Objective To summarize the progress in related basic research of molecular targeted therapy in pancreatic cancer. Method The relevant literatures on oncogenes, epigenome, tumour microenvironment and immunotherapy in recent years at home and abroad were reviewed. ResultsIn basic research, molecularly targeted drugs had shown some efficacy in the treatment of progression of pancreatic cancer, however, in clinical trials, more satisfactory results were not achieved. Conclusion Molecularly targeted therapies for pancreatic cancer are still at a preliminary stage of exploration, and basic research has not yet been effectively translated clinically, which requires further exploration efforts in subsequent studies to provide a more solid and reliable basis for precise treatment of pancreatic cancer and achieve better clinical benefits.
ObjectiveTo summarize the prevention method for pancreatic fistula following pancreaticoduodenec-tomy. MethodLiteratures related to the prevention methods for postoperative pancreatic fistula at home and abroad in recent years were retrieved and summarized. ResultsThe pancreatic fistula was a common complication following pancreaticoduodenectomy. It was mainly caused by preoperative continuous high jaundice, selection of intraoperative anastomosis, and early postoperative pancreatic juice secretion. Trypsinogen was activated by alkaline intestinal juice and then the nearby tissue was digested. Pancreatic juice flowed into abdominal cavity to digest the tissue, then caused serious complications or even death. Through the prevention of drugs, preoperative biliary drainage and intraoperative anastomosis, etc., the incidence of postoperative pancreatic fistula was slightly decreased. ConclusionThe prevention for postoperative pancreatic fistula is an integrated process, and it needs to be ran through the whole perioperative period.
ObjectiveTo summarize the research progress of the relationship between biliary flora and cholangiocarcinoma.MethodThe literatures on the relationship between biliary flora and cholangiocarcinoma were collected and reviewed.ResultsBiliary flora was closely related to the occurrence and development of biliary tract diseases. The inflammatory environment of the biliary tract was an important factor in the occurrence and development of cholangiocarcinoma. Microbes might induce chronic inflammation of the host tissue, leading to cell proliferation and genetic mutation, and ultimately leading to the occurrence of cholangiocarcinoma. Bacterial infection might play an important role in the pathogenesis of cholangiocarcinoma.ConclusionThe study of the role of biliary flora in the development of cholangiocarcinoma may open up a new direction for the prevention and treatment of cholangiocarcinoma.
ObjectiveTo systematically evaluate the effect of different enteral nutrition timing on patients with pancreaticoduodenectomy.MethodsPubMed, Embase, The Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP databases were searched to collect RCTs for nutritional support in pancreaticoduodenectomy patients. The search time was established until March 1 2019. After two independent investigators conducted literature screening, data extraction, and evaluation of the risk of bias in the included studies, a meta-metabolic analysis was performed using the R 3.5.3 software gemtc package, JAGS 3.4.0, and Revman software.ResultsA total of 8 RCTs were included, for a total of 825 patients. The results of reticular meta-analysis showed that there was no significant difference in the duration of hospitalization for patients with pancreaticoduodenectomy, between the enteral nutrition supported at different timing. The results of the ranking probability map suggested that preoperative enteral nutrition was a better option for supporting nutrition in patients with pancreaticoduodenectomy, secondly, timing to give was 24–48 hours after operation.ConclusionsAccording to the results of mesh meta-analysis and probabilistic ranking, the nutritional status of patients is corrected before surgery, and the effect of enteral nutrition is better than other nutritional support methods. Secondly, enteral nutrition should be given at 24–48 hours after operation in combination with ESPEN and ERAS recommendations.
Objective To explore the application of nutritional and inflammatory markers in the prognosis assessment of resectable pancreatic cancer, and to provide new ideas for the prognosis assessment of patients with pancreatic cancer. Method The recent studies on nutritional and inflammatory markers for prognosis of resectable pancreatic cancer at home and abroad were reviewed. Results Radical pancreaticoduodenectomy was the preferred treatment for patients with resectable pancreatic cancer. Poor nutritional status and severe systemic inflammatory response were closely related to postoperative tumor recurrence and other poor prognosis. Nutritional and inflammatory markers played an important role in evaluating the prognosis of resectable pancreatic cancer. Conclusion Nutritional and inflammatory markers, as simple and economical prognostic indicators, have broad clinical application prospects in the prognostic assessment of resectable pancreatic cancer.
Objective To summarize the research progress of magnetic-controlled capsule endoscopy (MCCE) in application for gastric diseases. Method By searching the literatures in domestic and foreign database, the latest literatures on the application of MCCE for gastric diseases were reviewed. Results Compared with traditional gastroscopy, the diagnostic accuracy of MCCE was comparable to that of traditional gastroscopy, and there was no serious complications had been reported in use of MCCE. In addition, MCCE had advantages of comfort, safety, and prevention of cross-infection. However, it could not be used for biopsy and treatment. With the constant technical innovation, application of MCCE would be more extensive in future. Conclusions The diagnostic accuracy of MCCE in gastric diseases is high. Compared with traditional gastroscopy, it has more advantages. The shortcomings of MCCE can be improved with the development of science and technology, and it can be used for the initial screening of gastric diseases.
ObjectiveTo summarize the current status of research in nutritional support for glutamine after hepatectomy.MethodThe literatures on nutritional support of glutamine after hepatectomy in recent years were reviewed by searching domestic and foreign literatures.ResultsThe administration of glutamine up-regulated the expression of liver regeneration genes after partial hepatectomy in malnourished rats, and then stimulated cell mitosis by paracrine and endocrine cells, affecting the uptake of amino acids by hepatocytes and intestinal cells, and promoting hepatocyte proliferation. In clinical applications, glutamine could improve postoperative liver function and immune function, reduce the incidence of infectious complications, then relatively shorten the length of hospital stay, and improve the clinical outcome of patients.ConclusionGlutamine is beneficial to the recovery of liver function and has clinical application value.
目的 探討實施腸內營養的途徑。方法 采用回顧性研究的方法，分析蘭州大學第一醫院2007年1月1日至2007年12月31日實施膽腸吻合術的15例患者的臨床資料，包括復發性膽管結石4例，膽管癌3例，膽總管囊腫3例，壺腹癌（不能根治）5例； 平均年齡75.5歲； 在行膽腸Roux-en-Y吻合時，利用空腸盲襻實施空腸造瘺，術后第12 h開始腸內營養。統計肛門排氣時間、住院時間及并發癥。結果 15例患者平均肛門排氣時間為54.6 h，平均住院時間為12 d，平均營養管拔除時間為20 d； 發生吻合口漏1例，肺部感染1例，切口感染1例，無一例因造瘺而發生機械性腸梗阻。結論 膽腸吻合利用空腸盲襻實施空腸造瘺腸內營養是腸內營養一種方便、可行的途徑，它可以減少并發癥的發生，縮短患者的住院時間，減輕患者的經濟負擔。與傳統的方法比較，不會引起咽部不適及肺部感染，患者依從性好； 不會導致機械性腸梗阻，安全可行。
ObjectiveTo systematically review efficacy of endoscopic ultrasonography guided biliary drainage (EUS-BD) and percutaneous transhepatic biliary drainage (PTBD) on patients with malignant obstructive jaundice.MethodsThe PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, and CNKI were searched online to collect the randomized controlled trials or cohort studies of EUS-BD versus PTBD on the patients with malignant obstructive jaundice from inception to November 30, 2018. Two reviewers independently screened the literatures, extracted the data and assessed the risk of bias of included the studies, then the meta-analysis was performed by using the RevMan 5.3 software.ResultsThree randomized controlled trials and 6 cohort studies involving 496 patients were included. The results of meta-analysis showed that: compared with the PTBD, the EUS-BD had the lower occurrence of complications [OR=0.30, 95% CI (0.20, 0.47), P<0.000 01], lower rate of reintervention [OR=0.11, 95% CI (0.06, 0.22), P<0.000 01], shorter hospital stay [MD=–3.42, 95% CI (–6.72, –0.13), P=0.04], and less hospital costs [SMD=–0.83, 95% CI (–1.16, –0.49), P<0.000 01]. There were no significant differences in the technical success rate [OR=0.88, 95% CI (0.20, 3.85), P=0.86] and clinical effective rate [OR=1.73, 95% CI (0.97, 3.11), P=0.06] between the two groups.ConclusionsCurrent evidence shows that EUS-BD has some advantages of lower occurrence of complications, lower rate of reintervention, shorter hospital stay, and less hospital costs in treatment of patients with malignant obstructive jaundice as compared with PTBD. There are no significant differences between two groups in technical success rate and clinical effective rate. Due to limited quality and quantity of included studies, more high quality studies required to be verified above conclusions.