ObjectiveTo summarize of clinical application and progress of duodenum-preserving pancreatic head resection (DPPHR).MethodThe relevant literatures published recently at domestic and abroad about the clinical application and progress of DPPHR were collected and reviewed.ResultsFor the benign lesions, low-grade malignancies and borderline tumors of the head of pancreas, the DPPHR could achieve the same expected therapeutic effect as the classical pancreatoduodenectomy. The DPPHR could reserve the continuity of stomach and duodenum while resecting lesions and improve the symptoms of patients, reduce the reconstruction of digestive tract and the resection of pancreas and surrounding tissues as much as possible, and retain the pancreas-intestinal axis, which was more in line with the physiology of human beings.ConclusionsAt present, DPPHR is worthy of further development and promotion in department of pancreas surgery, but current studies only focus on occurrence of short-term complications after operation. Because patients with benign diseases of pancreatic head have better prognosis and longer survival time after operation, we should pay attention to the long-term complications such as diarrhea, anemia and reflux cholangitis. More clinical studies need in future to be demonstrated superiority of DPPHR in clinical efficacy and to evaluate occurrence of long-term complications and their impact on quality of life of patients with DPPHR by comprehensive analysis of multiple evaluation indicators.
ObjectiveTo investigate the guiding value of preoperative imaging and intraoperative rapid pathology in the diagnosis and treatment of pancreatic cystic neoplasm (PCN).MethodsThe clinical data of 205 patients with PCN diagnosed by pathology from July 14, 2003 to July 31, 2018 were analyzed retrospectively. The precise and fuzzy diagnostic rate and misdiagnosis rate of PCN by preoperative imaging and intraoperative rapid pathology were analyzed.ResultsThe most commonly used preoperative imaging methods were ultrasound and CT, in 146 cases (82.95%) and 141 cases (80.11%), respectively. There were 54 cases (30.68%) with MRI. Of them, 47 cases were examined by single examination, 129 cases received combined examination, of which 123 cases (95.35%) were examined by ultrasound combined with CT. The precise and fuzzy diagnostic rate of PCN by ultrasound, CT, and MRI were 81.51% (119/146), 81.56% (115/141), and 87.04% (47/54), respectively. Comparison of ultrasound with CT and MRI showed statistical significance (χ2=47.747, P<0.001; χ2=11.873, P=0.018), but no significant difference was observed between CT and MRI (χ2=5.012, P>0.05). In 27 cases of false diagnosis by ultrasound, no obvious abnormality was found in 14 cases (51.85%), followed by misdiagnosis as pancreatic pseudocyst (11 cases, 40.74%). Of the 26 cases misdiagnosed as pancreatic cancer by CT, 57.69% (15 cases) were misdiagnosed as pancreatic cancer; 7 cases were misdiagnosed by MRI, 42.86% (3 cases) of patients were misdiagnosed as pancreatic cancer and pancreatic pseudocyst. Thirty-one cases were misdiagnosed by intraoperative rapid pathology, and most of them misdiagnosed as pancreatic pseudocyst (10 cases, 32.26%). The next was SPN misdiagnosed as pancreatic neuroendocrine tumor (7 cases, 22.58%). The precise and fuzzy diagnostic rates of PCN were 81.58% (124/152), 86.84% (132/152), and 97.37% (148/152) in preoperative imaging, intraoperative rapid pathology, and preoperative imaging combined with intraoperative rapid pathology, while the misdiagnostic rates were 18.42% (28/152), 13.16% (20/152), and 2.63% (4/152), respectively.ConclusionsIn preoperative imaging and intraoperative rapid pathological examination, it is possible that ultrasound could not find PCN lesions. CT and MRI are most likely to be misdiagnosed as pancreatic cancer. Intraoperative rapid pathological examination misdiagnosed as pancreatic pseudocyst is most common. Perfect preoperative imaging and rapid intraoperative pathology can improve the correct diagnosis rate of PCN and avoid unreasonable surgical intervention measures.
ObjectiveTo summarize and analyze the long-term clinical effect of duodenum-preserving pancreatic head resection (DPPHR) versus pancreaticoduodenectomy.MethodsThe clinical data of 102 patients who underwent DPPHR (n=35) or pancreaticoduodenectomy (n=67) from January 2014 to December 2019 in The First Affiliated Hospital of Xinjiang Medical University were analyzed retrospectively.ResultsThe operations of patients in the DPPHR group and the PD group were successfully complete, no one died during operation or perioperative period. The weight gain in one year after operation and incidences of exocrine dysfunction in the DPPHR group were all better than those of the PD group (P<0.05), but there was no significant difference on the other complications between the two groups (P>0.05). The pain score, diarrhea score, and the overall health status score in one year after operation significantly improved in the DPPHR group than those in the PD group (P<0.05).ConclusionDPPHR is more beneficial to improve the quality of life after operation, and is a better surgical procedure for benign and low-grade malignant diseases of pancreatic head.
ObjectiveTo investigate whether transplantation of islet cells combined with bone marrow mesenchymal stem cell (BMSCs) of the pancreatic subcapsular promoting revascularization of pancreatic islets in rats, so as to reduce the loss of islet cells after transplantation and improve the success rate of islet cell transplantation. MethodsThe model of diabetic rat was established. The BMSCs and islet cells were cultured and identified, then the simple islet cells, simple BMSCs, and combination of islet cells and BMSCs were injected into the pancreatic subcapsular of the islet cell group, BMSCs group, and combination group, respectively. In addition, the same amount of normal saline was injected into the same site as the control group. There were 10 rats in each group. The changes of blood glucose and serum insulin in different time point were detected in each group. The mRNA expressions of angiogenesis factors such as hypoxia inducible factor-1α (HIF-1α), stromal cell derived factor 1α (SDF1α), vascular endothelial growth factor (VEGF), and basic fibroblast growth factor 2 (FGF2) were determined by real-time quantitative PCR. Results① The blood glucose levels of the islet cell group and combination group were lower than those of the control group and the BMSCs group within 15 d after surgery (P<0.05) and decreased to the normal level, which of the combination group could still maintain the normal level until on day 29 (P<0.05), but which of the islet cell group began to increase on day 15 after surgery and was similar to that in the BMSCs group (P>0.05). ② Compared with the control group and the BMSCs group, the insulin levels were higher in the islet cell group and combination group on day 1, 3, 7, 15, and 29 after surgery (P<0.05), especially in the combination group. ③ The expression levels of HIF-1α, SDF1α, VEGF, and FGF2 mRNAs in the combination group were higher than those the other three groups, and the differences were statistically significant (P<0.05). ConclusionsIslet cell transplantation of pancreatic subcapsular could decrease blood glucose level in diabetic rats. Hypoglycemic effect of single islet cell transplantation gradually weakens on day 15 d after surgery. After BMSCs combined with islet cells transplantation, the glycemic effect of rat is stable for a longer time. Expressions of angiogenesis factors of BMSCs combined with islet cells transplantation rat are high, which combined with pathological sections suggests that BMSCs could promote vascular recanalization of islet transplantation.