Intravenous infusion of octreotide for prevention of pancreatic fistula after pancreaticoduodenectomy / 中国普通外科杂志

Objective To assess the effect of intravenous infusion of octreotide in prevention of pancreatic fistula after pancreaticoduodenectomy. Methods The clinical data of 74 cases of pancreaticoduodenectomy performed from January 1996 to July 2003 were retrospectively reviewed. These included 36 cases in control group in which octreotide was not adminstered,and 38 cases in octreotide group in which octreotide was administered by intravenous infusion of 0.5?g/( kg?h) for 12 hours per day from the operative day to postoperative day 7. The study parameters included clinical manifestation,drainage from peritioned cavity and the amount of drainage of pancreatic fluid. Results The drainage of pancreatic fluid at postoperative day 1,3,5 the in octreotide group was significantly less than those in the control group,the average hospital stay and the incidence of pancreatic fistula were significantly lower than those in the control group,and the drainage of pancreatic fluid was significantly increased after the withdrawal of octreotide in the octreotide group. Conclusions Intravenous infusion of octreotide can significantly lower the incidence of pancreatic fistula after pancreaticoduodenectomy.

Surgical excision of tumors in the body and tail of pancreas / 中国普通外科杂志

Objective To explore the methods of surgical treatment of patients with tumors in the body and tail of pancreas. Methods We analyzed the clinical data from 45 patients with tumors in the body and tail of pancreas who underwent surgical excision between 1984 and 2002 in our hospital. The 45 cases consisted of malignant tumors(n=33) and benign tumors(n=12). Operations performed included resection of the body and tail of pancreas(17 cases), combined-organ excision (24 cases) and local tumor resection(4 cases ). Results Pathological classification:carcinoma (33 cases), islet cell tumors (8 cases ), cystic adenoma (8 cases), epithelioid fibroma (1 case) and cystic teratoma (1 case). The average diameter-size of excised tumor was determined as follows: carcinoma in the body or tail of pancreas was(8.0?2.6)cm, and that of islet cell tumors was(6.5?2.4)cm. There were no operative deaths, but operation resulted in the following complications: pancreatic fistula (2 cases), subdiaphragmatic abscess (2 cases), pancreatic pseudocyst (1 case ), upper gastrointestinal bleeding(1 case) and infection or poor healing of incisional wound (3 cases). All of the complications were cured with conservative therapy. Conclusions Excision of the body and tail of pancreas is an effective method for the treatment of patients with tumors in the distal half of pancreas.Before operation, it is necessary to be routinely prepared to perform combined organ excision. Regarding the surgical handling of pancreatic stump, we select the use of ligation of main pancreatic duct plus mattress suture, which we believe could effectively prevent pancreatic fistula.

Application of modified duct-to-mucosa pancreaticojejunostomy in pancreaticoduodenectomy / 中国普通外科杂志

Objective To investigate a modified technique of pancreaticojejunostomy in pancreaticoduodenectomy ( PD ).Methods The clinical data of 72 patients of PD using the modified technique of duct-to-mucosa pancreaticojejunostomy for treatment of benign or malignant tumor of pancreas or duodenum was retrospectively analyzed.Results There were no operative deaths; 2 of the 72 patients (2.78%) had postoperative pancreatic fistula. 63 patients were followed up. Of the 63 cases, the digestion and absorption functions of gastrointestine were normal in 60 patients and they were well nourished,but 3 patients suffered from chronic steatorrhea and malnutrition.Conclusions The modified duct-to-mucosa pancreaticojejunostomy is a simple and safe technique. With this technique, the rate of pancreatic fistula or leakage is relatively low and the function of the remnant pancreatic is well preserved.