上腹部器官簇移植术后胰腺功能的监测

目的:探讨上腹部器官簇移植术后胰腺功能的监测方法。方法:分析我院5例上腹部器官簇移植成功的临床病例资料。结果:患者术后一般情况恢复良好，移植胰腺内、外分泌功能基本恢复正常，未发现有排斥反应。结论:围手术期通过动态监测患者血糖、C肽、血胰岛素和血尿淀粉酶、腹腔引流液淀粉酶以及十二指肠减压管引流液淀粉酶，并结合Doppler彩超检查，可以较好地了解移植胰腺的内、外分泌功能。     

体外循环围术期胰腺内外分泌功能的变化

体外循环（ＣＰＢ）心内直视手术期间，可引起体内各重要脏器的生化及病理生理改变。１９９５年２月至１９９５年５月我们对２０例ＣＰＢ手术病人术前、术后血中糖、淀粉酶、胰岛素及Ｃ肽进行了测定，试图探讨ＣＰＢ对胰腺内、外分泌功能的影响及其机制，现将结果报告如下...     

门、肠引流式胰肾一期联合移植5例报告

目的:总结胰腺内分泌门静脉引流、外分泌肠腔引流式（PE）一期胰、肾联合移植的临床经验。方法：对5例1型糖尿病并发尿毒症患者施行PE一期胰、肾联合移植术的临床资料及手术技术和非手术性并发症的预防进行回顾性分析。结果：5例手术均获成功，其中3例恢复良好，2例围手术期死亡，分别死于胰漏感染和FK506药物中毒。存活者术后3d血肌酐、尿素氮恢复正常;术后7d停用胰岛素，移植胰内、外分泌功能正常。结论：PE引流式胰腺移植在生理、代谢和免疫学等方面更具优势和合理性;PE式将是胰腺移植优先选择的术式;加强围手术期管理有助于减少术后并发症，取得良好疗效。     

血清淀粉酶和脂肪酶在腹部手术后胰腺损伤中的诊断价值

目的探讨血清淀粉酶和脂肪酶在腹部手术后胰腺损伤中的诊断价值。方法以2019年6月至2020年6月在本院就诊的腹部手术患者112例为研究对象,术前、术后24、48及72小时检测患者血清中淀粉酶和脂肪酶水平,并对胰腺进行影像学检查或术中探查,分析患者术后胰腺损伤及并发症的发生情况。结果术前、术后24、术后48和术后72小时间的血清淀粉酶和脂肪酶水平间的差异均有统计学意义(P0.05),术后24小时血清淀粉酶和脂肪酶水平最高。术后确诊为胰腺损伤18例,回声增强3例,胰腺肿大15例,胰腺断裂0例,淀粉酶或脂肪酶正常组、淀粉酶升高组、脂肪酶升高组、淀粉酶或脂肪酶正常组的胰腺彩超异常比例分别为14.29%(16/112)、10.71%(12/112)、8.93%(10/112)、1.79%(2/112),差异有统计学意义(χ2=11.420,P=0.01);淀粉酶诊断敏感性为66.67%,脂肪酶诊断敏感性为55.56%,均低于两者联合诊断敏感性(88.89%),差异有统计学意义(P0.05)。18例诊断为胰腺损伤的患者中,淀粉酶组的腹腔感染、腹痛或腹胀的发生率高于正常淀粉酶组,高淀粉酶和脂肪酶组的术后腹腔感染、腹痛或腹胀的发生率高于正常淀粉酶和脂肪酶组,差异均有统计学意义(P0.05)。结论腹部手术后血清淀粉酶和脂肪酶水平出现一过性升高,对继发性胰腺损伤有一定诊断价值,高血清淀粉酶和脂肪酶水平患者显示出更差的预后,临床应监测患者指标,以及早诊断和干预。     

腹部多器官联合移植患者移植胰腺功能的监测

对一例腹部多器官联合移植(AMVT)患者移植胰腺的功能进行了连续监测,结果表明,移植胰腺发生了血液再灌注的损伤但恢复很快,术后早期已经具备了良好的功能。据此认为:AMVT术后,血清C-肽结合血糖测定可较好反映移植胰腺的内分泌功能,血糖的监测对于治疗、特别是决定要否补充外源性胰岛素非常重要;存在外源性胰岛素的情况下,血胰岛素的检测临床意义不大;血淀粉酶和脂肪酶的测定可同时反映移植胰腺的损伤情况与外分泌功能,应作为AMVT术后移植胰腺功能监测的重要指标。     

改良式胰肾联合移植1例并文献复习

目的探讨改良式胰肾联合移植治疗2型糖尿病合并终末期肾病的移植效果。方法为1例2型糖尿病合并终末期肾病患者行改良式胰肾联合移植,其中移植胰腺的外分泌采用胰液空肠内引流术式,将供胰十二指肠节段与受体上段空肠直接行侧侧吻合。结果术后围手术期移植肾稳定泌尿,3800～4500ml/24h,3d后血清肌酐降至正常水平。术后胰腺功能恢复顺利,血、尿淀粉酶逐渐下降并稳定在正常范围,空腹血糖也于术后10d恢复至正常值范围以内。切口一期愈合,于术后两周出院。随访27个月移植肾功能正常,胰腺功能正常,未发生血栓、胰瘘、胰腺炎、排斥反应等并发症。结论改良式胰肾联合移植技术简单、安全,胰液经空肠引流更接近消化生理,是治疗糖尿病合并终末期肾病的有效手术方式。     

胰腺移植围手术期应用奥曲肽治疗的前瞻性随机临床研究

目前大多数胰腺移植中心采用膀胱引流十二指肠节段外分泌的技术。盐酸奥曲肽（善得定）是人工合成的生长抑素类药物，它能有效抑制胰腺外分泌且半衰期比天然激素长。因手术期应用奥曲肽已被证实能降低择期胰腺手术后胰腺炎、胰漏和腹腔内感染发生率。本研究目的皆在明确胰腺移植围手术期奥曲肽治疗的安全性和潜在益处。病人与方法1994年10月至1996年9月在芝加哥Illinois大学共施行17例胰腺移植。14例行胰肾联合移植，3例行单独胰腺移植。受试者被随机分为胰腺移植术后连续5天接受每8小时皮下注射奥曲肽100μg和不用该药治疗两组。首剂奥曲…     

生长抑素八肽对胰腺疾病术后并发胰瘘的疗效观察

生长抑素八肽对胰腺疾病术后并发胰瘘的疗效观察上海市东方医院外科（上海浦东南路２００１２０）李英，王维东胰腺手术的并发症与胰腺的外分泌有关，抑制胰腺分泌可改善术后病程，降低并发症的发生率（１）。生长抑素八肽（Ｏｃｔｒｅｏｔｉｄｅ）对胃肠道和胰腺的内分泌...     

奥曲肽联合兰索拉唑防治胆总管结石患者ERCP术后急性胰腺炎和高淀粉酶血症的疗效

目的：探讨奥曲肽联合兰索拉唑预防和治疗胆总管结石患者ERCP术后急性胰腺炎及高淀粉酶血症的疗效。 方法：回顾性分析2012年3月—2013年9月间确诊为胆总管结石并行ERCP的患者,所有患者给予醋酸奥曲肽联合兰索拉唑规律治疗,监测患者术后12、48 h血清淀粉酶和症状体征的变化情况。 结果：术后高淀粉酶血症的发生率为14.0%（6/43）,急性胰腺炎的发生率为4.7%（2/43）,所有患者经醋酸奥曲肽联合兰索拉唑规律治疗血淀粉酶水平全部降至正常参考值区间,症状消失。 结论：对于胆总管结石患者经内镜下相关治疗后,奥曲肽联合兰索拉唑的方法可以有效预防术后急性胰腺炎和高淀粉酶血症的发生。     

胰管塑料支架预防ERCP术后胰腺炎的临床应用

目的探讨胰管塑料支架预防内镜下逆行性胰胆管造影（ERCP）术后胰腺炎的临床效果。方法对我院2009年10月～2010年11月期间37例胆管炎或胆管结石患者在ERCP术中胆管插管困难患者的临床资料进行回顾性分析。这些患者均采用胰管括约肌小切口,并置入胰管塑料支架,观察是否并发术后胰腺炎或其他并发症。结果在接受ERCP的37例患者中,3例卅现高淀粉酶及高脂肪酶血症,其中1例淀粉酶高于正常值的3倍,余两例淀粉酶值分别为132和312IU／I,脂肪酶324和523IU／1。72小时后复查,上述结果均恢复正常。患者无腹痛,恶心呕吐等症状,胰腺周围无渗出或假性囊肿的出现。术后3～4周,电子胃镜下取出支架。除2例支架轻度外移1．0cm外,其余均放置良好,未见堵塞。结论ERCP胆管插管困难患者放置胰管塑料支架可以预防术后胰腺炎的发生。     

丙泊酚注射对苯妥英钠用药下行开颅术患儿肝胰功能及酸碱平衡的影响

背景在此项研究中,我们评估了应用苯妥英钠预防癫痫的患儿行开颅手术中输注丙泊酚对其肝、胰酶和酸碱平衡的影响。方法在这项前瞻性的临床研究中,我们测定了30例4—12岁患儿的血清谷草转氨酶（AST）、谷丙转氨酶（ALT）、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）、胰淀粉酶、胰脂肪酶及三酰甘油水平。患儿接受丙泊酚麻醉并应用苯妥英钠预防癫痫。以前已用苯妥英钠的患儿则继续用药。未曾用药者口服苯妥英钠5mg·kg^-1·d^-1。经医院批准于术前1天,术后第1、3、5、7天测定患儿血清中AST、ALT、GGT、ALP、胆红素、胰淀粉酶、胰脂肪酶、三酰甘油水平。分别于气管插管后、术中2小时和术中4小时、拔管以及拔管后1、2、6、12小时采集动脉血气样本。结果术后血清AST、ALT、GGT、ALP、胰淀粉酶、胰脂肪酶、三酰甘油水平显著高于术前基础值,且于术后第1天达峰值,并在1周内恢复正常。拔管后碱剩余与基础值相比显著降低,但仍在正常范围内,并于术后6小时恢复到基础值水平。患儿并未表现出肝炎或胰腺炎的临床症状或体征。胆红素水平正常。患儿在术后4—6个月内未发生肝胰相关的并发症。结论尽管开颅术患儿肝、胰酶在术后轻微上升,但丙泊酚全麻维持未对其酸碱平衡或肝、胰酶产生临床意义的显著影响。     

In Vivo Imaging of Human Pancreatic Microcirculation and Pancreatic Tissue Injury in Clinical Pancreas Transplantation

Pancreatitis remains to be a major complication following clinical pancreas transplantation. We performed orthogonal polarized spectral (OPS) imaging for direct in vivo visualization and quantification of human pancreatic microcirculation in six healthy donors for living donor liver transplantation and 13 patients undergoing simultaneous pancreas-kidney transplantation. We further determined the impact of microvascular dysfunction during early reperfusion on pancreatic graft injury. Exocrine and endocrine pancreatic impairment was determined by analysis of serum lipase, amylase and C-peptide levels. Compared to normal pancreas in liver donors (homogeneous acinar perfusion) functional capillary density (FCD) and capillary red blood flow velocity of reperfused grafts were significantly decreased. Elevated CRP concentrations on day 2 post-transplant and serum lipase and amylase levels determined on days 4-5 significantly correlated with microvascular dysfunction during the first 30 min of graft reperfusion. Post-transplant serum C-peptide also correlated significantly with pancreatic capillary perfusion. OPS imaging allows to intra-operatively assess physiologic pancreatic microcirculation and to determine microcirculatory impairment during early graft reperfusion. This impairment correlated with the manifestation of post-transplant dysfunction of both exocrine and endocrine pancreatic tissue. OPS imaging may be used clinically to determine the efficacy of interventions, aiming at attenuating microcirculatory impairment during the acute post-transplant reperfusion phase.     

Effect of somatostatin on basal and stimulated exocrine pancreatic secretion after partial duodenopancreatectomy. A clinical experimental study]

In a prospective trial 30 patients underwent pancreaticoduodenectomy (Whipple operation) for cancer. They were randomly assigned to receive Somatostatin (SST) (n = 15) or not (n = 15). SST was started at laparotomy with 250 micrograms/h and given over a period of 5 days. A small catheter, which was placed into the duct of the pancreatic remnant, gave access to the pancreatic juice. Volume, amylase, lipase and protein as well as bicarbonate outputs were analyzed. As regards endocrine function, insulin and glucagon plasma levels were measured. The nitrogen balance was calculated. A stimulation test was done on the fifth postoperative day. Six patients (3/3) were assessed as drop-outs. A significant reduction was found for volume, amylase, lipase, protein and bicarbonate with SST, this effect lasting for two days. Lipase however was reduced significantly for 5 days. Pancreatic exocrine function was reduced as well after stimulation, if SST was given. Insulin and glucagon were inhibited with SST, the latter more effectively. We found a positive nitrogen-balance as early as on the second postoperative day in the SST-group, whereas without SST this did not occur before the fourth postoperative day. This findings were significant on the third and fourth postoperative day. The inhibitoric effects of SST, which are demonstrated by our laboratory investigations, conform very well with a more favorable clinical course and a reduction of perioperative morbidity and mortality.     

Effect of nafamostat mesilate on serum activities of pancreatic enzymes and plasma hormone levels

To evaluate the effect of nafamostat mesilate, a potent protease inhibitor, on the pancreatic enzymes and the endocrine system in patients undergoing open-heart surgery with extracorporeal circulation, serum activities of amylase, trypsin, alpha 1-antitrypsin (alpha 1AT) and pancreatic secretory trypsin inhibitor (PSTI), and plasma levels of cortisol and catecholamines were measured. Seven patients (nafamostat group) received intravenous nafamostat mesilate 0.5 mg.kg-1.hr-1 during cardiopulmonary bypass (CPB). The remaining seven patients (non-nafamostat group) did not receive any protease inhibitor. Both groups showed the same changes in serum activities of pancreatic enzymes during CPB. In sera, the levels of amylase, trypsin and alpha 1AT decreased during CPB. Amylase and trypsin activities returned toward the preanesthetic levels after CPB, while alpha 1AT remained at lower levels. PSTI was unchanged during CPB. Plasma cortisol levels markedly increased during and after CPB, but there was no difference between nafamostat group and non-nafamostat group. Nafamostat group showed lower plasma dopamine levels and higher epinephrine levels compared with non-nafamostat group. The result suggests that nafamostat mesilate administered during CPB could not influence the changes in the activities of pancreatic enzymes. Further studies are needed to clarify the effect of this protease inhibitor on the endocrine system.     

SHOULD SERUM PANCREATIC LIPASE REPLACE SERUM AMYLASE AS A BIOMARKER OF ACUTE PANCREATITIS?

BACKGROUND: Serum pancreatic lipase may improve the diagnosis of pancreatitis compared to serum amylase. Both enzymes have been measured simultaneously at our hospital allowing for a comparison of their diagnostic accuracy. METHODS: Seventeen thousand five hundred and thirty-one measurements of either serum amylase and or serum pancreatic lipase were made on 10 931 patients treated at a metropolitan teaching hospital between January 2001 and May 2003. Of these, 8937 were initially treated in the Emergency Department. These results were collected in a database, which was linked by the patients' medical record number to the radiology and medical records. Patients with either an elevated lipase value or a discharge diagnosis of acute pancreatitis had their radiological diagnosis reviewed along with their biochemistry and histology record. The diagnosis of acute pancreatitis was made if there was radiological evidence of peripancreatic inflammation. RESULTS: One thousand eight hundred and twenty-five patients had either elevated serum amylase and or serum pancreatic lipase. The medical records coded for pancreatitis in a further 55 whose enzymes were not elevated. Three hundred and twenty of these had radiological evidence of acute pancreatitis. Receiver operator characteristic analysis of the initial sample from patients received in the Emergency Department showed improved diagnostic accuracy for serum pancreatic lipase (area under the curve (AUC) 0.948) compared with serum amylase (AUC, 0.906, P < 0.05). A clinically useful cut-off point would be at the diagnostic threshold; 208 U/L (normal <190 U/L) for serum pancreatic lipase and 114 U/L (normal 27-100 U/L) for serum amylase where the sensitivity was 90.3 cf., 76.8% and the specificity was 93 cf., 92.6%. 18.8% of the acute pancreatitis patients did not have elevated serum amylase while only 2.9% did not have elevated serum pancreatic lipase on the first emergency department measurement. CONCLUSION: It is concluded that serum pancreatic lipase is a more accurate biomarker of acute pancreatitis than serum amylase.     

Eosinophilia as an early indicator of pancreatic allograft rejection

Monitoring pancreas transplant recipients for rejection is an inexact science. Serial monitoring of urinary amylase has been used for patients with a bladder-drained pancreas. An increase in serum amylase and lipase has been utilized as an in vivo measure of pancreas rejection in patients with enteric pancreatic exocrine drainage. Decreases in urinary amylase or increases in serum amylase or lipase, respectively, in these two different types of surgical drainage would prompt a pancreas biopsy for histologic confirmation of rejection. Herein, we describe the case of an enteric-drained pancreatic transplant recipient who presented with peripheral eosinophilia at least one month before she developed increases in serum amylase and lipase. A pancreas allograft biopsy indicated eosinophilic acute cellular rejection. Peripheral eosinophilia may be a useful early indicator of pancreas graft rejection preceding changes in serum pancreatic enzymes by approximately one month.     

Effect of octreotide acetate on pancreatic exocrine function

Somatostatin and its analogs have been shown to inhibit both pancreatic endocrine and exocrine function. We hypothesized that octreotide acetate (Sandostatin), a somatostatin analog, decreases the pancreatic flow rate through a peptide-mediated mechanism and alters pancreatic fluid composition by inhibiting carbonic anhydrase action and circulating peptide levels. To test this hypothesis, we collected pancreatic fluid from six patients (four with pancreatic fistulas and two with pancreatic drains after pancreatic resection). Pancreatic fluid volume and chloride, sodium, potassium, amylase, lipase, and bicarbonate levels were measured before and after octreotide acetate therapy. Octreotide acetate reduced pancreatic fluid output by a mean of 75 percent (p less than 0.05), increased chloride concentration by 21 percent (p less than 0.05), and reduced bicarbonate content by 45 percent (p less than 0.05). Sodium levels were unchanged, but the potassium concentration was increased by 14 percent (p less than 0.05). Total amylase and lipase production per 24 hours was decreased by 63 percent and 27 percent, respectively (differences not significant). Somatostatin may be useful in the treatment of established pancreatic fistulas and may be a useful prophylactic tool to prevent postoperative fistula formation.     

Management of blunt pancreatic injury in children

BACKGROUND AND METHODS: Controversy persists regarding the management of pancreatic transection. Over the past 10 years, 51 patients admitted to the Children's Hospital of Pittsburgh sustained blunt pancreatic injuries. We reviewed their medical records to clarify the optimal management strategy and to define distinguishing characteristics, if any, of patients with pancreatic transection. RESULTS: Patients who sustained pancreatic transection had a significantly higher Injury Severity Score, length of stay, serum amylase, and serum lipase, than those patients who sustained pancreatic contusion. Patients who underwent laparotomy within 48 hours of injury for pancreatic transection had a significantly shorter length of stay than those who underwent laparotomy more than 48 hours after injury. CONCLUSION: Serum amylase greater than 200 and serum lipase greater than 1,800 may be useful clinical markers for major pancreatic ductal injury when combined with physical examination. Early operative intervention for pancreatic transection results in shorter length of stay and fewer complications.     

Pancreatic secretory trypsin inhibitor as a marker for early detection of rejection in canine pancreas allotransplantation

Serum pancreatic secretory trypsin inhibitor (PSTI)* was measured in the course of canine segmental pancreas allotransplantation without immunosuppression. Serum PSTI concentrations showed two distinct elevations: the first elevation was on the first day and the onset of the second elevation was the sixth day after operation. The first postoperative elevation of the serum PSTI level is thought to be related to the operative procedures, because the first elevation was observed after both autotransplantation and allotransplantation, and biopsies of the autograft and allograft at the first day after the operations showed nonspecific neutrophilic infiltration and no perivascular lymphoid infiltrates. The second postoperative elevation of the serum PSTI level is thought to reflect a rejection process because this elevation was not seen after autotransplantation, and biopsies of allografts at the sixth day after the operation showed typical perivascular lymphoid infiltrates and cellular rejection of the exocrine tissue. In addition, the onset of the second elevation of serum PSTI level preceded by about three days the onset of the elevation of blood sugar at the ninth day after the operation. The results suggest that serum PSTI can be used as a marker for diagnosis of early pancreatic allograft rejection.