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胰-十二指肠切除术后早期肠内营养支持的临床研究 被引量:13
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作者 张珂 孙文兵 +4 位作者 李志伟 张效东 王洪波 纪旭 洪智贤 《实用医学杂志》 CAS 2004年第1期37-39,共3页
目的 :了解早期肠内营养在胰 -十二指肠切除术后病人支持治疗中的作用和地位。方法 :3 1例胰 -十二指肠切除术病人按随机表分别进入肠内 (EN)或肠外 (PN )营养组 ,术后分别接受肠内外营养 ,观察两种营养方式对病人基础营养状况、内脏合... 目的 :了解早期肠内营养在胰 -十二指肠切除术后病人支持治疗中的作用和地位。方法 :3 1例胰 -十二指肠切除术病人按随机表分别进入肠内 (EN)或肠外 (PN )营养组 ,术后分别接受肠内外营养 ,观察两种营养方式对病人基础营养状况、内脏合成蛋白能力、胃肠功能、氮平衡、细胞免疫功能和经济消耗等方面的影响。结果 :两种营养方式均能改善病人的营养状况。肠内营养在恢复氮平衡 ,刺激肠道蠕动 ,减少经济消耗方面优于肠外营养 ,且差异有显著意义 (P <0 0 5 )。结论 展开更多
关键词 胰-十二指肠切除术 早期肠内营养支持 细胞免疫功能 肠外营养
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147例胰-十二指肠切除术的经验与教训
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作者 齐建成 蔡国全 《中国现代药物应用》 2009年第15期108-109,共2页
目的提高胰-十二指肠切除术生存率,降低死亡率。方法对全部病例的手术方法、术后并发症及采取的措施进行分析。结果手术死亡率近11%(16/147);乏特氏壶腹、胰头癌3年生存率为46%、30%,5年生存率为15.4%、12%。结论早期诊断、早期治疗、... 目的提高胰-十二指肠切除术生存率,降低死亡率。方法对全部病例的手术方法、术后并发症及采取的措施进行分析。结果手术死亡率近11%(16/147);乏特氏壶腹、胰头癌3年生存率为46%、30%,5年生存率为15.4%、12%。结论早期诊断、早期治疗、适当的手术术式及方法,及时、正确地处理术前及术后合并症是提高生存期,降低死亡率的重要步骤。 展开更多
关键词 胰-十二指肠切除术 生存率 死亡率 壶腹
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佝偻病——胰、十二指肠、胃部分切除术后
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作者 李梅 夏维波 +5 位作者 邢小平 周学瀛 孟迅吾 姜艳 王鸥 胡莹莹 《中华骨质疏松和骨矿盐疾病杂志》 2011年第1期60-63,共4页
消化道疾病或手术后维生素D缺乏十分常见,但临床医生往往关注原发病的诊治,而忽视了维生素D缺乏对患者的不利影响。本文详细介绍了1例因毛细血管瘤行胰、十二指肠、胃大部切除术后引起严重维生素D缺乏和佝偻病的青少年罕见病例,旨在提... 消化道疾病或手术后维生素D缺乏十分常见,但临床医生往往关注原发病的诊治,而忽视了维生素D缺乏对患者的不利影响。本文详细介绍了1例因毛细血管瘤行胰、十二指肠、胃大部切除术后引起严重维生素D缺乏和佝偻病的青少年罕见病例,旨在提醒临床医师重视诊治维生素D缺乏。 展开更多
关键词 维生素D缺乏 佝偻病 -十二指肠-胃部分切除
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Delayed gastric emptying is associated with pylorus-preserving but not classical Whipple pancreaticoduodenectomy:A review of the literature and critical reappraisal of the implicated pathomechanism 被引量:16
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作者 Kosmas I Paraskevas Costas Avgerinos +2 位作者 Costas Manes Dimitris Lytras Christos Dervenis 《World Journal of Gastroenterology》 SCIE CAS CSCD 2006年第37期5951-5958,共8页
Pylorus-preserving pancreaticoduodenectomy (PPPD) is nowadays considered the treatment of choice for periampullary tumors, namely carcinoma of the head, neck, or uncinate process of the pancreas, the ampulla of Vate... Pylorus-preserving pancreaticoduodenectomy (PPPD) is nowadays considered the treatment of choice for periampullary tumors, namely carcinoma of the head, neck, or uncinate process of the pancreas, the ampulla of Vater, distal common bile duct or carcinoma of the peri-Vaterian duodenum. Delayed gastric emptying (DGE) comprises one of the most troublesome complications of this procedure. A search of the literature using Pubmed/IVledline was performed to identify clinical trials examining the incidence rate of DGE following standard Whipple pancreaticoduodenectomy (PD) vs PPPD. Additionally we performed a thorough in-depth analysis of the implicated pathomechanism underlying the occurrence of DGE after PPPD. In contrast to early studies, the majority of recently performed clinical trials demonstrated no significant association between the occurrence of DGE with either PD or PPPD. PD and PPPD procedures are equally effective operations regarding the postoperative occurrence of DGE. Further randomized trials are required to investigate the efficacy of a recently reported (but not yet tested in largescale studies) modification, that is, PPPD with antecolic duodenojejunostomy. 展开更多
关键词 Pylorus-preserving pancreaticoduodenectomy Whipple pancreaticoduodenectomy Delayed gastric emptying Pancreatic surgery
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Distinguishing between parenchymal and anastomotic leakage at duct-to-mucosa pancreatic reconstruction in pancreaticoduodenectomy 被引量:7
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作者 Justin H Nguyen 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第43期6648-6654,共7页
AIM: To distinguish anastomotic from parenchymal leakage at duct-to-mucosa reconstruction of the pancreatic remnant. METHODS: We reviewed the charts of 68 pancreaticoduodenectomies performed between 5/2000 and 12/20... AIM: To distinguish anastomotic from parenchymal leakage at duct-to-mucosa reconstruction of the pancreatic remnant. METHODS: We reviewed the charts of 68 pancreaticoduodenectomies performed between 5/2000 and 12/2005 with end-to-side duct-to-mucosa pancreatojejunostomy (PJ). The results of pancreatography, as well as peripancreatic drain volumes, and amylase levels were analyzed. RESULTS: Of 68 pancreatojejunostomies, 48 had no leak by pancreatography and had low-drain amylase (normal); eight had no pancreatographic leak but had elevated drain amylase (parenchymal leak); and 12 had pancreatographic leak and elevated drain amylase (anastomotic leak). Although drain volumes in the parenchymal leak group were significantly elevated at postoperative day (POD) 4, no difference was found at POD 7. Drain amylase level was not significantly different at POD 4. In contrast, at POD 7, the anastomotic-leak group had significantly elevated drain amylase level compared with normal and parenchymalleak groups (14158 + 24083 IU/L vs 89 + 139 IU/L and 1707 + 1515 IU/L, respectively, P = 0.012). CONCLUSION: For pancreatic remnant reconstruction after pancreaticoduodenectomy, a combination of pancreatogram and peripancreatic drain amylase levels can be used to distinguish between parenchymal and anastomotic leakage at pancreatic remnant reconstruction. 展开更多
关键词 Anastomotic leak Pancreatic leak PANCREATICODUODENECTOMY Pancreatogram Whipple procedure
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Is delayed gastric emptying so terrible after pylorus-preserving pancreaticoduodenectomy? Prevention and management 被引量:5
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作者 Xian-Min Bu Jin Xu +4 位作者 Xian-Wei Dai Kai Ma Fu-Quan Yang Jun Hu Nai-Fu Wang 《World Journal of Gastroenterology》 SCIE CAS CSCD 2006年第39期6382-6385,共4页
AIM: To explore some operative techniques to prevent the occurrence of delayed gastric emptying (DGE) alter pylorus-preserving pancreaticoduodenectomy (PPPD).METHODS: One hundred and eighty-six patients in a sin... AIM: To explore some operative techniques to prevent the occurrence of delayed gastric emptying (DGE) alter pylorus-preserving pancreaticoduodenectomy (PPPD).METHODS: One hundred and eighty-six patients in a single medical center who accepted PPPD were retrospectively studied. The incidence of DGE was investigated and the influence of some operative techniques on the prevention of DGE was analyzed.RESULTS: During the operative process of PPPD, the methods of detached drainage of pancreatic fluid and bile and gastric fistulization were used. Postoperatively, six patients suffered DGE among the 186 cases; the incidence was 3.23% (6/186). One of them was complicated with intraabdominal infection at the same time, and two with pancreatic leakage.CONCLUSION: Appropriate maneuvers during operation are essential to avoid postoperative DGE in PPPD. The occurrence of DGE is avoidable. It should not be used as an argument to advocate hemigastrectomy in PPPD. 展开更多
关键词 Delayed gastric emptying Pylorus-preserving pancreaticoduodenectomy Gastric fistulization
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Clinical Study on Suspension Pancreatic-Duct-Jejunum End-to-Side Continuous Suture Anastomosis in Pancreaticoduodenectomy 被引量:5
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作者 Ke Dong Wei Xiong +1 位作者 Xiao-jiong Yu Chun Gu 《Chinese Medical Sciences Journal》 CAS CSCD 2013年第1期34-38,37-38,共5页
Objective To study the influence of Suspension Pancreatic-Duct-Jejunum End-to-Side Continuous Suture Anastomosis (SPDJCS) on the incidence of pancreatic fistula after pancreaticoduodenectomy, and to analyze its appl... Objective To study the influence of Suspension Pancreatic-Duct-Jejunum End-to-Side Continuous Suture Anastomosis (SPDJCS) on the incidence of pancreatic fistula after pancreaticoduodenectomy, and to analyze its applicability, safety, and efficacies. Methods A prospective controlled trial was conducted with 165 cases receiving pancreati- coduodenectomy in the Department of Hepatopancreatobiliary Surgery from January 2010 to May 2012. The patients were divided into Group A (end-to-end/end-to-side invaginated anastomosis, n=52), Group B (end-to-side mucosal anastomosis, n=48), and Group C (SPDJCS, n=65). The preoperative data, intra- operative data, and operative outcomes (incidence of pancreatic fistula, operation time, intraoperative blood loss, peritoneal drainage, peritoneal hemorrhage, peritoneal abscess, delayed gastric emptying, pulmonary infection, postoperative infection, blood transfusion, and perioperative mortality) were com- pared among the 3 groups. Results The total incidence of pancreatic fistula was 13.9% (23/165) in all the 165 patients. The inci- dence in Group A and Group B was 23.1% (12/52) and 18.8% (9/48), both higher than that in Group C [3.1% (2/65), both P〈0.05]. Group C showed significantly better outcomes than group A and B in terms of the opera- tion time (5.5±1.2 hours vs. 6.1±1.1 hours, 5.5±1.2 hours vs. 6.3±1.5 hours), volume of blood loss (412.0±205.0 mL vs. 525.0±217.0 mL, 412.0±205.0 mL vs. 514.0±217.0 mL), and postoperative drainage amount of plasma tubes (175.0±65.0 mE vs. 275.0±80.0 mL, 175.0±65.0 mL vs. 255.0±75.0 mL) (all P〈0.05), while Group A and Group B displayed no difference in these aspects (P〉0.05). As complications other than pancreatic fistula were concerned, the three groups were not different from each other (P〉0.05). Conclusions SPDJCS may have the effect of reducing the incidence of pancreatic fistula after pan- creaticoduodenectomy. It could be safe, practical and convenient technique of anastomosis for pancreaticoje- junostomy. 展开更多
关键词 PANCREATICODUODENECTOMY pancreatic fistula PANCREATICOJEJUNOSTOMY con- tinuous suture suspension of pancreatic duct
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Pancreatic fistula after pancreaticoduodenectomy:A comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer:Interrupted vs continuous stitches 被引量:31
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作者 Seung Eun Lee Sung Hoon Yang +1 位作者 Jin-Young Jang Sun-Whe Kim 《World Journal of Gastroenterology》 SCIE CAS CSCD 2007年第40期5351-5356,共6页
AIM: The purpose of this study is to find a better operative technique by comparing interrupted stitches with continuous stitches for the outer layer of the pancreaticojejunostomy, i.e. the stitches between the stump... AIM: The purpose of this study is to find a better operative technique by comparing interrupted stitches with continuous stitches for the outer layer of the pancreaticojejunostomy, i.e. the stitches between the stump parenchyma of the pancreas and the jejunal seromuscular layer, and other risk factors for the incidence of pancreatic leakage.METHODS: During the period January 1997 to October 2004, 133 patients have undergone the end-to-side and duct-to-mucosa pancreaticojejunostomy reconstruction after pancreaticoduodenectomy with interrupted suture for outer layer of the pancreaticojejunostomy and 170 patients with a continuous suture at our institution by one surgeon.RESULTS: There were no significant differences between the two groups in the diagnosis, texture of the pancreas, use of octreotide and pathologic stage. Pancreatic fistula occurred in 14 patients (11%) among the interrupted suture cases and in 10 (6%) among the continuous suture cases (P = 0.102). Major pancreatic leakage developed in three interrupted suture patients (2%) and zero continuous suture patients (P = 0.026). In multivariate analysis, soft pancreatic consistency (odds ratio, 5.5; 95% confidence interval 2.3-13.1) and common bile duct cancer (odds ratio, 3.7; 95%CI 1.6-8.5) were'predictive of pancreatic leakage.CONCLUSION: Pancreatic texture and pathology are the most important factors in determining the fate of pancreaticojejunal anastomosis and our continuous suture method was performed with significantly decreased occurrence of major pancreatic fistula. In conclusion, the continuous suture method is more feasible and safer in performing duct-to-mucosa pancreaticojejunostomy. 展开更多
关键词 PANCREATICODUODENECTOMY PANCREATICOJEJUNOSTOMY Pancreatic fistula
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Effect of preoperative biliary drainage on outcome of classical pancreaticoduodenectomy 被引量:12
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作者 Chandra Shekhar Bhati Chandrashekhar Kubal +4 位作者 Pankaj Kumar Sihag Ankur Atal Gupta Raj Kamal Jenav Nicholas G Inston Jagdish M Mehta 《World Journal of Gastroenterology》 SCIE CAS CSCD 2007年第8期1240-1242,共3页
AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pa... AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy. 展开更多
关键词 Whipple's operation Preoperative stenting SEPSIS Preoperative biliary drainage
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Treatment of massive pancreaticojejunal anastomotic hemorrhage after pancreatoduodenectomy 被引量:9
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作者 Chen Liu Ying-He Qiu Xiang-Ji Luo Bin Yi Xiao-Qing Jiang Wei-Feng Tan Yong Yu Meng-Chao Wu 《World Journal of Gastroenterology》 SCIE CAS CSCD 2009年第13期1625-1629,共5页
AIM: To compare the treatment modalities for patients with massive pancreaticojejunal anastomotic hemorrhage after pancreatoduodenectomy (PDT).METHODS: A retrospective study was undertaken to compare the outcomes ... AIM: To compare the treatment modalities for patients with massive pancreaticojejunal anastomotic hemorrhage after pancreatoduodenectomy (PDT).METHODS: A retrospective study was undertaken to compare the outcomes of two major treatment modalities: transcatheter arterial embolization (TAE) and open surgical hemostasis. Seventeen patients with acute massive hemorrhage after PDT were recruited in this study. A comparison of two treatment modalities was based upon the clinicopathological characteristics and hospitalization stay, complications, and patient prognosis of the patients after surgery.RESULTS: Of the 11 patients with massive hemorrhage after PDT treated with TAE, 1 died after discontinuing treatment, the other 10 stopped bleeding completely without recurrence of hemorrhage. AIJ the 10 patients recovered well and were discharged, with a mean hospital stay of 10.45 d after hemostasis. The patients who underwent TAE twice had a re-operation rate of 18.2% and a mortality rate of 0.9%. Among the six patients who received open surgical hemostasis, two underwent another round of open surgical hemostasis. The mortality was 50%, and the recurrence of hemorrhage was 16.67%, with a mean hospital stay of 39.5 d.CONCLUSION: TAE is a safe and effective treatment modality for patients with acute hemorrhage after PDT. Vasography should be performed to locate the bleeding site. 展开更多
关键词 PANCREATODUODENECTOMY Massivehemorrhage Transcatheter artery embolization COMPLICATION TREATMENT
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Risk factors of pancreatic leakage after pancreaticoduodenectomy 被引量:52
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作者 Yin-MoYang Xiao-DongTian YanZhuang Wei-MinWang Yuan-LianWan Yan-TingHuang 《World Journal of Gastroenterology》 SCIE CAS CSCD 2005年第16期2456-2461,共6页
AIM: To analyze the risk factors for pancreatic leakage after pancreaticoduodenectomy (PD) and to evaluate whether duct-to-mucosa pancreaticojejunostomy could reduce the risk of pancreatic leakage. METHODS: Sixty-two ... AIM: To analyze the risk factors for pancreatic leakage after pancreaticoduodenectomy (PD) and to evaluate whether duct-to-mucosa pancreaticojejunostomy could reduce the risk of pancreatic leakage. METHODS: Sixty-two patients who underwent PD at our hospital between January 2000 and November 2003 were reviewed retrospectively. The primary diseases of the patients included pancreas cancer, ampullary cancer, bile duct cancer, islet cell cancer, duodenal cancer, chronic pancreatitis, pancreatic cystadenoma, and gastric cancer. Standard PD was performed for 25 cases, PD with extended lymphadenectomy for 27 cases, pylorus-preserving PD for 10 cases. A duct-to-mucosa pancreaticojejunostomy was performed for patients with a hard pancreas and a dilated pancreatic duct, and a traditional end-to-end invagination pancreaticojejunostomy for patients with a soft pancreas and a non-dilated duct. Patients were divided into two groups according to the incidence of postoperative pancreaticojejunal anastomotic leakage: 10 cases with leakage and 52 cases without leakage. Seven preoperative and six intraoperative risk factors with the potential to affect the incidence of pancreatic leakage were analyzed with SPSS10.0 software. Logistic regression was then used to determine the effect of multiple factors on pancreatic leakage. RESULTS: Of the 62 patients, 10 (16.13%) were identified as having pancreatic leakage after operation. Other major postoperative complications included delayed gastric emptying (eight patients), abdominal bleeding (four patients), abdominal abscess (three patients) and wound infection (two patients). The overall surgical morbidity was 43.5% (27/62). The hospital mortality in this series was 4.84% (3/62), and the mortality associated with pancreatic fistula was 10% (1/10). Sixteen cases underwent duct-to-mucosa pancreaticojejunostomy and 1 case (1/16, 6.25%) devel-oped postoperative pancreatic leakage, 46 cases underwent invagination pancreaticojejunostomy and 9 cases (9/46, 19.6%) developed postoperative pancreatic leakage. General risk factors including patient age, gender, history of jaundice, preoperative nutrition, pathological diagnosis and the length of postoperative stay were similar in the two groups. There was no statistical difference in the incidence of pancreatic leakage between the patients who received the prophylactic use of octreotide after surgery and the patients who did not undergo somatostatin therapy. Moreover, multivariate logistic regression analysis showed that none of the above factors seemed to be associated with pancreatic fistula. Two intraoperative risk factors, pancreatic duct size and texture of the remnant pancreas, were found to be significantly associated with pancreatic leakage. The incidence of pancreatic leakage was 4.88% in patients with a pancreatic duct size greater than or equal to 3 mm and was 38.1% in those with ducts smaller than 3 mm (P = 0.002). The pancreatic leakage rate was 2.94% in patients with a hard pancreas and was 32.1% in those with a soft pancreas (P = 0.004). Operative time, blood loss and type of resection were similar in the two patient groups. The incidence of pancreatic leakage was 6.25% (1/16) in patients with duct-to-mucosa anastomosis, and was 19.6% (9/46) in those with traditional invagination anastomosis. Although the difference of pancreatic leakage between the two groups was obvious, no statistical signific-ance was found. This may be due to the small number of patients with duct-to-mucosa anastomosis. By further analyzing with multivariate logistic regression, both pancreatic duct size and texture of the remnant pancreas were demonstrated to be independent risk factors (P= 0.007 and 0.017, OR = 11.87 and 15.45). Although anastomotic technique was not a significant factor, pancreatic leakage rate was much less in cases that underwent duct-to-mucosa pancreaticojejunostomy. CONCLUSION: Pancreatic duct size and texture of the remnant pancreas are risk factors influencing pancreatic leakage after PD. Duct-to-mucosa pancreaticojejunostomy, as a safe and useful anastomotic technique, can reduce pancreatic leakage rate after PD. 展开更多
关键词 PANCREATICODUODENECTOMY Pancreatic leakage
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Pancreaticoduodenectomy for advanced gastric cancer with pancreaticoduodenal region involvement 被引量:7
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作者 Xin-Bao Wang Li-Tao Yang Ze-Wei Zhang Jian-Min Guo Xiang-Dong Cheng 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第21期3425-3429,共5页
AIM:To characterize the factors of the improved survival following combined pancreaticoduodenectomy(PD) and gastrectomy for the treatment of advanced gastric cancer with pancreaticoduodenal region involvement.METH... AIM:To characterize the factors of the improved survival following combined pancreaticoduodenectomy(PD) and gastrectomy for the treatment of advanced gastric cancer with pancreaticoduodenal region involvement.METHODS:From 1995 to 2004,53 patients with primary gastric cancer were diagnosed with synchronous(n = 44) or metachronous(n = 9) pancreaticoduodenal region involvement.Of these,17 patients(32%) underwent total gastrectomy(TG) or distal subtotal gastrectomy(SG) combined with PD simultaneously.The preoperative demographic,clinical information,clinicopathologic features and the surgical results of these 17 patients were considered as factors influencing survival and were analyzed by the Kaplan-Meier method with log-rank comparison.RESULTS:The actual 1-and 3-year survival rates of these 17 patients after resection were 77% and 34%,respectively,and three patients survived for more than 5 years after surgery.The tumor-free resection margin(P = 0.0174) and a well-differentiated histologic type(P = 0.0011) were significant prognostic factors on univariate analysis.No mortality occurred within one mo after operation,postoperative weight loss of different degree was present in all the patients with TG and 12 cases had other complications.There were 9(53%) cases of recurrence in 5-48 mo after operation.The survival rate in the palliative and explorative group was significantly(P = 0.0064) lower than in the combined PD group.CONCLUSION: Judicious use of en bloc PD and gastrectomy and strictly preventing postoperative complications may improve the long-term survival for advanced gastric cancer patients with pancreaticoduodenal region involvement. Well-differentiated histology and negative resection margin are the most important predictors of long survival. 展开更多
关键词 PANCREATICODUODENECTOMY Gastric cancer GASTRECTOMY Predictive factor PATIENTS
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Effect of preoperative biliary drainage on surgical results after pancreaticoduodenectomy in patients with distal common bile duct cancer:Focused on the rate of decrease in serum bilirubin 被引量:5
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作者 Yun Mee Choi Eung-Ho Cho +9 位作者 Keon-Young Lee Seung-Ik Ahn Sun Keun Choi Sei Joong Kim Yoon Seok Hur Young Up Cho Kee-Chun Hong Seok-Hwan Shin Kyung Rae Kim Ze-Hong Woo 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第7期1102-1107,共6页
AIM: To examine if the rate of decrease in serum bilirubin after preoperative biliary drainagecan be used as a predicting factor for surgical complications and postoperative recovery after pancreaticoduodenectomy in p... AIM: To examine if the rate of decrease in serum bilirubin after preoperative biliary drainagecan be used as a predicting factor for surgical complications and postoperative recovery after pancreaticoduodenectomy in patients with distal common bile duct cancer.METHODS: A retrospective study was performed in 49 consecutive patients who underwent pancrea-ticoduodenectomy for distal common bile duct cancer. Potential risk factors were compared between the complicated and uncomplicated groups. Also, the rates of decrease in serum bilirubin were compared pre- and postoperatively. RESULTS: Preoperative biliary drainage (PBD) was performed in 40 patients (81.6%). Postoperative morbidity and mortality rates were 46.9% (23/49) and 6.1% (3/49), respectively. The presence or absence of PBD was not different between the complicated and uncomplicated groups. In patients with PBD, neither the absolute level nor the rate of decrease in serum bilirubin was significantly different. Patients with rapid decrease preoperatively showed faster decrease during the first postoperative week (5.5 ± 4.4 μmol/L vs -1.7 ± 9.9 μmol/L, P = 0.004).CONCLUSION: PBD does not affect the surgical outcome of pancreaticoduodenectomy in patients with distal common bile duct cancer. There is a certain group of patients with a compromised hepatic excretory function, which is represented by the slow rate of decrease in serum bilirubin after PBD. 展开更多
关键词 Distal bile duct cancer Drainage BILIRUBIN RATE
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Bile tract adenomyoma:A case report 被引量:3
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作者 Gui-Ming Shu Yi-Jun Wang Zhi Du Dong-Yan Li Chang-Li Liu 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第4期647-650,共4页
This paper described a rare case of adenomyoma of common bile duct. The case is a 51-year-old man who was hospitalized for yellow color skin and sclera and itching for 2 mo without abdominal pain. Nothing special was ... This paper described a rare case of adenomyoma of common bile duct. The case is a 51-year-old man who was hospitalized for yellow color skin and sclera and itching for 2 mo without abdominal pain. Nothing special was found in physical examination except yellowish skin and sclera. The clinical presentation and Computerized Tomography (CT),Magnetic resonance cholangiopancreatography (MRCP),and ultrasonography suspected a tumor of the distal bile duct. The patient was treated successfully by pancreaticoduodenectomy. Histologically,the lesion consisted of adenoid and myofibrous tissue and moderate atypia. The immunophenotype of the epithelial component was cytokeratin 7+/cytokeratin 20-. The patient has been well without any evidence of recurrence for 12 mo since his operation. 展开更多
关键词 Common bile duct ADENOMYOMA DIAGNOSIS PANCREATICODUODENECTOMY
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Resected case of eosinophilic cholangiopathy presenting with secondary sclerosing cholangitis 被引量:4
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作者 Fumihiko Miura Takehide Asano +8 位作者 Hodaka Amano Masahiro Yoshida Naoyuki Toyota Keita Wada Kenichiro Kato Tadahiro Takada Junichi Fukushima Fukuo Kondo Hajime Takikawa 《World Journal of Gastroenterology》 SCIE CAS CSCD 2009年第11期1394-1397,共4页
Eosinophilic cholangiopathy is a rare condition characterized by eosinophilic infiltration of the biliary tract and causes sclerosing cholangitis. We report a patient with secondary sclerosing cholangitis with eosinop... Eosinophilic cholangiopathy is a rare condition characterized by eosinophilic infiltration of the biliary tract and causes sclerosing cholangitis. We report a patient with secondary sclerosing cholangitis with eosinophilic cholecystitis. A 46-year-old Japanese man was admitted to our hospital with jaundice. Computed tomography revealed dilatation of both the intrahepatic and extrahepatic bile ducts, diffuse thickening of the wall of the extrahepatic bile duct, and thickening of the gallbladder wall. Under the diagnosis of lower bile duct carcinoma, he underwent pyloruspreserving pancreatoduodenectomy and liver biopsy. On histopathological examination, conspicuous fibrosis was seen in the lower bile duct wall. In the gallbladder wall, marked eosinophilic infiltration was seen. Liver biopsy revealed mild portal fibrosis. He was diagnosed as definite eosinophilic cholecystitis with sclerosing cholangitis with unknown etiology. The possible etiology of sderosing cholangitis was consequent fibrosis from previous eosinophilic infiltration in the bile duct. The clinicopathological findings of our case and a literature review indicated that eosinophilic cholangiopathy could cause a condition mimicking primary sclerosing cholangitis (PSC). Bile duct wall thickening in patients with eosinophilic cholangitis might be due to fibrosis of the bile duct wall. Eosinophilic cholangiopathy might be confused as PSC with eosinophilia. 展开更多
关键词 Eosinophilc cholangiopathy Primarysclerosing cholangitis Secondary sclerosing cholangitis Obstructive jaundice
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Prognostic Factors of Ampulla of Vater Carcinoma after Radical Surgery 被引量:1
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作者 Dongbing Zhao Yongkai Wu Yi Shan Chengfeng Wang Ping Zhao 《Chinese Journal of Clinical Oncology》 CSCD 2009年第2期85-89,共5页
OBJECTIVE Ampullary carcinoma is a rare disease with betterprognosis than other periampullary neoplasms. This studyinvestigated the association between clinicopathologic factors andprognosis after radical resection of... OBJECTIVE Ampullary carcinoma is a rare disease with betterprognosis than other periampullary neoplasms. This studyinvestigated the association between clinicopathologic factors andprognosis after radical resection of ampulla of Vater carcinoma.METHODS Clinical data from 105 patients who underwentradical pancreaticoduodenectomy from January 1990 to December2005 were retrospectively analyzed by the Kaplan-Meier method,log-rank test, and the Cox proportional hazard model.RESULTS The in-hospital mortality rate was 8.6%, the lymphnode metastasis rate was 37.1%, and the five-year survival ratewas 42.8%. Pancreatic involvement (P = 0.027), tumor diameter (P= 0.008), T stage (P = 0.003), TNM stage (P < 0.001), and number ofmetastatic lymph nodes (P < 0.001) were associated with prognosiswhen the univariate analysis was used. Multivariate analysisshowed that the number of lymph node metastases (P < 0.001;OR: 1.923; CI: 1.367-2.705) and tumor diameter (P = 0.03; OR: 1.432;CI: 1.035-1.981) were the independent prognostic factors.CONCLUSION The number of metastatic lymph nodes andtumor diameter are important pathologic factors predictingprognosis of ampulla of Vater carcinoma after radical resection,and lymph node dissection during the radical surgery effectivelyimproves the survival rate. 展开更多
关键词 ampulla of Vater lymph node METASTASIS CARCINOMA prognosis.
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Pancreatic cancer–Curative resection
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作者 Christoph Michalski Jrg Kleeff +1 位作者 Markus Büchler Helmut Friess 《The Chinese-German Journal of Clinical Oncology》 CAS 2007年第2期149-153,共5页
Resecting pancreatic cancer is the only chance for cure for this devastating disease . It increases survival significantly and may also contribute to a better quality of life . While median survival for patients with ... Resecting pancreatic cancer is the only chance for cure for this devastating disease . It increases survival significantly and may also contribute to a better quality of life . While median survival for patients with unresectable pancreatic cancer is only about 4-8 months, resective surgery improves prognosis to a median survival of 14-20 months and 5-year survival rates of up to 25% . A few studies compared curative resection versus incomplete (R1 and R2) resections whereas only one randomized trial was conducted comparing surgery versus chemoradiation . All these studies confirmed the survival benefit seen in the retrospective data analyses: 展开更多
关键词 pancreatic cancer RESECTION PANCREATICODUODENECTOMY PANCREATECTOMY PROGNOSIS
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65 CASES OF PRESERVING PYLORUS PANCREATODUODENECTOMY:EXPERIENCE AND PROBLEMS
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作者 赵玉沛 蔡力行 +1 位作者 钟守先 朱预 《Chinese Medical Sciences Journal》 CAS CSCD 1994年第3期171-175,共5页
Sixty-five patients with neoplasm (62 cases) or pancreatitis (3 cases) were treated with preserving pylorus pancreatoduodenectomy (PPPD) from 1984 to 1991. One postoperative death occurred. Follow-up studies were perf... Sixty-five patients with neoplasm (62 cases) or pancreatitis (3 cases) were treated with preserving pylorus pancreatoduodenectomy (PPPD) from 1984 to 1991. One postoperative death occurred. Follow-up studies were performed in 35 patients who had been treated by PPPD or the standard Whipple's procedure; they were questioned carefully concerning clinical symptoms. Further studies were porformed in 20 patients with or without pylorus preservation (10 patients, respectively). Nutritional status and gastrointestinal digestive and absorptive functions were evaluated by detemination of serum components, gastric analysis, barium emptying time, D-xylose absorption test,14CO2 breath test, PABA, and other methods. The results demonstrated malnutrition and postgastrectomy syndromes in some patients after the standard Whipple' s procedure, but not in those with PPPD. The quality of life was better in the latter. Pylorus preservation may be the main reason for this above difference. Delayed gastric emptying in the early postoperative period was a complication in some patients(21%) treated by PPPD.We recommend PPPD for pancreatoduodenectomy. 展开更多
关键词 preserving pylorus pancreateduodenectomy Whipple's procedure
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Pancreatic cancer–Laparoscopic resection
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作者 Yupei Zhao Songjie Shen Junchao Guo 《The Chinese-German Journal of Clinical Oncology》 CAS 2007年第2期154-158,共5页
Objective: To assess current role of laparoscopic resection for pancreatic cancer, so as to improve the surgical management of pancreatic cancer. Methods: A comprehensive review of articles from PubMed was carried out... Objective: To assess current role of laparoscopic resection for pancreatic cancer, so as to improve the surgical management of pancreatic cancer. Methods: A comprehensive review of articles from PubMed was carried out. Results: Cur- rently, the advantages of a complete laparoscopic pancreatoduodenectomy (LPD) are still outweighed by the morbidity associ- ated with the procedure. However, laparoscopic distal pancreatectomy (LDP) offers patients benefits in terms of postoperative recovery and the length of hospital stay with similar morbidity and mortality to open surgery. Hand-assisted laparoscopic sur- gery can help to overcome the limitation of a complete laparoscopic surgery while maintaining a minimally invasive approach. Conclusion: Current literature suggests that laparoscopic resection of pancreatic cancer is feasible and safe in experienced hands. The hand-assisted laparoscopic surgery shows a promising future in pancreatic cancer surgery. 展开更多
关键词 pancreatic cancer laparoscopic surgery PANCREATICODUODENECTOMY distal pancreatectomy HAND-ASSISTED
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