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The Character and Surgery of Pseudocyst Due to Acute Pancreatitis （Report of 115 Cases）

ObjectiveTo determine the characters of symptomatic pancreatic pseudocyst due to acute pancreatitis and effects of surgical treatment with two kinds of procedure （internal drainage or external drainage）. MethodsOne hundred and fifteen cases hospitalized during recent ten years were retrospectively analyzed.ResultsWe found that necrotic tissue existed in the pseudocyst in most cases and infection might occur in these pseudocyst. Although effect of two kinds of surgery was similar, the clinical course was different. The complications after surgery were fewer in patients underwent internal drainage than that with procedure of external drainage, and average hospital day was 7d in cases with internal drainage and 11d in cases with external one respectively. Surgery of internal drainage used in treatment was not only successful in noninfectious and single pseudocyst, but in infectious or multiple seudocyst.ConclusionInternal drainage should be used in most cases and considered as the first selection in surgery of pseudocyst due to acute pancreatitis.

Nutritional Supart in Patients with Severe Acute Pancreatitis

Modulation of Disorder of InflammatoryAssociated Cytokines with ImmunoSuppressive Agents in Acute Pancreatitis

bjectiveTo observe the effecacy of immunosuppressive agents on modulation of the disorders of inflammatory and antiinflammatory cytokines in acute pancreatitis, and to investigate the mechanism of treatment of acute pancreatitis with immunosuppressive agents. MethodsSD male rats were divided into 6 groups: group 1, the normal control group (n=6); group 2, acute pancreatitis induced by ductual injection of 5%sodium cholate sulfur at the volume of 1.0 ml/kg without treatment (n=8). After the pancreatitis were induced, the rest rats were injected intravenously with 5Fu 40 mg/kg (group 3, n=6); or methylprednisolone 30 mg/kg (group 4, n=6); or cyclophosphamide 20 mg/kg (group 5, n=6); or methotrexate 1.2 mg/kg (group 6, n=6). Twentyfour hours afteroperation, the animals were killed, the blood samples were taken for measurement of TNFα, IL1, IL6 (by bioassay), and IL10, TGFβ (by ELISA) as well as amylase. ResultsThe inflammatory cytokines (TNFα,IL1,IL6 ) and the antiinflammatory cytokines (IL10 and TGFβ), in blood of acute pancreatitis were increased significantly. After treated with immunosuppressive agents, both the inflammatory and antiinflammatory cytokines were decreased in different degrees. Some indexes of the severity of acute pancreatitis, such as amylase and pancreatic weight were improved obviously.ConclusionImmunosuppressive agents can regulate inflammatoryassociated cytokines increased remarkably in the acute pancreatitis. Therefore, improvement of acute pancreatitis can be achieved through rectifying the abnormal immunity and relieving the pathophysiological disorders of the acute pancreatitis by immunosuppressive agents.

Effect of Early Application of Traditional Chinese Medicine in Treating Severe Acute Pancreatitis with Paralytic Intestinal Obstruction by Retention Enema Catharsis

目的：觀察柴芩承氣湯治療重癥急性胰腺炎(SAP)并發麻痹性腸梗阻 (Paralytic Intestinal Obstruction)的療效。方法:依據納入和排除標準,選取四川大學華西醫院中西醫結合科收治的SAP患者40例,按1∶1比例隨機分成試驗組(20例)和對照組(20例),試驗組入院時即給予柴芩承氣湯灌腸治療,對照組使用安慰劑灌腸治療;兩組入院時基線資料差異無統計學意義(Pgt;005)，且兩組均給予相同常規西醫治療。觀察入院后其首次自行排便排氣時間,入院時、入院后第3天、第7天APACHEⅡ評分及住院病程。結果:入院后首次自行排便排氣時間試驗組（302±154）天,低于對照組（453±241）天;入院后第3天APACHEⅡ評分試驗組（925±184）分，低于對照組（1163±222）分;入院后第7天APACHEⅡ評分試驗組（624±247）分，低于對照組（881±325）分。住院時間試驗組（2453±426）天,低于對照組（3032±589）天。結論:早期應用柴芩承氣湯灌腸治療SAP并發麻痹性腸梗阻,可縮短麻痹性腸梗阻的持續時間及減輕其危害,減少住院病程。

ＲＩＳＫ　ＦＡＣＴＯＲＳ　ＯＦ　ＰＡＮＣＲＥＡＴＩＣ　ＡＮＤ　ＰＥＲＩＰＡＮＣＲＥＡＴＩＣ　ＳＥＰＴＩＣ　ＮＥＣＲＯＳＩＳ　ＩＮ　ＡＣＵＴＥ　ＰＡＮＣＲＥＡＴＩＴＩＳ

Ａ　ｒｅｖｉｅｗ　ｏｆ　ｐａｔｉｅｎｔｓ　ｗｉｔｈ　ａｃｕｔｅ　ｐａｎｃｒｅａｔｉｔｉｓ　ｔｒｅａｔｅｄ　ｉｎ　ｔｈｉｓ　ｈｏｓｐｉｔａｌ　ｉｎ　ｒｅｃｅｎｔ　１０　ｙｅａｒｓ　ｗａｓ　ｍａｄｅ．Ｔｏ　ｄｅｔｅｒｍｉｎｅ　ｔｈｅ　ｒｉｓｋ　ｆａｃｔｏｒｓ　ｏｆ　ｓｅｐｔｉｃ　ｎｅｃｒｏｓｉｓ　ｉｎ　ａｎｄ　ａｒｏｕｎｄ　ｔｈｅ　ｐａｎｃｒｅａｓ，３２　ｃａｓｅｓ　ｗｉｔｈ　ｓｅｐｔｉｃ　ｎｅｃｒｏｓｉｓ　ｗｈｉｃｈ　ｗｅｒｅ　ｐｒｏｖｅｄ　ｉｎ　ｓｕｒｇｉｃａｌ　ｏｐｅｒａｔｉｏｎ　ａｎｄ　４４　ｃａｓｅｓ　ｗｉｔｈｏｕｔ　ｓｅｐｔｉｃ　ｎｅｃｒｏｓｉｓ（ａｓ　ｃｏｎｔｒｏｌ）ｗｅｒｅ　ｉｎｃｌｕｄｅｄ　ｉｎ　ｔｈｉｓ　ｓｔｕｄｙ．Ｔｈｅ　ｐｏｓｓｉｂｌｅ　ｆａｃｔｏｒｓ　ｗｅｒｅ　ｃｏｍｐａｒａｔｉｖｅｌｙ　ａｎａｌｙｓｅｄ．Ｔｈｅ　ｒｅｓｕｌｔｓ　ｓｈｏｗｅｄ　ｔｈａｔ　ｓｅｐｔｉｃ　ｎｅｃｒｏｓｉｓ　ｉｎ　ａｎｄ　ａｒｏｕｎｄ　ｔｈｅ　ｐａｎｃｒｅａｓ　ｏｂｖｉｏｕｓｌｙ　ｒｅｌａｔｅｄ　ｔｏ　ｔｈｅ　ｄｉａｇｎｏｓｔｉｃ　ｏｒ　ｔｈｅｒａｐｅｕｔｉｃ　ｐｕｎｃｔｕｒｅｓ，ｅａｒｌｙ　ｓｕｒｇｉｃａｌ　ｄｒａｉｎａｇｅ　ａｎｄ　ｐａｒａｌｙｔｉｃ　ｉｌｅｕｓ（ＯＲ　３０２－５４８，Ｐ＜００５)，ｂｕｔ　ｔｈｅｒｅ　ｗｅｒｅ　ｎｏ　ａｓｓｏｃｉａｔｉｏｎｓ　ｗｉｔｈ　ａｇｅ，ｅｔｉｏｌｏｇｙ，ｓｈｏｃｋ，ｒｅｓｐｉｒａｔｏｒｙ　ｆａｉｌｕｒｅ　ａｎｄ　ｔｏｔａｌ　ｐａｒｅｎｔｅｒａｌ　ｎｕｔｒｉｔｉｏｎ（ＯＲ　０７８－１２６，Ｐ＞００５）．Ｔｈｅ　ａｕｔｈｅｒｓ　ｓｕｇｇｅｓｔ　ｔｈａｔ　ｅｉｔｈｅｒ　ｐａｎｃｒｅａｔｉｃ，ｐｅｒｉｐａｎｃｒｅａｔｉｃ　ｐｕｎｃｔｕｒｅ　ｏｒ　ｅａｒｌｙ　ｓｕｒｇｉｃａｌ　ｄｒａｉｎａｇｅ　ｓｈｏｕｌｄ　ｂｅ　ｌｉｍｉｔｅｄ　ａｎｄ　ａｎｙ　ｍｅｄｉｃａｔｉｏｎ　ｗｈｉｃｈ　ｍａｋｅｓ　ｐａｒａｌｙｔｉｃ　ｉｌｅｕｓ　ｄｅｔｅｒｉｏｒａｔｅｄ　ｓｕｃｈ　ａｓ　ａｔｒｏｐｉｎｅ　ｓｈｏｕｌｄ　ｂｅ　ａｖｏｉｄｅｄ　ｉｎ　ｔｈｅ　ｔｒｅａｔｍｅｎｔ　ｏｆ　ａｃｕｔｅ　ｐａｎｃｒｅａｔｉｔｉｓ．

Relationship between Inducible Nitric Oxide Synthase and Endothelin mRNA Expression and Intestinal Damage and Effect of Salvia in Acute Pancreatitis

【摘要】目的探討重癥急性胰腺炎(SAP)時胰腺組織的誘導型一氧化氮合成酶(iNOS)、內皮素（ET1） mRNA表達狀態, 以及與血漿中NO、ET1濃度和腸道損傷的關系及丹參治療的影響。方法Wistar大鼠45只隨機分為3組:SAP模型組(A組),SAP丹參治療組(B組),假手術 組(C組),進行不同治療和觀察分析。結果A組血中淀粉酶(AML)、ET1、NO、內毒素(LPS)含量、125 I白蛋白累積指數及腹水量均顯著高于C組(Plt;0.01);與A組比較,B組胰腺ET1和iNOS mRNA表達較弱,血中AML、ET1、NO、LPS及腹水量顯著下降(Plt;0.01),125 I白蛋白累積指數較A組也有下降,但無差異(Pgt;0.05)。結論SAP時存在腸道損傷,胰腺組織ET1、iNOS mRNA的過度表達,使血中ET1、NO濃度升高,造成腸道屏障功能受損,腸通透性增加,引起內毒素血癥。丹參注射液通過減輕SAP時胰腺的病理損害程度,下調胰腺ET1和iNOS mRNA的表達,使血中ET1、NO濃度下降,對SAP及其腸道損傷有一定治療作用。

THE ROLE OF ENDOTHELIN IN THE PATHOGENIC MECHANISM OF ACUTE PANCREATITIS IN RATS

Objective To study the effects of endothelin (ET) on acute pancreatitis in rats. Methods The acute edematous pancreatitis (AEP) and hemorrhagic necrotizing pancreatitis (AHNP) model of rats were induced by cerulein and dextran-110 and endothelin-1 was administered on AEP rats via intravenous injection. Serum amylase, plasma ET and 6-Keto-PGF1α, pancreas hostologic observation were determined. Results The serum concentration of amylase increased markedly in AHNP rats, and there was a significant difference between AHNP and AEP (Ｐ＜0.01). A dose of extrinsic ET-1 may induce the conversion of AEP to AHNP in rats. The degree of pancreatic damage correlates positively with the level of the plasma ET. Conclusion Endothelin might take part in the development of acute pancreatitis, and play a key role in the conversion of AEP to AHNP.

The Treatment of Severe Acute Pancreatitis by Using Somatostatin and Parenteral Nutrition

目的探討生長抑素和腸外營養對重癥急性胰腺炎的治療作用。方法采用生長抑素和腸外營養支持對15例重癥急性胰腺炎患者進行治療（實驗組），并與同期22例未采用上述治療措施者（對照組）進行比較分析。生長抑素用思他寧，并按6 mg/d持續靜脈滴注； 腸外營養支持視臨床情況按常規給予。結果實驗組并發癥發生率、手術率和死亡率均顯著低于對照組（P＜0.01）。結論生長抑素和腸外營養支持對重癥急性胰腺炎具有較佳的治療效果。

Experimental Study of Relationship of Zonula Occludens-1 and Microvascular Injury in Rats with Severe Acute Pancreatitis

Objective To investigate the changes of expression of zonula occludens-1(ZO-1) in rats with severe acute pancreatitis (SAP), and to study the relationship between the ZO-1 protein and microvascular injury in rats with SAP. Methods Forty-eight Wistar rats were randomly divided into sham-operation (SO) group and SAP group, each group enrolled 24 rats. Pancreas of rats in SO group were flipped only after laparotomies, but rats of SAP group were injected with 5% sodium taurocholate by retrograding cholangiopancreatography micro pump to produce the SAP model. At 6, 12, and 24 hours after operation, 8 rats were sacrificed to get abdominal aortic blood for testing the levels of peripheral blood amylase, trypsin, interleukin-8(IL-8), tumor necrosis factor-α(TNF-α), and ZO-1 protein. At the same time, pancreatic tissues were got to perform HE staining and immunohistochemical staining for observation of the pathological changes and the expression of ZO-1 protein respectively. Results Compared with SO group at the same time, the levels of peripheral blood amylase, trypsin, IL-8, TNF-α, and ZO-1 protein were all higher in SAP group (P < 0.05). The level of amylase in SAP-24 hours group was higher than those of 6 hours group and 12 hours group(P < 0.05), the levels of trypsin, IL-8, and ZO-1 protein in SAP group increased over time (P < 0.05), but levels of TNF-αin 3 time points of SAP group did not differ with each other significantly(P > 0.05). Results of regression showed that in the SAP group, the level of ZO-1 protein in serum was significantly positive correlated with pathological score of pancreatic tissue(b=0.96, P < 0.05), levels of serum amylase(b=0.87, P < 0.05), trypsin(b=0.72, P < 0.05), and serum IL-8 (b=0.69, P < 0.05), but was not significantly correlated with level of TNF-α(P > 0.05). HE staining results showed that damage of pancreatic tissues became worse over time in SAP group, and the pathological score of SAP-6 hours group was lower than those of 12 hours group and 24 hours group (P < 0.05). Immunohistochemical staining results showed that, in SAP group, with the extension of time, the number of ZO-1 protein granules in pancreatic acinar cells and capillary wall reduced, and expressed in capillaries discontinuously. Conclusion During the course of SAP, the concentration of serum ZO-1 protein increase, but its expression in the pancreatic tissue degrade, which is closely associated with microvascular injury and progression of pancreatic tissues.

Status of Minimally Invasive Step-Up Approach in Treatment of Severe Acute Pancreatitis

ObjectiveTo summarize the clinical application of the minimally invasive step-up approach in the treatment of severe acute pancreatitis (SAP), and to explore the clinical indications, timing for the minimally invasive step-up approach, and to make comparison with open necrosectomy. MethodsThe literatures about the treatment of SAP in recent years were collected to make a review. ResultsThe minimally invasive step-up approach, comparing with open necrosectomy, was more effective to treat SAP, however, itself had its own limitations. In the treatment process, the optimal method was minimally invasive step-up approach, but also did not exclude open necrosectomy. ConclusionsThe treatment of SAP can not rely on a single method, it needs a comprehensive treatment which is relate with multidisciplinary management and highly individual choice. In addition, it needs further study to explore the timing and indications for transforming minimally invasive step-up approach into open necrosectomy.