Clinicopathological features of resectable carcinoma of the pancreatic head:a report of 102 cases / 中国普通外科杂志

Objective To explore the clinicopathelogical features of resectable carcinoma of the head of (pancreas).Methods A retrospcctive analysis was made on the clinicopathological data of 102 patients with cancer of the head of pancreas, who had received pancreatoduodenectomy from Nanfang Hospital in January 1990 to January 2003. Results The incidence rate of the peri-pancreatic tissue infiltration was 74.5%,the infiltration rate of retroperitonealfat was 27.5% and the incidence rate of peri-pancreatic lymph-node (metastasis) was 71.6%. Metastasis rate of 21.1% was seen in the abdominal aorta lymph nodes. (Conclusions) Surgically resectable carcinoma of the pancreatic head is not equivalent to early cancer. The surgical area of radical resection of cancer of the pancreatic head should at least include pancreatoduodenectomy and clearance of regional soft tissue and lymph nodes. It may be more reasonable if the abdominal aorta lymph nodes were assigned to the first station of lymph drainage of carcinoma of head of the pancreas.

Clinical study of solid-pseudopapillary tumor of pancreas:a report of 15 cases / 中国普通外科杂志

Objective To summarize the experience of diagnosis and treatment of solid-pseudopapillary tumor of pancreas (SPTP).Methods The clinical data of 15 patients with SPTP who were treated in our hospital from March,2003 to March,2006 were analyzed retrospectively.Results The 15 cases were all women, and the average age was 29.4 years.The chief manifestations were abdominal mass, abdominal pain or other abdominal discomfort. None of the 15 cases had history of pancreatitis or abdominal trauma, and no long history of drinking or smoking. Six cases were negative for CEA,CA50,CA199,CA125 and other tumor markers.Solid and solid-cystic masses in pancreas or solid and solid-cystic tumors in retroperitoneum were found both by B-mode ultrasonography and CT examinations. Preoperative fasting blood sugar was within normal limits. The tumor in 8 cases was located in the pancreatic head, in 6 cases was in the body and tail of pancreas, and in 1 case was in the neck of pancreas. The diameter of the tumors was 2.5-10 cm. No metastasis was found in the abdominal cavity or liver. Local excision was performed in 6 cases, distal pancreatectomy was performed in 5 cases, including 2 cases combined with splenectomy, and pancreaticoduodenectomy was performed in 3 cases, segmental pancreatectomy was performed in one patient with tumor in the neck of pancreas. The 15 cases showed typical pathologic manifestation of SPTP by microscopy. At followed up for 16-52 months, no evidence of recurrence or metastasis in these cases was found.Conclusions Solid-pseudopapillary tumor of pancreas primarily affects young women, and it may be located in any part of pancreas. Surgical resection is recommended as the treatment of choice, and the prognosis is good.

Diagnosis and treatment of pancreas head tumor:a report of 277 cases / 中国普通外科杂志

Objective To investigate the diagnosis and treatment of tumor of the head of pancreas(THP). Methods The clinical data of 277 cases of THP were restrospectively reviewed. All patients were diagnosed by US,CT, gastroenteric barium meal and /or operation. A comparison was made in 80 cases , who underwent pancreatoduodenectomy were divided into group A(41 patients operated during1982-1995) and group B(39 patients operated after January,1996) . Results 194 patients underwent surgical treatment,including explore laparotomy in 28,bilioenterostomy or T tube drainage in 86,pancreatoduodenectomy(PTD) in 80.Among 80 cases treated with PTD, the operation time,blood loss volume and blood transfusion volume during operation, and serious postoperative complication occurring rate in group A were significantly higher than those in group B(all P 0.05 ).The follow up results were as follows:the average survival time was (4.07 ?1.80) months in patients with bile external drainage, and (8.28 ?2.31) months in hepatojejunostomy,(P

The use of subcutaneous jejunum blind loop in pancreatoduodenectomy / 中国普通外科杂志

Objective To improve the technique of pancreatoduodenectomy in order to facilitate the(management) of complications and direct observation on follow up.Methods Pancreatoduodenectomy and Child′s method of digestive tract reconstruction was performed in 42 paltents.A blind loop of jejunum 5 to 6 cm in length was constructed beyond the pancreatojejular anastomosis and it was fixed to the subcutaneous(tissue) of the adjacent abdominal wall.Results Thirty-two cases recovered uneventfully,and 10 cases had complications induding pancreatic and biliary leakage and hemorrhage.These complications were successfully treated under direct vision by choledochoscope passed into the blind jejunal loop.This method of observation was used for long-time follow up in 22 cases,and revealed ercurrent tumor(n=5),bile duct stricture(n=4) and bile duct ascariasis(n=1).Conclusions This operative method did not cause new(complications) and it can be combined with the traditional operation.Postoperatively,direct observation and management of leakage of pancreatojejular anastomosis and biliointestinal anastomosis and hemorrhage can be accomplished,and the anastomoses and pancreatic stump can be directly observed at followup.

Clinical analysis of postoperative complications of pancreatoduodenectomy in 139 cases / 中国普通外科杂志

Objective To analyse the causes of postoperative complications of pancreatoduodenectomy(PD) and study measures for prevention and treatment of the complications.Methods A retrospective study was carried out on the data of 139 cases of pancreatoduodenectomy performed during recent 3 years in our(hospital).They included 91 cases of radical resection operation and 43 cases of pancreatoduodenectomy(combined) with vascular resection.Results There were 38 cases(27.4%) occurred complications after PD,including 10 cases(7.2%) of upper gastrointestinal hemorrhage,4 cases(2.9%) of hemorrhage in the abdominal cavity,and 6(4.3%) cases of pancreatic leakage,4cases(2.9%) of bile duct leakage,3((2.2%)) cases of intra-abdominal infection,5 cases(3.6%) of pulmonary infection,and 6 cases((4.3%)) of functional delayed gastric emptying.Four cases died during the peri-operative period.The overall mortality rate were 2.9%.Conclusions The main complications after PD were hemorrhage,pancreatic leakage,bile duct leakage and intra-abdominal cavity infection.Meticulons operative technique,the selection of appropriate anastomoses technique,careful observation and timely aggressive management in the postoperative period are the key points to reduce postoperative morbidity and motality rate after PD.

Resection procedure for pancreatic carcinoma in patients with tumour invasion to the portal vein / 中国普通外科杂志

Objective To discuss the resection technique for pancreatic carcinoma in patients with tumour(invasion) to the portal and/or superior mesentery vein,and the clinical significance of palliative resection of pancreatic carcinoma.Methods The clinical data of 71 cases of pancreatic carcinoma operated on within a period of 3 years were retrospectively reviewed.In patients with tumour invasion to the portal vein,a method of direc transection of pancreas was used in resection of the tumor,and was combined with local radiotherapy and chemotherapy.Results The resection rate was 57.75%.The complication rate was 22.54%.One patient died of multiple organ failure resulting from pneumonia.The survival rate at 6m,1-and 2-years was 100%,81.69%,and 40.85% respectively.Conclusions The direct transection method of pancreas(resection) is a simple and safe method to increase resection rate and prolong survival time for patients with(advanced) pancreatic carcinoma.

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.

Extended pancreaticoduodenectomy for carcinoma of head of pancreas / 中国普通外科杂志

Objective To study the effect of extended Whipple′s resection for carcinoma of head of pancreas.Methods Seventy-five patients who underwent surgery for carcinoma of head of pancreas were divided into control group(traditional Whipple′s operation,n=38) and study group(extended Whipple′s operation,n=37).The survival,complication,mortality and recurrence rates were compared between the 2 groups.Results In control group and study group,the complication rate was 60.53%and 29.73%;the mortality rate was 5.26% and 2.70%;the recurrence rate was 78.95% and 35.14%;and 3-year survival rate was 15.79% and 35.14%,respectively.Conclusions Extended Whipple′s resection for carcinoma of head of pancreas can decrease postoperative recurrence rate and increase 3-year survival rate.

Surgical treatment for patients with postpancreatic vascular invasion by pancreatic head carcinoma / 中国普通外科杂志

Objective To study the method of surgical treatment for patients with postpancreatic vascular invasion by pancreatic head carcinoma. Methods 25 patients with pancreatic head cancer and 1 with recurrent duodenal carcinoma with postpancreatic vessels involved by malignancy were treated by radical pancreatoduodenectomy with involved vascular resection(RPDIVR). Results There was no operation death in the 26 patients.Of the 26 cases, 4 had pancreatic fistula and 2 bile fistula postoperatively, but no vascular complication occurred. All of the 26 patients were followed up for 2.5-6.5 years( median time 4.5 years) and the average survival time was 56 months with 96.1%,88.4%, and 57.5% of 1,3,5 year survival rate. Coclusions (1)Colour Dopper imaging is a more useful and practical method in the preoperative examination of the vessels involved by malignancy. (2)When the postpancreatic vessels are involved by pancreatic head carcinoma, the rational treatment is RPDIVR. RPDIVR is a useful, safe, and an effective method and can improve the 5 year survival.

Pancreatoduodenectomy: a report of 126 cases / 中国普通外科杂志

Objective To introduce how to improve the operation quality and clinical effect of pancreatoduodenectomy (PD). Methods The morbidity and mortality of 126 patients with pancreatic head cancer or peri ampullary cancer treated by PD of traditional Child method and modified Child method ( pancreatic stump closing style pancrea to jejunum anastomosis) in our department from 1973 to 2002 were analyzed retrospectively. Results In modified Child method group, the morbidity of pancreatic leakage and the mortality of the operation were 2.4% and 4.7% respectively, which were significantly lower than those in the traditional method group(P

Diagnosis and treatment for carcinoma of the head of pancreas / 中国普通外科杂志

Objective To study the early diagnosis and the prognosis of carcinoma of the head of pancreas(CHP) and to determine the sensitivity of various detecting methods. Methods Data of preoperative diagnosis and prognosis in 22 patients with early stage of CHP and 168 patients with advanced CHP treated in our department in recent 15 years were retrospectively analyzed and compared. Results The early stage of CHP revealed no specific symptom. In early stage of CHP,the diagnlstic rate was 88.9%, detecting rate of cancer cells in pancreatic juice with ERCP was 88.4%, The sensitivity of needling cytologic examination during operation was 91.7%,the resection rate was 90.9%, 3years survival rate was 36.4%.Those were significantly higher than those in advanced CHP. Conclusions B mode ultrasonography and CT are the first choice of diagnosis for early stage of CHP. ERCP and selective celiac artery angiography can promote diagnostic rate. Searching carcinoma cells in pancreatic juice collected by ERCP and needling cytologic examination during operation can further improve the early diagnostic rate.In patients with early stage of CHP,the resection rate and post operation cure rate are significantly higher than those in patients with advanced CHP.