重症急性胰腺炎的营养支持

重症急性胰腺炎(SAP)约占所有急性胰腺炎(AP)的15％～20％左右，是指具有明显腹膜炎体征和(或)伴有器官功能障碍者．胰腺及胰周多有坏死，病死率为20％～60％。近年来，SAP的治疗多以非手术治疗为主，重点是脏器功能维护、液体复苏、纠正内稳态失调、抑制胰腺外分泌和预防胰腺坏死合并感染。只有在胰腺坏死合并感染时，才考虑手术     

重症急性胰腺炎延期手术治疗24例体会

重症急性胰腺炎(SAP)是一种凶险的急腹症,目前多强调积极的综合治疗,选择性手术,大大改善了SAP的预后.我院自2001年1月至2008年1月,对非胆道梗阻性SAP患者采取积极的非手术治疗,其中有24例待胰腺及胰周病变空腔化后行后期手术治疗,取得了满意的疗效.     

重症急性胰腺炎病人营养支持的特点

重症急性胰腺炎(Serious acute pancreatitis,SAP)指具有明显腹膜炎体征和(或)伴有器官功能障碍者,胰腺及胰周多有坏死,病死率为20％-60％。近年SAP的治疗多以非手术治疗为主,重点是脏器功能维护、液体复苏、纠正内稳态失调、抑制胰腺外分泌和预防胰腺坏死合并感染。只有在胰腺     

重症胰腺炎治疗方式及并发症98例分析

目的: 探讨重症胰腺炎(SAP)的有效治疗方法 。方法: 1983~1992年的42例以早期手术治疗为主（A组）,1992~1999年的56例以早期非手术治疗为主（B组）。比较两组的主要并发症及死亡率 。结果: 比较休克、胰腺坏死并发感染和器官功能衰竭等主要并发症的发生率及病死率,A组均高于B组（P<0.001) 。结论: 早期非手术治疗SAP明显优于早期手术治疗。     

重症急性胰腺炎的治疗体会

目的探讨提高重症急性胰腺炎治愈率,降低病死率的外科治疗策略。方法回顾性分析1994年~2004年20例SAP患者的治疗经验。结果20例中治愈18例,死亡2例,非手术治疗16例,手术治疗4例。结论SAP的早期尽可能采取非手术治疗,但对有明确的胆道梗阻,胰腺组织坏死继发严重感染时应及时行手术治疗。手术方式以简单易行保证充分引流及解除胆道梗阻为目的。     

重症急性胰腺炎胰腺感染的综合性预防及治疗

目的 探讨重症急性胰腺炎（SAP）继发胰腺感染的综合预防措施及治疗。方法 本组223例SAP均先行非手术治疗,采取促进胃肠道功能的恢复、应用抗生素、抗休克、预防多器官组织低灌注及低氧血症等多种措施预防胰腺感染。1990～1994年,将胰腺感染作为手术指征并立即进行手术;1995～1999年,加强对胰腺感染的预防,特别注意早期促进胃肠道功能的恢复。延期手术,将晚期局限性胰腺感染作为手术指征。结果 本组223例SAP中发生胰腺感染23例（10.3%）。两个阶段的胰腺感染率分别为12.4%及8.7%。胰腺感染局限者的病死率为8%（1/13）,低于胰腺感染未局限者的50%（5/10）,P=0.035。结论 积极、有效的综合性预防措施及延期手术治疗有助于降低SAP继发性胰腺感染率及胰腺感染的病死率。     

早期手术治疗重症急性胰腺炎20例分析

摘要： 为探讨重症急性胰腺炎（SAP）早期手术的效果，对6年间收治的20例SAP患者，在非手术治疗24~48h仍无好转的情况下因符合手术指征而行早期手术治疗进行回顾性分析。术中吸净腹腔积液；如胰腺坏死较轻不剪开胰腺被膜，如胰腺坏死较重则剪开胰腺被膜充分松动胰床，但不作过多的胰腺及腹膜后坏死组织清除。胆源性胰腺炎加行胆囊切除加T管引流。术后保持引流通畅。结果示，本组早期手术治愈率85.0%(17/20)，死亡3例，病死率15.0%，均死于术后多脏器衰竭。手术至死亡时间分别为21，31，36d。提示积极早期手术治疗可提高SAP的治疗效果。     

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我国重症急性胰腺炎(SAP)的治疗经过近30年的探索，治疗原则已基本达成共识，那就是急性反应期内可行非手术治疗，等坏死组织发生感染和包裹后再手术引流。大量文献表明，后期手术病人的存活率明显提高，而且住院费用和时间都明显缩短。但过度强调非手术治疗和无原则的推迟手术反而使病死率升高。因此，如何早期诊断感染和及时处理是进一步提高治愈率的重要环节。暴发性胰腺炎急性反应期的处理与SAP的处理有区别，单纯的非手术治疗往往难以奏效。因此，本文重点讨论SAP非手术治疗过程中胰腺内、外坏死组织感染的早期诊断和处理。     

非手术治疗重症急性胰腺炎探讨

目的　探讨非手术治疗重症急性胰腺炎 (SAP)的效果。方法　采用静脉输注丹参、管喂 /口服清胰汤煎剂等中西医结合非手术治疗SAP 6 3例 ,观察其临床疗效。结果　全组属SAPⅠ级 34例 ,Ⅱ级 2 9例 ;发生各类并发症 19例次 (30 .16 % ) ,死亡 3例 (4.76 % ) ,并发胰腺脓肿中转手术 4例。结论　非手术治疗SAP应遵循根据病因和临床阶段决定治疗重点的个体化原则 ,及时发现需要中转手术的情况 ;中西医结合治疗SAP效果优良。     

非手术治疗重症急性胰腺炎

20世纪90年代以来,重症急性胰腺炎(severeacute pancreatitis,SAP)的治疗已逐渐达成共识,在病程早期采取积极的非手术治疗,在病程后期当继发胰腺感染时,需手术治疗[1].     

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??Advances in canceration of chronic pancreatitis and diagnosis ZHANG Tai-ping,XU Jian-wei,ZHAO Yu-pei. Department of Surgery, Peking Union Medical College Hospital , Peking Union Medical College , Chinese Academy of Medical Science , Beijing 100730 , China
Corresponding author??ZHAO Yu-pei,E-mail??zhao8028@263.net
Abstract Chronic pancreatitis is closely related to pancreatic cancer. Patients with chronic pancreatitis have a markedly increased risk of pancreatic cancer compared with the general population. The nature of the transition between chronic inflammation and cancer is still a subject of debate. In the setting of CP, inflammatory cells, cytokines, chemokines, and activated signaling pathways play a role in the transformation of normal ductal epithelium to metaplastic metaplasia and early neoplastic lesions (pancreatic intraepithelial neoplasia (PanIN)), which eventually give rise to pancreatic cancer.Mass-forming chronic pancreatitis is similar with pancreatic cancer in clinical manifestation and imaging characteristic.It is difficult to differentiate mass of the head of pancreas. EUS-FNA and PET/CT is useful to differential diagnosis.     

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??Attention to the standardization of diagnosis and treatment of chronic pancreatitis ZHAO Yu-pei. Department of Surgery, Peking Union Medical College Hospital , Peking Union Medical College , Chinese Academy of Medical Science , Beijing 100730 , China
Abstract Chronic pancreatitis is a progressive and irreversible fibroinflammatory disease. So far, there is no diagnostic criteria and treatment algorithm widely accepted. Therefore, it is necessary to pay attention to the standardized diagnosis and therapy of chronic pancreatitis and make the problems to be seriously discussed. Administering the criterion and improving the recognition of the disease will enhance the diagnosis and treatment of chronic pancreatitis in China.     

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??Application and evaluation of neoadjuvant therapy in locally advanced pancreatic carcinoma ZHANG Tai-ping??CAO Zhe??ZHAO Yu-pei. Department of General Surgery??Peking Union Medical College Hospital??Peking Union Medical College??Chinese Academy of Medical Sciences??Beijing 100730??China
Corresponding author??ZHAO Yu-pei??E-mail??zhao8028@263.net
Abstract Radical resection is the effective means to prolong survival time of patients with pancreatic carcinoma. However??40% of the patients are diagnosed with locally advanced pancreatic carcinoma in the first clinic. Individualized neoadjuvant treatment is expected to bring the stage-down of locally advanced pancreatic carcinoma??in order to gain the chance of radical excision. But the specific treatment is still controversial. Neoadjuvant chemotherapy followed by sequential chemoradiotherapy is the most common strategy in the neoadjuvant therapy. Gemcitabine plus nab-Paclitaxel and FOLFIRINOX are expected to be the best chemotherapy regimens.     

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??Actuality of diagnosis and localization of insulinoma ZHANG Tai-ping??XU Jian-wei??ZHAO Yu-pei. Department of Surgery, Peking Union Medical College Hospital , Peking Union Medical College , Chinese Academy of Medical Science , Beijing 100730 , China
Corresponding author:ZHAO Yu-pei,E-mail:zhao8028@263.net
Abstract Insulinoma is one of the most common pancreatic endocrine tumors. Surgical treatment is the only curative method. Whipple triad and the ratio of insulin to glucose are the key points for diagnosis of insulinoma.We can do the process of 72h fasting test if it is necessary.Non-invasive diagnostic methods are the first choice for localization of the tumors. In our hospital the improved MSCT has a high accuracy up to 95.1%. Combination IOUS and exploration has the highest accuracy up to 100%.Invasive diagnostic methods like DSA,PTPC and ASVS have seldom been used.This paper makes a evaluation and overview of the localization of insulinoma and is also as a reference for clinic work.     

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??The current status and disparity in diagnosis and treatment of pancreatic endocrine tumor in China ZHAO Yu-pei. Department of Surgery, Peking Union Medical College Hospital , Peking Union Medical College , Chinese Academy of Medical Science , Beijing 100730 , China
Abstract Pancreatic endocrine tumor is a rare lesion in clinic, which has the characteristics of varied presentations of symptom and high misdiagnosis rate. After decades’ development, the diagnosis and treatment of pancreatic endocrine tumor in our country has made great progress, but still has a large disparity compared to the Western countries. Improving the recognition of this disease, establishing the patient transfer system and administering the correct treatment strategy will improve the diagnosis and treatment of pancreatic endocrine tumor in China.     

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??Pancreatobiliary malignancies and pancreatic carcinoma LIAO Quan, ZHAO Yu-pei. Department of Basic Surgery??Beijing Union Medical College Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences??Beijing 100730, China
Corresponding author: ZHAO Yu-pei??E-mail??zhao8028@263.net
Abstract Pancreatobiliary junction has a complex anatomy and a similar embryonic origin. The carcinogenesis of pancreatobiliary malignancies are different, which lead to various genesis, development and prognosis of the neoplasms. Pancreaticobiliary maljunction and field cancerization theory enriched the explanations of the genesis and development of pancreatobiliary malignancies. Both the differential diagnosis of pancreatobiliary malignancies and the confirm diagnose of pancreatic carcinoma are the key points for the clinical treatment of pancreatobiliary diseases. A better understanding of the aetiology and pathology and an appropriate choose of diagnostic methods are very helpful for the diagnosis and treatment of pancreatobiliary malignancies.     

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??The management of postoperative intra-abdominal hemorrhage after pancreaticoduodenectomy ZHANG Tai-ping??YANG Gang??ZHAO Yu-pei. Department of General Surgery??Peking Union Medical College Hospital??Peking Union Medical College??Beijing 100730??China
Corresponding author: ZHAO Yu-pei??E-mail??zhao8028@263.net
Abstract Intra-abdominal hemorrhage is one of the most serious postoperative complications after pancreaticoduodnectomy(PD). Due to urgent onset??quick change and severe consequences??it becomes a focus of clinical attention. Clarifying the time of onset??severity??cause and location of intra-abdominal hemorrhage of postoperative PD can help clinicians to choose accurate intervention time and therapy method. Early and mild hemorrhage can be treated conservatively??but reoperation is necessary if it’s severe. The outcome of late hemorrhage is serious, interventional treatment or reoperation should be taken as soon as possible. Meanwhile, clinicians should improve preoperative blood coagulation function, operate carefully and prevent postoperative complications actively, such as pancreatic fistula, to avoid intra-abdominal hemorrhage.     

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??Analysis of diagnosis and treatment of insulinomas in multiple endocrine neoplasia Type 1(MEN-1) patients ZHANG Tai-ping, ZHAN Han-xiang, ZHAO Yu-pei, et al. Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
Corresponding author: ZHAO Yu-pei, E-mail: zhao8028@263. net
Abstract Objectives To investigate the strategy for diagnosis and surgical procedure of insulinoma in multiple endocrine neoplasia Type 1(MEN-1) patients based on a retrospective study; Methods Medical records of patients diagnosed as MEN-1 related insulinoma from 1995 to 2010 in Peking Union Medical College Hospital were reviewed retrospectively. Clinical data was collected and statistically analyzed; Results A total of 21 patients were diagnosed as MEN-1 related insulinomas, which including 6 males and 15 females, 6 of them had family history of pancreatic endocrine tumor or MEN-1. Multiple tumors were found in 9 cases; 2 cases were malignant insulinomas. Parathyroid was the most common affected gland in these patients, followed by pituitary and adrenal gland.19 patients underwent operations, the lesions were resected in one-stage or subsequent stage based on the severity of high hormone levels harmfulness. Tumor enucleation was the most common operative procedure. In total, 58 lesions were resected, of which 65.5% are < 1 cm in size. Pancreatic fistula (Grade B) occurred in 5 patients, all these patients recovered by conservative treatment; Conclusions MEN-1 related insulinomas have special clinical characteristics, much more attentions should be paid to the high risk populations. Comprehensive exploratory surgery, intraoperative ultrasonography and blood glucose testing can help to remove all lesions. Other involvement glands can be treated in one or the following stage treatment, Surgeons should collaborate with relevant departments and some difficult cases can transferred to the big-volume centers.     

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??Clinical pathway for the diagnosis and treatment of asymptomatic pancreatic cystic neoplasms LIAO Quan,ZHAO Yu-pei. Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730,China
Corresponding author: Zhao Yu-pei, zhao8028@263.net
Abstract The prevalence of pancreatic cystic neoplasms has increased dramatically due to the frequent use of abdominal imaging in health examination. Resection is the only treatment method for PCN at present. For asymptomatic patients ,resection means high risk and a decrease in quality of life, therefore proper characterization of PCN is important not only to recognize premalignant lesions that will require surgical resection, but also to avoid unnecessary operation. PCN has the risk of recurrence, so follow-up after resection is also very important.     

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??Challenge of diagnosis and treatment in pancreatic tumors ZHAO Yu-pei??ZHANG Tai-ping??CAO Zhe. Department of General Surgery??Peking Union Medical College Hospital??Chinese Academy of Medical Sciences??Beijing 100730??China
Corresponding author??ZHAO Yu-pei??E-mail??zhao8028@263.net
Abstract Pancreatic tumor is one of the most challenging diseases in surgery. During the past decades??pancreatic surgery in China has achieved great development through the efforts of several generations of pancreatic surgeons. But in the new period??there are still many challenges in the diagnosis and therapy in pancreatic tumors. For instance, the mechanism of occurrence and development is still unclear, the prognosis of pancreatic tumors is still poor. Some new concepts of management in pancreatic tumors has evolved, and raise the new challenges. In order to promote the development of pancreas surgery in China, we should build the multi-center and multidisciplinary clinical research platform for pancreatic tumors. To standardize the multidisciplinary diagnosis and treatment, popularize the standardized workflow of pancreatic tumors. At the same time, it is also very important to train the clinical quality and scientific research thinking in young doctors.