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1.
目的:探讨术前计算机断层扫描(computed tomography,CT)对患者胰十二指肠切除(pancreaticoduodenectomy,PD)术后发生胰瘘的预测效果.方法:回顾性分析2011-01/2014-06武警浙江省总队嘉兴医院收治的60例行标准PD手术的患者的临床和影像学资料,将患者分为发生胰瘘组和未发生胰瘘组,对术后发生胰瘘的患者根据胰瘘的严重程度分为A级、B级、C级.比较各组的胰体部C T值、胰体部/腹主动脉的CT比值、胰管直径、胰腺厚度,采用简单线性相关分析各CT检查结果与胰瘘的严重程度分级的相关性,并采用受试者工作特征(receiver operation characteristic,ROC)曲线下面积评价其对PD术后发生胰瘘的预测价值.结果:60例患者术后共发生胰瘘12例,发生率为20.0%,其中A级7例,B级3例,C级2例.发生胰瘘组的胰体部CT值、胰体部/腹主动脉CT值、胰管直径显著低于未发生胰瘘组,胰腺厚度显著高于未发生胰瘘组,差异均具有统计学意义(P0.05).三个等级的胰瘘患者的各CT检查结果比较,差异均有统计学意义(F=9.658,8.730,8.931,10.050,P0.05).胰瘘严重程度与胰体部CT值、胰体部/腹主动脉的CT比值、胰管直径呈负相关,与胰腺厚度呈正相关(P0.05).胰体部CT值、胰体部/腹主动脉的CT比值、胰管直径、胰腺厚度的曲线下面积分别为0.820、0.794、0.809、0.765.结论:术前CT扫描对PD术后胰瘘的发生具有一定的预测价值,建议综合各指标进行调整术中的吻合方法和围手术期的管理措施,达到减少术后胰瘘发生风险、改善患者预后的目的.  相似文献   

2.
胰十二指肠切除术后胰瘘的预防与治疗   总被引:1,自引:0,他引:1  
目的探讨胰十二指肠切除术后胰瘘的预防与治疗。方法回顾性分析1995至2005年行胰十二指肠切除术的85例患者的临床资料,对胰瘘的预防与治疗方法进行分析总结。结果胰瘘发生率为12.94%(11/85),其中胰管外引流者1例,内引流者10例;胰瘘的发生与吻合技术、残胰断面的处理以及胰实质的坚硬度、胰管的直径有关;胰管内引流可预防胰十二指肠切除术后胰瘘。结论胰管内引流和良好的胰切面血供是预防胰十二指肠切除术后胰瘘的关键。通畅引流与肠内营养对治疗胰十二指肠切除术后胰瘘有重要作用。  相似文献   

3.
目的 探讨胰十二指肠切除术后胰瘘的预防与治疗.方法 回顾性分析1995至2005年行胰十二指肠切除术的85例患者的临床资料,对胰瘘的预防与治疗方法进行分析总结.结果 胰瘘发生率为12.94%(11/85),其中胰管外引流者1例,内引流者10例;胰瘘的发生与吻合技术、残胰断面的处理以及胰实质的坚硬度、胰管的直径有关;胰管内引流可预防胰十二指肠切除术后胰瘘.结论 胰管内引流和良好的胰切面血供是预防胰十二指肠切除术后胰瘘的关键.通畅引流与肠内营养对治疗胰十二指肠切除术后胰瘘有重要作用.  相似文献   

4.
肿瘤直径小于2cm 的胰癌为小胰癌。本文着重介绍小胰癌的临床特点及胰癌组织学分类方法,并评价某些肿瘤标记物及胰腺影象方法对小胰癌的诊断意义。手术切除、放疗,化疗和温热疗法乃是目前治疗胰癌的主要手段。  相似文献   

5.
胰十二指肠切除术能否进行在于探查, 关键在对胰颈与纤维板的探查和判定; 胰颈与纤维板的切除, 直接决定该手术能否成功以及疗效, 特别对胰头癌患者, 尤为重要. 本文详尽介绍胰颈与纤维板切除的方法、技巧和各种困难情况的处理.  相似文献   

6.
目的 分析胰十二指肠切除术后胰瘘发生的危险因素,为临床有效降低术后并发症提供理论依据.方法 回顾性分析2009年9月至2012年9月上海交通大学医学院附属仁济医院收治的352例因癌症行胰十二指肠切除术患者的临床资料,根据术后有无发生胰瘘将患者分为胰瘘组和非胰瘘组进行对列研究.对围手术期可能影响术后发生胰瘘的多种因素进行单因素分析及多变量Logistic回归分析.结果 共49例胰十二指肠切除术后发生胰瘘,胰瘘发生率为13.9% (49/352).经单因素及多因素分析,术后胰瘘的发生与患者性别和年龄、糖尿病病史、手术时间、术中出血量、是否血管切除重建、胰管是否留置支撑管、胰肠吻合时间、消化道重建方式等均无关;而胰腺质地脆、胰管直径<3 mm、术前血清总胆红素水平> 171 μmol/L、术前黄疸持续时间超过8周、术前血清白蛋白水平<30 g/L是影响术后胰瘘发生的独立危险因素(P值均<0.05).结论 胰腺质地、胰管直径、术前黄疸程度、黄疸持续时间及低蛋白血症是影响胰十二指肠切除术后胰瘘发生的危险因素.  相似文献   

7.
脂肪胰是与肥胖和代谢综合征密切相关的胰腺脂肪沉积。目前尚无脂肪胰的诊断、评估和治疗等标准或共识。脂肪胰在流行病学、高危因素、对全身代谢相关疾病的影响方面,与非酒精性脂肪性肝病(NAFLD)联系密切。该文综述了脂肪胰和NAFLD的病理生理机制及两者之间关系的研究进展,为进一步明确脂肪胰的发病机制、诊断和评估标准提供线索。  相似文献   

8.
胰头癌的MRCP临床应用研究   总被引:1,自引:0,他引:1  
本文研究探讨胰胆管磁共振水成像(MRCP)对胰头癌的临床诊断意义。通过经手术和病理证实的21例胰头癌病例的术前胰胆管磁共振水成像表现,应用MRCP扫描,扫描序列包括SE序列T1WI、FSE序列T2WI、T1WIFS、T2WIFS、MRCP冠状位扫描成像。21例胰头癌胰胆管磁共振水成像上,均有胆总管胰头段及主胰管胰头段因癌瘤侵袭而破坏截断和其残留段扩张的征象。20例胰头癌通过胰胆管磁共振水成像扫描确诊,1例胰头癌误诊为慢性胰头炎。  相似文献   

9.
<正>MODY 8是MODY家族中一个比较特殊的类型,同时伤害着胰腺的外分泌和内分泌。从发生学上看,胰腺衍生于发育中的胃尾侧的内胚层。在内胚层发育增生过程时,分别向背侧和腹侧形成2个不同结构~([1]),一个偏下方的腹胰,一个偏上方的背胰,背胰形成胰腺的大部分:胰头、胰体、胰尾,腹胰形成胰头的一部分。胰腺外分泌腺泡顶部含  相似文献   

10.
该胰切除术是胰头十二指肠和胰尾部切除的术式,是为了减少术后机能障碍和不良主诉,确立保存邻近胃和脾的术式。作者在1981~1984年施行28例胰切除术,其中15例(胰岛癌2例、慢性胰腺炎13例)是保存脾的胰尾切除;13例(胰头癌4例、慢性胰腺炎9例)是保存胃幽门的胰头十二指肠切除术。前者从胰把脾动静脉剥离保存脾脏;后者保存右胃大网动静脉。距离幽门3cm肛侧切除十二指肠,再次建立胰空肠端端吻合,  相似文献   

11.
The effects of a 60% partial pancreatectomy were studied in hyperglycemic GK (Goto-Kakizaki) rats. Partial pancreatectomy or a sham operation was performed on 12-week-old female Wistar rats, GK rats or hybrids between male GK rats and female Wistar rats. Measurements of pancreatic blood flow and islet blood flow were performed by a microsphere technique 2 weeks after surgery. Glucose tolerance was decreased in hybrid compared with Wistar rats, and in GK rats compared with both hybrid and Wistar rats before surgery. Partial pancreatectomy induced minor changes in glucose tolerance. Wistar rats had a decreased islet mass following partial pancreatectomy. Both hybrid and GK rats showed a significant decrease in relative islet volume, but only GK rats in total islet mass, compared with Wistar rats 2 weeks after surgery. Pancreatic blood flow and islet blood flow did not significantly differ between sham-operated Wistar, hybrid or GK rats. After partial pancreatectomy, islet blood flow in relation to islet mass increased 3-fold in Wistar rats and 2-fold in hybrid rats. In contrast, GK rats showed no increase in islet blood flow following partial pancreatectomy. It is concluded that compensatory mechanisms after partial pancreatectomy are operating less efficiently in hybrid and GK rats.  相似文献   

12.
The high- and low-avoidance animal (HAA and LAA respectively) strains of Hatano rats were originally selected and bred from Sprague-Dawley rats for their performance in the shuttle-box task. The present study focused on the activity of the hypothalamo-pituitary-adrenocortical (HPA) axis of HAA and LAA rats in response to restraint stress. The restraint stress induced an elevation in plasma concentrations of ACTH, prolactin, corticosterone and progesterone. Peak levels of plasma ACTH during stress conditions were significantly higher in HAA rats than in LAA rats, while peak levels of prolactin were significantly lower in HAA rats than in LAA rats. Under stress conditions, ACTH and prolactin synthesis in the anterior pituitary glands was significantly higher in HAA rats compared with LAA rats. The peak plasma concentrations of corticosterone, during restraint stress, were significantly higher in LAA rats compared with HAA rats. These results indicate that the response of the hypothalamo-pituitary axis to acute restraint stress is greater in HAA rats than in LAA rats, whereas the ACTH-induced adrenal response of corticosterone release is higher in LAA rats than in HAA rats. On the other hand, prolactin secretory activity is higher in LAA rats compared with HAA rats. These differences in endocrine responses to stress may be involved in the regulation of the avoidance responses in the shuttle-box task.  相似文献   

13.
The pulsatile patterns of LH and PRL secretion, and effects of stress on these patterns were examined in ovariectomized normotensive Wistar, spontaneously hypertensive, and genetically matched normotensive Wistar Kyoto rats. Judged by the overall mean of PRL concentrations, PRL levels in spontaneously hypertensive rats were not different from those in Wistar Kyoto rats, but the pulse amplitudes as well as the overall mean concentrations were significantly greater in both Wistar Kyoto and spontaneously hypertensive rats than in Wistar rats. Increases in PRL release during immobilization stress in spontaneously hypertensive rats occurred earlier than in Wistar rats, but the peak levels were not different between the two animal groups, though significantly lower in Wistar Kyoto rats than in Wistar rats. Overall mean of LH concentrations was higher, but pulse amplitude was smaller in spontaneously hypertensive rats than in Wistar Kyoto rats, and in both groups significantly smaller than in Wistar rats. The decrease in LH release owing to stress was similar in all animal groups. A significant association between LH and PRL peaks was evident in all animals, although the rate of association was lowest in Wistar Kyoto rats. In conclusion, the central nervous system mechanisms for both LH and PRL secretion differ markedly in both spontaneously hypertensive and Wistar Kyoto rats from those in Wistar rats, and no specific difference was found in spontaneously hypertensive rats compared with Wistar Kyoto and Wistar rats as controls.  相似文献   

14.
目的 研究葛根素对糖尿病大鼠糖基化终产物 (AGEs)水平和单核细胞趋化蛋白 1(MCP 1)表达的影响。方法 将大鼠随机分为正常对照组 (CON)、糖尿病组 (DM )、糖尿病氨基胍治疗组 (AG )和糖尿病葛根素治疗组 (PU )。腹腔注射链脲佐菌素诱导糖尿病模型 ,检测血清中AGEs(荧光法 )和MCP 1(ELISA)水平 ;病理切片PAS染色及电镜观察肾组织的病理改变。免疫组化检测肾皮质MCP 1的蛋白表达水平。结果 DM组血清AGEs和MCP 1水平较PU组和AG组明显增高 (均P <0 .0 5 ) ;电镜发现两个治疗组的肾小球基底膜和心肌细胞病理改变程度比糖尿病组轻 ;肾小球内皮细胞和系膜区MCP 1免疫组化染色阳性细胞数明显比糖尿病组少。结论 葛根素能降低糖尿病大鼠血清AGEs和MCP 1水平 ,减少肾皮质中MCP 1的表达 ,减轻肾脏和心肌的病变程度  相似文献   

15.
The influence of brain cholinergic activation on hepatic glycogenolysis and gluconeogenesis was studied in fed and 48-hour fasted rats. Neostigmine was injected into the third cerebral ventricle and hepatic venous plasma glucose, glucagon, insulin, and epinephrine were measured. The activity of hepatic phosphorylase-a and phosphoenolpyruvate-carboxykinase (PEP-CK) was also measured. Experimental groups: 1, intact rats; 2, rats infused with somatostatin through the femoral vein; 3, bilateral adrenodemedullated (ADMX) rats; 4, somatostatin infused ADMX rats; 5, 5-methoxyindole-2-carboxylic acid (MICA) was injected intraperitoneally 30 minutes before injection of neostigmine into the third cerebral ventricle of intact rats. MICA treatment completely suppressed the increase in hepatic glucose in fasted rats, but had no effect in fed rats. Phosphorylase-a activity was not changed in fasted rats, but increased in fed rats, intact rats, somatostatin-infused rats, somatostatin-infused ADMX rats, and ADMX rats in that order. PEP-CK was not changed in fed rats, but increased at 60 and 120 minutes after neostigmine injection into the third cerebral ventricle in fasted rats. We conclude that, in fed states, brain cholinergic activation causes glycogenolysis by epinephrine, glucagon, and direct neural innervation. In fasted states, on the other hand, gluconeogenesis is dependent on epinephrine alone to increase hepatic glucose output.  相似文献   

16.
The circadian variations in the hemodynamics and locomotor activity (ACT) of congenic rats derived from stroke-prone spontaneously hypertensive (SHRSP) rats and Wistar-Kyoto (WKY) rats have not been studied in detail. We used radio telemetry and the maximum entropy method to examine these variations. The systolic arterial pressure of the congenic rats was intermediate between those of the SHRSP rats and WKY rats, while their heart rate was lower than that of the SHRSP rats. The congenic rats also showed the highest ACT. The circadian variations in the heart rates of the congenic rats were more like those of the WKY rats, and the variations in their ACT were more similar to those of the SHRSP rats.  相似文献   

17.
复制大鼠异位心脏移植模型100例的体会   总被引:1,自引:1,他引:0  
目的 :总结复制大鼠腹腔异位心脏移植模型的体会。方法 :健康远交系Wistar大鼠为供体 ,SD大鼠为受体 ,各 10 0只。供心的升主动脉及主肺动脉分别与受体的腹主动脉和下腔静脉做端侧吻合 ,将供心移植于受体的腹腔内。结果 :共建立 10 0例大鼠异位心脏移植模型 ,供心缺血时间 (30± 5 )min ,手术成功率 91%。结论 :手术成功的关键 :1.麻醉剂量合适 ;2 .注意供心的保护 ,缩短供心缺血时间 ;3.提高血管吻合质量 ,避免吻合口出血及血流不通畅 ;4 .术后保温 ,纠正酸中毒  相似文献   

18.
We investigated the specific and associated effects of insulin and glucose on beta-cell growth and function in adult rats. By combining simultaneous infusion either of glucose and/or insulin or glucose and diazoxide, three groups of rats were constituted: hyperglycemic-hyperinsulinemic rats (high glucose-high insulin), hyperglycemic-euinsulinemic rats (high glucose), and euglycemic-hyperinsulinemic rats (high insulin). All the infusions lasted 48 h. Control rats were infused with 0.9% NaCl (saline controls). In all groups, beta-cell mass was significantly increased, compared with controls (by 70% in high glucose-high insulin rats, 65% in high glucose rats, and 50% in high insulin rats). The stimulation of neogenesis was suggested by the high number of islets budding from pancreatic ducts in high glucose-high insulin and high glucose rats and by the presence of numerous clusters of few beta-cells within the exocrine pancreas in high insulin rats. beta-Cell hypertrophy was observed only in high glucose-high insulin rats. The rate of beta-cell proliferation was similar to that of controls in high glucose-high insulin rats after a 48-h glucose infusion, dropped dramatically in high insulin rats, and dropped to a lesser extent in high glucose rats. In high glucose-high insulin and high glucose rats, beta-cell mass increase was related to a higher beta-cell responsiveness to glucose in vitro as measured by islet perifusion studies, whereas in high insulin rats, no significant enhancement of glucose induced insulin secretion could be noticed. The data show that glucose and insulin may have specific stimulating effects on beta-cell growth and function in vivo in adult rats independently of the influence they exert each other on their respective plasma concentration.  相似文献   

19.
We compared pancreatic exocrine secretion in 5-month-old WBN/Kob rats, a model of chronic pancreatitis, with that in Wistar rats of the same age in a conscious state. Basal pancreatic secretion and pancreatic wet weight in WBN/Kob rats were lower than the values for Wistar rats. There was no difference in plasma cholecystokinin (CCK) concentration between the two types of rats. When CCK-8 was intravenously administered, the stimulation of pancreatic protein secretion in WBN/Kob rats was weaker than that in Wistar rats. When bile and pancreatic juice were diverted from the duodenum, the resulting increase in the plasma CCK concentration was similar in both types of rats, but stimulation of the volume and protein output of pancreatic juice in WBN/Kob rats was weaker than that in Wistar rats. In addition, WBN/Kob rats exhibited little increase in pancreatic wet weight because of this diversion. When secretin was intravenously administered, the stimulation of fluid secretion in WBN/Kob rats was also weaker than that in Wistar rats. The binding of CCK-8 to pancreatic membrane fractions in WBN/Kob rats was much weaker than that in Wistar rats. Histological findings in WBN/Kob rat pancreas showed proliferation of fibrous tissue and atrophy of acinar cells. In conclusion, pancreatic exocrine secretion in response to the gastrointestinal hormones, CCK and secretin, was lower in WBN/Kob rats than in Wistar rats. These findings suggest that the hyposecretion of pancreas in WBN/Kob rats is hyporeaction of pan-creatic membrane to gastrointestinal hormones. (Received Feb. 5, 1997; accepted July 25, 1997)  相似文献   

20.
Diabetes is generally accompanied by abnormal levels of growth hormone and adrenal steroids, hormones known to modulate postpneumonectomy (post-PNX) compensatory lung growth. Thus, we examined the possibility that diabetes may affect post-PNX lung growth processes. Left PNX was performed in young diabetic rats (streptozotocin-induced; 75 mg/kg body weight) (DM-PNX) and in control rats (C-PNX), for comparison with sham-operated control rats (C-SHAM). The rats were permitted free access to food and water. Examination at day 7 after surgery showed that right lung absolute dry weight and absolute DNA, collagen and elastin contents were increased in C-PNX and DM-PNX rats (but only C-PNX values reached those of both lungs in C-SHAM rats). Body weights (BW) of DM-PNX rats were lower than those of C-PNX and C-SHAM rats. Lung DNNBW in C-PNX and DM-PNX rats were comparable, and matched values for both lungs in C-SHAM rats. Lung dry weight/BW, collagen/BW, and elastin/BW in DM-PNX rats exceeded values in C-PNX rats and even more for values of both lungs in C-SHAM rats. Data of another experiment, comparing DM-PNX rats with body weight-matched (by food limitation) PNX and control rats (WMC-PNX and WMC-SHAM rats, respectively) indicated comparable lung absolute DNA contents in DM-PNX and WMC-PNX rats (which matched values for both lungs in WMC-SHAM rats), however, lung absolute collagen and elastic contents were greater in the DM-PNX rats. These findings demonstrate that an underlying diabetic state per se does not prevent post-PNX compensatory hyperplastic lung growth, but can result in increased connective tissue contents. © 1995 Wiley-Liss, Inc.  相似文献   

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