Objective:To explore the strategy and efficacy using minimally invasive treatment for grade Ⅲ&Ⅳ blunt pancreatic injuries.Methods:Retrospective data retrieved from medical records of 13 patients with grade Ⅲ&Ⅳ blunt pancreatic injuries who underwent minimally invasive treatment at the Chinese PLA General Hospital from July 2011 to June 2019 were analysed. There were 10 males and 3 females, aged (38±9) years. Minimally invasive treatment included percutaneous catheter drainage (PCD) and minimal-access retroperitoneal pancreatic necrosectomy (MARPN). Date from enrolled patients were anylsed.Results:There were 9 patients suffering from grade Ⅲ injuries and 4 patients suffering from grade Ⅳ injuries. On initial conservative treatment of these 13 patients, all developed local complications. The local complications were treated using minimally invasive treatment strategies: 13 patients underwent PCD. The median intervention time for PCD was 25 days after trauma; 10 patients were further treated with MARPN, and the median intervention time of MARPN was 41 days after trauma. Twelve patients recovered well and were discharged home. One patient died. The mortality rate was 7.7% (1/13). The median postoperative hospital stay was 19 days.Conclusion:For patients with pancreatic grade Ⅲ&Ⅳ injuries who were hemodynamically stable and had no other associated gastrointestinal injuries, initial conservative treatment, followed by subsequent minimally invasive treatment based on MARPN technology could be used to treat local complications.

Objective:To study the use of left renal vein as a graft vessel in reconstruction after portal vein/superior mesenteric vein (PV-SMV) resection in pancreaticoduodenectomy.Methods:A retrospective study was conducted on 5 of these patients who underwent surgery from July 2008 to December 2017 at Chinese PLA General Hospital. The operative, complication and follow-up data were analysed.Results:There were 4 males and 1 female, with an average age of 57 (33-72) years. The mean operative time was 6.8 (5.4-9.1) h and the mean tumor size was 3.8 (2.8-4.8) cm. The average length of the PV-SMV defect left after resection was 3.8 (3.2-4.6) cm. The average length of the left renal vein used was 3.4 (3.0-4.1) cm. The operations were carried out in 3 patients with pancreatic cancer and in 2 patients with colon cancer pancreatic metastasis. The average postoperative hospital stay was 12 (10-25) days. Perioperative complications included 1 patient each with ascites, diarrhea and delayed gastric emptying. The creatinine levels ranged from 70-98 μmol/L preoperatively, with a transient creatinine rise to 80-156 μmol/L after operation and became 62-107 μmol/L upon discharge from hospital. The follow-up time was 4.3-17.8 months. Two patients died of recurrence/metastasis at 14.2 and 17.8 months after surgery.Conclusions:The left renal vein has the appropriate diameter and rich collateral branches. It has a sufficient length and it is conveniently located in the surgical field. This study showed that there was a minimal effect on renal function after its excision, and it can be used as a graft vessel for reconstruction in pancreaticoduodenectomy after PV-SMV resection.

Objective:To study the use of trans gastric sinus stent placement and drainage in management of persistent external pancreatic fistula.Methods:The clinical data of 12 patients who developed persistent external pancreatic fistulae after severe acute pancreatitis, pancreatic trauma or pancreatic surgery who were treated at the First Medical Center of Chinese PLA General Hospital from August 2018 to December 2020 were retrospectively analyzed. There were 10 males and 2 females, aged 30 to 65 years, median 43.5 years. These patients underwent trans gastric sinus stent placement and drainage, and were followed-up to study persistence of pancreatic fistula, new pancreatic fluid accumulation, complications and death.Results:In this study, there were 9 patients who developed persistent external pancreatic fistulae after severe acute pancreatitis, 2 patients after pancreatic trauma, and 1 patient after pancreatic surgery. The median operation time was 47 min (range 38-54 min). The technical success rate was 100.0% (12/12). The median follow-up was 22.5 months (range 2-29 months). Seven days after stenting, the percutaneous drainage tubes (urinary catheters) of all the patients were removed. One patient (8.3%) developed recurrence of pancreatic fistula 17 days after treatment. The same procedure of placing another stent was done and the patient recovered. Six months after treatment, 2 patients (16.7%) lost their stents, and 1 patient developed a pseudocyst (recurrence of pancreatic fistula). The maximum diameter of this pseudocyst increased gradually to 7cm after 9 months. A double pigtail drainage tube was placed under endoscopy in this patient, and the patients recovered. All the other patients did not develop recurrence of pancreatic fistula or pseudocyst. During the follow-up period, no patient developed any new complications including pancreatic fluid accumulation, fever, bleeding, infection and organ dysfunction, and no patients died.Conclusion:It was safe and efficacious to use trans gastric sinus stent placement for treatment of persistent external pancreatic fistula. However, the long-term outcomes require further studies.

Objective: To examine the effectiveness of non-operative of colonic fistula following acute pancreatitis. Methods: Retrospective analysis of 354 patients with acute pancreatitis who were admitted to Department of Hepatobiliary Surgery of Chinese People′s Liberation Army General Hospital from January 2013 to December 2018. Age of the patients was (46±14) years (range: 14-85 years); 249 cases (70.3%) were males. There were 41 cases of acute edematous pancreatitis and 313 cases of acute necrotising pancreatitis. Two hundred and fifteen cases were diagnosed as moderate severe acute pancreatitis and 139 were diagnosed as severe acute pancreatitis. Among 313 cases of acute necrotising pancreatitis, 62 cases underwent non-surgical treatment, 251 cases underwent surgical treatment in which 218 of minimal access retroperitoneal pancreatic necrosectomy underwent percutaneous nephroliguectomy with peripancreatic necrotic tissue removal technique. Results: There were 15 cases of colon fistula following acute necrotising pancreatitis, and the incidence rate was 4.2%(15/354). There were 7 males and 8 females, with age of (39±8) years (range: 27 to 50 years). The median interval between acute pancreatitis onset and diagnosis of colonic fistula was 71 days(27-134) days. Two cases occurred at the hepatic flexure of the colon, 4 cases at transverse colon, and 9 cases at splenic flexure of colon. Of the 354 patients, 39 cases died and the mortality was 11.0%. Two patients underwent laparotomy, and one of them died. The remaining 13 patients underwent non-surgical treatment and were discharged. Conclusion Acute pancreatitis with colonic fistula can be treated with non-surgical treatment and can achieve good prognosis.

Objective: To investigate the characteristics of spectrum and drug resistance of pathogens causing sepsis in patients with severe acute pancreatitis(SAP). Methods: The clinical data of 63 SAP patients with sepsis admitted in Department of Hepatobiliary, People′s Liberation Army General Hospital from January 2014 to December 2015 were retrospectively studied. There were 47 males and 16 females, aged from 22 to 73 years, with an average age of (52±11)years. Samples were collected mainly from: (1)pancreatic and peripancreatic necrosis and abdominal drainage; (2)bile; (3) blood or deep venous catheter; (4) sputum and tracheal catheter and thoracic drainage; (5) urine. Strain identification and drug-resistance test were preformed on positive specimens. Results: Of 244 pathogenic isolates, mainly derived from abdominal cavity(36.0%), blood stream (14.0%), central venous catheter(11.8%), necrotic tissue(9.1%) and sputum(8.1%); 154(63.1%) were gram-negative bacteria, 68 cases(27.9%) were gram-positive bacteria and 22 cases(9.0%) were fungi respectively. The top six common pathogens isolated were E. coli(16.0%), E.faecium and faecalis(15.2%), P.aeruginosa(10.7%), K.pneumonia(9.8%), Acinetobacter baumanni(8.2%), Stenotrophomonas maltophilia(5.3%)respectively. The detection rate of E. coli and K. pneumonia extended-spectrum β-lactamases(ESBL) was 84.6%(33/39) and 70.8%(17/24), the resistance rate to imipeniem was 12.8% and 25.0%, to cefperazone-sulbactam was 28.2% and 29.2%. As to P. aeruginosa and Acinetobacter bacillus, the resistance rate to imipeniem was 50.0% and 75.0%, to cefperazone-sulbactam was 42.3% and 70.0%; Stenotrophomonas maltophilia was completely resistant to cefperazone-sulbactam, but sensitive to minocycline, SMZ-TMP with the resistance rate less than 40.0%. Gram-positive bacterium strains mainly included E. faecium(38.2%, 26/68), E.faecalis(16.2%, 11/68) and Staphylococcus(35.3%, 24/68) which maintained high sensitivity to vancomycin, teicoplanin and linezolid, there was only one isolate resistant to vancomycin. Candida were the sole pathogens of fungal infections, sensitive to common antifungal drugs overall. Conclusions The gram-negative bacteria are the predominant pathogens mainly including ESBL-producing isolates(E.coli and K. pneumonia) and non-fermentation bacteria(P.aeruginosa and Acinetobacter bacillus) causing sepsis in SAP. The infection rate and drug-resistance rate of these two kinds of pathogens are relatively higher.

Objective: To compare and evaluate the curative effect of laparoscopic distal pancreatectomy(LDP) and traditional open distal pancreatectomy(ODP) in pancreatic ductal adenocarcinoma. Methods: The clinical data of 15 patients treated by LDP and 87 contemporaneous cases treated by ODP from January 2010 to November 2015 was collected, and the curative effect and prognosis of these patients were retrospectively analyzed. Results: The operation time of LDP group was (286.5±48.1) min, significantly longer than that of OPD group(226.6±56.8) min (P<0.05). The operative hemorrhage, postoperative exhaust time, recovery eating time, the whole and postoperative hospitalization time of LDP group were (188.7±108.9) ml, (2.2±1.3) d, (2.9±1.1) d, (13.2±10.4) d and (9.3±8.1) d, respectively, dramatically shorter than those of ODP group (625.2±982.1) ml, (4.3±1.7) d, (5.2±1.8) d, (20.7±8.7) d and (14.9±7.8) d, respectively (all of P<0.05). There were no intraoperative blood transfusion case in LDP group, however, 13 patients in ODP group received intraoperative blood transfusion, without significant difference (P=0.207). Alternatively, 6 cases occurred pancreatic fistula in LDP group, among them, 5 cases were grade A and 1 case was grade B; In ODP group, 17 cases occurred pancreatic fistula, among them 13 cases were grade A, 1 case was grade B and 3 cases were grade C, without significant differences (P=0.130). There were 2 cases of delayed gastric empty, 1 case of pulmonary infection in LDP group. In ODP group, there were 5 cases of postoperative delayed gastric empty, 3 cases of pulmonary infection and 6 cases of intra-abdominal infection, without significant differences (P>0.05). In both LDP group and ODP group, none occurred percutaneous drainage, re-admissions, second operation or perioperative death. Conclusions Compared to ODP, LDP is much safer and more steady in perioperative periodand operation. Patients of pancreatic ductal adenocarcinoma received LDP can acquire more benefit and recovery sooner, and LDP is a safe and effective operative method.

Objective Surgical resection is the primary form of curative treatment for hepatocellular carcinoma.Recent reports suggested that when compared to non-anatomical resection,anatomical liver resection improved prognosis of HCC patients.Whether anatomical liver resection should be the preferred routine procedure remains controversial.Methods The data of 236 HCC patients who underwent curative hepatectomy at the PLA General Hospital from January 2008 to July 2013 were reviewed.The data included basic information,procedure,tumor related information and follow-up data.Factors influencing overall survival and tumor-free survival rates were analyzed by multivariate analysis.Multivariate analysis and stratification analysis were also used to evaluate the long-term efficacy of the different procedures.Results The 5-year survival rate of anatomical liver resection was 75％,which was significantly better than that of non-anatomical resection (65 ％) (P ＜ 0.05).The tumor-free survival rate was 51％,which was significantly better than that of non-anatomical resection (34％) P ＜ 0.05).Antiviral therapy prolonged survival time and tumor-free survival time of HbsAg-positive patients.Surgical procedure,tumor diameter,tumor staging,antiviral therapy were influencing factors of overall survival.Surgical procedure,tumor staging,antiviral therapy were influencing factors of tumor-free survival.Anatomical resection improved the tumor-free survival for patients with tumor diameters less than 5 cm (P =0.098),improved tumor-free survival for patients with TNM stage T1 and T2 (P =0.059),and significantly improved the overall survival and tumor-free survivals for patients with T3,T4 (P ＜ 0.05).Conclusion Anatomical resection is recommended for treatment of patients with hepatocellular carcinoma.

Objective To investigate the application value of nephroscopic treatment for the infection after internal drainage in severe acute pancreatitis patients complicated with walled-off necrosis (WON). Methods Clinical data of 5 WON patients who were misdiagnosed with pancreatic pseudocyst and developed infected pancreatic necrosis after undergoing internal drainage in Chinese PLA General Hospital between January 2010 and February 2016 were retrospectively analyzed. Among the 5 patients, 3 were males and 2 were females, with the age ranging from 39 to 67 years old and the median of 47 years old. Two cases underwent open internal drainage and 3 underwent gastroscopic percutaneous catheter internal drainage. Typical clinical and imaging manifestations of infected pancreatic necrosis were all observed postoperatively. The informed consents of all patients were obtained and the local ethical committee approval was receive. Patients initially underwent CT guided percutaneous catheter drainage (PCD), and then underwent percutaneous nephroscopic debridement of peripancreatic necrotic tissues by retroperitoneal approach and postoperative lavage and drainage. Results Four cases recovered and discharged from hospital after once nephroscopic treatment, and 1 after twice nephroscopic treatment. The median postoperative length of stay was 15(7-32) d. No perioperative death or postoperative complications were observed. Conclusions Nephroscopic treatment is a good remedial therapy with advantages of minimal invasion and good efficacy for infection after internal drainage in patients with WON who are misdiagnosed with pancreatic pseudocyst.

OBJECTIVETo investigate the method and effect of percutaneous nephroscopic necrosectomy (PNN) for post-operatively resident infection of severe acute pancreatitis (SAP).

METHODSData of the 15 SAP patients with post-operatively resident infection treated by PNN from June 2008 to December 2014 in Chinese People's Liberation Army General Hospital were reviewed. Twelve of the patients underwent the laparotomy within 1 week, 1 in 3(rd) week, 1 in 4(th) week and the other one on the 127(th) day. All of the referrals firstly received (multi-)percutaneous catheter drainage (PCD), and then PNN operation according to the disease, followed by continuous irrigation-drainage.

RESULTSEleven patients were healed after received only one PNN operation, 2 patients for twice, 1 for three times and 1 for four times. The average post-operative time of hospital stay was 66.2 days (10-223 days). The complications after operation contained colon fistula (n = 1), abdominal hemorrhage (n = 1), pancreatic pseudocyst (n = 1), severe pulmonary infection (n = 1). Three patients eventually died.

CONCLUSIONSPercutaneous nephroscopic necrosectomy is a minimally invasive approach which could prevent the complicated re-laparotomy operation, result in less complication. It is an ideal method for treating SAP patients with post-operatively resident infection.

Drainage ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Operative Time ; Pancreatitis, Acute Necrotizing ; complications ; surgery ; Postoperative Complications ; microbiology ; Reoperation

OBJECTIVETo investigate the clinical features, diagnostic and therapeutic methods of primary hepatic neuroendocrine carcinoma.

METHODSThe clinicopathological data of fourteen patients with primary hepatic neuroendocrine carcinoma confirmed by pathology were analyzed retrospectively and related literatures were reviewed.

RESULTSThe fourteen patients, including eight males and six females, had an age range of 23-58 years (mean 45.9 years). Four tumors were located in the right liver lobe, four in the left liver lobe and six in both. The clinical manifestations were nonspecific and variable. The most common clinical manifestation was abdominal distention or right upper quadrant pain. Radiological findings were not specific and could not distinguish primary hepatic neuroendocrine tumor from hepatocellular carcinoma. Diagnosis of primary hepatic neuroendocrine tumor was confirmed by pathology using immunohistochemical staining and by the absence of extrahepatic primary lesions. Extrahepatic primary neuroendocrine carcinoma was ruled out by ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT), preoperative gastrointestinal endoscopy and long-term postoperative follow up. Three patients received surgical treatment, two cases received surgical resection and radiofrequency ablation (RFA), six patients received transarterial chemoembolization, one case received orthotopic liver transplantation, one case only received exploratory laparotomy, and one case received chemotherapy. All 14 patients were followed up and seven of them are still alive, the others died of liver failure or recurrence.

CONCLUSIONSPrimary hepatic neuroendocrine carcinomas are extremely rare. Its diagnosis should be confirmed by pathology. Preoperative fine needle biopsy is strongly recommended. Prognosis is relatively favorable. Surgical resection is treatment of first choice, and TACE, RFA, and chemotherapy can be used for unresectable patients.

Adult ; Biopsy, Fine-Needle ; Carcinoma, Hepatocellular ; complications ; pathology ; therapy ; Carcinoma, Neuroendocrine ; complications ; pathology ; therapy ; Catheter Ablation ; Chemoembolization, Therapeutic ; Female ; Hepatectomy ; Humans ; Liver ; pathology ; Liver Neoplasms ; complications ; pathology ; therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Positron-Emission Tomography ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed