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2007 2

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A novel method for reconstruction in laparoscopic pancreaticoduodenectomy: an experience of 13 cases

LU Bangyu, HUANG Yubin, CAI Xiaoyong, HUANG Fei, LU Wenqi, XU Jing, LIU Zujun, YAN Yihe, LI Jianjun, LI Jie

《医学前沿（英文）》 2007年第1卷第4期页码 369-372 doi: 10.1007/s11684-007-0071-x

摘要： Laparoscopic pancreaticoduodenectomy (LPD) is a challenging operation to general surgeon. Up to date, only about 135 cases have been reported, 16 cases in China, 119 cases outside China. The reconstruction of alimentary system is a key procedure to ensure success of the whole surgery. It is worth investigating the methods of reconstruction in LPD. A retrospective study is made to investigate the methods of reconstruction in LPD. We analyze 13 cases of LPD performed in our center. Child s or modified Child s method was used to make the reconstruction in our practice. We tried three methods to make the anastomosis of pancreaticojejunostomy, including end-to-end dunking binding pancreaticojejunostomy in two cases, end-to-end dunking pancreaticojejunostomy using interrupted suture in two cases, and duct-to-jejunal end-to-side embedding pancreaticojejunostomy in nine cases. The clinical data was collected and analyzed. Three of four patients, who underwent end-to-end pancreaticojejunostomy, had a little pancreatic leakage, especially in the first case. None of other nine patients, who underwent duct-to-jejunal end-to-side embedding pancreaticojejunostomy, was detected to have pancreatic leakage, and the operating time of these nine cases was less than other four cases. Duct-to-jejunal end-to-side embedding pancreaticojejunostomy is a safe and efficient method of reconstruction in LPD.

关键词： alimentary dunking pancreaticojejunostomy challenging operation anastomosis success

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Emergency adult living donor right lobe liver transplantation for fulminant hepatic failure

ZHANG Feng, WANG Xuehao, LI Xiangcheng, KONG Lianbao, SUN Beicheng, LI Guoqiang, QIAN Xiaofen, CHEN Feng, WANG Ke, LU Sheng, PU Liyong, LU Ling

《医学前沿（英文）》 2007年第1卷第3期页码 282-286 doi: 10.1007/s11684-007-0054-y

摘要： Fulminant hepatitis is fatal in most cases and timely liver transplantation is the only effective treatment. This study evaluates the survival outcomes of patients who underwent living-donor liver transplantation (LDLT) using right lobe liver grafts for fulminant liver failure due to hepatitis B infection. Nine cases of adult right lobe LDLT were performed in our department from September 2002 to August 2005 and the clinical and following-up data were reviewed. According to the pre-transplant Child-Pugh-Turcotte classification, the nine patients were classified as grade C. The model for end-stage liver disease (MELD) score of these patients ranged from 16 to 42. The principal complications before transplantation included abnormal renal function, hepatic coma of different degrees and alimentary tract hemorrhage. The main complications after transplantation included pulmonary infection in two cases, acute renal failure in three cases and transplantation-related encephalopathy in one case. No primary failure of vascular or biliary complications occurred. The one-year survival rate was 55.6%. There were no serious complications or deaths in donors. In general, it is extremely difficult to treat fulminant hepatitis by conservative regimen, particularly, in cases with rapid progression. Emergency adult living-donor liver transplantation is an effective treatment for fulminant hepatitis patients and is relatively safe for donors.

关键词： alimentary abnormal hemorrhage principal different