ObjectiveTo evaluate the effect of pathological portal vein (PV)/superior mesenteric vein (SMV) invasion during pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma and the clinical significance of PD with PV/SMV resection in patients without pathological evidence of venous invasion.MethodsFrom January 1, 2013 to December 31, 2017, data of 183 patients who had PD for pancreatic adenocarcinoma were collected. Eighty-one patients had PD with PV/SMV resection for pancreatic adenocarcinoma, among them, 42 cases (51.9%) had pathological PV/SMV invasion (PD+P/S+ group) and 39 patients (48.1%) didn’t have pathological PV/SMV invasion (PD+P/S− group). One hundred and two patients had a standard PD without PV/SMV resection (control group). Multivariate analysis was used to identify predictive variables which influencing survival and the Kaplan-Meier method to estimate patients’ survival.ResultsThere were no differences in gender, age, preoperative serum CA19-9 level, blood loss, tumor size, tumor TNM stage, positive lymph nodes, ratio of positive lymph nodes, degree of tumor differentiation, perineural invasion, postoperative adjuvant chemotherapy, type of operation, and margin status among 3 groups (P>0.05). And moreover, no significant differences were found between the PD combined PV/SMV resection group and the control group in the incidence of complications and mortality (P>0.05) and all no reoperation happened. Univariate analysis revealed a significant difference in overall survival (OS) among the PD+P/S+ group, PD+P/S– group and control group (P<0.001), median survival time were 10, 19 and 20 months, respectivly. Moreover, depth of PV/SMV invasion, use of postoperative adjuvant chemotherapy and tumor differentiation were independent prognostic factors by multivariate survival analysis.ConclusionsOS of patients with PV/SMV invasion is significantly worse than that of patients without PV/SMV invasion, no matter underwent PV/SMV resection or not. The cause of that maybe invade to the tunica intima by tumor limits OS of patients with pancreatic adenocarcinoma. OS of PV/SMV-resected patients without pathological PV/SMV invasion is similar to that of patients who had standard PD without PV/SMV resection. Whether the patients can benefit from routine resection of PV/SMV is still controversial.
ObjectiveTo evaluate the effect of transecting the body of pancreas via inferior mesenteric vein (IMV) pathway during pancreaticoduodenectomy (PD) with venous resection. MethodsAccording to the inclusion and exclusion criteria, from February 1, 2016 to January 1, 2021, the patients who underwent PD with portal vein / superior mesenteric vein (PV/SMV) resection for resectable pancreatic adenocarcinoma were gathered. According to whether the traditional approach could be adopted to create a tunnel in front of the PV/SMV axis, the patients were allocated to the standard procedure group (S-group) or a modified procedure group (M-group). In the M-group, the patients who transected the pancreatic body via IMV pathway were allocated to the IMV-subgroup, while the patients who transected the pancreatic body via the left side of PV or in the middle of the pancreas were allocated to the central subgroup (C-subgroup). The clinicopathologic characteristics and survival (overall survival) were compared between the M-group and S-group, as well as between the IMV-subgroup and C-subgroup. The survival curve was drawn using Kaplan-Meier method for survival analysis, and the risk factors affecting overall survival by Cox proportional hazards regression model. ResultsA total of 142 patients were gathered, including 77 in the S-group, 65 in the M-group, 29 in the IMV-subgroup and 36 in the C-subgroup. The results of clinicopathologic data of patients among the different groups showed that the M-group had a more intraoperative bleeding (P＜0.001), longer postoperative hospital stay (P=0.021), and a proportion of vascular invasion (P=0.017), as well as the IMV-subgroup only had a higher proportion of vascular invasion (P=0.030) as compared with the S-group; At the same time, compared with the C-subgroup, the IMV-subgroup had a less intraoperative bleeding volume (P＜0.001) and a higher proportion of R0 resection (P=0.031). There were no statistically differences in other clinicopathologic data among the groups (P＞0.05). The analysis of survival curve by Kaplan-Meier method showed that the median overall survival (OS) of IMV-subgroup, C-subgroup, and S-group was 21, 17, and 22 months, respectively. The OS of IMV-subgroup was better than that of the C-subgroup (χ2=4.676, P=0.031), which had no statistical difference between the IMV-subgroup and S-group ( χ2=0.007, P=0.934). The multivariate analysis results showed that the patients with postoperative adjuvant chemotherapy [RR=0.519, 95%CI (0.324, 0.833), P=0.007] and with R0 margin [RR=0.434, 95%CI (0.218, 0.865), P=0.018] were the protective factors affecting the OS, while low tumor differentiation [RR=2.433, 95%CI (1.587, 3.730), P<0.001], PV/SMV pathological invasion [RR=2.788, 95%CI (1.543, 5.039), P=0.001], and tumor infiltration into PV/SMV intima [RR=1.838, 95%CI (1.062, 3.181), P=0.030] were the risk factors affecting the OS. ConclusionsThe results of this study suggest that, transecting the body of pancreas via IMV pathway can improve the rate of R0 resection, improve OS, and do not increase postoperative morbidity and mortality. It may provide a better selection for transecting the body of pancreas when the anterior PV/SMV and posterior surface of the neck of the pancreas are invaded by tumors or has inflammatory adhesion.
ObjectiveTo explore clinical efficacy of Frey procedures for chronic pancreatitis. MethodsThirty two patients with chronic pancreatitis who underwent Frey procedures in our hospital from June 2000 to October 2009 were analyzed retrospectively. The rate of perioperative complications, pain relief, and especially endocrine and exocrine function of pancreas in longterm followup (mean 43 months) were analyzed. ResultsNo death occurred in all patients. Fat liquefaction of wound was found in two patients and pancreatic fistula was found in one patient, who was cured by conventional treatment. So the rate of perioperative complications was 9.4%(3/32). After Frey procedures, pain disappeared completely in sixteen patients (50.0%), pain relieved in fourteen patients (43.8%) and two cases were ineffective. Therefore, the rate of pain relief in longterm follow-up was 93.8%. The hospitalization was (11±2) d. After surgical treatment the illness of five patients with diabetes mellitus did not aggravate while new onset of diabetes mellitus was observed in three cases. For three cases who suffered from indigestion and steatorrhea, symptomatic relief was found in one patient treated by oral administration of pancreatin and inefficacy was observed in two cases. But four patients with new steatorrhea were found after operation. ConclusionUnder the strict surgical indications, Frey procedure is a safe and effective surgical method for the treatment of chronic pancreatitis.
Objective To summarize the current advance of xenotransplantation. Methods Relevant literatures about current advance of xenotransplantation published recently domestic and abroad were collected and reviewed. Results Major progress of xenotransplantation had been made in the understanding of xenoimmunobiology in the last two decades and in the threshold of clinical application. However, many problems of immunological rejection were still needed to be explored and resolved. Conclusion Xenotransplantation as a transplantation source has an extensive potential to resolve the shortage of transplanted organs for end-stage organ failure, how to suppress rejection and prolong survival of grafts more effectively is a focal point of search in the future.
ObjectiveTo investigate whether novel coronavirus pneumonia (COVID-19) patients complicated with digestive tract symptoms and its influence on digestive system related biochemical indexes.MethodsSixteen novel coronavirus pneumonia patients in our hospital were observed, and their epidemiological data, clinical manifestations and clinical laboratory indicators were analyzed statistically.ResultsThe age of the patients ranged from 5 to 75 years old, and the median age was 46.0 years old. Most of them were male (9 cases, 56.25%), the occurrence of COVID-19 appeared in family aggregation (12 cases, 75.00%). Sixt patients (37.50%) were complicated with basic diseases. The initial symptom involving digestive system accounting for 18.75% (3 cases) of all participants. The main manifestation of a diarrhea in 2 (12.5%) and melena in 1 (6.25%) patients, respectively. Five patients (31.25%) had symptoms of digestive system during the course of the disease, the main symptoms were diarrhea in 3 (18.75%), melena in 1 (6.25%) and loss of appetitein in 5 (31.25%) patients, respectively. The SARS-Cov-2 nucleic acid in the feces of the patients were negative in all patients. In 50.00% of the patients, the SARS-Cov-2 nucleic acid in the feces were negative, but the throat swab/sputum nucleic acid were still positive at the same time or later. Two patients (12.50%) had elevated ALT and 1 patient (6.25%) had elevated AST at the time of admission.ConclusionsPatients with COVID-19 will show symptoms of digestive tract.
【Abstract】 Objective To explore good methods for isolation and purification of rat islets. Methods The isletswere isolated from male SD rat pancreata by a collagenase perfusion method and purified by a modified method: added 4 kinds of Euro-Ficoll of different densities (F1: D=1.132, F2: D=1.108, F4: D=1.069, F5: D=1.023), discontinuous density gradient centrifuge the tube at 2 000 r/min for 20 minutes at 4℃ , then the islets between F1 and F2 were collected. The purity of islets was assessed by dithizone staining with islets counted and scored for size. Islets viabil ity was assessed by fluorescin diacetate / propidium iodide. The function of purified islets was judged by the test of insul in release and islets transplantation. Results After an improved method for optimized isolation and purification, (920±122) IEQ purified islets were obtained from one rat. Both the purity and viabil ity of islets were over 90%. The amount of insul in secretion was (18.25±0.32) mU/L and (36.70±3.57) mU/Lat 2.2 mmol/ L and 22.2 mmol/L concentration of glucose respectively, there was significant difference between the two phases(P lt; 0.05). The insul in release index was 2.01±0.15. Under 1 000 IEQ islets transplantation, the normal glucose level could beremained in diabetic rats. Conclusion High purity and high viabil ity islet cells can be got through improved collagenase perfusion and centrifugation on gradients method.
【摘要】 目的 探讨同种异基因骨髓间充质干细胞（bone mesenchamal stem cells，BMSC）静脉输注对大鼠到小鼠胰岛移植物的功能保护和小鼠糖尿病状态改善。 方法 全骨髓培养法获得C57BL/6小鼠BMSC。不连续梯度离心法分离纯化Sprague-Dawley（SD）大鼠胰岛，将300胰岛当量的胰岛单独或与BMSC联合移植入链脲菌素诱导的糖尿病BALB/c小鼠肾包膜下，并通过尾静脉在移植后0、3和5 d注射CM-DiI标记的BMSC 5×105/只，对照组给于磷酸盐缓冲溶液。移植后监测血糖，第9天处死小鼠，取肝、脾、胸腺、淋巴结和移植胰岛的肾脏，冰冻切片，荧光显微镜观察CM-DiI标记细胞的组织分布；免疫荧光法观察移植物中胰岛素和胰高血糖素表达，评价胰岛的功能。 结果 BMSC静脉输注后主要分布于胸腺，其次是脾脏和淋巴结，肾和肝组织中未观察到BMSC；BMSC联合胰岛移植组血糖控制水平优于其他组，且在第7天的口服糖耐量实验优于单纯胰岛移植组。 结论 与胰岛联合移植的BMSC对受者免疫器官和组织有明显的趋向性，且对胰岛细胞的体内存活有一定保护作用。【Abstract】 Objective To research on the protection function by the allogeneic rat bone mesenchymal stem cells (BMSC) on rat to mouse islet transplantation and the improvement of diabetic state in mouse. Methods BMSC were prepared from C57BL/6 mouse bone marrow cells and identified by flow cytometry (FCM). Islets were isolated from Sprague-Dawley (SD) rats with Ficoll discontinuous centrifugation. CM-DiI labeled BMSC at 5×105 for one mouse were intravenously infused into STZ induced diabetic BALB/c mice after rat to mouse islet transplantation at day 0, 3 and 5. Mice with PBS intravenously infused after islet transplantation were set as the negative controls. Blood glucose was monitored every day at the first 3 days after transplantation, and then monitored every two days. At day 9 after transplantation, spleen, thymus, lymph nods, liver and islets recipient kidney were harvested. Ice slices were prepared and CM-DiI labeled cells were investigated with fluorescence microscope. Results CM-DiI-labeled BMSC were mainly distributed in thymus followed by spleen and lymph nodes. In liver and kidney, there was no red fluorescence observed. The blood sugar control for combined BMSC infusion group was superior to other groups, and the control level of islet combined BMSC infusion group were better than single islet transplantation group in OGTT at day 7. Conclusion Allogeneic BMSC can sustain the insulin secretion of islets in vivo and tend to distribute in immune organs or adenoid tissues after infusion.