Analysis of surgical key points and postoperative rehabilitation management of total pancreaticoduodenectomy for pancreatic cancer
10.3760/cma.j.cn113884-20240104-00005
- VernacularTitle:全胰十二指肠切除术治疗胰腺癌手术要点及术后康复管理情况
- Author:
Zhe LIU
1
;
Yanan JIA
;
Yunzhao LUO
;
Shaocheng LYU
;
Wenli XU
;
Jiqiao ZHU
;
Ren LANG
;
Qiang HE
;
Xianliang LI
Author Information
1. 首都医科大学附属北京朝阳医院肝胆胰脾外科，北京 100020
- Keywords:
Pancreatic neoplasms;
Total pancreaticoduodenectomy;
Artery approach;
Vascular grafts
- From:
Chinese Journal of Hepatobiliary Surgery
2024;30(3):188-192
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the safety key points of total pancreaticoduodenectomy in the era of vascular resection technology and the important factors affecting rapid postoperative recovery.Methods:The clinical data of 52 patients with pancreatic cancer who underwent total pancreaticoduodenectomy in Beijing Chaoyang Hospital Affiliated to Capital Medical University from November 2014 to September 2022 were retrospectively analyzed, including 34 males and 18 females, aged (62±9). The intraoperative situation, incidence of postoperative complication, postoperative blood glucose control and postoperative survival rate were analyzed.Results:All operations of the 52 patients were successfully completed, including 48 patients underwent total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts via artery approach. The portal vein occlusion time was (20±5) min. The incidence of postoperative complications was 28.8% (15/52), including 2 cases of abnormal gastric empty, 2 cases of diarrhea, 2 cases of chylous fistula, 4 cases of abdominal infection, 1 case of gastrointestinal fistula, 3 cases of gastrointestinal bleeding, and 1 case of pulmonary infection. Subcutaneous short-acting insulin injection was used to control blood glucose in the early stage after surgery, short-acting insulin combined with long-acting insulin was used for subcutaneous injection before sleep for diet recovery. All patients did not experience uncontrolled hyperglycemia. The median survival time of 52 patients was 13 months, and the longest follow-up time was 38 months. There were 37 patients died of tumor recurrence, 4 patients died of cardiovascular and cerebrovascular accidents, and 1 patient died of pulmonary infection in the 42 died patients.Conclusions:Total pancreaticoduodenectomy via artery approach can improve the R 0 resection rate in pancreatic cancer patients with vascular invasion, the rate of postoperative complication and mortality has no significant increase. The postoperative blood sugar control is satisfactory and the quality of life is guaranteed.
