Pancreatic fistula after duct-to-mucosa pancreaticojejunostomy / 中华普通外科杂志

Objective To investigate the risk factors for pancreatic fistula after duct-to-mucosa pancreaticojejuuostomy (PD). Methods The clinical data of 101 cases undergoing duct-to-mucosa PD in our hospital from January 1994 to January 2008 were reviewed retrospectively. Results The incidence of pancreatic fistula was 9.9% (10/101). Univariate analysis showed level of preoperative jaundice(χ2=5.814, P= 0.016) , duration of jaundice (χ2= 4.17, P = 0.041 ), texture of the remnant pancreas (χ2=5.286, P = 0.021 ), diameter of pancreatic duct (χ2= 4.165, P = 0.041 ), blood loss during operation (χ2=5.273, P=0.022) were significantly associated with pancreatic fistula after duct-to-mucosa PD. Multivariate analysis regression revealed that texture of the remnant pancreas (OR = 13.355, P = 0.023), level of preoperative jaundice (OR = 12.126, P = 0.006), blood loss during operation (OR = 5.92, P =0.032 ) were independent risk factors. Logistic regression equation was as following: P=1/[<1+e-(-6.378+2.592 texture of the remrant pancress + 2.495 level of preopetative jaundice + 1.778 blood loss during operative)>]. The accuracy of the logistic equation was 92.1%. Conclusion Texture of the remnant pancreas, level of preoperative jaundice, blood loss during operation were the independent risk factors for the occurrence of PD after duct-to-mucosa PD. Improvement of operative technique and reduction of blood loss can decrease the incidence of pancreatic fistula.

Analysis of risk factors for intra-abdominal infection after pancreaticoduodenectomy / 中国综合临床

Objective To study the risk factors for intra-abdominal infection after pancreaticoduodenecto-my. Methods Clinical data of 101 cases undergoing pancreaticoduodenectomy in our hospital from January 1994 to January 2008 were reviewed retrospectively. The risk factors were analyzed. Results The incidence of intra-abdomi-hal infection was 12.9% (13/101). Univariate analysis showed postoperative pancreatic,biliary and intestinal fistu-la,pulmonary infection,preoperative acute cholangitis and texture of the remnant pancreas were the risk factors for intra-abdominal infection(P<0.05). Multivariate Logistic regression revealed that postoperative pancreatic, biliary and intestinal fistula, pulmonary infection, preoperative acute cholangitis were independent risk factors (OR = 11.914,9.891 and 7.197 ) of intra-abdominal infection after pancreaticoduodenectomy. Conclusion Preventing and curing pancreatic ,biliary and intestinal fistula, pulmonary infection, preoperative acute cholangitis can decrease the incidence of intra-abdominal infection.

The diagnosis, treatment and clinicopathologic analysis on gastrointestinal neuroendocrine carcinomas / 中国普通外科杂志

Objective To investigate the clinicopathologic features of gastrointestinal neuroendocrine carcinomas. MethodsThe diagnosis and treatment results of 45 cases were studied, and clinicopathologic features and immunohistochemical expressions of NSE, Syn and CgA were detected.ResultsMicroscopically carcinomas were divided into three types: type Ⅰ(25 cases), type Ⅱ(10 cases) and type Ⅲ(10 cases). The histologic categories were correlated with lymph node metastasis significantly( P0.05). The 5-year survival rate for type Ⅰ, type Ⅱ and type Ⅲ was 70%, 65% and 52%, respectively.ConclusionsThe combination of NSE, Syn and CgA immunohistochemical stainnig is necessary for the diagnosis of gastrointestinal neuroendocrine carcinomas. The histologic classification is coincident with the requirement of clinical treatment and prognosis.