胰腺癌早期症状隐匿，缺乏特异性，易被忽视，患者就诊时多为进展期，手术切除率特别是根治性手术切除率较低，远期疗效不佳。近20年来，尽管新的影像诊断技术及综合治疗手段不断问世，给许多恶性肿瘤的治疗开创了崭新的局面，但却未从根本上改变胰腺癌诊治的窘境。胰腺癌总体疗效较差，但早期病例根治术后仍可使其生存率明显延长。据美国对1989～1995年1340家医院的100313例胰腺癌的统计，Ⅰ期胰腺癌的5年生存率为32.8%。日本的全国统计资料显示，Ⅰ期胰腺导管癌的术后5年生存率达61%。可见，提高胰腺癌远期疗效的关键仍在于早期诊断。目前，影像学检查是胰腺癌最常用的检查手段，对影像学检查呈现出一些细微变化而难以定性的患者，下述方法可成为早期诊断的佐证。
ObjectiveTo explore the value of multi-slice CT angiography (MSCTA) in peripancreatic vascular invasion of pancreatic carcinoma. MethodsThirty-eight patients with pancreatic carcinoma were detected by MSCTA technology before operation. The peripancreatic vascular invasion of pancreatic carcinoma was evaluated by multi-planar reconstruction (MPR) and maximum intensity projection (MIP) combined with axial image, and compared with the surgical results. ResultsThe MSCTA results showed that there were 12 patients (31.6%) with vascular invasion in 38 patients with pancreatic carcinoma, and the surgical results showed that there were 16 patients (42.1%) with vascular invasion. There was a b fit goodness of two results (kappa=0.665, P=0.000). The sensibility and specificity of MSCTA was 68.8% (11/16) and 95.5% (21/22), respectively. ConclusionsMSCTA technology has a high correct rate in evaluation of peripancreatic vessel encroached by pancreatic carcinoma, the MSCTA result has a b consistency to the surgical result. It has a value of clinical application in evaluation of peripancreatic vessel encroached by pancreatic carcinoma.
ObjectiveTo investigate the current status and research progress of radioactive 125I seed implantation in the treatment of unresectable pancreatic cancer.MethodsReviewed the relevant literatures to summarize and analyze the mechanism of action, indications and contraindications, implantation methods, clinical efficacy, complications, and treatment measures of radioactive 125I seed implantation in the treatment of pancreatic cancer.ResultsThe mechanism of radioactive 125I seed implantation in the treatment of pancreatic cancer had been deeply studied in terms of gene expression and molecular signal level. The procedure was applicable to a wide range of patients; the implantation methods were abundant, CT and ultrasound guidance had their advantages; it could effectively inhibit tumor growth and improve overall survival rate. It was dramatically for pain relief, as well as low overall complication rate, and the complications could be alleviated by symptomatic treatment.ConclusionRadioactive 125I seed implantation in the treatment of unresectable pancreatic cancer has been widely promoted due to its simple operation and small trauma, and it is effective in controlling tumor growth, prolonging survival, and relieving pain.
目的 探讨胰管结石慢性胰腺炎的诊断和治疗。方法 收集我院1993年3月至2003年9月经手术治疗的胰管结石慢性胰腺炎患者34例的临床资料并进行回顾性分析。结果 全组病例均经B超和CT检查确诊，均经手术治疗。手术方式： 胰十二指肠切除术5例； 胰管切开取石、胰空肠Roux-Y吻合术27例，其中同时行胆囊切除术6例，Oddi扩约肌切开、T管引流术4例，胆肠Roux-Y吻合术2例； 胃空肠、胆肠吻合加活检术2例。治愈31例，缓解2例，死亡1例。结论 影像学检查是诊断本病的重要手段，准确率高。根据合并症和胰管扩张程度选择合适的手术方式，可取得良好治疗效果。
【摘要】 目的 探讨125I粒子植入治疗中晚期胰腺癌的临床并发症及相关护理措施。 方法 回顾分析2006年10月-2010年4月121例行125I粒子植入治疗的胰腺癌患者的临床治疗及护理，采取积极有效的护理措施，预防及处理并发症，促进患者康复。 结果 121例患者接受放射性125I粒子植入治疗后，7例出现胰瘘，13例出现胃肠道反应，经对症处理和精心护理后均治愈。 结论 125I粒子组织间植入近距离治疗中晚期胰腺癌近期疗效好、安全、副反应少，良好的护理对改善中晚期胰腺癌患者预后具有重要意义。【Abstract】 Objective To observe the complications in patients with middle and advanced pancreatic carcinoma due to treatment of 125I particle implantation, and the investigate the proper nursing methods. Methods The clinical data including the therapy and nursing methods for the complications in 121 patients with middle and advanced pancreatic carcinoma due to treatment of 125I particle implantation from October 2006 to October 2010 were retrospectively analyzed. The treatment and care for complication were analyzed. Results In the 121 patients who had been treated by 125I particle, pancreatic fistula occurred in seven, and severe gastrointestinal upset was found in 13. The patients with the complications recovered after postoperative treatment and nursing. Conclusion 125I particle implantation for patients with middle and advanced pancreatic carcinoma is effective and safe with a few side reactions; proper nursing is important to improve the prognosis.
Objective To investigate the effect of angiostatin gene combined with somastatin on inhibiting proliferation of human pancreatic cancer cell BXPC-3 and endothelial cell of vascular ECV-304 and on inducing their apoptosis in vitro. Methods The pcDNA3/angio was transfected BXPC-3 by liposome-mediated gene transfer method. RT-PCR and Western blot were used to detect the expression of angiostatin gene. In vitro, MTT and flow cytometry (FCM) were used to detect whether angiostatin gene combined with somastatin could effect the growth inhibition of BXPC-3 and ECV-304 cells. Results Angiostatin was expressed and secreted by transfected BXPC-3. The growth of BXPC-3 was inhibited by certain concentration of somatostatin (≥10 μg/ml, P＜0.01）, which was dependent on the dose of somatostatin in a concentration extent; Simultaneity apoptosis was induced （P＜0.01）. But the growth of ECV-304 was not inhibited with somatostation （Pgt;0.05）. Angiostatin could inhibit the growth of ECV-304 and induced apoptosis （P＜0.01）, but it had no effect on the growth of BXPC-3 （Pgt;0.05）. Angiostation gene combined with somatostation could inhibit the growth both of BXPC-3 and ECV-304 （P＜0.01）, and induce apoptosis of them （P＜0.01）; but the effect couldn’t be additived. Conclusions ①Somatostatin directly inhibits the proliferation of human pancreatic cancer cells and induces apoptosis, but it doesn’t directly inhibit angiogenesiso of human pancreatic cancer. ②Angiostatin specially inhibits the proliferation of endothelial cell of vascular and induces apoptosis. Angiostatin could inhibit angiogenesis of human pancreatic cancer to induce necrosis of cancer cell.