Recent advances on nutrition in treatment of acute pancreatitis / 国际外科学杂志

Acute pancreatitis (AP) is a common abdominal acute inflammatory disorder.Clinical manifestations of AP vary from self-limiting local inflammation to multiple organ failure causing significant mortality.At present,AP treatment methods mainly include non-surgical treatment such as fluid resuscitation and somatostatin,and minimally invasive or open surgical debridement treatment.Either treatment programs,nutritional support treatment is an essential part of them.According to the pathophysiological characteristics of AP onset,many scholars have emphasized that strategic nutritional support therapy is the key to limiting local inflammation,preventing and controlling AP-related complications.This article will provide an overview of the latest advances in nutritional support treatment of AP,including enteral and parenteral nutrition strategies in clinical treatment,and nutritional supplements such as glutamine,omega-3 fatty acids,vitamins and probiotics.

Necessity and controversy of drain placement after pancreaticoduodebectomy / 中华肝胆外科杂志

In the past,it is always believed that routine drainage after pancreaticoduodenectomy (PD) is one of the most crucial methods to prevent and detect postoperative complications and to reduce mortality.However,in more recent years,with the development of fast track surgery,scholars in pancreatic surgery have investigated the necessity of drainage after PD together with its merits and faults.Therefore,this paper gives a brief review on this topic.

Early persistent vacuum suction drainage in patients with high risk of pancreatic fistula after pancreaticoduodenectomy / 中华内分泌外科杂志

Objective To study the function of early persistent vacuum suction drainage in patients with high risk of pancreatic fistula after pancreaticoduodenectomy (PD).Methods From Jul.2010 to Jun.2013,the clinical data of 286 patients undergoing PD were retrospectively evaluated.87 patients with high risk of pancreatic fistula were screened and then divided into early persistent vacuum suction drainage group (the observation group) and conventional drainage group (the control group) according to postoperative drainage manners.We statistically analyzed the two groups in terms of general information,blood loss,operative time,medical expenses,hospital stay,mortality and morbidity of complications such as pancreatic fistula.Results There were 40 patients screened into the observation group and 47 patients into the control group.No difference was found between the observation group and the control group in basic clinical data or surgical data.There was no statistical difference between the two groups in delayed gastric emptying,bile leakage,bleeding or the incidence of pancreatic fistula and intra-abdominal infection.The incidence of pancreatic fistula with grade B and C in the observation group was statistically lower than that of the control group(12.5％ vs 34.0％,P＜0.05).The incidence of intraabdominal infection in observation group was statistically lower than those in the control group (20.0％ vs 40.4％,P＜0.05).The incidence of total complications in observation group was statistically lower than that in the control group (60.0％ vs 83.0％,P＜0.05),but no difference was found between the observation group and control group in morality.Early persistent vacuum suction drainage could reduce hospital stay((21.93±7.14) days vs (28.70±12.45) days,P＜0.05) and clinical expense ((64.8±12.0) thousands vs (75.2± 14.6) thousands,P＜0.05) in patients with high risk of pancreatic fistula after PD.Conclusions Early persistent vacuum suction drainage can reduce the rate of grade B and C pancreatic fistula in patients with high risk of pancreatic fistula undergoing PD.The manner can also reduce the incidence of intra-abdominal infection,total complications and cost of hospital stay.This manner can accelerate postoperative recovery of patients undergoing PD and is worth of widely used.

Impact of octreotide on pancreatic fistula after pancreaticoduodenectomy: a prospective study / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of utilizing octreotide during perioperative period on pancreatic fistula after pancreaticoduodenectomy (PD).</p><p><b>METHODS</b>Three hundreds and six patients admitted from January 2010 to October 2014, who prepared to undergo pancreaticoduodenectomy (PD) were randomly divided into octreotide group (147 cases) and control group (159 cases). In octreotide group, octreotide was used in subcutaneous injection instantly after PD, each 8 hours until postoperative 10(th) day, and patients in control group were injected with the same volume of saline. Differences of pancreatic fistula (Grade A, Grade B, Grade C), hospitalization days and treatment cost were compared. χ(2) test, t-test and Fisher exact test were used to analyzed to the data, respectively.</p><p><b>RESULTS</b>No statistical significance (P>0.05) between two groups in the incidence of pancreatic fistula after PD (Grade A: 8.8% vs. 10.2%, Grade B: 2.7% vs. 4.4%, Grade C: 0.7% vs. 1.3%; χ(2)=0.197, 0.700, 0.288; P=0.657, 0.403, 0.591), the length of hospitalization((12.1±1.2)days vs. (13.0±1.2)days)(t=1.711, P=0.104) and treatment cost (79 700±6 700 vs. 77 600±5 200)(t=1.378, P=0.185). When accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, compared with control group, octreotide group had the lower incidence rate of pancreatic fistula and clinical correlative pancreatic fistula(all P<0.05) after PD.</p><p><b>CONCLUSIONS</b>Generally, octreotide makes no contribution to reduce the incidence of pancreatic fistula after PD. However, for patients who is accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, octreotide can effectively prevent pancreatic fistula after PD.</p>

Diagnosis and treatment of 48 patients with intraductal papillary mucinous neoplasms of the pancreas / 中华肝胆外科杂志

Objective To investigate the diagnosis and treatment of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Methods The clinical data of patients with pathologically verified IPMN who underwent surgical treatment between January 2006 to April 2014 in the First Affiliated Hospital of Harbin Medical University were studied retrospectively.There were 27 males and 21 females.The average age was (57.8 ± 8.8) years old.The average caliber of the main pancreatic duct was (1.1 ± 0.6) cm.The average size of the branch duct IPMN was (4.6 ± 1.5) cm.Results 35 patients underwent pancreaticoduodenectomy.Eight patients underwent distal pancreatectomy.Two patients underwent duodenum-preserving pancreatic head resection.Two patients underwent splenic-preserving distal pancreatectomy and one patient underwent total pancreatectomy.No patient died in perioperative period,and the median length of hospital stay after surgery was 14.3 days.Postoperative pathological examination revealed 5 (10.4％) adenoma,12 (25.0％) moderate-grade dysplasia,14 (29.2％) high-grade dysplasia and 17 (35.4％) invasive carcinoma.The postoperative complication rate was 22.9％.The mean follow up period for the noninvasive tumors was 48.9 months,with no recurrence or deaths.The mean follow up period of the invasive tumors was 43.2 months,with 1 death and no recurrence.Conclusions The indications for resection of IPMN should be based on treatment guidelines and on the patient' s general condition.It is suggested that the diagnosis and treatment of IPMN should be conducted in specialized pancreatic surgery centers.

The clinical analysis of autoimmune pancreatitis: a report of 21 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical feature, diagnostic and therapeutic experience of autoimmune pancreatitis (AIP).</p><p><b>METHODS</b>Twenty-one patients with AIP treated in the First Affiliated Hospital, Harbin Medical University from January 2006 to July 2014 were analyzed retrospectively. There were 15 men and 6 women among the 21 cases and the age ranged from 36 to 64 years. The characters of diagnosis and treatment of AIP were explored through clinical symptoms, imaging features, serologic test results, diagnostic treatment, and histopathologic characteristics.</p><p><b>RESULTS</b>All the patients showed obstructive jaundice and upper abdominal pain to different extents as major manifestations and the levels of serum IgG4, CA19-9, CEA were elevated in 16 cases (76.2%), 6 cases (28.5%) and 3 cases (14.2%), respectively. CT showed diffuse enlargement of the pancreas in 9 cases, localized pancreatic head enlargement in 3 cases and focally pancreatic mass in 9 cases. AIP was confirmed by extrapancreatic involvement, radiological and serological results plus biopsy in 11 cases (52.4%), interpretation of response to steroid in 3 cases (14.3%) and open laparotomy in 7 cases (33.3%). Surgery included choledochojejunostomy in 3 cases, cholecystojejunostomy in 1 case, pancreaticoduodenectomy in 2 cases and distal pancreatectomy combined with splenectomy in 1 case. The pathologic results displayed massive lymphocytes and plasma cells infiltration in the pancreatic tissues as well as parenchymal fibrosis. Except for 1 patient who had no symptom, the regular steroid therapy was performed (oral prednisone) and all the patients were cured. The follow-up time range was from 3 to 93 months, 4 cases (19.0%) were recurrent followed by the symptoms alleviated after the steroid was applied again.</p><p><b>CONCLUSIONS</b>AIP is rare and characterized by non-specific clinical manifestations so that the early diagnosis is difficult with a high misdiagnosis rate. The clinicians should strengthen the recognition of AIP and the definite diagnosis depends on the combination of clinical manifestations, radiological, serological and histopathological results so as to avoid the unnecessary operation.</p>

Research advances in autoimmune pancreatitis / 中华肝胆外科杂志

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis which is closely related with abnormal autoimmune.To some extent,it is too difficult to identify the diagnosis between AIP and pancreatic cancer.The treatment includes hormone therapy and surgery.In this article,based on accumulating the experience in the diagnosis and treatment of AIP cases for many years and reviewing the related literatures,we evaluate its type,the etiology and the clinical presentations,as well as summarize the typical characteristics of pathology,radiology and serology.

Surgical management of hilar cholangiocarcinoma / 中华消化外科杂志

Objective To summarize the experience in surgical management of hilar cholangiocarcinoma.Methods The clinical data of 88 patients with hilar cholangiocarcinoma who received surgical treatment at the First Affiliated Hospital of Harbin Medical University from January 2007 to December 2011 were retrospectively analyzed.All the patients were diagnosed by imaging examination.According to the severity of jaundice and predictive remnant liver volume,19 patients received percutaneous transhepatic cholangial drainage (PTCD) and 4 received portal vein embolization.The fundamental operation consisted of hilar cholangiocarcinoma resection,skeletonization of hepatoduodenum ligament and Roux-en-Y cholangiojejunostomy,and the transanastomotic stent was placed for 6 months.The count data were analyzed using the chi-square test; the survival rate was analysed using the Kaplan-Meier method; the survival was analyzed using the Log-rank test.Results Of the 88 patients,58 patients (including 11 patients who received PTCD) received hilar cholangiocarcinoma resection.Of the 58 patients,43 (including 4 patients who received portal vein embolization preoperatively) received R0 resection,and 15 received palliative resection.Thirty patients received internal and (or) external drainage.Commitant partial hepatectomy was performed on 22 patients (including 9 received left hemihepatectomy,2 received extended left hemihepatectomy,7 received left hemihepatectomy + caudate lobectomy,4 received right hemihepatectomy).Commitant pancreatico-duodenectomy was performed on 7 patients,commitant hepatic artery resection on 3 patients,and commitant portal vein resection on 2 patients.According to the modified Bismuth-Corlette classification,there were 17 patients with type Ⅰ,19 with type Ⅱ,21 with type Ⅲa,20 with type Ⅲb,and 11 with type Ⅳ.Of the 58 patients who received hilar cholangiocarcinoma resection,19 had postoperative complications,and 2 patients died within 30 days after operation.Seventy-three patients were followed up,and the overall 1-,3-,5-year survival rates were 68.5％,28.8％,11.0％,respectively.The 1-,3-,5-year survival rates of patients who received R0 resection were 94.6％,43.2％,18.9％,respectively,which were significantly higher than 78.6％,35.7％ and 7.1％ of patients who received palliative resection (x2=4.77,P ＜0.05).The 1-,3-,5-year survival rates of patients who received palliative resection were significantly higher than 18.2％,0,0 of patients who received biliary drainage (x2 =13.26,P ＜ 0.05).Conclusions R0 resection is the best choice for patients with hilar cholangiocarcinoma,and biliary drainage with no resection is the last choice.Sufficient preoperative treatment,optimized choice of surgical procedure and exquisite surgical techniques are important for the improvement of the prognosis.

The impact of blood transfusion on postoperative short-term results of pancreaticoduodenectomy: a comparative study on 356 patients / 中华肝胆外科杂志

Objective To study the impact of blood transfusion on postoperative complications of pancreaticoduodenectomy.Methods The medical data of 356 patients who underwent pancreaticoduodenectomy from January 2005 to December 2011 were retrospectively analyzed.242 patients in the transfusion group received blood transfusion while the remaining patients in the non transfusion group received no blood transfusion.Results The rates of pancreatic fistula and pulmonary infection,mean operative time,intraoperative blood loss,and hospital stay were 17.8％,16.5％,6.4 h,920.0 ml and 29.1 d in the transfusion group compared with 8.8％,6.1％,5.4 h,150.0 ml and 25.9 d in the non-transfusion group,respectively (P＜0.05).However,there were no significant differences between the two groups in the rates of biliary fistula,gastrointestinal and intraabdominal bleeding,delayed gastric emptying and death.Conclusions Patients undergoing pancreaticoduodenectomy in the non-transfusion group had significantly lower rates of pancreatic fistula and pulmonary infection,shorter operative time and hospital stay,and less intraoperative blood loss.This study suggested that a reduction in intraoperative blood loss by advanced instruments and techniques,with operations carried out by experienced pancreatic surgeons in specialized pancreatic center,could result in a significantly lower postoperative complication rate.

The influence of timing of definitive operation on prognosis of patients with iatrogenic bile duct injury / 中华肝胆外科杂志

ObjectiveTo investigate the influence of timing of definitive operation on prognosis of patients with iatrogenic bile duct injury (IBDI). MethodsThe clinical data of 38 patients with IBDI were retrospectively analyzed. Of the 38 patients, the injury happened in 7 patients in our hospital while 31 patients were transferred in from other hospitals. We analyzed the previous operative records, the clinical manifestations of the patients, the radiological images and our operative findings in the definitive operations. According to the timing of the definitive operation, the patients were divided into the intraoperative repair group (n=26), the early repair group (n=15) and the delayed repair group (n=17). ResultsPatients in the intraoperative repair group had the best short-and long-term results, the shortest length of hospital stay and the lowest total cost. The early repair group, though having worse Results than the intraoperative repair group was still better than the delayed repair group. However, early detection of injuries and the ability to carry out timely corrective procedures depended on the availability of surgical expertise in the hospital. ConclusionsThe timing of definitive operation to provide corrective surgery to IBDI was a vitally important factor which affected prognosis.It is best to repair the injury within the same operation. The repair should be carried out by a doctor with ample experience in bile duct surgery.