Analysis of prognostic factors for hyperamylasemia following pancreaticoduodenectomy / 中华外科杂志

Objective@#To investigate the prognostic factors of hyperamylasemia following pancreaticoduodenectomy (PD) .@*Methods@#Clinical data of 359 patients were collected prospectively who underwent PD by the same group at Changhai Hospital of Navy Medical University from January 2017 to June 2018.There were 212 males and 147 females.The median age was 63 years old (range: 23 to 82 years old) .According to whether the patient′s serum amylase was greater than 120 U/L at 0 or 1 day after surgery,the patients were divided into hyperamylasemia group and non-hyperamylasemia group. Univariate analysis and multivariate analysis were used to find out the prognostic factors of hyperamylasemia after PD.@*Results@#Of the 359 patients, 238 cases (66.3%) developed hyperamylasemia.The incidence rate of clinically related pancreatic fistula (15.1% vs.2.5%, P<0.01) , grade B/C post pancreatectomy hemorrhage (8.8% vs. 2.5%, P<0.01) , and surgical site infection (9.2% vs. 3.3%, P=0.04) was significantly higher in the hyperamylasemia group.The severity of complications (CD grade≥Ⅲ: 11.3% vs.4.1%, P=0.023) and postoperative hospital stay (11 days vs. 9 days, P=0.001) were higher in the hyperamylasemia group.In the multivariate analysis, the main pancreatic duct diameter (MPD) ≤3 mm (OR=4.469, 95% CI: 2.563-7.793, P<0.01) , pathological type of disease (pancreatic cancer or pancreatitis) (OR=0.230, 95% CI: 0.122-0.436, P<0.01) and soft texture of pancreas (OR=3.297, 95%CI: 1.930-5.635, P<0.01) were independent prognostic factors for hyperamylasemia.@*Conclusions@#Post-PD hyperamylasemia increased the incidence and severity of postoperative complications after PD.MPD≤3 mm, soft texture of pancreas and pathological type of disease were independent prognostic factors of hyperamylasemia.

Robot-assisted distal pancreatectomy: a study on 61 patients / 中华肝胆外科杂志

Objective To study the effect of robot-assisted distal pancreatectomy.Methods 63 patients who were originally scheduled for robot-assisted distal pancreatectomy were vetrospectively analyzed from July 2013 to June 2017 in Changhai Hospital.Results The operations were successfully carried out in 61 patients.One patient was converted to open surgery because of extensive adhesions,and another patient underwent local excision of a pancreatic tumor.17 patients underwent robot-assisted spleen-preserving distal pancreatectomy,and 44 patients robot-assisted distal splenopancreatectomy.The mean operative time was 164.1 minutes.The intraoperative blood loss was 153.7 ml.Only 1 patient received 400 ml.of blood transfusion.The rate of postoperative pancreatic fistula was 45.9％.The rates of biochemical fistula and level B fistula were 37.7％ and 8.2％,respectively.No level C fistula was observed.Conclusion Robot-assisted distal pancreatectomywas an efficacious and safe technique with its unique advantages in spleen-preserving operations.

Isolation of superior mesenteric artery and resection of mesentery root is beneficial for radical pancreaticoduodenectomy in the treatment of pancreatic ductal adenocarcinoma / 中华胰腺病杂志

Objective To improve the prognosis and radical resection of the extended pancreaticoduodenectomy for patients with pancreatic cancer in the ucinate process involving mesentery mot. Methods From Jan. 2004 to Dec. 2007, a total of 23 ( 14 male and 9 female, aged between 30 and 72 years old) patients with pancreatic cancer in the ucinate process involving mesentery root were treated in our department. Curative resection was performed for all patients by the extended pancreaticoduodenectomy with superior mesenteric artery (SMA) isolation and mesentery root resection. The surgical procedure, the safety and prognosis were analyzed retrospectively. Results 12 patients underwent the procedure, among them 11 also underwent combined SMV partial resection and reconstruction. The operation time was (4.2 ± 1.1 ) hours, and the blood loss was ( 1 635 ± 1 362) ml with the blood transfusion of ( 1 609 ± 1 462 ) ml. There was no operation related death in this case series, and mild to severe diarrhea occurred in 6 cases. The post-operative stay ranged 9 to 30 days. The pathological examination showed that the tumor size was (5.3 ± 1.4) cm. 13 patients (57%) had one or more lymph nodes metastasis. 20 patients (87%) had nerve involvement. Among 11 patients with SMV partial resection and reconstruction, 10 patients had endangium involvement. 22 patients had negative surgical margins for all specimens. Rapid intra-operative frozen pathological examination showed negative surgical margins in one patient, however, post-operative paraffin section pathological examination revealed nerve involvement between SMA and celiac trunk. After a follow-up of 5 to 42 months, liver metastasis occurred in 4 patients, and local recurrence occurred in 3 patients. The 1-year and 2-year accumulated survival rates were 77.2% and 42.5%, respectively. Conclusions Isolation SMA and the mesentery resection in extended pancreaticodudenectomy were safe and useful. Using this modified technique, Radical operation resection could be achieved in the treatment of pancreatic cancer in uncinate process.

Control of coexpression plasmid of carcinoembryonic antigen and IL-2 gene by internal ribosome entrying site / 中国普通外科杂志

ObjectiveTo construct the eukaryotic coexpression plasmid CEA/IL-2, and to lay the foundation for further studying CEA nucleiotide vaccine , adjuvant and their effects of special antitumor immunity.MethodsThe eukaryotic expression plasmid (pcDNA3-CEA)containing the gene coding for CEA was obtained by RT-PCR and gene recombination techniques.Using enzymolysis,ligation and other techniques,an eukaryotic coexpression plasmid (pIRES-CEA/IL-2)containing two expression unites of CEA and IL-2 gene connected with internal ribosome site was constructed.ResultsThe coexpression plasmids were transformed into COS7 cells and expression of two proteins were demonstrated by ELISA, and flow cytometer and elecsy.CEA and IL-2 were (23.73?0.26)ng/ml,and(20.17?0.13)ng/ml respectively.ConclusionsThe eukaryotic expression plasmids pIRES-CEA/IL-2 could be successfully constructed and transformed into COS7 cells.Expression of two proteins were demonstrated with no difference on expression.

Clinical comparative study on hypercoagulation in patients with gastric cancer or pancreatic cancer after operation / 中国普通外科杂志

0.05). Low shear stress and high shear stress of BRV in GC control group were (20.32?5.42)mPa?s and(7.96?3.16)mPa?s, respectively;those in GC LMWH group were (11.42?5.03)mPa?s and (3.96?3.07)mPa?s,respectively after operatin. Low shear stress and high shear stress of BRV were (21.82?6.17)mPa?s and ( 8.62 ?3.48) mPa?s,respectively in PC control group;those in PC LMWH group were (13.11?5.17)mPa?s and (4.96?3.61)mPa?s. After operation,there were no hemorrhagic complications in GC and PC LMWH groups. Conclusions Low shear stress and high shear stress of BRV rise generally seeing in GC and PC patients after operation,and in PC patients are higer than those in GC patients. The use of Low molecular weight heparin could reduce the occurrence of thrmbosis.