| Objective In this study,we received postoperative complications and sugical outcomes in central pancreatectomy by Pancreaticogastrostomy and Pancreaticojejunostomy(PJ),to analyze the indications,perioperative treatment,pancreatic fistula complications.Summarized the postoperative PG and PJ construction skills and matters needing attention.Methods Fourty-four cases of patients received central pancreatectomy and diagnosed as benign,low-grade malignant tumor and benign lesion located in the neck and body of pancreas in the postoperative pathology in Changzheng Hospital from May 2012 to March 2016 were analyzed in the study.The 44 patients was divided into PG group and PJ group according to the reconstruction methods.The statistics including gender,age,tumor index,coagulative function index and regular biochemical indexes(hemoglobin,platelet,total bilirubin,albumin,prealbumin)of the patients were collected.The postoperative pathology findings of the two groups of patients were recoded.Postoperative complications(including pancreatic fistula,hemorrhage,stress ulcer,delayed gastric emptying,fasting blood-glucose pathoglycemia,fat liquefaction of operative incision and death),average operation duration,average Length of Stay(LOS),and the LOS of pancreatic fistula patients were analyzed in the study.The 44 cases were followed and data including digestive function recovery,tumor recurrence and life quality were recoded.All the data were analyzed by SPSS 19.0.Occurence,measurement data and comparison between groups were recorded with percentage,(?)±s and 2-Independent-Samples T Test respectively.Comparsions between groups n terms of Enumeration data were finished with χ~2 test.Inspection level(α)was 0.05.Results.There were 17 cases with patients with postoperative complications(38.64%)among the 44 central pancreatectomy cases with 21 in PG group and 23 in PJ group.There were 8 cases of complications(38.10%)in PG group.There were 7 cases of pancreatic fistula(33.33%)with one case followed by hemorrhage and infection and 1 case of fat liquefaction(4.76%)with a surgical removed tumor in diameter of(2.9±1.1)cm.The postoperative pathology findings showed that there were 4 cases of pancreatic neuroendocrineneoplasm,5 cases of intraductal papillary mucinous neoplasm,2 cases of solid pseudopapillary neoplasm of the pancreas,9 cases of pancreatic serous cystadenoma and 1 case of retention cyst of the pancreas.There were 9 cases of complications(39.13%)in PJ group.There were 8 cases of pancreatic fistula(34.78%)with one case followed by infection and 1 case of fat liquefaction(4.35%)with a surgical removed tumor in diameter of(3.2±1.3)cm.The postoperative pathology findings showed that there were 5 cases of intraductal papillary mucinous neoplasm,6 cases of solid pseudopapillary neoplasm of the pancreas,5 cases of chronic pancreatitis and 1 case of pancreatic ductal adenocarcinoma and 1 case of pancreatic duct stricture caused by trauma.Pancreatic fistula cases of A level(ISGPF)in PG group and PJ group were 6(28.57%)and 7(30.43%)respectively and the patients smoothly discharged from hospital.One patient with intraductal papillary mucinous neoplasm in PG group had a B level pancreatic fistula(ISGPF)3 days after operation with hemorrhage and infection.One patient with intraductal papillary mucinous neoplasm tumor in PJ group had a B level pancreatic fistula(ISGPF)5 days after operation with infection.After receiving pancreas fistula from proximal stump of pancreas drainage and conservative treatments like octreotide and parenteral nutrition,both patients are recovered and left hospital.Fat liquefaction of operative incision cases in PG group and PJ group were 1(4.76 %)and 1(4.35 %)respectively and the patients recovered after dressing change treatment.There was no hemorrhage,stress ulcer,delayed gastric emptying,fasting blood-glucose pathoglycemia and complications causing death.There were no statistical difference between the complications of the 2 groups(P>0.05).The average LOS of PG group and PJ group were(10.4±2.1)and(9.2±2.9)respectively with no statistical differences of the 2 groups(P>0.05).The follow-up survey showed patients in both groups had good the digestive function and good life quality without tumor reoccurrence.The surgical outcomes were satisfactory.Conclusions Central pancreatectomy can maintain the function of pancreas in a better way.Both the PG and PJ are safe.Our limited experience shows that the choice of reconstruction couldn’t completely avoid pancreatic fistula and complications.PG are operated in patients with soft pancreas tissues,pancreatic duct of normal diameter or big pancreatic stump.PJ are operated in patients with hard pancreas tissues,pancreatic duct of large diameter(>3mm).The quality of reconstruction and effective drainage is the key to prevention and treatment of pancreatic fistula.PG is easier.The incidence of pancreatic fistula could be control,and it is the same to the literature reported. |
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