Pancreatic fistula after pancreaticoduodenectomy: Risk factors and preventive strategies

Purpose: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a worrisome and life-threatening complication. This study aimed to investigate the risk factors and preventive strategies for POPF after PD. Materials and Methods: We retrospectively reviewed 301 consecutive patients who underwent PD at our hospitals between January 2011 and December 2017. We analyzed the pancreatic fistula rate according to the clinical characteristics, pathologic and laboratory findings, and the anastomotic methods and summarized the prevention measures. Results: Postoperative morbidities included pancreatic leakage in 10.30% (31/301), delayed gastric emptying in 22.92% (69/301), abdominal infection in 6.98% (21/301), post-PD hemorrhage in 4.65% (14/301), and bile leakage in 4.98% (15/301), and the mortality rate was 2.33% (7/301). POPF was the most prominent factor for preoperative morbidity. Significant risk factors for pancreatic fistula were a soft pancreas, small pancreatic duct, tumor location, and interrupted anastomosis. Of these, soft texture, pancreatic duct <4 mm, and end-to-end anastomosis through hand suture closure were independent risk factors on multivariate analysis, while interrupted anastomosis, internal stent, and somatostatin use were risk factors in the high-risk pancreas subgroup. Conclusions: Our study demonstrated that pancreatic fistula is related to a soft texture and small pancreatic duct. The surgeon must consider these risk factors when performing PD. Thus, we propose a risk- and indication-adapted choice of anastomosis or an individualized approach for the pancreatic remnant to reduce the pancreatic fistula rate

Comparison of image quality and radiation doses of double lower extremities full-length photography by two X-ray exposure modes / 医疗卫生装备

Objective To compare two exposure modes on image quality and radiation dose when used for double lower extremities full-length photography so as to provide guidance for clinical application. Methods Totally 60 patients undergoing double lower extremities full-length photography were selected with sequential experiment and then divided into two groups randomly and equally,of whom,there were four ones with genu varum.In the two groups,one group applied the exposure mode of AEC,and the other involved in FIXED mode.Then the two groups were compared on image quality and radiation dose. Results The exposure radiation to the patient under FIXED mode was higher than that under AEC mode although the common patients had the image quality with no significant difference in the two groups, and FIXED mode resulted in higher image quality for the patients with genu varum than AEC mode.Conclusion Exposure modes have effects on image quality and exposure dose,and it's suggested that AEC mode be applied for common patients from the aspect of radiation protection while FIXED mode be used for the patients with genu varum. [Chinese Medical Equipment Journal, 2018,39(5):68-70,74]