胰肠吻合术后吻合口狭窄九例临床分析

胰腺手术具有高风险性,其中胰肠吻合口漏是最常见、最危险的并发症,文献报道发生率为2％～24％[1],而病死率则高达20％～50％[2].随着外科技术的进步和经验的积累,术后早期并发症发生率已明显下降,而远期并发症如胆肠、胰肠吻合口狭窄等已逐渐引起关注.     

慢性胰腺炎糖尿病的发生率及其风险因素分析

Objective To investigate the incidence of diabetes mellitus and risk factors for the disease in chronic pancreatitis (CP) patients.Methods A historical cohort study on subjects with painful CP who were admitted to hospital from Jan.1997 to July 2007 were conducted.A life-table method was used to estimate the cumulative probability of the development of diabetes mellitus once clinical onset of abdominal pain.Cox proportional-hazards model was used for multivariate analysis of the variables including age,sex,drinking and smoking habits,etiological factor,presence of pancreatic masses,pancreatic calcifications,measure of intervention,diarrhea,weight loss and degree of pain.Results Data were obtained from 354 patients (239 males,mean age at onset of pain (38.1±17.6) years;alcoholic origin 18.1%) with painful CP.The mean follow-up period was (45.2±32.9)months.The rate of diabetes mellitus in CP patients was 16.1%.There was a high incidence (29.8%)of diabetes mellitus 1 year before the episodes of abdominal pain.The cumulative risk of diabetes mellitus in subjects 5 and 10 years after the episodes of pain was 9.3% and 20.7%,respectively.Cox proportional-hazards model selected smoking (＞10 pack years) (hazard rate (HR)= 3.3),mild abdominal pain (HR=5.2),weight loss (HR = 2.6) and pancreatic calcifications (HR = 2.2) as variables identifying subjects with diabetes mellitus in patients with painful CP before they were performed therapeutic endoscopy or surgical intervention.Smoking (＞10 pack years) (HR = 3.0),weight loss (HR= 2.8) and distal pancreatectomy (HR =7.3) were identified with an increased risk of diabetes mellitus in these cases after they received therapeutic endoscopy or surgical intervention.Conclusion The risk factors of diabetes mellitus for CP appears to be independent of smoking (＞10 pack years),mild abdominal pain,weight loss,pancreatic calcifications and distal pancreatectomy.     

胰腺间变癌的临床病理特点——附6例报告

目的胰腺间变癌是少见的胰腺外分泌恶性肿瘤，本文探讨其临床病理学特点。方法回顾性分析6例胰腺间变癌的临床特点并结合文献讨论。结果本组6例，其中男5例，女1例，年龄4j～74岁。肿瘤位于胰头3例，胰体尾3例。行胰头十二指肠切除术3例，其中1例作肠系膜上静脉切除重建术，另1例同时行肠系膜上动、静脉切除重建术。3例胰体尾肿块，2例行胰体尾切除、脾切除术．另1例肿瘤已侵犯周围脏器，行全胃、结肠脾曲、腹腔动脉切除术。病理检查：肿瘤细胞呈多形性．可见圆形、卵圆形、多边形和梭形的肿瘤细胞，核大深染，异型明显，也可见巨核或多核的瘤巨细胞及破骨细胞样巨细胞。随访5例，术后平均生存5．5月．均死于肿瘤腹腔内和肝脏转移。结论胰腺间变癌组织学特点为肿瘤细胞的多形性，并可见巨核或多核的巨细胞或破骨细胞样巨细胞．呈侵袭性生长，易侵犯周围脏器、大血管和发生肝脏、淋巴结转移，恶性程度高，预后差。     

运动相关蛋白Fascin在胰腺癌的表达及其临床意义

目的 探讨运动相关蛋白Fascin在胰腺癌的表达及其与临床病理特征的关系.方法 采用RT-PCR法检测SW1990、Patu8988、BxPC3、CfPAC1 4株胰腺癌细胞株Fascin mRNA表达;采用免疫组化方法 检测54例胰腺癌及42例相应癌旁胰腺组织Fascin蛋白表达.结果 胰腺癌细胞株SW1990、Patu8988、CfPAC1有Fascin mRNA表达,BxPC3无表达;54例胰腺癌组织Fascin蛋白表达阳性35例,占64.8%,42例癌旁胰腺组织中均无阳性表达.Fascin蛋白表达与肿瘤分化程度(P<0.01)和淋巴转移(P<0.05)呈显著正相关,但与肿瘤大小及远处转移无相关性(P>0.05).结论 Fascin蛋白在胰腺癌组织中有较高的阳性表达率,检测其表达有助于胰腺癌的诊断,并有助于判断胰腺癌恶性程度.     

慢性胰腺炎胰管空肠吻合术的临床观察

作者总结了本院1995年6月~2005年5月施行胰管空肠吻合术的53例慢性胰腺炎患者的临床资料,现报告如下。1资料与方法回顾性分析1995年6月~2O05年5月施行胰管空肠吻合术的53例慢性胰腺炎患者的临床资料。其中男34例,女19例;年龄l4~75岁,平均41.2;病程10d~13年,平均3.6年。临床表现     

慢性胰腺炎糖尿病的发生率及其风险因素分析

Objective To investigate the incidence of diabetes mellitus and risk factors for the disease in chronic pancreatitis (CP) patients.Methods A historical cohort study on subjects with painful CP who were admitted to hospital from Jan.1997 to July 2007 were conducted.A life-table method was used to estimate the cumulative probability of the development of diabetes mellitus once clinical onset of abdominal pain.Cox proportional-hazards model was used for multivariate analysis of the variables including age,sex,drinking and smoking habits,etiological factor,presence of pancreatic masses,pancreatic calcifications,measure of intervention,diarrhea,weight loss and degree of pain.Results Data were obtained from 354 patients (239 males,mean age at onset of pain (38.1±17.6) years;alcoholic origin 18.1%) with painful CP.The mean follow-up period was (45.2±32.9)months.The rate of diabetes mellitus in CP patients was 16.1%.There was a high incidence (29.8%)of diabetes mellitus 1 year before the episodes of abdominal pain.The cumulative risk of diabetes mellitus in subjects 5 and 10 years after the episodes of pain was 9.3% and 20.7%,respectively.Cox proportional-hazards model selected smoking (＞10 pack years) (hazard rate (HR)= 3.3),mild abdominal pain (HR=5.2),weight loss (HR = 2.6) and pancreatic calcifications (HR = 2.2) as variables identifying subjects with diabetes mellitus in patients with painful CP before they were performed therapeutic endoscopy or surgical intervention.Smoking (＞10 pack years) (HR = 3.0),weight loss (HR= 2.8) and distal pancreatectomy (HR =7.3) were identified with an increased risk of diabetes mellitus in these cases after they received therapeutic endoscopy or surgical intervention.Conclusion The risk factors of diabetes mellitus for CP appears to be independent of smoking (＞10 pack years),mild abdominal pain,weight loss,pancreatic calcifications and distal pancreatectomy.     

胰高血糖素瘤二例报告并文献回顾分析

目的:提高对少见病胰高血糖素瘤的诊治水平.方法:总结本院2例及国内24年间文献报道30例胰高血糖素瘤的诊治资料.结果:所有患者在病程中的不同阶段曾被误诊(多被误诊为湿疹和糖尿病),其中84.4%(27/32)患者有典型的胰高血糖素瘤临床特征(如轻度糖尿病,迁移性坏死性皮炎、舌炎、口角炎、贫血和体质量减轻等).21例行胰体尾切除术,1例行Whipple手术,1例行胆肠吻合术,2例行肿瘤局部切除或摘除术,7例不适宜手术或拒绝手术.病理结果显示27例为恶性,3例良性,2例性质不确定.治疗后多数患者皮疹在短期内消退,症状改善.结论:胰高血糖素瘤临床罕见,极易误诊;根据典型的胰高血糖素瘤综合征及实验室检查(血浆胰高血糖素水平)即可提出定性诊断,辅以影像学检查可提出定位诊断;根治性或姑息性手术切除是其有效的治疗方法.     

无痛性慢性胰腺炎的治疗及疗效

目的探究成人无腹痛慢性胰腺炎（CP）的治疗方法及其疗效。方法总结近10年CP患者临床资料，分析成人无痛性CP患者治疗措施及疗效。结果成人无痛性CP共56例，成功随访的46例（82．1％）中，男31例，女15例，年龄（51．6±14．5）岁，随访时间（34．5±27．1）个月。（1）CP胰管结石、胰管改变者26例：内镜介入治疗14例，外科手术治疗7例，两者联合治疗3例，保守治疗2例。（2）CP影像学表现为胰腺或腺周占位的18例：均外科手术治疗。以上两组患糖尿病和腹泻症状者均无减少，部分患者一般情况有改善；各1例患者死于胰腺癌。1例胰管结石患者取石术后结石复发。（3）CP胰管改变合并胰腺囊肿者2例：内镜与外科治疗各1例，后者手术后出现胃出血及肝硬化、黄疸，原因不明。结论内镜与外科治疗无痛性CP胰管结石疗效相近，而影像学表现为胰腺或腺周占位的CP则以外科手术为首选，单纯胰管改变患者治疗尚需观察。各种治疗仅可改善部分无痛性CP患者的一般情况；并应加强对无痛性CP患者的随访和定期复查。     

急性胰腺炎23例误诊分析

据调查,急性消化道疾病占舰艇人员发病率的30%[1],而其中急性胰腺炎近年来的发病率呈上升趋势,已经引起人们的关注.急性胰腺炎临床表现差异甚大,早期诊断有一定困难,误诊率高,一旦延误很容易转变成重症急性胰腺炎[2],故早期正确诊断及合理治疗显得尤为重要,本文通过对23例急性胰腺炎临床误诊分析,旨在探讨急性胰腺炎误诊原因及防范措施,尤其是在舰艇、乡村等医疗条件相对简陋的环境下如何提高对急性胰腺炎的早期诊断及治疗水平.     

手术史与胰腺癌发病相关性研究

探讨中国人胰腺癌的发生与阑尾切除术、胃部分切除术、胆囊切除术及扁桃体摘除术间的关系。病例对照研究以493例病理确诊胰腺癌患者作为病例组，1031例非肿瘤患者年龄、性别、居住地、经济收入频数匹配的同来源病例为对照组，计算比值比（OR）值及95％可信区间（CD），以估计阑尾切除术、胃部分切除术、胆囊切除术及扁桃体摘除术对胰腺癌的相对危险性，并做logistic回归分析。结果表明在阑尾切除术、胃部分切除术、胆囊切除术者中胰腺癌的危险性上升，趋势检验P均＜0.01，OR和95％CI分别为2.12(1.47-3.06）、3.11(1.49-6.50)、4.71(2.40-9.50)，而扁桃体摘除者为2.80(0.67-11.98），但logistic回归分析仅阑尾切除有统计学意义（P＜0.05）。