重症胰腺炎急性肺损伤猪模型的制备方法

目的 探讨建立符合临床特征的重症胰腺炎急性肺损伤(SP-ALI)猪模型的方法.方法 健康长白猪,体重25～30 kg,18头,随机分成空白对照组(对照组,4头),手术对照组(手术组,4头)和SP-ALI组(模型组,10头).其中模型组采用主胰管内逆行注入4%牛磺胆酸钠(1 ml/kg体重)诱导SP-ALI模型.三组均于术后即刻、术后6、12、24、48、72 h取血动态检测血淀粉酶、血钙、血氧分压、二氧化碳分压和血清内毒素(LPS)含量.术后72 h处死动物,计算肺组织湿/干重比,并观察胰腺与肺病理形态学变化.结果 牛磺胆酸钠诱导后6～72 h血清淀粉酶,二氧化碳分压和内毒素含量、肺病理组织学评分、肺组织湿/干重比均较对照组和手术组明显升高(P＜0.05或P＜0.01),血钙、血氧分压水平较对照组和手术组显著下降(P＜0.05或P＜0.01).术后72 h处死动物后可见模型组肺体积明显增大,肺组织重度点、片状出血及淤血改变,切面有大量暗红色血性液体流出.结论 经主胰管逆行注入4%牛磺胆酸钠可成功建立SP-ALI猪模型.具有临床复合性好、模型诱导成功率高、利于ICU支持下长时间持续动态观察和治疗等特点,是一种较为理想的SP-ALI大动物模型.     

腹腔镜治疗暴发性重症急性胰腺炎

目的探讨腹腔镜用于治疗暴发性重症急性胰腺炎（fulminant severe acute pancreatitis，FSAP）手术时机、方法及疗效。方法回顾分析我院采用腹腔镜手术治疗的11例FSAP的病人临床资料。腹腔镜下分离胃结肠韧带，进入网膜腔暴露胰腺，吸净渗出液，冲洗腹腔，清除胰腺坏死组织，网膜囊及盆腔置入灌洗管和多根引流管，术后用大量生理盐水持续灌洗引流至引出的灌洗液澄清。结果治愈8例，3例死于多器官功能衰竭，住院时间42—92天，平均58天。结论积极采用腹腔镜对FSAP进行手术治疗，可有效地改善FSAP的预后，是一种安全有效的治疗方法。     

BD针在重症急性胰腺炎急性肺损伤大鼠模型制备中的应用

目的 探讨BD针在重症急性胰腺炎急性肺损伤研究中大鼠模型建立的改良应用.方法 健康成年雄性SD大鼠40只,随机分为模型组(n=30)、假手术组(n=10),应用BD静脉留置针经十二指肠乳头逆行胰胆管注入4%牛磺胆酸(0.1 mL/ks),建立重症急性胰腺炎急性肺损伤大鼠模型.模型组在建立后3 h、6 h、12 h检测大鼠血淀粉酶、血气分析、腹水量、肺含水量,光镜下进行胰腺和肺组织病变程度评分.假手术组在术后12 h检测上述相关指标.结果 模型组较假手术组血淀粉酶、腹水量、肺含水率、PaCO2、胰腺和肺组织学评分明显升高(P＜0.05).同时PaO2,氧合指数明显降低(P＜0.05).结论 应用BD静脉留置针能有效制备简便、易复制、稳定性好的重症急性胰腺炎急性肺损伤大鼠模型.     

腹腔镜下腹膜腔灌洗引流治疗重症急性胰腺炎

重症急性胰腺炎临床经过凶险,病死率高,其临床特征是局部炎症引起全身炎症反应(SIR)及随后的多器官功能障碍综合征(MODS)。传统的早期清创引流往往成为二次打击,加速MODS的发生和发展。微创外科的优势是对机体的打击极小。因此,在腹腔镜下行早期腹膜腔灌洗引流,有可能阻止SIRS的进一步发展,降低MODS的发生,从而提高生存率。本研究旨在探讨腹腔镜下腹膜腔灌洗引流治疗重症急性胰腺炎的疗效。1临床资料1.1一般资料:自2002年1月至2002年12月,本院共收住25例急性胰腺炎病人,其中7例为重症急性胰腺炎。男性5例,女性2例;年龄58.5±9.1岁;…     

BD针在重症急性胰腺炎急性肺损伤大鼠模型制备中的应用

Objective To investigate the improvement of BD intravenous catheters used in inducing the model of acute lung injury with severe acute pancreatitis in rats.Methods Total 40 healthy adult male SD rats were randomly assigned to 2 groups,SO group(n=10),SAP group(n=30),4% tauroeholate(0.1ml/kg)was injected via retrograde biliopancreatic ducts by using BD intravenous catheters via duodenal papilla.The serum amylase,blood gas analysis,ascites volume,lung water content and the pathological score of pancreas and lung structure under light microscope were recorded when the SAP model were induced in 3 h,6 h and 12 h.The relative data mentioned as above also detected in SO group after 12 h.Results The score of the SAP group was significantly higher than the SO group in blood amylase,ascites volume,lung water content,PaCO2,pancreas and lung histology(P＜0.05).Meanwhile,PaO2,oxygenation index were decreased significantly(P＜0.05).Conclusion It is efficient to establish simple,reproducible and stabile rat model of acute lung injury with severe acute pancreatitis by using BD intravenous catheters.     

腹腔镜在治疗急性重症胰腺炎中的应用

目的；探讨经腹腔镜治疗急性重症胰腺炎的方法及疗效。方法：回顾性总结分析1994年至2000年采用腹腔镜治疗重症胰腺炎10例，术中横向电灼切开胃结肠韧带，充分暴露松动胰腺组织，吸尽胰周渗出液及坏死组织，用大量生理盐水冲洗腹腔，并视病情轻重置2－3根腹腔引流管。结果：10例患者住院时间15－18d，效果满意，1例半个月后复发。结论：经腹腔镜治疗重症急性胰腺炎有创伤小、并发症少且恢复快之优点，再次剖腹手术也较容易。     

腹腔镜手术治疗重症急性胰腺炎策略及要点

随着微创外科技术的发展及损伤控制外科理念的引入,重症急性胰腺炎的治疗已经发生根本性的改变。根据胰腺炎病理特点和腹膜后解剖特点合理地选择手术时机,应用腹腔镜、后腹腔镜或腹膜后坏死组织阶梯式清创术等手段对重症急性胰腺炎病人的胰腺坏死组织进行引流或清创已经成为其治疗的有效手段。     

重症急性胰腺炎的腹腔镜治疗现状

近些年,外科领域干预重症急性胰腺炎的方式、理念有了显著变化.以腹腔镜技术为代表的各种微创技术被不断被应用于重症急性胰腺炎的治疗,使其病死率及术后并发症发病率有了明显下降.目前国内外各中心报道的用腹腔镜治疗重症急性胰腺炎的方式却并不相同,总体来说各有特点,在本文中笔者就其不同方式的研究现状做一综述.     

重症急性胰腺炎腹腔镜术后冲洗及引流策略

目的探讨重症急性胰腺炎(severe acute pancreatitis, SAP)腹腔镜术后冲洗及引流策略。 方法回顾性分析南方医科大学附属顺德第一人民医院2007年1月至2015年12月期间采用腹腔镜手术治疗的54例非胆源性SAP的患者临床资料,全部患者均应用腹腔镜微创技术行胃结肠韧带切开,胰腺被膜切开减压,吸除胰周积液及清除坏死组织,在胰周留置多条引流管,术后采用多种灌洗及引流策略并观察疗效。 结果治愈50例,4例死亡,其中1例死于合并胰腺癌,2例死于迟发腹腔出血,1例死于多器官功能衰竭。术后冲洗时间(21.6 ± 14.5)d,引流管拔除时间(35.4 ± 22.4)d,术后住院时间(38.7 ± 24.6)d。其中1例术后32 d因胰周脓肿再次行腹腔镜手术,3例胰腺假性囊肿,1例保守治疗治愈,2例经穿刺引流后治愈。 结论SAP腹腔镜手术后,合理的冲洗及引流策略,可降低SAP的病死率,减少并发症。     

腹腔镜干预重症急性胰腺炎感染性坏死13例

[摘 要] 目的 探讨腹腔镜下治疗重症急性胰腺炎感染性坏死的手术时机、方法及疗效。方法 回顾性分析中南大学湘雅医学院附属株洲医院肝胆外科2016年1月至2017年12月期间实施腹腔镜下坏死组织清除及引流术的13例重症急性胰腺炎合并感染的临床资料。术前通过CT明确拟引流的感染病灶及拟采用路径,敞开感染病灶,通过直视下低压间断的生理盐水冲洗感染灶,清除部分坏死组织,病灶区放置多根腹腔引流管,术后6～10 d冲洗引流,如坏死组织较多,术后1个月开始用胆道镜和（或）经皮肾镜冲洗取出其内坏死物。结果 重症急性胰腺炎感染性坏死自发病距手术干预时间平均24.5 d（14～40 d）,均在腹腔镜下完成手术,无中转开腹。术中平均出血量60 mL（40～150 mL）,平均手术时间120 min（90～180 min);术中放置引流管的数量平均为4.3根（3～6根）。术后3例患者出现B级胰瘘,无腹腔内出血及假性囊肿形成,无死亡病例,术后平均住院时间77.5 d（15～230 d）。结论对经皮穿刺置管引流效果不佳或者不宜穿刺的重症胰腺炎感染性坏死的患者,采用腹腔镜下的胰周感染清创引流术是安全、有效的。     

Extrapancreatic organ manifestations in a moderately severe acute pancreatitis model

In order to study the extent of clinically relevant extrapancreatic organ injury in a moderately severe pancreatitis model, we examined the structural and functional features of the pancreas, lung, liver and kidney in a rat model simulating gallstone pancreatitis. The animals were divided into three groups: the low-ligation group, the high-ligation group and the control group, and sacrificed at 6, 24, 42, 60 and 96 h. In the low-ligation group, moderately severe acute pancreatitis was induced by the ligation of the common biliopancreatic duct plus intralipid intragastric injection, while controls underwent the ligation of the bile duct above the pancreas (the high-ligation group) or only sham operation (the control group) with fat injection. The pancreatitis induced hyperamylasemia, pancreatic oedema, haemorrhage, acinar cell necrosis and extensive fat necrosis. Accompanied with a peak value of serum amylase activity 24 h after the induction, the kidney changes developed, characterized by decrease in urine output, increase in serum urea and creatinine, and proximal convoluted tubular damage under electron microscope. There were no pancreatitis associated lung or liver changes. These results suggest that this model can be used to study the pathogenesis and therapy of renal injury during acute moderately severe pancreatitis.     

Extrapancreatic multiorgan injury in a severe sublethal acute pancreatitis model

In order to develop a new severe but sublethal acute pancreatitis model for the study of clinically relevant extrapancreatic multiorgan injury, we have induced acute pancreatitis in a rat model by intraductal injection with low dose and moderate concentration of bile acid under low pressure. We examined the structural and functional features in the pancreas, lung, liver and kidney. The animals were divided into two groups: the bile acid injection group and the control group. In the bile acid injection group, acute necrotizing pancreatitis was induced by intraductal administration of 0.2 ml of 2.0% bile acid under 30 cm H2O pressure, while the controls underwent the sham operation. The two groups were divided into six subgroups (8 rats for each) and sacrificed at 12, 24, 36, 48, 72 and 144 h, respectively. The pancreatitis induced hyperamylasemia, ascites, pancreatic oedema, haemorrhage, acinar cell necrosis and extensive fat necrosis without early mortality. Accompanied with the pancreatic injury, the function and histologic changes have developed continuously in the kidney and liver for 72 and 144 h in the bile acid injection animals respectively. No pancreatitis associated pulmonary changes were found. Taking into account the results with the two previously developed models of pancreatitis, we conclude that the extrapancreatic injury in acute pancreatitis is found in the liver, kidney and lung, in that order, depending on the severity of pancreatitis. The present sublethal pancreatitis model, in comparison with the two previously studied acute pancreatitis models, is perfect for pathogenetic and therapeutic study of liver and renal changes in acute necrotizing pancreatitis.     

腹腔镜联合动脉区域灌注治疗重症急性胰腺炎伴多器官功能障碍综合征

急性重症胰腺炎(severe acute pancreatitis,SAP)病人常死于多器官功能不全(multiple organ dysfunctions syndrome,MODS).南方医科大学附属南粤广东省第二人民医院自2001年1月至2006年10月对85例SAP伴MODS病人,进行了腹腔镜联合动脉区域灌注治疗SAP的临床研究,现报道如下.     

Development and validation of a predictive model for acute kidney injury in patients with moderately severe and severe acute pancreatitis

Clinical and Experimental Nephrology - Acute kidney injury is a serious complication of moderately severe and severe acute pancreatitis, which significantly increases mortality. There are currently...     

早期血滤对重症急性胰腺炎家猪血浆细胞因子水平的影响

目的　探讨早期血液滤过对重症急性胰腺炎 (SAP)家猪促抗炎细胞因子血浆水平的影响。方法　采用胰管逆行灌注人工胆汁的方法复制家猪SAP模型 ,随机分为胰腺炎血滤治疗组(HF组 ,n =8)和胰腺炎非血滤治疗组 (NHF组 ,n =8)。HF组使用高容量、零平衡血滤。用酶联免疫吸附试验检测两组动物建模前后血浆肿瘤坏死因子 (TNF) α、白细胞介素 (IL) 1β、IL 10的水平。结果　与NHF组相比 ,血滤治疗后HF组家猪TNF α、IL 1β的血浆水平较低 [血滤停止前( 618± 2 76)ng/L较 ( 13 75± 3 3 4)ng/L ;( 4 45± 14 1)ng/L较 ( 965± 2 65 )ng/L ,P <0 .0 1] ,IL 10与TNF α的比值较高 [血滤停止前 ( 0 .3 5 4± 0 .114 )较 ( 0 .12 5± 0 .0 3 2 ) ,P <0 .0 1]。结论　早期血滤能降低SAP家猪促炎细胞因子TNF α,IL 1β的血浆水平 ,升高IL 10 /TNF α的比值 ,使促抗炎细胞因子失衡得到部分纠正。     

Results of diagnostic laparoscopy in patients with acute pancreatitis]

Diagnostic laparoscopic intervention was performed in 339 patients with preliminary diagnosis of an acute pancreatitis (AP). In 164 (48.4%) patients other acute surgical disease was diagnosed and in 175 (51.6%)--an AP. After performance of laparoscopy 11 patients were operated on, in 164 (93.7%)--curative laparoscopic intervention was done. Diagnosis of AP was established in 15 (8.6%) patients during conduction of laparotomy, in 1 (0.6%)--during pathomorphologic investigation. Complications occurred in 4 (2.3%) patients.     

Early-phase peritoneal drainage and lavage in a rat model of severe acute pancreatitis

Purpose

To evaluate the effects of early-phase drainage on the survival rates and pancreatic pathological changes associated with severe acute pancreatitis (SAP) in a rat model.

Methods

Sprague–Dawley rats were divided into the following groups: SAP model (control), early drainage and delayed drainage. The 24-h survival rates were compared among the groups. In addition, the serum and ascites concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α were measured, and pancreatic pathological changes were observed.

Results

The survival rate significantly improved in the early drainage group. Compared with that observed in the control group, the serum TNF-α and IL-8 concentrations in the early drainage group decreased, while the serum IL-10 levels increased, and the ascites concentrations of IL-1β, IL-6, IL-8 and TNF-α decreased, while that of IL-10 increased significantly. In the delayed drainage group, only the ascites concentrations of TNF-α decreased. Meanwhile, the pancreatic pathological changes at 3, 6 and 24 h worsened in the early drainage group; however, the pancreatic lesions in the early drainage group were less mild than those seen in the control group.

Conclusions

Rebalancing the cytokine levels in ascites after early drainage may be a key factor for enhancing the survival rate in rats.

     

经腹腔镜灌洗引流治疗重症急性胰腺炎疗效分析

目的探讨经腹腔镜灌洗引流治疗重症急性胰腺炎(SAP)伴腹腔间隔室综合征(ACS)的疗效。方法应用腹腔镜微创外科技术对23例SAP的ACS病人行胃结肠韧带切开,胰腺被膜切开减压,吸尽胰周渗液及清除坏死组织,并置多管腹腔引流、灌洗。结果除1例SAP病人因术后并发多器官功能衰竭(MOF)、弥漫性血管内凝血(DIC)死亡外,其余22例均痊愈出院,随访半年无复发。结论腹腔镜灌洗引流治疗SAP的ACS方法简单、安全、有效,可以降低死亡率,减少并发症。