The neutrophil-to-lymphocyte ratio, CA19-9 and CEA in the diagnosis of pancreatic cancer / 中华肝胆外科杂志

Objective To study the neutrophil-lymphocyte ratio (NLR),CA19-9 and CEA in the diagnosis of pancreatic cancer (PC).Methods From January 2013 to June 2016,the data of 723 consecutive patients with pancreatic diseases were reviewed.Of these 723 patients,632 patients had PC (stage Ⅰ,Ⅱ 324 patients;stage Ⅲ,Ⅳ 289 patients),66 patients had pancreatic cystic tumors,and 26 patients had tumor-forming pancreatitis.The Receiver Operating Curve (ROC) and the logistic regression model were used to assess the blood biomarkers in predicting PC.Results Using the ROC,CA19-9 CEA,NLR,PLR,ALP,GGT,LDH,GLU and MONO# were useful in diagnosing malignant pancreatic diseases.Logistic regression analysis showed that CA19-9 (95％ CI:12.928 ～ 103.330;P ＜ 0.05),CEA (95％ CI:1.041 ～3.472,P＜0.05) and NLR (95％ CI:1.020～ 3.525,P =0.043) were independent variables in predicting PC.The concentrations of CA19-9,CEA,and NLR had the highest values in predicting PC.When CA19-9 was ＜37 kU/L,the concentrations of NLR and CEA had a high sensitivity and specificity (AUC =0.746,95％CI:0.675～0.816,P＜0.05) of 69.2％ and 73.6％,respectively.Conclusions The concentrations of CA19-9,CEA,and NLR had the highest prediction value for PC.When the level of CA19-9 was ＜37 kU/L,the combined use of NLR and CEA significantly improved the diagnostic specificity.

Surgical indication,diagnosis and treatment of suspected pancreatic cystic lesions / 局解手术学杂志

Objective To explore the surgical indication,diagnosis and treatment of suspected pancreatic cystic lesions.Methods To-tally 341 patients were admitted into our hospital because of pancreatic cystic lesions from October 2010 to October 2015.Except the 278 confirmed cases,the clinical data of the rest 63 patients with vague diagnosis were retrospectively analyzed.Results The surgical indication of pancreatic cystic lesions were:the lesion diameter was more than 4 cm;the imaging diagnosis was malignant;the lesion was combined with obvious clinical symptoms which can not explain with other diseases;there were asymptomatic pancreatic cystic lesion and main pancre-atic duct dilation without surgical risk factors;the follow-up showed that the desease is in development.Endoscopic ultrasonography guided fine needle aspiration is a useful supplement for more accurate diagnosis.However,it is an uncertain diagnostic value currently.Conclusion Diameter of lesion,uncertain imaging diagnosis,severe abdominal symptoms,obstructive jaundice and abnormal serum tumor markers are the surgical indication for patients.

Effects of two styles of pancreaticojejunostomy following pancreaticoduodenectomy on postoperative complications / 中华消化外科杂志

Objective To analyze postoperative complications of duct-to-mucosa pancreaticojejunostomy and side-to-end or end-to-end pancreaticojejunostomy following pancreaticoduodenectomy.Methods The clinical data of 342 patients who underwent pancreaticoduodenectomy at the West China Hospital of Sichuan University from June 2004 to May 2008 were retrospectively analyzed.All patients were divided into the duct-to-mucosa group (179 cases)and side-to-end or end-to-end group(163 cases)according to the styles of pancreaticojejunostomy.The relationship between the incidence and severity of postoperative complications of the 2 anastomotic styles were analyzed according to the Clavien grading system.The measurement data and the count data were analyzed using the t test or chi-square test.Results The overall complication rate was 48.8％(167/342),and the complication rate was 38.0％(68/179)in the side-to-end group and 60.7％(99/163)in the side-to-end or end-to-end group,with a significant difference between the 2 groups(x2=17.667,P ＜0.05).The incidences of grade Ⅱ and grade Ⅴ complications were 16.8％(30/179)and 1.1％(2/179)in the duct-to-mucosa group,which were significantly lower than 28.2％(46/163)and 5.5％(9/163)of the side-to-end or end-to-end group(x2=6.484,5.316,P ＜0.05).Conclusion Compared with side-to-end or end-to-end pancreaticojejunostomy,duct-to-mucosa pancreaticojejunostomy is a better style with a lower incidence of postoperative complication.

Death caused by severe acute pancreatitis:an anlaysis of 144 cases / 中华肝胆外科杂志

Objective To explore the main causes for death due to severe acute pancreatitis (SAP) to improve the level of diagnosis and treatment. Methods The clinical data of 1162 SAP cases treated in our hospital from June 1997 to May 2005 were retrospectively analyzed. Among which, 144patients (12. 39%) died, 82(7.06%)abandoned treatment and 936(80.55%)were cured. Results the APACHE Ⅱ scores and pancreas Balthazar CT scores of the death group were higher than that of the survival group. The percentage of single one organ dysfunction and multiple organ dysfunction syndrome (MODS) was significantly higher in the death group than in the survival group. The mortality rate of SAP without obvious inducing factors was significantly higher than that of SAP with inducing factors. Conclusion Integrated traditional and western non-surgical treatment is effective for SAP.The treatment for SAP without obvious inducing factors is a challenge. The mortality rate of SAP is primarily related to the pathological changes of pancreas and the patient's general condition. Early diagnosis and treatment is important to decrease mortality rate and maintaining the function of important organs is basic to ensure curative effect.

Simultaneous pancreas-kidney transplantation for type 2 diabetes mellitus complicated with endstaged renal disease in 1 case / 中国组织工程研究

We performed a simultaneous pancreas-kidney transplantation (SPK) for type 2 diabetes complicated with end-staged renal disease (ESRD) in March, 2007. The recipient was a 65-year old male, who suffered type 2 diabetes for 15 years and renal dysfunction for 5 years and other diabetic complications such as retinopathy and peripheral neuropathy. SPK was performed successfully for him, in which the kidney was placed in the left iliac fossa, while the pancreas in the right iliac fossa, with an entedc drainage for pancreas exocrine and a systemic drainage for endocrine. Serum C-peptide, creatinine and blood urea nitrogen reached normal levels on day 1,4 and 11 post-transplant, respectively. Blood glucose became stabilized gradually to normal level and therefore the injected insulin was stopped on day 16 post-transplant. Oral glucose tolerance test (OGTT) showed the function of grafted pancreas was normal after 3 weeks of transplant, and no transplant-related complications occurred. With the recipient followed up for 20 months, both his blood glucose level and renal function maintained normal without using insulin.

Operative mode based on clinicopathologic features in patients with chronic pancreatitis / 中国普通外科杂志

ObjectiveTo classify chronic pancreatitis (CP) based on pathological features and evaluate the benefits of different surgical procedures according to the pathological forms. Methods Forty CP cases during recent 9 years who underwent surgical therapy were retrospectively reviewed in association with clinicopathological analysis. Results Postoperative pain-relief rate was 79.16% in patients treated with longitudinal pancreaticojejunostomy(LPJ). In cases without enlarged pancreatic head or diverticulum of duodenum, postoperative pain-relief rate was 86%.Postoperative pain-relief rate was high by Whipple′s procedure, pylorus-preserving pancreaticoduodenectomy or Beger duodenum-preserving pancreatic head resection,while postoperative diabetes mellitus developed in 22%.Conclusions Both pathological form and operative procedure were factors influencing outcomes of CP.LPJ is still a main surgery for most CP patients with pancreatic fibrosis and dilated pancreatic duct and pancreatic stone.Some patients of CP with enlarged pancreatic head, hyperplasia of pancreatic parenchyma and pancreatic duct epithelia or complicated with diverticulum of the duodenum should be treated with resections targeting at the head of the pancreas.