跳至主要内容

Early Ligation of the Inferior Pancreaticoduodenal Artery Using Intraoperative Ultrasonography during Pancreaticoduodenectomy

Read  full  paper  at:
http://www.scirp.org/journal/PaperInformation.aspx?PaperID=53901#.VNsH5SzQrzE

ABSTRACT
Background: While the safety of pancreaticoduodenectomy (PD) has improved, the high level of difficulty associated with this operation means that the procedure carries a high mortality rate compared to other gastrointestinal operations. Various trials have been implemented in efforts to reduce the incidence of complications after PD. In particular, a large amount of intraoperative bleeding and the use of red blood cell transfusions are reportedly risk factors for postoperative complications after PD. Aim: In an attempt to reduce the amount of intraoperative bleeding during PD, consideration was given to the anatomical characteristics of the region of the pancreatic head, and the gastroduodenal artery (GDA) and inferior pancreaticoduodenal artery (IPDA) were ligated in advance of separating the head from the portal vein. We herein report the use of ultrasonography during PD to facilitate the early identification and ligation of the IPDA. Case Presentation: A 72-year-old female was diagnosed with pancreatic cancer and underwent pylorus-preserving pancreatoduodenectomy. We used ultrasonography during the operation to initially identify the IPDA and then ligate it in advance, after which the GDA was ligated before separating the pancreatic head from the superior mesenteric artery and portal vein. Identification of the IPDA was performed with the SMA as a guide using ultrasonography in Doppler mode. The amount of intraoperative bleeding was 235 ml. The patient left the hospital without any postoperative complications and has since demonstrated a good postoperative course, with no evidence of recurrent disease. Conclusions: Early ligation of the IPDA using intraoperative US is non-invasive and makes it simple to identify the IPDA. This method may be a useful technique for reducing intraoperative bleeding during the normal course of PD procedures.
Cite this paper
Sasaki, T. , Kato, D. , Shinya, S. , Yamashita, K. , Nakashima, R. , Shiwaku, H. , Yamauchi, Y. , Noritomi, T. and Yamashita, Y. (2015) Early Ligation of the Inferior Pancreaticoduodenal Artery Using Intraoperative Ultrasonography during Pancreaticoduodenectomy. Surgical Science, 6, 50-84. doi: 10.4236/ss.2015.62008.
 
References
[1]velopment of a More Reliable Anastomosis Technique. Journal of Hepato-Biliary-Pancreatic Surgery, 8, 230-237. http://dx.doi.org/10.1007/s005340170022
 
[2]Yeo, C.J., Cameron, J.L., Sohn, T.A., Coleman, J., Sauter, P.K. and Hruban, R.H. (1999) Pancreaticoduo- denectomy with or without Extended Retroperitoneal Lymphadenectomy for Periampullary Adenocarci- noma: Comparison of Morbidity and Mortality and Short-Term Outcome. Annals of Surgery, 229, 613-622. http://dx.doi.org/10.1097/00000658-199905000-00003
 
[3]Conlon, K.C., Labow, D., Leung, D., Smith, A., Jarnagin, W. and Coit, D.G. (2001) Prospective Randomized Clinical Trial of the Value of Intraperitoneal Drainage after Pancreatic Resection. Annals of Surgery, 234, 487-494. http://dx.doi.org/10.1097/00000658-200110000-00008
 
[4]Yeo, C.J., Cameron, J.L., Sohn, T.A., Lillemoe, K.D., Pitt, H.A. and Talamini, M.A. (1997) Six Hundred Fifty Consecutive Pancreaticoduodenectomies in the 1990s: Pathology, Complications, and Outcomes. Annals of Surgery, 226, 248-260. http://dx.doi.org/10.1097/00000658-199709000-00004
 
[5]Cullen, J.J., Sarr, M.G. and Ilstrup, D.M. (1994) Pancreatic Anastomotic Leak after Pancreaticoduo- denectomy: Incidence, Significance, and Management. The American Journal of Surgery, 168, 295-298. http://dx.doi.org/10.1016/S0002-9610(05)80151-5
 
[6]Miedema, B.W., Sarr, M.G., van Heerden, J.A., Nagorney, D.M., McIlrath, D.C. and Ilstrup, D. (1992) Complications Following Pancreaticoduodenectomy. Current Management. Archives of Surgery, 127, 945-949. http://dx.doi.org/10.1001/archsurg.1992.01420080079012
 
[7]Yeh, T.S., Jan, Y.Y., Jeng, L.B., Hwang, T.L., Wang, C.S. and Chen, S.C. (1997) Pancreaticojejunal Anastomotic Leak after Pancreaticoduodenectomy—Multivariate Analysis of Perioperative Risk Factors. Journal of Surgical Research, 67, 119-125. http://dx.doi.org/10.1006/jsre.1996.4974
 
[8]Gouma, D.J., van Geenen, R.C., van Gulik, T.M., de Haan, R.J., de Wit, L.T. and Busch, O.R. (2000) Rates of Complications and Death after Pancreaticoduodenectomy: Risk Factors and the Impact of Hospital Volume. Annals of Surgery, 232, 786-795. http://dx.doi.org/10.1097/00000658-200012000-00007
 
[9]Kawai, M., Tani, M., Terasawa, H., Ina, S., Hirono, S. and Nishioka, R. (2006) Early Removal of Prophylactic Drains Reduces the Risk of Intra-Abdominal Infections in Patients with Pancreatic Head Resection: Prospective Study for 104 Consecutive Patients. Annals of Surgery, 244, 1-7.
http://dx.doi.org/10.1097/01.sla.0000218077.14035.a6
 
[10]Kawai, M., Tani, M., Ina, S., Hirono, S., Nishioka, R. and Miyazawa, M. (2008) CLIP Method (Preoperative CT Image-Assessed Ligation of Inferior Pancreaticoduodenal Artery) Reduces Intraoperative Bleeding during Pancreaticoduodenectomy. World Journal of Surgery, 32, 82-87.
http://dx.doi.org/10.1007/s00268-007-9305-y
 
[11]Ohigashi, H., Ishikawa, O., Eguchi, H., Yamada, T., Sasaki, Y. and Noura, S. (2004) Early Ligation of the Inferior Pancreaticoduodenal Artery to Reduce Blood Loss during Pancreaticoduodenectomy. Hepato-Gastroenterology, 51, 4-5.
 
[12]Horiguchi, A., Ishihara, S., Ito, M., Nagata, H., Shimizu, T. and Furusawa, K. (2007) Pancreatoduo- denectomy in Which Dissection of the Efferent Arteries of the Head of the Pancreas Is Performed First. Journal of Hepato-Biliary-Pancreatic Surgery, 14, 575-578.
http://dx.doi.org/10.1007/s00534-006-1198-x
 
[13]Yang, Y.M., Tian, X.D., Zhuang, Y., Wang, W.M., Wan, Y.L. and Huang, Y.T. (2005) Risk Factors of Pancreatic Leakage after Pancreaticoduodenectomy. World Journal of Gastroenterology, 11, 2456-2461. http://dx.doi.org/10.3748/wjg.v11.i16.2456
 
[14]Bertelli, E., Di Gregorio, F., Bertelli, L. and Mosca, S. (1995) The Arterial Blood Supply of the Pancreas: A Review. I. The Superior Pancreaticoduodenal and the Anterior Superior Pancreaticoduodenal Arteries. An Anatomical and Radiological Study. Surgical and Radiologic Anatomy, 17, 97-106.
http://dx.doi.org/10.1007/BF01627566
 
[15]Bertelli, E., Di Gregorio, F., Bertelli, L., Civeli, L. and Mosca, S. (1996) The Arterial Blood Supply of the Pancreas: A Review. II. The Posterior Superior Pancreaticoduodenal Artery. An Anatomical and Radiological Study. Surgical and Radiologic Anatomy, 18, 1-9. http://dx.doi.org/10.1007/BF03207753
 
[16]Bertelli, E., Di Gregorio, F., Bertelli, L., Orazioli, D. and Bastianini, A. (1997) The Arterial Blood Supply of the Pancreas: A Review. IV. The Anterior Inferior and Posterior Pancreaticoduodenal aa., and Minor Sources of Blood Supply for the Head of the Pancreas. An Anatomical Review and Radiologic Study. Surgical and Radiologic Anatomy, 19, 203-212.                                                     eww150211lx
标签：

评论

发表评论

此博客中的热门博文

A Comparison of Methods Used to Determine the Oleic/Linoleic Acid Ratio in Cultivated Peanut (Arachis hypogaea L.)

Cultivated peanut ( Arachis hypogaea L.) is an important oil and food crop. It is also a cheap source of protein, a good source of essential vitamins and minerals, and a component of many food products. The fatty acid composition of peanuts has become increasingly important with the realization that oleic acid content significantly affects the development of rancidity. And oil content of peanuts significantly affects flavor and shelf-life. Early generation screening of breeding lines for high oleic acid content greatly increases the efficiency of developing new peanut varieties. The objective of this study was to compare the accuracy of methods used to classify individual peanut seed as high oleic or not high oleic. Three hundred and seventy-four (374) seeds, spanning twenty-three (23) genotypes varying in oil composition (i.e. high oleic (H) or normal/not high oleic (NH) inclusive of all four peanut market-types (runner, Spanish, Valencia and Virginia), were individually tested ...
发表评论
阅读全文

Location Optimization of a Coal Power Plant to Balance Costs against Plant’s Emission Exposure

Fuel and its delivery cost comprise the biggest expense in coal power plant operations. Delivery of electricity from generation to consumers requires investment in power lines and transmission grids. Placing a coal power plant or multiple power plants near dense population centers can lower transmission costs. If a coalmine is nearby, transportation costs can also be reduced. However, emissions from coal plants play a key role in worsening health crises in many countries. And coal upon combustion produces CO 2 , SO 2 , NO x , CO, Metallic and Particle Matter (PM10 & PM2.5). The presence of these chemical compounds in the atmosphere in close vicinity to humans, livestock, and agriculture carries detrimental health consequences. The goal of the research was to develop a methodology to minimize the public’s exposure to harmful emissions from coal power plants while maintaining minimal operational costs related to electric distribution losses and coal logistics. The objective was...
发表评论
阅读全文

Evaluation of the Safety and Efficacy of Continuous Use of a Home-Use High-Frequency Facial Treatment Appliance

At present, many home-use beauty devices are available in the market. In particular, many products developed for facial treatment use light, e.g., a flash lamp or a light-emitting diode (LED). In this study, the safety of 4 weeks’ continuous use of NEWA TM , a high-frequency facial treatment appliance, every alternate day at home was verified, and its efficacy was evaluated in Japanese individuals with healthy skin aged 30 years or older who complained of sagging of the facial skin.  Transepidermal water loss (TEWL), melanin levels, erythema levels, sebum secretion levels, skin color changes and wrinkle improvement in the facial skin were measured before the appliance began to be used (study baseline), at 2 and 4 weeks after it had begun to be used, and at 2 weeks after completion of the 4-week treatment period (6 weeks from the study baseline). In addition, data obtained by subjective evaluation by the subjects themselves on a visual analog scale (VAS) were also analyzed. Fur...
发表评论
阅读全文