慢性胰腺炎治疗中外科干预的抉择

慢性胰腺炎是由多种原因引起的胰腺实质弥漫性或局限性病理改变,病变持续发展且呈不可逆性,临床上表现出持续性腹痛,进行性的内、外分泌功能减退,同时出现胰管狭窄和/或扩张,胰石、胰腺潴留性或假性囊肿形成等合并症,因胰头炎性肿块导致胆道、十二指肠梗阻、胰源性门静脉高压等     

《急性胰腺炎诊治指南(2014版)》热点问题解读

近年来,急性胰腺炎(AP)的研究取得了巨大进展,其诊治的很多重要方面发生了明显的变化.2014年,中华医学会外科学分会胰腺外科学组对我国2007年发布的《重症急性胰腺炎诊治指南》进行了修订.修订后的指南,按严重度将AP分为轻症急性胰腺炎(MAP)、中重症急性胰腺炎(MSAP)和重症急性胰腺炎(SAP)三类,后两者主要区别是MSAP器官功能衰竭持续的时间≤48 h,而SAP＞ 48 h.影像学评估采用改良的CT严重指数(MSCTI)评分.局部并发症包括急性胰周液体积聚(APFC)、急性坏死物积聚(ANC)、包裹性坏死(WON)和假性囊肿.病程分期为早期(急性期)、中期(演进期)和晚期(感染期).感染性坏死是手术指征,无症状的无菌性坏死无需手术.手术须遵循延迟原则.手术方式包括经皮穿刺引流(PCD)、微创手术及开放手术,这些术式可单独或联合应用.     

缺氧微环境对胰腺癌细胞发生上皮向间叶转化的诱导作用

Objective To investigate whether hypoxic environment can promote the metastasis of pancreatic cancer cells by inducing epithelial to mesenchymal transition (EMT). Methods The Panc-1 cells were cultured in hypoxia environment. After cultured for indicated periods, the in vitro invasive ability of Pane-1 cells was compared with normoxia group using Transwell invasion assay. The epithelial marker E-cadherin and the mesenchymal marker vimentin were assayed by Western blot. The expression of Snail, a strong activator of EMT, was detected by real-time PCR. The HIF-1 α encoding cDNA was transiently trans-fected into the Pane-1 cells, and the E-cadherin and vimentin were analyzed. Results The number of cells invading to the lower side of the membrane under hypoxia was ( 121±5 ), whereas only ( 84±3 ) in no-morxia group ( P < 0.05 ). The relative expression of E-cadherin in normoxia, hyoxia groups at 12,24,48 hwas (0.59±0.04 vs 54.00±0.05,0.45±0.10,0.36±0.03 ), and that of vimentin was (0.36±0.05, 0.41±0.04,0.48±0.06,0.58±0.05 ) ( P < 0.05 ). The relative expression of Snail mRNA was in-creased in hypoxia environment, and the difference was significant after 72 h ( P < 0.05 ). Before and after HIF-1α cDNA was transfected into the Panc-1 cells, the relative expression of E-cadherin was 0.63± 0.05, and 0.47±0.07, and that of vimentin was 0.47±0.07, and 0.32±0.04 respectively ( P < 0.05 ). Conclusion Hypoxia microenvironment can activate HIF-1α and Snail to trigger EMT of pancreatic cancer cells.     

胰腺囊性肿瘤的诊断与治疗——附41例报告

目的探讨胰腺囊性肿瘤的诊断和治疗。方法对本院1990年6月至2004年6月收治的41例胰腺囊性肿瘤患者的临床特点进行回顾性分析。结果胰腺囊性肿瘤好发于中青年女性，无急性胰腺炎，无上腹部手术及外伤史。临床表现以上腹部肿块和疼痛不适较为多见。影像学检查胰腺肿块为囊性，囊实性或不规则分叶状。肿瘤位于胰头部14例，胰体尾部27例。行不同术式的肿瘤切除35例，内引流3例，剖腹探查、肿瘤活检2例，1例拒绝于术治疗。有效随访34例，随访12个月～13年，22例囊腺瘤，17例仍生存；12例囊腺癌，生存时间〈12个月2例，12个月至2年4例，6例健在，其中5年以上3例，最长1例已生存7年。结论提高对胰腺囊性肿瘤的认识，减少误诊和积极的手术切除是改善其预后的主要措施。     

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慢性胰腺炎(chronic pancreatitis,CP)发病率逐年增加,为了规范慢性胰腺炎的诊断和治疗,提高多学科综合诊治水平,中华医学会外科学分会胰腺外科学组对2008年制定的《慢性胰腺炎诊治指南(讨论稿)》予以修订。本次修订在原版本基础上,参照国际相关指南和最新研究成果,依据流行病学资料、循证医学证据和临床基础研究结果,结合近年来国内外在慢性胰腺炎诊治领域的进展,经中华医学会外科学分会胰腺外科学组全体成员大会共同讨论审阅,     

胰腺神经内分泌肿瘤治疗指南(2014)

胰腺神经内分泌肿瘤(pancreatic neuroendocrine neoplasms,p NENs)原称为胰岛细胞瘤,约占原发性胰腺肿瘤的3%。依据激素的分泌状态和患者的表现,分为功能性和无功能性神经内分泌肿瘤。无功能性p NENs占75%~85%;功能性p NENs常见的有胰岛素瘤和胃泌素瘤,胰岛素瘤一般位于胰腺,而胃泌素瘤多见于十二指肠或胰腺。其余的功能性p NENs均少见,统称为罕见功能性胰腺神经内分泌肿瘤(rare functional pancreatic neuroen-     

Etiology,Pathology, Management and Prognosis of Chronic Pancreatitis in Chinese Population: A Retrospective Study

The purpose of this study was to investigate the etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population. The clinical data of 142 patients with chronic pancreatitis were retrospectively studied. All patients were of Chinese nationality and hospitalized from January 2008 to December 2011. Their ages ranged from 14 to 76 years, with a mean of 43 years. Of 142 patients, there were 72 cases of obstructive chronic pancreatitis(50.70%), 19 cases of alcoholic chronic pancreatitis(13.38%), 14 cases of autoimmune pancreatitis(9.86%) and 37 cases of undetermined etiology(26.06%). Pathologically, the average inflammatory mass diameter was 3.8±3.3 cm, biliary obstruction occurred in 36 cases, gall stones in 70 cases, calcification in 88 cases, ductal dilatation in 61 cases, side branch dilatation in 32 cases, ductal irregularity in 10 cases, lymphocytic inflammation in 23 cases, obliterative phlebitis in 14 cases, extra pancreatic lesion in 19 cases and fibrosis in 142 cases. Location of pancreatic lesion in the region of head(n=97), neck(n=16), body(n=12), tail(n=15) and whole pancreas(n=2) influenced the choice of surgical procedures. Ninety-four patients(66.20%) received surgical treatment and 33.80% received other treatments. After operation, 80.85% of 94 patients experienced decreased pain, and 8.51% of 94 showed recovery of endocrine function but with a complication rate of 12.77%. All the operations were performed successfully. According to the pain scale of European Organization for Research and Treatment of Cancer(QLQ-C30) a decrease from 76±22 to 14±18 was observed. Etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population vary from others.     

重症急性胰腺炎治疗模式的历史变迁与疗效的突破

重症急性胰腺炎(serious acute pancreatitis,SAP)作为一种特殊类型的外科急腹症,历史上其治疗经历了多次在其早期倾向于保守或外科手术之间的钟摆式徘徊阶段.而每一个阶段对SAP的认识和治疗模式的变革,都在一定程度上提高了SAP的疗效.与上世纪70年代前SAP超过50%的总体病死率相比,近年来已降至10%～20%.应当说,SAP疗效取得了质的突破.回顾SAP认识和治疗变迁的历史,每一次认识和观点的变革、技术的进步以及疗效的改善,都是在实践、探索、认识和总结经验的基础上逐步实现的.而每一次学术界讨论的内容又集中地反映了在SAP认识和治疗方案与技术的进步上,这也正是SAP治疗效果不断提高的关键所在.     

1-甲基色氨酸对胰腺癌荷瘤鼠中调节性T细胞数量变化的影响

目的 观察1-甲基色氨酸(1-MT)对胰腺癌荷瘤鼠中调节性T细胞(Treg)数量变化的影响,比较树突状细胞(DC)疫苗与1-MT联合应用前后抗肿瘤作用的强弱.方法 建立小鼠胰腺癌模型;利用流式细胞术检测荷瘤鼠应用1-MT前后肿瘤组织周围引流淋巴结(TDLNs)及脾脏中CD4~+ CD25~+T细胞占CD4~+T比例;荧光定量聚合酶链反应(PCR)测量Foxp3在TDLNs及脾脏mRNA水平;利用肿瘤细胞裂解物冲击DC制备DC疫苗,并根据是否与1-MT联合应用分组(各组均为n=8);观测各组肿瘤体积的差异.结果 应用1-MT后,荷瘤鼠CD4~+ CD25~+ T细胞占CD~+T细胞的比例明显低于未应用组(TDLNs)分别为(16.01±2.21)%和(25.00±2.16)%(P<0.05);脾脏分别为(13.11±1.93)%和(22.14±2.33)%(P<0.05,P<0.01);应用1-MT组Foxp3 mRNA表达水平显著低于未应用组,应用1-MT组相对表达值:TDLNs0.947±0.216、脾细胞1.198±0.347,而未应用组分别为:1.927±0.256、1.798±0.237(P<0.05);1-MT+DC疫苗组肿瘤生长显著受到抑制,第36天肿瘤体积为(789.0±111.0)mm~3;显著小于DC疫苗组、1-MT组及对照组,肿瘤体积分别为:(1768.0±251.3)、(1854.0±192.1)、(1899.0±201.2)mm~3(P<0.01).结论 1-MT可以有效抑制胰腺癌荷瘤鼠癌组织周围引流淋巴结及脾脏CD4~+ CD25~+ Treg细胞的数量增加,从而增强DC疫苗抗肿瘤作用.