Biomedical subjects

Yi-Ming Shyr

Publications and source records attributed to Yi-Ming Shyr.

22 records · Page 2Linked to original sources

PubMedDate not supplied

Surgical treatment for serous cystadenoma of pancreas--segmental pancreatectomy or conventional resection?

BACKGROUND/AIMS: Benign tumors located in the neck or body of the pancreas are usually removed by left pancreatectomy or pancreaticoduodenectomy when enucleation is too risky for possible damage of the main pancreatic duct. But standard pancreatic resection has its potential operative risk and may result in loss of pancreatic parenchyme and cause impairment of pancreatic function. The aim of this study was to compare the results of segmental pancreatectomy, a limited resection of the mid-portion of the pancreas, and traditional extensive pancreatic resection, i.e. distal pancreatectomy or pancreaticoduodencetomy in patients with serous cystadenoma of the pancreas. METHODOLOGY: From January 1989 to February 2002, 19 patients with serous cystadenoma of the pancreas treated with pancreatic resection were reviewed. Among them segmental pancreatectomy was performed in 5 cases, distal pancreatectomy was carried out in 11, pancreaticoduodenectomy in 2 and total pancreatectomy in one patient. RESULTS: Operation time was significantly longer in segmental pancreatectomy than in distal pancreatectomy (P<0.001) and a greater blood loss was also noticed in the conventional resection. There was no operative mortality and the postoperative hospital stays were not different in any group. A higher rate of pancreatic fistula was encountered in segmental pancreatectomy, however all of the fistulas sealed off after conservative treatment. A trend of higher chance of developing postoperative diabetes was noticed in the conventional resection. Except for the patient who underwent total pancreatectomy no patient developed frank steatorrhea during long-term follow-up. CONCLUSIONS: Segmental pancreatectomy is a safe and technically feasible procedure in selected patients with benign pancreatic tumor. This procedure carries a similar surgical risk as that of standard operation, but avoids extensive pancreatic resection which in turn may preserve more pancreatic functions.

Adult↗

PubMedDate not supplied

Non-stented pancreaticogastrostomy for 111 patients undergoing pylorus-preserving pancreaticoduodenectomy.

BACKGROUND/AIMS: The main purpose is to clarify the roles of pancreatic stenting and duct-to-mucosa anastomosis in prevention of pancreatic leakage and exocrine insufficiency in pylorus-preserving pancreaticoduodenectomy with non-stented pancreaticogastrostomy (non-stented PPPD-PG). METHODOLOGY: Prospectively-collected data from 111 patients with resectable periampullary lesions undergoing non-stented PPPD-PG between January 1997 and February 2003 were analyzed. Severity of postoperative steatorrhea was assessed. Surgical morbidity and mortality were evaluated. RESULTS: Complications occurred in 38 (34.2%) patients, leading to 2 (1.8%) deaths. However, neither of the deaths were related to operation. The most common complication was gastric atonia (14.4%). Pancreatic leakage occurred only in 1 (0.9%) patient. Overall, there was no steatorrhea in 92 (82.8%) patients after non-stented PPPD-PG, including 69 (62.2%) patients without replacement of pancreatic enzymes and 23 (20.7%) patients after replacement of pancreatic enzymes. Moderate steatorrhea occurred in 17 (15.3%) patients, and severe steatorrhea only in 1 (0.9%) patient. Steatorrhea was significantly correlated with the consistency of pancreatic parenchyma (P=0.037), instead of the diameter of pancreatic duct. CONCLUSIONS: The findings of low incidence of pancreatic leakage and steatorrhea in this non-stented PPPD-PG study imply that pancreatic stenting and duct-to-mucosa anastomosis may not be crucial in prevention of pancreatic leakage and exocrine insufficiency after reconstruction with pancreaticogastrostomy.

Adolescent↗

PubMedDate not supplied

Malignant solid and pseudopapillary tumor of the pancreas--clinicohistological, immunohistochemical, and flow cytometric evaluation.

BACKGROUND/AIMS: Solid and pseudopapillary tumor of the pancreas is a benign and low malignant potential tumor. Prognosis is good after surgical resection but its malignant potential is usually defined after metastasis. We compared benign and malignant cases with clinicopathological, immunohistochemical and DNA flow cytometric studies. METHODOLOGY: From January 1991 to July 2004, seven patients were found to have solid and pseudopapillary tumor of the pancreas at Taipei Veterans General Hospital. The paraffin sections were reevaluated with hematoxylin & eosin stain, immunohistochemical stains, and DNA flow cytometric studies. RESULTS: It included 6 benign and one malignant case. The progesterone receptor, vimentin, neuron-specific enolase, and chromogranin A showed diffused positive stain in all cases. Estrogen receptor and P53 stain were negative in all 7 patients. Synaptophysin stain was negative in 6 no recurrence patients, but was positive only in the patient who suffered from recurrence. DNA flow cytometry showed diploid results in six non-malignant tumors. In the malignant patient, the tumor in the first operation showed diploid result, but tumors in second and third operations showed aneuploidy. CONCLUSIONS: Solid and pseudopapillary tumor of the pancreas should be considered as a potentially malignant disease in all patients and regular follow-up is mandatory.

Adolescent↗

PubMedDate not supplied

Effect of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy.

BACKGROUND/AIMS: Preoperative biliary drainage (PBD) in jaundiced patients undergoing pancreaticoduodenectomy remains controversial. METHODOLOGY: Retrospective analysis of 313 patients undergoing pancreaticoduodenectomy between 1991 and 2004 was performed. Patients were stratified into PBD and no preoperative biliary drainage (NPBD) groups. Perioperative morbidity and mortality were evaluated and surgical risks compared. Nine retrospective studies were also evaluated. RESULTS: PBD was performed in 210; 103 had NPBD. Common indications for PBD were jaundice and cholangitis. Postoperative complications occurred in 153; 20 died postoperatively. PBD patients were older and predominantly male. Cholangitis, low albumin, and higher preoperative bilirubin were increased in PBD. Pancreatic leakage and postoperative hospital days were increased in NPBD. Wound infection occurred more frequently in PBD, but this was not significant. Perioperative mortality rate was 6.7% in PBD compared to 5.8% in NPBD. Postoperative complication rate was 45.7% for PBD and 55.3% for NPBD. Twelve PBD patients had procedure-related complications. Of 2391 patients pooled from the nine reviews and our study (1516 PBD and 875 NPBD), no significant difference was observed in postoperative mortality and overall complications. Wound infection was significantly increased in PBD (p<0.001). CONCLUSIONS: Preoperative biliary drainage did not increase postoperative morbidity and mortality rate in pancreaticoduodenectomy patients, but should be used judiciously.

Aged↗