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Imaging Diagnosis of Pancreatic Endocrine Tumors

高頻圈套器切除支氣管內錯構瘤一例并文獻分析

目的 提高對支氣管內錯構瘤的臨床認識。 方法 報道 2014 年 6 月診斷的 1 例支氣管內錯構瘤，并結合臨床資料進行分析。 結果 支氣管內錯構瘤主要表現為呼吸困難，也可有咳嗽、咯血或阻塞性肺不張，易誤診為哮喘。胸部 CT、支氣管鏡檢查是診斷氣管內錯構瘤的主要手段，組織病理學檢查結果是確診依據。治療可根據腫瘤部位、大小以及患者狀態選擇手術或氣管鏡下切除。 結論 對支氣管舒張劑治療效果不好的呼吸困難患者應注意氣管內腫瘤的可能，氣管鏡下冷凍切除是治療氣管內錯構瘤的一種有效方法。

Short-term Therapeutic Effect of Adefovir Dipivoxil Combination with Thymopentin on Chronic Hepatitis B Patients with Positive Hepatitis B e Antigen

目的　觀察阿德福韋酯聯合胸腺五肽治療乙型肝炎病毒e抗原（HBeAg）陽性慢性乙型肝炎2年的療效。 方法　2007年1月－2009年1月間178例慢性乙型肝炎患者隨機分為試驗組91例和對照組87例。試驗組給予胸腺五肽1 mg，隔日皮下注射，療程52周；同時阿德福韋酯10 mg/d口服104周。對照組給予阿德福韋酯10 mg/d，口服104周。治療26、52、104周及停藥52周時，分別檢測血清丙氨酸氨基轉移酶（ALT）、天冬氨酸氨基轉移酶（AST）、乙型肝炎病毒（HBV）DNA含量及HBV血清標志物。 結果　治療52周后，試驗組在ALT復常率、AST復常率、HBV DNA轉陰率、HBeAg轉陰率與HBeAg/HBeAb血清轉換率方面都比對照組高。停藥52周時，試驗組與對照組的ALT復常率、AST復常率、HBV DNA轉陰率、HBeAg轉陰率、HBeAg/HBeAb血清轉換率分別為74.73%與51.72%、75.82%與54.02%、25.27%與8.05%、26.37%與10.34%、18.68%與8.05%（χ2=10.652、9.313、9.421、7.574、4.313，P＜0.05）。 結論　阿德福韋酯聯合胸腺五肽治療HBeAg陽性慢性乙型肝炎比單獨使用阿德福韋酯抗病毒治療效果更好，有助于提高HBeAg/HBeAb血清轉換率，減少停藥后病毒學突破，并且使用安全。Objective　To evaluate the efficacy of adefovir dipivoxil (ADV) combined with thymopentin on chronic hepatitis B patients with positive hepatitis B e antigen (HBeAg). Methods　Between January 2007 and January 2009, 178 chronic hepatitis B patients with positive HBeAg were randomly divided into two groups: the treatment group (91 cases) and the control group (87 cases). All patients in two groups received 10 mg of ADV once a day for 104 weeks, while the patients in the treatment group received 1 mg of thymopentin for subcutaneous injection every other day for 52 weeks. The rates of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) normalization, serum hepatitis B virus (HBV) DNA clearance and HBeAg loss and anti- HBeAg seroconversion were evaluated at pretreatment, and 52, 104 and 156 weeks after treatment, respectively. Results　After 52-week treatment, The rates of ALT and AST normalization, serum HBV DNA clearance and HBeAg loss and anti- HBeAg seroconversion in the treatment group were higher than those in the control group. In 52-week follow-up after 104 weeks treatment, the rates of ALT and AST normalization , serum HBV DNA clearance and HBeAg loss and anti- HBeAg seroconversion of two groups were 74.73% versus 51.72%, 75.82% versus 54.02%, 25.27% versus 8.05%, 26.37% versus 10.34%, 18.68% versus 8.05%, respectively (χ2 = 10.652, 9.313, 9.421, 7.574, 4.313; P＜0.05). Conclusions　It is more effective for adefovir dipivoxil combined with thymopentin on HBeAg-positive patients with chronic hepatitis B than using adefovir alone. Combination treatment could improve the rates of HBeAg seroconversion and reduce the breakthrough of HBV after drug withdrawal. And it is safe.

Role of Pancreatic Stellate Cells in Pancreatic Fibrosis

Objective To introduce the role of pancreatic stellate cells in pancreatic fibrosis and the progress in treatment of pancreatic fibrosis. MethodsRelevant literatures were collected and reviewed. Results Pancreatic stellate cells activation was closely related to pancreatic fibrosis. Inhibition of pancreatic stellate cells activation could provide a new approach in clinical treatment of chronic pancreatitis. Conclusion Pancreatic stellate cells are the key to pancreatic fibrosis, which are becoming the target for antifibrosis of the pancreas and treatment of chronic pancreatitis.

吉非替尼致間質性肺疾病二例并文獻復習

目的 提高對吉非替尼所致間質性肺疾病診斷和治療的認識。方法 對2 例吉非替尼所致間質性肺疾病予以報道, 結合有關文獻進行回顧性分析。結果 間質性肺疾病是吉非替尼較嚴重的不良反應, 其所致肺損傷的危險因素包括高齡、吸煙史、PS gt;2、應用時已存在肺間質性疾病或肺部感染、曾用化療或放療者; 臨床上早期多表現為發熱、干咳和呼吸困難, 肺CT 多提示以雙肺彌漫性毛玻璃樣浸潤影和肺實變為主; 大多在應用1 個月內發生, 進展迅速; 治療上以激素為主, 輔以抗感染和無創呼吸支持治療, 可在短時間內控制病情。結論 吉非替尼所致間質性肺疾病是臨床上嚴重的不良反應, 激素治療輔以無創呼吸支持可有效緩解病情。

Indications about removing abdominal drainage after pancreaticoduodenectomy

Objective To investigate the appropriate indication about removing abdominal drainage after pancreaticoduodenectomy. Method The clinical data of 156 patients who underwent pancreaticoduodenectomy in our hospital from January 2014 to June 2016 were analyzed retrospectively. The patients were divided into two groups, with 76 patients in the enhanced recovery after surgery (ERAS) group and 80 patients in the control group according to the type of indications about removing abdominal drainage. The time of removing abdominal drainage, hospital stay, incidence of postoperative complications, and readmission rate during 30 days after surgery were compared between the2 groups. Results Compared with the control group, the time of removing abdominal drainage 〔(6.2±2.5) dvs. (10.8±2.2) d,P<0.001〕and hospital stay〔(11.8±3.4) dvs. (15.7±3.6) d,P<0.001〕 of the ERAS group were both shorter, incidence of abdominal infection was lower〔1.3% (1/76)vs. 10.0% (8/80), P=0.020〕 , but there was no significant difference in the incidence of postoperative pancreatic fistula 〔18.4% (14/76) vs. 21.3% (17/80)〕 , delayed gastric emptying〔1.4% (1/76) vs. 7.5% (6/80)〕 , and the readmission rate during 30 days after surgery〔5.3% (4/76) vs. 3.8% (3/80)〕 , P>0.05. Conclusions Indications about removing abdominal drainage after pancreaticoduodenectomy by authors are safe.

Study on Relationship Between RasTG and Pancreatic Carcinoma

ObjectiveTo study the expressions of Ras trapping to Golgi (RasTG) genes in pancreatic carcinoma tissues and to observe the growth, proliferation and the impact of tumors formation of human pancreatic cancer cells (PANC-1), and to explore its mechanism. MethodsMade PANC1 as a target to research, transfected RasTG genes into PANC-1, used RNAi technology and observed the growth, proliferation and the impact of tumors formation of the cells. Meantime, contrasted the RasTG expressions between pancreatic ductal cancer and adjacent tissue by tissue microarray technology. Results①The expression of RasTG gene in tissues was not very differential， which was higher in the brain, liver, and adrenal gland. ②The expression of RasTG protein in pancreatic ductal carcinoma was significantly higher than that in adjacent tissues （Plt;0.05）. ③After RasTG RNAi in PANC-1 cells, the ability of growth and proliferation were decreased. ④The ability of tumors formation in PANC-1 cells after RNAi was decreased, carcinoma’s volume of transfected group was significantly smaller than that in the nontransfected group (Plt;0.05). ConclusionsRasTG gene is widely distributed in animals. RasTG protein in pancreatic carcinoma tissues is higher than that in adjacent tissues. The ability of proliferation, transformation and tumors formation in PANC-1 cells after RNAi of RasTG gene are restrained, RasTG gene is a positive regulatory factor.

Analysis on Clinical Efficacy of Frey Procedure for Chronic Pancreatitis

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 longterm followup (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 longterm 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.

Current Advance of Xenotransplantation

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.

Clinical Application of Beger Procedure and Frey Procedure for Benign Disease or Low-Grade Malignant Potential Lesion of Pancreas

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.