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25 June 2019, Volume 24 Issue 03 Previous Issue    Next Issue

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Experience of robotic middle pancreatectomy: a report of 177 cases SHI Yusheng, WANG Yue, QIN Kai, WENG Yuanchi, ZHAO Shulin, ZHAI Shuyu, TANG Xiaomei, HUO Zhen, DENG Xiaxing, SHEN Baiyong, PENG Chenghong 2019, 24 (03):  215-221.  DOI: 10.16139/j.1007-9610.2019.03.009 Abstract ( 772 )   PDF (1028KB) ( 256 )   Objectives Clinical effect and postoperative complications were compared between robotic middle pancreatectomy (RMP) and open middle pancreatectomy (OMP). Methods Retrospective study was done with 177 patients of the demographics and perioperative data including 115 cases of RMP group and 62 cases of OMP group in our hospital from December 2010 to December 2017. Results There were 41 male and 74 female with mean age (46.9± 14.2) years in RMP group, and 25 male and 37 female with age (53.0± 13.7) years in OMP group. It was seen biochemical pancreatic leakage 14 cases (12.2%) in RMP group and 7 cases (11.3%) in OMP group. Only pancreatic leakage grade B was present 38 ca-ses (33%) in RMP group. Pancreatic leakage grade B and C were present 14 cases (22.6%) in OMP group. Length of hospital stay was (24.5± 12.8) days in RMP group and (23.3± 17.8) days in OMP group (P>; 0.05). There was significant difference in operative time and intraoperative blood loss between 2 groups(P< 0.001). A total of 14 cases were found postoperative bleeding with treatment of digital subtraction angiography in 6 cases and reoperation in 6 cases and nonoperative hemostasis in 1 case. There was 1 case death for severe postoperative bleeding and other case death for acute pulmonary embolism. Conclusions Postoperative pancreatic leakage is still main complication of both RMP and OMP. RMP could be safe now with advantages of minimal invasive surgery. References | Related Articles | Metrics

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Laparoscopic versus open pancreaticoduodenectomy: short-term clinical efficacy evaluation WANG Hebin, PENG Feng, ZHU Feng, WANG Min, QIN Renyi 2019, 24 (03):  222-225.  DOI: 10.16139/j.1007-9610.2019.03.010 Abstract ( 347 )   PDF (419KB) ( 68 )   Objective To evaluate the short-term efficacy of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD). Methods A retrospective cohort study was conducted. The clinical data of 120 patients of LPD group and 137 patients of OPD group in our department from June 2017 to June 2018 were collected to compare perioperative efficacy between 2 groups. Results All 257 patients completed the operation smoothly. There was no significant difference in general and preoperative data between 2 groups (P>; 0.05). Compared with OPD group, patients in LPD group had less intraoperative blood loss (P< 0.001) and less cases with positive margin by postoperative pathology (P< 0.05). Postoperative complications including incidence with Clavien-Dindo grading≥; 3, postoperative hemorrhage, abdominal infection and gastric emptying dysfunction in LPD group were less than those in OPD group (P< 0.05). There was no statistical difference in the incidence of other complications (P>; 0.05). The hospital stay and analgesia time in LPD group during postoperative period were less than those in OPD group with statistical difference (P< 0.001). Conclusions LPD would be similar to OPD in short-term clinical efficacy when the team pass operative learning curve and some advantage was found such as less blood loss and less postoperative complications. References | Related Articles | Metrics

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Effectiveness and safety of ERCP in treatment of hemophilia A patients: a report of 7 cases REN Jiajun, LU Ye, MA Di, WANG Junqing, GONG Xiaoyong, YANG Yuchen, YE Feng, CHEN Yongjun, CHEN Sheng 2019, 24 (03):  226-229.  DOI: 10.16139/j.1007-9610.2019.03.011 Abstract ( 455 )   PDF (463KB) ( 138 )   Objective To investigate the effectiveness and safety of ERCP in treatment of hemophilia A patients. Methods The data of 7 cases with hemophilia A including 5 cases mild type and 2 cases moderate type in our hospital performed ERCP from December 2013 to March 2017 were retrospectively analyzed. Five cases had choledocholithiasis including 1 case combined with biliary infection and other 2 cases with biliary obstruction of pancreatic head cancer. Anti-hemophilic globulin (AHG) was given perioperatively combined with accurate monitor of coagulation factor level as well as vital signs. Results There were 2 cases with endoscopic papillary balloon dilation and bile duct stone removal, 2 cases with endosco-pic sphincterotomy and bile duct stone removal, 2 cases with endoscopic metal biliary drainage and 1 case with endosco-pic nasobiliary drainage (ENBD) only. Totally, ENBD was performed for 4 cases of bile duct stone. All patients discharged with hospital stay (9.6± 3.2) (7-16) d. The preoperative FⅧ:C was (18.7%± 11.1%) (1.2%-28.2%) and AHG dose was (2 743± 964) (2 000~4 000) U/d. There was no significant difference in the postoperative hemoglobin (100± 30)(51~131) g/L and hematocrit (0.293± 0.084) (0.160-0.396) when compared with those preoperatively (105± 35) (50-150) g/L and (0.307± 0.097) (0.161-0.423). The postoperative serum amylase was (105± 80)(28-237) U/L. No any ERCP perioperative complications were found including bleeding, gastronintestinal perforation and acute pancreatitis. Conclusions ERCP could be effective and safe for patients with hemophilia A after infusion of AHG and careful monitoring and perioperative treatment. References | Related Articles | Metrics

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Diagnostic value of free-breath diffusion-weighted MR imaging in autoimmune pancreatitis and pancreatic cancer YAN Cheng, NI Xiaoyan, YAO Xiuzhong, CHEN Caizhong, GU Junying 2019, 24 (03):  230-235.  DOI: 10.16139/j.1007-9610.2019.03.012 Abstract ( 403 )   PDF (1077KB) ( 289 )   Objective To investigate diffusion-weighted magnetic resonance imaging (DWI) using free-breathing with fat suppression acquisitions for the differential diagnosis of autoimmune pancreatitis (AIP) from pancreatic cancer. Methods The retrospective study was performed with both 15 cases of AIP and 30 cases of pancreatic cancer diagnosed by pathology. All patients underwent T1WI, T2WI, MRCP and DWI preoperatively on 3.0T MR imaging. Based on SE-EPI sequence using b values of 0 and 600 s/mm2, DWI sequences using free-breathing with fat suppression acquisitions were done. Apparent diffusion coefficient (ADC) value was obtained for the patients in AIP group and pancreatic cancer group. Results There was no statistical difference in sex, locus of lesion, upper abdomen pain, and jaundice of patients between 2 groups (P>; 0.05). Both AIP and pancreatic cancer displayed high signal intensity on images of DWI sequences using free-breathing acquisitions. DWI excellent rate was 95.5%. ADC value of AIP and pancreatic cancer was (0.001 58± 0.000 21) mm2/s and (0.001 87± 0.000 29) mm2/s respectively, with statistical difference between 2 groups (P=0.001 6). Conclusion DWI using free-breathing with fat suppression acquisitions may be helpful in differential diagnosis of AIP from pancreatic cancer. References | Related Articles | Metrics

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Early abdominal CT examination in decision making on diagnosis and treatment of acute biliary pancreatitis YAO Wei, KONG Lei, WU Qinghua, LU Yifan, YE Jinhua, ZHAO Liangchao, XU Jingci, LI Nengping 2019, 24 (03):  236-241.  DOI: 10.16139/j.1007-9610.2019.03.013 Abstract ( 426 )   PDF (600KB) ( 107 )   Objective To study the effect of early abdominal CT examination in decisions making on diagnosis and treatment of acute biliary pancreatitis (ABP). Methods From January 1, 2013 to December 30, 2016, consecutively admitted ABP patients within 48 hours of onset were enrolled and abdominal CT scan was performed to diagnose peripancreatic fluid collection, gallbladder stones, and common bile duct stones. ABP patients with neither peripancreatic fluid collection (mild type of Balthazar CT grade) nor organ dysfunction (Marshall score <2 ) were divided into 2 groups: early laparoscopic cholecystectomy (ELC) group and late laparoscopic cholecystectomy (LLC) group. Patients in ELC group had laparoscopic cholecystectomy (LC) during the period of 7 days after onset when abdominal pain was relieved and laboratory tests improved, but still in the fasting period. Patients in LLC group had LC at the onset 7 days later when no abdominal pain and normal laboratory test after treatment were found and fluid food at least 2 days without discomfort. If common bile duct stones was diagnosed by CT, endoscopic retrograde cholangiopancreatography (ERCP) with stone removal was done before LC. Results A total of 115 cases were eligible for inclusion in this study. There were 56 cases in ELC group and 59 cases in LLC group. Sensitivity of abdominal CT scan for diagnosis of gallbladder stones and common bile duct stones was >; 85%, and specificity 100%. ERCP with stone removal was performed for 44 cases combined endoscopic nasal bile duct drainage. All patients were cured and discharged without any complications including abdominal hemorrhage or infection, bile leakage, and no postoperative exacerbation of pancreatitis. Length of hospital stay, days before LC and LC operative time in ELC group were significantly less than those in LLC group, P< 0.05. There were no significant differences in operative blood loss between 2 groups and no bile duct injuries occurred. One case was converted to open surgery in LLC group. Conclusions Early abdominal CT would be instructive for the treatment options of ABP. ERCP with stone removal should be performed timely for the patients with common bile duct stones and ELC could be safely performed for the patients with neither peripancreatic fluid collection nor organ dysfunction to shorten hospital stay significantly. References | Related Articles | Metrics

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Nipple discharge as only presenting symptom of breast cancer: a report of 75 cases WANG Maoli, WU Kejin, MA Fenghua, DING Ang, YIN Chuyang, SONG Hui, SUN Jian, CHEN Hongliang 2019, 24 (03):  242-248.  DOI: 10.16139/j.1007-9610.2019.03.014 Abstract ( 515 )   PDF (822KB) ( 275 )   Objective To investigate the clinicopathological characteristics including diagnosis and treatment of breast cancer with nipple discharge as only presenting symptom. Methods The data of 75 patients with breast cancer in our hospital from 2010 to 2018 with nipple discharge as only presenting symptom and mammography or ultrasound exams negative were collected. A retrospective analysis was done with clinicopathological data including imaging, therapy and prognosis. Results All cases were female with mean age (52.9± 13.4) (27-78) years old. Seventy-one cases (94.7%) had bloody nipple discharge. Of 22 cases who underwent enhancement magnetic resonance imaging (MRI), 17 cases (77.3%) were positive with BIRADS category 4 or higher. Sixty-five cases underwent intraoperative frozen section pathology, of which 38 (58.5%) cases were benign lesions and 27 (41.5%) cases were malignant lesions. Pathological types included ductal carcinoma in situ (n=29), solid papillary carcinoma (n=39), invasive ductal carcinoma (n=6), and invasive mucinous carcinoma (n=1). The largest diameter of focus including papillary carcinoma and in situ carcinoma was from 0.2 cm to 6.0 cm with the median of 1.0 cm and the diameter less than 2 cm in 58 (77.3%) cases. Estrogen receptor was positive in 68 cases, progesterone receptor positive in 62 cases and Ki-67 low proliferation (< 20%) in 71 cases. Eight cases underwent breast-conserving surgery, 67 cases with mastectomy. There were 59 cases with sentinel lymph node biopsy, and 5 cases with axillary lymph node dissection. No lymph node metastasis was detected. Totally, 11 cases did not receive axillary lymph node biopsy. Adjuvant endocrine therapy was given to 68 cases and adjuvant chemotherapy to 2 cases with invasive carcinoma. There was no recurrence nor metastasis case. Conclusions Bloody nipple discharge was found in most patients of breast cancer with nipple discharge as only presenting symptom. Enhanced MRI would have great help for diagnosis. Intraoperative frozen sections biopsy had less positive for diagnosis of breast cancer. Most pathological types were ductal carcinoma in situ and papillary carcinoma with lesions small. The good prognosis was seen due to early clinical stage and no axillary lymph node metastasis. References | Related Articles | Metrics

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Cyst duct drainage in laparoscopic common bile duct exploration with primary closure XU Guoquan, GU Chunfei, YU Linhai, FENG Linsong, CHU Yongyue, ZHU Haifeng, FANG Shengli. 2019, 24 (03):  249-253.  DOI: 10.16139/j.1007-9610.2019.03.015 Abstract ( 437 )   PDF (735KB) ( 66 )   Objective To explore cystic duct drainage in transumbilical laparoscopic common bile duct exploration through cystic duct common bile duct junction with primary closure. Methods A total of 225 patients with a diagnosis of cholecystolithiasis and choledocholithiasis who underwent transumbilical laparoscopic cholecystectomy and common bile duct exploration through cystic duct common bile duct junction with primary closure between August 2013 and October 2018 were retrospectively analyzed and the data were collected. Of these, 119 cases had bile drainage through cystic duct with primary closure as drainage group, while 106 cases had only primary closure as closure group. Operative time, abdominal drainage time, postoperative hospital stay, hospital cost and postoperative complications were compared between two groups. Results Abdominal drainage time, postoperative hospital stay and hospital cost in drainage group were significantly lower than those in closure group (P< 0.05). There was no significant difference in operative time between two groups (P>; 0.05). The rate of postoperative bile leak(8.40%) in drainage group was less than that (16.04%) in closure group and the difference was statistical significantly (P< 0.05). There was no other any complication in two groups. Conclusions Cystic duct drainage in transumbilical laparoscopic common bile duct exploration through cystic duct common bile duct junction with primary closure would be safe and effective. References | Related Articles | Metrics

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Specialized clinical follow-up of patients with papillary thyroid microcarcinoma after radical resection GUO Ying, ZHENG Lei, ZHANG Shiyu, YANG Weiping, YAN Jieqi, KUANG Jie, CHEN Xi 2019, 24 (03):  254-258.  DOI: 10.16139/j.1007-9610.2019.03.016 Abstract ( 411 )   PDF (540KB) ( 194 )   Objective To investigate the effect of specialized standardized follow-up manual for postoperative patients with papillillary thyroid microcarcinoma (PTMC). Methods A total of 200 PTMC patients were randomly divided into study group and control group each 100 cases. Both groups received specialized health education during hospitalization. The patients in study group got specialized follow-up after discharge using the standardized manual of follow-up. Thyroid stimulating hormone (TSH) should be suppressed to 0.1 mU/L for patients with PTMC in both groups postoperatively. Contents of detailed specialized follow-up included diet, medical treatment and exercise. Outcome of follow-up was compared between 2 groups for TSH detection and neck ultrasound examination. Compliance rate was involved low-iodine diet, Euthyrox medication and exercise. Results No recurrent PTMC was found 3 months later postoperatively with ultrasound examination for both groups. Values of TSH in study group were significantly lower than those in control group after 1 month of operation (P< 0.05). There was statistical significant difference in regular follow-up rate, adherent rate of low iodine diet, Euthyrox medication and exercise between 2 groups (P< 0.05). Conclusions The application of specialized follow-up manual in postoperative patients is helpful to improve compliance for treatment and the effect of TSH inhibition. References | Related Articles | Metrics

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Clinical analysis of abdominal cocoon: a report of 9 cases XIA Yi, TANG Yonghua, GENG Zhichao, ZHAO Xuesong, HUANG Liang, MAO Enqiang, CHEN Erzhen, WANG Xiaoyan 2019, 24 (03):  259-263.  DOI: 10.16139/j.1007-9610.2019.03.017 Abstract ( 555 )   PDF (807KB) ( 124 )   Objective To analyze retrospectively the clinical manifestation and radiological findings of abdominal cocoon combined with the diagnosis, treatment and prognosis. Methods The data of 9 patients with abdominal cocoon in our hospital from January 2007 to June 2018 were reviewed including clinical feature and follow-up. Results Four cases were diagnosed as abdominal cocoon by CT examination before operation, and the remaining five cases were diagnosed by laparotomy. One case received non-operative treatment and 8 cases had operation. During the operation, some cases were found part of small intestine to be encapsulated in a cocoon-like membrane, some had all small intestine wrapped and some had part of colon involved. The main operation was to excise cocoon, lysis adhesion and release intestine. One case died due to multiple organ failure and 4 cases had early intestinal obstruction postoperatively. During a follow-up of 8 cases within the period from 6 months to 10 years, 1 case was lost followed up. Chronic abdominal pain was found in 1 case, intestinal obstruction in 2 cases and abdominal distention in 1 case. The other 3 cases recovered well. Conclusions Preoperative diagnosis of abdominal cocoon is difficult for there is no specific clinical manifestations. The characteristic images of abdominal enhanced CT scan with or without two dimensional reformations may be preoperative diagnostic clues. The main treatment of abdominal cocoon is surgery, and the overall prognosis of patients is satisfactory. References | Related Articles | Metrics

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Premedication with intranasal dexmedetomidine combined with ketamine in children FAN Zhidan, JIN Shanliang, YU Guifang, CHEN Lijun 2019, 24 (03):  264-267.  DOI: 10.16139/j.1007-9610.2019.03.018 Abstract ( 602 )   PDF (421KB) ( 130 )   Objective To evaluate the effect and security of premedication with intranasal dexmedetomidine combined with ketamine in children. Methods A total of 100 children received sclerotherapy on venous malformations, aged 1-5 years, American Society of Anesthesiologists Ⅰ-Ⅱ, were enrolled in this study. Fifty children were given intranasal dexmedetomidine at 2 μg/kg in one nostril and intranasal ketamine of 1 mg/kg in the other nostril as study group, and 50 children were given only dexmedetomidine at 2 μg/kg as control group. Premedication was performed at 30 min before operation. Heart rate (HR) and percutaneous oxygen saturation (SpO2) were recorded before premedication and 10 min(T1), 20 min(T2) and 30 min (T3) after premedication. When T3 after premedication modified observer’s assessment of alertness/sedation scale (MOAA/S) was assessed for children, sedation state. Parental separation anxiety scale (PSAS) was assessed for children emotional state. Sleep latency and wake-up time were recorded with intraoperative hypotension and bradycardia. Results The sedation assessed by the MOAA/S (≤; 3 points) in study group was significantly better than that in control group with statistical differences(P< 0.05). There was significant difference in PSAS scale between 2 groups (P< 0.05). There was no significant difference in HR and SpO2 except for the decrease in HR at T3 of control group (P< 0.05). The sleep latency was shorter and wake-up time was longer in study group when compared with those in control group (P< 0.05). There was no obvious hypotension and bradycardia in both groups. Conclusions Intranasal dexmedetomidine combined with ketamine would be a safe and simple premedication in children, which could sedate children well. References | Related Articles | Metrics