目的系统评价Braun吻合(BEE)对胰十二指肠切除术(PD)术后并发症的影响,重点分析对术后胃排空障碍(DGE)的影响,以探讨BEE的价值和意义,为临床应用提供循证医学方面的客观依据。方法计算机检索Cochrane Library、Pub Med、Embase、Web of ...目的系统评价Braun吻合(BEE)对胰十二指肠切除术(PD)术后并发症的影响,重点分析对术后胃排空障碍(DGE)的影响,以探讨BEE的价值和意义,为临床应用提供循证医学方面的客观依据。方法计算机检索Cochrane Library、Pub Med、Embase、Web of Science、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普和万方数据库关于BEE的相关文献,检索时间均从建库至2016年3月。按Cochrane系统评价的方法评价纳入研究的质量,使用Rev Man 5.3软件对研究资料进行统计分析。结果共纳入10篇文献,总计1544例患者。Meta分析结果显示:所有纳入文献中BEE组术后总并发症发生率(OR=0.61,95%CI=0.47~0.81,P=0.0006)和术后总DGE发生率(OR=0.36,95%CI=0.19~0.67,P=0.001)要低于非BEE组。同样,采用国际胰腺外科研究学组(ISGPS)标准的8篇文献中,BEE组总DGE发生率(OR=0.36,95%CI=0.18~0.72,P=0.004),B级DGE发生率(OR=0.36,95%CI=0.11~1.17,P=0.09)和C级DGE发生率(OR=0.28,95%CI=0.16~0.48,P<0.01)均要低于非BEE组。结论 Meta分析显示,BEE可以降低PD术后总并发症的发生率和DGE的发生率,尤其是可以降低C级DGE的发生率。展开更多
Background：Two types of pancreatic duct stents are used to improve postoperative outcomes of pancreatic anastomosis.The aim of this meta-analysis was to evaluate and compare the postoperative outcomes of patients wit...Background：Two types of pancreatic duct stents are used to improve postoperative outcomes of pancreatic anastomosis.The aim of this meta-analysis was to evaluate and compare the postoperative outcomes of patients with internal or external stenting during pancreaticoduodenectomy（PD）.Methods：We searched Pub Med,EMBASE,the Cochrane Library and Web of Science databases until the end of December,2014.Studies comparing outcomes of external vs.internal stent placement in PD were eligible for inclusion.Included literature was extracted and assessed by two independent reviewers.Results：Seven articles were identified for inclusion：three randomized controlled trials（RCTs）and four observational clinical studies（OCS）.The meta-analyses revealed that use of external stents had advantage on reducing the incidences of pancreatic fistula（PF）in total[odds ratio（OR）=0.69;95%confidence interval（CI）,0.48-0.99;P=0.04],PF in soft pancreas（OR=0.30;95%CI,0.16-0.56;P=0.0002）and delayed gastric emptying（DGE）（OR=0.58;95%CI,0.38-0.89;P=0.01）compared with internal stents.There were no significant differences in other postoperative outcomes between two stenting methods,including postoperative morbidity（OR=0.93;95%CI,0.39-2.23;P=0.88）,overall mortality（OR=0.70;95%CI,0.22-2.25;P=0.55）,and intra-abdominal collections（OR=0.67;95%CI,0.26-1.71;P=0.40）.Conclusions：Based upon this meta-analysis,the use of external pancreatic stents might have potential benefit in reducing the incidence of PF and DGE.Due to the limited number of original studies,more RCTs are needed to further support our result and clarify the issue.展开更多
The Italian team from Verona,questions the place of total pancreatectomy(TP)as an alternative to pancreaticoduodenectomy(PD)in patients at high risk of pancreatic fistula in a monocentric retrospective study running f...The Italian team from Verona,questions the place of total pancreatectomy(TP)as an alternative to pancreaticoduodenectomy(PD)in patients at high risk of pancreatic fistula in a monocentric retrospective study running from July 2017 to December 2019(1).A total of 702 patients were included,566 PD of which 101 were at high risk of pancreatic fistula(HR-PD),136 TP of which 86 were PD converted to TP(C-TP)for positive margin of pancreatic section for malignancy(49%),extensive vascular resection(14%)or technical reasons(27%)such as residual non-reconstructible pancreas/friable pancreas/microscopic Wirsung’s duct,10% for other reasons(bleeding......)Patients in the HR-PD group received externalized stent of the Wirsung duct.展开更多
Hepatobiliary pancreatic surgeons sometimes encounter an aberrant(or replaced)right hepatic artery(a-RHA,Hiatt types III-VI)during pancreaticoduodenectomy(PD).Arterial flow cutoff to the a-RHA may be associated with a...Hepatobiliary pancreatic surgeons sometimes encounter an aberrant(or replaced)right hepatic artery(a-RHA,Hiatt types III-VI)during pancreaticoduodenectomy(PD).Arterial flow cutoff to the a-RHA may be associated with a biliary leak or stenosis at the choledocho-jejunostomy and liver ischemia,resulting in ischemic cholangitis,liver abscess,and sepsis(1).展开更多
The standard surgery for distal common bile duct adenocarcinoma,pancreatic adenocarcinoma,and ampullary adenocarcinoma is pancreaticoduodenectomy(PD).PD is a technically challenging procedure with high mortality(0-3.5...The standard surgery for distal common bile duct adenocarcinoma,pancreatic adenocarcinoma,and ampullary adenocarcinoma is pancreaticoduodenectomy(PD).PD is a technically challenging procedure with high mortality(0-3.5%)and morbidity(38-50%)rates(1-5).It is essential to recognize the anatomy preoperatively,especially of the hepatic artery and positions of the tumors,to avoid adverse events(6,7).The aberrant right hepatic artery(aRHA)originating from the superior mesenteric artery(SMA)is the most frequent and considerable hepatic artery variation(8-10).展开更多
Background:The difference in volume change in a pancreatic remnant according to the type of pancreaticoenterostomy after pancreaticoduodenectomy(PD)for long-term follow-up is unknown.Also,there are few studies that ev...Background:The difference in volume change in a pancreatic remnant according to the type of pancreaticoenterostomy after pancreaticoduodenectomy(PD)for long-term follow-up is unknown.Also,there are few studies that evaluate the difference in general nutritional status and pancreatic endocrine function,including new-onset diabetes mellitus(NODM)depending on the type of pancreaticoenterostomy.This study aimed to compare serial pancreatic volume changes in pancreatic remnants between pancreatogastrostomy(PG)and pancreatojejunostomy(PJ)after PD and to evaluate the difference in general nutritional status and incidence of NODM between PG and PJ.Methods:This study enrolled 115 patients who had survived for more than 3 years after PD.They were divided into the PG group and the PJ group.Their clinicopathologic factors were collected and analyzed.We calculated serial pancreas volume and pancreatic duct size precisely from preoperative stage to 5 years after surgery by image-processing software specifically designed for navigation and visualization of multimodality and multidimensional images.Consecutive changes of albumin and body mass index(BMI)as related to general nutritional status were compared between the PG and PJ groups.To evaluate the incidence and risk factors of NODM following PD,subgroup analysis was performed in 88 patients who did not have diabetes preoperatively.Results:Most patient demographics were not significantly different between the PG group(n=45)and PJ group(n=70).There was no significant difference in volume reduction between the groups from postoperative 1 month to 5 years(PG group?18.21±14.66 mL versus PJ group?14.43±13.05 mL,P=0.209).But there was a significant difference in increased pancreatic duct size between the groups from postoperative 1 month to 5 years(PG group 1.66±2.20 mm versus PJ group 0.54±1.54 mm,P=0.007).There was no significant difference in the increase of total serum albumin between the groups for 5 years after surgery(PG group 0.51±0.47 g/dL,14.3%versus PJ group 0.42±0.展开更多
The history of pancreatic cancer surgery, though fraught with failure and setbacks, is punctuated by periods of incremental progress dependent upon the state of the art and the mettle of the surgeons daring enough to ...The history of pancreatic cancer surgery, though fraught with failure and setbacks, is punctuated by periods of incremental progress dependent upon the state of the art and the mettle of the surgeons daring enough to attempt it. Surgical anesthesia and the aseptic techniques developed during the latter half of the 19 th century were instrumental in establishing a viable setting for pancreatic surgery to develop. Together, they allowed for bolder interventions and improved survival through the postoperative period. Surgical management began with palliative procedures to address biliary obstruction in advanced disease. By the turn of the century, surgical pioneers such as Alessandro Codivilla and Walther Kausch were demonstrating the technical feasibility of pancreatic head resections and applying principles learned from palliation to perform complicated anatomical reconstructions. Allen O. Whipple, the namesake of the pancreaticoduodenectomy（PD）, was the first to take a systematic approach to refining the procedure. Perhaps his greatest contribution was sparking a renewed interest in the surgical management of periampullary cancers and engendering a community of surgeons who advanced the field through their collective efforts. Though the work of Whipple and his contemporaries legitimized PD as an accepted surgical option, it was the establishment of high-volume centers of excellence and a multidisciplinary approach in the later decades of the 20^th century that made it a viable surgical option. Today, pancreatic surgeons are experimenting with minimally invasive surgical techniques, expanding indications for resection, and investigating new methods for screening and early detection. In the future, the effective management of pancreatic cancer will depend upon our ability to reliably detect the earliest cancers and precursor lesions to allow for truly curative resections.展开更多
文摘目的系统评价Braun吻合(BEE)对胰十二指肠切除术(PD)术后并发症的影响,重点分析对术后胃排空障碍(DGE)的影响,以探讨BEE的价值和意义,为临床应用提供循证医学方面的客观依据。方法计算机检索Cochrane Library、Pub Med、Embase、Web of Science、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普和万方数据库关于BEE的相关文献,检索时间均从建库至2016年3月。按Cochrane系统评价的方法评价纳入研究的质量,使用Rev Man 5.3软件对研究资料进行统计分析。结果共纳入10篇文献,总计1544例患者。Meta分析结果显示:所有纳入文献中BEE组术后总并发症发生率(OR=0.61,95%CI=0.47~0.81,P=0.0006)和术后总DGE发生率(OR=0.36,95%CI=0.19~0.67,P=0.001)要低于非BEE组。同样,采用国际胰腺外科研究学组(ISGPS)标准的8篇文献中,BEE组总DGE发生率(OR=0.36,95%CI=0.18~0.72,P=0.004),B级DGE发生率(OR=0.36,95%CI=0.11~1.17,P=0.09)和C级DGE发生率(OR=0.28,95%CI=0.16~0.48,P<0.01)均要低于非BEE组。结论 Meta分析显示,BEE可以降低PD术后总并发症的发生率和DGE的发生率,尤其是可以降低C级DGE的发生率。
基金supported by Introductory Funding Project from Shanghai Science and Technolodge Bureau (124119a0600)
文摘Background：Two types of pancreatic duct stents are used to improve postoperative outcomes of pancreatic anastomosis.The aim of this meta-analysis was to evaluate and compare the postoperative outcomes of patients with internal or external stenting during pancreaticoduodenectomy（PD）.Methods：We searched Pub Med,EMBASE,the Cochrane Library and Web of Science databases until the end of December,2014.Studies comparing outcomes of external vs.internal stent placement in PD were eligible for inclusion.Included literature was extracted and assessed by two independent reviewers.Results：Seven articles were identified for inclusion：three randomized controlled trials（RCTs）and four observational clinical studies（OCS）.The meta-analyses revealed that use of external stents had advantage on reducing the incidences of pancreatic fistula（PF）in total[odds ratio（OR）=0.69;95%confidence interval（CI）,0.48-0.99;P=0.04],PF in soft pancreas（OR=0.30;95%CI,0.16-0.56;P=0.0002）and delayed gastric emptying（DGE）（OR=0.58;95%CI,0.38-0.89;P=0.01）compared with internal stents.There were no significant differences in other postoperative outcomes between two stenting methods,including postoperative morbidity（OR=0.93;95%CI,0.39-2.23;P=0.88）,overall mortality（OR=0.70;95%CI,0.22-2.25;P=0.55）,and intra-abdominal collections（OR=0.67;95%CI,0.26-1.71;P=0.40）.Conclusions：Based upon this meta-analysis,the use of external pancreatic stents might have potential benefit in reducing the incidence of PF and DGE.Due to the limited number of original studies,more RCTs are needed to further support our result and clarify the issue.
文摘The Italian team from Verona,questions the place of total pancreatectomy(TP)as an alternative to pancreaticoduodenectomy(PD)in patients at high risk of pancreatic fistula in a monocentric retrospective study running from July 2017 to December 2019(1).A total of 702 patients were included,566 PD of which 101 were at high risk of pancreatic fistula(HR-PD),136 TP of which 86 were PD converted to TP(C-TP)for positive margin of pancreatic section for malignancy(49%),extensive vascular resection(14%)or technical reasons(27%)such as residual non-reconstructible pancreas/friable pancreas/microscopic Wirsung’s duct,10% for other reasons(bleeding......)Patients in the HR-PD group received externalized stent of the Wirsung duct.
文摘Hepatobiliary pancreatic surgeons sometimes encounter an aberrant(or replaced)right hepatic artery(a-RHA,Hiatt types III-VI)during pancreaticoduodenectomy(PD).Arterial flow cutoff to the a-RHA may be associated with a biliary leak or stenosis at the choledocho-jejunostomy and liver ischemia,resulting in ischemic cholangitis,liver abscess,and sepsis(1).
文摘The standard surgery for distal common bile duct adenocarcinoma,pancreatic adenocarcinoma,and ampullary adenocarcinoma is pancreaticoduodenectomy(PD).PD is a technically challenging procedure with high mortality(0-3.5%)and morbidity(38-50%)rates(1-5).It is essential to recognize the anatomy preoperatively,especially of the hepatic artery and positions of the tumors,to avoid adverse events(6,7).The aberrant right hepatic artery(aRHA)originating from the superior mesenteric artery(SMA)is the most frequent and considerable hepatic artery variation(8-10).
文摘Background:The difference in volume change in a pancreatic remnant according to the type of pancreaticoenterostomy after pancreaticoduodenectomy(PD)for long-term follow-up is unknown.Also,there are few studies that evaluate the difference in general nutritional status and pancreatic endocrine function,including new-onset diabetes mellitus(NODM)depending on the type of pancreaticoenterostomy.This study aimed to compare serial pancreatic volume changes in pancreatic remnants between pancreatogastrostomy(PG)and pancreatojejunostomy(PJ)after PD and to evaluate the difference in general nutritional status and incidence of NODM between PG and PJ.Methods:This study enrolled 115 patients who had survived for more than 3 years after PD.They were divided into the PG group and the PJ group.Their clinicopathologic factors were collected and analyzed.We calculated serial pancreas volume and pancreatic duct size precisely from preoperative stage to 5 years after surgery by image-processing software specifically designed for navigation and visualization of multimodality and multidimensional images.Consecutive changes of albumin and body mass index(BMI)as related to general nutritional status were compared between the PG and PJ groups.To evaluate the incidence and risk factors of NODM following PD,subgroup analysis was performed in 88 patients who did not have diabetes preoperatively.Results:Most patient demographics were not significantly different between the PG group(n=45)and PJ group(n=70).There was no significant difference in volume reduction between the groups from postoperative 1 month to 5 years(PG group?18.21±14.66 mL versus PJ group?14.43±13.05 mL,P=0.209).But there was a significant difference in increased pancreatic duct size between the groups from postoperative 1 month to 5 years(PG group 1.66±2.20 mm versus PJ group 0.54±1.54 mm,P=0.007).There was no significant difference in the increase of total serum albumin between the groups for 5 years after surgery(PG group 0.51±0.47 g/dL,14.3%versus PJ group 0.42±0.
文摘The history of pancreatic cancer surgery, though fraught with failure and setbacks, is punctuated by periods of incremental progress dependent upon the state of the art and the mettle of the surgeons daring enough to attempt it. Surgical anesthesia and the aseptic techniques developed during the latter half of the 19 th century were instrumental in establishing a viable setting for pancreatic surgery to develop. Together, they allowed for bolder interventions and improved survival through the postoperative period. Surgical management began with palliative procedures to address biliary obstruction in advanced disease. By the turn of the century, surgical pioneers such as Alessandro Codivilla and Walther Kausch were demonstrating the technical feasibility of pancreatic head resections and applying principles learned from palliation to perform complicated anatomical reconstructions. Allen O. Whipple, the namesake of the pancreaticoduodenectomy（PD）, was the first to take a systematic approach to refining the procedure. Perhaps his greatest contribution was sparking a renewed interest in the surgical management of periampullary cancers and engendering a community of surgeons who advanced the field through their collective efforts. Though the work of Whipple and his contemporaries legitimized PD as an accepted surgical option, it was the establishment of high-volume centers of excellence and a multidisciplinary approach in the later decades of the 20^th century that made it a viable surgical option. Today, pancreatic surgeons are experimenting with minimally invasive surgical techniques, expanding indications for resection, and investigating new methods for screening and early detection. In the future, the effective management of pancreatic cancer will depend upon our ability to reliably detect the earliest cancers and precursor lesions to allow for truly curative resections.
