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Objective To analyze postoperative complications of duct-to-mucosa pancreaticojejunostomy and side-to-end or end-to-end pancreaticojejunostomy following pancreaticoduodenectomy.Methods The clinical data of 342 patients who underwent pancreaticoduodenectomy at the West China Hospital of Sichuan University from June 2004 to May 2008 were retrospectively analyzed.All patients were divided into the duct-to-mucosa group (179 cases)and side-to-end or end-to-end group(163 cases)according to the styles of pancreaticojejunostomy.The relationship between the incidence and severity of postoperative complications of the 2 anastomotic styles were analyzed according to the Clavien grading system.The measurement data and the count data were analyzed using the t test or chi-square test.Results The overall complication rate was 48.8％(167/342),and the complication rate was 38.0％(68/179)in the side-to-end group and 60.7％(99/163)in the side-to-end or end-to-end group,with a significant difference between the 2 groups(x2=17.667,P ＜0.05).The incidences of grade Ⅱ and grade Ⅴ complications were 16.8％(30/179)and 1.1％(2/179)in the duct-to-mucosa group,which were significantly lower than 28.2％(46/163)and 5.5％(9/163)of the side-to-end or end-to-end group(x2=6.484,5.316,P ＜0.05).Conclusion Compared with side-to-end or end-to-end pancreaticojejunostomy,duct-to-mucosa pancreaticojejunostomy is a better style with a lower incidence of postoperative complication.
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We present a 16-year-old boy with complete major pancreatic duct disruption in pancreatic neck. According to the American Association of Surgical Trauma Classification, the patient was diagnosed with pancreatic injuries grade IV and pseudocyst which was managed successfully by way of Ultrasound-guided percutaneous catheter drainage
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Objective To explore the main causes for death due to severe acute pancreatitis (SAP) to improve the level of diagnosis and treatment. Methods The clinical data of 1162 SAP cases treated in our hospital from June 1997 to May 2005 were retrospectively analyzed. Among which, 144patients (12. 39%) died, 82(7.06%)abandoned treatment and 936(80.55%)were cured. Results the APACHE Ⅱ scores and pancreas Balthazar CT scores of the death group were higher than that of the survival group. The percentage of single one organ dysfunction and multiple organ dysfunction syndrome (MODS) was significantly higher in the death group than in the survival group. The mortality rate of SAP without obvious inducing factors was significantly higher than that of SAP with inducing factors. Conclusion Integrated traditional and western non-surgical treatment is effective for SAP.The treatment for SAP without obvious inducing factors is a challenge. The mortality rate of SAP is primarily related to the pathological changes of pancreas and the patient's general condition. Early diagnosis and treatment is important to decrease mortality rate and maintaining the function of important organs is basic to ensure curative effect.
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We performed a simultaneous pancreas-kidney transplantation (SPK) for type 2 diabetes complicated with end-staged renal disease (ESRD) in March, 2007. The recipient was a 65-year old male, who suffered type 2 diabetes for 15 years and renal dysfunction for 5 years and other diabetic complications such as retinopathy and peripheral neuropathy. SPK was performed successfully for him, in which the kidney was placed in the left iliac fossa, while the pancreas in the right iliac fossa, with an entedc drainage for pancreas exocrine and a systemic drainage for endocrine. Serum C-peptide, creatinine and blood urea nitrogen reached normal levels on day 1,4 and 11 post-transplant, respectively. Blood glucose became stabilized gradually to normal level and therefore the injected insulin was stopped on day 16 post-transplant. Oral glucose tolerance test (OGTT) showed the function of grafted pancreas was normal after 3 weeks of transplant, and no transplant-related complications occurred. With the recipient followed up for 20 months, both his blood glucose level and renal function maintained normal without using insulin.
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OBJECTIVE: To investigate the mechanism of Chaiqin Chengqi Decoction (CQCQD), a compound of traditional Chinese herbal medicine, acting on the pancreatic acinar cell calcium overload in rats with acute pancreatitis (AP). METHODS: A total of 30 SD rats were randomly divided into normal control group, untreated group and CQCQD group (n=10, respectively). AP was induced in rats by caerulein (5x50 mug/kg) intraperitoneal injection within 4 h. The pancreatic tissue SERCA1 and SERCA2 mRNA expressions were detected by fluorescent quantization polymerase chain reaction method; intracellular calcium fluorescence intensity (FI) of pancreatic acinar cells and the pancreatic pathological score were measured by laser scanning confocal microscopy and light microscopy respectively. RESULTS: There were no SERCA1 mRNA expressions in pancreatic acinar cells of rats in the normal control group and the untreated group. The expression of pancreatic SERCA2 mRNA in the untreated group was down-regulated compared with that in the normal control group (expression ratio=0.536; P=0.001); the expression of pancreatic SERCA2 mRNA in the CQCQD group was up-regulated compared with that in the untreated group (expression ratio=2.00; P=0.012). The pancreatic pathological score in the CQCQD group was lower than that in the untreated group and the FI of Ca(2+) was also lower. CONCLUSION: CQCQD can up-regulate the expression of pancreatic SERCA2 mRNA, release the calcium overload, and hence reduce the pathological changes in pancreatic tissue.
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OBJECTIVE: To investigate the therapeutic effect of Yihuo Qingxia method, a traditional Chinese medicine therapeutic method for replenishing qi to activate blood, clearing away heat and dredging intestines, in treating hyperlipoidemia-related severe acute pancreatitis (SAP) in early stage. METHODS: One hundred and four patients with hyperlipoidemia-related SAP were divided into two groups: early group (admitted to hospital within 3 days after onset) and late group (admitted to hospital from 3 days to 7 days after onset). There were 52 cases in each group. All the patients were treated by Yihuo Qingxia method. RESULTS: There were no statistical differences in 48-hour Ranson scores, CT scores, 24-hour acute physiology and chronic heath evaluation II scores (APACHE II scores), and the levels of 24-hour serum triglyceride (TG) and serum glucose in the two groups (P>0.05). At the 10th day after onset, the serum TG level in early group was lower than that in late group (P<0.01). The incidences of acute respiratory distress syndrome, acute renal failure, hepatic inadequacy, congestive heart failure, shock, encephalopathy, infection and alimentary tract hemorrhage in early group were higher than those in late group (P<0.05). The mortality in early group was lower than that in the late group (P<0.05). The length of hospital stay in early group was shorter than that in late group (P<0.05). CONCLUSION: Yihuo Qingxia method has a good efficacy in treating hyperlipoidemia-related SAP in early stage.
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Objective To study the change of pancreatic microcirculation in the early phase of acute pancreatitis. Methods Literatures on acute pancreatitis and microcirculation were collected and reviewed.Results Pancreatic microcirculation has changed in the early phase of acute pancreatitis, including contraction of interlobular arteriole, slowing of blood fluid, increasing of pancreatic vascular permeability, leukocyte adherence in postcapillary venules, and decreasing of pancreatic perfusion.Conclusion Impairment of pancreatic microcirculation in the early phase of acute pancreatitis may play a key role in the progression of this disease.
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Objective To study the influence of clinicopathologic characteristics and surgical treatment of gastric cancer on patients' survival rate.Methods From Apr.1994 to Aug.2005, the data of 759 gastric cancer patients concerning surgical treatment, pathological diagnosis and outcome were collected. Retrospective analysis of the results was made, 3-year and 5-year survival rates were calculated by Kaplan-Meier curve method, univariate analysis was done through Log-rank and multiple factors comparison through Cox regression analysis, and follow-up duration was 4-131 months.Results Single factor analysis indicated that age,tumor location,diameter of tumor, Borrmann type, type of histology, TNM stage, depth of infiltration, lymph node metastasis, liver metastasis, peritoneal dissemination, blood of transfusion during operation, extent of the radical cure of the tumor and excision techniques were significantly influential factors for the prognosis of patients. Cox regression analysis showed that tumor location, diameter of tumor,depth of infiltration, lymph node metastasis,liver metastasis, TNM stage, peritoneal dissemination, blood transfusion during operation, extend of the radical cure of the tumor and excision techniques were independent factors influencing the postoperative survival rate.Conclusion Independent factors influencing the postoperative survival rate include tumor location, diameter of tumor, lymph node metastasis, infiltration depth of the tumor, pathological classification, liver metastasis, peritoneal dissemination, and TNM stage, extent of the radical cure of the tumor, lymphanodectomy techniques and blood transfusion during operation are also important factors.
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Objective To establish the model of pancreatoduodenal allotransplantation in pigs with enteric drainage (ED) and portal venous drainage (PVD). Methods Forty-six hybrid landraces were divided into two groups (donor and recipient groups) randomly, for pancreatoduodenal allotransplantation. Donors were perfused via abdomial aorta without clamping the portal venous outflow with UW solution after heparinization. Whole pancreatoduodenal graft was harvested with segments of abdomial aorta and portal vein and shaped under cold UW solution. Then, the end-to-end anastomosis was performed with the donor iliac artery bifurcation “Y” graft to the recipient superior mesenteric arteries and celiac artery. Furthermore, type Ⅰdiabete model was made by removal of the recipient pancreas. The venous anastomosis was reconstructed between the donor portal vein and the recipient superior mesenteric vein. Meanwhile, the end-to-side anastomosis was performed with the donor common iliac artery bifurcation “Y” graft to the recipient abdomial aorta and the side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum. External jugular vein was intubated for transfusion. The levels of blood glucose, insulin and glucagon in blood were measured before and during the operation and 1, 3, 5, 7 d after operation. Results Twenty-three cases of pancreatoduodenal allotranplantations were performed on pigs. One died from complication of anesthesia. Success rate of operation was 95.7%.Complications of operation happened in 2 cases in which one was phlebothrombosis, incidence 4.5% and the other was duodenojejunal anastomotic leak, incidence 4.5%. The level of blood glucose increased within 30 min and recovered on the 2nd day after removal of pancreas. The levels of insulin and glucagon decreased within 30 min and recovered on the 2nd day after removal of pancreas. Rejection curred at the 1st day and reached the worst level on the 9th day after transplantation without the change of insulin and glucagon in blood and clinical symptoms of rejection. Conclusion Pancreatoduodenal transplantation in pigs can treat type Ⅰ diabete. ED and PVD can keep the function of endocrine in normal. The techni- que of duodenal transplantation with ED and PVD may pave the way for the further development of pancreas transplantation in clinic.
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Objective To study the indication and means in dissection lymph nodes of the No.10 and No.11 without splenectomy in radical gastrectomy for gastric cancer. Methods According to the location, type of pathology, clinical and pathological classification, lymphatic drainage and spread of gastric carcinoma togather with the immunological function of spleen, selection of operative procedure without splenectomy should be considered, so the related literatures were reviewed. Results Retained spleen had been shown to improve 5 year survival of patients with gastric cancer of stage Ⅰ,Ⅱ and Ⅲ,splenectomy had been shown to improve 5 year survival of patients with gastric cancer of stage Ⅳ,whose carcinoma was infiltrating splenic and the lymph nodes of the No.10. The complications of different means of dissection of the lymph nodes made no difference.Conclusion Dissection of the lymph node without retained spleen or allogenic spleen transplantation is indicated for the patients with cancer of stage Ⅳ,whose spleen is invaded by the tumor.
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Objective To establish a mouse model of acute necrotizing pancreatitis.Methods Thirty six male ICR mice were randomly divided into control group ( n =6) and experimental group ( n =30). Each of the animals in the experimental group received 7 intraperitoneal injections of caerulein (50 ?g/kg body weight) in 0.9% NaCl at hourly intervals over 6 hours. The animals in the experimental group were killed at 9,18,24,48 and 72 hours respectively after the first caerulein injection. The control animals received the same volume of 0.9% NaCl without caerulein. The animals in the control group were killed at the 18th hour after the first intraperitoneal injection. The severity of acute necrotizing pancreatitis was evaluated in terms of amylase level, pancreatic weight/body weight and the histological changes. Variance analysis was employed in the processing of these data. Results Both amylase level and pancreatic weight elevated 9 hours after the first caerulein injection, and correlated with the course of pancreatitis. The maximums of both alterations were observed at the same time point (18 hours after the first injection of caerulein). Prominent interstitial inflammation and acinar cell necrosis occurred at the 18th hour, and the histological score for pancreatitis reached a maximum ( P
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Objective To evaluate a surgical procedure of low/ultralow colo-rectal(anal) anastomoses with sustaining bonding method after total mesorectal excision (TME) for lower rectal cancer. Methods After TME in 346 cases of lower rectal carcinoma, a sustaining anastomotic tube was inserted into the proximal colon, then the remnant was ligated and sutured. The rectal remnant no less than 1cm was preserved by colo-rectal anastomoses of modified Welch operation,while the rectal remnant no more than 1cm were preserved by colo-anal anastomoses with anal sphincter preservation. Results There was no perioperative mortality. Anastomotic leakage developed in 4 cases (1.2%), and anastomotic stenosis in 10 (2.9%). Postoperative 5 year survival and recurrence was 78.6%, 6.3% respectively. The defecation function was satisfactory in 82.6% cases. Conclusions Low/ultra-low colo-rectal(anal) anastomoses with sustaining bonding method after TME is safe and effective for lower rectal cancer.
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We summarized and evaluated the radical effect and feasibility of the ano-saving operation for low rectal carcinoma by reviewing literature in recent years about the operative indication, the excision dimension, total mesorectum excision, selection of operative mode, 5-year survival rate and follow-up of the anal saving operation in low rectal carcinoma.The main points are as follows: (1)The operative indication of ano-saving operation is done according to the location,invasion depth and pelvic lymphatic metastasis of low rectal carcinoma.(2)The preoperative digital anal examination,rectal intraluminal ultrasound,pelvic CT and MRI can direct the selection of operative indication.(3)The operation of low rectal carcinoma should adhere to total mesorectum excision,but the lateral lymphadenectomy is necessary.(4)The wtra low resection is the major operative mode for low rectal carcionoma.(5)We should simultaneously perform the ano-saving operation through treating and preventing hepatic metastasis.The ano-saving operation can not only have radical treatment effect,but also improve the quality of life in patients with low rectal carcinoma.
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ObjectiveTo evaluate the indication, the operation pattern and therapeutic effect of the ano-saving surgery in low rectal carcinoma. MethodsAccording to anorectal finger-examination, IRUS,and CT, 94 out the 161 rectal cancer patients were selected to have ano-saving surgery from August 1993 to December 1994.Excreting function, 5-year survival rate and local recurrence rate of the various operation were compared. ResultsThe perfomed rate of ano-saving operation in low rectal cancer was 58.4%. Among them, low anastomosis was done in 6 cases, ultra-low anastomosis in 48 cases,Park′s operation in 25 cases,and Bacon operation in15 . The death rate was 2.1%(2 cases).Incidence of anastomotic leakage after the surgery was 3.2%(3 cases), and only 13 cases had anastomotic narrowing(13.8%) within 1 year. The successful rates of excreting function after the surgery were respectively as follows: low anastomosis 100%, ultra-low anastomosis 97.9%,Park′s surgery 88.0%,and Bacon surgery 53.3%. The 5 year survival rates and the local recurrence rates were respectively,as follows: low anastomosis 83.3% and 0; ultra-low anastomosis 79.2% and 4.2%; Park′s 64.0% and 12.0%; and Bacon 66.7% and 13.3%,respectively. ConclusionsUltra-low colo rectum anastomosis becomes the main operative pattern to preserve anal sphincter in low rectal cancer.There is no difference in the 5-year survival rate and the excreting function among low, ultra-low anastomosis and Park′s operation, but the low and ultra-low colo-rectum anastomosis were obviously better than that of Bacon and Miles operation.The local recurrence rates of low and ultra-low colon-rectum anastomosis are lower than that of Miles′.There is no difference in the 5-year survival rate and local recurrence rate between Park′s, Bacon and Miles operation.
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ObjectiveTo classify chronic pancreatitis (CP) based on pathological features and evaluate the benefits of different surgical procedures according to the pathological forms. Methods Forty CP cases during recent 9 years who underwent surgical therapy were retrospectively reviewed in association with clinicopathological analysis. Results Postoperative pain-relief rate was 79.16% in patients treated with longitudinal pancreaticojejunostomy(LPJ). In cases without enlarged pancreatic head or diverticulum of duodenum, postoperative pain-relief rate was 86%.Postoperative pain-relief rate was high by Whipple′s procedure, pylorus-preserving pancreaticoduodenectomy or Beger duodenum-preserving pancreatic head resection,while postoperative diabetes mellitus developed in 22%.Conclusions Both pathological form and operative procedure were factors influencing outcomes of CP.LPJ is still a main surgery for most CP patients with pancreatic fibrosis and dilated pancreatic duct and pancreatic stone.Some patients of CP with enlarged pancreatic head, hyperplasia of pancreatic parenchyma and pancreatic duct epithelia or complicated with diverticulum of the duodenum should be treated with resections targeting at the head of the pancreas.
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ObjectiveTo evaluate a new coloanal anastomosis preserving dentate line and anal sphincter. Methods After total mesorectal excision in 87 patients with low rectal carcinoma, the rectum no more than 1cm above the dentate line was preserved. The rectal mucosa was stripped and the dentate line was saved, then a sustaining anastomotic tube was fixed into the proximal colon, and the colon was pulled down and anastomosed with the remnant rectum 0.5cm above the dentate line. Results The ultralow coloanal anastomosis with anal sphincter preservation was accomplished. No perioperative death and anastomotic leakage occurred. The patients were followed up for 2 to 6 months and the follow-up rate was 89%. There was no anastomotic recurrence. Soft tissue recurrence in pelvic cavity was found in 3 cases, lymph node recurrence in obturator space recurrence in 2 cases and liver metastasis in 6 cases. Anastomotic stenosis was found in 6 cases 12 months later. The defecation function returned to normal six months after operation. Conclusions The sustaining banding method in the ultralow coloanal anastomosis with anal sphincter preservation is a safe and reliable surgical procedure.