【摘要】 目的 探討胰管結石的診斷和治療方法。 方法 回顧性分析2000年1月－2009年1月收治的50例胰管結石患者臨床資料。其中男37例，女13例；年齡36~70歲，平均49歲。病程7 d~10年，平均6.8年。46例出現腹正中及左上腹間歇疼痛，伴腰背部放射痛。50例均行B型超聲和CT檢查，診斷陽性率分別為90%（45/50）和96%（48/50）；27例行磁共振胰膽管成像檢查，診斷陽性率為92.6%（25/27）。所有患者均行手術治療，包括胰十二指腸切除術8例；胰管切開取石、胰空腸Roux-Y吻合術42例，同時行膽囊切除術12例，Oddi括約肌切開、T管引流術6例，膽腸Roux-Y吻合術2例。 結果 所有患者均取出胰管結石，結石大小為0.2~2.0 cm，結石數目為1~50枚。1例患者術后發生切口感染，經積極抗感染及傷口換藥處理后治愈。46例治愈出院，2例好轉出院， 2例術后出現并發癥死亡。術后40例獲隨訪，隨訪時間1~48個月，平均24個月。隨訪期間2例胰管結石伴胰頭癌患者因術后胰頭癌復發死亡。余38例中有8例術后胰管結石復發，再次行手術治療后治愈；其中有2例術后仍有腹痛，但較術前有明顯好轉。 結論 影像學檢查是診斷胰管結石的重要手段，準確率高，一旦診斷應根據合并癥和胰管擴張程度選擇合適的手術方式，可取得良好治療效果。【Abstract】 Objective To investigate the diagnosis and treatment methods for pancreatolithiasis. Methods The clinical data of 50 patients with pancreatolithiasis from January 2000 to January 2009 were retrospectively analyzed. Among them, there were 37 males and 13 females aged between 36 and 70 averaging at 49.3. The course of the diseases ranged from 7 days to 10 years with an average time period of 6.8 years. Forty-six patients had intermittent pain in the median abdomen and left upper quadrant combined by ectopic pain in the back. Various image examinations including abdomen ultrasonography, CT scan, and magnetic resonance cholangiopancreatography (MRCP) were performed in 50, 50, and 27 patients, respectively. Pancreatic duct stones were found in 45 of 50 cases (90％) with ultrasonograhy, 48 of 50 cases (96%) with CT scan, and 25 of 27 cases (92.5%) with MRCP. All patients received surgeries including 8 cases of pancreatodudenectomy, 42 cases of pancreatolithotomy plus side to side pancreatojejunostomy. At the same time, there were 12 cases of cholecystectomy, 6 cases of sphincterotomy and T-duct drainage, and 2 cases of Roux-Y anastomosis. Results Pancreatic duct stones were successfully removed in all cases, and the size of the stones ranged from 0.2 to 2.0 cm in diameter. The number of stones removed from each patient ranged from 1 to 50. Symptoms of all patients ameliorated obviously. One patient had incision infection after surgery, and recovered through active antibiotic treatment. Forty-six patients were cured and discharged from the hospital; 2 patients had their conditions improved and were discharged from the hospital; and the other 2 patients died of postoperative complications. Forty patients were followed up for 1 to 48 months with an average time of 24 months. During the follow-up, 2 patients with pancreatolithiasis and carcinoma of head of pancreas died of the recurrence of the cancer. Eight patients had recurrence of pancreatic stones and were cured after a second operation. Among the 8 cured patients, 2 still had abdominal pain, but their conditions were greatly improved after surgery. Conclusion Imaging techniques are important methods in diagnosing pancreatolithiasis with a high precision. Once the diagnosis of pancreatolithiasis is made, surgical procedures should be selected according to the combined diseases and the level of pancreatic duct dilation.
ObjectiveTo investigate the clinical characteristics of pancreatitis, panniculitis, and polyarthritis syndrome (PPP syndrome). MethodsA patient with PPP syndrome in July 2013 was reported. The clinical features of 33 cases of PPP syndrome at home and abroad were reviewed. ResultsOur patient with panniculitis and arthritis as the first manifestation had few abdominal symptoms despite high serum levels of pancreatic enzymes. In the 34 PPP cases, 70.6% (24/34) had absent or mild abdominal symptoms, easily leading to misdiagnosis. Multi-joint involvement was more common, and in almost 1/3 of the patients, joint symptoms with poor NSAIDs and/or hormonal responses predated the identification of pancreatic disease. Panniculitis biopsy found characteristic "ghost cells". Ten patients died of complications of pancreatic disease (including 2 cases of cancer), and the mortality rate was as high as 29.4% (10/34). ConclusionPPP syndrome with mild abdominal symptoms and high mortality should be taken for the treatment of pancreatic disease, to prevent misdiagnosis and mistreatment.
To survey the penetrance of Nimodipine to blood-pancreatic barrier. Pancreatic fluid of 15 cases with pancreatic diseases were respectively sampled from pancreatic drainage tubes at different time after Nimodipine taken orally, and the concentrations of Nimodipine in the fluid were measured with high performance liquid chromatography (HPLC). The average concentration of Nimodipine in pancreatic fluid at 0.5,1,1.5,2,2.5,3,3.5,4 hours after Nimodipine administration were 4.79,7.31,9.21,8.04,6.05,5.11,3.37 and 1.19 ng/ml, respectively. The highest value of Nimodipine level in pancreatic fluid were 9.21 ng/ml at 1.5 to 2 hours following Nimodipine taken orally. These suggested that the Nimodipine can penetrate across the bloodpancreatic barrier and make its pharmacolohical effect in pancreatic tissue.
Objective To investigate the spiral CT manifestations of the collateral circulation pathways resulting from splenic vein occlusion (SVO) duo to pancreatic diseases. Methods The CT imaging and clinical data of 33 cases of pancreatic disease with SVO, including 28 cases of pancreatic carcinoma, 3 cases of acute pancreatitis and 2 cases of chronic pancreatitis, were retrospectively analyzed.Results Tortuous and dilated vessels were observed in the areas between splenic hilum and gastric fundus and/or along the gastric greater curvature in all 33 cases. In isolated SVO cases, the short gastric vein (SGV, 86%)，coronary vein (CV, 79%)，gastroepiploic vein (GEV, 79%) and gastrocolic trunk (GCT, 57%) were varicose and dilated. While in nonisolated SVO，other collateral veins such as the right superior colic vein (RSCV, 37%），middle colic vein (MCV, 37%） and posterior superior pancreaticoduodenal vein (PSPDV, 21%） were seen as well. Conclusion The two predominant collateral pathways of SVO are ①SGV→gastric fundal veins→CV， and ②GEV→GCT→SMV. They have characteristic imaging features on spiral CT and are of clinical significance in both preoperative staging of pancreatic carcinoma and the evaluation of pancreatogenic segmental portal hypertension.
Objective To explore the clinical value of laparoscopy in the treatment of pancreatic diseases. Methods Twelve patients with pancreatic diseases received laparoscopic surgery. Among which 9 patients with cystic diseases, 4 cases underwent laparoscopic spleen-preserving distal pancreatectomy, 2 cases received distal pancreatectomy and splenectomy, and 3 cases underwent pancreatic cystectomy. Laparoscopic insulinoma enucleation was performed for 2 patients who suffered from insulinoma. Besides, a patient suffered from pancreatic carcinoma recurrence received left thoracoscopic splanchnicectomy. Results All the operations were accomplished successfully, including 8 total laparoscopic surgery and 4 laparoscopic assisted surgery. The average operative time was 225 min （range 100-420 min）, and the average volume of blood loss was 80 ml （range 2-150 ml）. Pancreatic fistula was observed in 1 patient which was cured by conservative therapy. The postoperative average hospital stay was 7.2 d （range 5-13 d）. The patient with recurrent pancreatic carcinoma survived for 6 months after operation and the pain-killing effect was satisfactory. With a follow-up of 10-36 months for other patients, the surgical effects were ideal and no recurrence occurred.Conclusion With the advantages of less trauma， less pain， fast recovery， and low morbidity rate, laparoscopic surgery is an effective and safe method for the treatment of pancreatic diseases, and thus may be widely used in the clinical settings in the future.
內鏡技術的問世是醫學史上的一次革命，是21世紀醫學的重要進展之一。目前,內鏡技術在肝膽胰外科領域得到了廣泛的應用，有力地促進了肝膽胰外科的發展，肝膽胰內鏡技術已成為微創外科重要的組成部分。。。。。。
ObjectiveTo summarize the current application status and research progress of extracellular volume (ECV) fraction based on imaging examinations in pancreatic diseases. MethodThe literature relevant to research was summarized, including the clinical studies of the ECV fraction that based on computed tomography and magnetic resonance imaging in pancreatic inflammation, neoplastic lesions, fibrosis, and other diseases. ResultsBiopsy of pancreas was technically challenging due to its unique anatomical location. The ECV fraction was the quantitative index of extracellular matrix that played a regulatory role in the process of tumor proliferation and invasion. And the production of collagen fibers and the deposition of extracellular matrix could increase the extracellular space in the progression of tissue fibrosis. Therefore, the ECV fraction obtained based on imaging examination could not only avoid invasive examination, but also reflect the status of tumor microenvironment and evaluate the degree of tissue fibrosis. The ECV fraction had the potential to serve as a novel quantitative imaging evaluation index for pancreatic diseases. ConclusionsAccording to the current research status and progress of ECV fraction in pancreatic-related diseases, ECV fraction is increasingly being utilized as a non-invasive biomarker across various pancreatic-related conditions. It holds the potential to predict tumor grading, degree of fibrosis, post-chemotherapy response, cancer patient survival, etc. Consequently, it exhibits promising prospects for clinical application research.