慢性胰腺假性囊肿18例手术治疗体会

目的 探讨慢性胰腺假性囊肿的手术方法及效果.方法 对18例慢性胰腺假性囊肿患者的临床资料进行回顾性分析.18例患者择期行囊肿内引流术,其中16例行空肠-囊肿Roux-en-Y吻合术（6例合并胆囊结石者附加胆囊切除术）,2例行胃-囊肿吻合术.术后给予生长抑素、抗生素及加强营养支持治疗,预防吻合口漏、出血等并发症的发生.结果 行空肠-囊肿Roux-en-Y吻合的16例患者术后均恢复顺利;行胃-囊肿吻合术的2例患者术后出现吻合口出血1例,经对症保守治疗后痊愈.所有患者术后6周复查CT示囊肿已消失.随访1～5年,均无复发,无并发症发生.结论 囊肿内引流手术治疗慢性胰腺假性囊肿疗效确切、操作简单,适合基层医院开展.     

胰腺假性囊肿手术分析

目的 探讨胰腺假性囊肿(PPC)的病因、转归及由此采取的临床外科治疗方式.方法 对43例PPC患者的临床外科手术资料进行回顾性分析.结果 本组治愈36例,复发4例,其中l例囊肿单纯切除术后复发,1例为囊肿合并胰尾、脾切除术后复发,2例囊肿外引流术后胰瘘,二期分别行囊肿或瘘管空肠吻合术最终治愈,死亡3例,分别死于吻合口漏合并感染中毒性休克及重症胰腺炙期间继发重症感染.结论 PPC需要手术治疗时应根据病人的具体情况选择合适的术式.     

儿童假性胰腺囊肿的外科治疗

通过对经手术治疗２０例儿童假性胰腺囊肿的临床分析,对分病的病因、病理、诊断及外科治疗进行了讨论。强调一旦诊断明确,应采取积极的手术治疗,手术方式以囊肿空肠Ｒｏｕｘ－Ｙ型吻合术为宜。     

假性胰腺囊肿的外科治疗

自2000年1月至2008年1月对假性胰腺囊肿25例行外科手术治疗，现报告如下。     

小儿胰腺假性囊肿临床诊治体会

目的总结小儿胰腺假性囊肿的诊治体会。方法回顾性分析10例小儿胰腺假性囊肿的临床表现、诊断及治疗方法。5例行外引流术，5例行内引流术（4例行囊肿胃吻合内引流术，1例行囊肿空肠Roux—Y内引流术）。结果除行外引流术1例复发外，其余恢复良好。结论选择合适的时机和术式是治疗小儿胰腺假性囊肿的关键。     

腹腔镜外科手术治疗胰腺假性囊肿

目的：探讨腹腔镜治疗胰腺假性囊肿的临床意义、适应证及方法。方法：2001年12月～2002年8月。2例病人接受了腹腔镜胰腺假性囊肿手术，其中l例行腹腔镜胰腺假行囊肿切除术，另l例行腹腔镜囊肿胃吻合术。结果：2例手术均顺利完成，手术时间120-135min，出血50-60ml，术后24h胃肠功能恢复，无并发症发生，术后7d出院。结论：腹腔镜手术治疗胰腺假性囊肿是一种安全、可靠、微创的新技术，可根据囊肿与周围的粘连程度、基底宽窄及位于胰腺的部位不同而选择囊肿切除或内引流术。     

内镜下胃内引流术治疗胰腺假性囊肿

目的探讨十二指肠镜下胰腺假性囊肿-胃内引流术的临床效果。方法对该院2007年6月～2011年1月实施的10例内镜下胰腺假性囊肿-胃内引流术治疗的临床资料进行回顾性分析。结果该组10例均在胃镜、十二指肠镜下成功实施胰腺假性囊肿-胃内引流术,术后恢复良好,无近、远期并发症发生,随访17个月～4年,效果良好,囊肿全部消失。结论十二指肠镜下胰腺假性囊肿-胃内引流术是治疗胰腺假性囊肿的一种有效、安全方法。但需要选择合适的病例。     

手术治疗胰腺假性囊肿12例

胰腺假性囊肿是急慢性胰腺炎、胰腺外伤常见的并发症.我院自2002～2005年共手术治疗胰腺假性囊肿12例,现就其诊断、治疗总结报告如下.     

胰腺假性囊肿的外科治疗

目的：总结胰腺假性囊肿的外科治疗方式及其经验。方法：回顾性分析我院1990年1月至2006年12月49例胰腺假性囊肿的临床资料。结果：根据囊肿部位、形成时间及囊壁厚度，采用非手术治疗7例，经皮穿刺置管引流6例，开腹手术32例（外引流7例，内引流26例，囊肿切除3例、序贯式外-内引流术6例）。全组无死亡病例，手术后并发症发生率9．5%（11／40）。结论：胰腺假性囊肿的外科治疗根据具体情况采用不同的手术方式，手术治疗尽可能行内引流术，其中囊肿胃吻合手术是一种简单合理的内引流术式，对于难以排除恶性的假性囊肿应尽量切除。     

中晚期胰腺癌术中加体外放射治疗临床观察

目的 分析术中放射治疗(IORT)加体外放射治疗(EBRT)对中晚期胰腺癌患者的疗效。方法 对20例伴有严重背痛和腹痛而又无法手术切除的中晚期胰腺癌患者，进行了IORT加EBRT，观察止痛效果和平均生存期。结果 本组11例患者疼痛完全缓解(55％)，7例患者部分缓解(35％)，平均生存期为8．3个月。同期进行的30例胰腺癌切除术患者平均生存期是7个月。结论 IORT加EBRT能明显缓解患者的疼痛，并延长患者的生存期，是一种较好的中晚期胰腺癌姑息治疗方法。     

胰腺癌的基因治疗进展

近年来,胰腺癌的基因治疗作为一种新的治疗手段备受关注,其很多研究已进入临床阶段.胰腺癌基因治疗的研究主要包括：基因信号传导抑制、基因治疗等.本文就近期胰腺癌的基因治疗研究成果与存在的问题作一综述.     

妊娠期症状性上尿路结石的外科治疗

目的探讨妊娠期症状性上尿路结石的外科治疗手段及疗效。方法对19例复发性严重肾绞痛及梗阻性肾积水合并肾周围炎孕患，首选13F小儿膀胱镜下5F双J管逆插留置，逆插失败者选择输尿管镜手术或患肾造瘘术。结果全部病例疼痛消失无复发，泌尿系感染控制，复查肾积水消失或减轻。6例术后3周内结石自行排出。结论小儿膀胱镜下双J管逆插留置安全有效，是外科治疗复发性严重肾绞痛与梗阻性感染的最佳手段。输尿管镜手术是逆插失败后的选择。     

Pancreatic tuberculosis mimicking pancreatic carcinoma during anti-tuberculosis therapy: A case report

Pancreatic tuberculosis (TB) is a rare condition, even in immunocompetent hosts. A case is presented of pancreatic TB that mimicked pancreatic head carcinoma in a 40-year-old immunocompetent male patient. The patient was admitted to our hospital after suffering for nine days from epigastralgia and obstructive jaundice. Computed tomography revealed a pancreatic mass that mimicked a pancreatic head carcinoma. The patient had undergone an operation four months prior for thoracic TB and was undergoing anti-TB therapy. A previous abdominal ultrasound was unremarkable with the exception of gallbladder steroid deposits. The patient underwent surgery due to the progressive discomfort of the upper abdomen and a mass that resembled a pancreatic malignancy. A biopsy of the pancreas and lymph nodes was performed, revealing TB infection. The patient received a cholecystostomy tube and recovered after being administered standard anti-TB therapy for 15 mo. This case is reported to emphasize the rare contribution of pancreatic TB to pancreatic masses and obstructive jaundice.     

Sequential therapy with combined trans-papillary endoscopic naso-pancreatic and endoscopic retrograde pancreatic drainage for pancreatic pseudocysts

BACKGROUNDEndoscopic retrograde pancreatic drainage (ERPD) and stent implantation has become the major treatment method for pancreatic pseudocysts. However, it is associated with a high recurrence rate and infection.AIMTo manage pancreatic pseudocysts by sequential therapy with endoscopic naso-pancreatic drainage (ENPD) combined with ERPD and evaluate the treatment outcome.METHODSOne hundred and sixty-two cases of pancreatic pseudocyst confirmed by endoscopic examination at our hospital between January 2014 and January 2020 were retrospectively analyzed. There were 152 cases of intubation via the duodenal papilla, of which 92 involved pancreatic duct stent implantation and 60 involved sequential therapy with combined ENPD and ERPD (two-step procedure). The success rate of the procedure, incidence of complications (infection, bleeding, etc.), recurrence, and length and cost of hospitalization were compared between the two groups.RESULTSThe incidence of infection was significantly higher in the ERPD group (12 cases) than in the two-step procedure group (2 cases). Twelve patients developed infection in the ERPD group, and anti-infection therapy was effective in five cases but not in the remaining seven cases. Infection presented as fever and chills in the two-step procedure group. The reoperation rate was significantly higher in the ERPD group with seven cases compared with zero cases in the two-step procedure group (P < 0.05). Similarly, the recurrence rate was significantly higher in the ERPD group (19 cases) than in the two-step procedure group (0 cases).CONCLUSIONSequential therapy with combined ENPD and ERPD is safe and effective in patients with pancreatic pseudocysts.     

In advanced pancreatic cancer: The value and significance of interventional therapy

Pancreatic cancer is famous as “the king of cancer” due to its high degree of malignancy, rapid course of disease development, and poor prognosis. Relevant epidemiological studies have indicated that with improvement in people’s standard of living, the morbidity and mortality of pancreatic cancer has increased. At the same time, the disease shows an obvious upward trend worldwide. Pancreatic cancer has become a major public health problem that seriously affects the life and health of people. The present review focuses on the recent advances in interventional therapy such as transcatheter arterial infusion, radiofrequency ablation, microwave ablation, and irreversible electroporation of pancreatic cancer.     

Short segment involvement of the common bile duct in pancreatic carcinoma

Short segment involvement of the mid-portion of the common bile duct by pancreatic carcinoma is common. It is generally not appreciated on transhepatic cholangiograms or during percutaneous drainage procedures since the uninvolved distal duct is rarely opacified. This pattern helps explain the ease of passing guidewires beyond the initial point of obstruction during drainage procedures. Knowledge of this anatomy may also have diagnostic and therapeutic significance. In some situations a special effort to opacify the distal duct may be warranted.     

Safety of pancreatic surgery with special reference to antithrombotic therapy: A systematic review of the literature

BACKGROUNDPostpancreatectomy hemorrhage (PPH) is the most severe type of complication after pancreatic surgery, although the effect of antithrombotic therapy (ATT) on PPH is largely unknown. The safety and efficacy of chemical thromboprophylaxis for venous thromboembolism (VTE) remains controversial. AIMTo elucidate the effect of ATT on PPH. METHODSPublished articles between 2013 and 2020 were searched from PubMed and Google Scholar, and after careful reviewing of all studies, studies concerning ATT and pancreatic surgery were included. Data such as study design, type of surgical procedures, type of antithrombotic drugs, and surgical outcome were extracted from the studies.RESULTSNineteen published articles with a total of 37863 patients who underwent pancreatic surgery were included in the systematic review. Fourteen were cohort studies, with only three being prospective in nature. Two studies demonstrated that in patients receiving chronic ATT, which were mostly managed by heparin bridging, the risk of PPH was higher compared with those without ATT, and one study showed that patients with direct-acting oral anticoagulants managed by heparin bridging had significantly higher postoperative bleeding rates than others. The remaining six studies reported that pancreatic surgery can be safely performed in patients receiving chronic ATT, even under preoperative aspirin continuation. Concerning chemical thromboprophylaxis for VTE, most studies have shown a potentially high risk of PPH in patients undergoing chemical thromboprophylaxis; however, its effectiveness against VTE has not been statistically demonstrated, particularly among Asian patients.CONCLUSIONPancreatic surgery in chronically ATT-received patients can be safely performed without an increase in the occurrence of PPH, although the safety and efficacy of chemical thromboprophylaxis for VTE during pancreatic surgery is still controversial. Further investigation using reliable studies with good design is required to establish definite protocols or guidelines.     

高营养疗法治疗肠瘘、胰瘘的护理

肠瘘、胰瘘是腹部外科手术后常见的严重并发症。采用全肠外营养和肠内营养,治疗肠瘘、胰瘘２３例,给患者提供维持生命的所需营养,并给予有效的护理,提高了患者生活质量,缩短了住院时间,取得了满意的效果     

Clinical and pathologic characteristics of pancreatic necrosis in critically ill children

BACKGROUND: Pancreatic damage in critically ill patients is associated with the progressive failure of multiple organs, but little is known about its clinical characteristics. At present, no guidelines are available for the diagnosis and management of pancreatic damage. This study was undertaken to analyze the clinical and pathologic characteristics of pancreatic necrosis in critically ill children, and to find some biological markers of pancreatic damage or pancreatic necrosis.METHODS: We retrospectively reviewed the clinical data, laboratory results, and autopsy findings of 25 children, who were admitted to Hunan Children’s Hospital, China from 2003 to 2009, and died of multiple organ failure. The autopsy revealed pancreatic necrosis in 5 children, in whom sectional or gross autopsy was performed.RESULTS: The 5 children had acute onset and a fever. Two children had abdominal pain and 2 had abdominal bulging, flatulence and gastrointestinal bleeding. Four children had abnormal liver function, characterized by decreased albumin and 3 children had elevated level of C-reactive protein (CRP). B-ultrasonography revealed abnormal acoustic image of the pancreas in all children, and autopsy confirmed pancreatic necrosis, which may be associated with the damage of the adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other organs. Children 1 and 2 died of acute hemorrhagic necrotizing pancreatitis (AHNP); children 3-5 died of multiple organ dysfunction syndrome (MODS) due to pancreatic necrosis.CONCLUSION: Pancreatic damage or pancreatic necrosis in critically ill children is characterized by acute onset, severity, short course, multiple organ damage or failure. It may be asymptomatic in early stage, and easy to be ignored.