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Objective:To study the clinical features in patients with acute necrotizing pancreatitis (ANP) complicated by hemorrhage, and to analyze the treatments and their outcomes.Methods:The clinical data of 44 ANP patients with hemorrhage managed at the Department of Pancreas Center, the First Affiliated Hospital of Nanjing Medical University from September 2015 to December 2020 were retrospectively analyzed. There were 34 males and 10 females, aged (48.9±12.2) years old. Clinical data were collected on the bleeding sites, bleeding interventions, and treatment outcomes. Follow-up visits were made by outpatients visits or telephone.Results:Of the 44 patients with bleeding, 8 had gastrointestinal bleeding, 31 had intra-abdominal bleeding, and the remaining 5 had mixed bleeding sites. The median interval from onset of ANP to development of hemorrhage was 30.5(20.8, 40.3) d. For the 13 patients with gastrointestinal bleeding and mixed sites of bleeding: 4 patients were successfully treated by endoscopically for upper gastrointestinal ulcers, 5 patients were successfully treated by endovascular embolization using digital subtraction angiography (DSA) to detect the sites of bleeding, and 4 patients were successfully treated by surgery. For the 31 patients with intra-abdominal hemorrhage: 24 underwent DSA. For the 7 patients who did not undergo DSA, 3 who were hemodynamically stable were treated conservatively, 2 underwent immediate open surgery to stop bleeding within 24 h after surgical debridement of infected pancreatic necrosis, 1 did not undergo DSA because the family members decided to abandon further treatment, and 1 died while preparing for DSA. For the 29 patients who underwent DSA, vascular abnormalities were found in 69.0%(20/29), with splenic artery hemorrhage being the most common. In the 44 patients with bleeding: 29.5%(13/44) were examined by endoscopy, and 4 were successfully stopped by endoscopic treatment; 65.9%(29/44) patients were examined by DSA, and 15 patients were successfully treated by intravascular embolization; 14 patients (31.9%) were treated by open surgery and 11 patients were successfully stopped. The mortality rate was 47.7%(21/44), of which 5 patients died from hemorrhagic shock complicated by multiple organ dysfunction syndrome (MODS) and 16 patients died from sepsis complicated by MODS. The mortality rate of 55.6%(20/36) in patients with intra-abdominal and mixed sites of bleeding was significantly higher than that of the 12.5%(1/8) in patients with gastrointestinal bleeding ( P=0.048). None of the 23 surviving patients developed recurrence of intra-abdominal and/or gastrointestinal bleeding on follow-up. Conclusion:Major bleeding commonly occurred about 1 month after ANP and it was associated with a higher in-hospital mortality rate. DSA, endoscopy, and open surgery were effective means to achieve hemostasis.
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Pancreatic diseases is a kind of complex, high-risk gastrointestinal diseases. Pancreatic cancer is highly malignant and seriously endangers people′s health. Developing multi-center, large-scale real world research can better understand the incidence patterns and treatment outcomes of pancreatic diseases. Based on the multi-center and heterogeneous data, the authors for-mulate data standards for real world studies of pancreatic diseases, and build a database of pancreatic cancer, integrating and sharing data from multi-center sources, in order to fully explore the scientific research value of pancreatic cancer clinical information, and provide experience and reference for the construction of other real world research specific disease databases in the future.
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Dyspepsia is the one of the most common clinical manifestations of digestive system diseases and has various and complex causes， among which pancreatic tumor is a relatively uncommon cause and is easily neglected in clinical practice. The dual factors of tumor and dyspepsia may cause a significant reduction in the quality of life of patients. At present， there is still a lack of standardized diagnosis and treatment strategies for dyspepsia associated with pancreatic tumors， and this article reviews the diagnosis and treatment of this disease.
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Objective:To summarize the clinical manifestations, diagnosis and surgical treatment of abdominal unicentric Castleman's disease.Methods:The clinical data of abdominal unicentric Castleman's disease cases admitted to the General Surgery Department of the First Affiliated Hospital,Nanjing Medical University from Jan 2009 to Dec 2019 was retrospectively analyzed.Results:A total of 18 patients were included with definite pathological diagnosis. The main complaint was abdominal pain and discomfort (50%, 6/12), dizziness and fatigue (25%, 3/12), multiple rash with oral ulcer (16.7%, 2/12) and weight loss (8.3%, 1/12). All patients received surgical resection. Postoperative pathology showed clear vascular type in 15 patients and plasma cell type in 3 patients. There were no major complications nor mortality.Conclusion:Abdominal unicentric Castleman's disease has diverse clinical manifestations, which was difficult for preoperative diagnosis, postoperative prognosis is satisfactory.
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Objective:To investigate the application value of TRIANGLE operation in radical resection of pancreatic cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 30 patients with pancreatic cancer who underwent TRIANGLE operation in the First Affiliated Hospital of Nanjing Medical University from March 2020 to July 2020 were collected. There were 18 females and 12 males, aged from 41 to 79 years, with a median age of 65 years. After assessment of the resectability and dissection of the hepatoduodenal ligament, the superior mesenteric artery, celiac axis, common hepatic artery, portal vein and superior mesenteric vein of patients were exposed. According to the location of tumor, patients were performed pancreaticoduodenectomy, distal pancreatectomy or total pancreatectomy combined with dissection of putatively tumor-infiltrated lymphatic and neural tissue from the triangular space. During the TRIANGLE operation, it required to at least finish the skeletonization of right semi-circumference of the superior mesenteric artery and celiac axis in cases of pancreatico-duodenectomy, whereas the left semi-circumference in cases of distal pancreatectomy. In principle, both of the superior mesenteric artery and celiac axis were circumferentially skeletonized for cases of total pancreatectomy. Lymphatic, neural and fibrous tissues between the superior mesenteric artery and the celiac artery were completely dissected in all patients. Observation indicators: (1) surgical conditions and postoperative histopathological examination; (2) postoperative recovery situations; (3) follow-up. Regular follow-up was conducted by telephone interview or outpatient examinations to understand tumor recurrence and metastasis of patients up to January 2021. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages, Fisher exact probability method was used for comparison between groups. Results:(1) Surgical conditions and postoperative histopathological examination: all patients underwent open operation, including 21 cases of pancreaticoduodenec-tomy, 6 cases of distal pancreatectomy, 2 cases of total pancreatectomy, 1 case of mid-segment preserving pancreatectomy. There were 16 cases combined with portal vein-superior mesenteric vein resection and 3 cases combined with left adrenal resection. For the dissection area of superior mesenteric artery-celiac axis, one cycle was conducted in 5 of 30 patients, one and a quarter cycle in 8 patients, one and a half cycle in 8 patients, one and three quarters?two cycles in 9 patients. There were 16 cases with left gastric vein dissection and 14 cases with left gastric vein preservation. The operative time of 30 patients was 287 minutes (range, 165?495 minutes) and the volume of intraoperative blood loss was 275 mL(range, 50?800 mL). Nine patients received intraoperative transfusion of red blood cells or frozen plasma. Postoperative histopathological examination showed that the tumor diameter was 3.4 cm (range, 1.2?7.3 cm), the number of harvested lymph nodes was 20 (range, 9?35), the number of positive lymph nodes was 2 (0?19). Of the 30 patients,20 cases had moderately differentiated tumor and 10 cases had poorly differentiated tumor. R 0 resection was achieved in 9 patients, 1 mm R 1 resection in 17 patients, and R 1 resection in 4 patients. Postoperative pathological T stages: 3 of 30 patents were in stage T1, 18 cases were in stage T2, 5 cases were in stage T3, and 4 cases were in stage T4. Postoperative pathological N stages: 9 of 30 patents were in stage N0, 13 cases were in stage N1, and 8 cases were in stage N2. Postoperative pathological TNM stages: 2 of 30 patents were in stage Ⅰa, 2 cases were in stage Ⅰb, 3 case were in stage Ⅱa, 11 cases were in stage Ⅱb, 12 cases were in stage Ⅲ. (2) Postoperative recovery situations: 20 of 30 patients had postoperative complications, including 6 cases of Clavien-Dindo grade I complications, 9 cases of grade Ⅱ complications, 3 cases of grade Ⅲa complications, 2 cases of grade V complications. The incidence of postoperative diarrhea was 0 in cases with one cycle dissection of tissues around superior mesenteric artery-celiac axis, 1/8 in cases with one and a quarter cycle dissection, 4/8 in cases with one and a half cycle dissection, 9/9 in cases in with one and three quarters-two cycles dissection, showing a significant difference between the four groups ( P<0.05). The incidence of delayed gastric emptying was 5/16 in patients with left gastric vein dissection, versus 1/14 in patients with left gastric vein preservation, showing no significant difference between the two groups ( P>0.05). Nineteen of 30 patients received adjuvant chemotherapy.Twenty-eight of 30 patients were successfully discharged from hospital, with the duration of postoperative hospital stay of 15 days(range, 8?68 days) and the rest of 2 patients died. Three patients had unplanned readmission within postoperative 90 days. (3) Follow-up: all the 28 patients discharged from hospital were followed up for 1.0?9.0 months, with the median follow-up time of 6.5 months. During the follow-up, one patient with locally advanced pancreatic cancer had local recurrence, 9 patients had liver metastasis (including 4 cases with resectable pancreatic cancer, 4 cases with borderline resectable pancreatic cancer, 1 case with borderline resectable pancreatic cancer), and 1 patient with borderline resectable pancreatic cancer had peritoneal metastasis. The rest of 17 patients survived without tumor recurrence. Conclusions:TRIANGLE operation in the radical resection of pancreatic cancer has high radicality and low postoperative local recurrence, but a slightly high morbidity and mortality rate. Its long-term efficacy needs to be further evaluated. It is recommend that this procedure should be performed for selected patients after neoadjuvant chemotherapy in high-volume pancreatic surgery centers.
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Pain control is one of the primary objectives in the treatment for chronic pancreatitis (CP). More and more evidence clearly shows that early surgery is superior to endoscope-surgery step-up strategy in pain control, and how to accelerate the translation of high-level evidence into clinical practice will be the next initiative. Meanwhile, how to establish the diagnosis for early CP and prediction model(s) for the effectiveness of endoscopic treatment in CP are two related key directions for future research. Multidiscipline cooperation is an important component in CP treatment, and will be an important way to promote an individualized, reasonable and precise management for CP.
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Objective@#To evaluate risk factors for delayed gastric emptying(DGE)following pancreaticoduodenectomy(PD).@*Methods@#There were 492 consecutive patients who underwent PD in Pancreas Center, the First Affiliated Hospital with Nanjing Medical University between January 2012 and December 2014 were identified from a prospective database.There were 315 male and 177 female patients with a median age of 60.5 years.Univariate and multivariate analyses were performed to investigate the independent risk factors for clinically relevant DGE(CR-DGE).@*Results@#The overall incidence of DGE was 29.5%, with Grade B and C occurring at 4.3% and 5.9%, respectively.In multivariate analysis, pancreatic duct diameter less than 3 mm(OR=1.888, P=0.042), pylorus-preserving pancreaticoduodenectomy(OR=2.627, P=0.005) and clinically relevant postoperative pancreatic fistula(OR=2.740, P=0.007) were independently associated with CR-DGE.Other main complications such as postoperative pancreatic fistula, pyoperitoneum, intraabdominal infection were also associated with the severity of DGE(χ2=21.360, 14.422, 14.378; P=0.011, 0.002, 0.002). DGE patients had a significantly prolonged postoperative length of stay(31(24-41)d vs. 13(11-17)d) and increased medical cost((122 367.5±66 068.3)yuan vs. (78 200.7±27 043.9)yuan)(both P<0.01).@*Conclusions@#Small pancreatic duct, underwent pylorus-preserving pancreaticoduodenectomy and suffered postoperative pancreatic fistula might indicate a high risk of CR-DGE.
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Radical resection remains essential for prolonging survival and increasing the possibility of cure in pancreatic cancer.However,few patients are resectable at the time of diagnosis,with a portion of patients presenting with portal and superior mesenteric vein invasion and regarded as resectable or locally advanced disease.Venous resection in pancreatectomy enables achievement of tumor-free margins in patients with venous invasion.This review provides an overview of preoperative evaluation,resection and reconstruction types,vascular grafts selection,morbidity,mortality and survival in radical pancreatectomy with portal and superior mesenteric vein resection.
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Objective@#To explore the clinical effect of a novel artery first and uncinate process first approach for laparoscopic pancreaticoduodenectomy(LPD), emphasizing the left lateral and posterior dissection of uncinate process (UP) via Treitz ligament approach.@*Methods@#From April to November 2016, 18 patients received LPD with a novel approach in Pancreas Center of the First Affiliated Hospital with Nanjing Medical University. All patients were diagnosed as pancreatic head or peri-ampulla tumor, without major vessel invasion nor distant metastasis. For resection, routine caudal view was used in the first step, to dissect the anterior medial border between uncinate process and superior mesenteric vein(SMV). Lymphatic tissues were completely dissected form anterior surface of hepatoduodenal ligament. In the second step, left lateral view with camera from left para-umbilical trocar was used, Treitz ligament was incised, SMA root was exposed. After anticlockwise rotation and retraction of mesentery, the anatomic relationship between SMA trunk, inferior pancreaticoduodenal artery(IPDA), jejunal branch of SMV, and distal part of UP, could be perfectly exposed from left lateral view. SMA was dissected from its root until the position above the uncinate process and duodenum, IPDA was transected, distal part of UP was freed from SMA. In the third step, right lateral view and caudal view were alternatively used; proximal UP mesentery was completely dissected out from SMA root, CA root and posterior surface of hepatoduodenal ligament. Pancreaticoduodenectomy was completed in the forth step after transection of pancreatic neck and common hepatic duct.@*Results@#The SMA root and distal UP were successfully dissected out via Treitz ligament approach in all 18 patients, among them, distal UP was completely excised in 8 patients from left view. Postoperative pathology showed R0 resection rate in 69%. Postoperative complication included intra-abdominal hemorrhage in 1 patient, pancreatic fistula in 7 patients(6 cases with grade A and 1 case with grade B), delayed gastric emptying in 4 patients (2 cases with grade A, 2 cases with grade B). Average postoperative hospital stay was (15.5±6.8)days.@*Conclusion@#The novel artery first and uncinate process first approach through Treitz ligament could help surgeons to completely dissect the full length of meso-pancreas along celiac axis-SMA axis in LPD.
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Locally advanced pancreatic cancer often invades the surrounding blood vessels. Currently, pancreatectomy combined with venous resection for the treatment of patients with venous involvement is accepted worldwide, but pancreatectomy combined with arterial resection for arterial involvement is still controversial. With reference to the latest research advances at home and abroad and the experience in our center, this article investigates the value of arterial resection in pancreatic cancer surgery, in order to provide a reference for clinical studies.
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Pancreatic neuroendocrine neoplasmas (PNENs) are classified into functioning & non-functioning tumors. The radical surgery is the only effective way for the cure & long-term survival. For the locoregional resectable tumors, the surgical resection is the first choice of treatment; the surgical procedures include local resection (enucleation) and standard resection. For the insulinomas and non-functioning tumors less than 2 cm, local resection (enucleation),distal pancreatectomy with spleen-preservation or segmental pancreatectomy are the commonly selected procedures. The radical resections with regional lymph nodes dissection, including pancreaticoduodenectomy, distal pancreatectomy and middle segmental pancreatectomy, should be applied for tumors more than 2 cm or malignant ones. For the locoregional advanced or unresectable functioning tumors, debulking surgery should be performed and more than 90% of the lesions including primary and metastatic tumors should be removed; for the non-functioning tumors, if complicated with biliary & digestive tract obstruction or hemorrhage, the primary tumors should be resected. The liver is the most frequent site of metastases for PNENs and three types of metastases are defined. For typeⅠmetastasis, patients are recommended for surgery if there are no contraindications; For type II metastasis, debulking surgery should be applied and at least 90% of metastatic lesions should be resected, and for patients with primary tumors removed and no extrahepatic metastases, or for patients with well-differentiated (G1/G2) tumors, liver transplantation may be indicated. For the unresectable type Ⅲ metastasis, multiple adjuvant therapies should be chosen.
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Humans , Lymph Node Excision , Neoplasm Metastasis , Neuroendocrine Tumors , General Surgery , Pancreatectomy , Pancreatic Neoplasms , General SurgeryABSTRACT
Objective To investigate the diagnosis and surgical management of adult choledochal cyst.Methods The clinical data of 58 adult patients with congenital choledochal cyst who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 1997 to December 2010 were retrospectively analyzed.All patients were diangosed by the B ultrasonography,computed tomography (CT),Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Surgical procedures were selected according to the diagnosis and Todani classification.All data were analyzed using the t test or chi-square test.Results The accurate rates of B sonography,CT,MRCP and ERCP were 78％ (45/58),92％ (23/25),9/9 and 5/5,respectively.Forty-one patients underwent complete excision of the cyst + hepaticojejunostomy (2 patients were converted from laparotomy due to abdominal adhesions),2 underwent resection of the cyst and involed hepatic segments + hepaticojejunostomy,8 underwent laparoscopic excision of the cyst + hepaticojejunostomy,1 underwent left hemihepatectomy,3 underwent pancreaticoduodenectomy ( including partial hepatectomy in 1 patient),2 underwent common bile duct exploration + cholecystectomy due to acute obstructive suppurative cholangitis,1 underwent external drainage of choledochal cyst due to advanced malignance.The mean operation time and postoperative duration of hospital stay of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were (235 ± 70) minutes,(320 ± 50) minutes,and ( 10.0 ± 2.3 ) days,( 12.6 ±6.6) days,respectively,with significant differences between the 2 groups (t =3.157,2.162,P ＜ 0.05).The postoperative morbidities of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were 18％ (7/39) and 3/8,respectively,with no significant difference (x2 =1.515,P ＞ 0.05 ).Canceration of the choledochal cyst was observed in 6 patients( 10％ ).No perioperative mortality was observed,and the operative complication rate was 24％ (14/58).The duration of the follow up ranged from 1 to 15 years,no severe long-term complications were observed in patients with benign lesions.Four of the 6 patients with malignancy died in 1 year after operation,the other 2 patients survived for 3 years and 5 years,respectively.Conclusions Abdominal B ultrasonography should be the first choice for diagnosing adult congenital choledochal cyst,while MRCP is the gold standard.Surgical intervention should be timely considered once diagnosed. Complete excision of the cyst combined with Roux-en-Y hepaticojejunostomy is the first choice of treatment.
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Objective To describe a novel technical modification of the uncinate process first approach with a retrograde dissection of the pancreatic head.Methods The authors described the surgical technique,and reported their preliminary experience.The surgical data,postoperative outcomes and pathological results of patients who were submitted to PD/PP PD (20 patients) and TP (3 patients) for pancreatic neoplasm using “the uncinate process first” technique between December 2010and May 2011 were reviewed.Retrograde resection of the pancreatic head was performed starting with the uncinate process after division of the first jejunal loop.The transection of the pancreas was the last operative step of the resection.The technical aspects and possible advantages of this procedure were discussed.Results The authors used this technique successfully in 23 patients.In 3 patients with a replaced or accessory RHA,the arteries were all successfully preserved.In another patient with a replaced HCA,the artery was also successfully preserved.In 1 patient with adenocarcinoma which involved the SMV,en-bloc vascular resection was carried out.Additionally,the authors used this technique on 3 patients with IPMN-2 and SPPN-1 to carry out total pancreatectomy.The uncinate process first was performed on 23 patients without any intraoperative and postoperative complication and massive bleeding.No patient required blood transfusion.The surgical margins,including retroperitoneal marginswere negative.Conclusions The “uncinate process first” approach can be used as an alternative approach in modern pancreatic surgery.Further studies are required to evaluate this procedure regarding operative parameters and postoperative outcomes when compared with the standard resectional procedure.
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ObjectiveTo investigate the value of uncinate process first for pancreaticoduodenectomy (PD).MethodsThe clinical data of 19 patients admitted from December 2010 to March 2011,who underwent uncinate process first for PD were studied.ResultsAmong the 19 patients,there were 5 cases of periampullary adenocarcinoma,11 cases of pancreatic cancer,1 case of duodenum aggressive fibromatosis,1 case of main pancreatic duct type IPMN,1 case of SPN.During operation,3 patients (21％) were found to have abnormal or aberrant right hepatic artery.Among the 11 patients with pancreatic cancer,there are Peripancreatic lymph node(3 ～7) metastasis,in 7 cases,and nerve invasion occurred in 8 cases.All the N16 lymph nodes,pancreatic stump,bile duct margin,duodenum and retroperitoneal margin were negative,and all the cases were subjected to R0 resection.The median time for the portal vein blocking was 16 minutes.The average operation time was 4h and there was no major bleeding occurred,and the mean blood loss was 600 ml.No intractable diarrhea occurred post-operatively. Conclusions Uncinate process first for PD offers a comfortable,safe,accurate and controllable method to resect pancreatic head.
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Objective To investigate the clinical features, diagnosis and treatment of malignant pancreatic endocrine tumor. Methods The clinical data of 38 patients with malignant pancreatic endocrine tumor who had been admitted to First Affiliated Hospital of Nanjing Medical University from January 1969 to December 2008 were analyzed retrospectively. Of all patients, 6 were with insulinoma, 23 with pancreatic polypeptide tumor, 4 with glucagonoma and 5 with pancreatic carcinoid. Results All patients except 1 with insulinoma were found with pancreatic lesion by imaging examination. The resection rate was 87% (33/38). Pathological examination found 7 patients with liver metastasis, 5 with lymph node metastasis, 1 with tumor thrombus in vessels and lymphatic vessels, and 28 with local invasion. Twenty-four patients were followed up, and neither recurrence nor metastasis was found except 1 patient with insulinoma who received reoperation for local recurrence and 1 patient with pancreatic carcinoid who received radiofrequency ablation for liver metastasis. Conclusions The diagnosis of pancreatic endocrine tumor mainly depends on imaging examination. The malignancy of pancreatic endocrine tumor is determined after the comprehensive analysis of preoperative imaging findings, intraoperative examination, post-operative pathological examination and the data obtained during follow-up. The malignant pancreatic endocrine tumor should be managed actively by resection because of its relatively low malignancy, high operative resectability and relatively good prognosis.
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Objective To summarize the experience in the diagnosis and treatment of solid pseudopapillary tumors of the pancreas. Methods Ten consecutive patients who underwent surgery with pathologically confirmed solid pseudopapillary tumors of the pancreas between October 2005 and December 2008 were retrospectively reviewed. Results All of the 10 patients were female and the median age at diagnosis was 24 years (range, 11 -39 years). Abdominal discomfort or pain were the most common presenting symptoms. 4 patients had palpable abdominal mass at physical examination. The tumors appeared on ultrasonography and/or CT, MRI as solid or cystic masses. The preoperative serum biochemical parameters and tumor markers level were within the normal range. All the patients underwent surgical treatment. The tumors were located in the head/neck (n = 6) or the distal part (n = 4) of the pancreas. The surgical procedures included enucleation (n=3) , distal pancreatectomy (n=3 , two with preservation of the spleen, one combined with splenectomy, distal gastrectomy and partial colectomy) , segmental pancreatectomy with pancreaticojejunostomy (n=3) and pancreaticoduodenectomy (n = 1). Pancreatic fistula (n = 2) was observed postoperatively and resolved with conservative treatment. The median resected tumor size was 5. 9 cm. All patients were alive and remained recurrence and metastasis free after a median followk-up of 19. 2 months (range, 8～42 months). Conclusions Solid pseudopapillary tumor of the pancreas was rare neoplasm occurred predominantly in young women with low malignant potential. Aggressive resection should be attempted and could result in excellent prognosis.
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Objective To investigate the therapeutic effect of ehlorpromazine in rats with acute necrotizing pancreatitis (ANP). Methods 120 healthy female SD rats were randomly divided into three groups: normal control group (NC group, n=30); acute necrotizing pancreatitis group (ANP group, n=45) and chlorpromazine treatment group (CPZ group, n=45). ANP was induced by the injection of 5% sodium taurocholate (1 ml/kg) into pancreatic duct, NC group were injected with same amount of saline. 0.4% chlorpromazine (0.25 ml/100 g) was intraperitoneally administered in CPZ group at 0 h, 24 h, 48 h after ANP was established. Same amount of normal saline was given to ANP group and NC group in the same way and at the same time points. The rats were sacrificed at 24, 48, 72 h after ANP was induced. The blood samples were collected for analysis of serum amylase (AMY), phospholipase A2 (PLA2), interleukin-6 (IL-6). Pancreas was harvested for evaluation of pathologic changes. Results The pathologic changes in ANP group were compatible with pathologic changes of ANP. The pathologic scores in CPZ group was 3.57±0.73 at 72 hours after ANP induced, which was significantly lower than 13.29±1.03 in ANP group. The serum amylase and PLA2 levels in CPZ group at 72 hours after ANP induced were (1658.0±277.0) U/L and ( 12.26±1.40) ng/ml respectively, the corresponding values of ANP group were (3666.7±1233.0) U/L and (16.81±1.13)ng/ml, respectively. The difference was statistically significantly (P＜0.01). The serum IL-6 levels of CPZ group at 24,48 72 hours were (116.27±14.49) pg/ml, (75.35±6.17) pg/ml, (82.75± 8.86) pg/ml respectively, the corresponding values of CPZ group were (160.88±27.19) pg/ml, (111.77± 19.10)pg/ml, (125.51±30.71) pg/ml respectively. There was a significant difference between the two groups (P＜0.01). Conclusions Chlorpromazine may have a therapeutic effect on ANP.
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Objective:To study the expression and clinical significance of neuron-specific enolase,chromogranin and synaptophysin in islet cell tumors.Methods:Twenty-one paraffin-embedded specimens with islet tumors and 3 cases cholangiocarcinoma and tissue nearby the tumor were recruited from Jan 1988 to Jun 2001.The S-P method was used for the detection of chromogranin,synaptophysin and neuron-specific enolase.Results:There were positive expressions of neuron-specific enolase,chromogranin and synaptophysin in 19,15 and 18 cases respectively,while negative results were observed in 3 cases of cholangiocarcinoma and the para-cancer tissue.Conclusion:CG,SYN and NSE may be specific tumor markers of islet cell tumors and combined detection can help to enhance the sensitivity.