Objective To investigate clinicopathologic features, pathogenesis, and diagnosis and treatment of hereditary pancreatitis (HP). Method The relevant literatures on HP research in recent years were searched and reviewed. Results The HP was similar to the pancreatitis caused by the cholelithiasis, excessive alcohol consumption, hyperlipidemia, etc. in the histomorphology, function, and clinical manifestations and it was difficult to be distinguished. However, HP was different from the other types of chronic pancreatitis due to its early onset, familial, and high risk of pancreatic cancer. The HP was mainly caused by the PRSS1 mutations, and its mutation types mainly included the R122H, N29I, A16V, K23R, etc., among which the R122H and N29I were the two most common types of mutations. There was no specific treatment for the HP. The principles of treatment of HP were similar to the pancreatitist caused by other etiologies, including the nutritional support, blood sugar control, analgesia, etc.. In addition to the medical treatment, the surgical intervention was also the important means for the treatment of HP, including the pancreatic partial resection, total pancreatectomy or total pancreatectomy combined with islet cell autografting. Conclusions HP is an autosomal dominant hereditary disease characterized by recurrent attacks of pancreatitis. Relevant gene tests could be performed for patient with highly suspected HP. It faces great challenges in treatment of HP. Pathogenesis of HP needs to be constantly explored and experimental study of multicenter and large sample needs to be further studied in order to determine its best treatment strategy.
ObjectiveTo explore the advantages and disadvantages of duodenum-preserving pancreatic head resection (DPPHR) in the clinical application of pancreatic surgical diseases, and to summarize the progress of minimally invasive application of DPPHR combined with the current application of laparoscopy and robot surgery in pancreatic surgery. MethodThe related research literatures about DPPHR at home and abroad in recent years were searched and reviewed. ResultsThe effect of DPPHR compared with traditional pancreaticoduodenectomy (PD) for treatment of benign pancreatic diseases was still controversial, and the postoperative remission effect, perioperative period, occurrence of long-term complications and improvement of quality of life were not very advantageous compared with PD, and the prognosis of minimally invasive surgery was poor. ConclusionDPPHR remains highly controversial for surgical intervention in benign pancreatic disease and has enormous scope for advances in minimally invasive surgical applications in pancreatic surgery, but more clinical studies are needed to verify its clinical efficacy.
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.
Objective To study effects of Helicobacter pylori on oncogenesis and progression of pancreatic cancer. Method The current literatures on the relationship between the Helicobacter pylori and the pancreatic cancer were collected and reviewed. Results The Helicobacter pylori infection might play a role in the development of the pancreatic cancer. The infection rate of the Helicobacter pylori in the patients with pancreatic cancer is higher than that of the healthy controls; furthermore, in the patients with Helicobacter pylori antibody positive, the infection rate of the Helicobacter pylori in the cytotoxin-associated gene A-negative strains of Helicobacter pylori is significantly higher than that of the healthy controls. Conclusions Helicobacter pylori infection is related to occurrence and development of pancreatic cancer. Specific mechanism is still not clarified and further research is need to study.
Objective To investigate the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of acute obstructive suppurative pancreatic ductitis (AOSPD). Method The literature reports on AOSPD at home and abroad were reviewed and analyzed comprehensively based on clinical experience. Results AOSPD was a rare clinically infectious disease of purulent pancreatic duct. Chronic pancreatitis and ampullary operations were the main pathogenesis factors. The clinical symptoms were non-specific, and the imaging manifestations were pancreatic duct dilatation and pancreatic duct calculi. The clinical diagnosis was mainly determined by epigastrium CT or endoscopic retrograde cholangiopancreatography, which was easy to be misdiagnosed and missed. Conclusion The clinical diagnosis of AOSPD is difficult, early pancreatic duct drainage is the key to the treatment, and attention should be paid to its diagnosis and treatment.
ObjectiveTo investigate the etiology of pediatric pancreatitis and the effect of endoscopic retrograde cholangiopancreatography (ERCP) in it. MethodsPatients hospitalized for pancreatitis in West China Hospital of Sichuan University from Jan. 2008 to Jun. 2023 were included according to the inclusion and exclusion criteria. Totally, 241 cases (207 cases with acute pancreatitis and 34 with chronic pancreatitis) were included. Patients were divided into primary group (n=168) and recurrent group (n=73) according to their previous medical history. ResultsThe duration of hospitalization in the primary group was longer than that in the recurrent group [10.0 (7.0, 16.0) d vs. 7.5 (6.0, 11.8) d, P=0.012]. The proportion of acute pancreatitis in primary group (163/168, 97.0%) was higher than that in the recurrent group (44/73, 60.3%), P<0.001. There was no significant difference in the etiological component ratio between the primary and recurrent groups (χ2=7.504, P=0.347). However, in the primary group, the first etiology was biliary factors (38/163, 23.3%), and the second was biliary pancreatic anatomic abnormality (22/163, 13.5%). In the recurrence group, biliary pancreatic anatomic abnormality (13/44, 29.5%) was the first cause, and biliary factor (7/44, 15.9%) was the second cause. Among 207 cases with acute pancreatitis, there were 114 cases (55.1%) with clear etiology, including 45 cases (21.7%) of biliary factors, 35 cases (16.9%) of abnormal biliary pancreatic structure, 12 cases (5.8%) of traumatic factors, and 10 cases (4.8%) of drug-induced factors. In this study, 66 cases were treated with ERCP for pancreatitis, and a total of 103 ERCP operations were performed with cannulation success rate of 100%. Twenty-three cases (23/37, 62.2%) of acute pancreatitis resulted from biliary and biliary pancreatic structure abnormalities received ERCP. In biliary acute pancreatitis, the removal rate of choledocholithiasis in single ERCP operation was 80.0% (8/10). The clinical symptoms (abdominal pain, jaundice, and fever) of all cases were significantly improved after surgery, and no complications such as cholangitis, bleeding and perforation occurred. ConclusionsBiliary, congenital pancreatic anatomical abnormalities, drugs and trauma are the common causes of acute pancreatitis in children. ERCP is a safe and effective treatment for children with biliary pancreatitis, pancreatic anatomical abnormalities, and chronic pancreatitis.
Objective To summarize current research advances of mechanism and treatment of pancreatic endocrine and exocrine insufficiency in chronic pancreatitis. Method The related literatures about the research progress of the pancreatic endocrine and exocrine insufficiency in the chronic pancreatitis in recent years were retrieved and reviewed. Results In recent years, it had many new studies and discoveries on the pancreatic endocrine and exocrine insufficiency in the chronic pancreatitis. The mechanism of the pancreatic exocrine dysfunction was mainly due to the decrease of the pancreatin secretion in the patients with chronic pancreatitis. The mechanism of the pancreatic endocrine insufficiency was mainly due to the damage of the pancreatic exocrine gland and islet tissue in the chronic pancreas, which leaded to the destruction of the pancreatic endocrine cells, the other endocrine cells, and the disturbance of the intestine-islet axis, followed by the disorder of the various hormones (insulin, glucagon, pancreatic polypeptide, etc.), and eventually manifested the glucose tolerance or dominant diabetes. Conclusions At present, although there is a certain degree understanding for pancreatic endocrine and exocrine insufficiency in chronic pancreatitis, there are no breakthroughs in its mechanism and treatment, and effect is lack of large sample and multicenter clinical control study. Exploring more optimized detection methods and establishing a perfect treatment system is goal of future development and research.
The surgical treatment of chronic pancreatitis, benign, borderline and low-grade malignant tumors of the pancreatic head is definite in effect. How to preserve more functional organs is the focus of such surgeries. The duodenum, common bile duct and Oddi’s sphincter-preserving pancreatic head total resection (DCOPPHTR) surgical method pioneered by the author team has theoretical advantages compared to other surgical methods. However, due to the difficulty of surgical operation and higher requirements for surgeons, its widespread application is limited. By elaborating on the invention principle and evolution process of this surgery, analyzing the key steps in detail and showing the clinical effects, the author proves that DCOPPHTR is safe and effective and has higher clinical application value.
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.
Objective To explore changes and challenges on management of chronic pancreatitis. Methods The updated clinical guidelines and the latest research findings were collected and reviewed. Results The proposition of a new mechanistic definition and identification of an early stage give us a novel insight into chronic pancreatitis. The intraductal pancreatic calcifications has been regarded as the most reliable ultrasonography and CT features of chronic pancreatitis. In addition, the endoscopic ultrasonography is also of great value. The present surgical strategies are established on the concepts of step-up approach and damage control. The surgery perform better than the endoscopic treatment in the long-term outcome, but the timing course of surgery need to be further investigated. Conclusions Early diagnosis and treatment plays a critical role in cases of chronic pancreatitis. More patients of chronic pancreatitis should be treated in a multidisciplinary team as future perspectives.