This paper is to explore changes of intestinal mucosal barrier, intestinal flora, and bacterial translocation in rats with severe acute pancreatitis (SAP). Twenty four male SD rats were randomly divided into the control group (n=10) and the experimental group (n=14). The model of severe acute pancreatitis of rats was induced by the method of injecting adversely 5% sodium taurocholate into the common biliary-pancreatic duct. All of the rats were killed after 24 hours and the level of the serum amylase and the plasma endotoxin was determined after that. The pathological changes of pancreas and small intestine were observed through hematoxylin-eosin staining (HE staining) and the abdominal viscera bacterial translocation rates were tested. With the method of real-time polymerase chain reaction (RT-PCR) the quantity of the intestinal flora was analyzed. In the control group, the level of Escherichia coli, Lactobacillus and Bifidobacterium were 2.08±1.29, 11.04±7.55 and 12.21±4.95, respectively. On the contrast, the level of Escherichia coli in the cecum contents was much higher (9.72±3.58, P < 0.01), while the Lactobacillus number was decreased significantly (0.67±0.34, P < 0.01), and the Bifidobacterium number was also decreased (4.59±3.42, P < 0.05) in the experimental group, so the ratio of Bifidobacterium/Escherichia coli was reversed. Besides, in the experimental group, the plasma endotoxin positive rates and the bacterial translocation rates were much higher (P < 0.01 or P < 0.05) and the pathology scores of pancreas and small intestines were also significantly higher (P < 0.01) than those in the control group. These results indicated that in severe acute pancreatitis rats, the intestinal mucosal barrier was severely damaged and the dysbacteriosis occurs in the intestinal canal. And these might relate to the occurrence and development of multiple organ infection.
ObjectiveTo determine the effectiveness of Yidantong recipe retained enema combined with external application of Jinhuang powder on non-severe acute pancreatitis (NSAP). MethodsA total of 134 patients with NSAP, admitted to the Third People’s Hospital of Chengdu from September 2019 to August 2022 were included in this retrospective cohort study. All patients received routine Western medicine treatment, and they were divided into a observation group (n=66) and a control group (n=68) based on whether they underwent treatment of Yidantong recipe retained enema combined with external application of Jinhuang powder. The variables including incidence of adverse clinical outcome events, severity scores after treatment, the recovery time of flatus and bowel movement, duration of fasting food and water, scores of traditional Chinese medicine (TCM) syndromes and numerical value of blood indices before and after treatment, and the treatment effect of the two groups were statistically analyzed. ResultsCompared with that of the control group, the incidence of multiple organ dysfunction syndrome (MODS) and severe acute pancreatitis (SAP) of the observation group was lower (P<0.05), and the reduction before and after treatment of APACHEⅡ score, BISAP score and Ranson score in the observation group was more than those in the control group (P<0.05). Compared with that of the control group, the recovery time of flatus and bowel movement and duration of fasting food and water of the observation group was shorter (P<0.05). The reduction before and after treatment of the scores of TCM syndromes (abdominal pain, abdominal distention, nausea and vomiting, dry mouth and bitter taste) and numerical value of blood amylase (AMY), alanine aminotransferase (ALT), alanine aminotransferase (AST) and C-reactive protein (CRP) in the observation group were more than those in the control group (P<0.05). Compared with that of the control group (83.33%), the total effective rate of the scores of TCM syndromes (95.59%) of the observation group was higher (P<0.05).ConclusionYidantong recipe retained enema combined with external application of Jinhuang powder in the treatment of NSAP is effective by combining with routine Western medicine.
ObjectiveTo summarize the blood routine indexes and predictive systems that can predict the severity of acute pancreatitis (AP). MethodThe recent domestic and foreign literatures on the predictive value of blood routine indexes for the severity of AP were reviewed.ResultsFrom the current research results at domestic and foreign, independent blood routine indexes such as red blood cell distribution width, average platelet volume, hematocrit (TCT), platelet (PLT) count, platelet distribution width, percentage of immature granulocytes (IG%), and some blood routine calculation indexes such as neutrophil to lymphocyte ratio (NLR), PLT to lymphocyte ratio (PLR), red blood cell distribution width to PLT ratio (RPR), neutrophil-monocyte product, and so on, all had different predictive value for the severity of AP. In addition, multiple prediction modes such as blood routine indexes combined with some serological indexes or other scoring systems could also be used to predict the severity of AP. In general, the predictive value of the NLR, IG%, and HCT on the severity of AP had been unanimously recognized by researchers. However, the conclusions of related studies on the predictive values of PLT, PLR, and RPR on the severity of AP were still controversial. ConclusionsAt present, there are a variety of blood routine indexes can be used to predict severity of AP, but their predictive values are different. Further researches are still needed.
Objective To summarize the risk factors, diagnosis, and treatment experience of intra-abdominal bleeding following surgeries for severe acute pancreatitis. Methods A retrospective review was conducted of 347 patients underwent necrosectomy for severe acute pancreatitis between January 2011 and December 2015 at West China Hospital of Sichuan University. Results Of the 347 patients, thirty-eight patients had intra-abdominal bleeding after surgeries, including 5 patients who had twice bleeding. The bleeding positions including splenic vein (n=7), splenic artery (n=2), pancreatic and peripancreatic vessels (n=8), colonic mesangial vessels (n=6), other vessels (n=12), and extensive osmotic bleeding in abdominal cavity (n=7). Hemostatic modes: suture (n=20), compression hemostasis (n=18), transcatheteranerial embolism (n=2), suture and compression hemostasis (n=4), and conservative treatment (n=1). There were 19 dead patients of 38 bleeding patients. There were statistically significant differences between the hemorrhage group and the non-hemorrhage group on gender, acute physiology and chronic health evaluation (APACHEⅡ) scores and modified Marshall scores at admission, interval onset to surgery, surgical approaches, and morbidity (P<0.05). Compared with the non-hemorrhage group, there were more males, higher APACHE Ⅱ scores and modified Marshall scores, longer interval onset to surgery, and higher mortality in the hemorrhage group. Multivariable logistic regression analysis showed that male patients had higher risk of intra-abdominal bleeding (OR=3.980, P=0.004), as the grow of APACHEⅡ scores, the risk of intra-abdominal bleeding increased (OR=1.487, P<0.001). Conclusions We should pay more attention on the male SAP patients as well as patients with multiple organ dysfunction.
ObjectiveTo explore the safety and feasibility of retrolaparoscopy in treatment of severe acute pancreatitis complicated with infected pancreatic necrosis. MethodsClinical data of 20 patients with severe acute pancreatitis complicated with infectious pancreatic necrosis who received retrolaparoscopy treatment in our hospital from May 2017 to May 2022 were retrospectively collected. ResultsAmong the 20 patients, 18 patients underwent percutaneous catheter drainage, 1 pregnant patient with severe acute pancreatitis underwent laparotomy drainage in the first phase, and 1 patient underwent laparotomy drainage in the first phase from another hospital. All patients underwent successful retroperitoneal drainage, microscopic debridement and drainage were performed. The operation time was 68–106 minutes, (89.8±11.7) minutes; intraoperative bleeding was 100–300 mL, (171.3±61.0) mL; hospitalization was 28–62 d, with median time of 48 d. After the operation, the systemic poisoning symptoms of the patients were quickly relieved. One patient underwent twice retroperitoneoscopic debridement surgeries, and the remaining patients underwent only once retroperitoneoscopic debridement drainage surgery. There were no complications in 17 patients, but 1 patient was complicated by colonic fistula after surgery, 2 patients suffered from abdominal bleeding. After the operation, 20 patients were interviewed, and the follow-up time was 6–62 months, with the median of 31 months. During postoperative follow-up period, the patients’ symptoms completely disappeared and there was no recurrence. ConclusionThe retrolaparoscopic approach in treatment of severe acute pancreatitis complicated with infected pancreatic necrosis is safe and effective, and has few complications.
ObjectiveTo explore clinical effect of enteral nutrition (EN) through nasojejunal tube in severe acute pancreatitis (SAP).MethodsThe clinical and pathological data of 76 patients with SAP who met the inclusion criteria and treated in the Third People’s Hospital of Henan Province from June 2015 to December 2018 were retrospectively collected. According to the nutritional support therapy adopted in the course of treatment, the patients were divided into an EN group (n=44) and a parenteral nutrition group (PN group, n=32), the patients in the EN group were given the EN through the nasojejunal tube and the patients in the PN group were given the routine PN. The APACHE Ⅱ and SOFA scores, nutritional status, and immune function were observed before the treatment and on week 2 after the treatment in the two groups.ResultsThere were no significant differences in the general data of the gender, age, body mass index, etc. between the two groups (P>0.050). ① The score of APACHEⅡ or SOFA score on week 2 after the treatment in both groups was significantly lower than that before the treatment (P<0.050), which in the EN group was significantly lower than that in the PN group on week 2 after the treatment (P<0.050). ② The levels of albumin and prealbumin were increased significantly and the hemoglobin level was decreased (P<0.050) on week 2 after the treatment as compared with those before the treatment in the two groups (P<0.050), which in the EN group were significantly higher than those in the PN group on week 2 after the treatment (P<0.050). ③ The CD4, CD8, and CD4/CD8 and IgG, IgM, and IgA on week 2 after the treatment were significantly lower than those before the treatment in these two groups (P<0.050), which in the EN group were significantly higher than those in the PN group on week 2 after the treatment (P<0.050). ④ The levels of endotoxin, D-lactic acid, diamine oxidase, and serum high mobility group protein B1 on week 2 after the treatment were significantly lower than those before the treatment in the two groups (P<0.050), and which in the EN group were significantly lower than those of the PN group on week 2 after the treatment (P<0.050). ⑤ The complications rate in the EN group was significantly lower than that in the PN group [20.45% (9/44) versus 53.13% (17/32), χ2=8.786, P=0.003].ConclusionEN through nasojejunal tube has a good effect on patients with SAP, which is helpful to improve their immune and nutritional status.
ObjectiveTo investigate treatment of severe acute pancreatitis (SAP) concurrent peripancreatic walled-off necrosis.MethodsThe clinical data and treatment of a patient with SAP from the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The results of discussion of multidisciplinary team (MDT) were summarized.ResultsThe patient was admitted for the SAP with high fever, abdominal pain, and dyspnea for 2 weeks. The enhanced CT scan of the upper abdomen presented severe acute necrotizing pancreatitis with massive peripancreatic walled-off necrosis and pleural effusion. After the full discussion of SAP MDT, the percutaneous sinus tract necrosectomy (PSTN) was performed to relieved the symptom. After the two-stage PSTN treatment, the peripancreatic necrotic tissue was obviously reduced, the drainage was unobstructed, the clinical symptoms and biochemical indicators were obviously improved, and the patient was discharged on day 6 after the surgery.ConclusionsSAP is a critical situation with rapid progression and high mortality, and timing and approach of intervention for complications are very difficult to handle. PSTN could treat SAP with early appearance of infection or walled-off necrosis, which has advantages of less trauma, higher efficiency, and faster recovery as compared with traditional method and is of valuable in clinical practice.
ObjectiveTo summarize progress of immune response in severe acute pancreatitis (SAP) and to provide a basis for appropriate immunotheraphy.MethodThe relevant literatures about the effect of immune response in the SAP with infectious complications in recent years were reviewed.ResultsThe inflammatory cascade reaction occurred in the early stage of SAP. Subsequently, the compensatory anti-inflammatory response syndrome (CARS) arised and immune response of the organism was suppressed. At this stage, the rate of infection was higher than before.ConclusionsCARS is one of major reasons in SAP with infectious complications. At present, fluid infusion, fasting, parenteral nutrition and like are major therapies in SAP. If corresponding immunotherapy could be carried out according to immune mechanism of SAP infection, that is, early appropriate immunosuppressive therapy and dynamic monitoring of body’s immune system state should be performed, when it is found that immunosuppression is present, appropriate immunostimulus therapy will be possible to reduce mortality of SAP and improve its prognosis.
ObjectiveTo investigate the therapeutic effect of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site in treatment of hyperlipidemic severe acute pancreatitis (HL-SAP). MethodsThe clinical data of 34 patients with HL-SAP initially underwent B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site from January 2010 to June 2014 were retrospectively analyzed. According to the different of the onset to treatment time, 34 cases were divided into the≤24 h group and > 24 h group. The serum platelet activating factor (PAF) and triglyceride (TG) at the time of admission and after admission 1, 3, 5, 7, and 10 days were detected, and the hospitalization time, mortality, and the rate of conversion to open surgery were observed. ResultsThe levels of PAF and TG in the both groups tended to gradually decrease with different degrees, were significantly lower than that the before treatment (P < 0.05), and the decline of PAF and TG in≤24 h group were more significant than > 24 h group. The hospitalization time, mortality, and the rate of conversion to open surgery in the≤24 h group were significantly lower than those of the > 24 h group (P < 0.05). ConclusionThe early using of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site would have a beneficial impact on the management of HL-SAP and complications.
ObjectiveTo explore the protective effect of rapamycin on pancreatic damage in severe acute pancreatitis (SAP) and further to explain its protective mechanism.MethodsNinety selected SPF males SD rats were randomly divided into 3 groups: sham-operated group (SO group), SAP group, and rapamycin group (RAPA group), with 30 rats in each group. Then each group of rats were randomly divided into 3 subgroups of 24 h, 36 h, and 48 h, 10 rats in each subgroup. Rats in each group underwent laparotomy, the model was prepared by retrograde injection of solutions into biliopancreatic duct, rats of the SO group were injected with 0.9% normal saline, rats of the SAP group and RAPA group were injected with 5% sodium taurocholate solution, but rats of the RAPA group were injected with rapamycin at 30 min before the injection of 5% sodium taurocholate. All the survival rats in corresponding subgroup were killed at 24 h,36 h, and 48 h after operation respectively, then serum and pancreas tissues of rats were collected, serum inflammatory factors content of IL-1β, IL-6, and TNF-α were detected by ELISA method, expression levels of p-mTOR and p-S6K1 in pancreas were detected by Western blot, pancreas tissues were stained by Hematoxylin-Eosin Staining and pathological changes of pancreas were scored under light microscope.Results① At the timepoint of 24 h, 36 h, and 48 h, the order of the expression levels of p-mTOR and p-S6K1 in pancreatic tissues of 3 groups were all as follows: SO group<RAPA group<SAP group, there were significant difference among any 2 groups (P<0.05). ② IL-1β: at the timepoint of 48 h, the order of the content of IL-1β in 3 groups were as follows: SO group<RAPA group<SAP group, there were significant differences among any 2 groups (P<0.05); IL-6: at the timepoint of 36 h and 48 h, the order of the content of IL-6 in3 groups were as follows: SO group<RAPA group<SAP group, there were significant differences among any 2 groups (P<0.05); TNF-α: at the timepoint of 48 h, the order of the content of TNF-α in 3 groups was as follows: SO/RAPA group<SAP group (P<0.05), but there was no significant difference between the SO group and RAPA group (P>0.05). ③ Pancreatic histological score: at the timepoint of 24 h, 36 h, and 48 h, the order of the pancreatic histological score in3 groups was all as follows: SO group<RAPA group <SAP group, there were significant differences among any 2 groups (P<0.05). ④ The expression levels of p-mTOR and p-S6K1 in pancreatic tissue were positively correlated with the pathological scores of pancreatic tissue (r=0.97, P<0.01; r=0.89, P<0.01).ConclusionRapamycin can reduce the degree of pancreatic damage in SAP and has protective effect on pancreatic tissue.