【Abstract】Objective To study the change of pancreatic microcirculation in the early phase of acute pancreatitis. MethodsLiteratures on acute pancreatitis and microcirculation were collected and reviewed.ResultsPancreatic microcirculation has changed in the early phase of acute pancreatitis, including contraction of interlobular arteriole, slowing of blood fluid, increasing of pancreatic vascular permeability, leukocyte adherence in postcapillary venules, and decreasing of pancreatic perfusion.Conclusion Impairment of pancreatic microcirculation in the early phase of acute pancreatitis may play a key role in the progression of this disease.
慢性胰腺炎是胰腺进行性炎症性疾病，以胰腺实质持续性破坏和纤维化等不可逆性的形态改变为其特征，并引起顽固性疼痛和(或)永久性功能丧失。迄今，其发病机理、病理生理和疾病过程仍不十分清楚，各种治疗也仅限于疾病的并发症。
目的介绍直肠癌根治手术中防止盆腔大出血的经验与紧急处理措施。方法1993年8月至2000年4月我科完成直肠癌根治手术687例。术者掌握盆腔解剖，沿间隙操作，保护好骶前静脉丛； 沿髂内动脉内侧镰状筋膜处理侧韧带，有时结扎直肠中动脉； 肿瘤浸润阴道或前列腺可边切除边缝合； 盆腔侧壁中度浸润者可在侧方淋巴结清除的同时，合并髂内动、静脉分支和肿瘤切除。发生盆腔大出血，根据大出血部位及肿瘤情况可采用骶丛止血钉按压法，纱布压迫止血法，缝扎止血法或血管修补术止血。结果发生术中大出血仅14例，术中失血量＜400 ml 5例，400～800 ml 8例，＞800 ml 1例。止血后未发生再次大出血。行Miles手术8例，保肛手术6例，无手术中死亡。结论直肠癌根治手术中按解剖层次正确操作，阻断直肠周围血流可防止盆腔大出血。发生盆腔大出血可用骶丛止血钉、纱布压迫、缝扎止血或血管修补术止血。
The purpose of this study was to determine the contribution of endotoxin (ET) in ocurrence and progression of acute pancreatitis (AP). The results indicated that correlation of ET changes with multiple organ damage in AP. The degree of ET elevation correlated well with the severty of AP. The level of plasma ET of severe AP patients was much higher than that of mild AP patients (Ｐ＜0.05). The chance of multiple organ damage got greater while the plasma ET level got higher. Moreover, the severety change of severe AP correlated with the change of plasma ET level. In other words, the ET level was reduced while the disease was recovering, elevated while it was becoming worse and maintained high level in dead cases. We think that plasma ET level can be used as a reference for differenciating mild AP with severe AP and a predictor for the prognosis of AP.
Objective To explore the effect of Frey procedure on patients with chronic pancreatitis, and evaluate pain control as well as the quality of life (QOL) after Frey procedure. Methods The clinical data of 81 patients with chronic pancreatitis who underwent Frey procedure in West China Hospital of Sichuan University from January 2010 to January 2015 were retrospectively analyzed. Izbicki pain score and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) were used to assess pain and QOL respectively. Results The mean value of operative time were (252±70) minutes (180-430 minutes), the mean value of blood loss were (220±142) mL (100-550 mL), and the mean value of hospital stay were (14.1±4.9) days (8-36 days). After Frey procedure, delayed gastric emptying occurred in 4 patients, hemorrhage occurred in 1 patient, wound infection or fat liquefaction occurred in 6 patients, abdominal infection and pyoperitoneum occurred in 4 patients, and pancreatic fistula occurred in 3 patients. All of the patients were followed up for 4-60 months, and the median time were 28 months. During the follow up period, 11 patients developed diabetes and 10 patients developed steatorrhea, respectively. In addition, the pain related score, including frequency of pain attacks, visual analogue scale of pain, analgetic medication, inability to work, and total pain score, were significantly reduced after Frey procedure (P＜0.001). Moreover, all the functional scales of EORTC -QLQ-C30, except for cognitive function, were improved postoperatively (P ＜0.001). Regarding to the symptom scales, the score of fatigue, pain, loss of appetite, and loss of body weight were significantly lower after surgery (P＜0.050). The scores of QOL after surgery were higher than before surgery (P＜0.001). Conclusion Frey procedure results in good post-operative pain control and significant improvement in qol.
目的 探讨急性胰腺炎继发感染的治疗方法。方法 分析总结我院1998～1999年收治的20例胰腺感染患者，采用经后上腰腹膜后引流及灌洗方法治疗的资料。结果 术后并发症： 残余脓肿2例，消化道出血1例，肠瘘4例，胰瘘6例，经治疗后患者全部治愈。结论 该治疗方法残余感染及死亡率低。
目的 探讨急性胰腺炎后网膜囊早期症状性和感染性假性囊肿的手术引流治疗。 方法 对8例网膜囊早期症状性或感染性假性囊肿行内引流和外引流相结合的引流效果进行临床观察和分析。 结果 内、外引流相结合的方法治疗8例早期症状性假性囊肿或感染性假性囊肿均获得治愈，无并发症。 结论 在急性胰腺炎后早期的网膜囊症状性或感染性假性囊肿的治疗中，内、外引流相结合的治疗方法有更大的适应范围，可以取内、外引流之利，弃内、外引流之弊。