【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。
ObjectiveTo explore the protective effect of rapamycin on pancreatic damage in severe acute pancreatitis (SAP) and further to explain its protective mechanism.MethodsNinety selected SPF males SD rats were randomly divided into 3 groups: sham-operated group (SO group), SAP group, and rapamycin group (RAPA group), with 30 rats in each group. Then each group of rats were randomly divided into 3 subgroups of 24 h, 36 h, and 48 h, 10 rats in each subgroup. Rats in each group underwent laparotomy, the model was prepared by retrograde injection of solutions into biliopancreatic duct, rats of the SO group were injected with 0.9% normal saline, rats of the SAP group and RAPA group were injected with 5% sodium taurocholate solution, but rats of the RAPA group were injected with rapamycin at 30 min before the injection of 5% sodium taurocholate. All the survival rats in corresponding subgroup were killed at 24 h,36 h, and 48 h after operation respectively, then serum and pancreas tissues of rats were collected, serum inflammatory factors content of IL-1β, IL-6, and TNF-α were detected by ELISA method, expression levels of p-mTOR and p-S6K1 in pancreas were detected by Western blot, pancreas tissues were stained by Hematoxylin-Eosin Staining and pathological changes of pancreas were scored under light microscope.Results① At the timepoint of 24 h, 36 h, and 48 h, the order of the expression levels of p-mTOR and p-S6K1 in pancreatic tissues of 3 groups were all as follows: SO group<RAPA group<SAP group, there were significant difference among any 2 groups (P<0.05). ② IL-1β: at the timepoint of 48 h, the order of the content of IL-1β in 3 groups were as follows: SO group<RAPA group<SAP group, there were significant differences among any 2 groups (P<0.05); IL-6: at the timepoint of 36 h and 48 h, the order of the content of IL-6 in3 groups were as follows: SO group<RAPA group<SAP group, there were significant differences among any 2 groups (P<0.05); TNF-α: at the timepoint of 48 h, the order of the content of TNF-α in 3 groups was as follows: SO/RAPA group<SAP group (P<0.05), but there was no significant difference between the SO group and RAPA group (P>0.05). ③ Pancreatic histological score: at the timepoint of 24 h, 36 h, and 48 h, the order of the pancreatic histological score in3 groups was all as follows: SO group<RAPA group <SAP group, there were significant differences among any 2 groups (P<0.05). ④ The expression levels of p-mTOR and p-S6K1 in pancreatic tissue were positively correlated with the pathological scores of pancreatic tissue (r=0.97, P<0.01; r=0.89, P<0.01).ConclusionRapamycin can reduce the degree of pancreatic damage in SAP and has protective effect on pancreatic tissue.
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.
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.
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.
ObjectiveTo understand the related application and future development trend of enteral nutrition (EN) support in the treatment of patients with malignant obstructive jaundice (MOJ), and provide a reference for clinical decision-making. MethodThe relevant literatures on EN support in the treatment of MOJ at home and abroad in recent years were reviewed. ResultsIn the treatment of patients with MOJ, EN support treatment could maintain the integrity of intestinal mucosal barrier function, reduce intestinal permeability, and reduce bacterial ectopic. At the same time, it could effectively improve the immune function of patients, promote the recovery of liver function, reduce the stress response of patients, reduce the incidence of complications, accelerate the postoperative recovery of patients and shorten the hospitalization time of patients. ConclusionEN support is an important measure in treatment of MOJ, which can obviously promote recovery of patients.
Objective To explore the protective effect of rapamycin on brain tissues injury in severe acute pancreatitis (SAP) and its possible mechanism in experimental rats. Methods Ninety SPF males SD rats were randomly divided into 3 groups by random envelope opening method: sham operation group (SO group), SAP group, and rapamycin group (RAPA group), then the rats of each group were divided into 24 h, 36 h, and 48 h 3 subgroups by random number table method. Rats in each group underwent laparotomy, the model was prepared by retrograde injection of solutions into biliopancreatic duct, rat of the SO group was injected with 0.9% normal saline (2 mL/kg), rats of the SAP group and the RAPA group were injected with 5% sodium taurocholate solution (2 mL/kg), but rat of the RAPA group was injected with rapamycin (1 mg/kg) at 30 min before narcosis. All survival rats in each subgroup were killed at 24 h, 36 h, and 48 h respectively, then the pancreas and brain tissues of rats were collected, pancreas and brain tissues were stained by hematoxylin-eosin staining, brain tissues were stained by Luxol fast blue additionally, pathological changes of brain tissues were scored under light microscope. The protective effect of rapamycin on brain tissues injury was determined by comparing the differences in the degree of brain tissues among 3 groups. The phosphorylated mammaliantarget of rapamycin (p-mTOR) and phosphorylated ribosomal 40S small subunitS6 protein kinase (p-S6K1) expression levels in brain tissues were detected by Western blot. In addition, the correlations between the expression levels of p-mTOR and p-S6K1 in brain tissues and the degree of brain tissues injury were analyzed to further explore the possible mechanism of rapamycin’s protective effect on brain tissues injury in SAP. Results① At the point of 24 h, 36 h, and 48 h, the order of the relative expression levels of p-mTOR and p-S6K1 in brain tissues of three groups were all as follows: the SO group < the RAPA group < the SAP group (P<0.05). ② At the point of 24 h, 36 h, and 48 h, the order of brain histological score in three groups were all as follows: the SO group < the RAPA group < the SAP group (P<0.05). ③ The relative expression levels of p-mTOR and p-S6K1 in brain tissues were positively correlated with pathological scores of brain tissues (r=0.99, P<0.01; r=0.97, P<0.01). ConclusionRapamycin plays a protective role in pancreatic brain tissues injure by down-regulating the expression levels of p-mTOR and p-S6K1 in mTOR signaling pathway.
ObjectiveTo discuss the changes of myelin basic protein (MBP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in serum and cerebrospinal fluid of experimental pancreatic encephalopathy rat model, analyze the relationship between each factor and the occurrence and development of pancreatic encephalopathy, and to provide the experimental basis for clinical diagnosis and treatment of pancreatic encephalopathy. MethodsSelecting 40 SD rats were randomly divided into sham operation group (SO group, n=10) and pancreatic encephalopathy group (PE group, n=30), respectively by the duodenal papilla retrograde pancreatic puncture injection of saline solution or 5% sodium taurocholic acid induced rat pancreatic encephalopathy model were set up. The rats in SO group were sacrificed on 1 d, and the PE group were sacrificed ten rats on 1 d, 3 d, and 7 d, respectively after surgery. The brain and pancreatic tissues of rats in each group were taken to observe the pathological changes of the rats and the brain white blood cells within microvessels gathered and coanda phenomenon. The water content of brain tissues, and the contents of MBP, TNF-α and TL-6 in serum and cerebrospinal fluid were detected. ResultsThe changes of brain nerve cell edema and nerve fiber demyelination were obvious in PE group rats after surgery with the extension of time. The contents of MBP, TNF-α and TL-6 in serum and cerebrospinal fluid on 1 d, 3 d, and 7 d after surgery in PE group were significantly higher than that SO group (P<0.05), and gradually increased with the extension of time. But by two two compared, the change trend of the above three indicators were different. ConclusionsMBP, TNF, and IL-6 on the occurrence and development of brain damage of pancreatic encephalopathy play a synergistic effect. To detecte the MBP, TNF-a, and IL-6 content in blood and cerebrospinal fluid could be diagnosed and evaluated the pancreatic encephalopathy.
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。