改良式胃造瘘术的临床应用

胰十二指肠切除术后患者通常需较长时间留置鼻胃引流管，这样势必会使鼻咽部分泌物增多、黏膜糜烂出血，甚至会发生肺部感染。我们对传统的胃造瘘术进行了改良，旨在有效地避免上述并发症的发生。[第一段]     

RCAS1在胰腺癌诊断中的作用

Objective To evaluate the effect of receptor-binding cancer antigen expressed on SiSO cells(RCASI) as serum tumor marker on the diagnosis of pancreatic cancer. Methods Receiver-operating characteristics(ROC) curve methods were used to assay the serum content of RCAS1 ,CA19-9 and CA242 in 46 patients with pancreatic cancer, 18 patients and 20 normal tissues of chronic pancreatitis detected by enzymelinkod immunosorbent assay (ELISA), and the results were analyzed by statistics methods. The expressions of RCAS1 protein were analyzed by immunohistochemical method in 32 patients with pancreatic cancer, 10 patients with chronic pancreatitis and 6 cases of normal pancreatic specimens. Results The serum levels of RCAS1 ,CA19-9 and CA242 in pancreatic cancer were higher than that in chronic pancreatitis respectively (P ＜ 0.01). The area under curve of RCAS1, CA19-9 and CA242 were 0.826, 0.804 and 0.737 ,respectively. Subgroup analysis indicated that the RCAS1 and CA19-9 levels of pancreatic cancer patients without obstructive jaundice were lower than those for patients with obstructive jaundice (P＜0.01). CA19-9 levels of patients with resectable pancreatic cancer were lower than those with unresectable pancreatic cancer(P ＜ 0.01). Immunohistochemistry showed that the expression rates of RCAS1 in pancreatic cancer and chronic pancreatitis were 87.5% and 40.0% ,respectively (P ＜0. 05). Conclusions In diagnosis of pancreatic cancer,the clinical value of RCAS1 is available. And the combination test of RCAS1 and CA19-9 have clinical value to evaluate if the pancreatic cancer can be resected before operation.     

慢性胰腺炎与胰腺癌的关系及诊治现状与展望

慢性胰腺炎是一种胰腺的进展性和不可逆性炎症病变 ,最终将导致胰腺结构破坏和内、外分泌功能的丧失。病程通常呈反复发作性 ,表现为复发性腹痛或慢性无痛综合征。急性胰腺炎、慢性胰腺炎和胰腺癌这三种疾病之间存在着较复杂的关系。急性胰腺炎的发作通常先于慢性胰腺炎几年时间 ,而胰腺癌往往是在慢性胰腺炎明确诊断后 2 0年左右发生 ,关于他们在发病上是否存在着一定的序贯性或是有其他短暂的联系 ,目前仍有争论。一些资料完整的临床病例随访分析提示 ,长期患慢性胰腺炎的患者发展为胰腺癌的危险性明显高于普通人群。1　慢性胰腺炎和胰腺…     

胰头损伤的手术方式选择

胰头损伤包括腹部外伤所致的胰头外伤及外科手术的副损伤，后者又称为医源性胰头损伤。近年来由于交通事故及暴力犯罪的增加，胰腺外伤的发病率呈上升趋势，因此胰头外伤也有所增加。在处理原则、手术方式及并发症的处理上，医源性胰头损伤与胰头外伤基本相同，故这里统称为胰头损伤。由于胰头的解剖部位及其生理保护，只有当较强的外力作用于右上腹时才能损伤胰头。因此一般都合并有十二指肠的损伤及其他腹腔脏器的损伤。胰头十二指肠损伤后大量胰液、十二指肠液、胆汁外溢到腹腔，胰酶迅速被激活，而产生极强的消化作用，因此后果严重，病…     

109例成人型胆管囊肿的诊治经验

Objective To discuss the diagnosis and treatment of congenital choledochal cyst (CCC).Methods The clinical data of 109 adult patients with congenital choledochal cyst admitted in Peking Union Medical College Hospita between 1984 and 2007 were retrospectively analyzed.The male: female ratio was 1 : 3.8.The mean age was 32.8 years.Seventy-eight of the patients belonged to Todani type Ⅰ, while twenty-six to type Ⅳ and five to type Ⅴ.There was no case of type Ⅱ or Ⅲ.Results Right upper abdominal pain or discomfort and recurrent cholangitis were the predominant presentations.Thirty patients had undergone previous surgical procedures while 26 procedures were done before 2000.B-US and MRCP were the primary methods for diagnosis after 2000.Ninety-four patients underwent complete excision of the extrahepatic cyst and hepaticojejunostomy.Four patients required the left lateral hepateetomy in addition.Four patients were testified malignant change by pathological examination.There were four pancreatic fistulas and two Subphrenic abscesses.There was no postoperative death.Forty-six patients were available for follow-up.The late complications in-eluded recurrent cholangitis, hepaticojejunostomy anastomosis stricture and intrahepatic biliary calcu-la.Conclusions Right upper abdominal pain or discomfort and recurrent cholangitis were the most common presentations in adult congenital choledochal cyst patients.B-US and MRCP should be the prefered imaging methods for diagnosis.Complete excision of the extrahepatic cyst and hepaticojeju-nostomy were ideal treatment.     

保留幽门的胰十二指肠切除术(文献综述)

自1935年 Whipple 等首先报告应用胰十二指肠切除术成功地切除了一例壶腹癌,并于1945年提出手术的标准方案后,这种手术已得到广泛应用。其手术技术及消化道重建方法也有了很大改进,但切除胃窦部和幽门仍是胰十二指肠切除术的基本要求。其目的在于防止术后吻合口溃疡的发生和保证癌肿的彻底根治。然而胃部分切除术后可能出现一系列并发症,如胆汁返流性胃炎、小胃综合症、倾倒综合症、腹泻及体重减轻等。故对胃酸分泌正常及排空功能良好     

与导泻和灌肠法不同的一种新口服灌洗液用于结肠术前准备(英)

机械洗肠和应用抗菌素进行术前肠道准备已成为结直肠外科的标准方法,从而减少了感染性併发症。目前通常使用聚乙二醇电解质灌洗液(PEG—ELS)进行术前肠道准备。为改善其味道和进一步纯化其生理性能,一种新的等渗平衡液无硫电解质灌洗液(SF—     

胰血管活性肠肽瘤综合征

作者报告了２例胰血管活性肠肽瘤，均具有典型胰血管活性肠肽瘤综合征且合并远处转移。２例均行手术及术后化疗，其中１例术前用生长抑素控制症状，手术切除肿瘤后症状改善明显。观察表明生长抑素对控制症状有明显效果，而早期诊断是决定预后的关键。作者结合文献对胰血管活性肠肽瘤的一般临床特点和诊治问题进行了探讨。     

重视中晚期胰头癌的综合治疗

尽管针对胰腺癌的影像学诊断和分子生物学诊断取得了相当的进展,但其早期诊断问题远未解决,85％的患者就诊时已属晚期。美国的资料显示胰腺癌的手术切除率和5年生存率在过去20年中并无明显变化。因此中晚期胰腺癌问题是临床胰腺癌诊治的重点,应高度重视。     

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重症急性胰腺炎(severe acute pancreatitis,SAP)是一种外科急重症,病情凶险,病死率高,一直以来都是急性胰腺炎(acute pancreatitis,AP)中治疗的难题和焦点。本文仅就其外科干预时机的选择及多学科协作阐述如下。1外科干预在SAP治疗中的价值随着对SAP的认识越来越深入,对本病的治疗理念也经历了数次转变,最初以内科治疗为主,逐渐转变到外科治疗为主,再到现在的理念,即在非手术治疗基础上进行适时的必要的外科干预治疗。