The purpose of this study is to compare the clinical efficacy and economic cost of enucleation after placement of pancreatic duct stents before surgery with that of direct enucleation alone, and to evaluate its safety and feasibility.
The research contents of this study include: patients with insulinoma near the main pancreatic duct in the head and neck of the pancreas were randomly divided into two groups: the preoperative pancreatic duct stent enucleation group (stended EN), the direct en group (DEN), the Sen group asked a digestive endoscopist to place the pancreatic duct stent before surgery, and the next day or the next day after surgery, and the den group received enucleation directly. The safety of the two groups was compared, including the evaluation of surgical effect Postoperative complications and long-term prognosis based on follow-up data analysis; At the same time, the differences between the two groups were evaluated from the perspective of health economics.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
78
Advance placement of pancreatic stents endoscopically
Patients will receive direct enucleation surgery
Peking Union Medical College Hospital
Beijing, Beijing Municipality, China
RECRUITINGRate of POPF within 3 months after EN.
Postoperative clinically relevant pancreatic fistula in this study adopts the definition proposed by the international pancreatic surgery research group (ISGPS)
Time frame: 3 days to 3 months after enucleation (or the extubation time),up to 6 month after inclusion
Rate of postoperative abdominal infection within 3 weeks after EN
Abdominal infection can be basically diagnosed if one of the following conditions occurs: 1. After 3 days of operation, the patient developed chills, high fever, abdominal distension, intestinal paralysis, etc., which lasted for more than 24 hours. The laboratory examination results showed that the leukocyte count increased significantly, with or without hypoproteinemia and anemia, and the imaging images showed the accumulation of fluid in the abdominal cavity; 2. The aspiration fluid was purulent or bacteria were detected in the fluid; 3. The infection was localized and formed inclusion. In imaging, fluid accumulation foci with clear edges and with or without gas could be seen.
Time frame: 3 days to 3 weeks after enucleation (or the extubation time),,up to 6 month after inclusion
Rate of postoperative delayed gastric emptying within 3 weeks after EN
Gastric emptying disorder can be diagnosed if the solid diet cannot be restored 1 week after operation and the gastric tube cannot be removed.
Time frame: 3 days to 3 weeks after enucleation (or the extubation time)
Rate of postoperative hemorrhagepostpancreatectomy haemorrhage within 3 weeks after EN
Postoperative hemorrhage refers to the occurrence of bloody fluid in the abdominal drainage tube or gastrointestinal decompression tube, which can also be manifested as blood in the stool, accompanied by changes in vital signs such as heart rate and blood pressure, as well as a decrease in hemoglobin concentration.
Time frame: 1 days to 3 weeks after enucleation (or the extubation time),,up to 6 month after inclusion
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Rate of postoperative dyspepsia within 6 months after EN
According to Rome IV standard, the diagnosis should meet the following requirements: Symptoms appear for at least 2 months, and must include one or more of the following uncomfortable symptoms, and at least 4 times a month: a. fullness after meals; b. Early satiety; c. Epigastric pain or burning sensation has nothing to do with defecation; d. After proper evaluation, the symptoms cannot be completely explained by other disease conditions.
Time frame: 2 weeks to 6 months after enucleation,,up to 6 month after inclusion
Rate of postoperative lung infection within 3 weeks after EN
Patients with any of the following conditions: a. continuous fever or leukocytosis, accompanied by postoperative chest X-ray or chest CT positive findings (consolidation of lung, pneumonia, atelectasis, with or without pleural effusion), and decreased body temperature after antibiotics; b. Sputum culture is positive, accompanied by continuous fever or leukocyte elevation, and body temperature drops after antibiotics; c. Pleural effusion affects the patient's breathing and requires pleural puncture and drainage.
Time frame: 1 days to 3 weeks after enucleation (or the extubation time),,up to 6 month after inclusion
Rate of postoperative hyperglycemia within 6 months after EN
the diagnosis should meet at least one of the following requirements: a. hemoglobin A1c (HbA1c) value ≥ 6.5%; b. If the fasting blood glucose is ≥ 126mg / dl, the test should be repeated on another day. Fasting is defined as at least 8 hours without calorie intake; c. Oral glucose tolerance test (OGTT), plasma glucose ≥ 200 mg / dl at 2 hours after 75g (100g for pregnant women) glucose load; d. Hyperglycemic symptoms and accidental (random) plasma glucose ≥ 200mg / dl.
Time frame: 2 weeks to 6 months after enucleation,,up to 6 month after inclusion
Rate of post-stent-placement acute pancreatitis in Stented EN group within in 3 weeks after EN
Patients with any two of the following three criteria can be diagnosed : a. abdominal pain consistent with the onset; b. Biochemical evidence of pancreatitis (serum amylase and / or lipase greater than 3 times the upper limit of normal); c. Typical manifestations of abdominal image (pancreatic edema / necrosis or exudation and effusion around the pancreas)
Time frame: 1 days to 3 days after stent placement,,up to 6 month after inclusion
Operation time
Time frame: Measure during operation,,up to 6 month after inclusion
Intraoperative blood loss
Time frame: Measure during operation,,up to 6 month after inclusion
Total cost of hospitalization
Time frame: Measure during the whole hospitalization procedure of each patient,,up to 6 month after inclusion