【摘要】目的 总结胰十二指肠切除术(pancreaticoduodenectomy,PD)早期（术后30 d内）并发症发生的相关危险因素，指导围手术期患者的有效治疗。方法 回顾性分析2002年1月至2007年1月期间71例行PD的临床资料,分析早期并发症的发生情况及相关影响因素。结果 PD术后并发症发生率为46.5%(33/71)。Logistic多变量分析确定了2个与PD术后早期并发症相关的变量即术中输血量≥800 ml(OR=8.227)和胰液引流入肠道(OR=5.134)。结论 PD的手术风险目前仍较高，运用胰液外引流、加强围手术期处理是预防并发症的重要环节。
ObjectiveTo explore the protective effect of rapamycin on pancreatic damage in severe acute pancreatitis (SAP) and further to explain its protective mechanism.MethodsNinety selected SPF males SD rats were randomly divided into 3 groups: sham-operated group (SO group), SAP group, and rapamycin group (RAPA group), with 30 rats in each group. Then each group of rats were randomly divided into 3 subgroups of 24 h, 36 h, and 48 h, 10 rats in each subgroup. Rats in each group underwent laparotomy, the model was prepared by retrograde injection of solutions into biliopancreatic duct, rats of the SO group were injected with 0.9% normal saline, rats of the SAP group and RAPA group were injected with 5% sodium taurocholate solution, but rats of the RAPA group were injected with rapamycin at 30 min before the injection of 5% sodium taurocholate. All the survival rats in corresponding subgroup were killed at 24 h,36 h, and 48 h after operation respectively, then serum and pancreas tissues of rats were collected, serum inflammatory factors content of IL-1β, IL-6, and TNF-α were detected by ELISA method, expression levels of p-mTOR and p-S6K1 in pancreas were detected by Western blot, pancreas tissues were stained by Hematoxylin-Eosin Staining and pathological changes of pancreas were scored under light microscope.Results① At the timepoint of 24 h, 36 h, and 48 h, the order of the expression levels of p-mTOR and p-S6K1 in pancreatic tissues of 3 groups were all as follows: SO group<RAPA group<SAP group, there were significant difference among any 2 groups (P<0.05). ② IL-1β: at the timepoint of 48 h, the order of the content of IL-1β in 3 groups were as follows: SO group<RAPA group<SAP group, there were significant differences among any 2 groups (P<0.05); IL-6: at the timepoint of 36 h and 48 h, the order of the content of IL-6 in3 groups were as follows: SO group<RAPA group<SAP group, there were significant differences among any 2 groups (P<0.05); TNF-α: at the timepoint of 48 h, the order of the content of TNF-α in 3 groups was as follows: SO/RAPA group<SAP group (P<0.05), but there was no significant difference between the SO group and RAPA group (P>0.05). ③ Pancreatic histological score: at the timepoint of 24 h, 36 h, and 48 h, the order of the pancreatic histological score in3 groups was all as follows: SO group<RAPA group <SAP group, there were significant differences among any 2 groups (P<0.05). ④ The expression levels of p-mTOR and p-S6K1 in pancreatic tissue were positively correlated with the pathological scores of pancreatic tissue (r=0.97, P<0.01; r=0.89, P<0.01).ConclusionRapamycin can reduce the degree of pancreatic damage in SAP and has protective effect on pancreatic tissue.
ObjectiveTo discuss the changes of myelin basic protein (MBP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in serum and cerebrospinal fluid of experimental pancreatic encephalopathy rat model, analyze the relationship between each factor and the occurrence and development of pancreatic encephalopathy, and to provide the experimental basis for clinical diagnosis and treatment of pancreatic encephalopathy. MethodsSelecting 40 SD rats were randomly divided into sham operation group (SO group, n=10) and pancreatic encephalopathy group (PE group, n=30), respectively by the duodenal papilla retrograde pancreatic puncture injection of saline solution or 5% sodium taurocholic acid induced rat pancreatic encephalopathy model were set up. The rats in SO group were sacrificed on 1 d, and the PE group were sacrificed ten rats on 1 d, 3 d, and 7 d, respectively after surgery. The brain and pancreatic tissues of rats in each group were taken to observe the pathological changes of the rats and the brain white blood cells within microvessels gathered and coanda phenomenon. The water content of brain tissues, and the contents of MBP, TNF-α and TL-6 in serum and cerebrospinal fluid were detected. ResultsThe changes of brain nerve cell edema and nerve fiber demyelination were obvious in PE group rats after surgery with the extension of time. The contents of MBP, TNF-α and TL-6 in serum and cerebrospinal fluid on 1 d, 3 d, and 7 d after surgery in PE group were significantly higher than that SO group (P<0.05), and gradually increased with the extension of time. But by two two compared, the change trend of the above three indicators were different. ConclusionsMBP, TNF, and IL-6 on the occurrence and development of brain damage of pancreatic encephalopathy play a synergistic effect. To detecte the MBP, TNF-a, and IL-6 content in blood and cerebrospinal fluid could be diagnosed and evaluated the pancreatic encephalopathy.
Objective To investigate the historical evolution and the research progress of pancreaticoenterostomy method in the pancreaticoduodenectomy. Methods The related literatures of PubMed， EMBASE， Wanfang， CNKI， and VIP databases were retrieved and reviewed. The advantages and disadvantages of various pancreaticojejunostomy type in pancreaticoduodenectomy were summarized. Results The type of pancreaticoenterostomy is the major influence factors for the pancreaticoduodenectomy success or failure and the patients’s recovery. Conclusion According to the specific cases， the type of pancreaticojejunostomy in skilled operation is the key to success.
目的总结肝包膜下胆汁瘤（HSB）的病因、临床诊断及治疗方法。 方法回顾性分析笔者所在医院收治的1例HSB患者的临床资料，并进行文献复习。 结果12例患者中，术前诊断为胆总管结石/胆囊结石慢性胆囊炎4例，胆总管结石1例，胆囊结石2例，急性化脓性胆囊炎2例，不详3例；行腹腔镜胆囊切除术（LC）7例，行内窥镜逆行胰胆管造影1例，行LC+腹腔镜胆管取石术1例，行开腹胆囊切除术3例；发病至手术时间7～40 d，平均14.3 d；右肝9例，胆囊窝及右肝前叶膈顶部、胆囊窝及右肝后叶和左肝各1例；11例单发，1例左肝多发；HSB直径7.6～29.1 cm，平均15.7 cm；肝脏包膜下积液量800～3 000 mL，平均1 400 mL；液体吸收时间7～120 d，平均37 d。主要治疗方案为置管引流7例（包括手术开腹置管外引流2例），B超引导下反复穿刺抽吸4例，1例不详；2例反复穿刺引流效果较差，行手术治疗。 结论HSB的发病原因目前尚无统一意见，诊断首选影像学检查，治疗以保守治疗+B超引导下经皮反复穿刺抽吸为主。
目的 探讨川芎嗪对大鼠重症急性胰腺炎（SAP）脑损伤的保护作用。方法 将72只健康Wistar大鼠按数字表法随机均分为对照组、SAP组和川芎嗪治疗组3组。对照组仅剖腹翻动胰腺后即缝合腹壁； SAP组采用胰腺被膜下均匀注射5%牛磺胆酸钠（2ml/kg体重）制备SAP动物模型；川芎嗪治疗组在SAP建模后5min于大鼠尾静脉注射川芎嗪注射液（100mg/kg体重）。各组大鼠分别于术后第6、12及24 h观察胰腺组织及脑组织的病理改变，检测血清淀粉酶、 脑组织含水量和微血管内白细胞聚集附壁计数，以及脑组织中MDA、TNF-α和IL-1β水平。结果 对照组胰腺组织无明显改变；SAP组胰腺组织腺泡细胞坏死，结构不清，间质水肿，红细胞漏出，部分腺导管扩张，有点片状出血坏死，炎性细胞浸润；川芎嗪治疗组胰腺组织病理改变较同一时相的SAP组明显减轻。对照组脑组织无明显改变；SAP组脑组织神经元细胞水肿，微血管内白细胞聚集及附壁，脑组织内有炎性细胞增生、聚集，且随时间延长上述表现逐渐加重；川芎嗪治疗组脑组织病理改变较同一时相的SAP组明显减轻。SAP组大鼠各时相脑组织含水量和微血管内白细胞聚集附壁计数，脑组织中TNF-α、IL-1β和MDA水平，以及血淀粉酶含量均明显高于对照组（P＜0.05）；川芎嗪治疗组大鼠各时相的上述指标均明显低于SAP组（P＜0.05）。结论 大鼠脑组织中的TNF-α、IL-1β及MDA参与了SAP脑损伤的病理过程，川芎嗪对SAP大鼠脑损伤具有保护、治疗作用。
To study the role of endotoxin in acute hemorrhagic necrotizing pancreatitis (AHNP), the change of endotoxin were studied in rats AHNP models by injection of 5% sodium taurocholate 1 ml/kg into pancreatic duct, and the effects of recombinant interleukin-2 (IL-2) in the treatment of AHNP were observed in this experiment. The results indicated that endotoxin involved the aggravation of AHNP and was associated with the increase of serum phospholipas-2 (PLA2), and these mediators were positively correlated with severe degrees of pancreatic damage. The results also suggeste that IL-2 might inhibit the overexpression of endotoxin and PLA2 and mitigate the pancreatic injury and decrease the 72h-mortality rate of AHNP from 66.7% to 26.7% (Ｐ＜0.01). Endotoxin might play a major role in the pathogenesis of AHNP and IL-2 might have a potential role in the treatment of AHNP.