Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

Objective Pancreatic neuroendocrine carcinoma ( pNEC) is a highly malignant tumor. This study aimed to evaluate the role of surgery and the prognosis for patients with pancreatic neuroendocrine carcinoma ( pNEC ) . Methods We collected and reviewed all clinical data of patients who underwent radical surgery for pNEC from Jan 2000 through Jan 2016 in our hospital. Cox?regression analysis wasused to evaluate the factors potentially influencing survival. Results Twenty patients including 11 males and 9 females ( median age, 62.5 years) were included in this study. All patients underwent radical surgery and 17 cases received postoperative platinum?based chemotherapy. The median follow?up time was 41 months (range, 1 to 127 months).The 1?,3?, and 5?year survival rates of the patients were 66.7%, 51.5% and 28.1%, with a median survival time of 75.3 months.The multivariate analysis indicated that tumor size and Ki?67 index were of prognostic significance. Conclusions Pancreatic neuroendocrine carcinomas are rare but increasing in incidence. Patients with localized nonmetastatic primary tumors seem to benefit from surgery. Early diagnosis and multimodality therapy are key points of an improved survival.

Objective Pancreatic neuroendocrine carcinoma ( pNEC) is a highly malignant tumor. This study aimed to evaluate the role of surgery and the prognosis for patients with pancreatic neuroendocrine carcinoma ( pNEC ) . Methods We collected and reviewed all clinical data of patients who underwent radical surgery for pNEC from Jan 2000 through Jan 2016 in our hospital. Cox?regression analysis wasused to evaluate the factors potentially influencing survival. Results Twenty patients including 11 males and 9 females ( median age, 62.5 years) were included in this study. All patients underwent radical surgery and 17 cases received postoperative platinum?based chemotherapy. The median follow?up time was 41 months (range, 1 to 127 months).The 1?,3?, and 5?year survival rates of the patients were 66.7%, 51.5% and 28.1%, with a median survival time of 75.3 months.The multivariate analysis indicated that tumor size and Ki?67 index were of prognostic significance. Conclusions Pancreatic neuroendocrine carcinomas are rare but increasing in incidence. Patients with localized nonmetastatic primary tumors seem to benefit from surgery. Early diagnosis and multimodality therapy are key points of an improved survival.

OBJECTIVETo explore the learning curve for middle pancreatectomy by comparing the outcomes of middle pancreatectomy operated by a single treatment group at different stages.

METHODSA total of 48 patients received middle pancreatectomy by single treatment group between January 2006 and April 2014 at our hospital. These 48 cases were divided into 10 stages (5 cases in each) according to the operation sequence. The operation time, blood loss, surgical complications, rate of negative margin and postoperative hospital stay were analyzed retrospectively.

RESULTSThere was no significant difference among the 10 stages in respect to surgical complications, rate of negative margin and postoperative hospital stay (P>0.05). The median operation time and blood loss in the first stage was 375 min and 530 ml, respectively. The median operation time and blood loss in the second stage was 280 min and 330 ml, respectively. There were significant differences between these two stages and the other later stages in median operation time and blood loss (P<0.01). However, there was no significant difference among the stages 3 to 10 in the median operation time and blood loss (P>0.05 for all).

CONCLUSIONAfter 10-15 cases of middle pancreatectomy, a surgeon can be skilled and experienced in this surgical procedure with few surgical complications.

Humans ; Learning Curve ; Length of Stay ; Operative Time ; Pancreatectomy ; methods ; Retrospective Studies

OBJECTIVETo investigate the value of Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and a modification of the POSSUM system (P-P0SSUM) scoring system in predicting the surgical operative risk of pancreaticoduodenectomy for periampullary tumors.

METHODSPOSSUM and P-POSSUM scoring systems were used to retrospectively evaluate the clinical data of 432 patients with periampullar tumors who underwent pancreaticoduodenectomy in the Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from January 1985 to December 2010. The predictive occurrence of postoperative complications and mortality rate were calculated according to the formula. ROC curve analysis and different group of risk factors were used to determine the discrimination ability of the two score systems, and to determine their predictive efficacy by comparing the actual and predictive complications and mortality rates, using Hosmer-Lemeshow test to determine the goodness of fit of the two scoring systems.

RESULTSThe average physiological score of the 432 patients was 16.1 ± 3.5, and the average surgical severity score was 19.6 ± 2.7. ROC curve analysis showed that the area under ROC curve for mortality predicted by POSSUM and P-POSSUM were 0.893 and 0.888, showing a non-significant difference (P > 0.05) between them. The area under ROC curve for operative complications predicted by POSSUM scoring system was 0.575. The POSSUM score system was most accurate for the prediction of complication rates of 20%-40%, showing the O/E value of 0.81. Compared with the POSSUM score system, P-POSSUM had better ability in the prediction of postoperative mortality, when the predicted value of mortality was greater than 15%, the predictive result was more accurate, and the O/E value was 1.00.

CONCLUSIONSPOSSUM and P-POSSUM scoring system have good value in predicting the mortality of patients with periampullary tumors undergoing pancreaticoduodenectomy, but a poorer value of POSSUM score system in prediction of complications. We can establish a more suitable scoring system for pancreaticoduodenectomy by modifying the score constant and weight, to better predict surgical risk and reduce the operative complications and mortality.

Ampulla of Vater ; Common Bile Duct Neoplasms ; mortality ; surgery ; Humans ; Morbidity ; Pancreaticoduodenectomy ; adverse effects ; mortality ; Postoperative Complications ; diagnosis ; mortality ; Postoperative Period ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Risk Assessment ; Risk Factors

Objective To investigate the value of Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity(POSSUM)and a modification of the POSSUM system(P?P0SSUM) scoring system in predicting the surgical operative risk of pancreaticoduodenectomy for periampullary tumors. Methods POSSUM and P?POSSUM scoring systems were used to retrospectively evaluate the clinical data of 432 patients with periampullar tumors who underwent pancreaticoduodenectomy in the Department of Abdominal Surgery, Cancer Hospital,ChineseAcademy of Medical Sciences from January 1985 to December 2010. The predictive occurrence of postoperative complications and mortality rate were calculated according to the formula. ROC curve analysis and different group of risk factors were used to determine the discrimination ability of the two score systems, and to determine their predictive efficacy by comparing the actual and predictive complications and mortality rates, using Hosmer?Lemeshow test to determine the goodness of fit of the two scoring systems. Results The average physiological score of the 432 patients was 16.1±3.5, and the average surgical severity scorewas 19.6±2.7. ROC curve analysis showed that the area under ROC curve for mortality predicted by POSSUM and P?POSSUM were 0.893 and 0.888, showing a non?significant difference ( P>0. 05 ) between them. The area under ROC curve for operative complications predicted by POSSUM scoring system was 0. 575. The POSSUM score system was most accurate for the prediction of complication rates of 20%?40%, showing the O/E value of 0.81. Compared with the POSSUM score system, P?POSSUM had better ability in the prediction of postoperative mortality, when the predicted value of mortality was greater than 15%, the predictive result was more accurate, and the O/E value was 1.00. Conclusions POSSUM and P?POSSUM scoring system have good value in predicting the mortality of patients with periampullary tumors undergoing pancreaticoduodenectomy, but a poorer value of POSSUM score system in prediction of complications. We can establish a more suitable scoring system for pancreaticoduodenectomy by modifying the score constant and weight, to better predict surgical risk and reduce the operative complications and mortality.

Objective To explore the learning curve for middle pancreatectomy by comparing the outcomes of middle pancreatectomy operated by a single treatment group at different stages. Methods A total of 48 patients received middle pancreatectomy by single treatment group between January 2006 and April 2014 at our hospital. These 48 cases were divided into 10 stages ( 5 cases in each) according to the operation sequence. The operation time, blood loss, surgical complications, rate of negative margin and postoperative hospital stay were analyzed retrospectively. Results There was no significant difference among the 10 stages in respect to surgical complications, rate of negative margin and postoperative hospital stay ( P>0.05) . The median operation time and blood loss in the first stage was 375 min and 530 ml, respectively. The median operation time and blood loss in the second stage was 280 min and 330 ml, respectively. There were significant differences between these two stages and the other later stages in median operation time and blood loss ( P<0.01) . However, there was no significant difference among the stages 3 to 10 in the median operation time and blood loss ( P>0.05 for all) . Conclusion After 10?15 cases of middle pancreatectomy, a surgeon can be skilled and experienced in this surgical procedure with few surgical complications.

Objective To investigate the value of Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity(POSSUM)and a modification of the POSSUM system(P?P0SSUM) scoring system in predicting the surgical operative risk of pancreaticoduodenectomy for periampullary tumors. Methods POSSUM and P?POSSUM scoring systems were used to retrospectively evaluate the clinical data of 432 patients with periampullar tumors who underwent pancreaticoduodenectomy in the Department of Abdominal Surgery, Cancer Hospital,ChineseAcademy of Medical Sciences from January 1985 to December 2010. The predictive occurrence of postoperative complications and mortality rate were calculated according to the formula. ROC curve analysis and different group of risk factors were used to determine the discrimination ability of the two score systems, and to determine their predictive efficacy by comparing the actual and predictive complications and mortality rates, using Hosmer?Lemeshow test to determine the goodness of fit of the two scoring systems. Results The average physiological score of the 432 patients was 16.1±3.5, and the average surgical severity scorewas 19.6±2.7. ROC curve analysis showed that the area under ROC curve for mortality predicted by POSSUM and P?POSSUM were 0.893 and 0.888, showing a non?significant difference ( P>0. 05 ) between them. The area under ROC curve for operative complications predicted by POSSUM scoring system was 0. 575. The POSSUM score system was most accurate for the prediction of complication rates of 20%?40%, showing the O/E value of 0.81. Compared with the POSSUM score system, P?POSSUM had better ability in the prediction of postoperative mortality, when the predicted value of mortality was greater than 15%, the predictive result was more accurate, and the O/E value was 1.00. Conclusions POSSUM and P?POSSUM scoring system have good value in predicting the mortality of patients with periampullary tumors undergoing pancreaticoduodenectomy, but a poorer value of POSSUM score system in prediction of complications. We can establish a more suitable scoring system for pancreaticoduodenectomy by modifying the score constant and weight, to better predict surgical risk and reduce the operative complications and mortality.

Objective To explore the learning curve for middle pancreatectomy by comparing the outcomes of middle pancreatectomy operated by a single treatment group at different stages. Methods A total of 48 patients received middle pancreatectomy by single treatment group between January 2006 and April 2014 at our hospital. These 48 cases were divided into 10 stages ( 5 cases in each) according to the operation sequence. The operation time, blood loss, surgical complications, rate of negative margin and postoperative hospital stay were analyzed retrospectively. Results There was no significant difference among the 10 stages in respect to surgical complications, rate of negative margin and postoperative hospital stay ( P>0.05) . The median operation time and blood loss in the first stage was 375 min and 530 ml, respectively. The median operation time and blood loss in the second stage was 280 min and 330 ml, respectively. There were significant differences between these two stages and the other later stages in median operation time and blood loss ( P<0.01) . However, there was no significant difference among the stages 3 to 10 in the median operation time and blood loss ( P>0.05 for all) . Conclusion After 10?15 cases of middle pancreatectomy, a surgeon can be skilled and experienced in this surgical procedure with few surgical complications.

OBJECTIVETo investigate the complications in intra-operative radiotherapy (IORT) for patients with local advanced pancreatic cancer.

METHODSThe clinical data, operation material, overall dose of IORT, postoperative therapy, complications, treatment and prognosis were retrospectively analyzed in all the in-hospital pancreatic cancer patients from Nov 2008 to Jan 2012.

RESULTSThere were 115 patients with local advanced pancreatic cancer treated with IORT in this study. 81 cases had a tumor in the head of pancreas and 34 cases in the pancreatic body and tail. The operation method was IORT combined with internal drainage surgery. The intra-operative radiotherapy was performed using Mobetron mobile electron accelerator, with a total dose of 12-20 Gy. Bilioenteric anastomosis and/or gastrointestinal anastomosis were included in the internal drainage surgery. Gastroparesis syndrome (10.4%), hemorrhage (3.5%), abdominal infection (2.6%), pancreatic fistula (0.9%) and renal failure (1.7%) were the common postoperative complication of IORT. All patients were cured except one who died of digestive tract hemorrhage.

CONCLUSIONSMajor complications of IORT are gastroparesis syndrome, abdominal infection and hemorrhage. The incidence of gastroparesis syndrome is at the top of the list. However, early complications have a relatively better prognosis, indicating that IORT is a safe and reliable therapy for patients with locally advanced pancreatic cancer.

Combined Modality Therapy ; Humans ; Pancreatic Neoplasms ; radiotherapy ; Radiotherapy Dosage ; Retrospective Studies