| Part 1 Clinical Application Research of Modified Invagination for PancreaticojejunostomyObjective To explore the clinical application value of modified invagination for pancreaticojeiunostomy in pancreaticoduodenectomy(PD).Methods A retrospective cohort study method was used.The clinical and pathological data of 39 patients with PD admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2014 to December 2017 were collected.The age was(60±7)years,and the age range was 4l to 75 years.Nineteen of them underwent modified invagination for pancreaticojeiunostomy and were set to the innovation group;20 cases of mucosal-to-mucosal pancreaticojeiunostomy were set to the traditional group.The surgical conditions,postoperative complications,and follow-up were collected and analyzed.Result(1)Surgical conditions: innovation group in the operation time,intraoperative blood loss,pancreatic texture(soft and hard),pancreatic duct diameter,pancreatic duct removal time,somatostatin use,and postoperative hospital stay were(342±47)min,400ml(300ml,400ml),10/9 cases,3.1mm(2.9mm,3.4mm),37d(32d,63d),17 cases,18d(15d,22d);the above indicators of the traditional group were(392±95)min,400 ml(300ml,525ml),6/14 cases,3.6 mm(2.6mm,4.2mm),43d(34d,49d),18 cases,24d(15d,27d).The intraoperative blood loss,pancreatic texture(soft and hard),pancreatic duct diameter,pancreatic duct removal time,use of somatostatin,and postoperative hospital stay were not significantly different between the two groups(P> 0.05);There was a statistically significant difference in the operation time between patients(P <0.05).(2)Postoperative complications: 6 patients in the innovation group had postoperative complications;11 patients in the traditional group had postoperative complications,and the same patient could have multiple complications.There was no significant difference in postoperative complications between the two groups of patients(P>0.05);there was a significant difference in the comparison of postoperative B and C pancreatic fistulas between the two groups(P <0.05).(3)Follow-up: Of the 39 patients,33 were followed up(18 in the innovation group and 15 in the traditional group).The follow-up time was 3 to 57 months,and the median follow-up time was 17 months.There were 5 cases of tumor recurrence and metastasis in the innovation group,1 case of tumor recurrence at 34 months after operation,1 case of dilated pancreatic duct with intermittent abdominal pain and bloating,5 cases of indigestion,1 case of back pain,and 5 cases of good recovery;traditional group tumors There were 10 cases of recurrence and metastasis,2 cases of main pancreatic duct dilatation and intermittent abdominal pain and bloating,2 cases of indigestion,and 1case of good recovery.Conclusion It is safe and feasible to use the modified invagination for reconstruction in PD surgery,which can simplify the operation,reduce the requirements of the operator’s operation technology,shorten the operation time,and reduce the incidence of postoperative B and C pancreatic fistula.Part 2 Animal experimental study on Modified Invagination for PancreaticojejunostomyObjective By establishing an animal model that simulates pancreatoduodenectomy,to investigate the effectiveness and safety of the modified invagination pancreaticojejunostomy.Methods A mongrel dog was used to establish a model.Twelve experimental animals were randomly divided into two groups of six animals,and the optimized nested pancreaticojejunostomy was set as the experimental group,and the mucosal-mucosal pancreaticojejunostomy was set as the control group.The perioperative period(preoperative,postoperative 7 days,14 days,30 days)general data,biochemical indicators and postoperative histopathological changes were collected and analyzed.Result(1)General information: Two animals in each group died during the experiment.There were no significant differences in postoperative mortality,B / C grade pancreatic fistula,postoperative body weight,and other complications between the two groups(P>0.05);pancreaticojejunostomy time in the experimental group was 13.9±1.4min,and the control group was 18.6±3.7min,the difference was statistically significant(P <0.05).(2)Biochemical indicators: Comparison of perioperative fasting blood glucose between the two groups was statistically significant(P <0.05),and there was no significant difference in serum amylase and albumin(P> 0.05);When compared with preoperative time at different time points,postoperative amylase was statistically significant in the experimental group(P <0.05),and the rest was not statistically significant(P> 0.05).(3)Histopathological changes at 30 days after operation: The pancreatic-intestinal anastomosis of the experimental group healed well,the inflammatory response of the anastomosis was mild,there was no obvious edema on the pancreas and jejunum side,and the structure was intact.The two are coherent and tightly fit.The mucosa on both sides of the anastomosis is smooth and continuous.The submucosal fibrous tissue is hyperplastic,coherent and natural,with a small amount of inflammatory cells infiltration.Masson staining shows a large amount of collagen proliferation at the anastomosis of the pancreas and intestines.Collagen fibers and elastic fibers Arranged neatly,it is ring-shaped,and the anastomosis heals better.In the control group,the anastomosis of the pancreatic and intestinal anastomosis was healed.It was seen that the inflammation was severe,the intestine and pancreatic tissue were edema,and the pancreatic and intestinal anastomosis was severely adhered to the surrounding tissue.HE staining showed that some pancreatic tissue was necrotic,and the adhesion between the pancreas and intestine was not tight.The tissue structure is relatively disordered,and a small amount of inflammatory cells are infiltrated.Masson staining shows a small amount of collagen proliferation at the anastomosis of the pancreas and intestine.The collagen fibers and elastic fibers are unevenly distributed and arranged in a wave-like disorder.The anastomosis heals in general.Immunohistochemical results showed that the expression of TGF-β1 protein in the pancreatic-intestinal anastomosis of both groups was positive,showing brown particles,but the expression of TGF-β1 protein in the anastomosis of the pancreatico-intestinal anastomosis in the experimental group was significantly higher than that in the control group(P <0.05).Masson staining results showed that the content of collagen fibers at the anastomotic site of the pancreas and intestine of the experimental group was higher than that of the control group(P <0.05).RT-PCR results showed that there was no significant difference in the m RNA content of IL-6,TNF-α and TGF-β1 in the two groups of tissue samples before and after surgery(P> 0.05).Conclusion The modified invagination pancreaticojejunostomy has a reasonable design and simple operation.The pancreaticojejunostomy has a short duration and a low incidence of postoperative pancreatic fistula.The pancreaticojejunostomy heals well after 30 days and is worth recommending for clinical use. |
