Objective To investigate the early diagnosis and treatment methods of primary duodenal papilla carcinoma. Methods The medical records of 54 patients with primary duodenal papilla adenocarcinoma underwent operation between January 2002 and December 2008 were reviewed. Results Thirty seven cases received fiberduodenoscopy and 35 cases received ERCP, and the accuracy of them were both 100%. Forty four patients received duodenopancreatectomy and 10 patients received jaundice-reducing operation. The 1-, 3-, and 5-year cumulation survival rate was 68%, 50%, and 29%, respectively. Conclusions Fiberduodenoscopy and ERCP are the effective diagnostic methods for duodenal papilla carcinoma. Early diagnosis and early rational radical operation are essential for successful treatment of duodenal papilla carcinoma.
ObjectiveTo investigate the proportion of peripheral blood CD4+CD25+ regulatory T cells (Tregs) in patients with pancreatic head carcinoma, the dynamic changes of these cells before and after pancreatoduodenectomy were also analyzed. MethodsThe proportions of peripheral blood CD4+CD25+ Tregs in patients with pancreatic head carcinoma and normal individuals were examined by using flow cytometric analysis. The CD4+/CD8+ ratio was also studied before and after operation. ResultsThe patients with pancreatic head carcinoma showed higher ratio of CD4+CD25+ and CD4+CD25high Tregs compared with normal control before operation (Plt;0.05). However, the percentage of these T cells reduced significantly after pancreatoduodenectomy, which was most obviously on the 3rd day after operation (Plt;0.01, Plt;0.05). After operation, CA199 level began to decrease, which was obvious on the fourteen day after operation. This tendency of CD4+CD25high Tregs changes was similar to that of CA199. The patients showed an decreased ratios of CD4+/CD8+ compared with normal controls, which further declined after operation, and reached the lowest point on the seventh day after operation (Plt;0.05). ConclusionsPancreatoduodenectomy may be helpful for the recovery of antitumor immunity. The perioperative period of patients with pancreatic head carcinoma may be a beneficial windowphase for immune intervention and Tregs may be served as target cells.
目的探讨十二指肠球后溃疡大出血急诊手术治疗的临床疗效及对术后再出血的预防措施。方法回顾性分析我院2001年1月至2011年8月期间18例术中确诊的十二指肠球后溃疡并大出血手术患者的临床资料。结果18例急诊手术，其中Nissen法12例，Graham法5例，Bancroft法1例。全部顺利成功完成手术，术后第1天再出血1例，经保守治疗治愈，均痊愈，无一例患者死亡。结论对于经保守治疗无效的上消化道大出血，急诊手术是挽救患者的关键，术后正确静脉使用奥美拉唑，维持胃内pH值gt;6.4是防止术后再出血的重要保障。
目的 探讨胰十二指肠切除术后胰瘘引起腹腔大出血行外科治疗的可行性。方法 在343例行胰十二指肠切除术的患者中，2例术后发生严重的胰瘘伴有腹腔大出血，均再次手术行胰肠分离式桥式内引流术。结果 经术后支持治疗、持续腹腔冲洗、抑制胰酶分泌，治疗成功，顺利出院。术后随访18个月，没有胰管梗阻和脱落的迹象。患者没有发生糖尿病。结论 胰十二指肠切除术后胰瘘导致的腹腔大出血治疗非常困难，通过外科再手术行胰肠分离式桥式内引流术，取得成功，避免了复杂的全胰切除，挽救了胰腺功能，提高了患者的成功救治机会，改善了患者术后的生活质量。
Objective To evaluate the application of a surgical method in pancreaticoduodenectomy. Methods All the 211 cases of purse-string invaginated pancreaticojejunostomy performed from Dec.1985 to Dec.2007 were reviewed. Firstly, an accordant plastic tube was put and fastened in main pancreatic duct, and pancreas was ligated at 2-3 cm apart from the pancreatic stump to let secretin flow far away. Furthermore, invaginated pancreaticojejunostomy was performed to get closer between pancreas and jejunum. Results Pancreatic fistula and perioperative death didn’t occur among these 211 cases. The complications included 2 cases of incision dehiscence, 4 cases of biliary fistula and 1 case of scission of superior mesentric artery. Conclusion Purse-string invaginated double-layer anastomosis of pancreaticojejunal would be feasible for pancreaticoduodenectomy preventing pancreatic fistula.
Objective To investigate the roles of cell apoptosis and the gene expressions of Fas, FasL, bcl-2 and bax in acute rejection of pancreaticoduodenal transplantation and to evaluate the function of duodenum biopsy for early detection of rejection in rats. Methods Wistar and SD rats were divided into two groups: ①Wistar rats that underwent allogenic pancreaticoduodenal transplantation from the organs of SD rats; ②Wistar rats that received homogenic transplantation. The grafts were then harvested on day 3, 5 and 7 after the transplantation, and all graft samples were observed with HE staining and TUNEL was also used to detect apoptotic cells. The expressions of Fas, FasL, bcl-2 and bax were measured by immunochemical method. According to Nakhleh’s score, pathologic features of transplanted pancreas and duodenum were ranged from one to three scores in order. Results The percentage of same or different scores between the pathological scores of pancreas and duodenum in allogenic pancreaticoduodenal transplantation group were 61.1% (11/18) and 38.9% (7/18) respectively, and there were 6 specimens of pancreatic tissue got higher scores with only one higher score for duodenum. There were significant differences of histopathologic rejection scores and apoptotic indices between the two groups, respectively (P＜0.05， P＜0.01). Apoptotic indices of pancreas and duodenum both showed positive correlations with histopathologic rejection scores (r=0.965， P＜0.01; r=0.942, P＜0.01). The rejection score and apoptotic index elevated, the expression of FasL increased, bcl-2 decreased, and Fas and bax changed over time after operation. Conclusion Apoptosis maybe significantly positive correlated with the degrees of damage of the acute pancreaticoduodenal allograft rejection, and the apoptotic index maybe valuable to estimate the damage. FasL and bcl-2 were significantly related to the impairment of acute pancreatic allograft rejection as well. Duodenum biopsy may contribute to the early diagnosis of the rejecting transplanted tissues.
目的 探讨胰十二指肠切除术后严重并发症的防治方法。方法 分析2002～2005年7例胰十二指肠切除术后严重并发症的资料。结果 手术严重并发症发生率为25.9%（7/27），经积极治疗后无一例死亡。结论 术中仔细操作和操作技术改进是降低胰十二指肠切除术并发症发生率的关键，并发症经积极治疗后有望痊愈。
【摘要】目的 探讨十二指肠镜、腹腔镜联合治疗胆囊结石合并胆总管结石的治疗效果。 方法 采用十二指肠镜取出胆总管结石后，再用腹腔镜切除胆囊治疗胆囊结石合并胆总管结石病例的方法。 结果 51例患者的治疗均获得成功。 结论 胆囊结石合并胆总管结石的病例，通过十二指肠镜取出胆总管结石后，再行腹腔镜胆囊切除术，可避免开腹或腹腔镜胆总管探查等操作较复杂、创伤较大的手术方式。
【摘要】目的探讨提高可切除胰头癌疗效和降低手术风险的方法。方法回顾我院1996年1月至2001年12月期间行根治性胰十二指肠切除术治疗的胰头癌病例，对可切除胰头癌患者的术前评估、围手术期治疗和术式选择进行分析。结果外科收治胰头癌271例，行根治性切除术73例，根治切除率为26.9%（73/271），围手术期死亡率为6.8%（5/73）。其中56例行改良扩大的胰十二指肠切除术，1年和3年生存率分别为71.4%和33.9%。结论根治性胰十二指肠切除术是可切除胰头癌惟一可能提供治愈机会的治疗选择。加强术前评估并同时重视围手术期处理，有助于改善预后。
【摘要】目的探讨十二指肠憩室的诊断与治疗。方法对南方医院1982～2002年20年期间收治的110例十二指肠憩室患者的临床资料作回顾性分析。结果憩室分布于十二指肠球部10例，降部77例，水平部15例，升部8例； 憩室合并炎症28例，合并出血14例，合并急、慢性胆胰疾病35例，无合并症33例。手术治疗47例，其中行十二指肠憩室切除术10例，憩室内翻缝合术5例，胃大部切除术13例，胃大部切除+胆肠RouxenY吻合术10例，Oddi氏括约肌成形术2例，胃大部切除+胆囊切除术5例，胰十二指肠切除术2例。术后发生十二指肠瘘1例，手术治疗47例全部治愈，无一例死亡。结论十二指肠憩室以降部多发，无症状者可行保守治疗，若合并炎症、出血、胆胰疾病，则需根据憩室部位合理选择手术方式。