Cystic tumors of the pancreas: Opportunities and risks

Pancreatic cystic neoplasms(PCNs) are a high prevalence disease. It is estimated that about 20% of the general population is affected by PCNs. Some of those lesions can progress till cancer, while others behave in a benign fashion. In particular intraductal papillary mucinousneoplasms of the pancreas can be considered as the pancreatic analogon to colonic polyps. Treatment of these precursor lesions at an early stage can potentially reduce pancreas cancer mortality and introduce a new "era" of preemptive pancreatic surgery. However, only few of those lesions have an aggressive behavior. The accuracy of preoperative diagnosis, i.e., the distinction between the various PCNs is around 60%, and the ability to predict the future outcome is also less accurate. For this reason, a significant number of patients are currently over-treated with an unnecessary, high-risk surgery. Furthermore, the majority of patients with PCN are on life-long follow-up with imaging modality, which has huge cost implications for the Health Care System for limited benefits considering that a significant proportion of PCNs are or behave like benign lesions. The current guidelines for the diagnosis and management of PCNs are more based on expert opinion than on evidence. For all those reasons, the management of cystic tumors of the pancreas remains a controversial area of pancreatology. On one hand, the detection of PCNs and the surgical treatment of pre-cancerous neoplasms can be considered a big opportunity to reduce pancreatic cancer related mortality. On the other hand, PCNs are associated with a considerable risk of under- or over- treatment of patients and incur high costs for the Health Care System.     

应用负压封闭引流治疗高位小肠瘘

目的观察和评价采用负压封闭引流(vacuum sealing drainage,VSD)治疗高位小肠外瘘的临床效果。方法笔者科室2014年3月~2015年12月收治12例高位小肠外瘘患者,其中男性7例,女性5例,年龄32~65岁,平均52岁。对瘘口及瘘道采用VSD进行引流,同时辅以营养、支持、抗感染等手段进行治疗。结果全组患者瘘口全部关闭愈合,避免了手术,且愈合时间较短,平均愈合时间45.3d。结论采用VSD应用于高位小肠外瘘引流效果较常规方法优势明显,既能有效控制感染,又能明显缩短愈合时间,值得推广。     

Transperineal ultrasonography in perianal Crohn disease: A valuable imaging modality

Aims of treatment for Crohn disease have moved beyond the resolution of clinical symptoms to objective end points including endoscopic and radiological normality. Regular re-evaluation of disease status to safely, readily and reliably detect the presence of inflammation and complications is paramount. Improvements in sonographic technology over recent years have facilitated a growing enthusiasm among radiologists and gastroenterologists in the use of ultrasound for the assessment of inflammatory bowel disease. Transabdominal intestinal ultrasound is accurate, affordable and safe for the assessment of lumi-nal inflammation and complications in Crohn disease, and can be performed with or without the use of intravenous contrast enhancement. Perianal fistulizing disease is a common, complex and often treatment-refractory complication of Crohn disease, which requires regular radiological monitoring. Endoanal ultrasound is invasive, uncomfortable and yields limited assessment of the perineal region. Although magnetic resonance imaging of the pelvis is established, timely access may be a problem. Transperineal ultrasound has been described in small studies, and is an accurate, painless and cost-effective method for documenting perianal fluid collections, fistulas and sinus tracts. In the present article, the authors review the literature regarding perineal ultrasound for the assessment of perianal Crohn disease and use case examples to illustrate its clinical utility.     

Repair of tracheo-oesophageal fistula secondary to button battery ingestion: A combined cervical and median sternotomy approach

A three-year-old child developed a large tracheo-oesophageal fistula secondary to a button battery being lodged in the upper oesophagus for 36 hours. The diagnosis was confirmed with a contrast swallow. Operative access was gained through a combined right cervical incision and complete median sternotomy. Repair of the fistula required a segmental resection of both the trachea and oesophagus followed by primary anastomosis.     

Early detection of pancreatic cancer

Pancreatic adenocarcinoma is a low-incident but highly mortal disease. It accounts for only 3% of estimated new cancer cases each year but is currently the fourth common cause of cancer mortality. By 2030, it is expected to be the 2^nd leading cause of cancer death. There is a clear need to diagnose and classify pancreatic cancer at earlier stages in order to give patients the best chance at a definitive cure through surgery. Three precursor lesions that distinctly lead to pancreatic adenocarcinoma have been identified, and we have increasing understanding the non-genetic and genetic risk factors for the disease. With increased understanding about the risk factors, the familial patters, and associated accumulation of genetic mutations involved in pancreatic cancer, we know that there are mutations that occur early in the development of pancreatic cancer and that improved genetic risk-based strategies in screening for pancreatic cancer may be possible and successful at saving or prolonging lives. The remaining challenge is that current standards for diagnosing pancreatic cancer remain too invasive and too costly for widespread screening for pancreatic cancer. Furthermore, the promises of noninvasive methods of detection such as blood, saliva, and stool remain underdeveloped or lack robust testing. However, significant progress has been made, and we are drawing closer to a strategy for the screening and early detection of pancreatic cancer.     

淋巴结瘘型气管支气管结核的临床分析

目的探讨淋巴结瘘型气管支气管结核(TBTB,Ⅵ型)好发人群、临床症状、影像学表现、纤支镜下表现及转归。方法分析65例TBTB(Ⅵ型)患者,总结临床症状、影像学表现、纤支镜下的表现及转归。结果 (1)好发于年轻人(20~35岁)(75.3%)。(2)入院前平均病程4月,主要症状为咳嗽、咳痰、发热、胸痛等。(3)影像学表现:肺膨胀不全,肺门影增大,气道软组织影等。(4)好发部位:左上支气管、隆突及双侧主支气管、左下支气管、右上支气管、中叶支气管。结论 (1)TBTB(Ⅵ型)症状、影像学特征不典型。(2)患者需随访纤支镜及胸部CT至气道及纵隔内病变完全吸收后方可停药,以免复发。     

腹壁坏死性筋膜炎的认识与治疗

坏死性筋膜炎是皮肤软组织感染中最为凶险的类型，往往并发脓毒症休克和多器官功能障碍，死亡率较高。常见的坏死性筋膜炎是社区获得性感染，而临床上发生在腹壁的坏死性筋膜炎也并不罕见，如发生于经皮内镜胃造口管或者造口周围的坏死性筋膜炎，也有发生于整形手术、妇科手术、结直肠手术后的坏死性筋膜炎。腹部手术后发生消化道瘘并发腹壁坏死性筋膜炎，病死率高，值得重视。尽早诊断与及时实施包括坏死组织清除、消化道瘘引流以及腹腔开放在内的感染源控制措施至关重要。