腹腔镜手术治疗新生儿环状胰腺的护理体会

<正>环状胰腺是先天性的胰腺发育畸形,是指胰腺组织未正常分布在十二指肠框内,而是呈环形或钳形部分或完全包绕十二指肠降部,从而引起十二指肠完全性或不完全性梗阻,是先天性十二指肠梗阻的原因之一,占先天性十二指肠梗阻的10%~30%[1],一经诊断,需手术治疗。随着腹腔镜技术在小儿外科的发展及镜下缝合技术的不断成熟,腹腔镜技术对新生儿腹部疾病的诊治逐渐得到推广[2]。2012年3月至2013年3月我科为10例环状胰腺新生儿行腹腔镜手术诊     

环状胰腺合并十二指肠布氏腺囊肿致上消化道梗阻一例

<正>环状胰腺为先天畸形，多为儿童发现，成人报道较少。十二指肠布氏腺囊肿（Brunner’s gland cyst）是十二指肠的一种罕见良性疾病，其病因不明，而环状胰腺合并十二指肠布氏腺囊肿目前尚未见报道。南京医科大学第一附属医院胰腺中心于2016年9月4日收治了1例环状胰腺合并十二指肠布氏腺囊肿所致上消化道梗阻的病例，现将诊治经过报道如下。     

成人环状胰腺的临床诊治分析：附13例报告

目的：探讨成人环状胰腺的诊断和临床治疗措施。 方法：回顾性分析2006年7月—2014年6月收治的13例成人环状胰腺患者的临床表现、辅助检查、手术治疗方式及术后并发症等临床资料。 结果：临床表现以顽固性呕吐、反复上腹部疼痛及腹胀等十二指肠梗阻表现为主,患者术前行上消化道造影、腹部平片、腹部CT及MRCP等检查,13例患者均行手术治疗,其中行十二指肠与十二指肠侧侧吻合3例,行胃次全切除、Billroth-II式吻合术6例,行胃空肠吻合术3例,行十二指肠空肠侧侧吻合术1例。术后3例出现肺部感染,切口感染1例,胃空肠吻合口瘘及十二指肠瘘各1例,均经负压引流后治愈;1例术后吻合口狭窄,再次手术后治愈。 结论：成人环状胰腺患者临床表现主要以呕吐、反复上腹部疼痛及腹胀等十二指肠梗阻表现为主,术前检查以腹部平片、上消化道造影、腹部CT及MRCP检查为主,治疗以手术治疗为主,手术方式主要以胃次全切除、Billroth-II式吻合术、十二指肠侧侧吻合及胃空肠吻合术为主,术后并发症主要为肠瘘,吻合口狭窄,肺部感染等。     

小儿环状胰腺五例报告

目的：探讨小儿环状胰腺引起消化道梗阻的原因与临床特点。方法：对本组5例手术治疗的小儿环状胰腺的临床特点、手术所见及尸检结果进行综合分析，从中寻找各年龄组间肠梗阻原因、病理改变及并发畸形的关系。结果：新生儿环状胰腺均表现为高位完全性肠梗阻症状，多合并十二指肠膜状闭锁；年长儿则出现慢性不完全性肠梗阻症状，常为环状胰腺压迫十二指肠所致。环状胰腺直接引起十二指肠狭窄占35．8％。结论：有症状的环状胰腺患儿均应手术治疗，手术方法以建立通畅的消化道为原则，术中应详细探查有无肠闭锁等并发畸形。     

成人环状胰腺诊断疑难分析

为了提高术前诊断率，为治疗提供参考依据和经验。统计分析了国内21例成人环状胰腺的有关资料，手术21例，术中发现11例为不完全型，10例为完全型。术后死亡1例。提出其发生是因胰腺组织胚胎发生异常所致。我国成人环状胰腺的临床特点：男多于女；60％在20～30岁发病，病程长；有压迫造成十二指肠梗阻症状；X线、CT检查有诊断价值。有症状者行胃空肠吻合术治疗。     

新生儿十二指肠梗阻的诊断与治疗

新生儿十二指肠梗阻多为高位梗阻,先天因素所致。引起新生儿十二指肠梗阻的原因分为肠道内源性及外源性因素,部分病例内、外源性病因同时存在。外源性因素包括肠旋转不良及环状胰腺等：内源性因素主要是十二指肠闭锁或狭窄,其中以肠旋转不良最为常见。     

成人环状胰腺诊断疑难分析

环状胰腺是胰腺组织完全或不完全环绕十二指肠的胚胎发生异常。1818年Tiedemann首先报道,1862年Ecker经解剖病例明确其导管系统后命名为Annular Pancreas。以后于手术中陆续被发现并为大家所重视。Ecker报道以后欧美统计了300例,日本1922-1990年统计了121例成人环状胰腺,国内1955-2003年统计到36例,我院诊治1例共37例。现就国内成人环状胰腺的临床诊断疑难进行分析总结,以期对临床医师有所帮助。     

成人十二指肠水平段环状胰腺一例

正成人环状胰腺临床少见,多表现为胰腺组织呈环状或带状包绕十二指肠降段,个别位于十二指肠水平段或十二指肠球部[1]。现将我院收治的一例位于十二指肠水平段的成人环状胰腺报道如下。病例患者,女,57岁,因反复呕吐、上腹部疼痛伴体重减轻半年,加重1个月于2015年3月8日入院,患者呕吐时轻时重,一般于饭后2~3 h后发生,时有腐臭味。于5个月前在内科检查后给予抑酸、促进胃肠蠕动、保护胃黏膜等方法治疗后     

胰腺体尾癌误诊原因探讨(附50例报告)

我院1960～1986年经手术和病理证实为胰腺癌182例,其中胰体尾癌60例(32.9%)。胰腺体尾癌入院前,后误诊为其他疾病50例,误诊率为83.3%。由于胰体癌临床表现复杂,诊断上有一定困难。为了从误诊病例中吸取教训,提高确诊率及手术切除率,本文着重就胰腺体尾癌误诊原因及与本病诊断有关的一些问题进行探讨。临床资料本组男性35例,女性15例,年龄最大70岁,最小23岁。误诊病种:误诊为慢性胰腺炎、胰源性腹泻、假性胰腺囊肿、慢性胆囊炎,肝胆管结石、胃癌、上消化道出血、结核性腹膜炎、腹膜后肿瘤、胆管癌各4例,环状胰腺、十二指肠憩室、十二指肠结核各2例,胃神经宫能症、传染性肝炎、十二指肠肿瘤、慢性萎缩性胃炎各1例。消化不良、上腹饱胀、打嗝50     

腹腔镜治疗新生儿先天性十二指肠梗阻的围手术期护理

<正>先天性十二指肠梗阻是新生儿常见的消化道发育畸形,按病因分为内源性和外源性两种。常见的内源性疾病系十二指肠本身肠管发育过程受阻导致十二指肠闭锁或狭窄;常见的外源性疾病包括由于胰腺始基未消失形成的环状胰腺     

Diffuse pancreatic adenocarcinoma identified in an adult with annular pancreas

Annular pancreas is a congenital anomaly resulting from malrotation of the pancreatic ventral bud. Although annular pancreas in the adult is rare, it may be recognized with increased frequency as a result of more liberal use of pancreatic imaging studies in patients with chronic abdominal pain and suspected chronic pancreatitis. Malignancy in the setting of annular pancreas is an uncommon event that has been reported previously but has almost always been related to the annular (ventral) segment. We report an interesting case in which pancreatic adenocarcinoma diffusely involving the dorsal (nonannular) segment presented in a middle-aged female patient. This unusual presentation points out the importance of considering neoplasia as part of the differential diagnosis and the possibility of pancreatic pathology in the dorsal, nonannular segment when there is no obvious duodenal or biliary obstruction involving the annular ventral segment.     

Annular Pancreas: A Rare Cause of Duodenal Obstruction in Adults

Annular pancreas is an uncommon congenital anomaly which usually presents itself in infants and newborn. Rarely it can present in late adult life with wide range of clinical severities thereby making its diagnosis difficult. Pre-operative diagnosis is often difficult. CT scan can illustrate the pancreatic tissue encircling the duodenum. ERCP and MRCP are useful in outlining the annular pancreatic duct. Surgery still remains necessary to confirm diagnosis and bypassing the obstructed segment.We report a case of 61 year female presenting with duodenal obstruction due to annular pancreas.     

Annular Pancreas in an Adult

A case of chronic duodenal obstruction due to an annular pancreas in a man aged 49 years is presented. At laparotomy the obstruction was bypassed by an antecolic gastro-jejunostomy. The symptoms, diagnosis and treatment of annular pancreas presenting in adult life are discussed.     

Annular Pancreatitis and Gastric Cancer

Annular pancreas can present in adult life, usually when inflammation of the pancreatic ring causes duodenal stenosis. Although peptic ulcer is often associated with annular pancreas, an association with gastric carcinoma has not been previously described. Here we report a patient with annular pancreas, chronic alcoholic pancreatitis and gastric carcinoma, who was successfully treated by radical proximal pancreatoduodenectomy.     

Carcinoma of the Ampulla of Vater Associated with Annular Pancreas

Carcinoma of the ampulla of Vater associated with annular pancreas is a rare entity. Only seven cases have been reported so far in the English literature. We herein report one such case in a 42-year-lady who presented with progressively increasing jaundice and pain in the upper abdomen for past 2 months. A magnetic resonance cholangiopancreaticography (MRCP) and MRI revealed an annular pancreas with an ampullary mass and a dilated CBD. An upper gastrointestinal endoscopic biopsy from the ampullary mass revealed a moderately differentiated adenocarcinoma. She was diagnosed as having annular pancreas with periampullary cancer that was subsequently confirmed at laparotomy. Histological examination confirmed a complete annular pancreas with a 2 cm × 2 cm moderately differentiated adenocarcinoma of the ampulla of Vater. The management, however, remains as in any case of periampullary malignancy. This highlights the importance that obstructive jaundice in an adult patient presenting with annular pancreas may be associated with a coexisting periampullary malignancy.     

Pancreas anulare als seltene Differentialdiagnose der Duodenalstenose im Erwachsenenalter

Annular pancreas is a rare congenital malformation of the pancreas. In about 50% of the cases the malformation is asymptomatic until the third to fifth decade. We report on a 52-year-old male patient who presented with subtotal duodenal and gastric outlet stenosis. Duodenohemipancreatectomy (Whipple's procedure) was performed. The histological examination showed an annular pancreas with complicating inflammatory reactions (tryptic sialadenitis) of the pancreatic head causing additional obstruction. Annular pancreas should be taken into account as a possible cause of adult duodenal obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) is the diagnostic modality of choice, and in combination with computed tomography the diagnosis can be obtained preoperatively in many patients. However, there are still patients in whom the diagnosis can finally be obtained only intraoperatively especially in cases where inflammatory pseudotumors or subtotal duodenal stenosis make ERCP impossible.     

Annular pancreas in the adult: two case reports and review of more than a century of literature

This paper brings the diagnosis and treatment of this interesting yet infrequent condition to contemporary standards through an assessment of past literature and a re-evaluation of the problem in view of technological advances. Two cases of annular pancreas are cited with a review of the last 183 years of literature. Only 100 cases, however, were reported in enough detail to examine outcomes in general and to arrive at a reasonable conclusion in terms of recommendations for diagnosis and operative intervention in adult annular pancreas. Two observations are brought to light. Despite all present diagnostic tools including endoscopic retrograde cholangiopancreatography diagnosis at best is made in only 60 per cent of patients preoperatively. Intraoperative expertise remains the best diagnostic modality available to date. Enteroenterostomy seems to be the intervention of choice for a multitude of anatomic and physiologic reasons and with a wide array of surgical options available when additional factors need to be addressed.     

Annular pancreas in the adult: management with laparoscopic gastrojejunostomy

Annular pancreas is an uncommon congenital anomaly associated with duodenal atresia in neonates. Rarely, the condition may manifest later in life. These symptoms include abdominal pain, nausea, and vomiting and usually arise due to obstruction to gastric emptying. Abdominal CT scan with high resolution and angiography protocol and magnetic resonance imaging are useful in confirming the presence of annular pancreas. Operative management involves bypassing the obstructed duodenum. Duodenoduodenostomy is routinely performed in neonates with annular pancreas. In adults, the duodenum is less mobile, and duodenojejunostomy or gastrojejunostomy are recommended. We report two cases of annular pancreas in adults treated with laparoscopic gastrojejunostomy.     

An annular pancreas associated with carcinoma of the papilla of Vater: report of a case

An annular pancreas is an uncommon congenital anomaly that usually presents early in childhood. Malignancy in the setting of an annular pancreas is unusual. We herein report a case of annular pancreas with carcinoma of the papilla of Vater. A 59-year-old man presented with epigastric discomfort and was referred to us after gastroduodenal endoscopy showed a tumor of the papilla of Vater. Preoperative imaging showed the pancreatic parenchyma encircling the descending duodenum and a tumor at the papilla of Vater. A pancreaticoduodenectomy was performed for the annular pancreas and the ampullary tumor. Histological examination confirmed a complete annular pancreas and carcinoma in situ of the papilla of Vater. We also provide a review of the reported cases of an annular pancreas with periampullary neoplasms and discuss the clinical characteristics of this anomaly.