The Distal Pancreatectomy Of Pancreatic Body Residual Analysis In Different Treatments

Objective:Discuss the distal pancreatectomy of pancreatic body residual the pros and cons of different treatments,focuses on analyzing the relationship between different treatment and postoperative pancreatic fistula,explores the pancreas stub which approach is more reasonable.Methods:Retrospective analysis of 2003-2003 year the first affiliated hospital of kunming medical university in 74 cases(including trauma,stone and tumor,etc.)line of the distal pancreatectomy in patients with clinical data.1.The first analysis of patients with pancreas texture soft,whether preoperative what effect associated with chronic pancreatitis with pancreatic fistula.2.According to its pancreatic stump a different approach is divided into four groups:(1)Pure using Endo-GIA staple group of 17 cases(later referred to as the staple group;(2)Pure manual suture group 19 cases(later referred to as the hand suture group;(3)A combination of Endo-GIA staple and manual suture group of 22 cases(later referred to as the combined group;(4)The pancreaticojejunostomy group.First of all patients admitted to hospital chief complaint of whether there is a obvious symptoms(such as abdominal pain,nausea,vomiting,jaundice,etc.),whether preoperative comorbid chronic pancreatitis and pancreatic texture relationship with pancreatic fistula were analysed.Then respectively analyses the following differences:(1)Each of the patient’s general condition(such as sex ratio,age,BMI);(2)Postoperative pancreatic fistula rate;(3)Intraoperative blood loss;(4)The operation time;(5)Postoperative hospital stay;(6)Hospital costs.Results:1.The preoperative general relations with pancreatic fistula:(1)Groups of patients in the proportion of gender,age,BMI had no obvious difference;(2)Complained of has obvious symptoms prior to admission of postoperative pancreatic fistula rate is 34.37%,with no obvious symptoms prior to admission of postoperative pancreatic fistula rate 45.24%,P = 0.474,there was no statistically significant difference between;(3)Pancreas texture soft of postoperative pancreatic fistula rate is 51.16%,a hard postoperative pancreatic fistula rate 25.81%,P = 0.033,the difference was statistically significant;(4)Preoperative with 24.13%rate of postoperative pancreatic fistula with chronic pancreatitis,chronic pancreatitis,postoperative pancreatic fistula rate 51.11%,P = 0.029,the difference was statistically significant;2.Pancreatic stump handling relations with pancreatic fistula:the staple group,the hand suture group,the combined group and the pancreaticojej unostomy group respectively:70.59%,31.57%,31.82%,31.25%.The hand suture group,the combined group and the pancreaticojejunostomy group of pancreatic fistula of pancreas rate is lower than that of staple group,difference was statistically significant.The hand suture group,the joint and the pancreaticojejunostomy group has no statistically significant difference;3.Four groups in terms of intraoperative blood loss,respective:150.18±24.49ml,153.94±14.29ml,155.38±32.59ml,153.68±35.24ml,there were no significant differences;4.In terms of operation time,the pancreaticojejunostomy group(232.50±33.37 min)higher than the hand suture group(194.95±33.82min),the hand suture group was higher than the joint group(161.36±29.89 min)and the staple group,(167.65±34.15 min),the combined group and the staple group have no significant difference;5.Four groups respectively on postoperative hospital stay:12.06±2.95d,12.05±3.15d,10.73±2.51d,14.69±3.03d,the pancreaticojejunostomy group is significa-ntily higher than the other three groups,while the other three groups have no significant difference;6.On the total hospitalization expenses,the hand suture group is the lowest(4.01±0.88 million yuan),the staple group(5.14±0.90 million yuan)and the combined group(4.66±0.68 million yuan)has no obvious difference,and the pancreaticojejunos-tomy group(5.69±0.87 million yuan)is the highest;Conclusions:1.Four groups of patients in the proportion of gender,age and BMI had no obvious difference,have clinical comparability.Whether with obvious symptoms prior to admission with no obvious relationship between postoperative pancreatic fistula;Quality of a material soft pancreas postoperative pancreatic fistula occurred more often;Preoperative to offer less postoperative pancreatic fistula with chronic pancreatitis;but the other three groups have no obvious difference in postoperative pancreatic fistula.So we do not recommend using separate closed the structure of pancreatic stump;2.Comparative analysis of different treatment methods:(1)In terms of postoperative pancreatic fistula,the staple group of pancreatic fistula rate is the highest but the other three groups have no obvious difference in postoperative pancreatic fistula.So we do not recommend using Endo-GIA stapler treatment of pancreatic stump;(2)In terms of intraoperative blood loss,four groups was no significant difference;(3)In the aspect of operation time,the pancreaticojejunostomy group is higher than the hand suture group,the hand suture group was higher than the combined group and the staple group,and there is no difference between the combined group and the staple group.Long operation time may increase the risk of intraoperative related complications;(4)In terms of postoperative hospital stay,the pancreaticojejunostomy group is significantly higher than other three groups,and the other three groups have no significant difference.Long hospitalization time will increase the psychological pressure of patients,on the one hand,on the other hand also can produce more cost;(5)In terms of hospitalization expense,the pancreaticojejunostomy group is the highest,and the hand suture group was the lowest,the staple group and the combined group is the same,in the middle position.To sum up,in the process of actual operation,patients with clinical workers should be considered in patients with actual situation,before we decide to use what method.