Duodenum and ventral pancreas preserving subtotal pancreatectomy for low-grade malignant neoplasms of the pancreas: An alternative procedure to total pancreatectomy for low-grade pancreatic neoplasms.

AIM: To describe the indications, technique and outcomes of the novel surgical procedure of duodenum and ventral pancreas preserving subtotal pancreatectomy (DVPPSP). METHODS: Data collected retrospectively from 43 patients who underwent DVPPSP and TP between 2009 and 2015 in our single centre were analysed. For enrolment, only patients with low-grade pancreatic neoplasms, such as pancreatic neuroendocrine tumors, intraductal papillary mucinous neoplasms (IPMNs), and solid pseudo-papillary tumors, were included. Ten DVPPSP (group 1) and 13 TP (group 2) patients were selected in this study. RESULTS: There were no significant differences in age, gender, comorbidities, preoperative symptoms, American Society of Anesthesiologists score or indications for surgery between the two groups. The most common indication was IPMN for DVPPSP and TP (60% vs 85%, P = 0.411). Compared with the TP group, the DVPPSP group had comparable postoperative morbidities (P = 0.405) and mortalities (both nil), but significantly shorter operative time (232 ± 19.6 min vs 335 ± 32.3 min, P < 0.001). DVPPSP preserved better long-term pancreatic function with less supplementary therapy (P < 0.001) and better quality of life (QoL) after surgery, including better scores in social (P = 0.042) and global health (P = 0.047) on functional scales and less appetite loss (P = 0.049) on the symptom scale. CONCLUSION: DVPPSP is a feasible and safe procedure that could be an alternative to TP for low-grade neoplasms arising from the body and tail region but across the neck region of the pancreas; DVPPSP had better metabolic function and QoL after surgery.

The effect of Chaiqin Chengqi Decoction () on modulating serum matrix metalloproteinase 9 in patients with severe acute pancreatitis.

OBJECTIVE: To investigate the effect of Chaiqin Chengqi Decoction (, CQCQD) on regulating serum matrix metalloproteinase 9 (MMP-9) in patients with severe acute pancreatitis (SAP). METHODS: Thirty-five SAP patients hospitalized in West China Hospital from September 1, 2008 to February 28, 2009 were randomly assigned to two groups using a computer-derived random number sequence in a ratio of 1:1, treatment group (18 patients) and the placebo control group (17 patients). The patients in the treatment group were administered with CQCQD by gastric perfusion (50 mL/2 h) and retention enema (200 mL/6 h) for 7 days. The two groups had similar baseline information. The clinical indicators, including the initial Balthazar's computed tomography (CT) score, acute physiology and chronic health evaluation II (APACHE II) scores on 1st, 3rd, 5th and 7th day, incidences and durations of complications and the serum C-reactive protein (CRP), levels of MMP-9 on the 1st, 3rd, 5th and 7th day, were recorded and compared between the two groups. RESULTS: The serum MMP-9, CRP and the APACHE II scores on the 3rd, 5th and 7th day in the treatment group were lower than those in the control group (P<0.05). The serum MMP-9 was positively correlated with the APACHE II score on the 1st day (r=0.430, P=0.01). The durations of acute respiratory distress syndrome (5.4±2.4 vs. 2.9±1.3), acute hepatitis (4.6±0.8 vs. 1.9±0.6) and acute heart failure (3.9±1.6 vs. 1.3±0.6, <0.05) in the control group were longer than those in the treatment group. CONCLUSION: CQCQD could decrease the serum MMP-9 to relieve the severity of clinical symptoms and prevent the development of multiple organ dysfunction syndrome in patients with SAP.

[Clinical study on the treatment of severe acute pancreatitis by integrated traditional Chinese medicine and Western medicine].

OBJECTIVE: To sum up clinical experiences and formulate a new treatment program for the effective managment of severe acute pancreatitis(SAP) by integrated TCM and western medicine. METHODS: The therapeutic regimens and end results of 1376 cases of SAP in three periods were reviewed and analyzed. Period I (1980-1990) was characterized by early surgical intervention supplemented with integrated traditional Chinese and western medical therapy, period II (1991-1993) by integrated traditional Chinese and western medical therapy supplemented with surgery for early complications, and period III (1994-2003) by integrated traditional Chinese and western medical therapy supplemented with surgery for local infectious complications at a late stage in the course of disease. RESULTS: With use of integrated traditional Chinese and western medical therapy in the treatment of SAP, the proportion of surgical operation and the case-fatality rate kept declining in the three consecutive periods, the proportions of operation being 77.59%, 54.54% and 19.38%, and the case-fatality rates being 40.52%, 17.17% and 10.77%, respectively. CONCLUSION: Integrated TCM and western medicine is effective for most SAP cases, and surgery is indicated mainly for late complications such as necrotizing infection. Early surgery should be handled with more circumspection and strictness in most of the patients with SAP.