胰空肠端侧吻合肠内置管吸引预防胰十二脂肠切除术后胰瘘

胰空肠端侧吻合肠内置管吸引预防胰十二脂肠切除术后胰瘘在胰十二胰肠切除术中，我们采用胰空肠端侧套入式吻合并在空肠袢内放置直径０．８～１．０ｃｍ的引流管引出体外进行低负压吸引的方法，防止术后胰空肠吻合口瘘并发症的发生。经１１例病人临床观察，效果满意。我们...     

胰十二指肠联合伤的手术处理

目的 提高对胰十二指肠联合伤的救治能力。方法 回顾性总结我院从１９７９年３月至１９９９年６月手术处理的１６例胰十二指肠联合损伤。结果 治愈１５例。并发症６例：其中２例胰瘘，１例肠瘘，１例十二指肠空肠吻合口出血，１例胰腺假性囊肿，１例死于胆肠吻合口瘘。结论 根据胰十二指肠联合损伤的严重程度不同，采取不同手术方式才能取得良好结果。     

预防胰瘘发生有新法

预防胰瘘发生有新法第四军医大学唐都医院普外科高德明、何泽生教授等，通过临床实践，设计出胰腺残端封闭套入空肠吻合加Ｔ型管引流减压术，使胰瘘发生率由过去传统术式的２８．１％降至４．７％。手术死亡率由３４．４％降至４．８％，提高了疗效，增强了手术安全性。胰...     

供胰的切取保存及修整技术

目的：探讨胰肾联合移植术的供体器官切取、保存及修整的技术方法。方法：1998年5月～2003年9月共联合整块切取腹部多器官86例次，期间施行2例改良式胰液空肠引流胰十二指肠及肾一期联合移植术，结合我院联合整块切取腹部多器官的经验，及胰肾联合移植临床开展情况对供胰的切取与修整技术进行总结。结果：联合整块切取腹部多器官86例均成功，热缺血时间在3min之内。施行2例改良式胰液空肠引流胰十二指肠及肾一期联合移植术，术后移植胰、肾功能均恢复正常，无其它外科并发症。结论：掌握正确的供胰切取、保存及修整方法是保证移植成功的关键因素，主要包括供胰切取的速度与质量以及修整过程中的一些注意点，以尽量缩短热缺血时间，减少损伤。     

预防胰漏简便的胰肠吻合法临床应用分析

目的探讨一种更为简便、实用、安全的胰肠吻合方法。方法我院2007年2月至2011年7月收治的38例不同胰腺手术患者胰肠吻合时采用5%碘酊处理空肠襻粘膜。结果全部患者均在7～12 min（平均9.1 min）内顺利完成胰肠吻合,无手术死亡,术后无吻合口出血、吻合口漏或胰漏等严重并发症。随访6～36个月患者胰腺内外分泌功能良好。结论在利用医用生物胶粘合作用下,用5%碘酊处理空肠襻粘膜,可防止胰漏,使胰肠吻合术更简便、安全和实用。     

大肠引流预防术后大肠吻合口瘘的疗效分析

目的探讨大肠引流对大肠癌术后吻合口瘘的预防。方法回顾性分析1992～2007年间的大肠癌根治性切除腹内肠吻合36例的资料。随机分成两组。甲组行大肠引流21例，乙组未行大肠引流15例。结果吻合口瘘发生甲组1例，乙组2例，经统计学处理有显著差异（P〈0．05）。结论大肠癌术中放置大肠引流管能降低吻合口瘘的发生率。     

双套管引流+肛门直肠双套管持续低压冲洗在中低位直肠癌术后患者吻合口瘘防控中的成本-效果比较

目的:分析双套管引流+肛门直肠双套管持续低压冲洗在中低位直肠癌术后患者吻合口瘘防控中的成本-效果.方法:选取我院2020年2月～2021年2月期间收治的中低位直肠癌患者96例作为研究对象,均行腹腔镜辅助下肿瘤前切除术,依据随机数字表法分为2组,每组48例.对照组行传统腹腔引流,研究组行双套管引流+肛门直肠双套管持续低压冲洗,统计康复指标(引流管内置时间、住院时间、住院费用)、吻合口瘘发生率、吻合口瘘有关并发症发生率、其他并发症发生率.结果:两组吻合口瘘发生率对比,无明显差异(P>0.05).研究组住院时间、引流管放置时间、住院费用少于对照组(P<0.05).研究组吻合口瘘有关并发症发生率6.25％低于对照组25.00％(P<0.05).研究组二次手术率0.00％低于对照组16.67％,术后6个月吻合口狭窄率0.00％低于对照组18.75％(P<0.05).研究组其他并发症发生率2.08％低于对照组18.75％(P<0.05).结论:双套管引流+肛门直肠双套管持续低压冲洗在中低位直肠癌术后患者具有预防吻合口瘘效果,且能减少医疗成本,缩短住院时间与引流管放置时间,并增加安全性.     

胰液中的分泌型IgA

分泌型IgA(SIgA)广泛存在于消化道、呼吸道、乳汁等外分泌液中。胰液中是否含SIgA迄今为止未见报道。我们用放射免疫分析法测定了15例27份胰液标本SIgA含量。 本院肝胆外科1990年3月～1991年5月所做的胰十二指肠根治手术15例(男11例,女4例),年龄39～63岁,平均51±8岁。其中十二指肠乳头癌5例,胰头癌6例,乏特氏壶腹癌4例。术中切除胰腺头体部或头部,残余胰管内放入合适硅胶管(胰液引流管)引流出体外。术后1～21天留取早晨新鲜胰液标本。标本经冻融搅拌后离心取上清于-20C保存待测。用放射免疫法(双抗体-PEG法)测定。抗SIgA抗体放免药盒系上海放免所提供。标本按10倍、100倍稀释。     

胰管畸形伴胆胰管汇流异常一例

1 胆胰管汇合最常见的异常为共同通路>1.5cm,称合流异常,是先天性胆管扩张的常见原因之一.胆胰管汇合时又常见两种变异:一为胰胆管合流异常型(p-c型),即胰管注入胆总管;另一种为胆胰管合流异常型(c-p型),即胆总管注入胰管.正常或上述异常时均为一条胰管与胆总管合流.本例有三条胰管注入胆总管并伴胆胰管合流异常非常罕见,现将我们的尸体解剖所见报道如下.男尸,48岁,发育正常,生前曾诊断为胆总管扩张、胆囊炎.检查胰、胆管所见:胰管起自胰尾,横行贯穿胰的全长,中途先后汇集许多胰小管,在距十二指肠后内壁 4.5cm处胰管分出两支,一支横行呈直角穿入十二指肠内侧壁,开口于十二指肠小乳头.此支胰管直径 0.2～0.25cm.另一支向下向后迂曲走行,收纳胰颈、胰头部的小分支,此支自分出后在5.5cm处又分出呈“Y”型的两分支,且分别呈直角注入胆总管左后侧壁,在胆总管内二分支开口间距为 0.7cm,呈上下分布.此外见胰头及胰钩突部胰液汇流一独立     

内镜下治疗吻合口瘘的护理体会

目的 探讨内镜下治疗吻合口瘘的护理方法.方法 对22例食管胃吻合口瘘的病人行电子胃镜下覆膜食管内支架治疗及放置空肠营养管治疗,同时做好术前准备、心理护理、术中医护患的配合、术后生命体征及并发症观察和空肠营养管的护理.结果 病人能正确配合,内镜下支架置入成功率和有效率100%.术后并发症:疼痛7例,出血3例,支架移位2例.结论 高质量的术前、术后护理及术中医护患的默契配合是治疗成功的保证.     

THE CHOLEDOCHO-PANCREATICO-DUCTAL JUNCTION IN INFANTILE OBSTRUCTIVE JAUNDICE DISEASES

A histopathological study on how the common bile duct and main pancreatic duct open into the duodenum was performed on autopsied cases of infantile obstructive jaundice diseases, and control cases. The so-called "common channel" formation type (Type III) was divided into two types; the junction of the common bile duct and the pancreatic duct was situated in the mucosal or submucosal layer of the duodenum in type IIIa and the junction below the propria muscularis of the duodenum in type IIIb. Type IIIb was identified in 17 out of 28 cases in congenital biliary atresia and in 2 cases of congenital choledochal cyst, while the control cases all belonged to type IIIa. In cases of type IIIb the well-developed sphincter muscle was located in the submucosal layer and it surrounded the common channel after joining of both ducts suggesting the possibility of free communication of both ducts. As the intraductal pressure of pancreatic duct is normally higher than that of the bile duct, reflux of pancreatic juice may occur into the bile duct. Abnormal choledocho-pancreaticoductal junction was suggested to be a pathogenic factor which causes infantile obstructive jaundice diseases.     

液电碎石、扩张导管、支架技术在腹腔镜胆总管探查术中的应用

目的 探讨液电碎石、扩张导管、支架技术在腹腔镜胆总管探查术中的应用价值。方法 在腹腔镜胆总管探查术中，采用液电碎石技术处理梗阻性或嵌顿性结石，扩张导管技术对胆总管下端狭窄或结石梗阻部位施行扩张术，支架技术对胆总管下端梗阻为主的良恶性狭窄施行支撑内引流术或联合T管外引流术。结果 液电碎石技术处理梗阻性或嵌顿性结石27例均获成功，无并发症。扩张导管技术扩张膜状狭窄43例均获成功，处理胆总管下端结石梗阻16例成功13例，胆漏2例经术中常规放置的腹腔引流管引流自愈，残石3例经术中放置的T管引流术后2个月胆管镜取出，无中转开腹、肠穿孔、胆管穿孔、胆管大出血、胰腺炎，无死亡。支架技术治疗56例病人中49例手术获成功(无胆漏，支架位置正确、引流通畅、黄疸减轻或消退)，1例中转开腹，2例胆漏，1例残石，2例支架位置错误，1例死亡。结论 只要选择合适的病例，液电碎石、扩张导管、支架技术在腹腔镜胆总管探查术中的应用均有效、安全、简便、可行。     

NN'-dicyclohexylcarbodiimide (DCCD) reduces pancreatic NaHCO3 secretion without changing pancreatic tissue ATP levels

To study the mechanism responsible for pancreatic NaHCO3 secretion, the inhibitor NN'-dicyclohexylcarbodiimide (DCCD) was administered to six secretin-infused, anaesthetized pigs. Pancreatic juice was collected from a catheter in the main pancreatic duct. Secretion rate was measured at several arterial pH values in each animal, both before and after DCCD. 15 (14-30) mumol kg-1 body wt DCCD, intra-arterially, reduced pancreatic NaHCO3 secretion from 296 (234-398) to 181 (134-237) mumol min-1 at arterial pH 7.43 (7.42-7.47). Similar fractional reductions of secretion occurred at lower arterial pH. Pancreatic tissue ATP concentration, 1.8 (1.4-2.0) mumol g-1 wet wt, was not changed by DCCD. DCCD, less than or equal to 10(-4) mol l-1, did not change Na,K-ATPase nor carbonic anhydrase activities in separate in vitro assay systems. It is concluded that DCCD reduced pancreatic NaHCO3 secretion by a mechanism not involving ATP depletion nor inhibition of Na,K-ATPase nor carbonic anhydrase activities in pancreatic cells. Because DCCD inhibits proton pumps, DCCD may have reduced NaHCO3 secretion through interfering with a proton pump involved in extruding H+ from HCO-3 secreting cells to interstitial fluid in the pancreas.     

复发性泪囊炎鼻腔泪囊解剖学特点及其在内镜下鼻腔泪囊吻合联合支架植入术中的应用

目的 内镜下观察鼻腔泪囊的解剖结构，采用鼻腔泪囊吻合术联合支架植入方式治疗慢性复发性泪囊炎，并观察其疗效。 方法 收集2010年1月至2019年1月期间就诊于甘肃省人民医院耳鼻咽喉头颈外科的已行传统内镜下鼻腔泪囊吻合术后再次复发的慢性泪囊炎患者30例，共计30只眼，予以再次行内镜下鼻腔泪囊吻合术，术中联合支架植入术，术后3个月拔出泪道支架，观察患者术后流泪症状，冲洗泪道判断泪道阻塞情况，随访期为12个月。 结果 随访至12个月时，30例患者14只眼无诉流泪，溢泪，冲洗泪道通畅，鼻内镜下观察见造瘘口通畅，造瘘口无明显缩小；30例12只眼无诉流泪，溢泪，冲洗泪道通畅，但可见造瘘口缩小；4只眼可见造瘘口旁肉芽增生，再次堵塞造瘘口，治疗整体有效率为87%。 结论 内镜下鼻腔泪囊吻合术联合支架植入是治疗慢性复发性泪囊炎一种有效方法，临床效果良好。     

Gallstones, the choledochoduodenal junction and initiation of acute pancreatitis: are two stones the culprits rather than one stone?

Reflux of biliary secretions into the pancreatic duct following gallstone obstruction of the common biliary pancreatic ampulla has been implicated as a cause of acute pancreatitis. However, the pancreatic duct pressure is higher than the biliary pressure and, therefore, the simple obstruction of the choledochoduodenal junction by one gallstone does not result in biliary pancreatic reflux. We propose a mechanism whereby simultaneous migration and sequential impaction above and below the common biliary pancreatic ampulla of two gallstones allows for the creation of a toxic bile-pancreatic juice mixture in the common bile duct, subsequent reversal of the pressure gradient and reflux of the toxic secretions into the pancreatic duct.     

SUDDEN DEATH DUE TO INFANTILE PANCREATITIS

The autopsy of a 10-month-old infant girl who died suddenly after a 2-day illness revealed acute pancreatitis and DIG. While the definitive etiology remains unknown, retention of pancreatic juice accompanying proliferation of papillary epithelium within the pancreatic duct adjacent to the ampulla Vater was suggested. Acute interstitial pancreatitis was assumed to have resulted from suppurative inflammation of the pancreatic duct. DIC was probably caused by the release of pancreatic enzymes.     

Quantitative distribution of brush cells in the rat gastrointestinal tract: brush cell population coincides with NaHCO3 secretion

The function of brush cells is obscure, but recent cytochemical studies indicate that rat bile duct brush cells secrete NaHCO₃. The aim of this study was to determine the quantitative distribution of brush cells at 16 sites of the rat gastrointestinal tract and to investigate the role of NaHCO₃ secretion at these sites. Specimens of 16 sites of the gastrointestinal tracts of three female Long-Evans rats were fixed in a periodate-lysine-paraformaldehyde solution. Frozen sections were stained with the anti-cytokeratin 18 antibody, a selective marker for brush cells. The numbers of brush cells were counted from photographs. The percentages of brush cells in the epithelium at the 16 sites were gastric groove, 32.3%; corpus adjacent to the gastric groove, 2.5%; corpus, 0.4%; antrum, 0.4%; duodenum adjacent to the pyloric ring, 2.3%; proximal duodenum, 0%; duodenum facing the bile duct orifice, 0%; distal duodenum, 0.2%; proximal jejunum, 0.1%; transitional site between the jejunum and the ileum, 0.1%; distal ileum, Peyer’s patch dome, 1.5%; and the villi, 0.4%; caecum, 2.1%; proximal colon, 0.2%; middle colon, 0.1%; distal colon, 0.1%; and rectum, 0.1%. We concluded that the population of brush cells is high in the gastric groove, the duodenum adjacent to the pyloric ring, and the caecum, where NaHCO₃ is postulated to neutralize gastric HCL or organic acids produced by enteric bacteria. The brush cell population is low in the duodenum and jejunum, which receive bile and pancreatic juice.     

Amylase secretion by the perfused cat pancreas in relation to the secretion of calcium and other electrolytes and as influenced by the extrenal ionic environment

1. Amylase secretion from the perfused pancreas consists of two components: a small continuous basal secretion and a stimulated secretion in response to acetylcholine or cholecystokinin-pancreozymin. The response to small doses of either stimulant was repeatable over several hours.2. The calcium concentration of pancreatic juice, always less than that of the perfusate, was normally constant above secretory rates of 0.15 g/10 min. However, when the concentration of enzymes in the juice rose, either after stimulation or at very low secretory rates, the calcium concentration rose in parallel, suggesting that this calcium is bound to, or is a component of, pancreatic enzymes.3. Elevation of the perfusate calcium concentration resulted in a parallel increase in the calcium concentration of the pancreatic juice.4. Calcium-free solutions initially caused a small reduction in basal and stimulated amylase secretion and, after prolonged periods of perfusion, abolished stimulated secretion and caused a reduction in electrolyte secretion. The latter was completely reversed by calcium-rich perfusates but the effects on enzyme secretion were only partially reversible.5. Calcium-rich perfusates had no effect on the rate of electrolyte secretion but potentiated submaximally stimulated amylase secretion.6. Barium did not substitute for calcium in supporting pancreatic secretion.7. Alterations in the extracellular concentrations of sodium, potassium and magnesium had no direct effect on amylase secretion.8. The local anaesthetic tetracaine inhibited amylase secretion at a lower concentration than that required to inhibit electrolyte secretion.9. It is concluded (a) that calcium is secreted into the pancreatic juice in two fractions, one associated with enzymes and the other with the electrolyte component of the juice; and (b) that calcium ions play an important role in the stimulus-secretion coupling of pancreatic acinar cells, but that the effects of calcium depletion on electrolyte secretion may principally be due to alterations in the permeability of the duct system.     

Bio-sensor system discriminating between the biliary and pancreatic ductal systems

Sphincter of Oddi manometry is the “gold standard” to evaluate the ductal anatomy of patients with suspected sphincter of Oddi dysfunction. During such procedure it can be unclear which duct is being investigated without radiographs. Bilirubin and other pigments in bile strongly absorb blue light, whereas pancreatic fluid is clear and does not absorb blue light. The bio-sensor system incorporates fibre-optic technology to measure blue light absorbance in the ducts. Bench tests and animal tests were conducted utilising possums. In bench and animal experiments the bio-sensor correctly discriminated between bile and pancreatic juice, based on the absorbance of blue light. The mean absorbance of the bile was 3.57±1.74 and that of the pancreatic duct fluid was 0.53±0.34 (P<0.01) in the animal models. The optical sensing system could be incorporated into a manometry catheter to aid sphincter of Oddi manometry shortening procedure time and reduce radiography exposure.     

Adsorption of palmitic, stearic and oleic acids in the sheep in the presence or absence of bile and-or pancreatic juice

1. The absorption of (3)H- and (14)C-labelled palmitic, stearic and oleic acids under control conditions and in the absence of bile and/or pancreatic juice has been studied in sheep prepared with intestinal cannulae and reentrant fistulation of the thoracic lymph duct.2. Under control conditions the percentage recoveries in thoracic duct lymph of fatty acids introduced into the duodenum were: stearic acid 59.6 +/- 3.2 (mean +/- S.E. of mean), palmitic acid 71.1 +/- 1.2 and oleic acid 80.4 +/- 1.9.3. At the peak of absorption over 90% of the radioactivity was located in the triglyceride fraction.4. It was calculated that between 1900 and 3800 ml. lymph containing up to 20 g lipid flowed daily from the thoracic duct. The major fatty acids of lymph triglycerides were C(16:0) (26%), C(18:0) (39%) and C(18:1) (19%).5. In the absence of pancreatic juice, but in the presence of bile, the absorption of stearic, palmitic and oleic acids was 0.8, 4.-8.5 and 26% respectively of the dose injected into the duodenum. In the absence of bile but presence of pancreatic juice corresponding values were 0.1-0.5, 1.8 and 7.7%.6. In the absence of pancreatic juice the total lipid content of thoracic duct lymph fell from 800 to 80 mg% within 4 hr. When bile was also absent the lipid content of lymph fell further to 50 mg%.7. It is concluded that pancreatic juice functions in the lumen of the intestine probably through the production from biliary lecithin of the lysolecithin necessary for the optimum absorption of lipids.