腹腔镜胆囊切除术后早期急性胰腺炎的诊断与处理

目的探讨腹腔镜胆囊切除（laparoscopic cholecystectomy,LC）术后早期胰腺炎的临床特点及治疗措施。方法1998年4月～2006年6月,行LC18470例,术后早期（〈14d）急性胰腺炎16例（0.09%）。对于无胆道梗阻的病例,采取综合保守治疗（胃肠减压、抗感染、应用生长抑素等）;如明确有胆道梗阻,则行开腹胆总管探查术。结果14例保守治疗治愈,住院时间8～22d,平均12d;开腹手术2例。无围手术期死亡。16例随访5个月～3年,平均14个月,无胰腺炎、胆总管结石复发。结论LC术后在不恰当饮食等各种诱因作用下早期易并发以腹痛为主要表现的急性胰腺炎,多数经保守治疗可取得很好的效果。     

急性胆源性胰腺炎与高脂血症性胰腺炎的临床特征比较

目的:比较胆源性胰腺炎(BAP)和高脂血症性胰腺炎(HTGAP)的临床特征,为临床诊治提供参考证据.方法:收集整理天津市职业病防治院2018年12月—2020年12月收治的170例临床诊断为急性胰腺炎的病历资料,BAP组106例,HTGAP组64例,比较分析两组的临床基线数据、实验室检查和并发症等数据.结果:相比于BA...     

Acute gallstone pancreatitis: a constant challenge for the surgeon

Introduction  

Acute pancreatitis is an inflammation of the pancreas caused by autodigestion of the gland by its enzymes. It includes a broad spectrum of pancreatic disease, which varies from parenchymal edema to necrosis. The objective of the current study was to describe the symptoms of the patients with gallstone-associated pancreatitis and to reinforce the opinion that operation, within the first 72 hours after the onset of the disease, has many advantages and has to be considered as a treatment option when ERCP is not available.     

Acute Biliary Pancreatitis: An Experience in a Tertiary Level Hospital of Nepal

Acute Biliary Pancreatitis is one of the commonest forms of pancreatitis in Nepal. Controversies exist as to the most appropriate way of management of these cases. The present study was carried out to evaluate the management and outcome of Acute Biliary Pancreatitis cases in a tertiary level hospital of Nepal. A retrospective analysis of the patients managed with Acute Biliary Pancreatits was done. All patients admitted with the diagnosis of Acute Biliary Pancreatitis over a period of 2 years were included in the study. The variables measured were age, sex, clinical presentation, laboratory investigations, mode of treatment and outcome. A total of 45 cases had Acute Biliary Pancreatitis suggesting a prevalence of 28 %. The mean age was 45 ± 10 year. 39 patients (86.6 %) were treated with conservative management. 23 patients (54 %) had an uneventful recovery without any complications. 21 patients (46 %) developed some form of complications but recovered successfully. Mortality was seen in only one patient in the conservatively treated group. In a resource poor setting such as Nepal, definitive management is not always possible. Conservative management of Acute Biliary Pancreatitis has a favorable outcome in the majority of our patients with acceptable morbidity and mortality. Definitive management can be safely performed during index admission where possible.     

Acute Renal Failure as a Complication of Acute Pancreatitis

To assess the prevalence of acute renal failure (ARF) inpatients with acute pancreatitis, as well as the factors predictive of a lethal outcome, we retrospectively studied the data of all patients admitted to our hospital over a 5-year period. Between 1989 and 1993, 554 patients presented with acute pancreatitis, of which 24 (4.4%) subsequently developed ARF. Death occurred in 14/24 (58%) of patients with ARF, and was associated with an increased incidence of multiorgan failure. There was no statistically significant difference in the age, admission blood pressure, or admission pulse rate of the patients who survived and those who died. In contrast, death was associated with a higher Ranson score, and the increased prevalence of multiorgan failure. The length of hospitalization of the nonsurviving group was significantly shorter. Acute renal failure is not a common finding in patients with acute pancreatitis. However, when it occurs, it is associated with a poor prognosis, and is predicted by a higher Ranson score and the presence of multiorgan failure.     

Analysis of Acute Cellular Rejection Episodes in Recipients of Primary Intestinal Transplantation: A Single Center, 11-Year Experience

Intestinal transplantation has evolved over the years with major improvements in patient and graft survival. Acute cellular rejection of the intestine, however, still remains one of the most challenging aspects of postoperative management. We analyzed retrospectively collected data from 209 recipients of primary intestinal grafts at our institution over the past 11 years. A total of 290 episodes of biopsy-proven rejection requiring clinical treatment were analyzed. Rejection episodes doubled in length, on average, with each increasing grade (mild, moderate, severe). We observed increased incidence of overall rejection and particularly severe rejection in recipients of isolated intestinal and liver-intestine grafts in comparison with multivisceral grafts. Two rejection history variables had a significant negative impact on graft survival: the occurrence of a severe rejection episode and a rejection episode lasting >or=21 days. The lower incidence rate of severe rejection in recipients of multivisceral grafts might be due to a combination of increased donor lymphatic tissue and larger load of donor-derived immune competent cells present in the graft. The development of more effective monitoring and treatment protocols to prevent the occurrence of severe and/or lengthy rejection episodes is of critical importance for intestinal graft survival.     

Acute Renal Failure Complicating Severe Acute Pancreatitis

The records of 563 patients admitted to the hospital with diagnosis of acute pancreatitis have been studied retrospectively. The aim of the study was to investigate the prevalence of acute renal failure (ARF) in these patients, and to evaluate the most important risk factors for ARF development and mortality. The prevalence of ARF in studied population was 14%, but only 3.8% of ARF patients with acute pancreatitis had isolated renal failure. Other patients had additional failure of other organ systems, 68.4% of whom had multiorgan failure (MOF) before the onset of ARF. In only 8.9% of ARF patients was the renal system the first organ system to fail. Patients with ARF were significantly older, had more preexisting chronic diseases (including chronic renal failure), usually had MOF, and local pancreatic complications relative to these in the group with normal renal function. The development of ARF was directly influenced by severity of acute pancreatitis. The mortality rate in ARF patients was 74.7%, compared to an 7.4% mortality of patients with acute pancreatitis and normal renal function. Preexisting chronic disease, the presence of MOF and their number, local pancreatic complications, and older age of the patients increased mortality in ARF patients. The prognosis of patients with oliguric ARF requiring renal replacement therapy was extremely poor, indicating the importance of prevention of ARF in the patients with acute pancreatitis.     

急性胰腺炎的营养支持

目的 讨肠内营养在急性胰腺炎营养支持中的应用价值。方法 检索有关Medline文献并综述。结果 全胃肠外营养(TPN)曾是急性胰腺炎营养支持的主要手段，但费用昂贵和并发症多；空肠内的肠内营养能获得“胰腺休息”，并能有效防止急性胰腺炎全身炎症反应综合征(SIRS)和多脏器功能衰竭(MOF)。结论 只要没有肠梗阻，急性胰腺炎的营养支持应首选肠内营养。     

Current Surgical Management of Acute Pancreatitis

Background: About 20% of the patients with acute pancreatitis may run a rapidly progressive or fulminant course resulting in the multiple organ dysfunction syndrome with or without accompanying sepsis. In this subset of patients, the mortality rate still ranges from less than 10% with sterile to over 30% with infected pancreatic necrosis. The goal of this review is to assess the available treatment strategies to allow the development of a formalized surgical approach to those patients.

Methods: A literature review of management of acute pancreatitis.

Results and conclusion: Over the past 20 years, there has been a substantial change in the surgical management of severe acute pancreatitis. This change has been away from a preventive surgery based on early major interventions towards a surgery of complications based increasingly on less aggressive options that take place at a later stage of the attack with specific criteria governing the timing of surgical therapy.

Non-surgical options remain more than ever the cornerstone of management in many of these patients.     

急性坏死性胰腺炎外科治疗的十年回顾性分析

目的:探讨急性坏死性胰腺炎的合理治疗方案、手术指征及手术方式.方法:回顾近10年来我科74例急性坏死性胰腺炎的外科治疗方式,对比经典术式、简化术式及非手术治疗三个不同治疗组的严重并发症发生率及治疗结果.结果:非手术组平均住院天数、ARDS和休克等严重并症的发生率均显著低于手术组;简化术式组的相应指标明显低于经典术式组.各组死亡率:手术组为25%(10/40),非手术组为2.9%(1/34);在手术组40例中,经典术式组为46.7%(7/15),简化术式组为12%(3/25),本组总的治愈率达85.1%.结论:ANP在未发生感染的早期行非手术治疗是可取的;如出现继发感染,可再中转手术;术式应简化,以适度的清除坏死组织和引流较为合理.     

实验研究细胞因子在急性胰腺炎发病机理中的作用

目的：观察大鼠血清中细胞因子在急性胰腺炎发病机理中的作用。方法：检测血清中细胞因子和TNF-α，观察胰、肝、肺、肾的病理变化及胰腺细胞培养液中淀粉酶和PLA_2化。结果：在坏死性胰腺炎和水肿性胰腺炎大鼠血清中，IL-1β、IL-6、IL-2和TNF-α都明显高于正常对照组(P＜0.01），水肿性和坏死性胰腺炎的胰组织中4种细胞因子都高于正常胰腺组（P＜0.01），但两者之间未见明显差别。水肿性胰腺炎分离培养的胰腺细胞上清液中测出IL-6和TNF-α都高于正常胰腺组。结论:急性胰腺炎症过程中有多种细胞因子参与发病机理，其在体内放大作用造成胰腺本身在内的全身多器官功能损害，而且细胞因子的升高与疾病的严重程度相关。     

急性胰腺炎的CT评价

目的：探讨急性胰腺炎及其并发症的CT表现和急性胰腺炎严重程度的评价方法。方法：回顾CT诊断急性胰腺炎及其并发症、评价急性胰腺炎严重程度的文献。结果：CT增强扫描早期判断胰腺坏死的检测率为90％，而对发病4d后评价胰腺坏死的敏感性几乎为100％，急性胰腺炎CT严重度指数与胰腺局部并发症的发生和急性胰腺炎死亡率有极好的相关性。结论：CT增强扫描能显示胰腺坏死、评价炎性过程的范围和发现局部并发症，是综合评价急性胰腺炎的首选影像学方法。     

妊娠合并急性胰腺炎的诊断与治疗(附5例报告)

目的　提高对妊娠合并急性胰腺炎的认识和警惕性 ,降低孕产妇的病死率。方法　对本院 1992年 3月～ 2 0 0 2年 3月收治的妊娠合并急性胰腺炎的 5例进行回顾性分析。结果　本组病例大多发病于妊娠晚期 ,且多为重症急性胰腺炎 ;误诊 2例 ,误诊孕产妇病死率显著增高 ;中止妊娠不能降低孕产妇病死率。结论　妊娠合并急性胰腺炎的早期诊断与治疗是改善病人预后的基础 ,其治疗应遵循“个体化”原则 ,并协同妇产科医生妥善进行胎儿的处置     

Duodenal Polypectomy is a Rare Cause of Acute Pancreatitis

Endoscopic duodenal polypectomy is a routine procedure particularly useful for obtaining histological diagnosis but it is not without serious complications. This is a case report of severe necrotising pancreatitis after duodenal polypectomy. We suggest that experienced endoscopists should carry out polypectomies and that clear guidelines for the management of duodenal polyps are required. Patients undergoing endoscopic duodenal polypectomies should be placed at the beginning of the endoscopy list and observed for at least 4 h.     

参附注射液联合奥曲肽治疗急性胰腺炎

目的:观察参附注射液联合奥曲肽治疗急性胰腺炎的临床疗效。方法:将86例急性胰腺炎患者随机分为治疗组44例与对照组42例,均采用常规治疗及静脉注射奥曲肽,治疗组加用参附注射液100 mL,1次/d;两组均治疗5~10 d。结果:治疗组多项观察指标的恢复情况明显优于对照组,平均住院日明显缩短。结论:参附注射液可能通过改善胰腺微循环,保护或改善心肌、肺、肝等重要器官的功能,促进胃肠蠕动功能,减少肠道细菌移位,从而快速改善患者病情,缩短住院时间。     

选择素与急性胰腺炎

目的 了解选择素在急性胰腺炎发病及病程进展中的作用，为进一步研究提供方向，指导临床治疗实践。方法 综述选择素在急性胰腺炎时的病理生理作用机理。结果 选择素水平在急性胰腺炎过程中古明显变化，并与细胞因子、氧自由基、补体等密切相关。结论 选择素是急性胰腺炎病理机理的组成部分，其表达水平对临床疾病的观察及治疗有指导意义。     

急性坏死性胰腺炎外科治疗20年经验总结

总结了1974年8月～1994年11月243例急性坏死性胰腺炎外科治疗的经验.按治疗观点及治疗方式分为三个阶段.第一阶段1974年8月～1987年12月为针对胰腺坏死作早期彻底切除坏死组织手术,辅以“三造瘘”、“创口敞开”、“局部灌洗”等措施.治愈率为61.3%.第二阶段1988年1月～1991年6月以坏死是否伴有感染为指征,对有感染者作手术治疗,治愈率67.1%;对非感染者作保守治疗,治愈率85.7%,总治愈率提高到68.5%.第三阶段1991年7月～1994年11月治疗有二特点.第一是在手术时间上强调后期手术,如在严密的治疗观察下感染能缓解控制、可延缓到后期手术;对于有恶化倾向、或对阻塞性胆源性胰腺炎及胰腺脓肿穿破致腹膜炎等病例则作早期或急诊手术.第二是建立综合治疗体系,依靠多学科的参与使患者渡过诸如全身细菌、霉菌感染、深部脓肿的处理、以及全身严重消耗的纠正等、使手术治愈率提高到80%、非手术治愈率达到100%、总治愈率为83.1%.     

硫化氢在重症急性胰腺炎患者血浆中的表达及意义

目的:探讨硫化氢(H2S)在重症急性胰腺炎患者血浆中的表达及意义。方法:重症急性胰腺炎(A组)患者40例,同期健康体检者40例为正常对照组(B组)。敏感硫电极法测定血浆H2S浓度,化学法测定血浆NO含量,采用ELISA检测血浆中TNF-α、IL-6、高敏C反应蛋白(hsCRP)表达。结果:A组TNF-α、IL-6、hsCRP、NO及H2S均显著高于B组(P<0.01),H2S与TNF-α、IL-6、hsCRP、NO呈正相关(r=0.612、0.743、0.629、0.649,P<0.01)。结论:内源性H2S是一种炎症介质,在重症急性胰腺炎中起促进炎症反应效应。     

急性胰腺炎患者凝血功能的变化及临床意义

目的探讨急性胰腺炎(AP)患者凝血功能的变化及临床意义。方法选择26例急性水肿型胰腺炎患者(AEP组),21例急性重型胰腺炎患者(SAP组)和30例年龄、性别与体质量指数(BMI)相匹配的健康人(对照组),测定凝血功能血浆凝血酶原时间(PT)、凝血酶原时间国际标准化指数(INR)、部分活化凝血酶原时间(APTT)、纤维蛋白原浓度(FIB)和血小板计数(BPC)并计算24 h内急性生理学与慢性健康状况评分(APACHEⅡ评分),观察并比较上述指标在3组中的不同。结果 SAP组的PT、INR、APTT及FIB均显著高于AEP组和对照组,AEP组的PT、INR、APTT、FIB亦显著高于对照组,差异有统计学意义(均P0.05)。与对照组相比,SAP组和AEP组的BPC均显著降低(均P0.05);与AEP组相比,SAP的BPC亦显著降低(P0.05)。SAP组的A-PACHEⅡ评分显著高于AEP组,差异有统计学意义(P0.05)。Spearman相关分析显示,AEP组和SAP组的PT、INR、APTT、FIB、BPC均与APACHEⅡ评分呈正相关(均P0.05)。结论急性胰腺炎患者凝血功能变化与病情严重程度相关。