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Objective:To analyze the adverse reactions of patients with multidrug-resistant pulmonary tuberculosis treated with linezolid, and to provide reference for clinical rational use of drugs.Methods:A total of 189 patients with multidrug-resistant pulmonary tuberculosis who were admitted to Hunan Chest Hospital between June 2019 and June 2020 were retrospectively included, and were divided into the linezolid group and the control group. The control group was given a standardized anti-tuberculosis treatment without linezolid, and the linezolid group was given linezolid in addition to standardized regimens. The occurrences of hematological toxicity, peripheral neuritis, optic neuritis and other adverse reactions in the two groups after anti-tuberculosis treatment were recorded. The risk factors for adverse reactions of linezolid were analyzed. Statistical analysis was performed using independent samples t test and chi-square test, and logistic regression was used to analyze the risk factors for adverse reactions of linezolid. Results:A total of 189 patients with MDR-TB were included in this study, including 108 in the linezolid group and 81 in the control group. There were no significant differences in baseline characteristics between the linezolid and control groups. The frequencies of leukopenia, anemia, thrombocytopenia, peripheral neuritis and optic neuritis in the linezolid group were 20.4%(22/108), 47.2%(51/108), 21.3%(23/108), 20.4%(22/108) and 13.9%(15/108), respectively, which were all significantly higher than those in the control group (8.6%(7/81), 27.2%(22/81), 9.9%(8/81), 1.2%(1/81) and 4.9%(4/81), respectively), and the differences were all statistically significant ( χ2=4.90, 7.86, 4.40, 15.86 and 4.10, respectively, all P<0.050). Patients older than 45 years of age was independent risk factor for leukopenia (odds ratio ( OR)=3.08, 95% confidence interval ( CI) 1.03 to 9.25, P<0.050) and thrombocytopenia ( OR=2.41, 95% CI 1.09 to 5.35, P<0.050) after linezolid administration. The higher value of white blood cell at baseline ( OR=0.48, 95% CI 0.30 to 0.76, P=0.002) was an independent protective factor for leukopenia associated with linezolid. Conclusions:Pancytopenia, peripheral neuritis and optic neuritis are prone to appear when linezolid is used to treat patients with multidrug-resistant pulmonary tuberculosis. In clinical practice, closely monitoring the adverse reactions during the use of linezolid for anti-tuberculosis treatment is needed.
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ObjectivesTo investigate the effects of 5-aza-2-deoxycytidine(5-Aza-dC),a methylation inhibitor,on the expression and methylation of tissue factor pathway Inhibitor (TFPI-2) gene in PANC1 cell line of pancreatic cancer.MethodsPANC1 cell lines were treated with different dosages of 5-Aza-dC ( 1× 10-7,5 × 10-7,1× 10 -6 mol/L).The status of TFPI-2 methylafion and expressions of TFPI-2 mRNA and protein were determined by MSP,RT-PCR,and Western blot.Results TFPI-2 gene CpG island was completely methylated,and there was no expression of TFPI-2 mRNA and protein without 5-Aza-dC treatment.After treatment with different dosages of 5-Aza-dC( 1 × 10-7,5 × 10 -7,1 × 10-6 mol/L),TFPI-2 gene CpG hypermethylation was reversed from incomplete methylated to complete non-methylated.The relative expressions of TFPI-2 mRNA were 0.211± 0.087,O.327 ± 0.068,0.609 ± 0.017; and the relative expressions of TFPI-2 protein were O.429 ± O.121,O.675 ± O.044,1.132 ± O.124 in a dose-dependent manner ( P ＜0.05 ).ConclusionsThe hypermethylatien of promoter region may be the primary reason for TFPI-2 gene expression down-rogtdation and inactivation.5-Aza-dC may reverse the hypermethylation of TFPI-2 gene,and induce the m-expression of TFPI-2 mRNA and protein.
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Objective To investigate effects of 5-aza-2'-deoxycytidine(5-Aza-dC)and trichostatin A(TSA)on the methylation and expression of TFPI-2 gene in pancreatic cancer Panc-1 cells.Methods We treated pancreatic cancer Panc-1 cells with 5-Aza-dC and TSA alone or combined.TFPI 2 gene's DNA,mRNA and protein were determined by MSP,RT-PCR and Western blot.Results The hypermethylation of TFPI-2 gene in Panc-1 cells was reversed after treated with 5 Aza-dC alone or in combination with TSA.The re-introduction or raised expression of TFPI-2 mRNA and protein was detected in Panc-1 cells after treated with 5 Aza dC alone or in combination.However,we did not see the hypermethylation of TFPI 2 gene reversed nor detected TFPI 2 gene mRNA and protein after treated with TSA alone.Conclusions The methylation of the promoter region for the TFPI-2 gene is a main cause for its transcriptional activation in Panc-1 cells.The hypermethylation of TFPI-2 gene in Panc-1 cell was reversed and the expression of TFPI-2 gene mRNA and protein was detected after trea ted with 5-Aza-dC alone or in combination with TSA.Treatment of TSA alone does not have significant effect on TFPI-2 gene reexpression.
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ObjectiveTo explore the histopathological changes of bile duct,liver and local tissue for injurious biliary stricture(IBS). MethodTo observe the morphological and pathological changes of bile duct, local tissue and liver in different periods with dogs as the established animal model for IBS. ResultBile duct obstruction due to injury can expand the proximal bile duct up to 18.91 ±1.85 mm as the pressure goes up. Damage to local tissue triggers acute inflammation. In early injury phase (within 10 d), inflammatory cell infiltration and proliferation appears on the wall of the duct with increased mucosal edema as well as thickening of the biliary ductile wall. In the late injury phase (15 d), the degree of infiltration of inflammatory cells, edema and mucosal thickness were reduced whereas fibroblast and collagen tissue were proliferated extensively. The wall of biliary duct also becomes fibrotic and thickens. Quantitative analysis of the inflammatory edema shows the most severe outcome on the 5th day (HE staining WBC count of 54.2±5.8 unit) and its severity progressively subsides on the 15th day. (HE staining WBC count of 41.7±7.2 vs 54.2±5.8 a, P＜0.0,5). In the early obstruction (5 d and 10 d), the liver cells showed mild to moderate swelling and its degeneration is often associated with steatosis and sinusoidal expansion and congestion. As the obstruction time increases in the 20 d and 30 d group, liver cells starts to show extensive vacuolation and sinusoidal occlusion. ConclusionsEarly phase (5 days) of acute bile duct obstruction due to injury shows rapid expansion of the bile duct, edema in the bile duct itself as well as its surrounding tissue and liver damage. After 15 days, the local inflammatory edema is greatly reduced and is replaced by hyperplasia of fibers and collagen. Liver damage appears to be irreversible after 20 days. Considering local environmental and systemic conditions, the optimal time frame to repair obstruction of bile duct surgically is between 10-20 days.
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Objective To discuss the method of the surgical treatment for retained and regenerate hepaticolithiasis, and to improve the theraputic level. Methods In recent 5 years,in our hospital,136 cases of retained and regenerate hepaticolithiasis were treated by combination of hepatolobectomy with other operation, and these cases were analyzed retrospectivly. Results One patient died after operation (0. 7%),8 patients had other complications including: biliary fistuta(6 cases, 4.4%), subphrenic abscess (2 cases,1.5%). All cases were visited for 2.5 - 8.3 years, 115 (84.6%) cases had not any symptom, 6 (4.4%)cases had infection of biliary tract, 6(4.4%) cases had retained calculus, 9(6.6%) cases recurred calculus 2 -5 years after operation. Conclusion Retained and regenerate hepaticolithiasis should be treated by combination of hepatolobectomy with other operation and fiber choledochoscope and B ultrasound of operation, which can increase therapeutic effect.
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Objective To observe the pathological changes of tissues of the injured bile duct, and to provide theoretical basis for bile duct repair. Methods Dog models of obstructive biliary injury were established.Sixty dogs were equally divided into five groups according to the duration of biliary obstruction: biliary obstruction for 5 days (BDL5 group), 10 days (BDL10 group), 15 days (BDL15 group), 20 days (BDL20 group) and 30 days (BDL30 group). The morphological and pathological changes of bile duct and local tissues were observed, and biliary-enteric Roux-en-Y anastomosis was applied to repair the injured bile duct and postoperative complications were observed. All data were analyzed by LSD test, independent sample t test, one-way analysis of variance and chi-square test. Results Proximal bile duct rapidly expanded as the pressure increased in the early stage, and the bile duct expanded to ( 15.6 ± 1.8)mm in the BDL10 group. The expansion rate decreased in the later stage,and the bile duct expanded to (18.9 ± 1.9)mm in the B DL15 group. Acute inflammation was observed in injured local tissues. The acute inflammation was severe in the BDL5 group with white blood cell count of 54 ± 6, and the acute inflammation was relatively mild in the BDL15 group with white blood cell count of 42 ± 7. There was a significant difference between the BDL5 group and BDL15 group in the degree of acute inflammation (t =4. 688,P ＜ 0. 05). The content of the collagen was increased in the injured bile duct as time passed by. Bile duct repair was successfully performed on 57 dogs. Ten dogs ( three in the BDL5 group, four in the BDL10 group, one in the BDL15 group, one in the BDL20 group and one in the BDL30 group) died of bile leakage after the operation. The incidences of bile leakage was 30% (7/23) within 10 days and 9% (3/34) beyond 10 days, with a significant difference between the two groups (x2 =4.429, P＜0.05). Conclusion Ten days after obstructive biliary injury,an obvious reduction of bile duct expansion and edema of the bile duct is observed, the difficulty of the operation is reduced and the incidence of bile leakage is low, so 10 days after the incidence of obstructive biliary injury is the proper timing for the surgical repair.
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Objective To explore the optimal timing of operation for experimental obstructive jaundice in a dog model. Method A dog model of bile duct stricture (BDS) was established. Dogs were divided into (n = 12 in each group) 6 groups, ie control, BDS days 5, 10, 15, 20, and 30. In each dog,the morphology and local histopathology of the bile duct, and the liver function in different periods were observed. At the time of surgery biopsy was taken and Roux-en-Y hepaticojejunostomy performed. Surgical complications and survival were evaluated. Result After bile duct obstruction, the proximal bile duct dilated continuously. The diameter of bile duct was 15.6 ± 1.7 mm at the 10th day. The injury bile ductshowed the acute inflammation change. In the early time (in 10 days), inflammatory cells increased in the tissues, mucous edema aggravated, the wall was edematous thickening, it was most severe ( WBC counting 54 ±6) in the 5th day. In the later period (10 -30 days), inflammatory cells reduced, bile duct wall became fibrosis, which was most obvious in the 15th day (42 ± 7 vs 54 ± 6, P ＜ 0.05 ). During the development of jaundice, serum bilirubin reached the highest level in the early period ( BDS days 5 group),then presented a platform time, and then rised extremely at the last stage of the experiment ( BDS day 30 group) . Changes of ALT and AST paralleled that of bilirubin before the 20th day of obstruction and then plummeted. BDS was repaired successfully in 57 dogs. Ten dogs died postoperatively due to bile leakage within 10 days, 3 dogs in BDS days 5 group (3/11), 4 in BDS days 10 group (4/12), one each in other groups. Postoperatively 13 BDS dogs died of malnutrition and organ failure within 3 months, including one each in days 5 and days 10 group, two each in days 15 and days 20 group, and 7 in days 30 group (P＜0. 05). Conclusion Considering the changes of morphology, physical function and result of follow up.The period between 10 and 20 days after acute bile duct injury is optimal for surgical repair.
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Autoimmune pancreatitis is a chronic autoimmune-related pancreatitis.It is characterized by a high globulin, IgG~4 increased, anti-carbonic anhydrase antibody and anti-lactoferrin antibodies exist, diffuse swelling of the pancreas, a significant lymphocyte infiltration accompanied by fibrosis, multiple clinical manifestations , and sensitive to the hormone treatment.
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Objectives To evaluate the effect of probiotics enteral nutrition therapy on the inflammatory reaction and immune function in acute necrotizing pancreatits(ANP)in rats.Methods 100 SD rats were divided randomly into control group(C group,n=20),ANP gruop,enteral nutrition group (EN group,n=20),probiotics group(P group,n=20)and enteral nutrition plus probiotics group(PEN group,n=20),ANP were induced by retrograde injection of 5% sodium tautocholate(1.5ml/kg)into the biliary and pancreatic duct.The nasojejunal tube was placed via gastric route.The rats were sacrificed at 12h,24h,48h and 72h after ANP modeling.Serum MIF and amylase levels,as well as CD_3~+,CD_4~+,CD_8~+were measured and MIF was determined by immunohistochemistry and the histopathological changes in pancreatic tissue were observed.Results Serum MIF and amvlase levels were all increase when compared with that in C group.72h after ANP modeling,srum MIF leves in EN,P,PEN groups were(117.59±1.86)μg/L,(108.39±1.99) μg/L and (95.33±1.96) μg/L,respectivdy;serum amylase levels were (2799±161)U/L,(2482±140)U/L and (2146±572 )U/L,respectively;the values in P and PEN groups were significantly lower than that of EN group(P＜0.05),the values in PEN groups were significantly lower than that of P group (P＜0.05 ).After ANP induction,CD_4~+/CD_8~+ values in EN,P and PEN groups were 0.93±0.12,1.31±0.13,1.51±0.10,respectively;the values in P and PEN groups were significantly higher than that of EN group(P＜0.05 ),the values in PEN groups were significantly higher than that of P group (P＜0.05 ).MIF positive rates in C,ANP,EN,P and PEN group were 45%,96%,95%,65% and 60% ,respectively;the values in P and PEN groups were significantly lower than those of ANP and EN group (P＜0.05 ).At 72 h,the damage of pancreatic tissue was more severe in EN and P groups than that in PEN group.Conclusions Probioties enteral nutrition could effectively regulate inflammation mediator and cytokines in rats with ANP,and enhance immune function.
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Objective To study the residual gallbladder stones and the relationship between the onset of acute pancreatitis and its surgical treatment.Methods Retrospective analysis was made in 13 patients with residual gallbladder admitted tO the hospital from June 1998 to December 2007,of which 8 cases of residual gallbladder stones and acute pancreatitis were invostigated.Thirteen cases of patients had underovent cholecystectomy 2 to 9 years before,the first symptoms occurred before 1 month to 8 years.Other remnants of the gallbladder were diagnosed by B-ultrasound and CT,magnetic resonance cholangiopancreatography (MRCP).Results Two cases were confirmedas pigment stones;6 cases as cholesterol stones(size0.2 cm ～0.5 cm,an average of 3.2 cm);1 cases as anonlalous pancre-aticobiliary junction(anomalous pancreaticobiliary ductal union,APBDU);5 cases as anomal;8 cases(61.5%)as episode of acute pancreatitis.Au patients underwent resection of residual gallbladder,with line choledochal cyst excision and biliary-enteric Roux-en-Y internal drainage in 1 case.choledocholithotomy T-tube drainage in 3 cases.Postoperative follow-up of residual gallstone was done in 8 cases,no pancreatitis attack in 6 cases,pancreatitis attack in 2 cases.Significant difference was found in onset of acute pancreatitis (P=0.019,P<0.05).Five patients without stones in patients with postoperative all none pancreatitis attack.Conclusion Patients with residual gallbladder stones are prone to acute pancreatitis,and cholecystectomy for patients with residual treatment Can reduce the pancreatitis attack.
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Objective To investigate the effect of diabetes on hyperlipidemic acute panereatitis. Methods The clinical data of 96 patients with hyperlipidemic acute pancreatitis from Jun 1996 to Jun 2006 were retrospectively reviewed. Results Of all 96 patients, 21.9% (21/96) suffered from severe acute pancreatitis ( SAP ), 78. 1% ( 75/96 ) suffered from mild acute pancreatitis ( MAP ), respectively. Twenty-four patients (25%) were diabetics. Triglyceride level, obesity rate, SAP cases and APACHE Ⅱ scores in patients with diabetes were significantly higher than those of no-diabetes patients( P < 0. 05 ). The glucose level, diabetes of history length, triglyceride level and fat were the independent factors for prognosis of acute pancreatitis with hyperlipidemia by the Cox model analysis. With the increasing of APACHE Ⅱ score, the blood glucose level of patients increased. Blood glucose level in a short period of time does not correlate with lipid levels. Conclusions The level of blood glucose is related with hyperlipidemic acute pancreatitis, the history of the diabetes to a certain extent influences the development of hyperlipidemic acute pancreatitis.
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Hypcrlipidemia is one of etiological factors of pancreatitis,of which the genesis has somewhat speci ficity.This article reviews hyperlipidemia related pancreatitis about its conception,etiology,classification,pathogene sis.specific clinical manifestation as well as diagnosis and treatment.
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Objective To investigate the effects of Ulinastatin (UTI) on the expression of NF-κB and ET-1 in rats with acute necrotizing pancreatitis (ANP)-associated lung injury and morphology of lung tissue.Methods 60 Sprague-Dawley rats were randomly divided into 3 groups with 20 rats in each group,including sham operation (SO) group,ANP group and UTI group.ANP was induced by injection of 5% sodium taurocholate (1 ml/kg) into pancreatic duct;normal saline was injected for SO group with same amount.UTI was injected for UTI group with the amount of 10 000 U/L via tail vein after ANP induction.The rats were sacrificed 24 h later.The contents of serum amylase,TNF-α and wet/dry weight ratio of the lung were measured.The expression of NF-κB and ET-I protein were detected by immunohistochemical method.The level of apoptosis was detected by TUNEL Results The contents of serum amylase,TNF-α,and wet/dry weight ratio of the lungin in UTI group at 24 hours were (5 648±378)IU/L,( 89.19±3.54) ng/L and 4.55 ±0.07,respectively;which were significantly lower than the corresponding (6 799±437 )IU/L,(183.30±8.18) ng/L and 4.89±0.20 in ANP group (P＜0.05 ).There was no NF-κB and ET-1 expression,and no apoptosis was present in SO group.The positive rates of NF-κB and ET-1 in UTI group were (19±3 ) % and(8±1) %,respectively,the corresponding values in ANP group were (25±2) % and (13±1 ) %,respectively (P ＜ 0.05 ).The level of apoptotie index in UTI group was 13.75±1.25,which was higher than that (6.90±0,85) in ANP group ( P ＜ 0.05 ).Conclusions The high expression of NF-κB and ET-1 in lung tissue may cause lung injury.UTI could ameliorate the microcirculation and lung injury caused by inflammation.
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Background and purpose: TFPI-2 is a new serine proteinase inhibitor,it is related to many tumors.In this study,the effect of TFPI-2 gene on cell proliferation and apoptosis of human pancreatic cancer cell line Panc-1 were investigated.Methods:The growth curve was drawn for the 3 groups,Panc-1-TFPI-2、Panc-1-V and Panc-1.DNA strand breaks were used to detect the apoptosis of the 3 groups,and the change of cell cycle and apoptosis index was evaluated by flow cytometry.Results:Compared with nontransfected cells,the growth of Panc-1 cell transfected with TFPI-2 was inhibited significantly.The transfected cells showed a significant increase in G1/G0 phase.The apoptosis of Panc-1-TFPI-2 cell could be identified by DNA strand breaks and flow cytometry in comparison with the control group.The apoptosis index of the Panc-1-TFPI-2 cell(6.9?0.5)% was higher than the group Panc-1-V and group Panc-1[(3.0?0.4)% and(3.5?0.4)%]P
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Objective To investigate the invasion ability of Panc-1 cells in vivo and in vitro after being transfected with tissue factor pathway inhibitor 2 gene(TFPI-2).Methods The expression vector pEGFP-C1-TFPI-2 was transfected into human pancreatic cancer line Panc-1 cells by using liposome.TFPI-2 mRNA and protein of transfected and nontransfected cells were detected by reverse transcription-polymerase chain reaction(RT-PCR)and Western blot respectively.The tumor cells invasive behavior of transfected(Panc-1-TFPI-2)and nontransfected(Panc-1-V and Panc-1-P)cells were assessed in vitro through Boyden Chamber method.The transfected and nontransfected cells were implanted into nude mice to observe its growth and metastasis in vivo.Results Expressions of mRNA and protein of TFPI-2 were confirmed in transfected cells.After TFPI-2 transfection,the number of Panc-1-TFPI-2,Panc-1-V and Panc-1-P cells passing through membrane of Boyden Chamber were 24.4?3.5,61.3?4.1 and 60.2?3.9,respectively.The number of TFPI-2-expressing cells to traverse a Matrigel-coated membrane was obviously decreased compared with that of non-expressing cells,the invasion ability was lower than that before transfection in vitro.The subcutaneous tumor volume of the Panc-1-TFPI-2 group was(438.0?69.8)mm3,the Panc-1-V group was(852.0?102.9)mm3 and the Panc-1-P group was(831.0?78.1)mm3,P
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Objective To investigate the possibility of DCs transfected with CTLA4Ig cDNA by retrovirus vector to induce antigen specific hyporesponsiveness.Methods The modified DCs(CTLA4Ig-DCs) were prepared by transferring the DCs from cultured rat BM cells with the constructed retro-virus CTLA4Ig vector.The CTLA4Ig gene expression was detected on the prepared DCs by RT-PCR and Dot-ELISA methods.The influence of the modified DCs on mixed lymphocyte reaction(MLR) intensity was determined by T cell proliferation.Results The CTLA4Ig gene could be transferred successfully to DCs by retrovirus vector,which was confirmed by RT-PCR and Dot-ELISA methods.As compared with control group,DCsRev could significantly and antigen-specifically inhibit MLR in vitro in a dose-and time-dependent manner.The number of DCRev from 10~(3) to 10~(4) could reach the maximal inhibition by(69.12 %).On the other hand,the inhibition capacity of DCsRev was increased from(48 h) to 12 h prior to adding stimulating cells and the maximal inhibition was(98.3 %) at(12 h).Analysis of T cell proliferation revealed that donor-specific inhibition could be induced by DCsRev in an ex-vivo model.But this kind of inhibition was not lifetime.Conclusions The CTLA4Ig gene could be transferred successfully to DCs by retrovirus vector.This kind of DCs lost capacity of stimulating MLR,and could inhibit T cell proliferation,which might be responsible for the antigen-specific suppression induced by DCsRev.
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Objective To study the value of various MR imaging techniques in the preoperative diagnosis and preoperative assessment of resectability in patients with hilar cholangiocarcinoma.Methods Seventy-eight (patients) with hilar cholangiocarcinoma were diagnosed by imaging of MRI/MRCP/MRA.Based on imaging (analysis) of the extent of local tumor invasion,vascular involvement,hepatic lobar atrophy and distant (metastasis),a preoperative imaging assessment of resectability was done in 78 patients.This preoperative (assessment) was compared with the surgical and pathological findings,so as to evaluate the imaging value in prediction of whether or not resection was feasible in patiens with hilar cholangiocarcinma.Results Of 21 (patients) with unresectable disease according to imaging evaluation, laparotomy was performed in 10 cases,and in all 10cases the tumor was proven not to be resectable at operation.Thus,the surgical and pathological (findings) were in accordance with the result of imaging.Surgical exploration was performed in 57 patients with potentially resectable disease according to imaging evaluation. In this group, the intra-operative diagnosis of the location and nature of tumor was to be in line with the preoperative assessment of imaging, The (diagnosis) accuracy rate was 100%, and 40 patients underwent resection,the resection rate was 70.2%. Of 40 (patients) with resection,29 patients underwent curative resection,the curative resection rate was (50.9)%;11 patients underwent palliative resection.The other 17 patients were found to have (unresectable) disease at laparotomy,including 3 portal venous involvement,5 hepatic arterial (invasion),7 metastatic disease,2 hepatic parenchymal massive involvement. These diseases were not found in pre-operative imaging evaluation.Conclusions MR multi-imaging techniques have high accuracy in the diagnosis of the location and nature of hilar cholangiocarcinoma,and could evaluate accurately the feasibility of resection in patients with hilar cholangiocarcinoma. The main causes of unresectability lie in metastasis of tumor and local vascular involvement.
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Objective To investigate the reasonable operation timing for patients with acute pancreatitis without obvious infectious manifestation. Methods The findings during the operation and pathological changes in 27 pantients with necrotic pancreatitis were analysed retrospectively.Results Six patients underwent surgical treatment with in 3 weeks. The delimitation between non-necrotic pancreas and necrotic pancreas was not very clear, and the abdominal adhesion and edema were serious. Other 14 cases were subjected to the surgical treatment 3-4 weeks after the onset of illness. The delimitation was clear in 9 cases without obviously infectious signs, but the adhesion of the pancreas bed to the greater omentum or the transverse mesocolon was evident. Various degrees of necrosis was found in 3 cases, and the infection together with pancreatic necrosis developed in the other 2 cases. The rest 7 patients were operated on 5-7 weeks after the disease onset, different degrees of infection and necrosis developed in 3 cases, and local pancreatic abscess formation could be observed.There was a lot of necrosis of fatty tissues on the peri-pancreas and the root of mesentery. Conclusions Clear away of necrotic pancreatic tissue is suitable in 3-4 weeks after the onset of illness in patients with non-infectious necrosis of pancreas.If operation is performed in the initial 3 weeks, intraoperative bleeding may be severe because the detachment between the non-necrotic tissues and necrotic tissues of pancreas was not yet formed completely, which may lead to hard to do the operation and result in increasing intraoperative bleeding and even increasing reoperation .If operation was done after 5 weeks, the infection of the necrotic pancreatic tissues can be seen in most of the cases, and the infection degree in the abdominal cavity may also be serious, which may need more operations to treat.
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Objective To discuss the relationship of congenital choledochus cyst(CCC)with occurrence of pancreatitis in adults and methods of surgical treatment.Methods The clinical data of 17 adult patients with congenital choledochus cyst who underwent surgical treatment from 1997-2005 were analyzed retrospectively.Results Clinical diagnosis was made mainly by B-ultrasound,MRCP,intraoperative cholangiography,ERCP and CT scans.Among 17 cases,10 cases were congenital choledochus cyst typeⅠ,4 cases type Ⅱ,1 case type Ⅲ,1 case type Ⅳ and 1 case type Ⅴ;and associated with cholelithiasis in 14 cases(bile pigment stone in 11cases,cholesterol calculus 3cases),chronic cholecytitis 5 cases,polypoid lesions of gallbladder 1 case,anomalous pancreaticobiliary junction(APBJ)10 cases,and pancreatitis 10 cases.Resection of extrahepatic cyst with Roux-y hepaticojejunostimy was performed in 15 cases,preserving pylorus pancreatoduodinectomy in 1 case,and cholecystectomy and T tube drainage in 1 case.Excellent and good results were achieved on follow-up in 14 out of the 17 CCC cases undergoing surgical treatment,while pancreatitis occurred in 2 cases and unexpected death in 1 case.Conclusions Pancreatitis is apt to occurr in CCC with APBJ and bile pigment stone in choledochus.The incidence of pancreatitis in CCC and APBJ(P-B)can be decreased by resection of extrahepatic cyst and Roux-en-Y hepaticojejunostimy and cholecystectomy.