ObjectiveTo summarize recent research advancement on radically surgical therapy of carcinoma of the body and tail of pancreas． MethodsRelevant literatures about radically surgical therapy of carcinoma of the body and tail of pancreas were collected and reviewed． ResultsRecent experimental researches indicated that distal pancreatectomy was the common used surgical way to treat carcinoma of the body and tail of pancreas. Besides， spleenpreserving distal pancreatectomy, distal pancreatectomy with en bloc celiac axis resection, and laparoscopic distal pancreatectomy were also the choices to the treatment of carcinoma of the body and tail of pancreas. ConclusionThe surgical way to treat carcinoma of the body and tail of pancreas has advanced for these years, but furthermore development requires more great efforts.
This is the first successful case expriences,a method of the procurement of the fetal cadavertic multiple argans for transplantation of the pancreas and thyroid-pararthyroid glands was produced. The liver,pancreas,duodenum,spleen,and both kidneys were harvested en bloc by a group of surgeons,and the right hem-ithyroid-parathyroid glands with pedicle of thd blood vessels wre removed by another group.The pancreas together with the spleen were transplanted to a patient having diabetes mellitus. The thyroid-parathyroid glands were given to another case with bypothyroidism and hypoparathyroidism.Both cases had good results.This method had dicreased the warm ischemia of the transplants,and could provide liver,pancreas,spleen,kidneys and thyroid-parathyroid glands to solve the problem of shortage of fetal organs.
Objective To explore the clinical therapeutic value of pancreatoduodenectomy in patients with carcinoma of ampulla of Vater (AVC). Methods The clinical data of 195 patients with AVC between March 1995 and March 2009 in this hospital were analyzed retrospectively. All the patients were divided into non-surgery group (n＝51), palliative surgery group (n＝96), and resection group (n＝48) according to the treatment methods. Results The 1-year, 3-year, and 5-year survival rates in the resection group were higher than those in the non-surgery group and the palliative surgery group (Plt;0.01). However, the incidence of complications in the resection group was higher than that in the nonsurgery group or the palliative surgery group (Plt;0.05). The radical resection rates, 1-year, 3-year, and 5-year survival rates of carcinomas of head of pancreas were significantly lower than those of carcinomas of the terminal of common bile duct or carcinomas of duodenal papilla (Plt;0.05, Plt;0.01). There was no significant difference of the perioperative mortality, complications rate, 1-year, 3-year, or 5-year survival rate between preoperative drainage jaundice group and preoperative nondrainage jaundice group (Pgt;0.05). The perioperative mortality in the resection group above the age of 70 years old was higher than that of less than or equal to 70 years old （Plt;0.05）. Compared with the non-surgery group or palliative surgery group, there were significant increasement of the incidence of serious or deadly perioperative complications in the resection group (Plt;0.05). Conclusions Surgical resection remains one of the most important measures of the treatment of AVC, in particular, the radical pancreatoduodenectomy is the only effect way for AVC, thus significantly prolonging the patient’s postoperative survivals and significantly improving the qualities of life.
ObjectiveTo compare the efficacy between laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in treatment of carcinoma of head of pancreas. MethodsClinical data of 60 patients with locally advanced carcinoma of head of pancreas who underwent pancreaticoduodenectomy in our hospital from October 2004 to October 2009 were collected, of which 26 patients were in LPD group and 34 patients were in OPD group. ResultsOperative time and hospitalization expense of patients in LPD group were both longer or more than those of OPD group (P<0.05), but blood loss, time of starting activity, time of aeration, time of pulling out the drainage tube, time of pulling out the stomach tube, time of absolute resting on bed, and hospitalization time in LPD group were all shorter or lower than those of OPD group (P<0.05). There were 25 patients suffered with postoperative complications, including 10 patients in LPD group and 15 patients in OPD group, and there was no significant difference between the 2 groups in total incidence of postoperative complication (P>0.05). But in the specific postoperative complication, the incidences of pancreatic fistula and biliary fistula of LPD group were higher than those of OPD group (P<0.05), but incidences of incision infection, pulmonary infection, and systemic infection were all lower than those of OPD group (P<0.05). All patients were followed up for 1-60 months with the median time of 21.5 months. During the follow-up period, in LPD group, 24 patients suffered with recurrence, 20 patients suffered with tumor metastasis, and 24 patients died; in LPD group, 31 patients suffered with recurrence, 25 patients suffered with tumor metastasis, and 31 patients died. There were no significant difference between the 2 groups in the recurrence rate, metastasis rate, mortality, and survival situation (P>0.05). ConclusionsFor carcinoma of head of pancreas, postoperative recovery and infection complications of LPD are significantly superior than those of OPD. But compared with the OPD, it has no obvious advantage in reducing the pancreatic fistula, biliary fistula, delayed gastric emptying, and other complications, and it also has no obvious advantage in improving the long-term survival situation too.
ObjectiveTo summarize the perioperative management experience and the treatment strategy of hyperkalemia after simultaneous pancreas and kidney transplantation (SPK).MethodThe clinical data of patients with diabetes combined with end-stage renal disease who accepted SPK in the Organ Transplantation Center of West China Hospital of Sichuan University from November 2017 to November 2019 were retrospectively analyzed.ResultsA total of 6 patients accepted SPK totally. The cold ischemia time of all allografts was less than 8 h. The levels of fasting blood glucose and serum creatinine were normal in the 5 surviving patients, and the diabetic complications were relieved or improved, except for 1 patient who died of cardiac arrest due to acute left heart failure. There were 1 case of delayed primary renal function recovery, 2 cases of bleeding in the surgical area of pancreas transplantation, 1 case of gastrointestinal bleeding, 3 cases of microthrombosis in the blood vessels of pancreas transplantation, 2 cases of perirenal effusion infection, 2 cases of pulmonary infection, and 1 case of ureterobladder anastomotic leakage, all of which were cured after symptomatic treatment. Only 2 patients occurred hyperkalemia after SPK (the highest level was 6.49 mmol/L and 6.67 mmol/L respectively), and transfusion of 10% glucose injection contain insulin, emergency dialysis and oral fludrocortisone were successively performed on them to restore the potassium density in 1 month and 2 months after surgery. There were no complications of perioperative surgical technical hemorrhage, intestinal leakage, large arteriovenous thrombosis, necrotizing pancreatitis, etc.ConclusionsSPK is the most effective treatment for patients with diabetes combined with end-stage renal disease. Transfusion of 10% glucose injection contain insulin, emergency dialysis, and oral fludrocortisone are effective strategies in treating hyperkalemia after SPK.
Objective To study the clinical significance of central pancreatectomy in treatment of benign tumor of neck and body of pancreas. Methods The clinical data of 29 patients with benign tumor of pancreas were reviewed retrospectively in our hospital during the past 5 years. Results There was no perioperative death. Mean of operative time was （165±45） min （125-270min）， mean of blood loss was （173±88） mL （50-450mL）. The pathological diagnosis of all the patients were benign. Pancreatic fistula occurred in 10 patients. One patient with bleeding after operation was treated with another two operations. Twenty-one patients were followed-up with the time ranged from 3 months to 4 years （average 16 months）. There were no complications related to diabetes. Conclusion Central pancreatectomy is reasonable for patients with benign tumor of pancreas， it could well preserve the endocrine and exocrine function of pancreas， and improve the quality of life of patients.
Objective To summarize the CT, MRI, and positron emission computed tomography (PET) imaging findings of hematologic malignancies of the pancreas, so as to improve the capacity of its diagnosis. Methods After searching articles concerning radiological research about hematologic malignancies of the pancreas, summarizing its imaging characteristics. Results Hematologic malignancies of the pancreas include pancreatic lymphoma, pancreatic multiple myeloma, myeloid sarcoma, posttransplantation lymphoproliferative disorder, and giant lymph node hyperplasia. ① Pancreatic lymphoma: imaging features of pancreatic lymphoma are segmental or diffuse homogeneous enlargement of the pancreas, diameter of mass >5 cm, adenopathy below the level of renal veins, and lack of pancreatic duct dilation. Blurred margins of pancreas by lymphadenopathy is highly suggestive of lymphoma. ② Pancreatic multiple myeloma: pancreatic multiple myeloma are hyperintense on both T1- and T2-weighted images. ③ Pancreatic granulocytic sarcoma: pancreatic granulocytic sarcoma present as homogeneous hypoenhancing mass on CT, usually without pancreatic duct dilation. On MRI, the lesions are isointense and mildly hyperintense on T1- and T2-weighted images respectively. ④ Posttransplantation lymphoproliferative disorder: diameter of leison of posttransplantation lymphoproliferative disorder usually is >5 cm with poor enhancement. Lesions are mildly hyperintense on T2-weighted images and extremely hypermetabolic on PET images. ⑤ Giant lymph node hyperplasia: it mainly appear as solitary noninvasive masses. Punctate calcification and surrounding supply vessels are observed in hyaline vascular type. Plasma cell type demonstrate unapparent enhancement and less calcification. Conclusions Hematologic malignancies of the pancreas manifest different imaging features on CT, MRI, and PET. Familiarity with such characteristics helps to early recognize diseases and determine next-step measures.
ObjectiveTo summarize the application of magnetic resonance imaging (MRI) in the evaluation of pancreatic exocrine function.MethodIn this paper, we reviewed and summarized the related literatures about the application of MRI in the field of pancreatic exocrine function evaluation in recent years.ResultsA variety of MRI techniques could be used to detect the pancreatic exocrine function. In addition to conventional MRI techniques, there were also MRI stimulated by pancreatic secretions, cine (dynamic) cholangiopancreatography based on space selective reverse recovery pulse, and so on.ConclusionThe new MRI techniques have potential for semi-quantitative and quantitative evaluation of pancreatic exocrine function.
Objective To summarize the recent application progress of dual-energy CT in pancreatic imaging. Methods The domestic and international published literatures related to the application of dual-energy CT in pancreatic imaging in recent years were collected and reviewed. Results Dual-energy CT could provide the morphological image and function information of tissues and organs simultaneously. At present, the clinical application of dual-energy CT in pancreatic imaging included low tube voltage technology, iodine overlay, virtual non-enhanced imaging, and monoenergetic imaging. Conclusion Dual-energy CT could contribute to detecting pancreatic lesions, reducing radiation dose, and improving image quality in pancreatic imaging.
ObjectiveTo summarize the current status of imaging in intraductal papillary mucinous neoplasms of the pancreas (IPMN).MethodThe related literatures of imaging about IPMN of the pancreas were searched in the PubMed, CNKI, VIP, and Wanfang Data databases, etc.ResultsA variety of imaging techniques could be used to diagnosis IPMN of the pancreas, including CT, MRI, EUS, and PET-CT. The CT and MRI had great performances to diagnose and differential diagnosis of benign and malignant IPMN of the pancreas. The MRI with new targeted nanoparticle contrast agents could be used to diagnosis the early IPMN of the pancreas. The EUS was very good at detecting the wall nodules in the IPMN of the pancreas. Compared with the CT and MRI, the ability of EUS to grade IPMN of the pancreas was uncertain. The PET-CT was of high performance for the differential diagnosis between the benign and malignant IPMN of the pancreas.ConclusionsVarious imaging technologies have their own advantages in diagnosing IPMN of pancreas. MRI is currently the optimal choice when condition is permit.