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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 investigate the role of hepatic Kupffer cells in acute hemorrhagic necrotizing pancreatitis associated lung injury(AHNP LI) and the therapeutic effects of gadolinium chloride(GdcI_3). Methods Forty-two Wistar rats were randomly divided into four groups:(I) sham operation group;(II) AHNP group;(III) Gdcl_3 (protection) group(Gdcl3 10mg/kg);(IV) Gdcl_3control group(Gdcl_3 10mg/kg).In the sham operation group, the (abdominal) vescera were shifted around for several times and the abdomen was closed.The AHNP model was induced by retrograde intraductal administration of 5% sodium taurcholate(1ml/kg,0.1ml/min).In the Gdcl_3 protection group,Gdcl_3 solution was admmistered by caudal vein injection one day before the AHNP model was made.In these 3 group of animals,specimens were obtained in order at 3h and 6h postoperatively:(1)Blood was withdrawn from the abdominal aorta to determine serum amylase,TNF?,IL-1(in addition,in the sham operation group,blood AST and ALT were determined);(2)A portion of liguefied right lung was obtained to determine MPO;another portion was fixed with 10% formalin for tissue pathological examination;(3)Bronchoalveolar lavage fluid of excised left lung was obtained ,and then alveolar macrophages were isolated,collected and purified.After removal of their nuclear (proteins),the alveolar macrophages were tested to determine NF-?B activation with the use of chemical illumination ELISA method;and (4)pancreatic tissue was reserved for pathological examination.In the Gdcl_3 control group, Gdcl_3 was administered by caudal vein injection,the animals were sacrificed 24h later,and blood was obtained to determine blood AST and ALT. Results In the Gdcl_3 prevention group,the level of MPO in lung tissue,serum (levels) of TNP? and IL-1,and NF-?B activation of alveolar (macrophages) were all significanfly reduced as compared with the AHNP model group(in all,P
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Objective To investigate the pathogentic factor of severe acute pancreatitis(SAP)-associated lung injury and the protective function of octreotide combined with alinastatin on SAP-associated lung injury in rats.Methods Eighty SD rats were randomly divided into 5 groups.Sham operative(S)group,SAP group,(octreotide)(O)group,ulinastatin(U)group and octreotide + ulinastatin (O+U)group,and each group was divided into 6h,12h sub-groups.After AP models were induced,the serum concentration of amylase(AMY),tumor necrosis factor?(TNF-?),malondiadehyde(MDA),and the concentration of(myeloperoxidase)(MPO) in lung tissue were determined;and the pancreas and lung pathology were graded,the changes of the above-mentioned indexes after using octreotide and ulinastatin were compared.Results(1)Compared to SAP group,AMY,TNF-?,MDA,MPO,and pancreas pathology score were decreased significantly in each of the 3 therapy groups during the same period;and at 12h,in O+U sub-group,lung pathology score also decreased compared to SAP group(P
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Objective To investigate the changes of Toll-like receptor 2 and 4 gene expression in lungs with acute injury induced by acute hemorrhagic necrotizing pancreatitis(AHNP) in rats.Methods Forty SD male rats were randomly divided into sham-operated group(n=10),and AHNP group(n=30).Of all the rats,the lungs were dissected for lung histological scores and bronchoalveolar lavages were harvested for lung injury index.TLR2,4mRNA expression in the lungs was measured by RT-PCR at different time points.(Results) TLR2,4mRNA could be detected in lungs with low values in sham-operated group;but they were markedly increased at 3 hours in AHNP group,peaking at 6~12 hours(P
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Objective To investigate the effect of MMP-9 on severe acute pancreatitis(SAP) associated with lung injury,and the preventive function of MMP-9 inhibitor (BB-94) in SAP associated with lung injury in rats. Methods SD rats were randomly divided into three groups: Shamed-operated groups (control groups,n=10);SAP groups (n=14);SAP with MMP-9 inhibitor preconditioning groups (BB-94 group,n=15). The samples for test of the wet weigh index of lung,serum amylase level,white cell count,the number of cells and protein in bronchoalveolus lavage fluid,histologic scoring of lung injury and MMP-9 in lung were detected 24 hours after SAP models were set up.Results The parameters mentioned above in SAP group were significant higher than those in controll group and BB-94 group (P
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Objective To discuss the predisposing factors,prognosis and treatment of pancreatic encephalopathy(PE) in acute pancreatitis(AP). Methods Nineteen cases of AP complicated with PE were retrospectively studied. Results The occurrence rate of PE was 12.0%. PE often occurred in association with such factors as hyperpyrexia, water-electrolyte disturbance, and hypoxemia. Among the 19 patients,11 patients received surgical operation and 8 were treated conservatively.The total fatality rate reached 52.6%(10/19), significantly higher than other concurrently treated cases of severe acute pancreatits(SAP) (20.7%,P
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Objective To study the clinical characteristic and correlation factors of fungal infection in severe acute pancreatitis(SAP). Methods Clinical data of SAP patients with fungal infection (fungus infection group-F1 group) and with bacterial infection (bacteria infection group, B1 group) in January,1994-December,2001 were retrospective analysed and compared. Results There were 40 cases in F1 group, 84 cases in B1 group. There were no significant difference in age, sexual, causes, APACHE II score between the two groups, Hospitalization in F1 was significantly longer than that in B1 group (57.7d∶42.7d, P= 0.044 ).Diabetes-mellitus, SAP grade II, multi-operation, intestinal and/or bile duct fistulas were related to fungal infection in SAP; mortality in F1 group was significantly higher than that in B1 group (P= 0.02 ). Conclusions Diabetes-mellitus, SAP grade II, multi-operation, intestine and/or bile duct fistulas are the risk factors of patients with severe acute pancreatitis developing fungal infection; fungus infection can increase the mortalily of SAP patients.Extra-pancreas fungal infection is commonly seen in digestive tract, respiratory tract and urinary system. unknown consciousness change and massive bleeding may indicate that the patient is complicated with fungal infection.
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Objective To study the pathological changes of acute hemorrhagic necrotizing pancreatitis(AHNP) complicated with acute lung injury(ALI). Method The model of AHNP with ALI was established in rats. The changes of function and structure of pancreas and lung were observed. Results One hour after induction of the model , pancreas showed mild edema and congestion . 12 hours after introduction of the model , the typical pathological changs of AHNP were found . The lung extravascular water volume and levels of PaCO 2 increased significantly, and the PaCO 2 decreased obviously. Morphological examination demonstrated that inflammatory cell , insterstitial edema , intra-alveolar hemorrhage ,desquamate and disintegration occurred in the lungs. Conclusions The pancreatic and pulmonary morphologic changes in this model is similar to the changes in clinical AHNP with ALI , which suggests that the model can be used to study the mechanism of AHNP with ALI and evaluate the effect of drugs for AHNP with ALI.
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Objective To evaluate the curative methods of periampullary diverticula(PAD) complicated with biliopancreatic disease.Methods The clinical data of 32 cases of PAD complicated with biliopancreatic disease treated by surgical or endoscopic measures were retrospectively analyzed.Results Of the 32 cases,16 cases were treated with gastroectomy and Roux-en-Y gastrojejunostomy,and 8 with gastroectomy and Billroth Ⅱ gastrojejunostomy,8 with endoscopic sphincterotomy (EST).Postoperative complication occured in 4 cases,but no operative death.Twenty-seven cases were followed up for 5 months-8 years, and the results were excellent in 20 cases, good in 7 cases.Conclusions Gastroectomy and Roux-en-Y gastrojejunostomy is a better surgical method for PAD complicated with biliopancreatic disease.EST has become a new effective measure to deal with the diseases;It will be safe to use the first method for patients with intradiverticular papilla if it treated by EST.
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Objective To study the clinical characters,diagnosis and principles of treatmentof acute pancreatitis during pregnancy.Methods Forty-eight cases of acute pancreatitis during pregnancy treated in the recent 8 years were retrospectively analyzed,38 cases had non-surgical treatment(of which 36 cases were cured);10 cases had surgical treatment to remove necrotic tissue and mainly termination of pregnancy.Results Most of the cases in this group had simple pancreatitis,which accounted for 64.58%(31/48).There were 5 cases of maternal(10.42%) death and three cases of fetal(6.25%) death,and all were in patients with severe pancreatitis.Fatality rate of pregnant women with severe pancreatitis was 29.41%.Conclusions Acute pancreatitis during pregnancy is a serious disease with low prevalence rate,but has high fatality rate,and is the primary cause of death in acute abdomen of pregnancy.Nonoperative treatment is the first choice of treatment in this condition.In severe cases,timely surgical intervention is warranted,and the surgical indications should not be altered because of the pregnancy.The safety of both the pregnant woman and the fetus must simultaneously be kept into mind during therapy.
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Objective To study the surgical treatment of pancreatolithiasis.Methods The clinical data of thirty-seven patients with pancreatolithiasis admitted to our hospital from 1994 to 2007 were reviewed.Results According to the results of imaging examination (BUS,CT,ERCP) and finding during surgery, pancreatolithiasis was classified into three types: TypeⅠ,the stones were mainly located in the head of pancreas, and Whipple procedure was the treatment of choice. TypeⅡ, the stones were mainly located in the body and tail of pancreas, and resection of the tail of pancreas alone or combined with splenectomy was the management of choice. TypeⅢ, the stones were diffusely scattered in the main duct from the head to tail of pancreas, and pancreatoduodenectomy,together with pancreatolithotomy and pancreatojejunostomy with wide anastomotic stoma was the choice of management. There was no mortality in this series. Within 2 weeks after treatment, symptoms ameliorated to different degrees in all the patients. Thirty one patients were followed up for 6 to 72 months, the results were satisfactory.Conclusions The individualized strategy, based on the type of stone location, is of great importance in the management of pancreatolithiasis. The key of surgical treatment of pancreatolithiasis is as follows: removal of pancreatoliths, excision of diseased pancreas, and adequate pancreatic drainage.
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Objective To determine the prevention and therapy of fungal infection in patients with severe acute pancreatitis (SAP). Methods Seventy patients with SAP admitted from July,1998 to June,2002 were randomly divided into 3 groups: garlicin prevention group, fluconazole (low dosage) prevention group and control group.The incidence of fungal infection, the fungal clearance and mortality after the treatment were compared. Results The incidence of fungal infection in garlicin group and fluconazole group was lower than that in control group. (16%∶30%,P
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Objective To evaluate the effect of combination of growth hormone(GH),somatostatin(ST) with hypocaloric parenteral nutrition(HPN) on SAP patients with MOD. Methods forty one cases of SAP complicated with MOD were randomedly divided into control group (20 cases) and experiment group (21 cases). In experiment group ,total calories and nitrogen were given 62.9～83.9kJ/(kg?d) and 0.10～ 0.12g/(kg?d). lipid calorie was supplied in less than 40 percent of the total energy.GH was percutaneously injected for 7d and ST was intravenously injected for 7～14d. Control group was given TPN only.Serum albumin, pre albumin, transferring,CRP,total lymphocyte count(TLC), urea nitrogen, nitrogen balance and serum TNF ?, IL 1,IL 6 level were determined before treatment and on the day 7 after treatment. Results After treatment, serum albumin and pre albumin and transferring increased significantly (P
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Objective To investigate the protective effects of glycine on the lung injury in acute necrotizing pancreatitis(ANP). Methods Male Wistar rats were randomly divided into 4 groups: sham operation, ANP group,pretreated group and treatment group(with intravenous glycine 1g/kg). Serum TNF ? level,glutathione (GSH) and myeloperoxidase (MPO) in pulmonary homogenate were determined at 6, 12, and 24h hours after ANP induced. Pulmonary pathology and 3 day survival rate were compared between the groups.Results Compared with ANP group,in glycine pretreated group serum TNF ? level significantly reduced at 6,12, and 24h,while in glycine treatment group serum TNF ? level decreased at 24-hour . In glycine pretreated group or treatment group, the pulmonary GSH content were decreased.In both glycine pretreated group and glycine treatment group, pulmonary MPO activity decreased at 12 and 24h,and pulmonary pathologic severity significantly ameliorated and survival rate increased. Conclusions Although glycine can not increase the GSH synthesis,but giving prophylactic or therapeutic glycine may be effective in improving acute lung injury in ANP, probably through the inhibition of the infiltration and activation of leukocytes.
