Objective To explore the change of postoperative pancreatic fistula (POPF) in modified pancreaticoenteric anastomosis in pancreaticoduodenectomy.Methods This paper retrospectively analyzed clinical data of 122 patients who suffered pancreaticoduodenectomy or enlarged pancreaticoduodenectomy from Apr.2008 to Sep.2017 in West China Hospital of Sichuan University.All surgeries were operated by a surgeon.30 patients from Apr.2008 to Dec.2010 were divided to control group,and 92 patients from Jan.2011 to Sep.2017 were the experimental group.Pancreatic duct-jejunum mucosa anastomosis was adopted in the two groups,but the method in experimental group was modified.Clinically relevant POPF was compared between the two groups.Results The rate of clinically relevant POPF was 0％ (0/92) in the experimental group,while it was 13.3(4/30) in the control group.Conclusion Modified technique for duct-to-mucosa pamcreaticojejunostomy can reduce the incidence of POPF.

Objective To explore the clinical effect of the application of 4R crisis management theory in skin care of ICU patients .Methods Totals of 1 937 cases of ICU surgical patients from September 2009 to December 2010 in our hospital , who received the traditional management method , were set to be the control group.The other 2 129 cases of ICU surgical patients from January 2011 to April 2012, who received the 4R crisis management theory in skin care based on the traditional management method , were set to be the experiment group .The occurrence of complications such as eczema , pressure ulcer , frostbite and empyrosis and the recovery of the pressure ulcer outside hospital of the two groups were observed and compared .Results In the control group , there were sixty-three cases of eczema , twenty-five cases of pressure ulcer ( five were caused by nasogatric tube , one by blood pressure cuff , eighteen by nasotracheal intubation , one by prominence of sacra) , and ten cases of skin damage caused by adhesive plaster or electrode pads ;In experiment group , there were twenty-one cases of eczema , eleven cases of pressure ulcer ( eleven by nasotracheal intubation ) , one case of scald, three cases of skin damage caused by adhesive plaster .The experiment group in improvement of eczema, pressure ulcer, and skin damage was statistically significantly better than those in the control group (χ2 =25.74, 6.92,4.48, respectively;P<0.05).In the control group, seven cases appeared pressure ulcer from outside the hospital, among which no one healed, five improved, and two not improved.While pressure ulcer from outside the hospital were nine in the experiment group , among which four healed and five improved , with a statistically significant difference between the two groups (χ2 =5.45, P<0.05).Conclusions The application of 4R crisis management theory in skin care of ICU patients will effectively prevent and reduce the complications related to the skin so that the purpose of improving nursing quality and safeguarding the patients can be achieved.