ObjectiveTo understand the research progress of treatment of hyperkalemia after simultaneous pancreas and kidney transplantation (SPK), and to provide the basis for the prevention and treatment of hyperkalemia after SPK.MethodThe relevant literatures about hyperkalemia after SPK in recent years were reviewed.ResultsThe pancreas and kidney that maintained the stability of serum potassium in different ways had been confirmed in current studies. The newly transplanted organ dysfunction after SPK and the use of drugs after SPK both caused hyperkalemia. The treatment principle of hyperkalemia after SPK was to take corresponding prevention and treatment measures according to different reasons.ConclusionsSPK is the best treatment for diabetic renal failure. Postoperative hyperkalemia is one of the most common complications, and timely and correct management is of great significance to the survival and prognosis of patients.
Objective To summarize the imaging manifestation and identification of ectopic pancreas (EP), so as to improve clinicians and radiologists’ knowledge of EP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate and avoiding unnecessary surgery. Methods Combined with clinical experience and relevant literatures in recent years, the histopathology, common imaging manifestations and main differential diagnosis of ectopic pancreas were summarized. Results EP is a rare congenital developmental anomaly of pancreas, the most common location is the upper digestive system. At present, the commonly used imaging technology is computed tomography. The imaging findings of ectopic pancreas were similar to those of normal pancreas, and its density and enhancement characteristics were related to its histopathological composition. The specific signs of ectopic pancreas include “central umbilical sign” “ductal structure” and “flat/adherent sign”. Heterotopic pancreas should be differentiated from submucosal tumor of gastrointestinal tract. Conclusions The imaging findings of EP have certain characteristics. For some cases with atypical imaging findings, imaging diagnosis is difficult.
【Abstract】 Objective To summarize the experience in radical excision of carcinoma of head of pancreas in order to improve the surgical skills and reduce the occurrence of postoperative complications. Methods The clinical material of 55 patients (ages: 32-72 years; mean age: 56.5 years) with carcinoma of head of pancreas who received radical excision from January 1996 to March 2005 were analyzed retrospectively. All the cases were pathologically verified as ductal adenocarcinoma of head of pancreas. The treatment time following the operations was divided into two phases by year 2002 ( phaseⅠ: 1996-2002; phaseⅡ: 2002-2005). Different surgical treatment groups were fixed and ICU and other measures were implemented during the second phase. Results All the patients, consisting of 31 males and 24 females, underwent consecutive extended resection. The radically curative rates of phaseⅠand phaseⅡ were 25.9%(29/112) and 34.7%(26/75), respectively, and the complication rates were 48.3%（14/29） and 19.2%（5/26）, respectively. A variety of surgical skills would improve the operation, including extended regional lymphadenectomy, resection of involved nerve plexus, combined vessel resection and comprehensive bleeding-control technique and so on. Conclusion The improvement of radically curative effect and the reduction of complication rate depend on the advancement of surgical skills and the further understanding of pathophysiology of carcinoma of head of pancreas.
ObjectiveTo observe the effect of 5Fluorouracil(5FU) on the exocrine pancreas. MethodsThe effects of 5FU were investigated in 8 patients who had undergone pancreatoduodenectomy. The pancreatic juice was temporarily diverted to the exterior via a pancreatic duct catheter.Ten days after operation,the patients were injected intravenously with 5FU 500 mg/d for three days. The samples of pancreatic juice were taken for measurement of amylase,pH, HCO3-, Na+, K+, Cl-, Ca2+ and Mg2+.ResultsThe amylase, pH, HCO3-, Na+, K+, Cl-, Ca2+ and Mg2+ did not alteredsignificantly before and after 5FU injection.Conclusion5FU has no shortterm effect on exocrine pancreas. Therefore, improvement of acute pancreatitis cannot be achieved through inhibiting pancreatic enzymes synthesis.
ObjectiveTo summarize clinical features, imaging findings, and pathological characteristics of pancreas intraductal papillary mucinous neoplasm (IPMN) and to improve effect of clinical diagnosis and treatment of pancreas IPMN.MethodThe clinical data of 45 patients with pancreas IPMN who underwent surgical resection from February 2014 to February 2019 in the First Affiliated Hospital of Soochow University were retrospectively analyzed.ResultsOf the 45 patients with pancreas IPMN, 28 patients were male and 17 patients were female, aged from 44 to 81 years old with (65±21) years old. There were 35 patients with age > 60 years old. The most common clinical manifestation was the upper abdominal discomfort (26 patients) and the lesions mainly occurred in the head of pancreas (20 patients). Twenty-four (58.5%, 24/41) patients and 17 (81.0%, 17/21) patients were definitely diagnosed by the CT and MRI, respectively. Twenty-five patients underwent the pancreaticoduodenectomy, 5 patients underwent the partial pancreatectomy, 2 patient underwent the pancreatic tumor resection, 12 patients underwent the pancreatic body and tail resection, 1 patient underwent the total pancreatectomy. The pathological findings showed that 15 cases were mild dysplasia, 5 cases were moderate dysplasia, 3 cases were severe dysplasia. Six cases invaded the pancreas and its surrounding adipose tissue, 5 cases invaded the tissue outside the pancreas. After the discharge, 28/32 patients were followed up for 3 to 24 months. Among all the followed-up patients, the 1-year survival rate was 100% (28/28) and the 2-year survival rate was 96.4% (27/28). The patients underwent the CT examination on the 3rd, 6th, 12th,18th, and 24th month, no lymph node metastasis was found.ConclusionsPancreas IPMN is more common in the elderly, mainly manifests as gastrointestinal symptoms, such as upper abdominal discomfort, etc. Surgery is its main treatment mean. Preoperative diagnosis mainly depends on CT examination and MRI examination, but positive rate of MRI examination is higher. Postoperative pathological section shows different degree of dysplasia.
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.
ObjectiveTo do a brief introduction and prospects for simultaneous pancreas and kidney transplanta-tion from aspects of recipient screening, choice of operative method, prognosis, quality of life, and complications. MethodDomestic and international literatures were collected to summary the effect, prognosis, and the latest progress of simultaneous pancreas and kidney transplantation in the treatment of diabetes. ResultsAs a kind of mature treatment of diabetic with end-stage renal disease, simultaneous pancreas and kidney transplantation had been carried out in most transplantation centers around the world, it had the definite therapeutic effect and controllable side effects, the life quality of posttransplantation patients would be improved notably. However, the screen of transplantation patient, the selection of transplantation operation, and the postoperative immunosuppressive protocols had not yet been reached a consensus. ConclusionsSimultaneous pancreas and kidney transplantation is the most effective treatment for type 1 diabetes patients with end-stage renal disease, it provides a more feasible and more physiological way for the secretion of insulin. Although the patient has to undergo a major operation and take some risk, simultaneous pancreas and kidney transplantation still improves the patient's survival rate and the quality of life, and reduces the incidence of complications related to diabetes. Based on the above reasons, simultaneous pancreas and kidney transplantation should be a preferred treatment for all eligible patients.
Pancreatic sinistral portal hypertension (PSPH) is a clinical syndrome resulting from pancreatic disease that blocks splenic vein return, which includes acute and chronic pancreatitis, pancreatic tumors, and iatrogenic factors related to pancreatic surgery. Most PSPH patients present with isolated gastric varices, splenomegaly and hypersplenism, with normal liver function, and upper gastrointestinal bleeding caused by varices in the fundus of the stomach is the most serious clinical manifestation. The treatment of PSPH can be divided into the treatment of portal hypertension in the spleen and stomach region, including close follow-up, medication, endoscopic therapy, splenic artery embolization and splenectomy, etc. The primary diseases of pancreas are mainly treated for acute pancreatitis, chronic pancreatitis and pancreatic tumor. In particular, PSPH related to pancreatic surgery should be concerned.
Objective To find out the beneficial and harmful effectiveness of tacrolimus (TAC) compared with cyclosporine A (CSA) for simultaneous pancreas-kidney transplant (SPKT) recipients. Methods Randomized controlled trials (RCTs) of TAC versus CSA for SPKT recipients were collected from The Cochrane Library, MEDLINE, EMbase, SCI, and CBM database. Bias risk assessment and meta-analysis were performed based on the methods recommended by the Cochrane Collaboration. Results Five RCTs including 342 recipients were included. Pooled data of pancreas survival favored TAC (RR=1.15, 95%CI 1.04 to 1.27; RD=0.11, 95%CI 0.03 to 0.19). However, there were no significant differences of acute rejection (RR=0.81, 95%CI 0.58 to 1.12), patient survival (RR=1.00, 95%CI 0.94 to 1.05), kidney survival (RR=1.02, 95%CI 0.95 to 1.09), and infection (RR=1.00, 95%CI 0.83 to 1.20). Conclusion Based on the recent evidence, TAC results in higher episodes of pancreas survival compared with CSA after SPKT. Treating 100 patients with TAC instead of CSA would increase pancreas survival in 11 recipients.
ObjectiveTo summarize the status and progress of imaging studies of pancreatic neuroendocrine neoplasms (pNENs).MethodThe relevant literatures published recently at domestic and abroad about the imaging of pNENs were collected and reviewed.ResultsDue to poor visibility of pancreatic body and tail, the application of ultrasound (US) was limited. Compared with US, endoscopic ultrasound (EUS) and contrast-enhanced ultrasound (CEUS) could improve the detection rate of pNENs. The ability of plain CT scans to differentiate pathological grades was still controversial, but the value of enhanced scan was higher. CT texture analysis was feasible in the discrimination of nonhypervascular pNENs and pancreatic ductal adenocarcinoma (PDAC). Teta2 was the parameter with the highest diagnostic performance. The enhanced features of MRI were similar to CT. Combined with the apparent diffusion coefficient (ADC) value, the diagnostic and classification capabilities of MRI were improved, and the sensitivity and specificity of different ADC thresholds were also different. 68Ga-tetraazacyclododecane tetraacetic acid (68Ga-DOTA) peptide PET-CT had good preliminary diagnostic value for well-differentiated pNENs, and 18Fluoro-fluorodeoxyglucose (18F-FDG) PET-CT had limited diagnostic value.ConclusionsSomatostatin receptor imaging is of high diagnostic value and can guide clinical treatment and predict prognosis, but it has not been widely used in China. Conventional morphological images have advantages in the diagnosis and classification of pNENs. Therefore, it is important to choose a proper image inspection method.