Annular pancreas in neonate patients Vomiting and weight loss in a 13-day newborn / Pâncreas Anular no período neonatal Vômitos e perda de peso em neonato com 13 dias de vida

Objective: Reinforce that, despite being a rare condition, the annular pancreas must be considered a differential diagnosis for intestinal obstructions in the newborn period. Case description: This case report refers to a 13-days newborn admitted to the emergency room presenting with postprandial vomiting and progressive weight loss since maternity discharge. The patient did not respond to initial interventions that included IV antibiotics and nasogastric tube insertion. A contrast study of the upper digestive tract (esophagus, stomach, and duodenum) found a luminal narrowing on the second duodenal portion. The patient was submitted to an exploratory laparotomy which found a pancreatic-tissue ring involving the second part of the duodenum. Despite rare, we reinforce that the annular pancreas must be considered a differential diagnosis for intestinal obstructions in the newborn period. Comments: Annular pancreas is a rare congenital defect in which a ring of pancreatic tissue encircles the duodenum, causing different degrees of intestinal obstruction. (AU)

Objetivo: Evidenciar que, apesar de condição rara, o pâncreas anular deve se firmar como diagnóstico dife-rencial das obstruções intestinais no período neonatal. Descrição do caso: Este relato aborda o caso de uma paciente de 13 dias de vida admitida no pronto atendimento com queixa de volumosos vômitos pós-prandiais e perda de peso progressiva desde a alta da maternidade. Apesar das medidas iniciais, com ressuscitação volêmica, antibioticoterapia e passagem de sonda nasogástrica para descompressão, a paciente evolui sem melhora. Exame contrastado de esôfago-estômago-duodeno detectou estreitamento luminal da segunda porção duodenal. Paciente submetida à laparotomia exploradora, que evidenciou anel de tecido pancreático estreitando o trânsito intestinal na região. Comentários: O pâncreas anular é uma anomalia congênita rara na qual um anel de tecido pancreático envolve a porção descendente do duodeno, causando graus variados de obstrução intestinal extrínseca. (AU)

Treatment of pancreatic diseases and prevention of infection during outbreak of 2019 coronavirus disease / 中华外科杂志

Objective@#To explorethe proper protective measures for pancreaticdiseases treatment during theoutbreak of 2019 coronavirus disease(COVID-19).@*Method@#Clinical data of four cases of patients that suffered COVID-19from February 2nd, 2020 to February 9th, 2020 in pancreatic surgery were reviewed.After the first patientscuffednosocomial infection of COVID-19, the general protective measures in our department wereupdated.Only one patient was admitted to each room alone, with no more than one caregiver.The body temperature of care givers was measuredtwice a day.Primary protections were applied to all staff.The floor was sterilized using disinfectant with an effective chlorine concentration of 1000 mg/L.The protective measures for interventional procedures were as follow.Primary protection was applied to the operators ofcentral venipuncture catheter, percutaneous abdominal/pleural drainage, percutaneous retroperitoneal drainage, percutaneous transhepatic cholangial drainage and other surgical procedures with local anesthesiaand epidural anesthesia.Secondary protection was applied to the operators of endoscopic retrograde cholangiopancreatography and surgical procedures with general anesthesia.@*Results@#During Feb 2nd, 2020 to Feb 9th, 2020, four patients in our department were diagnosed with COVID-19, of which one was died of COVID-19, two were cured, and one is still in hospital for COVID-19.After the update ofprotective measures in our department, no more nosocomial infection of COVID-19occurred.Two central venipuncture catheter, three percutaneous abdominal/pleural drainage, one percutaneous retroperitoneal drainage, one percuteneous transhepatic cholecyst drainage and one open surgery with general anesthesia were performed with no infection of operators.@*Conclusions@#The caregivers of patients are potential infection source of COVID-19.Enhanced protective measures including the management measures of caregivers can decrease the risk of nosocomial infection of COVID-19.

Current status of the research on nonalcoholic fatty pancreatic disease / 临床肝胆病杂志

Nonalcoholic fatty pancreatic disease (NAFPD) is defined as pancreatic fat deposition associated with obesity in the absence of significant drinking, and its pathogenesis remains unclear. NAFPD is closely associated with nonalcoholic fatty liver disease (NAFLD), type 2 diabetes, pancreatitis, pancreatic tumor, and pancreatic fistula after pancreaticoduodenal surgery and can promote the spread of pancreatic cancer cells and result in the early death of patients with pancreatic cancer. The diagnosis and evaluation of NAFPD mainly rely on pathological biopsy and imaging examination, but their clinical application is limited by detection techniques and diagnostic level. Major prevention and treatment methods for NAFPD include a reduction in body weight, bariatric surgery, and pharmacotherapy. Since there are few articles on NAFPD and it is not taken seriously in clinical practice, there are significant differences in the clinical diagnosis and treatment of this disease. Therefore, this article elaborates on the current status of research on NAFPD and the advances in its diagnosis and treatment.

Application of artificial intelligence in endoscopic ultrasonography diagnosis of pancreatic diseases / 中华胰腺病杂志

The development of endoscopic ultrasonography (EUS) examination technology provides a new means for the diagnosis and treatment of pancreatic diseases, but how to form an objective and efficient diagnosis and treatment method is still a hot and difficult focus in EUS research. In recent years, artificial intelligence technology has developed rapidly and penetrated into various fields of medicine. Previous research suggests that artificial intelligence can be used to assist in detecting images for accurate and rapid EUS diagnosis. By adopting different classification models and combining different ultrasound methods, artificial intelligence has achieved high sensitivity and specificity in the diagnosis of various pancreatic diseases, and can be applied to the prognosis evaluation of patients with pancreatic tumor after treatment. In the future, the development of artificial intelligence in the EUS field will surely take root in the specialized segmentation field.

Application of artificial intelligence and big data in pancreatic diseases / 中华胰腺病杂志

With the development of computer science and technology, artificial intelligence and big data have made key breakthroughs in various areas. The medical and health field has also been greatly affected. Although the diagnosis, treatment, monitoring and management of pancreatic diseases is relatively difficult, artificial intelligence and medical big data are being applied in these aspects and showing obvious advantages and potential for the application.

Research status of pancreatic portal hypertension / 临床外科杂志

Pancreatic portal hypertension is a rare clinical syndrome which caused by pancreatic disease.The most significant symptoms are isolated gastric varices,splenomegaly and normal liver func-tion.The key of treatment are the primary disease and splenectomy.The prognosis of pancreatic portal hy-pertension depends on pancreatic disease and complications like gastrointestinal bleeding.

Pancreatic portal hypertension: progress in diagnosis and treatment / 中华肝胆外科杂志

Pancreatic portal hypertension (PPH),which accounts for about 5％ of extrahepatic portal hypertension cases,is mainly caused by pancreatic tumor,chronic pancreatitis and pancreatic ductal lithiasis.The pathogenesis and pathological characteristics of PPH are attributed to anatomical structure between splenic vein and pancreas.It is different from cirrhotic portal hypertension,PPH patients may present with less esophageal and gastric fundus varices,but more significant gastric body varices.The portal vein radiography is recognized as the golden standard for PPH diagnosis.There are two types of treatment modalities for PPH,symptomatic treatment and pathogenesis-based treatment.In clinically,we should take careful consideration into portal hypertension and primary disease,aim to resolve causes and manage complication concurrently.

Rendimiento diagnóstico del marcador tumoral CA 19-9 en la diferenciación entre patología bilio-pancreática benigna y maligna / Accuracy of the tumor marker CA 19-9 in the differentiation of benign and malignant bilio-pancreatic diseases

Introduction: CA 19-9 has been identified as a derivative of sialic Lewis blood group A and is expressed in 95 percent of the population. Several studies have documented an overproduction of CA 19-9 in malignant pancreatic and biliary tree diseases. The objective of this study is to determine the accuracy of the tumor marker CA 19-9 differentiating benign and malignant bilio-pancreatic diseases. Material and Methods: diagnostic test study. We reviewed the records of all patients with malignant bilio-pancreatic diseases and benign biliary calculous diseases evaluated in Hospital Base Osorno between august 2007 and december 2011, with CA 19-9 as part of their study. Results: 71 patients met the inclusion criteria, 17 men and 54 women, with a mean age of 60.7 +/- 15.3 years old. Twenty nine (40.8 percent) cases were benign and 42 (59.2 percent) cases malignant. For a cutoff level of 37 U/ml the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to differentiate benign from malignant disease was 81 percent, 72.4 percent, 81 percent and 72.4 percent, respectively. For a cut off level of 130 U/ml specificity and PPV increased to 96.6 percent and 96.4 percent, respectively. Conclusions: the use of CA 19-9 is useful in the diagnosis of patients with suspected bilio-pancreatic malignant disease. The optimization of the normal published value can help to improve accuracy.

Introducción: El CA 19-9 se ha identificado como un derivado siálico del grupo sanguíneo Lewis A y se expresa en el 95 por ciento de la población. Numerosos estudios han documentado una sobreproducción de CA 19-9 en tumores malignos del árbol biliar y páncreas. El objetivo de este estudio es determinar la utilidad del marcador tumoral CA 19-9 en la diferenciación de patología bilio-pancreática benigna y maligna. Material y Métodos: estudio de pruebas diagnósticas. Se revisaron los antecedentes de todos los pacientes con patología bilio-pancreática maligna y enfermedad litiásica biliar benigna, evaluados en el Hospital Base de Osorno entre agosto de 2007 y diciembre de 2011, a los que se les haya solicitado CA 19-9 como parte de su estudio. Resultados: 71 pacientes cumplieron los criterios de inclusión, 17 hombres y 54 mujeres, con una media de 60,7 +/- 15,3 años de edad. Veintinueve (40,8 por ciento) casos correspondieron patología benigna y 42 (59,2 por ciento) casos a patología maligna. Para un valor de corte de 37 U/ml la sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN) para diferenciar enfermedad benigna de maligna fue de 81 por ciento, 72,4 por ciento, 81 por ciento y 72,4 por ciento, respectivamente. Para un valor de corte de 130 U/ ml la especificidad y el VPP aumentaron a 96,6 por ciento y 96,4 por ciento, respectivamente. Conclusiones: el uso del Ca 19-9 es útil en el proceso diagnóstico de pacientes con sospecha de patología bilio-pancreática maligna. La optimización de los valores sobre el valor de normalidad publicado puede ayudar a mejorar su rendimiento.

Tratamiento médico de la pancreatitis aguda / Medical treatment of acute pancreatitis

Se revisan los últimos avances en el manejo médico de la pancreatitis aguda. Estos se basan en los cambios que van desde el mayor conocimiento de la fisiopatología y la clínica y el desarrollo de técnicas para el manejo de las complicaciones. El reconocimiento del mal pronóstico dado por la falla persistente de órganos (mayor a 48 horas) y la evolución lenta pero sin severidad de los pacientes con complicaciones locales, ha hecho redefinir la clasificación de la pancreatitis, estratificándose al paciente con cuadros leves, moderados y severos. De los múltiples scores de severidad disponibles para predecir la severidad, APACHE II y BISAP son los que demuestran mayor valor en los trabajos realizados en el Perú. El uso de hidratación enérgica al inicio del cuadro, para evitar el daño a nivel de la microcirculación pancreática, la nutrición enteral precoz cuando se predice un cuadro severo o prolongado, además de la analgesia con narcóticos, son algunas de las medidas que se preconizan en la actualidad. Se discute además la evidencia de realimentar con sólidos en vez de dieta líquida desde el primer día de inicio de dieta a pacientes con pancreatitis leve. Por último se presenta la evidencia del uso de necrosectomía endoscópica como alternativa a la necrosectomía quirúrgica.

We review recent advances in medical management of acute pancreatitis. These are based on changes ranging from increased knowledge of the pathophysiology and clinical development of techniques for the management of complications. The recognition of poor prognosis given persistent organ failure (more than 48 hours) and the slow evolution without severity of patients with local complications, has redefined the classification of pancreatitis, stratifying the patient with mild, moderate and severe. Of the many available severity scores to predict severity, APACHE II and BISAP are demonstrating greater value on work done in Peru. Using vigorous hydration to avoid damage to the pancreatic microcirculation level, early enteral nutrition when it predicts a severe or prolonged disease in addition to narcotic analgesia, are some of the measures advocated in the present. I also discuss the evidence of refeeding with solid rather than liquid diet to patients with mild pancreatitis. Finally, evidence of safety and good outcomes of endoscopic necrosectomy is presented as an alternative to surgical necrosectomy.

Diagnosis and treatment of pancreatic sinistral portal hypertension with splenomegaly / 中华肝胆外科杂志

Objective To study the diagnosis and treatment of pancreatic sinistral portal hypertension with splenomegaly.Method From January 2010 to December 2012,twenty-six cases of pancreatic sinistral portal hypertension with splenomegaly were retrospectively analyzed.Results The underlying pancreatic diseases were chronic pancreatitis (n=12,46 ％),pancreatic pseudocyst (n=5,19％),mass of pancreatic body and tail (n=6,23％),autoimmunie pancreatitis (n=2,8％) and pancreatic trauma (n=1,4 ％).All the 26 patients presented with splenomegaly,but there was no evidence of cirrhosis or abnormal hepatic function.Three cases presented with a history of upper gastrointestinal bleeding.Gastroscopy or upper gastrointestinal visualization revealed all 26 patients had varices in the gastric fundus and 6 patients had inferior segment oesophageal varices simultaneously.19 patients underwent operative treatment,2 patients underwent splenic artery embolization and 5 patients were treated conservatively.22 patients were followed up for 6 months to 30 months,the follow-up rate was 85 ％,and there were no upper gastrointestinal bleeding.Hypersplenism disappeared in all the 19 patients after operation.2 patients succumbed to pancreatic malignant tumor.Conclusions Splenomegaly is one characteristic clinical manifestation of pancreatic sinistral portal hypertension.It could be cured by operation.The choice of treatment depends on the patient's condition.The management of the primary pancreatic disease should also be emphasized.

Experiment study on pancreatic injury induced by smoking inhalation and alcohol consumption / 中华消化杂志

Objective To eveluate the pancreatic injury induced by smoking alone or combined with alcohol consumption,and its possible mechanism.Methods The Wistar rats were divided into control group (n=10),smoking group (n=30),drinking group (n=42) and smoking combined with drinking group (combination group,n=48).Serum levels of interleukin (IL)-6,superoxide dismutase (SOD) activities,monocyte chemoattractant protein-1 (MCP-1) and hydroxyproline were determined at 4th-,8th- and 12th- week.The pathohistological changes of the pancreas were examined using HE staining and the expression of α-smooth muscle actin (α-SMA) were measured by immunohistochemistry.ResultsIn contrast to control group,pancreatic changes including cytoplasmic vacuolation and increased levels of α-SMA and hydroxyproline were found in both smoking and drinking groups at the 8th-week (P<0.01).Whereas these changes were aggravated in combination group (P<0.05).Serum level of IL-6 and MCP-1 expression in pancreatic tissue were significantly increased in smoking group when compared with control group.But MCP-1 expression was lower in drinking group than control group.Moreover,the SOD activity in pancreatic tissue decreased in smoking and drinking groups,especially in combination group.Conclusions Long-term smoking can induce cytoplasmic vacuolation in pancreatic acinar cells,enhance inflammatory factors and chemokine expression and aggravate oxidative stress response in pancreas.These changes are aggravated when smoking and drinking coexisted.The mechanism behind it may be associated with increased oxidative stress response in pancreas.

Agonistas PPAR (Rosiglitazona, Bezafibrato e Fenofibrato) e alterações bioquímicas e estruturais em órgãos-alvo de camundongos C57BL/6 alimentados com dieta hiperlipídica rica em sacarose / PPAR agonists (Rosiglitazone, Bezafibrate and Fenofibrate) and biochemical and structural alterations in organs target of C57BL/6 mice fed high-fat high sucrose chow

Este trabalho teve o objetivo de estudar o efeito de medicamentos com diferentes ações agonista PPAR (rosiglitazona, fenofibrato e bezafibrato) sobre o perfil lipídico, glicídico e alterações na massa corporal e morfologia do tecido adiposo e pancreático em modelo de diabetes e sobrepeso induzido por dieta. Camundongos C57BL/6 (2 meses de idade) foram alimentados com dieta padrão (SC, n=10) ou dieta hiperlipídica rica em sacarose (HFHS, n=40) por 6 semanas. Logo após, os animais HFHS foram subdividos em: HFHS não tratado e HFHS tratado com rosiglitazona (HFHS-Ro), fenofibrato (HFHS-Fe) ou bezafibrato (HFHS-BZ) (5 semanas). Os camundongos alimentados com dieta HFHS apresentaram maior glicemia e insulina de jejum (+33% e +138%, respectivamente), intolerância à glicose, resistência à insulina, aumento da massa corporal (MC) (+20%) e adiposidade, hipertrofia de adipócitos e redução da imunocoloração para adiponectina no tecido adiposo. No pâncreas houve aumento da massa (+28%), acúmulo de gordura (+700%), hipertrofia da ilhota (+38%) e redução da imunocoloração para GLUT-2 (-60%). A rosiglitazona diminuiu a glicemia e insulina de jejum, porém induziu o ganho de MC e hipertrofia cardíaca. O fenofibrato estabilizou a MC, enquanto o bezafibrato levou a perda de MC. Apenas o bezafibrato impediu a hipertrofia da ilhota. A imunocoloração para GLUT-2 foi aumentada por todos os medicamentos, e não houve alterações na imunocoloração para o PPARalfa. Sinais morfológicos de pancreatite foram vistos no grupo HFHS-Fe, apesar dos níveis normais de amilase e lipase séricos. A rosiglitazona exacerbou a infiltração intrapancreática de gordura (+75% vs. HFHS), e o bezafibrato aumentou a imunocoloração para o PPARbeta/delta nas ilhotas pancreáticas. Em conclusão, o bezafibrato apresentou um efeito mais amplo sobre as alterações metabólicas, morfológicas e biométricas decorrentes da dieta HFHS, sugerindo que a inibição das três isoformas do PPAR seria melhor do que a inibição...

This work aimed to evaluate the effect of peroxisome proliferator-activated receptor (PPAR) agonists (rosiglitazone, fenofibrate and bezafibrate) on lipid and glucose metabolism, body mass, and adipose and pancreatic tissue morphology in a model of diet-induced type 2 diabetes and overweight in mice. Two-month-old male C57BL/6 mice were fed a standard chow (SC, n=10) or a high-fat high-sucrose chow (HFHS, n=40) for 6 weeks, and then HFHS-fed mice were subdivided by treatment: untreated HFHS and HFHS treated with rosiglitazone (HFHS-Ro), fenofibrate (HFHS-Fe), or bezafibrate (HFHS-Bz) (5 weeks on medication). HFHS-fed mice have altered fasting glucose (+33%) and insulin (+138%), GI, IR, increased body mass (+20%) and fat pad weight, adipocyte hypertrophy, and decreased adiponectin immunostain. They also presented increased pancreatic (+28%) mass, intrapancreatic fat (+700%), islet hypertrophy (+38%), and decreased GLUT-2 immunostain (-60%). Rosiglitazone reduced fasting glucose and insulin but induced weight gain and heart hypertrophy. Fenofibrate impaired body mass gain, while bezafibrate induced weight loss. Only bezafibrate impaired islet hypertrophy. GLUT-2 immunostain was improved by all treatments, and there were no alterations in PPAR-alfa stain. There were morphological signs of pancreatitis in fenofibrate-treated mice, although there was no alteration in serum amylase and lipase. Rosiglitazone exacerbated pancreatic fat infiltration (+75% vs. HFHS group), and bezafibrate increased PPAR-beta expression in pancreatic islets. In conclusion, bezafibrate showed a wider range of action on metabolic, morphologic, and biometric alterations due to HFHS intake, suggesting that inhibiting the three PPAR isoforms is better than inhititing each isoform alone. Rosiglitazone exacerbated body mass gain, pancreatic fat infiltration and induced heart hyperthophy as well, thus, precaution has to be taken in prescribing rosiglitazone to obese patients.

Advance in pancreatic duct calculi / 国际外科学杂志

The morbidity of pancreatic duct calculus is increasing every year in China. Currently the main therapeutic methods include non-surgical treatment and surgical treatment. Non-surgical treatments contain endoscopic calculus extracting and / or extracorporeal shock wave lithotripsy. Surgical treatment has two categories: drainage of the pancreatic duct decompression and pancreatectomy. Concrete treatment or surgical options should follow the strategy of individual.

Surgical treatment for pancreatic disrupture with major duct injury / 国际外科学杂志

Objective To investigate the selection and efficacy of operative medality for pancreatic transec-tion with major duct injury. Methods The clinical data were retrospectively analyzed in 21 patients with pancreatic disruption. They were treated in our hospital from Jan. 1995 to Feb. 2009. There were 14 males and 7 females in these cases with a mean age of 26 years (range 9-53 years). The trauma causes of them were blunt injuries in 13 and patent injuries in 8 cases. The injury grade (according to American Association for the Surgery of Trauma) distribution for these patients was grade Ⅲin 8 cases, grade Ⅳ in 8 cases, and grade V in 3. The early emergency operation was performed in eighteen within 12 hours, and delayed opera-tion was in three cases. Of these operative medalities, Roux-en-Y distal panereatojejunostomy was in 10 ca-ses, pancreatoduodenectomy was in 3, modified duodenal diverticulizatian was in 2, distal pancreatectomy was in 3, tube installing in major duct and external drainage, and suture of pancreatic section was in 2, su-ture of two broken sides in 1 (Roux-en-Y distal pancreatojejunostomy in second time). Results Twenty patients were cured, and one was died after a procedure of pancreatoduodenectomy. The postoperative pan-creatic fistula happened in 3 cases and recovered well with conservative line of management. Conclusions For improving the outcome of pancreatic transection, the earlier exploratory laparotomy and carrying out concept of "Damage Control Surgery" are critical. The individual operative modality based on the grade should be a-dopted in the surgical procedure.

The value of DWI in diagnosis and differential diagnosis of pancreatic carcinoma from chronic lump type pancreatitis / 中华胰腺病杂志

Objective To evaluate the ability of diffusion-weighted imaging (DWI)in differentiating pancreatic carcinoma from chronic lump type pancreatitis. Methods Totally 38 cases of pancreatic cancer, 9 cases of chronic lump type pancreatitis, 15 cases of normal patients underwent DWI. DWI with b value＝0, 500, 1 000 s/mm2 was performed twice. Apparent diffusion coefficient (ADC) was measured by analysis of imagines of ADC. Results The mean ADC value of 38 subjects with pancreatic carcinoma was (1.411± 0.101)×10-3 mm2/sec, the mean ADC value of 9 subjects with lump type pancreatitis was (1.053±0.113) ×10-3 mm2/sec, and the mean ADC value of normal pancreas subjects was (1.245±0.112)×10-3 mm2/s. The difference between the three groups were statistically significant (P＜0.05). Conclusions DWI may have the clinical potential to differentiate chronic lump type pancreatitis from pancreatic carcinoma.

Two Cases of Pancreatic Panniculitis / 대한피부과학회지

Several pancreatic diseases have been associated with a characteristic variant of panniculitis, named pancreatic panniculitis. This variant appears in approximately 2~3% of all patients with pancreatic diseases. We experienced two cases of panniculitis associated with pancreatic diseases. Two patients presented with erythematous tender subcutaneous nodules on the lower extremities. The serum amylase and lipase levels were significantly elevated. Histopathologic findings showed subcutaneous fat necrosis, ghost cell formation and mixed infiltration of neutrophils at the periphery. The lesions subsided gradually with the correction of the underlying pancreatic diseases.

The present and the future of therapeutic endoscopy in the pancreatic disease / 대한내과학회지

No abstract available.

Infestation state of clonorchis sinensis in patients with pancreatobiliary diseases in ulsan: based on bile examination / 대한내과학회지

BACKGROUND: Bile examination is believed to be the most precise method for detecting Clonorchis sinensis (CS) eggs. We carried out bile examination to evaluate infestation state of CS in patients with pancreatobiliary diseases in Ulsan, known as an endemic area of CS infestation. METHODS: We examined CS eggs in bile in three hundreds and nine patients with pancreatobiliary diseases. The bile was obtained from endoscopic nasobiliary or percutaneous transhepatic biliary drainage tubes. RESULTS: The overall egg positive rate was 27.5% (35.3% in male, 17.6% in female). The egg positive rate was not significantly different according to the age group: 20.0% in thirties, 26.7% in forties, 24.2% in fifties, 29.9% in sixties, 36.2% in seventies and 16.7% in eighties or more. The egg positive rate according to the disease, except CS cholangitis, was not also statistically different: 32.6% in bile duct cancer, 38.5% in gallbladder cancer, 11.1% in ampulla of Vater cancer, 24.0% in pancreatic cancer, 26.4% in gallstone diseases and 12.5% in the reminder. The location of gallstone and whether CS related diseases or CS unrelated diseases did not affect the egg positive rates. The egg positive rate in patients with normal radiological findings including cholangiography was 17.0%. CONCLUSION: This result shows that regardless of age, sex, and sorts of diseases, the infestation rate of CS was very high. On the basis of our results, it is therefore presumes that clonorchiasis is still endemic disease in Korea.

Minimally Invasive Surgery in Hepato-Biliary-Pancreatic Disease

The indication of laparoscopic procedure is continuously extending in the field of hepato-biliary-pancreatic surgery. Laparoscopic cholecystectomy has become a standard treatment for the disease of the gallbladder. Its application has widened to include conditions that once considered to be relative contraindications of laparoscopic cholecystectomy such as acute cholecystitis, complicated cholecystitis, previous operation history, and old age. Recently, a laparoscopic CBD exploration has been used for the treatment of CBD stone disease with good results. This operation may obviate the risk of immediate and long-term problem of sphincterotomy of the Ampulla of Vater resulting from endoscopic extraction of the CBD stone. For the biliary tract disease, pioneering operation of the laparoscopic IHD exploration and Roux-en-Y choledochojejunostomy have been successfully performed in our country. In terms of laparoscopic pancreatic surgery, a cystogastrostomy and a distal pancreatectomy are feasible operations. However, its indication is limited to benign or pre-malignant diseases. A pancreaticoduodenectomy with a laparoscopic technique is still not recommended. For the laparoscopic surgery of the liver, it has been initially applied to unroofing of a liver cyst or wedge resection. However, anatomic liver resections were successfully performed. The parenchymal dissection of the liver has been possible with the development of innovative laparoscopic equipments. Liver resection can be done with a laparoscopy-assisted method or a totally laparoscopic method. With accumulation of experience and the development of equipments, laparoscopic surgery has become a major operative tool in the hepato-biliary-pancreatic disease with an advantage of minimal invasiveness.

Clinical Application of Laparoscopy in Treatment of Pancreatic Diseases (Report of 12 Cases) / 中国普外基础与临床杂志

Objective To explore the clinical value of laparoscopy in the treatment of pancreatic diseases.Methods Twelve patients with pancreatic diseases received laparoscopic surgery.Among which 9 patients with cystic diseases,4 cases underwent laparoscopic spleen-preserving distal pancreatectomy,2 cases received distal pancreatectomy and splenectomy,and 3 cases underwent pancreatic cystectomy.Laparoscopic insulinoma enucleation was performed for 2 patients who suffered from insulinoma.Besides,a patient suffered from pancreatic carcinoma recurrence received left thoracoscopic splanchnicectomy.Results All the operations were accomplished successfully,including 8 total laparoscopic surgery and 4 laparoscopic assisted surgery.The average operative time was 225 min(range 100-420 min),and the average volume of blood loss was 80 ml(range 2-150 ml).Pancreatic fistula was observed in 1 patient which was cured by conservative therapy.The postoperative average hospital stay was 7.2 d(range 5-13 d).The patient with recurrent pancreatic carcinoma survived for 6 months after operation and the pain-killing effect was satisfactory.With a follow-up of 10-36 months for other patients,the surgical effects were ideal and no recurrence occurred.Conclusion With the advantages of less trauma,less pain,fast recovery,and low morbidity rate,laparoscopic surgery is an effective and safe method for the treatment of pancreatic diseases,and thus may be widely used in the clinical settings in the future.