

BACKGROUND/AIMS: Hepatoduodenal ligament lymph node (LN) dissection has been performed as a part of extended LN dissection during the operation for gastric cancer. And additional cholecystectomy has been performed for more radical node dissection and prevention of cholelithiasis in some centers. There are rare studies and reports about the injury of bile duct system with the operation for gastric cancer. The aim of this study is to evaluate the risk of biliary tree injury with LN dissection for gastric cancer. METHODS: 254 patients of gastric cancer were treated with gastrectomy with LN dissection at Kangnam general hospital between January 1996 and December 2001. Among this group, 151 patients of advanced gastric cancer underwent extended LN dissection of D2+alpha or D3 including hepatoduodenal ligament LN and 69 patients of early gastric cancer underwent D2. And we routinely conducted cholecystectomy for advanced and early gastric cancer. Of these patients, 5 cases without remained or recurred tumor of bile leakage after operation were reviewed. And we analyzed the changes of liver function tests (LFT) of 15 patients of early gastric cancer and 21 patients of advanced gastric cancer whose LFT follow-up data were available. RESULTS: The rate of bile leakage was 2.3% (5 patients) after LN dissection of hepatoduodenal ligament for gastric cancer. Among this group, 3 patients underwent reoperation due to unexpected bile leakage and 2 patients underwent T tube choledochostomy due to minor injury to common hepatic duct on operation. One patient died of sepsis with continued bile leakage after T tube removal on the postoperative 41st day. The serum alkaline phosphatase was increased after operation especially in advanced gastric cancer without clinical significance and there was no other significant abnormality in LFT after hepatoduodenal LN dissection and cholecystectomy in non-recurrent cases. CONCLUSION: Extended lymph node dissection including hepatoduodenal ligament LN and cholecystectomy may have the possibility of increasing the risk of bile duct injury. It is important to select the patients who will benefit from hepatoduodenal ligament LN dissection and cholecystectomy. And meticulous surgical technique to operate biliary tract and adequate management of biliary injury are needed.

The Normal Anatomy and CT Study of HDL / 实用放射学杂志

Objective To study the normal anatomy and pathologic CT findings of HDL and compare the HDL dimension of two conditions.Methods 160 consecutive CT scans of the normal upper abdomen were reviewed and 19 cases of cadavers were used.Results There was no statistics differences between the cadavers and normal subjects on HDL.Conclusion The real dimension of HDL can be replaced by the measurement on CT image,CT is a accurate means of measuring HDL in vival of human being.