Résumé
Objective:To explore the safety of laparoscopic antegrade modular pancreatosplenectomy (L-RAMPS) through vascular axis approach in the treatment of pancreatic body and tail adenocarcinoma.Methods:The clinical data of 12 patients with pancreatic body and tail adenocarcinoma undergoing L-RAMPS in Department of Hepatobiliary Pancreatic Surgery, Anhui No.2 Provincial People's Hospital from April 2021 to December 2022 were retrospectively analyzed, including eight males and four females, aged (65.8±11.6) years. Data regarding operative time, intraoperative blood loss, anal exhaust time, postoperative hospital stay, lymph node dissection, pathology, and postoperative complications, and survival were analyzed.Results:The procedures were successfully completed in all 12 patients. Eight patients underwent anterior L-RAMPS, four underwent posterior L-RAMPS. In one patient laparoscopic procedure was almost completed, but eventually conversed to open surgery due to vascular invasion. The operative time was (221.5±21.7) min, the intraoperative blood loss was (224.1±125.3) ml, the anal exhaust time was (3.5±1.0) d, and the postoperative hospital stay was (10.0±3.9) d. All patients underwent R 0 resection, and (15.1±3.7) lymph nodes were dissected. Positive lymph nodes were confirmed in four patients. Six patients had postoperative pancreatic fistula. The patients had been followed up for a median time of 9.5 (3.2-15.0) months, and three patients died. Conclusion:The vascular axis approach could optimize the L-RAMPS surgical approach and improve surgical safety.
Résumé
Objective: To explore the efficacy of 125I particle bile duct intraluminal and intratumoral implantation for treatment of unresectable pancreatic head carcinoma (PHC). Methods: Clinical data of 72 patients with unresectable PHC were analyzed retrospectively. Among them 37 patients were treated with 125I particle bile duct intraluminal and intratumoral implantation (125I group), and 35 cases underwent laparoscopic palliative surgery (PS group). The postoperative liver function, complications, medial survival time and survival rate at the end of follow-up were compared between the two groups. Results: The levels of serum total bilirubin, alanine aminotransferase and aspartate aminotransferase significantly decreased compared with those of preoperation, the level of serum albumin significantly decreased at 1, 3 and 6 months of postoperation in both groups, especially in 125I group at 3 and 6 months of postoperation (all P<0.05). The incidence of postoperative complications was 28.57% (10/35) in PS group and 21.62% (8/37) in 125I group, and there was no significant difference between the two groups (P=0.496). The medial survival time was 9 months in PS group and 11 months in 125I group (P=0.041). Conclusion: 125I particle bile duct intraluminal and intratumoral implantation can effectively alleviate symptoms of bile duct obstruction and prolong survival time of PHC patients.