【Abstract】 Objective To investigate the origin, prevention and treatment of postoperative complications and death rate after pancreaticoduodenectomy （PD）. Methods Retrospective study on the clinical materials of complications and death rate was done on 106 cases of PD performed in our hospital during July 1985 to December 2002. Results In this group, 37 cases (34.91%) had postoperative complications, and the incidence rate of severe complications was 19.81% (21/106), the death rate was 10.38% (11/106). Compared between the two groups with preoperative bilirubin gt;342 μmol/L and ≤342 μmol/L, the incidence of total complications increased evidently (P＜0.05), and the bleeding amount，infusion amount and operation time in those with complications or dead ones were evidently higher than those without complications (P＜0.05). Conclusion The safty and resectability of PD has improved evidently in recent years but good skills, careful operation, the experience of the operatior and careful perioperative treatment and nursing are of crucial importance to reduce the complications and death rate.
Objective To investigate the role of Notch signaling pathway in pancreas development and pancreatic cancer. Methods The related literatures were reviewed and analyzed. Results Notch signaling played a role early in development by maintaining pancreatic epithelial cells in a progenitor state and delaying their differentiation until timely appropriate. Notch signaling was reactivated in the initiation and progression of pancreatic cancer. Conclusion Notch signaling pathway plays an important role in the pancreas development. Sustained Notch signaling activity promotes the progression of pancreatic cancer, and may be one of major factors in the initiation of pancreatic cancer.
ObjectiveTo construct DPC4 gene recombinant expression vector and to study the inhibitory effect of DPC4 on the growth of human pancreatic adenocarcinoma cell line (PC3) cells.MethodsDPC4 cDNA was amplified from K562 cell line using RTPCR, and was cloned into the pcDNA3.1 vector to construct a recombinant expression vector plasmid pcDNA3.1DPC4. The recombinant expression plasmid was transferred into PC3 cells by liposome method. After G418 selection, cell cycle and apoptosis were assessed by flow cytometry, then the cell growth rate was estimated by cell count. The cells being not transferred plasmid and transferred pcDNA3.1 plasmid were used as controls.ResultsThe DPC4 gene recombinant expression vector was constructed. Wildtype DPC4 gene attributed to the increase of G1 phase cells and the decrease of S phase cells in PC3 cells,and could inhibit the growth of PC3 cells, the cell growth rates was reduced to 34.3%-41.1% of that of the controls, but cell apoptosis was not observed on all groups. ConclusionWildtype DPC4 gene could inhibit the proliferation of human pancreatic adenocarcinoma cells and could become one of the target genes of pancreas adenocarcinoma gene therapy
【Abstract】Objective To investigate the effect of ischemia on the treatment of advanced body and tail carcinoma of pancreas. Methods In operation the proximal spleen artery was ligated, a chemotherapy pump was installed to connect the distal spleenic artery and urea solution (40%) was injected through the device during and after operation. The pathology and pathophysiology change in dogs were observed. Results All the eight dogs studied were alive after operation, no serious complication appeared, pancreatic cells were replaced by fibrosis. Conclusion Infusion of 40% urea solution is a safe and effective ischemic method, it can lead to all sorts of pancreatic cell necrosis and fibrosis. It may be a good madality in the treatment of advanced pancreatic carcinoma.
ObjectivesTo explore the mechanisms by which ischmic preconditioning (IPC), ischemic postconditioning (IPO) and IPCIPO exert influence on ischemic reperfusion injury (IRI) of the graft of SD rat after pancreas transplantation. MethodsAfter the establishment of diabetic SD rats model by using streptozotocin, 24 rats suffered from pancreas transplantation and were randomly averagely divided into four groups: I/R group, IPC group, IPO group, and IPC-IPO group. Six diabetic SD rats suffered with sham operation were served as SO group. The blood glucose level of rats in each group was detected before and after reperfusion, the contents of malonaldehyde (MDA) and super oxide dismutase (SOD) of pancreas allograft were tested at 2 h after reperfusion, and the apoptosis index (AI) of pancreas allograft was monitored by using TUNEL method. ResultsThe blood glucose level of rats in each group was not significantly different (Pgt;0.05). In SO group, the blood glucose level of rats was significantly higher than other groups (Plt;0.01). The blood glucose levels of rats after reperfusion decreased from the levels before reperfusion in I/R group, IPC group, IPO group, and IPC-IPO group (Plt;0.05 or Plt;0.01), furthermore the blood glucose level of rats in I/R group was significantly higher than that in abovementioned three groups (Plt;0.01), although among which the difference was not markedly (Pgt;0.05). When compared with I/R group, the MDA contents of rats after reperfusion in IPC group, IPO group， and IPC-IPO group decreased (Plt;0.01), while the SOD contents of rats after reperfusion increased (Plt;0.01). In rats of SO group, the MDA and SOD contents were significantly higher and lower than other groups, respectively (Plt;0.01). The MDA and SOD contents in IPC group, IPO group, and IPC-IPO group were not different (Pgt;0.05). The AI of pancreas allograft at 2 h after reperfusion in I/R group 〔(47.31±4.52)%〕, IPC group 〔(26.25±3.17)%〕, IPO group 〔(24.73±3.62)%〕, and IPC-IPO group 〔(25.5±4.15)%〕 were higher than that in SO group 〔(3.16±0.53)%〕, Plt;0.01. The AI of pancreas allograft in IPC group, IPO group, and IPC-IPO group were not different (Pgt;0.05), but they were lower than that in I/R group (Plt;0.01). Pathological results showed that injury of pancreas allograft in I/R group was most severe. ConclusionsIPO and IPC are associated with comparable effectiveness to protect graft from IRI during pancreas transplantation. The combined protective effects of IPC and IPO do not appear to be additive, which is equal to IPC or IPO alone.
Objective To investigate the diagnosis and treatment of pancreatic gastrinoma. Methods The clinical data of 13 patients with pancreatic gastrinoma who were admitted to Hainan Provincial People’s Hospital from Jan. 1990 to Dec. 2010 were retrospectively analyzed. Etiologic and localization diagnosis were preformed preoperatively according to the manifestation and the results of color Doppler ultrasound and computer tomography，respectively. All patients received chemoradiotherapy after operation according to the pathology results. Results All of the thirteen patients underwent operation. The location of pancreatic gastrinoma was found in the head of the pancreas in 9 cases，in the tail of the pancreas in 1 case，in the body of the pancreas in 2 cases， and 1 case with multiple pancreatic gastrinonma，respectively. The diameters of the pancreatic gastrinoma were 0.2-4.0cm and 11 patiens were above 2.0cm. One patient underwent resection of the body and tail of the pancreas and spleen，seven patients underwent tumor resection，two patients underwent resection of the choledocho-pancreatic junction， and three patients underwent pancreaticoduodenectomy. One patient complicated with pancreatic leakage and two with incision infection. Twelve patients were followed up for 16-120 months （mean 78 months）. Clinical symptoms such as diarrhea disappeared after operation in twelve patients. Results of electronic gastroscopy in 6 months after continuous treatment with proton pump inhibition agents showed that the gastric ulcer were healed，the 12 hour gastric juice volume and the level of the gastric acid were in the normal range. Ten patients were cured，but one patient died because of other disease in 1 year after operation，one patient died because of recurrence in 1.5 years after operation， and one patient died in 4 years after reoperation of liver metastases. Conclusion Surgical treatment is a effective method for pancreatic gastrinoma.
Objective To establish the model of pancreatoduodenal allotransplantation in pigs with enteric drainage (ED) and portal venous drainage (PVD). Methods Forty-six hybrid landraces were divided into two groups (donor and recipient groups) randomly, for pancreatoduodenal allotransplantation. Donors were perfused via abdomial aorta without clamping the portal venous outflow with UW solution after heparinization. Whole pancreatoduodenal graft was arvested with segments of abdomial aorta and portal vein and shaped under cold UW solution. Then, the end-to-end nastomosis was performed with the donor iliac artery bifurcation “Y” graft to the recipient superior mesenteric arteries and celiac artery. Furthermore, type Ⅰdiabete model was made by removal of the recipient pancreas. The venous anastomosis was reconstructed between the donor portal vein and the recipient superior mesenteric vein. Meanwhile, the end-to-side anastomosis was performed with the donor common iliac artery bifurcation “Y” graft to the recipient abdomial aorta and the side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum. External jugular vein was intubated for transfusion. The levels of blood glucose， insulin and glucagon in blood were measured before and during the operation and 1， 3， 5， 7 d after operation. Results Twenty-three cases of pancreatoduodenal allotranplantations were performed on pigs. One died from complication of anesthesia. Success rate of operation was 95.7％.Complications of operation happened in 2 cases in which one was phlebothrombosis, incidence 4.5％and the other was duodenojejunal anastomotic leak, incidence 4.5％. The level of blood glucose increased within 30 min and recovered on the 2nd day after removal of pancreas. The levels of insulin and glucagon decreased within 30 min and recovered on the 2nd day after removal of pancreas. Rejection curred at the 1st day and reached the worst level on the 9th day after transplantation without the change of insulin and glucagon in blood and clinical symptoms of rejection. Conclusion Pancreatoduodenal transplantation in pigs can treat type Ⅰ diabete. ED and PVD can keep the function of endocrine in normal. The technique of duodenal transplantation with ED and PVD may pave the way for the further development of pancreas transplantation in clinic.
In order to avoid lesion of adjacent organs which were often occurred after routine cryotherapy of pancreanoduodinal area, a new cryosurgical method of isolated pancreano-duodinal area was designed for treatment of neoplasm in this area, the feasibility of this method was tried in four pigs.After bile common duct, tail of pancreas, stomach, and jejunum were divided and protected by dry cotton pad, the isolated pancreano-duodinal area was twice fozen to -170℃, maintaining ten minutes with LCS 2000 cryogenic surgical system, then alimentary tract was reconstructed with cholecystojejunostomy and gastroenterostomy. Animals were observed for 1-4 weeks. There was only transient elevation of amylase postoperation and the liver function and blood sugar remained normal. No any complication was seen except a small pseudocyst in lesser omentum. Thorough destruction of pancreatic tissue by enough deep and time course of cryotherapy was emphasized and some technic problem also were discussed. Based on our experiment, cryosurgery of isolated pancreano-duodenum will be considered as a safe and effect therapy of pancreano-duodinal neoplasm.
Objective To investigate the CT imaging features of pancreatic fatty replacement and its clinical significance. Methods Three patients with pancreatic fatty replacement detected by CT were retrospectively analyzed. CT examination included plain scan and contrast-enhanced scanning at the arterial and portal venous phases. The shape, size, density, pancreatic lobulation and interlobular spaces, course of the pancreatic duct were carefully observed. The clinic and laboratory data were also analyzed to determine the clinical significance of pancreatic fatty replacement. Results ①Imaging features: Two patients had complete fatty replacement involving the entire pancreas, another one had most fatty replacement sparing the posterior aspect of head and tail. Two patients had regular configuration of pancreas. The size of pancreas was slightly enlarged in 2 patients. Lobular atrophy and widening of interlobular spaces were present in all 3 patients. The pancreatic duct was normal in 3 patients. ②Clinic findings: Chronic diarrhea was present in 3 patients. Two patiens had diabetes （one had chronic cholangitis with choledochal lithiasis）， another one had small stone in the common bile duct. Serum lipase was low in 3 patients, of which one had low serum amylase. Conclusion Pancreatic fatty replacement demonstrates certain characteristic CT appearances, and is usually associated with disturbances of both the endocrine and exocrine functions of the pancreas.
ObjectiveTo analyze the CT features of solid pseudopapillary tumor of pancreas (SPTP). MethodsEight patients with SPTP received triple phasic contrast-enhanced CT, and its consistency with pathological findings was analyzed. ResultsSPTP manifested as a solitary and exogenous mass, with a heterogeneous pattern composed of solid and polycystic parts. The shape of SPTP was spherical in four patients, oval in two patients, and shallow lobulation in another two patients. In contrast-enhanced phase images, the solid parts showed mild to moderate enhancement in both arterial and portal phases. Complete capsule was showed in seven patients, and nodules were found in the wall of mass in five patients. Hemorrhage was seen in two patients and calcification was showed in five patients. The dilation of pancreatic duct was found in one patient, liver metastases was showed in one patient, and the invasion of tumor to posterior gastric wall was found in one patient. Pseudopapillary structure, hemorrhage, necrosis, and cystic degeneration were showed in all patients by histological study. ConclusionSPTP has certain characteristic CT imaging manifestations consistent with histological features, which is helpful for the diagnosis and differential diagnosis of SPTP.