To evaluate the present status of treatment of chronic pancreatitis, 116 consecutive patients with chronic pancreatitis during the last decade (1986～1996) have been surveyed retrospectively. The clinical date has been analized statisticaly. Etiology: biliogenic 56 cases (48.3%), alcoholic 17 (14.6%), idiopathic 34 (29.3%) and other 9 cases (7.8%). Better result was achieved in surgical treatment group (81 cases) than in conservative group (35 cases), pain free: 65.5% vs 33.3%. The accumulated five-year survival rate was 56.3%, 92.2% and 78.1% in alcoholic, billiogenic and idiopathic type of chronic pancreatitis respectively. Morbidity and mortality of diarrhea and diabetes mellitus increased at followup. The authors conclude that the chronic pancreatitis patients associated with obstruction of biliopancreatic duct should undergo operation early and will ameliorate abdominal pain.
Objective To compare the surgical outcome of surgical treatment for chronic pancreatic head mass pancreatitis combined with pancreatic duct stones. Methods Clinical data of 19 patients diagnosed as chronic pancreatic head mass pancreatitis combined with pancreatic duct stones by pathology in our hospital were analyzed retrospectively and patients were divided into Beger group (n=9) and Frey group (n=10) according to operation type. Results The duration of operation, blood loss, morbidity, ratio of postoperative pancreatic fistula of grade B, ratio of abdominal cavity infection, ratio of gastric emptying dysfunction, total length of hospital stay, and total hospitalization cost in Frey group were less or lower than those in Beger group significantly (P ＜0.05). None of death or pancreatic fistula of grade C happened in both 2 groups, and abdominal pain and jaundice were subsided in all patients. There were 18 patients (94.7%) were followed up for (8.6±2.5) years ( 5-12 years), and just 1 patient of Frey group was not available for followup. The ratios of 5-year pain subsided of 2 groups were both 7/9, there was no significant difference between the 2 groups (P>0.05). During the follow-up period, there was no dead, relapsed, cancerate or reoperation, but 2 patients suffered from diabetes (1 patient of Frey group and 1 patient of Beger group), 2 patients suffered from steatorrhea (1 patient of Frey group and 1 patient of Beger group), and there was no significant difference between the 2 groups in the ratios of diabetes and steatorrhea (P>0.05). Conclusion The effect is equal for Frey surgery and Beger surgery in treatment of chronic pancreatic head mass pancreatitis combined with pancreatic duct stones, but recover of patient who receives Frey surgery is better than that of Beger surgery.
ObjectiveTo study the expression of HOX A9 mRNA and its clinicopathological significance in the benign and malignant lesions of pancreas. MethodsIn situ hybridization for HOX A9 mRNA was used on routine paraffinembedded sections. ResultsThe positive rate and scoring mean of HOX A9 mRNA expression was significanfly lower in pancreatic carcinoma (49%, 3.3±2.1) than that in chronic pancreatitis (95%, 5.4±0.8) and pericancerous tissues (80%, 4.6±1.2), the negative case of HOX A9 mRNA in chronic pancreatitis and pericancerous tissues showed middle or severelyatypical hyperplasis of the ductal epitheli. The positive rate and scoring mean of HOX A9 mRNA expression was significantly higher in the cases of welldifferentiation (63%, 4.0±2.2) or without metastasis (64%, 4.1±2.2) than that in the ones of poorlydifferentiation (32%, 2.6±2.3) or with metastasis (32%, 2.7±2.2). ConclusionThe expression of HOX A9 mRNA might be related the carcinogenesis, progress, biological behaviors, and prognosis of pancreatic carcinoma. The assay of HOX A9 mRNA expression in the benign lesions of pancreas might have important clinical values in the prevention and earlystage finding of the pancreatic carcinoma.
Objective To summarize the principle and application of functional MR imaging of pancreatic carcinoma and chronic mass-forming type pancreatitis. Methods Articles about diffusion-weighted imaging (DWI), magnetic resonance spectrum imaging (MRSI) and dynamic contrast-enhanced MR imaging of pancreatic carcinoma and chronic pancreatitis were reviewed and analyzed. Results Functional MR imaging could reflected the differences in molecules diffusion, metabolism and tissue perfusion between pancreatic carcinoma and chronic pancreatitis. Conclusion As a non-invasive protocol, functional MR imaging can provide useful information in differential diagnosis between chronic mass-forming type pancreatitis and pancreatic carcinoma.
ObjectiveTo review the current clinical application of Beger procedure and Frey procedure for benign disease or low-grade malignant potential lesion of pancreas. MethodsRelevant literatures about current advance of clinical application of Beger procedure and Frey procedure published recently of domestic and abroad were collected and reviewed. ResultsWith the concept of organ-preserving operations was adopted in recent years, Beger procedure and Frey procedure were applied generally. Beger procedure and Frey procedure were associated with tolerable perioperative risk, postoperative complications, and good outcomes in the aspects of preservation of function and curability in these lesions compared to conventional pancreatectomy, with preservation of the physiological food passage, thus patients gained weight faster, had less pain, and demonstrated better exocrine and endocrine pancreatic function postoperatively and an improvement in the quality of life. Both procedures had reached an international position as a standard operation for the treatment of benign disease or low-grade malignant potential lesion of pancreas. But after long-term following-up early advantages were no longer present. ConclusionsBeger procedure and Frey procedure are safe and effective in providing good outcomes in the aspects of preservation of function and curability in benign disease or low-grade malignant potential lesion of pancreas. Organ-preserving pancreatectomy could become a new organ-preserving standard operation.
Objective To investigate the magnetic resonance imaging （MRI） assessment and functional evaluation of chronic pancreatitis （CP）. Methods Literatures about MRI assessment of CP （especially the evaluation of pancreatic exocrine function with MRI） were reviewed. Results Some early parenchymal changes （pancreatic size，signal intensity of pancreas， and enhancement pattern） in the CP could be visualized by MRI；ductal changes could be visualized by MR cholangiopancreatography （MRCP）；and secretin-stimulated MRCP （combination of both morphologic and functional evaluation） not only improved the visualization of pancreatic duct and side branches，but also allowed evaluation of the pancreatic exocrine function noninvasively. Secretin-stimulated diffusion weighted imaging also could be used as a noninvasive method to assess pancreatic exocrine function. Conclusions Conventional MRI and （or） secretin-stimulated MRI can become valuable means in CP （especially early-stage CP）， with furnishing morphologic and functional information simultaneously. However，further research is needed to verify the diagnostic accuracy of these modalities.
Objective To discuss the methods of producing experimental models of chronic pancreatitis and their individual properties. Methods The recent literatures about experimental models of chronic pancreatitis were reviewed and analyzed. Methods of producing experimental models and their individual properties were summarized, and best models suitable for varied chronic pancreatitis were afforded. Results Diet, ligation of pancreatic duct, caerulein, dibutyltin dichloride (DBTC), arterial ligation, injecting microspheres into artery, and injection of pancreatic duct could induce different experimental models of chronic pancreatitis. Spontaneous chronic pancreatitis was induced by diet, chronic obstructive pancreatitis produced by ligation and injection of pancreatic duct, chronic relapsing pancreatitis evoked by caerulein, and chronic active pancreatitis made by arterial ligation and injecting microspheres into artery.Conclusion Different methods could induce models of chronic pancreatitis, which had their individual properties.
Objective To explore the effect of Frey procedure on patients with chronic pancreatitis, and evaluate pain control as well as the quality of life (QOL) after Frey procedure. Methods The clinical data of 81 patients with chronic pancreatitis who underwent Frey procedure in West China Hospital of Sichuan University from January 2010 to January 2015 were retrospectively analyzed. Izbicki pain score and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) were used to assess pain and QOL respectively. Results The mean value of operative time were (252±70) minutes (180-430 minutes), the mean value of blood loss were (220±142) mL (100-550 mL), and the mean value of hospital stay were (14.1±4.9) days (8-36 days). After Frey procedure, delayed gastric emptying occurred in 4 patients, hemorrhage occurred in 1 patient, wound infection or fat liquefaction occurred in 6 patients, abdominal infection and pyoperitoneum occurred in 4 patients, and pancreatic fistula occurred in 3 patients. All of the patients were followed up for 4-60 months, and the median time were 28 months. During the follow up period, 11 patients developed diabetes and 10 patients developed steatorrhea, respectively. In addition, the pain related score, including frequency of pain attacks, visual analogue scale of pain, analgetic medication, inability to work, and total pain score, were significantly reduced after Frey procedure (P＜0.001). Moreover, all the functional scales of EORTC -QLQ-C30, except for cognitive function, were improved postoperatively (P ＜0.001). Regarding to the symptom scales, the score of fatigue, pain, loss of appetite, and loss of body weight were significantly lower after surgery (P＜0.050). The scores of QOL after surgery were higher than before surgery (P＜0.001). Conclusion Frey procedure results in good post-operative pain control and significant improvement in qol.
The course of chronic pancreatitis is prolonged, and pain is the main symptom, which seriously affects the quality of life and work ability of patients. Its treatment is the most important and complex problem. This article systematically describes the theoretical basis, indications, efficacy, selection and balance of drugs, endoscopy, surgery and other measures related to pain treatment.
Objective To introduce the role of pancreatic stellate cells in pancreatic fibrosis and the progress in treatment of pancreatic fibrosis. MethodsRelevant literatures were collected and reviewed. Results Pancreatic stellate cells activation was closely related to pancreatic fibrosis. Inhibition of pancreatic stellate cells activation could provide a new approach in clinical treatment of chronic pancreatitis. Conclusion Pancreatic stellate cells are the key to pancreatic fibrosis, which are becoming the target for antifibrosis of the pancreas and treatment of chronic pancreatitis.