急性胰腺炎大鼠血浆内皮素和一氧化氮水平变化及卡托普利的早期干预作用

目的 观察急性胰腺炎大鼠血浆内皮素、一氧化氮水平变化及血管紧张素转换酶抑制剂卡托普利对其的早期干预作用。方法 63只SD大鼠分对照组、急性胰腺炎组、卡托普利干预组3组进行不同处理。对照组仅作胃窦切开再缝合术；急性胰腺炎组用十二指肠闭襻法制作急性胰腺炎模型；卡托普利干预组在胰腺炎模型制备后立即腹腔注射卡托普利针(5mg／kg)，在病程不同时点测定血浆内皮素、一氧化氮水平，并观察胰腺组织病理学改变。结果 急性胰腺炎组随病变的进展，胰腺炎病理由水肿向出血坏死发展，而内皮素和一氧化氮从两者平行升高逐渐转向内皮素单一升高，致内皮素／一氧化氮比值上升；卡托普利干预组则胰腺炎病理改变减轻，胰腺组织病理学评分降低，且血浆内皮素水平低于急性胰腺炎组，而一氧化氮总体水平与急性胰腺炎组比较差别无显著性意义，内皮素／一氧化氮比值基本与对照组一致。结论 早期应用卡托普利可维持内皮素与一氧化氮平衡，对大鼠急性胰腺炎病变可能有保护作用。     

重症急性胰腺炎33例临床分析

目的　加强对重症急性胰腺炎的认识 ,探讨重症急性胰腺炎的有效治疗方法。方法　对我院 1997～ 2 0 0 3年收治的 3 3例重症急性胰腺炎作回顾性分析。结果　 3 3例病人中 ,治愈 2 8例 ,死亡 5例。行手术治疗 12例 ,死亡 2例 ;行非手术治疗 2 1例 ,死亡 3例。休克和MOF是主要死亡原因。结论　重症急性胰腺炎治疗宜采用手术治疗与非手术治疗并存在的双轨制体系 ,早期以非手治疗为主 ,应严格掌握手术指征。     

急性胰腺炎患者vW因子的变化及其临床意义

目的　探讨急性胰腺炎患者血浆vW因子的变化及其临床意义。方法　采用双抗体夹心固相酶免疫法测定 3 5例急性胰腺炎患者和 3 0名健康献血者的血浆vW因子水平 ,对其进行相关性分析。结果　急性胰腺炎患者入院后 2 4h血浆vW因子水平为 2 15 .0 %± 2 3 .4% ,显著高于正常对照组 10 7.5 %± 2 9.6% (P <0 .0 0 1) ;重症急性胰腺炎患者血浆vW因子显著高于轻型急性胰腺炎患者 (P <0 .0 1) ;血浆vW因子预测重症AP的敏感性、特异性和准确性分别是 91.7%、87.0 %和 88.7%。结论　急性胰腺炎患者存在血管内皮损伤 ;测定急性胰腺炎患者血浆vW因子水平可早期预测病情的严重程度     

善宁治疗急性胰腺炎临床疗效观察

目的:观察人工合成的生长抑素类似物(善宁)治疗急性胰腺炎(AP)的临床疗效.方法:对我院1999～2008年收治的156例AP患者分为治疗组与对照组各78例,对照组采用一般常规治疗方法,治疗组在一般常规治疗的基础上加用善宁0.1 mg,缓慢静脉推注后,继以25μg/h的速度持续静脉滴注,连用7～14天.观察两组腹痛缓解时间;实验室检查:白细胞计数、血淀粉酶、血钙与血糖恢复正常时间,多器官功能障碍(MODS)发生情况,恢复进食的时间.结果:善宁治疗组比对照组明显降低血淀粉酶,减少腹痛缓解时间,降低MODS的发生.结论:善宁能有效改善AP的临床症状,减少并发症.     

异搏定区域动脉灌注在阻止急性胰腺炎重症化治疗中的作用

目的探讨钙拮抗剂异搏定区域动脉灌注在阻止急性胰腺炎重症化治疗中的作用。方法45例轻型急性胰腺炎患者被随机分为3组常规治疗组、静脉治疗组及动脉灌注组。入院后,常规治疗组采取常规保守治疗;静脉治疗组行合理液体治疗,静脉注射异搏定;动脉灌注组液体补充同时采用持续动脉灌注异搏定1~2周。测定治疗后1、4及7d血清肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、黏附分子-1(ICAM-1)及P-选择素(P-selectin)水平。结果治疗后4、7d,血清TNF-α和P-selectin水平动脉灌注组较静脉治疗组及常规治疗组明显降低(P<0.05);血清IL-1β水平动脉灌注组和静脉治疗组均较常规治疗组明显降低(P<0.05);血清ICAM-1水平动脉灌注组明显低于常规治疗组(P<0.05)。结论持续区域动脉灌注异搏定可能通过减少细胞因子的产生,抑制黏附分子P-selectin和ICAM-1的上调,阻止急性胰腺炎重症化发展。     

Current practice patterns in pancreatic surgery: Results of a multi-institutional analysis of seven large surgical departments in germany with 1454 pancreatic head resections, 1999 to 2004 (german advanced surgical treatment study group)

Despite decreasing mortality rates, morbidity is still high after pancreatic head resection. Comparative data in the United States and Europe show a relationship between hospital volume and mortality. Treatment strategies vary frequently, partially because of the lack of evidence-based data. We performed a multi-institutional analysis in Germany evaluating current numbers, indications, techniques, and complication rates of pancreatic head resection. Questionnaires were completed by seven high-volume surgical departments regarding quantitative and qualitative aspects of pancreatic head resections in the period from 1999 to 2004 (five prospective and two retrospective institutional databases). A total of 1454 pancreatic head resections (944 for malignancy) were reported. Mean annual hospital volume ranged from 14 to 52 (10 to 43 in malignancy). Mortality was between 1.1% and 4.8%, morbidity was between 24% and 46%, and pancreatic leakage was between 9% and 20%. In malignant disease, all centers perform standard lymphadenectomy and regard arterial infiltration as a contraindication for resection. However, the rate of portal vein resection varied from 0% to 28%. No consensus is seen on the type of surgery for malignancy and chronic pancreatitis. After resection for pancreatic cancer less than one fourth of the patients receive adjuvant therapy. The results of our analysis in Germany confirm that pancreatic head resection can be performed with low mortality in specialized units. Variations in indications, operative technique, and perioperative care may demonstrate the lack of evidence-based data and/or personal and institutional experience. The low number of patients receiving adjuvant therapy after resection of pancreatic cancer suggests that more efforts must be made to establish novel adjuvant therapies under randomized study conditions. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (oral presentation).     

十二指肠镜下逆行胆胰管造影及取石并发急性胰腺炎6例分析

目的探讨十二指肠镜下逆行胆胰管造影(ERCP)及取石(EST)引发急性胰腺炎的防治方法。方法对该院已行ERCP和EST的42例患者的临床资料进行回顾性分析。结果6例术后并发急性胰腺炎，其中1例死亡。结论ERCP和EST引发急性胰腺炎，主要有两种情况，一是化学刺激引发急性胰腺炎；另一方面为共同通道受阻引发急性胰腺炎，只有在操作中认真防范，术后仔细观察、处理，该并发症是可以防治的。     

吡咯烷二硫氨基甲酸酯对大鼠重症急性胰腺炎的影响

目的　探讨核转录因子 (NF κB)抑制剂吡咯烷二硫氨基甲酸酯 (PDTC)对大鼠重症急性胰腺炎 (SAP)的影响。方法　将 3 6只Wistar大鼠随机分组 :假手术组 (n =6) ,假手术 静脉注射组 (n =6) ,SAP组 (n =12 )和试验组 (n =12 )。各组于造模 6h后 ,测定血清淀粉酶及脂肪酶含量 ,取胰腺组织进行病理学评分 ,采用免疫组织化学法检测NF κB激活水平及胰腺细胞凋亡情况。结果　SAP组和试验组的胰腺细胞内NF κB呈激活状态 ,存在胰腺细胞凋亡 ,与前两组差异有显著性 (P <0 .0 1) ,试验组大鼠的胰腺组织病理学评分、血清淀粉酶及脂肪酶含量、NF κB激活及细胞凋亡水平与SAP组差异存在显著性 (P <0 .0 5 )。结论　在SAP发病机制中 ,NF κB是多种炎症介质的始动因子 ,PDTC可以有效抑制胰腺细胞中NF κB的激活 ,促进胰腺细胞凋亡 ,减少胰酶释放 ,减轻胰腺组织的病理损害。     

Effect of early and late antibiotic treatment in experimental acute pancreatitis in rats

Background The clinical course in acute necrotizing pancreatitis is mainly determined by bacterial infection of pancreatic and peripancreatic necrosis. The effect of two antibiotic regimens for early and late treatment was investigated in the taurocholate model of necrotizing pancreatitis in the rat. Materials and methods Seventy male Wistar rats were divided into five pancreatitis groups (12 animals each) and a sham-operated group (10 animals). Pancreatitis was induced by intraductal infusion of 3% taurocholate under sterile conditions. Animals received two different antibiotic regimes (20 mg/kg imipenem or 20 mg/kg ciprofloxacin plus 20 mg/kg metronidazole) early at 2, 12, 20, and 28 h after induction of pancreatitis or late at 16 and 24 h after induction of pancreatitis or no antibiotics (control). Animals were examined after 30 h for pancreatic and extrapancreatic infection. Results Early and late antibiotic treatment with both regimes could significantly reduce pancreatic infection from 58 to 8–25%. However, extrapancreatic infection was only reduced by early antibiotic therapy. While quinolones also reduced bacterial counts in small and large bowel, imipenem did not. Conclusions In our animal model of necrotizing pancreatitis, early and late treatment with ciprofloxacin/metronidazole and imipenem reduce bacterial infection of the pancreas. Extrapancreatic infection, however, is reduced significantly only by early antibiotic treatment. The effectivity of early antibiotic treatment in the clinical setting should be subject to further investigation with improved study design and sufficient patient numbers.