Objective: To compare the clinical therapeutic effects of arterial first approach pancreaticoduodenectomy(AFA-PD) with standard approach pancreaticoduodenectomy(SPD) in the treatment of borderline resectable pancreatic cancer (BRPC). Methods: A retrospective analysis of the clinical data of 113 cases of pancreatic cancer patients from January 2014 to August 2015 at Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, including 43 cases in AFA-PD group and 70 cases in SPD group.Every patient had gone high-resolusion computed tomography before the surgery, when BRPC was definitely diagnosed by both experienced radiologist and pancreatic surgeon.There were 24 males and 19 females in the AFA-PD group, with average age of (61.6±10.2)years.And in the SPD group, there were 47 males and 23 females, with average age of (62.7±9.4)years. Results: The operation time was (210.7±31.5)minutes in AFA-PD group, (187.9±27.4)minutes in SPD group, and peroperative bleeding volume was (1 007.1±566.3)ml in AFA-PD group, (700.0±390.0)ml in the other group.Those two indicators of AFA-PD group, compared with SPD group, were relatively higher, the difference was statistically significant(all P<0.01). And with regard to postoperative diarrhea(9.3% vs.5.7%), postoperative 1, 3 days of white blood cells(postoperative 1 day: (13.3±1.1)×10⁹/L vs.(12.4±2.4)×10⁹/L; postoperative 3 days: (12.7±1.6)×10⁹/L vs.(11.7±2.5)×10⁹/L), postoperative 1, 3, 5 days of peritoneal drainage fluid volume(postoperative 1 day: (184±42)ml vs.(156±54)ml; postoperative 3 days: (155±48)ml vs.(133±35)ml; postoperative 5 days: (66±20)ml vs.(47±31)ml), the differences between the two groups were statistically significant (all P<0.05). One patient in the SPD group was treated with unplanned secondary surgery for postoperative intraperitoneal hemorrhage, and the patient was cured and discharged.There was no death in the two groups within 30 days after surgical operation and no patient with positive gastric margin, duodenal margin, or anterior margin.The resection rate of superiormesenteric artery(SMA) margin R0 in AFA-PD group was higher than that in SPD group (P=0.019). The two groups were followed up for 14 to 30 months.As for AFA-PD group, the average survival time, progression free survival time and median survival time was respectively (20.4±1.2)months, (21.5±1.4)months and 20 months.There were 3 cases(7.0%) with local recurrence and 8 cases(18.6%) with liver metastasis or distant metastasis.In the SPD group, the average survival time, progression free survival time and median survival time was (17.1±1.1)months, (16.4±1.3)months and 16 months, respectively.There were 13 cases(18.6%) with local recurrence and 25 cases(35.7%) with liver metastasis or distant metastasis.As a result, the AFA-PD group had longer survival time(P=0.001)and progression free survival time(P=0.002). However, the lower local recurrence and distant metastasis rate in AFA-PD group did not reach statistical standard (P>0.05). Conclusion The arterial first approach pancreaticoduodenectomy is safe and effective in the treatment of borderline resectable pancreatic cancer, which can improve the resection rate of SMA margin R0, and prolong patient survival time.

Objective:To investigate the clinical characteristics and risk factors for patients with chronic periprosthetic joint infection (PJI) combined with sinus tract.Methods:The patients with PJI following hip and knee arthroplasty from July 2014 to January 2020 in our institution were retrospectively reviewed. There were 96 males and 101 females, aged from 26 to 86 years with mean age of 62.02±13.54 years. There were 95 hip PJI patients (48.2%, 95/197), 102 knee PJI patients (51.8%, 102/197), 68 patients (34.5%, 68/197) with sinus tract, 129 patients (65.5%, 129/197) without sinus tract, 162 patients (82.2%, 162/197) with positive culture results and 35 patients (17.8%, 35/197) with negative culture results. The patients were divided into two groups according to the sinus tract formation. The diagnosis of PJI was based on the 2011 Musculoskeletal Infection Society (MSIS) criteria. All of the included patients underwent serological laboratory tests (white blood cell count, neutrophil percentage, lymphocyte percentage, hemoglobin, platelet count, mean platelet volume, urea, creatinine, albumin, erythrocyte sedimentation rate, C-reactive protein) and pathogen isolation. The influence of sinus tract on the above test and the effects of complications on sinus tract formation were analyzed. We further investigated the relationship between sinus tract formation and the features of pathogen. In addition, the risk factors for sinus tract formation were analyzed.Results:The mean values of all serological tests were without statistical difference between the groups with and without sinus tract ( P>0.05). The presence of complications had no effect on the occurrence of sinus tract ( P>0.05). The incidence of sinus tract with highly virulent pathogen infection group (52.1%, 25/48) was significantly higher than that in low virulence pathogen group (27.5%, 19/69), in culture negative patients (40.0%, 14/35) and in other cases (22.2%, 10/45; χ 2=11.519, P=0.009). There was no statistical difference between groups based on the Gram staining, antibiotic resistance and polymicrobial infection. Multivariate logistic regression analysis revealed positive associations of extra joint infections ( OR=4.426, 95% CI: 1.095, 17.884) and high virulent pathogen infections ( OR=2.633, 95% CI: 1.171, 5.918) and negative association of age ≥70 ( OR=0.436, 95% CI: 0.205, 0.927) with the risk of sinus tract formation. Conclusion:The presence of sinus tract has no effect on the routine serum tests in patients with chronic PJI. There is only virulence factor which might affect sinus tract formation. For patients with the extra joint infections and high virulence pathogen infections, the formation of sinus tract should be vigilant during treatment.