胰腺组织学特点对胰肠吻合方式潜在风险的分析

目的：通过研究胰腺组织学特点,探讨胰肠吻合方式存在的潜在组织学风险。方法：选择新疆医科大学第一附属医院2005年4月—2007年12月行胰十二指肠切除术（PD）82例患者。术中取胰腺组织学标本,研究胰腺周围组织结构、胰腺小叶间隙的组织结构特点和胰腺断面胰腺组织和胰管组织学特点,分析术后胰瘘组织学因素。结果：发生胰瘘15例,发生率为18.3%,胰瘘组和无胰瘘组术前年龄、总胆红素、血清白蛋白、血红蛋白情况两组比较无统计学意义（均P>0.05）。在胰腺组织学方面,胰腺质软31例,发生胰瘘11例;胰腺质硬51例,发生胰瘘4例,两者比较有统计学意义（P<0.05）;胰腺组织标本显示,胰腺腺体的周围均为疏松结缔组织,无被膜结构,以及胰腺断面可见主胰管和次级胰管均可能是胰瘘发生的组织学潜在风险。结论：对于具体的胰腺组织,应该重视胰腺组织学特点,选择合理的胰肠吻合方式以及如何弥补该吻合方式所存在的潜在风险均显得重要。     

节段性胰腺切除术治疗胰腺疾病

对胰头，颈和体部食性病变传统上均行Ｗｈｉｐｐｌｅ手术。Ｗｈｉｐｐｌｅ手术范围大，手术步骤比较和繁杂，并发症较多，为了克服上述缺点，我们采用胰腺病变外节段性切除治疗４例胰腺疾病。该术式保留了胃、十二指肠及胆道系统的生理通道，避免了胆肠和胃肠吻合可能发生的并发症，简化了手术步骤，加快了术后患者的恢复，疗效满意。     

生长抑素治疗良性胰腺疾病的现况

生长抑素能强有力地抑制胰腺分泌。随着人工合成生长抑素类似物的出现，临床上已广泛应用于多种良性胰腺疾病的治疗。本文总结了生长抑素的作用机制，评估了生长抑素类似物在急性胰腺炎、胰瘘、慢性胰腺炎、胰腺假性囊肿、胰源性腹水和胰腺切除术后的作用。     

钙通道阻滞剂与胰腺疾病

钙通道阻滞剂与胰腺疾病曹天生综述史海安审校钙离子是细胞内包括细胞增生的各种生物反应的一种重要中介物质。钙通道阻滞剂是近年心血管药理学的重要进展之一，研究发现该类药物对急性胰腺炎（ＡＰ）和胰腺肿瘤有一定程度的治疗作用。一、钙通道阻带剂与急性胰腺炎目前，...     

胰腺疾病的内镜诊断与治疗

近年胰腺疾病的发病率呈不断上升趋势 ,但随着内镜技术的发展特别是 ERCP的开展及应用 ,使胰腺疾病的诊断与治疗发生了划时代的变革。不但可以在内镜下直接取材或通过间接影像来提高胰腺癌及其它胰腺疾病的诊断率 ,而且治疗性内镜在一定程度上已取代了沿用已久的外科手术 ,渐已成为胰腺疾病治疗中不可缺少的技术。1　胰腺疾病的内镜诊断1 .1　胰腺癌由于胰腺癌多起源于胰管上皮细胞 ,故早期就可引起胰管狭窄或梗阻、扩张和移位 ,所以 ERCP对发现早期胰腺癌有重要意义。胰头癌时可引起胆总管、主胰管梗阻 ,在同一水平段同时出现胰胆管狭…     

保持完整的胰腺被膜治疗早期重症胰腺炎

重症胰腺炎是临床常见病，且治疗困难，如果治疗不当，其死亡率相当高［１］。目前的观点是，早期手术治疗是不适宜的，但就手术加重病情的原因尚无研究。在１９９０～１９９２年，我们按传统手术方法治疗５例重症胰腺炎患者，效果不佳。１９９３年以后，我们采用腹腔内灌洗或改良后的手术方法，在保持完整的胰腺被膜的前提下，治疗早期重症胰腺炎２２例，取得良好的效果。临床资料１．一般资料：本组２７例，男１８例，女９例，最大年龄６８岁，最小年龄４３岁，中位年龄５１岁，根据国内１９９１年临床诊断及分级标准［２］，该组患者均为…     

中段胰腺切除术在胰腺疾病中应用

目的 探讨中段胰腺切除术在治疗胰腺颈体部疾病的可行性.方法 回顾分析12例胰腺颈体部疾病患者实施中段胰腺切除术的临床资料.结果 2例为内分泌肿瘤（1例无功能胰岛细胞瘤,1例有功能胰岛细胞瘤）,2例为黏液性囊性肿瘤,5例低度恶性肿瘤（实性假乳头状瘤）,1例转移性癌,1例慢性胰腺炎,1例胰腺体部横断伤.手术时间（2.8±0...     

胰腺疾病的手术引流问题

胰腺疾病的手术引流问题上海第二医科大学附属瑞金医院（２０００２５）袁祖荣张圣道胰腺疾病手术后是否要常规放置引流，放置何种引流物，采用何种引流方法等一系列问题受到胰腺外科医师的关注和重视。当然每个医院甚至每个外科医师根据自己的经验和习惯对引流问题都有各...     

Pathomorphologic study of undifferentiated carcinoma in seven cases: relationship between tumor and pancreatic duct epithelium

Background/purpose  By the time undifferentiated carcinoma is detected, it has formed a large mass, and it is reportedly difficult to pathologically observe its relationship with the pancreatic duct. In this study, we examined the pancreatic ducts of seven patients of surgical samples, and pathomorphologically investigated the relationship between the adenocarcinomatous and sarcomatous components and the pattern of tumor extension. In addition, we evaluated the usefulness of pancreatic juice cytology by comparison with the findings of the main pancreatic duct (MPD). Methods  Seven primary undifferentiated carcinomas of the pancreas (from three male and four female patients with a mean age of 59 years) were analyzed. Histopathological evaluation was based on the WHO diagnostic criteria. Pancreatic juice cytology was performed and evaluated in two patients. Results  All the undifferentiated carcinomas contained adenocarcinomatous and sarcomatous components, and two had a distinct glandular structure. However, we could not pathomorphologically confirm the continuity of the adenomatous with the sarcomatous components in any of the patients. Three undifferentiated carcinomas contained osteoclast-like giant cells. Pathological observation of the tumor and MPD was possible in three of the seven undifferentiated carcinomas. PanIN-3 was observed in the MPD of three patients, suggesting extension into the MPD. In one of these three, the tumor presented intraductal growth in the MPD, and preoperative pancreatic juice cytology revealed atypical cells with osteoclast-like giant cells. In the remaining two, the tumor extraductally compressed the MPD upward. Conclusions  Undifferentiated carcinoma showed two patterns of cancer extension: (1) invasion and expansive growth during the sarcomatous transformation of adenocarcinoma, and (2) intraductal extension. In addition, some undifferentiated carcinomas showed extension in the MPD. Of note, postoperative pancreatic juice cytology may be useful for the diagnosis.     

胰腺中段切除术在胰腺疾病中应用(附17例报告)

目的 探讨胰腺中段切除术在治疗胰腺颈体部疾病的可行性及临床应用价值.方法 回顾分析西安交通大学第一附属医院2006年6月～2012年3月17例胰腺颈体部疾病患者实施胰腺中段切除术的临床资料,胰岛细胞瘤4例(2例为无功能性),黏液性囊腺瘤4例,浆液性囊腺瘤3例,实性假乳头状瘤3例,非侵袭性胰管内乳头状粘液癌2例(病理科已核实),外伤胰腺颈体部横断伤1例.结果 17例均行胰腺中段切除,胰体空肠Roux-en-Y吻合14例,胰头、胰体空肠双吻合3例,术后胰瘘5例(29.4％),出血2例(11.8％),经非手术治疗后痊愈.随访时间5个月-2年,1例因腹腔转移多器官衰竭术后5个月死亡;1例术后8个月因心脑血管疾病死亡;其余均存活,且随访期血糖监测正常,无其它并发症.结论 对于胰腺颈体部良性或低度恶性肿瘤,胰腺中段切除术是一种比较理想的手术方式,该术式能最大程度保留胰腺组织,维持胰腺的内、外分泌功能,维持上消化道连续性,可获得满意的治疗效果.     

超声内镜检查与胰腺疾病内镜治疗

超声内镜检查原理与腹部超声相似,其区别只是将微型高频超声探头安装在内镜顶端,进行实时超声扫描.胰腺是腹膜后器官,由于EUS插入胃和十二指肠肠腔内扫查,可清晰显示胰腺结构.随着EUS的广泛应用和内镜附件发展,EUS在胰腺疾病微创治疗中的地位越来越高.EUS-FNA与注射技术、EUS-CPN、EUS介导放射粒子植入术和内镜超声引导下胰腺假性囊肿穿刺引流等治疗技术会逐步推广应用,成为继ERCP内镜治疗后胰腺疾病微创治疗的重要方法.     

Solitary pancreatic tuberculosis mimicking advanced pancreatic carcinoma

A 40-year-old woman was referred for pancreatic head carcinoma invading the portal vein. The dichotomy between the radiological findings and the general condition of the patient, as well as the laboratory results (no evidence of cholestasis), cast doubt on the diagnosis. There was no history of tuberculosis. The chest radiograph revealed no pathological findings. The anatomic relationships of the lesion entailed a high risk of vascular injury if tissue biopsy were to be done; therefore, diagnostic laparotomy was performed. Biopsy revealed granulomas with caseous necrosis, consistent with tuberculosis. After 6 months of antituberculosis treatment, the lesions had completely resolved. Tuberculosis should be considered in the differential diagnosis of pancreatic masses, particularly in regions where the disease is endemic. The condition usually resembles an advanced pancreatic tumor. Performing a biopsy of inoperable lesions and maintaining a reasonable skepticism in regard to the evaluation of operable lesions (attention to nonexclusive but helpful clues, such as young patient age, history of tuberculosis, absence of jaundice) will lead to the diagnosis in most patients. Diagnostic laparotomy may be required in a small subset of patients. The response to antituberculosis treatment is very favorable. The role of resection (e.g., pancreatoduodenectomy) is very limited. Received: December 1, 2000 / Accepted: January 25, 2001     

胰激肽原酶在男科疾病中的应用

男科疾病治疗中活跃着一批具有广泛生物学作用的药物,激肽原酶就是代表之一。包括激肽原(底物)、激肽原酶(活性酶)、激肽(效应物)和激肽酶(灭活酶)在内的激肽生物系统在生殖器官和精液中均有存在,它们参与了许多生殖过程的精确调节,并以其独特的生物学特性,广泛应用于男科疾病的治疗。本文介绍了胰激肽原酶治疗男科疾病的作用机制,并系统地介绍其在常规药物治疗、辅助生殖技术、生殖道感染及精索静脉曲张中对精子质量的改善作用,改善糖尿病患者的勃起功能,以及在慢性前列腺炎及男性更年期综合征中的潜在应用价值。     

磁共振胰胆管成像与经内镜逆行胰胆管造影对胆胰疾病诊断价值的比较研究

目的 评价磁共振胰胆管成像(MRCP)与经内镜逆行胰胆管造影(ERCP)对胆胰疾病的诊断价值.方法 对134例怀疑为胆胰管疾病病人行MRCP,并与58例ERCP比较,所有病例均经手术病理证实.结果 134例MRCP均获成功,在行ERCP中54例成功,4例失败者改行PTC检查成功.MRCP和ERCP总的诊断准确率分别为90.3%和88.9%.结论 MRCP对胆胰系统疾病中恶性梗阻所致的梗阻性黄疸诊断准确性较高,对胆总管、肝内胆管较小结石的诊断不如ERCP敏感及准确,而且不能治疗,提示MRCP和ERCP各有优越点,二者合理应用可提高胆胰系统疾病的诊断符合率.     

胰头癌的临床病理特点与根治术后预后的关系

目的　探讨胰头癌临床病理特点与根治术后预后的关系。方法　回顾分析 5 6例行胰头十二指肠切除术的胰头癌病人的临床病理特点 ,并用Kaplan Meier法、log rank法及秩和检验分析术后生存时间及生存时间之间的差异。结果　胰腺前方被膜及组织被肿瘤侵犯的 19例较未被侵犯的 37例、门静脉系被肿瘤侵犯的 18例较未被侵犯的 38例、淋巴结转移的 2 9例较无转移的 2 7例、腹膜种植转移的 3例较无种植转移的 5 3例、肝转移的 5例较无转移的 5 1例、远隔脏器转移 (包括腹膜种植转移和肝转移在内 )的 11例较无转移的 4 5例术后生存率均低 (P >0 0 5 )。而肿瘤大小 ,胰后面组织、胰内胆管、十二指肠壁、动脉系、胰腺外神经丛等被肿瘤侵犯与否与术后生存率均无关。结论　在胰头癌 ,淋巴结转移、腹膜种植转移及肝等远隔脏器转移、胰腺前方被膜及组织和门静脉系受侵可能是胰头十二指肠切除术后的预后决定因素。     

Laparoscopic drainage of pancreatic pseudocysts

Background. Laparoscopic drainage of pancreatic pseudocysts (PPs) has been used in selected cases. The aim of this study is to analyze our results with the laparoscopic technique and to compare them with those of a cohort of patients treated by open surgery during the same time period.Patients and methods. Ten patients underwent laparoscopic drainage of PPs during a 7-year period [laparoscopic group (LG)]. The type of drainage was chosen according to the size and location of the PP. Demography, surgical details, results, and complications were analyzed and contrasted with those of 6 patients who underwent open drainage [open group (OG)].Results. All patients presented with mature PPs developed after a documented episode of acute pancreatitis. Mean age of the LG was 42 years (six males and four females). In the OG, mean age was 36 years (five males and one female). Etiology of the pancreatitis was alcoholic in eight patients, biliary in five, toxic in two, and associated with systemic lupus erythematous in one. Laparoscopic procedures included Roux-en-Y cystojejunostomy in four patients, extraluminal cystogastrostomy in four, and intraluminal cystogastrostomy in two. There were no conversions. In the OG, cystogastrostomy was performed in three patients and Roux-en-Y cystojejunostomy in three. One patient in the LG developed upper gastrointestinal bleeding the day after surgery that resolved uneventfully, one patient presented a postoperative abscess that required open drainage, and one patient presented a residual pseudocyst that was treated by endoscopy. Morbidity in the OG included a small bowel obstruction secondary to an internal hernia that required reoperation, pneumonia, and a residual pseudocyst that was treated conservatively in one patient each. At a median follow-up of 22 months (range, 1–72) all patients were asymptomatic with no evidence of recurrent disease by computed tomography scan.Conclusion. Laparoscopic drainage of PPs is feasible, safe, and effective. Results are similar to those obtained using the open technique.     

华支睾吸虫感染与肝胆胰外科疾病的关系(附650例临床分析)

目的 探讨华支睾吸虫感染者发生肝胆胰外科疾病的情况，提高对该寄生虫病诊断和治疗的认识。方法 回顾650例华支睾吸虫感染者的临床资料，分析其合并肝胆胰外科疾病的情况。结果 324例(49．85％)合并有肝胆胰外科疾病，胆道疾病289例，占合并症的89．2％，肝脏疾病19例(5．87％)，胰腺疾病16例(4．94％)。单病种最多的是胆石症184例(56．8％)。全组中151例(23．23％)实施了手术治疗，22例实施了内镜下十二指肠乳头括约肌切开术(EST)治疗。结论 华支睾吸虫感染是流行区肝胆胰外科疾病的最主要致病因素，以胆道疾病，尤其是胆石症最多见。     

Nonstandard pancreatic resections for unusual lesions

BACKGROUND: Pancreatic resections including pancreaticoduodenectomy and distal pancreatectomy are the standard of care for patients with malignant tumors of the pancreas. Patients with benign disease or unusual tumors may benefit from other nonstandard resections. METHODS: A review of the literature and the author's experiences were undertaken. RESULTS: Parenchymal-sparing surgeries including pancreatic enucleation, central pancreatectomy, splenic-preserving distal pancreatectomy, and duodenal-preserving pancreatic head resection are described. The utility of each procedure is reviewed. Outcome results from published series are included. CONCLUSIONS: Nonstandard pancreatic resections should be considered in select patients with unusual lesions. Such procedures are safe and effective and may be associated with a reduced incidence of exocrine insufficiency.