背胰形态变异的影像学特征

目的 总结背胰形态变异的影像学特征及其临床意义.方法 回顾性分析47例背胰形态变异患者的CT、MRI资料,分类解释其影像学特征.结果 (1)背胰缩小类.背胰发育不全(n=7):胰腺长度(91.59 ±22.39) mm,呈“短胰腺”表现,4例(4/7)胰头增大,存留胰腺呈“蝌蚪状”,其中3例(3/7)形成环状胰腺;2例(2/7)合并多脾综合征、下腔静脉肝段缺如.(2)背胰增大类.①胰尾增宽(n=18):胰尾最大宽径(36.12±6.59)mm,超过胰体宽径,胰腺呈类似“哑铃状”表现.②背胰局部隆起(n=13):胰颈、体及尾部腹侧缘的局限性隆起,高度(15.72±2.65) mm,长度(18.59±3.64) mm,多位于胰颈.(3)背胰相关分裂类.①背胰脂肪裂隙(n=7):脂肪裂隙宽度(3.51±2.42) mm,深度(19.45±5.84) mm,表现为线条状脂肪密度(信号)影,5例(5/7)位于胰体、尾,2例(2/7)位于腹胰与背胰融合区.②胰尾分叉(n=3):胰尾局限性分叉呈“燕尾状”表现,最大宽径(26.63±1.75) mm,分叉角度(99.27±30.73)度.结论 背胰发育异常可导致胰腺多种形态改变,影像学表现有一定特征,了解胰腺的发育过程,熟悉该类变异的影像学表现有助于正确诊断,从而避免不必要的临床治疗.     

胰腺分裂:是一种外科疾病吗?

胰腺分裂(Pancreas divisum PD)是一种胰管系统的解剖变异,一种先天性异常.在人胚胎第五到第七周间,前肠长出背芽和腹芽形成了胰腺,由于十二指肠旋转的关系,腹芽顺时钟旋转并和背芽融合,腹芽形成了钩突部和胰头下部,背芽则形成胰头的其余部分和体尾部.腹侧胰管和背侧胰管汇合在一起形成主胰管(Wirsung氏管),开口于瓦特氏壶腹部.背侧胰管也常存在,开口于壶腹上方2～3cm处十二指肠内,为副胰管即Santorini氏管.如腹背部胰管未能融合,其结果就成为PD.胚胎性胰管存在的结果腹侧管即Wirsung氏管引流钩突部和胰头下部,而     

胰腺脂肪瘤1例报告

胰腺脂肪瘤是临床上罕见胰腺良性肿瘤。我们于1994年收治1例,报告如下。 患者:男,57岁,因胃溃疡出血就诊时行B超检查发现胰头部可见一不规则低回声区的2.2×2.9cm,胰头宽3.0cm,胰体1.7cm,胆管胰管无扩张。CT平扫和增强扫描均于胰头腹侧可见约4×4.8cm椭圆形低密度区,CT值为-110Hu,密度均均,病灶由胰腺实质内向外生长,致胰腺实质受压变簿,未见胰管扩张(图1)。血清总胆红素9.4umol/L。碱性磷酸酶41u/L。诊断:①胃溃疡并出血;②     

保留十二指肠、胆管和乳头的胰头切除胰管端端吻合术

对2例胰头粘液囊肿患者施行了切除胰头并保留十二指肠、胆管和乳头，同时行胰管端端吻合术，效果良好。进腹后，分离胃、结肠韧带，暴后胰腺前面。不游离十二指肠，结扎、切断督网膜右血管，在胰腺上端分离鲁十二指肠动脉根部，显露胰十H指肠上动脉前支（ASPD）和后支（PSPD）的分叉部，结扎、切断ASPD，保留PSOD。在门静脉前方切断胰腺，分离结扎胰腺与门静脉之间的一些小血管直至能如及肠系膜上动脉（SMA）。确定胆总管前壁位置，并向乳头方向分离，剥离胰腺实质，使之与十二指肠分离，然后找出胆胰管汇合部，将一手指插入胰腺后…     

保留胰腺的十二指肠切除术的临床应用

胰头十二指肠区域实际上有胰腺、胆道和十二指肠均在其内,其病变可以发生在十二指肠的任何部位和壶腹周围区,但主要发生在壶腹部。胰头十二指肠区域是一个外科治疗的困难部位,动一而涉及其它脏器。1十二指肠和壶腹部病变治疗的历史Halsted在1899年首先进行十二指肠乳头癌局部切     

胰管空肠黏膜吻合预防Whipple术后胰瘘的发生

1995年开始我们对 6 3例行胰十二指肠切除的患者采用胰管空肠黏膜吻合方式 ,无 1例发生胰瘘和消化道出血 ,取得满意效果 ,现报告如下。临床资料1.一般资料 :本组共 6 3例 ,其中男 4 1例 ,女 2 2例 ;年龄2 8～ 89岁 ,平均 5 3岁。胰头癌 34例 ,壶腹周围癌 17例 ,胃窦癌 4例 ,十二指肠癌 2例 ,慢性胰腺炎 5例 ,十二指肠异位胰腺伴炎性假瘤形成 1例。2 .手术方式 :(1)离断胰腺 :在预定胰腺切线的上、下缘常规各缝扎 1针 ,用尖刀边切边缝扎止血 ,缝合时不宜大块组织结扎。仔细观察胰腺断面 ,无论胰管有无扩张 ,在胰腺断面中部近后缘处均可见清亮…     

壶腹周围肿瘤患者腹腔镜胰十二指肠切除术后胰瘘的危险因素分析

回顾性分析2018年1月至10月在吉林大学第一医院行腹腔镜胰十二指肠切除术(LPD)的100例壶腹周围肿瘤患者的临床资料, 其中男性55例, 女性45例, 年龄(56.4±11.1)岁。依据术后1个月内是否发生胰瘘分为两组:胰瘘组(n=12)和非胰瘘组(n=88)。单因素分析发现两组患者的体质量指数、肿瘤糖类抗原199、胰腺质地、胰管直径、手术时间、术中出血量、肿瘤位置差异有统计学意义(均P<0.05)。进一步多因素logistic回归分析发现, 手术时间长(OR=1.059, 95%CI:1.015～1.106, P=0.009)、胰腺质地软(OR=0.074, 95%CI:0.006～0.951, P=0.046)、胰管直径≤3 mm(OR=0.010, 95%CI:0.001～0.631, P=0.030)和非胰腺肿瘤(OR=0.013, 95%CI:0.001～0.726, P=0.034)是壶腹周围肿瘤患者LPD术后胰瘘的独立危险因素。     

保留十二指肠胰头全切除术

保留十二指肠胰头全切除术要点：采用柯克手法将胰头从后腹膜分离,直至见到肠系膜下静脉。沿着肠系膜上静脉解剖直至胰颈。结扎切断Henle静脉干。游离、悬吊胃十二指肠动脉,暴露门静脉。缝扎胰腺上下缘、结扎胰头以减少横断胰颈时的出血。切断胰腺勾突,残端缝扎止血。沿着胰头部实质与十二指肠之间的疏松结缔组织解剖,结扎从胰十二指肠动脉弓到胰头的分支。沿着胰头与胆总管之间解剖。切断主胰管,残端用5/0普理灵线缝扎。胰管空肠吻合采用胰管对粘膜吻合法。     

胰管结石合并壶腹部周围病变的诊断及手术方式探讨

目的探讨胰腺结石合并壶腹部周围病变的诊断和手术方式。方法回顾性分析1994年4月-2005年10月32例胰管结石中8例合并壶腹部周围病变的临床资料。结果8例胰腺结石合并壶腹部周围病变患者中5例术前未获得明确诊断。3例胰管结石合并胰头癌患者行胰十二指肠切除、胰空肠捆绑吻合术，术后生存期分别为14个月、18个月和23个月；3例十二指肠乳头癌合并胰管结石行胰十二指肠切除、胰管切开取石、胰管端侧与空肠侧侧吻合术，分别已生存10个月、12个月和18个月；1例环状胰腺、十二指肠膜状闭锁合并胰腺结石行胰头部及环状胰腺、十二指肠球部和部分降部、胆管下端切除、十二指肠胰体尾捆绑吻合、胆肠吻合术；1例胰管结石合并胰腺钩突囊肿行囊肿切除、胰管与空肠侧侧吻合术，2例术后效果均良好。结论胰管结石患者应考虑合并壶腹部周围病变可能，合理选择手术方式不仅可以改善患者生活质量、还可以延长生存时间。     

门静脉型环状胰腺研究进展

门静脉型环状胰腺（CPP）指胰腺钩突部与胰体部融合，造成胰腺组织完全环绕门静脉及（或）其主干属支（如肠系膜上静脉、脾静脉）的变异。CPP是罕见的先天性胰腺变异，无临床症状，不需要治疗，易被忽视。其主要的诊断方式是增强CT、MRI检查和手术探查。根据胰腺包绕血管情况和主胰管与门静脉关系，CPP可分为Karasaki分型和Joseph分型。在胰十二指肠切除术和胰体尾切除术中，因胰腺组织包绕门静脉，可能造成残余2个胰腺断面，增加胰肠吻合的难度和术后胰瘘风险。外科医生应知晓此种变异类型，并设计个体化的胰腺手术方式。     

Extrapancreatic lymphoepithelial cyst of the pancreas

A lymphoepithelial cyst is reported. A 68-year-old man consulted a surgeon, presenting with a sense of abdominal fullness. Ultrasonography and computed tomography revealed a large tumor, 10 cm in diameter, behind the head of the pancreas. Celiac arteriography at our hospital showed feeding arteries from the dorsal pancreatic artery and the pancreatic arcades. CA19-9 was elevated to 178 U/ml. Laparotomy was performed. The tumor was well demarcated from the surrounding tissue by a fibrous capsule and there was no continuity to the pancreatic parenchyma. Simple tumorectomy and distal gastrectomy for peptic gastric ulcer disease were performed. The cut surface revealed a multicystic lesion containing atheromatous substances. Histopathologically, the internal surface of the cyst was lined with stratified squamous epithelium containing mucin-producing cells; many germinal centers were observed in the cyst wall.     

Serial analysis of biomarkers of acute pancreas allograft rejection

Cashion AK, Sabek O, Driscoll C, Gaber L, Tolley E, Gaber AO. Serial analysis of biomarkers of acute pancreas allograft rejection.
Clin Transplant 2010: 24: E214–E222. © 2010 John Wiley & Sons A/S. Abstract: Pancreas transplant recipients experience graft loss in spite of improvements in immunosuppressant therapies and diagnostic technologies. Therefore, a method to improve detection and management of acute rejection is needed. This longitudinal study investigated the usefulness of three biomarkers, granzyme B, perforin, and human leukocyte antigen‐DR alpha (HLA‐DR) measured by real‐time PCR on peripheral blood mononuclear cells, for their ability to detect acute rejection and its resolution in 13 recipients of pancreas allograft. Data demonstrated that pre‐transplant baseline expression of biomarkers decreased following the initiation of immunosuppression. Throughout follow‐up (range 3–27 months), individuals without acute rejection episodes had little variation in their biomarker levels. Recipients with biopsy‐proven rejection had a significant increase in the levels of biomarkers as early as five wk before clinical rejection diagnosis. Furthermore, all seven patients with biopsy‐proven rejection demonstrated a decrease in the levels of granzyme B and perforin following the increased immunosuppression for the treatment of rejection. This is the first clinical serial measurement of biomarkers in recipients of pancreas transplants. The data demonstrate that upregulation of granzyme B, perforin, and HLA‐DR in peripheral blood mononuclear cells are sensitive to changes in the immune environment and could possibly be used to identify those patients at higher risk of rejection.     

Late pancreas retransplantation

Pancreas retransplantation, excluding immediate retransplantation for graft thrombosis, is a technically treacherous operation with the added challenges of adhesions from the prior transplant and difficulties identifying usable recipient vessels. The goal of this study was to review our single‐center experience with late pancreas retransplantation. Charts for all pancreas transplant recipients between 01/2003 and 04/2013 were reviewed for demographics, graft and patient survival, length of stay (LOS), readmissions, and technical complications. Of 473 pancreas transplants, there were 20 late pancreas retransplants compared to 441 first transplants. There were no significant differences in donor or recipient demographics. There was no significant difference in graft or patient survival. The mean and median lengths of stay were 22 and nine d, respectively (range 5–175 d), and 11 recipients required readmission within the first three months post‐transplant. Five patients were reexplored in the early postoperative period for an enteric leak at the site of the primary allograft (n = 1), complications of percutaneous gastrostomy tube placement (n = 1), hemorrhage (n = 1), and negative laparotomy for hyperglycemia (n = 2). Pancreas retransplantation is technically challenging but can be safely performed with graft and recipient survival comparable to primary transplants.     

Outcomes after simultaneous kidney‐pancreas versus pancreas after kidney transplantation in the current era

Simultaneous pancreas and kidney (SPK) and pancreas after kidney (PAK) transplant are both potential options for diabetic ESRD patients. Historically, PAK pancreas graft outcomes were felt to be inferior to SPK pancreas graft outcomes. Little is known about outcomes in the modern era of transplantation. We analyzed our SPK and PAK recipients transplanted between 01/2000 and 12/2016. There were a total of 635 pancreas and kidney transplant recipients during the study period, 611 SPK and 24 PAK. Twelve of the PAK patients received a living donor kidney. There were no significant differences between the two groups in kidney or pancreas graft rejection at 1 year. Similarly, 1‐year graft survival for both organs was not different. At last follow‐up, uncensored and death‐censored graft survival was not statistically different for kidney or pancreas grafts. In addition, in Cox regression analysis SPK and PAK were associated with similar graft survival. Although the majority of pancreas transplants are in the form of SPK, PAK is an acceptable alternative. Simultaneous pancreas and kidney avoids donor risks associated with live donation, so may be preferable in regions with short wait times, but PAK with a living donor kidney may be the best alternative in regions with long SPK wait times.     

Preservation of the donor pancreas for whole pancreas and islet transplantation

Ridgway D, Manas D, Shaw J, White S. Preservation of the donor pancreas for whole pancreas and islet transplantation.
Clin Transplant 2010: 24: 1–19. © 2009 John Wiley & Sons A/S.
Abstract:  Whole pancreas and islet cell transplantation are both reliant upon the procurement and preservation of a high quality donor pancreas for a successful outcome. In the climate of a reducing donor pool it is imperative that donor optimization, meticulous surgical retrieval and evidence based methods of preservation are practiced to ensure optimal graft quality. Moreover expanded criteria donors and novel methods of pancreas preservation have the potential to expand the number of usable grafts and increase the availability of these transplant modalities to suitable patients with diabetes. This article provides a review of the current literature surrounding donor management, surgical technique and the various technologies of organ preservation applicable to the donor pancreas.     

Clinicopathologic evaluation of mucin-producing tumor of the pancreas

We studied the diagnostic problems, surgical management, and histopathologic characteristics of 28 patients with intra-ductal tumors and mucinous cystadenomas of the pancreas who underwent surgical resection. Endoscopic ultrasonography (EUS) and endoscopic retrograde pancreatography (ERP) were the most useful means for confident diagnosis of the diseases. New diagnostic modalities, including intra-pancreatic ductal endoscopy and intraductal ultrasonography, also improved the qualitative diagnosis of these tumors. Minimally invasive surgery i.e., duodenum-and choledochus-preserving resection of the head of the pancreas, was conducted in our patients. The long-term results were good and no patients had disease recurrence. Although these diseases are regarded as precancerous lesions of the pancreas, there were several unclear points regarding biologic behavior and the correlation with invasive cystadenocarcinoma. Thus, a molecular biological explanation concerning the roles of oncogenes such asp53 and Ki-ras in carcinogenesis is an important question that remains to be resolved.     

Benign schwannoma of the pancreas

Reported cases of intrapancreatic schwannomas have recently increased in the literature. However, none of these cases were diagnosed clearly as schwannoma preoperatively. We herein describe the clinicopathologic findings of a solitary benign schwannoma occurring in the head of the pancreas. Additionally, the differential diagnosis versus other cystic- and solid-appearing pancreatic masses is briefly discussed.     

Annular pancreas in a fetus and its three-dimensional reconstruction

A three-dimensional 50-times scale reconstruction was made of an annular pancreas from an 18-week-old fetus. By the use of radio-opaque paint, the anatomy of the pancreaticobiliary system within the reconstructed duodenum was clearly revealed. The anatomical arrangement indicated that the annulus was formed from the ventral anlage of the pancreas and that part of the annulus intermingled with the duodenal wall. These findings are consistent with Lecco 's theory of the embryogenesis of annular pancreas. The visualisation of internal structures in a reconstruction by the use of radio-opaque paint has not been described previously. This could be a useful technique in other embryological studies of the continuity of microscopic internal structures. Annular pancreas has been described previously by Weissberg in a 16-mm embryo. This report is the second case of a fetal annular pancreas in the literature.