小儿假性胰腺囊肿的诊断和治疗

目的探讨准确地诊断和治疗小儿假性胰腺囊肿.方法总结近10年来我们收治经B超、钡餐、CT和MRI以及手术证实的假性胰腺囊肿15例.结果发现15例中男11例,女4例,年龄最小1岁4个月,最大13岁,平均年龄9.4岁.而且7例有明显外伤史(7/15,占40%),恶心呕吐(14/15,占93%)、腹痛(11/15,占73%),腹部肿块(10/15,占66%)为主要临床表现,其次有发热、消瘦、贫血.此外,在诊断上除依靠病史、体检和临床表现外,B超是最适宜和有价值的诊断依据,钡餐、CT和MRI可以帮助诊断和鉴别诊断,还发现一旦血清淀粉酶下降后又重新回升,不但对确诊有重要意义,也是手术的重要指证.14例接受手术治疗患儿均恢复良好,无1例死亡.结论①小儿假性胰腺囊肿诊断除主要依靠病史、体征外,B超对小儿仍是有价值的辅助检查,诊断困难时可结合钡餐、CT和MRI加以鉴别.②小儿假性胰腺囊肿多与外伤有关,男＞女,因男孩好动、顽皮受伤机率多.③囊肿形成超过6周,或者B超显示囊肿壁形成明显时应选用内引流手术,较大囊肿仅外引流难以治愈.     

Einfluβ bildgebender diagnostischer verfahren auf therapiewahl und prognose traumatischer pankreas- und duodenalverletzungen

27 patients with pancreatic and 8 with duodenal injuries were studied, 66% of whom had associated abdominal injuries. Peritoneal lavage was performed in 10 cases, and ultrasonography in 15. Laparotomy was considered to be indicated on the basis of the results in 9 cases of peritoneal lavage and in 12 cases of ultrasound examination, but in only 1 case and 2 cases, respectively, did the findings constitute the only reason for performing a laparotomy. Pancreatic and duodenal injuries were directly confirmed by ultrasonography and computer tomography only in a minority of cases. The morbiditiy of pancreatic and duodenal injuries was 66% and 25%, respectively, and lethality, 19% and 25%. Despite modern imaging techniques, clinical examination is of paramount importance for the decision as to whether operative therapy is indicated; delay leads to increased morbidity and lethality.     

Intracisternal injection of TRH antibody blocks gastric emptying stimulated by 2-deoxy-d-glucose in rats

We evaluated the effect of 2-deoxy-d-glucose (2-DG) on gastric emptying of a non nutrient solution in conscious rats using a Phenol red method. Intravenous injection of 2-deoxy-d-glucose dose-dependently increased the rate of gastric emptying. This stimulatory action of 2-DG was abolished by subdiaphragmatic vagotomy. Intracisternal injection of thyrotropin-releasing hormone (TRH) antibody blocked intracisternal TRH and intravenous 2-DG-induced enhancement of gastric empyting but not the stimulation of gastric emptying induced by intracisternal pancreatic polypeptide. The TRH antibody injected intraperitoneally had no effect. These results suggest that endogenous TRH in the brain is involved in vagal-dependent stimulation of gastric emptying by 2-DG.     

L—盐酸赖氨酸对脑损伤大鼠胰高血糖素和血糖含量的影响

目的　研究 Ｌ盐酸赖氨酸对脑损伤后大鼠的胰高血糖素、胰岛素及血糖含量的影响。方法　采用落体法致大鼠脑损伤;伤后立刻一次腹腔注射 Ｌ盐酸赖氨酸,２４ｈ 后断头处死,用免疫组织化学 Ａ Ｂ Ｃ 法结合图像分析技术,观察 Ｌ盐酸赖氨酸（６２１ ．５ｍｇ·ｋｇ － １ 及３１０ ．８ｍｇ·ｋｇ － １） 对脑损伤后大鼠胰岛 Ａ 细胞内胰高血糖素（ Ｇｌｕ） 及 Ｂ 细胞内胰岛素（ Ｉｎｓ） 免疫反应强度和光密度值的影响;用生化分析仪测定血糖含量。结果　 Ｌ盐酸赖氨酸能显著增强 Ａ 细胞内 Ｇｌｕ 免疫反应强度,提高平均光密度值,增加 Ｇｌｕ 的含量,并降低血糖水平,但对 Ｂ 细胞内 Ｉｎｓ 的免疫反应强度及光密度值无明显影响。结论　 Ｌ盐酸赖氨酸可抑制 Ｇｌｕ 的释放并产生显著的降血糖作用。     

内窥镜十二指肠乳头切开术的应用解剖

目的：为临床经内窥镜十二指肠乳头括约肌切开术（Ｅｎｄｏｓｃｏｐｉｃｓｐｈｉｎｃｔｅｒｏｔｏｍｙ,ＥＳＴ）提供形态学的依据。方法：３０例正常成人腹部标本,解剖观测胆总管、胰管、肝胰壶腹和乳头区长度、宽度,胆总管与胰管的夹角,肝胰壶腹区的血管分布。结果：肝胰壶腹及十二指肠乳头区的营养动脉平均为２．１支,均来源于胰十二指肠上动脉、胰十二指肠下动脉,其中肝胰壶腹区及十二指肠乳头区９～１２点钟处营养动脉的出现率为４６．１％（２９支）。测量胆总管、胰管、壶腹末端的长度分别为３２．１±８．９ｍｍ、９．９±３．９ｍｍ、１２．８±２．９ｍｍ;宽度分别为７．２±２．２ｍｍ、３．１±０．６ｍｍ、７．１±１．４ｍｍ。胆总管和胰管间的夹角７０％为２０°至４５°,平均３５．４°。结论：本实验的结果为临床在ＥＳＴ中选择切开部位和切开的深度等提供了理论依据,对防止术后并发症具有重要的临床意义。     

5-氟尿嘧啶在胰十二指肠切除术患者血液和胰液中的动态分布

探讨５－氟尿嘧啶能否通过胰十二指肠切除术后的残留胰腺组织进入胰液中,并达有效的治疗浓度,为胰腺为临床合理化疗提供理论依据。方法通过观察胰十二指肠切除术患者胰快速推注５－氟尿嘧啶后血液和胰液中药物动态分布及相关性,术后静脉一次性快速推注５－氟尿嘧啶１．０ｇ／ｍ＾２,在给药前后按设计时间点分别采集静脉血和胰液,采用高效液相色谱法测定血浆和胰液５－氟尿嘧啶药物浓度,应用ＰＣＮＯＮＬＩＮ程序程序计算共动态     

胰腺假性囊肿治疗方法的选择

该文报告２３例胰腺假性囊肿,根据病期、囊肿大小、部位选择治疗方法,其中非手术治疗５例,外引流１例,内引流１４例,囊肿切除术３例。结果：无手术死亡,非手术治愈５例,外引流术后胰瘘１例,囊肿切除术后复发１例,内引流术后无严重并发症出现。我们认为急性囊肿应观察６周,有些病例有自行消散的可能,慢性囊肿一经确诊即可行内引流治疗,内引流是目前较理想的有效手术方式     

Molecular diagnosis of exocrine pancreatic cancer using a percutaneous technique

Background: The K-ras oncogene is activated by point mutations at codon 12 in most patients with exocrine pancreatic cancer. Mutant-enriched polymerase chain reaction (PCR) amplification can enhance the detection of mutated K-ras. This technique was applied to patients undergoing percutaneous fine-needle aspiration (FNA) biopsy of suspect pancreatic lesions. Methods: Twenty-five patients underwent percutaneous FNA of the pancreas for cytologic and molecular analysis. After preparing cytologic smears, the 22-gauge needle and syringe used for FNA were rinsed in RPMI-1640. The specimen was centrifuged, and DNA was extracted from the supernatant and subjected to mutant-enriched PCR using appropriate mismatched primers that introduce a BstNI restriction endonuclease cleavage site at codon 12 of wild-type, but not mutant, K-ras. After digestion with BstNI, the DNA was reamplified. To increase assay sensitivity, the final five PCR cycles were completed incorporating 5 μCi of (α-32P)dCTP. The DNA was then redigested and subjected to gel electrophoresis and autoradiography. Results: The median amount of DNA retrieved per specimen was 3.33 μg. Mutant K-ras was detected as a band of 143 bps; residual wild-type DNA was seen as a 114-bp fragment. Twenty-one of 25 specimens demonstrated mutated K-ras DNA. Two patients with nondiagnostic cytology results had mutated K-ras DNA; adenocarcinoma of pancreatic origin was confirmed in both cases after pancreatectomy. Conclusion: The molecular diagnosis of pancreatic cancer through identification of mutations in K-ras can be readily performed on specimens obtained by percutaneous FNA. As aggressive multimodality management of this disease becomes more common, pretreatment analysis of molecular determinants may have greater clinical significance. Presented at the 48th Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

Phosphate and thiophosphate group donating adenine and guanine nucleotides inhibit glibenclamide binding to membranes from pancreatic islets

Summary In microsomes obtained from mouse pancreatic islets, the Mg complex of adenosine 5-triphosphate (MgATP) increased the dissociation constant (K _D) for binding of [³H]glibenclamide by sixfold. In the presence of Mg²⁺, not only ATP but also adenosine 5-0-(3-thiotriphosphate) (ATPS), adenosine 5-diphosphate (ADP), guanosine 5-triphosphate (GTP), guanosine 5-diphosphate (GDP), guanosine 5-0-(3-thiotriphosphate) (GTPTS) and guanosine 5-0-(2-thiodiphosphate) (GDP S) inhibited binding of [³H]glibenclamide. These effects were not observed in the absence of Mg²⁺. Half maximally effective concentrations of the Mg complexes of ATP, ADP, ATPS and GDP were 11.6, 19.0, 62.3 and 90.1 mol/l, respectively. The non-hydrolyzable analogues adenosine 5-(,-imidotriphosphate) (AMP-PNP) and guanosine 5-(,-imidotriphosphate) (GMP-PNP) did not alter [³H]glibenclamide binding in the presence of Mg²⁺. MgADP acted much more slowly than MgATP and both MgADP and MgADP did not inhibit [³H]glibenclamide binding when the concentrations of MgATP and MgATP were kept low by the hexokinase reaction. Development of MgATP-induced inhibition of [³H]glibenclamide binding and dissociation of [³H]-glibenclamide binding occurred at similar rates. However, the reversal of MgATP-induced inhibition of [³H]glibenclamide binding was slower than the association of [³H]glibenclamide with its binding site. Exogenous alkaline phosphatase accelerated the reversal of MgATP-induced inhibition of [³H]glibenclamide binding. MgATP enhanced displacement of [³H]glibenclamide binding by diazoxide. The data suggest that sulfonylureas and diazoxide exert their effects by interaction with the same binding site at the sulfonylurea receptor and that protein phosphorylation modulates the affinity of the receptor.Some of the results described here are part of the medical theses of S. Löser and I. Rietze Send offprint requests to M. Schwanstecher at the above address     

胰腺囊实性肿瘤8例临床病理学分析

目的 观察胰腺囊实性肿瘤(CSTP)的临床病理及免疫组化特点。方法 组织学HE、PAS法，免疫组化SP法。结果 8例CSTP中，女性7例，男性1例；年龄19～32岁，平均26岁。手术后均无复发；肿瘤平均直径9cm，有包膜、囊实性相问。镜检：肿瘤由乳头和囊实性区混合而成，细胞大小形态较一致，核圆、卵圆，异形不明显，核分裂罕见。免疫组化8例al抗胰蛋白酶、VIMENTIN弥漫阳性，2例CK阳性，3例CgA、Syn局灶阳性；Insulin、EMA阴性。结论 胰腺囊实性肿瘤多发生于年轻女性，具有独特临床病理特点。预后好，应视为低度恶性肿瘤。