Evaluation Of Effect Of One-stage Or Two-stage Pancreaticoduodenectomy In The Treatment Of Intraoperative Findings Of The Ampulla Occupation

Background:Combined with ampullary tumors,cholangiocarcinoma or pancreatic head cancer patients with acute abdomen in the clinical more common,large-scale top three hospitals through a variety of medical treatment can be diagnosed before surgery and after full preoperative preparation for PD surgery;But in some cases,laparotomy patients may be found in the operation of the ampulla around the tumor,the surgeon needs to face whether the choice of whether the same time PD surgery.This dilemma is more frequent in grassroots hospitals in developing countries.In emergencies,there is a lack of clinical evidence for surgical indications and treatment outcomes for one-PD or two-stage PD surgery.Methods:This study collected a total of 137 patients who were diagnosed with PD surgeryfrom Qilu Hospital of Shandong University and Shanxi Central Hospital from May 2004 to May 2015,as well as 27 patients undergoing an emergency laparotomy for retroperitoneal or pancreatic Cancer patients with clinical data.Twenty-seven patients undergoing laparotomy in patients with retroperitoneal or pancreatic cancer were divided into two groups according to whether or not they were divided into two groups.Among them,10 patients underwent an emergency one-stage PD operation and 17 patients two-stage PD surgery.The cost,outcome and complication of conventional PD and emergency PD,one-stage PD and two-stage PD were analyzed by chi-square test,Fisher test or Student t test.Results:Compared with emergency PD,the conventional PD duration of hospitalization was shorter(P<0.001),less bleeding(P<0.001),shorter operation time(P<0.001),and lower cost(P<0.001).(P = 0.04),the duration of two-stage PD was shorter(P =0.004),the operation time was shorter(P = 0.047),and the cost of treatment was low(P<0.05).= 0.003).There was no significant difference in the incidence of complications such as bile leakage,pancreatic fistula,postoperative bleeding and other complications.Conclusions:Conventional PD is the best treatment for the treatment of the tumor around the ampulla,should be as much as possible to improve the preoperative examination to reduce the need for surgical surgeon to choose the occurrence of the situation.When the emergency PD is unavoidable,the decision for one or two PDs depends on the overall condition of the patient.PD patients with short hospital stay,short operation time,less treatment costs,less blood in the second phase of PD.