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Predictive Factors for Complications After pancreaticoduodenectomy

Predictive Factors for Complications After Pancreaticoduoden...

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中国抗癌协会胆道肿瘤专业委员会成立大会暨第一届全国胆道...

作者： Cheng Qing-bao,Jiang Xiang-qing,Luo Xiang-ji,Yi Bin,Liu Chen,Zhang Bai-he Department of biliary surgeryⅠ,Eastern hepatobiliary surgical hospital

＜正＞Background Knowledge of the risk factors for complications following pancreaticoduodenectomy（PD） is sparse and there is not a consensus regarding the criteria to define the complications.The objective of this study was to determine the predictive risk factors for this surgery using the international study group definition.Methods Between October 1999 and September 2005,data from 295 consecutive patients who underwent a PD in the Eastern Hepatobiliary Surgery Hospital were recorded prospectively.Medical records and specific charts from surgical procedures,histopathology reports,and intens ve care units were continually scrutinized.Multivariable logistic regression analyses were used to estimate relative risks and their 95%confidence intervals.Results Among 295 patients undergoing PD,103（34.9%） experienced at least one complication.Operations by low-volume surgeons（＜50 PD surgeries across their lifetime） were followed by more abdominal complications（odds ratio[OR]45.2）.End-to-end pancreaticojejunostomy（PJ） resulted in more complications than end-to-side PJ（OR 2.7）.Diabetes mellitus, increased estimated blood loss,and soft gland texture significantly increased the risks of abdominal complications. Systemic morbidity（OR 9.9） was the only independent predictive factor for mortality.Conclusion High-volume surgeons and end-to-side PJ greatly reduce the risk of abdominal complications in patients undergoing PD.The higher abdominal complications rate in patients with soft gland texture was similar to those found in previous reports.Moreover,PD should be performed with considerable attention in patients with diabetes mellitus.

关键词： pancreaticoduodenectomy morbidity mortality pancreatic fistula

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Endovascular graft exclusion for gastroduodenal artery remnant hemorrhage after pancreaticoduodenectomy

Endovascular graft exclusion for gastroduodenal artery remna...

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中国抗癌协会胆道肿瘤专业委员会成立大会暨第一届全国胆道...

作者： Liu Chen,Li Bin,Luo Xiang-ji,Yu Yong,Fen Fei-ling,Yang Ye-fa,Chen Dong,LongXing-an, Cheng Hong-yan,Jiang Xiao-qing Department of Biliary duct surgeryⅠ Depatment of Interventional treatment Depatment of Radiology Eastern hepatic biliary hospital,Secondary military medicine university

＜正＞Background:Intra-abdominal aortic bleeding after pancreatoduodenectomy（PD） is a fatal complication which leads to high mortality rate in the event of dangerous situations.Therapeutic options include reoperation or endovascular minimally invasive techniques such as embolization traditionally.The present article describes our experiences with endovascular graft exclusion（EVGE） by implantation of membrane-covered stent grafts. Methods:The findings of two patients with gastroduodenal artery remnant rupture and hemorrhage are described.All patients were treated with placement of membrane-covered stent grafts in the common hepatic artery（EVGE）.The patients’medical records,radiological reports,and images were retrospectively reviewed. Technical success was defined as immediate cessation of hemorrhage.Clinical success was defined as hemodynamic stability. Results:Two stent grafts were implanted in the common hepatic artery,respectively.The patient developed recurrent hemorrhages of the common hepatic artery,Technical and clinical success was achieved at every procedure.There were no major complications in two patients after EVGE. Conclusions:Endovascular graft exclusion（EVGE） using membrane-covered stent grafts is an effective and safe procedure for the treatment of intra-abdominal arterial bleeding after pancreatoduodenectomy（PD） The technique is a promising alternative to standard procedures such as surgical repair or embolization.

关键词： pancreatoduodenectomy pancreatic fistula intra-abdominal aortic bleeding endovascular graft exclusion membrane-covered stent grafts

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