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The degree of pancreatic fibrosis can be estimated using the time-signal intensity curve (TIC) of the pancreas, obtained with dynamic magnetic resonance imaging (MRI). We have investigated whether trainee surgeons can perform pancreatic anastomosis safely, without the occurrence of POPF, when patients are selected carefully based on a preoperative assessment of pancreatic fibrosis. Methods: Seventy-two consecutive patients who underwent pancreatic head resection were enrolled in this prospective trial. Dynamic contrast-enhanced MRI of the pancreas was performed preoperatively in all patients who, based on their pancreatic TIC profile, were then allocated to one of two groups: Group A comprised patients with type I pancreatic TIC, signifying a normal pancreas without fibrosis (n = 46); Group B comprised patients with type II or III pancreatic TIC, signifying a fibrotic pancreas (n = 26). An end-to-side duct-to-mucosa pancreaticojejunostomy was performed in all patients, with all patients in Group A operated on by two experienced surgeons, and all patients in Group B operated on by one of eight trainee surgeons at various stages of training. Results: There was no operative mortality. POPF developed in 19 patients: 12 patients with grade A POPF and seven with grade B. All except one of the POPF occurred in Group A patients. The POPF in the one patient from Group B was grade A (p \u003c 0.001). 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Patient allocation based on preoperative assessment of pancreatic fibrosis to secure pancreatic anastomosis performed by trainee surgeons: a prospective study
http://hdl.handle.net/10069/26615
http://hdl.handle.net/10069/26615e423db10-b44b-4456-90e6-bbd740746369
名前 / ファイル | ライセンス | アクション |
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JHBPS17_831.pdf (686.5 kB)
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Item type | 学術雑誌論文 / Journal Article(1) | |||||
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公開日 | 2011-12-01 | |||||
タイトル | ||||||
タイトル | Patient allocation based on preoperative assessment of pancreatic fibrosis to secure pancreatic anastomosis performed by trainee surgeons: a prospective study | |||||
言語 | ||||||
言語 | eng | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | Education | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | Pancreatic anastomosis | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | Pancreatic fibrosis | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | Pancreatic fistula | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | Trainee surgeons | |||||
資源タイプ | ||||||
資源タイプ識別子 | http://purl.org/coar/resource_type/c_6501 | |||||
資源タイプ | journal article | |||||
著者 |
Tajima, Yoshitsugu
× Tajima, Yoshitsugu× Kuroki, Tamotsu× Kitasato, Amane× Adachi, Tomohiko× Isomoto, Ichiro× Uetani, Masataka× Kanematsu, Takashi |
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抄録 | ||||||
内容記述タイプ | Abstract | |||||
内容記述 | Background: A fragile or non-fibrotic pancreas increases the risk of postoperative pancreatic fistula (POPF) after pancreatic head resection, whereas pancreatic fibrosis decreases the risk. The degree of pancreatic fibrosis can be estimated using the time-signal intensity curve (TIC) of the pancreas, obtained with dynamic magnetic resonance imaging (MRI). We have investigated whether trainee surgeons can perform pancreatic anastomosis safely, without the occurrence of POPF, when patients are selected carefully based on a preoperative assessment of pancreatic fibrosis. Methods: Seventy-two consecutive patients who underwent pancreatic head resection were enrolled in this prospective trial. Dynamic contrast-enhanced MRI of the pancreas was performed preoperatively in all patients who, based on their pancreatic TIC profile, were then allocated to one of two groups: Group A comprised patients with type I pancreatic TIC, signifying a normal pancreas without fibrosis (n = 46); Group B comprised patients with type II or III pancreatic TIC, signifying a fibrotic pancreas (n = 26). An end-to-side duct-to-mucosa pancreaticojejunostomy was performed in all patients, with all patients in Group A operated on by two experienced surgeons, and all patients in Group B operated on by one of eight trainee surgeons at various stages of training. Results: There was no operative mortality. POPF developed in 19 patients: 12 patients with grade A POPF and seven with grade B. All except one of the POPF occurred in Group A patients. The POPF in the one patient from Group B was grade A (p < 0.001). Conclusions: A trainee surgeon can perform a secure pancreatic anastomosis without the occurrence of POPF in patients with a pancreas displaying a fibrotic pancreatic TIC on dynamic MRI scans. | |||||
書誌情報 |
Journal of Hepato-Biliary-Pancreatic Sciences 巻 17, 号 6, p. 831-838, 発行日 2010-11 |
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出版者 | ||||||
出版者 | 日本肝胆膵外科学会 | |||||
出版者別言語 | ||||||
Japanese Society of Hepato-Biliary-Pancreatic Surgery | ||||||
ISSN | ||||||
収録物識別子タイプ | ISSN | |||||
収録物識別子 | 18686974 | |||||
書誌レコードID | ||||||
収録物識別子タイプ | NCID | |||||
収録物識別子 | AA12507209 | |||||
DOI | ||||||
関連タイプ | isVersionOf | |||||
識別子タイプ | DOI | |||||
関連識別子 | 10.1007/s00534-010-0277-1 | |||||
権利 | ||||||
権利情報 | © 2010 Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer. | |||||
権利 | ||||||
権利情報 | The original publication is available at www.springerlink.com | |||||
著者版フラグ | ||||||
出版タイプ | AM | |||||
出版タイプResource | http://purl.org/coar/version/c_ab4af688f83e57aa | |||||
引用 | ||||||
内容記述タイプ | Other | |||||
内容記述 | Journal of Hepato-Biliary-Pancreatic Sciences, 17(6), pp.831-838; 2010 |