ObjectiveTo study the expression of zonula occluden-1 (ZO-1) in ileum tissues and the possible mechanism of intestinal mucosal barrier injury in rats with severe acute pancreatitis (SAP). MethodsFifty SD male rats were randomly divided into sham operation group and SAP group, then SAP group was divided into four subgroups with 10 rats in each subgroup according to the sampling time of 3, 6, 12, and 24 h. The SAP model was made by injecting 5% bovine sodium deoxycholate into biliarypancreatic duct with Aho’s method. The rats were killed at 3, 6, 12, and 24 h after making model. The rats in the sham operation group were killed directly. Tumor necrosis factor-α (TNF-α), diamine oxidase (DAO), and histological changes in pancreatic and intestinal pathologies were observed. At the same time, the ZO-1 protein and mRNA expressions of ileum tissues were detected by immunohistochemistry and RT-PCR, respectively. ResultsCompared with the sham operation group 〔TNF-α: (10.83±0.96) ng/L; DAO: (354.79±3.67) U/L; ZO-1 protein: (10.40±0.45) score; ZO-1 mRNA: 0.878±0.014 8〕, the levels of TNF-α at different time 〔3 h: (125.30±0.94) ng/L; 6 h: (181.89±4.93) ng/L; 12 h: (230.58±1.28) ng/L; 24 h: (198.89±4.83) ng/L〕 were significantly higher (Plt;0.05), the activities of DAO 〔3 h: (235.77±0.67) U/L; 6 h: (117.22±5.58) U/L; 12 h: (106.69±1.39) U/L; 24 h: (91.18±1.09) U/L〕 were significantly lower (Plt;0.05), ZO-1 protein 〔3 h: (8.70±0.22) score; 6 h: (3.73±0.19) score; 12 h: (3.92±0.22) score; 24 h: (4.29±0.30) score〕 and mRNA (3 h: 0.806±0.020 7; 6 h: 0.370±0.015 8; 12 h: 0.502±0.019 2; 24 h: 0.562±0.030 3) expressions of the ileum tissues were significantly lower (Plt;0.05) in the SAP group; Meanwhile, the necrosis of ileum mucous membrane chorioepithelium, angiorrhexis and hemorrhage, and inflammatory cell infiltration in the pancreatic and ileum tissues were also observed. ConclusionThe decrease of expression of ZO-1 in ileum tissues is one of the vital causes for mucosal barrier injury in SAP, probably through acts the excessive release of inflammatory cytokines TNF-α and the decrease of DAO activity.
Objective To investigate the effect of the duct-to-mucosa anastomosis in invaginating end-to-side pancreaticojejunostomy. Methods A retrospective review was conducted for 200 patients treated with pancreaticoduod-enectomy （PD） between August 2005 and December 2012. Reconstruction of digestive tract in PD was done according to the method described by Child. The duct-to-mucosa anastomosis was applied in the invaginating end-to-side pancrea-ticojejunostomy. The outline of the anastomosis structures was as follows：anastomosis of pancreatic duct and jejunal mucosa， anastomosis of pancreatic and jejunal resection margin， and anastomosis of pancreas and jejunal seromuscular layer. A cilicone tube was put into the pancreatic duct and lead to the jejunum. The anastomotic stoma was covered with part of the omentum majus, and put a drainage tube under the anastomotic stoma. Results The operation went smoothly，and no deaths occurred during perioperative period. The surgical time was 280-420 min， the average time was （298±77） min. The pancreatic fistula were observed in 22 patients （11%）， including 17 patients in Grade A， 2 patients in Grade B， and 3 patients in Grade C. The other complications were observed in 19 patients， including 16 patients with addominal infection， 1 patient with bleeding from splenic vein， 1 patient with bleeding from ruptured of pseudoaneurysm at biliary intestinal anastomosis， 1 patient with abdominal abscess. Three patients with pancreatic fistula in Grade C were cured by reoperation, and the other patients with pancreatic fistula were cured by expectant treatment. Conclusions The duct-to-mucosa anastomosis in invaginating end-to-side pancreaticojejunostomy is a simple and safe procedure that has the advantage in reducing the incidence of the pancreatic fistula. Using omentum to cover the anastomotic could localize the diffusion of panreactic fistula， and reduce the incidence of serious complications caused by pancreatic fistula.