Application Of Total Pancreatectomy In The Treatment Of Pancreatic Diseases(Report Of 12 Cases)

Objective : To investigate the feasibility,safety and clinical efficacy of total pancreatectomy performed for pancreatic diseases.Methods:The clinical data of twelve cases of underwent total pancreatectomy in the pancreas center of the second affiliated hospital of Nanjing medical university between January 2016 and January 2018 were reviewed retrospectively.The data include gender,age,preoperative complications,American association of anesthesiologists score,surgical methods,operation time,intraoperative blood loss,intraoperative blood transfusion,lymph node dissection and metastasis,pathological types,postoperative complications,postoperative hospitalization days.Follow-up included fasting blood glucose levels,daily short-acting insulin,long-acting insulin,total insulin,and pancreatic enzyme dosage,nutritional status,and survival.Results:Twelve cases underwent total pancreatectomy successfully.Mean operation time was 360.42±69.88 minutes and mean estimated intraoperative blood loss was383.33±180.07 m L.Eight patients had intraoperative blood transfusion,with the average volume of 472.08 ± 376.21 m L.There was no perioperative death,and postoperative morbidity was 41.7%(5/12),including delayed gastric emptying in 2cases,bile leakage in 1 case,intra-abdominal infection and bleeding in 1 case.Three of them underwent second surgery,and the second operation rate was 25%.the rest of the complications were recovered after active conservative treatment.The average postoperative hospital stay was 40.83 ± 35 days,and the median postoperative hospital stay was 22(15-22)days.Eleven patients were successfully followed up,and one patient was lost to follow,with an average follow-up time of 13(4-28)months.During follow-up,hypoglycemia occurred in 2 patient.The mean short-acting insulin amount was 20.18±5.56 U/d,the average long-acting insulin amount was 10.45±4.27 U/d,the average fasting blood glucose level was 8.13±1.38 mmol/L,and the average pancreatic enzyme dosage was 0.93±0.28 g/d.In terms of quality of life,the weight of 5 patients increased,no significant changes in 3 patients and decreased in 3patients compared with that pre-operation.The symptoms of abdominal and lumbar back pain were significantly improved in 10 patients after operation,unchanged in one patients.Diarrhea occurred in 2 patients and was improved after taking more pancreatic enzyme.Of the 11 patients who were followed up,two patient died and the rest survived.Conclusion : Total pancreatectomy is a safe and effective surgical method for the treatment of pancreatic diseases.For pancreatic surgeons,we should actively strive for and apply it rationally.After total pancreatectomy with enhanced healthy education,standardized blood glucose control and oral pancreatic enzyme replacement therapy,the efficacy of the procedure was satisfactory,postoperative blood glucose control was stable,and the quality of life of patients can be improved.