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Correlation of serum albumin and prognostic nutritional index with outcomes following pancreaticoduodenectomy

World Journal of Clinical Cases 2019年第1期7卷 28-38页

作者： Narongsak Rungsakulkij Pongsatorn Tangtawee Wikran Suragul Paramin Muangkaew Somkit Mingphruedhi suraida aeesoa Department of Surgery Faculty of Medicine Ramathibodi Hospital Mahidol University

BACKGROUND Pancreaticoduodenectomy(PD) is a complex surgical procedure with a high morbidity rate. The serious complications are major risk factors for poor longterm surgical outcome. Studies have reported an association between early postoperative prognostic nutritional index(PNI) and prediction of severe complications after abdominal surgery. However, there have been no studies on the use of early postoperative PNI for predicting serious complications following PD.AIM To analyze the risk factors and early postoperative PNI for predicting severe complications following PD.METHODS We retrospectively analyzed 238 patients who underwent PD at our hospital between January 2007 and December 2017. The postoperative complications were classified according to the Dindo-Clavien classification. Grade Ⅲ-Ⅴ postoperative complications were classified as serious. The risk factors for serious complications were analyzed by univariate analysis and multivariate logistic regression analysis.RESULTS Overall complications were detected in 157 of 238 patients(65.9%) who underwent PD. The grade Ⅲ-Ⅴ complication rate was 26.47%(63/238 patients).The mortality rate was 3.7%(9/238 patients). Multivariate logistic regression analysis revealed that preoperative serum albumin [odds ratio(OR): 0.883, 95%confidence interval(CI): 0.80-0.96; P < 0.01] and PNI on postoperative day 3 <40.5(OR: 2.77, 95%CI: 1.21-6.38, P < 0.05) were independent factors associated with grade Ⅲ-Ⅴ postoperative complications.CONCLUSION Perioperative albumin is an important factor associated with serious complications following PD. Low early postoperative PNI(< 40.5) is a predictor for serious complications.

关键词： Postoperative complications Pancreatectomy Serum albumin Risk factors Prognostic nutritional index

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Prognostic role of alpha-fetoprotein response after hepatocellular carcinoma resection

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World Journal of Clinical Cases 2018年第6期6卷 110-120页

作者： Narongsak Rungsakulkij Wikran Suragul Somkit Mingphruedhi Pongsatorn Tangtawee Paramin Muangkaew suraida aeesoa Department of Surgery Faculty of MedicineRamathibodi HospitalMahidol University

AIM To investigate whether the change in pre-/post-operation serum alpha-fetoprotein(AFP) levels is a predictive factor for hepatocellular carcinoma(HCC) outcomes.METHODS We retrospectively analyzed 334 HCC patients who underwent hepatic resection at our hospital between January 2006 and December 2016. The patients were classified into three groups according to their change in serum AFP levels:(1) the normal group, pre-AFP ≤ 20 ng/m L and post-AFP ≤ 20 ng/m L;(2) the response group, pre-AFP > 20 ng/m L and post-AFP decrease of ≥ 50% of pre-AFP; and(3) the non-response group, pre-AFP level > 20 ng/m L and post-AFP decrease of 20 ng/m L RESULTS Univariate and multivariate analyses revealed thatmultiple tumors [hazard ratio(HR): 1.646, 95%CI: 1.15-2.35, P < 0.05], microvascular invasion(m VI)(HR: 1.573, 95%CI: 1.05-2.35, P < 0.05), and the nonresponse group(HR: 2.425, 95% CI: 1.42-4.13, P < 0.05) were significant independent risk factors for recurrencefree survival. Similarly, multiple tumors(HR: 1.99, 95%CI: 1.12-3.52, P < 0.05), m VI(HR: 3.24, 95%CI: 1.77-5.90, P < 0.05), and the non-response group(HR: 3.62, 95%CI: 1.59-8.21, P < 0.05) were also significant independent risk factors for overall survival. The nonresponse group had significantly lower overall survival rates and recurrence-free survival rates than both the normal group and the response group(P < 0.05). Thus, patients with no response regarding post-surgery AFP levels were associated with poor outcomes.CONCLUSION Serum AFP responses are significant prognostic factors for the surgical outcomes of HCC patients, suggesting post-resection AFP levels can direct the management of HCC patients.

关键词： Risk factors Prognosis Alpha-fetoprotein Hepatocellular carcinoma Liver neoplasms

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Risk factors for pancreatic fistula following pancreaticoduodenectomy: A retrospective study in a Thai tertiary center

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World Journal of Gastrointestinal Surgery 2017年第12期9卷 270-280页

作者： Narongsak Rungsakulkij Somkit Mingphruedhi Pongsatorn Tangtawee Chonlada Krutsri Paramin Muangkaew Wikran Suragul Penampai Tannaphai suraida aeesoa Department of Surgery Faculty of Medicine Ramathibodi Hospital Mahidol University Department of Radiology Faculty of Medicine Ramathibodi HospitalMahidol University

AIM To analyze the risk factors of postoperative pancreatic fistula following pancreaticoduodenectomy in a Thai tertiary care center.METHODS We retrospectively analyzed 179 patients who underwent pancreaticoduodenectomy at our hospital from January 2001 to December 2016. Pancreatic fistula were classified into three categories according to a definition made by an International Study Group on Pancreatic Fistula. The risk factors for pancreatic fistula were analyzed by univariate analysis and multivariate logistic regression analysis.RESULTS Pancreatic fistula were detected in 88/179 patients(49%) who underwent pancreaticoduodenectomy. Fifty-eight pancreatic fistula(65.9%) were grade A, 22 cases(25.0%) were grade B and eight cases(9.1%) were grade C. Clinically relevant pancreatic fistula were detected in 30/179 patients(16.7%). The 30-d mortality rate was 1.67%(3/179 patients). Multivariate logistic regression analysis revealed that soft pancreatic texture(odds ratio = 3.598, 95%CI: 1.77-7.32) was the most significant risk factor for pancreatic fistula. A preoperative serum bilirubin level of > 3 mg/d L was the most significant risk factor for clinically relevant pancreatic fistula according to univariate and multivariate analysis.CONCLUSION Soft pancreatic tissue is the most significant risk factor for postoperative pancreatic fistula. A high preoperative serum bilirubin level(> 3 mg/d L) is the most significant risk factor for clinically relevant pancreatic fistula.

关键词： Risk factors Pancreatic fistula Pancreas Pancreatectomy Pancreaticoduodenectomy

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Fluorescence cholangiography enhances surgical residents’ biliary delineation skill for laparoscopic cholecystectomies

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World Journal of Gastrointestinal Surgery 2020年第3期12卷 93-103页

作者： Narongsak Rungsakulkij Siraprapa Thewmorakot Wikran Suragul Watoo Vassanasiri Pongsatorn Tangtawee Paramin Muangkaew Somkit Mingphruedhi suraida aeesoa Department of Surgery Faculty of Medicine Ramathibodi Hospital Mahidol University

BACKGROUND Laparoscopic cholecystectomy(LC)is a minimally invasive procedure,often performed by surgical residents(SRs).Fluorescence cholangiography(FC)enables real-time identification of biliary anatomy.AIM To investigate the benefit of FC for enhancing SRs’identification skills.METHODS Prospective data was collected from January 2018 to June 2018 at our hospital.The study cohorts were the SRs(study group,n=15)and the surgical staff(SS;control group,n=9).Participants were assigned to watch videos of LCs with FC from five different patients who had gallbladder disease,and identify structures in the video clips(including cystic duct,common bile duct,common hepatic duct,and cystic artery),first without FC,and then with FC.RESULTS In the without-FC phase,the overall misidentification rate by SRs(21.7%)was greater than that of the SS(11.8%;P=0.018),However,in the FC phase,the two groups did not significantly differ in misidentification rates(23.3%vs 23.3%,P=0.99).Paired-structure analysis of the without-FC and with-FC phases for the SR group found a significantly higher misidentification rate in the without-FC phase than the with-FC phase(21.9%vs 10.9%;P<0.01).However,misidentification rates in the with-FC phase did not significantly differ between SRs and SS.CONCLUSION FC enhanced identification skills of inexperienced surgeons during LC compared with conventional training.Combined with simulation-based video training,FC is a promising tool for enhancing technical and decision skills of trainees and inexperienced surgeons.

关键词： Laparoscopic cholecystectomy Fluorescence Cholangiography Residency Education

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Lower Lid Entropion Secondary to Missed Intraorbital Foreign Body in a Child

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Open Journal of Ophthalmology 2016年第4期6卷 198-204页

作者： Othman Khairuddin Abdul Rashid suraida Li Min Evelyn Tai Hussein Adil Ahmad Tajudin Liza-Sharmini Ibrahim Mohtar Department of Ophthalmology School of Medical Sciences Universiti Sains Malaysia Health Campus Kubang Kerian Malaysia Hospital Universiti Sains Malaysia Kubang Kerian Malaysia

Background: Intraorbital foreign bodies can result in various complications if not appropriately managed. Aim: To report a case of lower lid entropion secondary to a missed intraorbital foreign body. Case Presentation: A 7-year-old boy presented with inward turning of the left lower lid for three days prior to admission. A week before, the child was in the garden when part of the roof of their home suddenly broke off, with pieces of the debris falling near him. He complained of left eye irritation, but a visit to a general practitioner found no eye abnormalities. Three days after that, the mother sought an ophthalmology opinion as she noticed inversion of the left lower lid. On examination, visual acuity in both eyes was 6/6. There was left lower lid entropion, and a deeply embedded foreign body seen in the lower lid. No other eye abnormalities noted. Computed tomography scan of the orbits revealed a welldefined foreign object in the lower orbit, fracturing the antero-superior wall of the left maxillary sinus. The left eye foreign body was removed uneventfully via a transconjunctival approach. Conclusion: A thorough examination is mandatory in any case of ocular trauma especially in young children, who are usually unable to provide a clear history of the injury.

关键词： Eye Eye Injuries Eye Foreign Bodies Child Entropion

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