【摘要】目的 总结胰十二指肠切除术(pancreaticoduodenectomy,PD)早期（术后30 d内）并发症发生的相关危险因素，指导围手术期患者的有效治疗。方法 回顾性分析2002年1月至2007年1月期间71例行PD的临床资料,分析早期并发症的发生情况及相关影响因素。结果 PD术后并发症发生率为46.5%(33/71)。Logistic多变量分析确定了2个与PD术后早期并发症相关的变量即术中输血量≥800 ml(OR=8.227)和胰液引流入肠道(OR=5.134)。结论 PD的手术风险目前仍较高，运用胰液外引流、加强围手术期处理是预防并发症的重要环节。
To study the role of endotoxin in acute hemorrhagic necrotizing pancreatitis (AHNP), the change of endotoxin were studied in rats AHNP models by injection of 5% sodium taurocholate 1 ml/kg into pancreatic duct, and the effects of recombinant interleukin-2 (IL-2) in the treatment of AHNP were observed in this experiment. The results indicated that endotoxin involved the aggravation of AHNP and was associated with the increase of serum phospholipas-2 (PLA2), and these mediators were positively correlated with severe degrees of pancreatic damage. The results also suggeste that IL-2 might inhibit the overexpression of endotoxin and PLA2 and mitigate the pancreatic injury and decrease the 72h-mortality rate of AHNP from 66.7% to 26.7% (Ｐ＜0.01). Endotoxin might play a major role in the pathogenesis of AHNP and IL-2 might have a potential role in the treatment of AHNP.
Objective To investigate the historical evolution and the research progress of pancreaticoenterostomy method in the pancreaticoduodenectomy. Methods The related literatures of PubMed， EMBASE， Wanfang， CNKI， and VIP databases were retrieved and reviewed. The advantages and disadvantages of various pancreaticojejunostomy type in pancreaticoduodenectomy were summarized. Results The type of pancreaticoenterostomy is the major influence factors for the pancreaticoduodenectomy success or failure and the patients’s recovery. Conclusion According to the specific cases， the type of pancreaticojejunostomy in skilled operation is the key to success.
目的 探讨川芎嗪对大鼠重症急性胰腺炎（SAP）脑损伤的保护作用。方法 将72只健康Wistar大鼠按数字表法随机均分为对照组、SAP组和川芎嗪治疗组3组。对照组仅剖腹翻动胰腺后即缝合腹壁； SAP组采用胰腺被膜下均匀注射5%牛磺胆酸钠（2ml/kg体重）制备SAP动物模型；川芎嗪治疗组在SAP建模后5min于大鼠尾静脉注射川芎嗪注射液（100mg/kg体重）。各组大鼠分别于术后第6、12及24 h观察胰腺组织及脑组织的病理改变，检测血清淀粉酶、 脑组织含水量和微血管内白细胞聚集附壁计数，以及脑组织中MDA、TNF-α和IL-1β水平。结果 对照组胰腺组织无明显改变；SAP组胰腺组织腺泡细胞坏死，结构不清，间质水肿，红细胞漏出，部分腺导管扩张，有点片状出血坏死，炎性细胞浸润；川芎嗪治疗组胰腺组织病理改变较同一时相的SAP组明显减轻。对照组脑组织无明显改变；SAP组脑组织神经元细胞水肿，微血管内白细胞聚集及附壁，脑组织内有炎性细胞增生、聚集，且随时间延长上述表现逐渐加重；川芎嗪治疗组脑组织病理改变较同一时相的SAP组明显减轻。SAP组大鼠各时相脑组织含水量和微血管内白细胞聚集附壁计数，脑组织中TNF-α、IL-1β和MDA水平，以及血淀粉酶含量均明显高于对照组（P＜0.05）；川芎嗪治疗组大鼠各时相的上述指标均明显低于SAP组（P＜0.05）。结论 大鼠脑组织中的TNF-α、IL-1β及MDA参与了SAP脑损伤的病理过程，川芎嗪对SAP大鼠脑损伤具有保护、治疗作用。
Objective To study the effects of malondialdehyde (MDA), superoxide dismutase (SOD) and tumor necrosis factor-α (TNF-α) on brain tissue in rats with pancreatic encephalopathy (PE). Methods Thirty-six Wistar rats were randomly divided into control group (n=6) and PE model group (n=30). In control group, rats were injected with normal saline by internal carotid artery (0.1 ml/100 g) and were killed on the first day after the injection. In PE model group, rats were injected with phospholipases A2 (0.1 ml/100 g, 1 000 U/0.1 ml) by internal carotid artery, to establish animal model of PE in rat and 10 rats were killed on day 1, 3, 7 respectively after the injection. The changes of water content in the brain were measured. Leucocytes aggregation and margination in the microvessels, and the changes of cerebral cells and nerve fibers were observed. The levels of MDA, TNF-α and the activity of SOD were tested in the brain homogenate in rats. Results In PE model group, water contents of brain increased; The phenomena of leucocytes accumulation and margination, cellular edema of neurons and demyelination of nerve fibers became more obvious; The levels of MDA and TNF-α increased significantly than those in the control group, while the activity of SOD reduced (P＜0．05， P＜0.01)． Conclusion Inthe rat model of PE, MDA, SOD, and TNF-α play important roles on the occurrence and development of brain injury.
ObjectiveTo investigate the differential diagnosis of chronic pancreatitis with mass of pancreatic head and pancreatic carcinoma, and choose the effective treatment of chronic pancreatitis with mass of pancreatic head. MethodsEighty cases of chronic pancreatitis with mass of pancreatic head from January 2008 to January 2014 in this hospital were retrospectively analyzed.The preoperative blood tumor markers, hepatobiliary and pancreatic color Doppler ultrasound, CT strengthen, MRI, MRCP, or other imaging studies were tested for all the patients. ResultsThere were 4 cases of long-term drinking or excessive drinking history in 8 cases of chronic pancreatitis with mass of pancreatic head.The past medical history included 5 patients with acute pancreatitis, 3 patients with chronic cholecystitis, 2 patients with cholecystolithiasis.Six patients had varying degree of jaundice and 5 patients had left upper abdominal pain.There were 4 patients with high blood sugar, 6 patients with serum hyperbilirubin, 5 patients with elevated CA19-9 and 2 patients with elevated CEA by serum assay.The imaging revealed that a mass was in the head of the pancreas.The standard pancreaticoduodenectomy was performed in 6 cases, duodenum-preserving pancreatic head resection was performed in 2 cases.These 8 patients underwent the intraoperative fine needle aspiration cytological examination revealed the changes of chronic pancreatitis by postoperative pathology.The levels of CA19-9 and CEA on 1 week after operation were reduced to normal levels in patients with elevated CA19-9 and CEA alone or together.There was no case of serious complications such as postoperative pancreatic leakage and bile leakage.The intermittent vomiting appeared in 3 months after duodenum-preserving pancreatic head resection, the upper gastrointestinal radiography showed the stenosis of duodenum, the contrac-tures of the duodenum, especial the descending duodenum, was found through reoperation, the symptom was relief after gastrojejunal anastomosis.The recurrence was not seen in all these 8 patients with follow-up of 1-6 years. ConclusionsThe jaundice and abdominal for the patients with pancreatic head mass of chronic pancreatitis and pancreatic cancer pain are the main symptoms, but their characteristics are different, the former is minor, volatility, and intermittent; the latter is sustained and progressively aggravated.Understanding of past medical history for the identification of both is some significances.CA19-9 and CEA as the identification of the pancreatic head mass in chronic pancreatitis and pancreatic cancer is not meaningful.Patients with chronic pancreatitis of pancreatic mass are finished by multi-needle biopsy for pancreatic head mass, duodenum-preserving pancreatic head resection is preferred.Patients with invasive pancreatic mass and peripheral vascular adhesion must undergo standard pancreaticoduodenectomy.
目的总结肝包膜下胆汁瘤（HSB）的病因、临床诊断及治疗方法。 方法回顾性分析笔者所在医院收治的1例HSB患者的临床资料，并进行文献复习。 结果12例患者中，术前诊断为胆总管结石/胆囊结石慢性胆囊炎4例，胆总管结石1例，胆囊结石2例，急性化脓性胆囊炎2例，不详3例；行腹腔镜胆囊切除术（LC）7例，行内窥镜逆行胰胆管造影1例，行LC+腹腔镜胆管取石术1例，行开腹胆囊切除术3例；发病至手术时间7～40 d，平均14.3 d；右肝9例，胆囊窝及右肝前叶膈顶部、胆囊窝及右肝后叶和左肝各1例；11例单发，1例左肝多发；HSB直径7.6～29.1 cm，平均15.7 cm；肝脏包膜下积液量800～3 000 mL，平均1 400 mL；液体吸收时间7～120 d，平均37 d。主要治疗方案为置管引流7例（包括手术开腹置管外引流2例），B超引导下反复穿刺抽吸4例，1例不详；2例反复穿刺引流效果较差，行手术治疗。 结论HSB的发病原因目前尚无统一意见，诊断首选影像学检查，治疗以保守治疗+B超引导下经皮反复穿刺抽吸为主。