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.
ObjectiveTo evaluate the causes, clinical features, diagnosis and treatment of chronic pancreatitis (CP). MethodsWe retrospectively analyzed the clinical features of 47 patients with CP in the Sixth People's Hospital of Chengdu City from February 2008 to December 2011. ResultsThere were 24 cases of biliary pancreatitis (51.1%), and 17 cases of alcoholic pancreatitis (36.2%). The clinical manifestations included abdominal pain in 40 patients (87.2%), diarrhea in 12 patients (25.5%), and diabetes mellitus in 13 patients (27.6%). Sixteen patients were diagnosed based on the ultrasonographic results (34.0%), 41 by computed tomography (CT) (87.2%), and 31 by endoscopic retrograde cholangiopancreatography (ERCP) (88.6%). Plain abdominal radiograph showed that 9 patients had calcification, mainly composed of Ⅰ and Ⅱ classes (44.7% and 51.1%), followed by class Ⅳ and stage 3. Management for chronic pancreatitis included medical treatment (10 cases, 21.2%) and surgical treatment (13 case, 27.6%), endoscopic treatment (24 cases, 51.6%). ConclusionThe causes of chronic pancreatitis are biliary and alcoholic factors. Medical, endoscopic and surgical procedures are involved to treat chronic pancreatitis, especially for the relief of intractable chronic abdominal pain.
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.
Nineteen cats were randomly divided into two groups, 7 cats (group A) recieved about 200 times spotty injections of total of 2 ml of 94% alcohol in pancreatic parenchyma and 12 cats (group B) underwent intraductal alcohoh, partial obstruction of the main pancreatic duct (MPD) and intraparenchymal alcohol. Acute necrotizing pancreatitis occurred in all of the experimental cats after operation. 2 cats in group A (28.6%) died within 48 hours postoperatively. 4 cats in group B (33.3%) died, among them, 3 within 48 hours and 1 died after 2 weeks. Morphological and functional recovery of the exocrine pancreas were found in all the 5 survivals in group A, while 8 cats in group B developed chronic pancreatitis 15 weeks after the operation. The above results show that simple pancreatic necrosis can be recovered after eliminating the etiological factors and if these factors, whatever is primary or secondary still exist and continue to damage the pancreas, chronic pancreatitis may develop.
Objective To compare the therapy effect between surgical therapy and endoscopic therapy for chronic pancreatitis (CP) combined with pancreatic ductal stones (PDS). Methods Clinical data of 113 cases of CP combined with PDS who got treatment in Southwest Hospital of The Third Military Medical University between January 2010 and December 2015 were analyzed retrospectively, 84 of them underwent surgery (surgery group), and 29 of them got endoscopic therapy (endoscopy group). Results The operative time, intraoperative bleeding volume, postoperative hospital stay, and days in hospital, mortality, incidence of complication (pancreatic fistula, delayed gastric emptying, diabetes mellitus, and acute pancreatitis) of the surgery group were all higher than those of endoscopy group (P ＜0.05), but the ratios of the two-stage surgery and recurrence of PDS were all lower (P ＜00.05). The differences between symptom remission rate and residual stones rate were not statistically significant (P>0.05). Conclusions For cases of CP combined with PDS, the clinical therapy effect in symptom remission and residual stones between surgical and endoscopic therapy is similar, but compared with the endoscopic therapy, the operative time, intraoperative bleeding volume, postoperative hospital stay, and days in hospital of the surgical therapy are both longer. However, the ratios of the two-stage surgery and recurrence of PDS in the endoscopy group is significantly higher than those of surgery group.
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 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.
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.
Objective To study the expression of thymidine phosporylase (TP) and the counts of lymph vessels in pancreatic cancer and chronic pancreatitis tissues, and to explore their clinicopathologic significances and correlation in the course of pancreatic cancer. Methods SP immunohistochemical method was used to detetct the expression of TP and the locations of lymph vessels on the routinely paraffin-embedded sections of the specimens from 51 cases pancreatic cancer and 10 cases of chronic pancreatitis. Results The positive rate of TP and the counts of lymph vessels were significantly higher (P＜0.05 and P＜0.01 respectively) in pancreatic cancer 〔54.9%, (12.5±4.3)/HP〕 than those in chronic pancreatitis 〔20.0%，(5.2±2.4)/HP〕. The positive rate of TP and the counts of lymph vessels were significantly lower （P＜0.05, P＜0.01） in well-differentiated adenocarcinoma cases and cases without metastasis compared with poor-differentiated adenocarcinoma cases and cases with metastasis. The counts of lymph vessels were significantly higher in the positive cases of TP than those in the negative ones in pancreatic cancer 〔(13.8±3.4)/HP vs (10.9±3.2)/HP〕, P＜0.01.Conclusion The expression of TP and counts of lymph vessels might be important markers reflecting the progression, biological behaviors, metastatic status and prognosis of pancreatic cancer. TP might promote lympoangiogenesis in pancreatic cancer tissues.
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.