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Objective Observe the effect and the indications of intermittent short veno-venuous hemofiltration(ISVVH) in severe acute pancreatitis(SAP). Methods APACHE II scores≥14 and fluids imbalance were respectively used to define as the indication of starting hemofiltration and ending hemofiltration. In 39 patients with SAP,19 underwent ISVVH(IS group),and the other 20 patients were not accepted hemofiltration (N group). APACHE II scores, Balthazar CT grades and the plasma levels of procalitonin(PCT), TNF-?, IL-6, IL-8, IL-1ra, IL-2 and IL-10 were observed. Results At admission and 2d after admission, APACHE II scores in IS group and N group were (13.8?3.1)and (17.8?3.2) ( P
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Objective To investigate the protevtive effect and mechanism of early using selective digestive decontamination (SDD) on severe acute pancreatitis(SAP) in rats.Methods Sixty rats were randomly assigned into SAP group and SAP+SDD group after SAP model was set up.Rats in the SAP+SDD group underwent SDD immediately after the model was established and last for 3 days. The peripheral and portal vein serum endotoxin, tumor necrosis factor -a (TNF-a) and interleukin -1 (IL-1) at 24 hours, 48 hours, and 72 hours and the mortality, average living time and the degree of pancreatic necrosis were observed and compared in the 2 groups. Results The levels of peripheral and portal vein serum endotoxin, TNF-? , IL-1,and the mortalities in SAP+SDD group were significantly lower than those in SAP group(all P
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Objective To elucidate the clinical features,and the principles in diagnosis and treatment of hyperlipidemic pancreatitis.Methods The clinical data of 262 cases with acute pancreatitis from January,2004 to April,2006,were studied.Results Among 262 cases,46 cases were diagnosed as hyperlipidemic pancreatitis(17.5%,46/262),that included 32 cases with mild acute pancreatitis(69.0%) and 14 cases with severe acute pancreatitis(31.0%).Depending on the severity of pancreatitis,different treatments were adopted.Among the 46 cases,10 were treated operatively.As a result,43 cases were cured,accounting for 93.5% of all cases,and 3 cases died,accounting for 21.4% of cases with severe acute pancreatitis.Conclusions Hyperlipidemia can induce acute pancreatitis,and many may have severe pancreatitis.Treatment is mainly by nonoperative management but different therapeutic measures should be adopted according to the severity of pancreatitis.
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Objective To evaluate the efficacy of MRCP in the determination of common bile duct (CBD) exploration in gallstone pancreatitis(GP). Methods The clinical data of the patients who underwent CBD exploration due to gallstone pancreatitis during two different periods were retrospectively reviewed. Between 1995 and 1999,46 patients with gallstone pancreatitis underwent CBD explorations based on the preoperative ultrasonographic examination of stones and dilatation of CBD . Between 2000 to 2002,the explorations were carried out in 30 patients based on MRCP findings. Results Negative exploration occurred in 28 patients (60.8%) during the first period and 7 patients (23.3%) during the second period. The difference of negative CBD exploration rate between the two groups was statistical significance(P
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Objective To investigate the role of staging nutrition(SN) in the treatment of severe acute pancreatitis(SAP). Methods One hundred patients with SAP treated in our hospital since 1997 were randomly divided into two groups: Total parenteral nutrition group(TPN group,50 cases) and staging nutrition group (SN group,50 cases). The curative effects and complications between two groups were analyzed and compared. Results The incidences of total complications,incubation complication,double infection,hepatic function injury,abdominal cavity infection and hospital stay in SN-group were significantly lower than those in TPN-group(all P
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Objective To study the effect of hyperbaric oxygen(HBO) treatment on plasma endotoxin,sCD14 and plasma endotoxin inactivation capacity(EIC) in acute necrotizing pancreatitis(ANP) in rats and its possible mechanism.Methods SD rats were randomly divided into control group,sham operation group,ANP group and ANP+HBO group.Rat ANP models were made by retrograde injection of 3.5% sodium(taurocholate)(2.5mL/kg) into the pancreatic duct.Thirty minues after models had been made,ANP+HBO group was treated by hyperbaric oxygen for 2h.At 3h,6h,and 10h after establishment of rat models,the plasma endotoxin,sCD14,EIC,TXB_2 and 6-K-PGF_(1a) leves were determined in each group.Results At 3h and 6 h after rat models were established,the levels of endotoxin,sCD14,and TXB_2 in ANP+HBO group were significantly lower than those in ANP group(P
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Objective To introduce the current status of the diagnosis and treatment of acute pancreatitis (AP). Methods With the reference of relevent articles issued in this periodical, the summary was mad on author's professinal knowledge and special clinical experience. Results and conclusions The pathology of AP is varied. The staging of AP is divided into mild type and severe type. 90% of patients with AP take a mild course and clinical improvement can be achieved by non operative therapy; meanwhile the other 10% of patients of AP take a severity course and operation is necessary when the patients complicated with infection. Operation principle: the timing is not to be early and the procedure is not to be large. New advance had been made in the diagnosis and treatment of AP, which has improved the curative rate and reduced the mortality. For some causes, nation standard of diagnosis and treatment of AP could not been performed in many primary hospitals. It is effective for primary hospital to treat AP with Chinese medicine. The author provides four items in experience: early diagnosis, distinguishing the staging of AP(mild or severe) and improving curative effect; reducing course of treatment; preventing complicantions; and combining Chinese medicine with west medicine for AP. This is the current status of diagnosis and treatment of AP in China.
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Objective To introduce the current status of treatment of severe acute pancreatitis (SAP). Methods This summarization paper of SAP was made on literature review. Results During the stage of acute reaction , therapy should be emphasized on non surgical management, such as maintaining the homodynamics ; inhibiting the overexpress of cytokines and pancreatic secretion; administering antibiotics preventively, TPN and improving the function of other damaged organs.The operation timing should be delayed if possible.Thus it could increas the cure rate, decrease complications and the possibility of reopeneration. But in the case of SAP with biliary obstruction, secondary infection with necrosis of pancreas; failure to respond to initial intensive treatment and clinical diagnostic was uncertain, early surgery should be performed. The operation should be easy to be done, ensuring enough drainage, and resolving the obstruction of biliary tract. During the septic stage, besides administerded antibiotics and EN, surgery is primary therapeutic method: necrosectomy and continuous closed lavage were considered as a better treatment of infected necrosis focus, while pancreatic absecess should be drained operatively. During the last stage of residual infection, abdominal abscesses should be drained thoroughly. Conculsions According to the etiology and stage of SAP, comprehesive management guided by "individualized plan"is probably a better strategy of treatment of SAP.
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Objective To investigate the principles of treatment for severe acute pancreatitis(SAP). Methods A retrospective analysis of the data of 217 cases of SAP with regards to clinical features,mortality rate and conversion to surgical operation.In this group,66 cases received early operation and 24 cases were converted to operation after initial conservative treatment.Results The overall cure rate was 80.2%(174/217). Among them,90 cases underwent operative treatment,with a cure rate of 72.2%(65/90),and 127 cases underwent conservative treatment with a cure rate of 85.8%(109/127).Conclusions The initial treatment of SAP should be conservative. Operation should be performed if there is a specific indication for early surgical intervention,or for conversion to operation.
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Objective To explore a rational treatment program for the non-surgical treatment of severe acute pancreatitis (SAP) in the early stage. Methods The data of 123 cases of SAP treated from 1986 to 2004 were collected and divided into two groups according to admission time and treatment procedure. Group A:53 cases admitted from 1986 to 1992,treated mainly by operation. Group B :70 cases admitted from 1992 to 2004 ,treated mainly by non-surgical procedures. Results The mortality rate in group A and B was 33.9 %(18/53) and 7.1% (5/70),respectively,while the incidence rate of complications such as ARDS,shock,renal failure,pancreatic abscess,cardiac failure in group A was 28.3%(15/53),16.9%(9/53),20.8%(11/53),16.9%(9/53),24.5%(13/53),and in group B was 14.3%(10/70),7.1%(5/70),7.1%(5/70),2.8%(2/70), 4.2%(3/70),respectively. There was significant difference between the two groups (P
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0.05).Conclusions This study shows that in severe acute biliary pancreatitis patiens with biliary tract obstruction, emergency endoscopic therapy should be performed within 48 hours from the onset of symptoms; patients with mild acute biliary pancreatitis shoud also undergo prompt endoscopic therapy after ineffective conservative management or appearance of symptoms of acute biliary tract infection.
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Objective To explore the therapeutic modalities and clinical characters of acute pancreatitis (AP) in the middle or late stage of pregnancy.Methods There were 26 cases of AP in the middle or late stage of pregnancy, among which 18 cases (69.2 %) received conservative therapy, and 8 cases (30.8 %) underwent operation for removal of necrotic tissue and termination of pregnancy.Results Two cases of both fetus and mother death occurred, whereas 24 mothers were cured. 15 (57.7 %) fetuses were healthy but 11(42.3 %) died.Conclusions The women in middle and late stage of pregnancy are inclined to pancreatitis because of hormonal changes, especially in those with history of cholecystitis and cholelithiasis. The main method of management is active non-operative therapy and surgical intervention when necessary, so as to decrease the tragedy of both maternal and fetal death.
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Objective To investigate the optimal therapeutic strategy of severe acute pancreatitis(SAP). Methods The effect of treatment of non operation, endoscopy and operation on cure rate, complication rate and course of the disease in SAP were retrospectively analysed. Results Non operative, endoscopic and operative treatment included 33, 8 and 19 cases respectively.Cure rate, complication rate and course of the disease in non operation group were 85.7%(24/28), 16.7%(4/24), (25?8)days respectively;in endoscope group were 100%(8/8), 12.5%(1/8), (19?4)day respectively;in operation group were 68.4%(13/19), 38.5%(5/13), (57?14)day respectively. Conclusions According to the difference of pathogeny and severity,the treatment should be taken individually.In acute reaction phase of SAP should be treated with non operation,if there isn't existence of promoting facters.For gallstone SAP, endoscopy or operation is the first choice of treatment.If patients can not be cured by non operation or endoscopy,operaton should be performed.