RESUMO
Objective:To study the clinical characteristics and management strategies of late bleeding after laparoscopic pancreaticoduodenectomy (LPD).Methods:The clinical data of 58 patients with post-pancreaticoduodenectomy hemorrhage (PPH) admitted to the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from March 2018 to March 2022 were retrospectively analyzed, including 42 males and 16 females, aged (61.88±11.02) years old. According to the occurrence of intra-abdominal erosion factors (e.g., pancreatic fistula, biliary fistula, gastrointestinal anastomotic fistula, intra-abdominal abscess), patients were divided into the erosion group ( n=42) and non-erosion group ( n=16). All patients underwent standard lymphadenectomy. Clinical data including the PPH time-point, occurrence of rebleeding, and treatment outcomes were accessed. The management strategies of PPH in the two groups of patients were analyzed. Results:The PPH time-point in the erosion group and non-erosion patients was 8.00 (5.00, 19.25) d and 21.50 (12.75, 26.75) d, respectively ( P=0.001). PPH can occurred within one month after surgery in both erosion and non-erosion groups. In the erosion group, 31 cases (73.81%, 31/42) were treated by re-operation, two (4.76%, 2/42) by interventional radiology and nine (21.43%, 9/42) with conservative protocol, respectively. In the non-erosion group, five cases (31.25%, 5/16) were treated by re-operation, seven (43.75%, 7/16) by interventional radiology and four (25.00%, 4/16) with conservative protocol, respectively. The incidence of re-bleeding is higher in the erosion group [47.6% (20/42) vs 12.5% (2/16), P<0.05]. Clinical manifestations, sites and severity of bleeding, and treatment outcomes were also different in the erosion and non-erosion groups (all P<0.05). Conclusions:The occurrence of intra-abdominal erosion factors can affect the clinical characteristics and treatment strategy of late bleeding after laparoscopic pancreaticoduodenectomy. Surgery remains the treatment of choice for post-pancreaticoduodenectomy hemorrhage either as an urgent or last resort.
RESUMO
Objective:To study the single purse-string parachute suturing technique for pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy, and to determine its feasibility and safety.Methods:The clinical data of 71 patients who underwent laparoscopic pancreaticoduodenectomy using the single purse-string parachute suturing technique for pancreaticojejunostomy from October 2018 to October 2021 at the Second Hospital of Hebei Medical University were retrospectively analyzed. There were 41 males and 30 females, with age (59.1±9.7) years old. The operative time, intraoperative blood loss, complication rate and other data were analyzed.Results:All 71 patients successfully underwent total laparoscopic pancreaticoduodenectomy, with 5 patients who underwent 2D laparoscopic surgery and 66 patients 3D laparoscopic surgery. There were additional vascular resection and reconstruction in 2 patients. The operative time was (388.9±92.9) min, the intraoperative blood loss was (411.3±176.9) ml, and the postoperative hospital stay was (14.1±5.8) d. The operation time of 71 patients who underwent the single purse-string parachute technique of pancreaticojejunostomy was (26.9±6.8) min. Postoperative complications occurred in 18 patients (25.4%). Grade B pancreatic fistula occurred in 2 patients (2.8%), and the longest time for removal of abdominal drain was 17 days after operation. Among the 71 patients, complications including biliary fistula occurred in 6 patients (8.5%), delayed gastric emptying in 5 patients (7.0%), pulmonary infection in 4 patients (5.6%), non-pancreatic fistula-related abdominal infection in 4 patients (5.6%), non-pancreatic fistula-related abdominal bleeding in 1 patient (1.4%), biliary tract bleeding in 1 patient (1.4%), and chylous leakage in 2 patients (2.8%).Conclusion:The single purse-string parachute technique of pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy had the advantages of being safe and reliable. The procedure is worthy of furthers promotion.
RESUMO
Objective To introduce the detailed surgical procedure of parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD),and to study its clinical results.Methods A retrospective study was conducted on 31 patients who underwent parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy between January 2016 and June 2018 in our department.Results Of 31 patients who underwent total laparoscopic pancreaticoduodenectomy,5 patients underwent two-dimensional (2D) LPD and 26 underwent three-dimensional (3D) LPD.Total mesopancreas excision (TMpE) was performed in 12 patients,including 2 patients combined with PV-SMV segmental resection and reconstruction.The mean operative duration,and mean estimated blood loss,post-operative hospital stay were 412.8 ± 102.4 min,462.8 ± 396.7 ml,14.7 ± 8.9 d,respectively.The operating time of parachute-like-suture double-pouch pancreaticojejunostomy was 29.7 ± 6.8 min (20 ～45 min).Post-operative complications occurred in 8 patients (25.8％),3 of whom suffered from more than two types of complications.There were 2 patients (6.5％) with postoperative B/C grade pancreatic fistula,4 patients with postoperative biliary leakage (12.9％),3 patients with delayed gastric emptying (9.7％),1 patient with portal vein thrombosis (3.2％) and 1 patient with peritoneal effusion (3.2％).One patient died during perioperative period due to gastrointestinal hemorrhage.Conclusions Parachute-like-suture double-pouch pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy was a simple,convenient,reliable method.It is worthy of clinical promotion and further studied.
RESUMO
Objective To assess the respective value and limitation of cardioangiography and ultrasonography in interventional therapy for congenital heart disease in children,and to discuss the clinical significance of the combined use of both examinations. Methods A total of 162 children with congenital heart disease,screened by ultrasonography,were enrolled in this study.The disorders included VSD(n=50),PDA(n=96)and PS(n=16).Before the interventional therapy all the cases accepted cardioangiography and ultrasonography examinations,and the diameter of the abnormal passage was measured.The difference in the diameter between two examinations was compared and statistically analyzed by using paired t test.All the cases accepted both examinations after the interventional therapy to check the location of the occluder and the result of balloon dilatation.Results Both cardiovascular angiography and ultrasonography could make a definite diagnosis of congenital bean disease in children,and could well display the location and shape of the abnormalities.The diameter of VSD(n=50)measured by cardioangiography and ultrasonography was(4.93±2.73)mm and(5.66±2.77)mm respectively,with no significant statistical difference existing between two methods(P＞0.05).The diameter at the narrowest site of PDA(n=96)measured by cardioangiography and ultrasonography was(3.22±1.45)mm and(3.96±1.42)mm respectively,with a significant difference existing between two methods(P＜0.05).In 16 PS cases,the diameter of valvular ring determined on cardioangiogram and on ultrasonogram wag(16.16±4.26)mm and(17.94±5.50)mm respectively,with no significant difference between two groups(P＞0.05).During the operation of VSD,the monitoring ultrasonography revealed that the valvular opening and closing was interfered by the occluder in 9 cases,so the occluder was re-adjusted till it was fixed to proper position. After the interventional therapy for VSD and PDA,cardioangiography detected a small residual shunt in 7 cases,which completely disappeared 24 hours later on ultrasonography.After balloon dilation in all 16 children with PS the right ventricle-pulmonary artery pressure difference was reduced by more than 50%and the pressure figure reached the standard of clinical Cure.The interventional procedure was successfully completed in all patients except for three cases. Conclusion In treating children of congenital heart disease with interventional procedures,the determination of the lesion's diameter and the selection of the occluder should be based on cardioangiographic measurement,although ultrasonography is more helpful in making preoperative screening and postoperative evaluation.