Clinical analysis of 165 cases of pancreaticoduodenectomy / 中华胰腺病杂志

ABSTRACT

Objective To investigate the evolution of pancreaticoduodenectomy and its significance in different time periods. Methods The clinical data of 165 patients from 1988 to 2008 in the department of general surgery, Zhangzhou Municipal Hospital with pancreaticoduodenectomy were retrospectively analyzed.Among 165 cases, simple pancreatoduodenectomy (PD) were performed in 138 cases, pylorus preserving pancreatoduodenectomy (PPPD) were performed in 14 cases, and extended pancreaticoduodenectomy were performed in 13 cases. The methods of pancreato-enteric reconstruction in pancreaticoduodenectomy included 68 cases with binding pancreaticojejunostomy (Peng's type Ⅰ ); 61 cases with pancreaticogastrostomy; 30 cases with traditional pancreaticojejunostomy; and 6 cases with duct-to-mucous pancreaticojejunostomy.Results From 1988 to 1998 (the first 10 years), 50 patients underwent pancreaticoduodenectomy, including 42 cases of PD and 8 cases of PPPD, and no case of extended pancreaticoduodenectomy. The mean amount of blood loss was (620 ± 180)ml, mean amount of blood transfusion was (530 ± 120)ml, the mean operation time was (6.5 ±3.5)h. Anastomotic fistula occurred in 7 cases, the incidence of anastomotic fistula was 14.0%(7/50); and 2 cases died during perioperative period with a mortality rate of 4.0% (2/50). From 1999 to 2008 (the latter 10 years), 115 patients underwent pancreaticoduodenectomy, including 96 cases of PD, 6 cases of PPPD, and 13 cases of extended PD. The mean amount of blood loss was (360 ± 110)ml, mean amount of blood transfusion was (400 ± 6 ) ml, the mean operation time was ( 3.0 ± 2.5 ) h, Anastomotic fistula occurred in 4 cases with an incidence of 3.5% ( 4/115 ); and one case during perioperative period with a mortality rate of 0.61%. The postoperative follow up time was ranging from 6 months to 5 years in 109 patients, the 1, 3,5 year survival rate was 87.2%, 54.1% and 39.5%. Conclusions In the latter 10 years, the amount of blood loss, the operation time, the mortality, and the incidence of pancreatic fistula have decreased significantly compared to the first 10 years.