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Role of total pancreatectomy in the treatment of paraduodenal pancreatitis:A case report 预览
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作者 Danko Mikulic Tomislav Bubalo +3 位作者 Anna Mrzljak Anita Skrtic Stipislav Jadrijevic Tajana Filipec Kanizaj 《世界胃肠外科杂志:英文版(电子版)》 2019年第6期296-302,共7页
BACKGROUND Paraduodenal pancreatitis(PP)is a rare form of chronic pancreatitis presenting with symptoms of duodenal obstruction.Conservative treatment is often unsuccessful and pancreaticoduodenectomy is the preferred... BACKGROUND Paraduodenal pancreatitis(PP)is a rare form of chronic pancreatitis presenting with symptoms of duodenal obstruction.Conservative treatment is often unsuccessful and pancreaticoduodenectomy is the preferred surgical approach.A mini review of the outcomes of surgical therapy for PP shows that the results of pancreaticoduodenectomy are predominantly favorable.CASE SUMMARY In our case report of PP,we describe an unusual course first presenting with the symptoms of chronic pancreatitis and a pseudocyst of the pancreatic tail.A pseudocystojejunostomy was performed and the late postoperative course was complicated with the symptoms of duodenal obstruction.At laparotomy,PP was found and the patient was treated with a total pancreatectomy.The postoperative course was uneventful and good weight gain with resolution of pain was demonstrated at follow up visits.CONCLUSION Surgery is currently the optimal treatment option for PP.It is also the best diagnostic tool in distinguishing between pancreatitis and pancreatic adenocarcinoma. 展开更多
关键词 Paraduodenal PANCREATITIS GROOVE PANCREATITIS CHRONIC PANCREATITIS TOTAL PANCREATECTOMY Case report
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Evaluation and management of acute pancreatitis 预览
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作者 Ahmed T Chatila Mohammad Bilal Praveen Guturu 《世界临床病例杂志》 2019年第9期1006-1020,共15页
Acute pancreatitis (AP) is one of the most common gastrointestinal causes for hospi-talization in the United States. In 2015, AP accounted for approximately 390000 hospitalizations. The burden of AP is only expected t... Acute pancreatitis (AP) is one of the most common gastrointestinal causes for hospi-talization in the United States. In 2015, AP accounted for approximately 390000 hospitalizations. The burden of AP is only expected to increase over time. Despite recent advances in medicine, pancreatitis continues to be associated with a substantial morbidity and mortality. The most common cause of AP is gallstones, followed closely by alcohol use. The diagnosis of pancreatitis is established with any two of three following criteria:(1) Abdominal pain consistent with that of AP;(2) Serum amylase and/or lipase greater than three times the upper limit of normal;and (3) Characteristics findings seen in crosssectional abdominal imaging. Multiple criteria and scoring systems have been established for assessing severity of AP. The cornerstones of management include aggressive intravenous hydration, appropriate nutrition and pain management. Endoscopic retrograde cholangiopancreatography and surgery are important aspects in management of acute gallstone pancreatitis. We provide a comprehensive review of evaluation and management of AP. 展开更多
关键词 ACUTE PANCREATITIS NECROTIZING PANCREATITIS RESUSCITATION GALLSTONE PANCREATITIS
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自身免疫性胰腺炎的诊断 预览
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作者 尚海涛 李忠廉(审校) 《天津医药》 CAS 北大核心 2019年第7期771-776,共6页
自身免疫性胰腺炎(AIP)是一类特殊的慢性胰腺炎,其临床上依据组织学分为Ⅰ型和Ⅱ型。我国以Ⅰ型为主,是IgG4相关性疾病的一部分,常表现为梗阻性黄疸或胰腺实质的肿块。组织学上表现为病变组织大量淋巴浆细胞的浸润及慢性纤维化。虽然国... 自身免疫性胰腺炎(AIP)是一类特殊的慢性胰腺炎,其临床上依据组织学分为Ⅰ型和Ⅱ型。我国以Ⅰ型为主,是IgG4相关性疾病的一部分,常表现为梗阻性黄疸或胰腺实质的肿块。组织学上表现为病变组织大量淋巴浆细胞的浸润及慢性纤维化。虽然国际胰腺病协会围绕其影像学、血清学、组织学及激素治疗的反应制定了诊断标准,但AIP的临床表现较为隐匿和多样,其诊断仍然具有挑战性,特别是表现为胰腺肿块的患者,需要时刻警惕胰腺癌的风险。本文从影像学、组织学角度对文献进行了概述,重点是这种复杂疾病的诊断及误诊的风险,以期提高本病的鉴别诊断水平。 展开更多
关键词 自身免疫疾病 胰腺炎 综述 IGG4相关性疾病 自身免疫性胰腺炎
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胸腔积液联合血清MCP-1、sTREM-1对急性胰腺炎严重程度的早期评估价值
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作者 宋磊 高明 《中国普通外科杂志》 CAS CSCD 北大核心 2019年第3期299-305,共7页
目的:探讨胸腔积液联合血清单核细胞趋化蛋白1(MCP-1)、可溶性髓系细胞触发受体1(sTREM-1)对急性胰腺炎(AP)严重程度的早期评估价值。方法:收集2017年12月-2018年12月收治的75例AP患者资料,根据病情的轻重将其分为轻症组(31例)和非轻症... 目的:探讨胸腔积液联合血清单核细胞趋化蛋白1(MCP-1)、可溶性髓系细胞触发受体1(sTREM-1)对急性胰腺炎(AP)严重程度的早期评估价值。方法:收集2017年12月-2018年12月收治的75例AP患者资料,根据病情的轻重将其分为轻症组(31例)和非轻症组(44例),比较两组入院时胸腔积液的发生率与其他临床指标的差异,并分析两组血清MCP-1、sTREM-1水平与健康人的差异以及动态变化。通过ROC曲线下面积(AUC)评判各观察指标对AP严重程度的早期评估效能。结果:两组患者性别、年龄、发病原因无统计学差异(均P>0.05),非轻症组C-反应蛋白(CRP)水平、APACHEII评分、胸腔积液发生率明显高于轻症组,且住院时间明显长于轻症组(均P<0.05);血清MCP-1及sTREM-1水平在轻症组与非轻症组均明显高于健康人,但两者在非轻症组均持续高于非轻症组(均P<0.05)。采用CRP(≥98.55mg/L)、APACHEII评分(≥8)、胸腔积液、MCP-1(≥27.84pg/mL)、sTREM-1(≥0.39ng/mL)为指标,分析各自或联合对AP严重程度的预测能力,结果显示,胸腔积液联合血清MCP-1、sTREM-1的评估价值最高(AUC为0.884,灵敏度93.2%,特异度91.3%)。结论:胸腔积液联合血清MCP-1、sTREM-1检测在AP严重程度早期评估方面具有一定临床价值。 展开更多
关键词 胰腺炎 胸腔积液 趋化因子CCL2 髓系细胞触发受体-1
Early immune response in post endoscopic retrograde cholangiopancreatography pancreatitis as a model for acute pancreatitis 预览
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作者 Ivana Plavsic Ivana Zitinic +3 位作者 Vera Tulic Goran Poropat Marinko Marusic Goran Hauser 《世界荟萃分析杂志》 2019年第3期96-100,共5页
This opinion review summarizes comparison of clinical presentation and immunology of post-endoscopic pancreatitis and acute pancreatitis (AP) of other etiology. The rationale for this topic was found in studies that m... This opinion review summarizes comparison of clinical presentation and immunology of post-endoscopic pancreatitis and acute pancreatitis (AP) of other etiology. The rationale for this topic was found in studies that mention differences in clinical presentation between these entities, stating that severe form of AP after endoscopic retrograde cholangiopancreatography was more severe than AP of other etiology. Found difference in clinical presentation may have a background in different immunology that needs to be further investigated. 展开更多
关键词 INNATE immunity PANCREATITIS IMMUNOLOGY POST endoscopic RETROGRADE CHOLANGIOPANCREATOGRAPHY PANCREATITIS
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肿块型慢性胰腺炎的临床特征及诊治:附16例报告
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作者 黄昊苏 严璐 +3 位作者 龙禛朴 余阳华 陈霄霄 彭杰 《中国普通外科杂志》 CAS CSCD 北大核心 2019年第3期320-326,共7页
目的:探讨肿块型慢性胰腺炎的临床特征及诊治。方法:回顾性分析2010-2018年收治的16例肿块型慢性胰腺炎患者的临床资料。结果:16例中男13例,女3例,就诊时中位年龄48.5岁。主要临床表现为腹痛及黄疸,6例CA19-9轻度升高(47.85~235.95U/mL... 目的:探讨肿块型慢性胰腺炎的临床特征及诊治。方法:回顾性分析2010-2018年收治的16例肿块型慢性胰腺炎患者的临床资料。结果:16例中男13例,女3例,就诊时中位年龄48.5岁。主要临床表现为腹痛及黄疸,6例CA19-9轻度升高(47.85~235.95U/mL)。所有患者均行腹部CT检查,均可见胰腺占位,其中3例(18.8%)考虑慢性胰腺炎可能;部分患者行B超、ERCP或其他检查,均主要提示胰腺占位,但均缺乏特征性。16例均行手术治疗,其中11例行胰十二指肠切除术,4例行胰体尾切除+脾脏切除术,1例行保留十二指肠的胰头肿块局部切除+胰肠吻合内引流+胆肠吻合内引流术,术后症状均明显缓解,未发生胰瘘、胆瘘、腹腔出血等并发症。术后病理学检查均为慢性胰腺炎。平均随访3年,手术效果良好。结论:肿块型慢性胰腺炎在临床表现及影像学特征上与胰腺癌极为相似,误诊率较高,需结合病史、临床表现、实验室及影像学检查、组织病理结果进行综合判断,手术干预效果良好。 展开更多
关键词 胰腺炎 慢性/诊断 胰腺炎 慢性/治疗 胰腺肿瘤
内镜下逆行胰胆管造影术后胰腺炎的诊断与防治进展 预览
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作者 刘姗姗 宋吉涛 许军 《胃肠病学和肝病学杂志》 CAS 2019年第6期714-718,共5页
内镜下逆行胰胆管造影术后胰腺炎(post-endoscopic retrograde cholangio-pancreatography pancreatitis,PEP)是内镜下逆行胰胆管造影术(endoscopic retrograde cholangio-pancreatography, ERCP)术后最常见的并发症,其发病率高,病情严... 内镜下逆行胰胆管造影术后胰腺炎(post-endoscopic retrograde cholangio-pancreatography pancreatitis,PEP)是内镜下逆行胰胆管造影术(endoscopic retrograde cholangio-pancreatography, ERCP)术后最常见的并发症,其发病率高,病情严重时甚至导致患者死亡。PEP病因复杂,病理生理学机制尚不明确,对PEP的早期识别、风险分层与防治策略仍是目前研究的重点。本文对PEP相关研究成果作一概述,以期为临床工作提供参考。 展开更多
关键词 内镜下逆行胰胆管造影术 胰腺炎 ERCP术后胰腺炎 风险分层 防治策略
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Piezo1:a novel mechanism of pressure-induced pancreatitis
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作者 Pingbo Yao Hong Zhao +1 位作者 Jiangang Cao Linxi Chen 《生物化学与生物物理学报:英文版》 SCIE CAS CSCD 2019年第3期344-345,共2页
Pancreatitis,the pancreas digestion itself as well as its surroundings,is a potentially fatal disease involved in severe public health care burdens [1].It is broadly classified into acute and chronic pancreatitis.The ... Pancreatitis,the pancreas digestion itself as well as its surroundings,is a potentially fatal disease involved in severe public health care burdens [1].It is broadly classified into acute and chronic pancreatitis.The incidence of acute pancreatitis is 13–45 cases per 100,000 persons each year worldwide.Compared with acute pancreatitis,chronic pancreatitis,although lower in prevalence than acute pancreatitis,has profound effects on the patient’s quality of life.It has long been recognized that the pancreas is prominently sensitive to mechanical injury,which in turn triggers the occurrence of pancreatitis.For instance,gallstones are the most common cause for acute pancreatitis and the increased pressure within the gland could be responsible for gallstone pancreatitis [2].In addition,endoscopic retrograde cholangiopancreatography(ERCP)carries a risk of post-ERCP pancreatitis.And it is believed that the acute pancreatitis induced by ERCP is due to the increased intraductal pressure [3].Furthermore,in the process of surgery,manipulation of the pancreas can trigger acute pancreatitis,which is complicating postoperative recovery [4].Therefore,it is widely believed that the pancreas itself is sensitive to mechanical forces. 展开更多
关键词 PRESSURE-INDUCED PANCREATITIS post-ERCP PANCREATITIS PANCREAS DIGESTION itself
1型自身免疫性胰腺炎27例临床特征
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作者 陈梦诗 梁晓宇 +1 位作者 林志辉 孙龙昊 《中华肝胆外科杂志》 CAS CSCD 北大核心 2019年第8期592-595,共4页
目的分析27例1型自身免疫性胰腺炎(AIP)的临床特征,旨在提高该病的诊治水平。方法回顾性分析2012年1月至2018年10月福建省立医院收治的27例1型AIP患者的临床特征。结果27例1型AIP患者中男性25例(92.6%),女性2例(7.4%),男女比例12.5∶1;... 目的分析27例1型自身免疫性胰腺炎(AIP)的临床特征,旨在提高该病的诊治水平。方法回顾性分析2012年1月至2018年10月福建省立医院收治的27例1型AIP患者的临床特征。结果27例1型AIP患者中男性25例(92.6%),女性2例(7.4%),男女比例12.5∶1;发病年龄(59.5±14.3)岁。最常见的临床表现为黄疸和腹痛(均为16例,59.3%),最常见的合并症为IgG4相关性硬化性胆管炎(17例,63.0%)。26例患者的MRCP,胰腺以弥漫性肿大为主(14例,53.8%),2例(7.7%)胰管狭窄。胆管狭窄以胆总管胰腺段受累为主(22例,84.6%),移形性狭窄17例(65.4%)。27例患者均接受激素治疗,并获得临床、血清学好转,随诊未见复发。2例因血IgG4持续高水平,继续予激素5 mg维持治疗。结论1型AIP是IgG4相关性疾病在胰腺的局部表现,其胰腺外受累以IgG4相关性硬化性胆管炎多见。该病激素治疗有效,部分患者需要长期维持治疗。 展开更多
关键词 胰腺炎 免疫球蛋白G 胰胆管造影术 磁共振 自身免疫性胰腺炎 治疗结果
Diagnosis and treatment of pancreas divisum:A literature review 预览
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作者 Valentina Ferri Emilio Vicente +5 位作者 Yolanda Quijano Benedetto Ielpo Hipolito Duran Eduardo Diaz Isabel Fabra Riccardo Caruso 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第4期332-336,共5页
Background:Pancreas divisum is a congenital embryological disease caused by a lack of fusion between the ventral and dorsal pancreatic ducts in the early stages of embryogenesis.Recurrent acute pancreatitis,chronic pa... Background:Pancreas divisum is a congenital embryological disease caused by a lack of fusion between the ventral and dorsal pancreatic ducts in the early stages of embryogenesis.Recurrent acute pancreatitis,chronic pancreatitis or chronic abdominal pain are the main clinical syndromes at presentation and occur in only 5%of the patients with pancreas divisum.This review aimed to discuss diagnosis and treatment strategies in patients with symptomatic pancreas divisum.Data sources:We report a literature review from 1990 up to January 2018 to explore the various diagnostic modalities and surgical techniques and results reported in the surgical treatment of pancreas divisum.Results:There are limited reports available on this topic in the literature.We analyzed and described the main indications in the treatment of pancreas divisum,focusing on surgical treatment and a discussion of the different approaches.Furthermore,we report the results from our experience in two cases of pancreas divisum treated by pancreatic head resection with segmental duodenectomy(the Nakao procedure).Conclusions:Pancreas divisum is a common pancreatic malformation in which only a few patients develop a symptomatic disease.Surgical treatment is needed in case of endoscopic drainage failure and in cases complicated with chronic pancreatitis and local complications.Many techniques,of greater or lesser complexity,have been proposed. 展开更多
关键词 Pancreas divisum Duodenal-preserving pancreatectomy Chronic pancreatitis Recurrent acute pancreatitis
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Present state of endoscopic ultrasonography-guided fine needle aspiration for the diagnosis of autoimmune pancreatitis type 1 预览
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作者 Mitsuru Sugimoto Tadayuki Takagi +11 位作者 Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato Hiroki Irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Takuto Hikichi Hiromasa Ohira 《世界荟萃分析杂志》 2019年第5期218-223,共6页
Autoimmune pancreatitis(AIP)is defined as pancreatitis caused by irregular narrowing of the pancreatic duct accompanied by pancreatic swelling,fibrosis and lymphocyte infiltration,events that are related to autoimmune... Autoimmune pancreatitis(AIP)is defined as pancreatitis caused by irregular narrowing of the pancreatic duct accompanied by pancreatic swelling,fibrosis and lymphocyte infiltration,events that are related to autoimmune mechanisms.The 2010 International Consensus Diagnostic Criteria for AIP defined pancreatitis as“type 1”when increased levels of serum IgG4 were present and other organs were involved;lymphoplasmacytic sclerosing pancreatitis was the main histological characteristic.Apart from surgery,endoscopic ultrasonographyguided fine needle aspiration(EUS-FNA)is the only method for the histological diagnosis of AIP;however,this method is difficult.The use of larger-diameter FNA needles and trucut biopsy did not improve the diagnostic performance of EUS-FNA,but it has improved gradually.In this review,we look back at past efforts to improve the diagnostic performance of EUS-FNA and reveal the present state of EUS-FNA for the histological diagnosis of AIP type 1. 展开更多
关键词 AUTOIMMUNE PANCREATITIS TYPE 1 Endoscopic ultrasonography-guided fine needle ASPIRATION IgG4-related disease Lymphoplasmacytic SCLEROSING PANCREATITIS
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重症急性胰腺炎的外科治疗进展
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作者 陶锐 马荣 龚建平 《国际外科学杂志》 2019年第5期349-352,共4页
重症急性胰腺炎(SAP)是较常见的外科急腹症之一,其因起病急、进展快、预后差、病死率高等特点,一直是治疗的难点。其早期监护和治疗往往能在一定程度上改善预后,过去曾主张早期手术治疗。随着影像学、医疗技术的进步及对该病的深入研究... 重症急性胰腺炎(SAP)是较常见的外科急腹症之一,其因起病急、进展快、预后差、病死率高等特点,一直是治疗的难点。其早期监护和治疗往往能在一定程度上改善预后,过去曾主张早期手术治疗。随着影像学、医疗技术的进步及对该病的深入研究,对于SAP的治疗已从观念上发生了巨大变化,外科手术的方式也有了突破性的改变,虽然方法选择上仍有诸多争议,但基本已从传统的手术方式逐渐过渡到微创手术。本文主要对SAP外科治疗进展作一综述。 展开更多
关键词 胰腺炎 重症监护 外科手术 进展
脂肪胰诊断及其临床意义的研究进展 预览
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作者 林海萍(综述) 俞世安(审校) 《中国临床新医学》 2019年第6期679-682,共4页
近年来研究发现脂肪胰(fatty pancreas,FP)主要表现为胰腺实质细胞内外的脂肪积聚。目前临床上对其主要有超声、计算机断层扫描(computed tomography,CT)、磁共振(magnetic resonance,MR)等多种诊断方法。临床研究还发现其与糖尿病、胰... 近年来研究发现脂肪胰(fatty pancreas,FP)主要表现为胰腺实质细胞内外的脂肪积聚。目前临床上对其主要有超声、计算机断层扫描(computed tomography,CT)、磁共振(magnetic resonance,MR)等多种诊断方法。临床研究还发现其与糖尿病、胰腺肿瘤等多种疾病相关。该文主要对其临床诊断及临床意义作一综述。 展开更多
关键词 脂肪胰 胰腺炎 胰腺肿瘤
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乌司他丁对糖尿病酮症酸中毒合并胰腺炎患者体内CX3CL1、HMGB1含量的影响 预览
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作者 卫静 唐治国 +1 位作者 寇立臣 黎璞 《四川医学》 CAS 2019年第1期60-63,共4页
目的探讨乌司他丁对糖尿病酮症酸中毒合并胰腺炎患者胰腺组织内趋化因子CX3CL1、高迁移率族蛋白B1(HMGB1)含量的影响。方法选取我院2013年1月至2017年12月收治的糖尿病酮症酸中毒合并胰腺炎患者40例,按照随机数字表法均分为观察组和对照... 目的探讨乌司他丁对糖尿病酮症酸中毒合并胰腺炎患者胰腺组织内趋化因子CX3CL1、高迁移率族蛋白B1(HMGB1)含量的影响。方法选取我院2013年1月至2017年12月收治的糖尿病酮症酸中毒合并胰腺炎患者40例,按照随机数字表法均分为观察组和对照组,每组20例。对照组患者给予常规西药治疗,观察组患者在此基础上加用乌司他丁治疗。观察两组患者测胰腺组织CX3CL1、HMGB1水平变化并进行比较分析。结果治疗前两组患者HMGB1、TNF-α、CX3CL1、血液淀粉酶、血糖、血酮体表达水平比较,差异无统计学意义(P﹥0.05);同组治疗前后相比,两组患者HMGB1、TNF-α、CX3CL1、血液淀粉酶、血糖、血酮体水平均显著降低,观察组明显低于对照组,两组之间差异有统计学意义(P﹤0.05)。观察组的血淀粉酶恢复正常时间,腹痛腹胀缓解时间均明显短于对照组,差异有统计学意义(P﹤0.05)。结论乌司他丁可降低糖尿病酮症酸中毒合并胰腺炎患者体内CX3CL1、HMGB1含量,并有效改善临床症状,提高疗效。 展开更多
关键词 乌司他丁 糖尿病酮症酸中毒 胰腺炎 CX3CL1 HMGB1
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Effects of Da-Cheng-Qi decoction on enteroparalysis and serum inflammatory cytokines in patients with severe acute pancreatitis 预览
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作者 Xiao Wang Guo-Hong Yang +6 位作者 Chen-Xiao Wang Chun-Ying Li Min Guo Ming-Hao Liu Zhen-Jun Zeng Jun Ma Qin-Sheng Zhang 《TMR传统医学研究》 2019年第4期205-212,共8页
Objective: The objective of this study was to investigate the effects of Da-Cheng-Qi decoction (DCQD) on enteroparalysis and levels of the serum inflammatory cytokines C-C motif chemokine ligand 2 (CCL2) and interleuk... Objective: The objective of this study was to investigate the effects of Da-Cheng-Qi decoction (DCQD) on enteroparalysis and levels of the serum inflammatory cytokines C-C motif chemokine ligand 2 (CCL2) and interleukin-8 (IL-8) in patients with severe acute pancreatitis (SAP). Methods: A total of 48 patients diagnosed with SAP who hospitalized in First Affiliated Hospital of Henan Traditional Chinese Medicine University from May 1, 2016 to May 30, 2018 were randomly assigned to the control or treatment groups. Patients in the control group (n = 22) received conventional treatment and those in the treatment group (n = 26) received conventional treatment as well as additional DCQD for 10 days. The duration of abdominal pain and distension, the time when bowel sounds returned to normal, changes in the levels of serum amylase, lipase, C-reactive protein (CRP), CCL2 and IL-8, as well as acute physiology and chronic health evaluation (APACHE)Ⅱ scores of patients on days 1 and 10 were recorded and compared. Results: The duration of abdominal pain and distension, the time when bowel sounds returned to normal, the levels of blood amylase, lipase and CRP, and APACHE Ⅱ scores of patients in the treatment group decreased significantly compared with those of patients in the control group. Though there were no statistical differences in serum CCL2 and IL-8 concentrations on day 1 between patients in these two groups, the levels of serum CCL2 and IL-8 in the treatment group were lower than those in the control group on day 10. Conclusion: DCQD may decrease the levels of CCL2, CRP, and IL-8 in patients with SAP, quickly relieve enteroparalysis, and shorten hospitalization duration. 展开更多
关键词 Da-Cheng-Qi DECOCTION Severe acute PANCREATITIS CRP CCL2 IL-8
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Role of pancreatoscopy in management of pancreatic disease:A systematic review 预览
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作者 Tarun Kaura Field F Willingham Saurabh Chawla 《世界胃肠内镜杂志:英文版(电子版)》 2019年第2期155-167,共13页
BACKGROUND Per-oral pancreatoscopy(POP)plays a role in the diagnosis and therapy of pancreatic diseases.With recent technological advances,there has been renewed interest in this modality.AIM To evaluate the efficacy ... BACKGROUND Per-oral pancreatoscopy(POP)plays a role in the diagnosis and therapy of pancreatic diseases.With recent technological advances,there has been renewed interest in this modality.AIM To evaluate the efficacy and safety of POP in management of pancreatic stone disease and pancreatic ductal neoplasia.METHODS To determine the safety and efficacy of POP in the management of pancreatic diseases,a systematic search was conducted in MEDLINE,EMBASE and Ovid.Articles in languages other than English and case reports were excluded.All published case series were eligible.Data specific to POP were extracted from studies,which combined cholangiopancreatoscopy.Ten studies were included in the analysis of POP therapy for pancreatic stone disease,and 15 case series satisfied the criteria for inclusion for the role of POP in the management of pancreatic ductal neoplasia.The examined data were subcategorized according to adjunctive modalities,such as direct tissue sampling,cytology,the role of intraoperative POP,intraductal ultrasound(IDUS)and POP combined with image-enhancing technology.RESULTS The success rate for complete ductal stone clearance ranged from 37.5%-100%.Factors associated with failure included the presence of strictures,multiple stones and the inability to visualize the target area.Although direct visualization can identify malignant and premalignant conditions,there is significant overlap with benign diseases.Visually-directed biopsies provide a high degree of accuracy,and represent a unique approach for tissue acquisition in patients with ductal abnormalities.Addition of pancreatic fluid cytology increases diagnostic yield for indeterminate lesions.Protrusions larger than 3 mm noted on IDUS are significantly more likely to be associated with malignancy.The rate of adverse events associated with POP ranged from 0%-35%.CONCLUSION Current evidence supports wider adoption of pancreatoscopy,as it is safe and effective.Improved patient selection and utilization of novel technologies may further enhance its rol 展开更多
关键词 PANCREATOSCOPY Cholangiopancreatoscopy Chronic pancreatitis PANCREATIC DUCT stones INTRADUCTAL papillary MUCINOUS neoplasm PANCREATIC cancer PANCREATIC DUCT STRICTURE
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Zinc deficiency in patients with chronic pancreatitis 预览
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作者 Miroslav Vujasinovic Aleksandra Hedstrom +4 位作者 Patrick Maisonneuve Roberto Valente Henrik von Horn J-Matthias Lohr Stephan L Haas 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第5期600-607,共8页
BACKGROUND Zinc is a key element in numerous proteins and plays an important role in essential cell functions such as defense against free radicals and DNA damage repair.Chronic pancreatitis(CP)is a chronic inflammati... BACKGROUND Zinc is a key element in numerous proteins and plays an important role in essential cell functions such as defense against free radicals and DNA damage repair.Chronic pancreatitis(CP)is a chronic inflammation with progressive fibrosis of pancreas ultimately resulting in pancreatic exocrine insufficiency(PEI),which is associated with malnutrition.Studies analyzing zinc levels in patients with CP are sparse and lead to conflicting results.AIM To investigate serum zinc levels in patients with CP of various etiologies.METHODS Between October 2015 and March 2018,patients with a diagnosis of CP were identified and recruited from the Pancreatic Outpatient Clinic at the Karolinska University Hospital in Stockholm,Sweden.Demographic,clinical and laboratory data were analyzed.Etiology of CP was determined according to the MANNHEIM classification system into the following etiological subcategories:alcohol consumption,nicotine consumption,hereditary factors,efferent pancreatic duct factors and immunological factors.Pancreatic exocrine function was defined as normal(fecal elastase 1>200μg/g),mildly reduced(100-200μg/g)and severely reduced(fecal elastase 1<100μg/g).RESULTS A total of 150 patients were included in the analysis.Zinc deficiency(<11μmol/L)was present in 39(26.0%)of patients:22 females and 17 males.In the group of patients with zinc deficiency,76.7%of patients had an exocrine pancreatic insufficiency(FE-1<200μg/g).Older age was significantly associated with low zinc levels.Following a univariate analysis,patients aged 60-69 and patients≥70 years of age had a significantly higher prevalence of zinc deficiencies compared to patients<40 years of age[OR:3.8,95%CI(1.08-13.4);P=0.04];[OR 6.26,95%CI(1.94-20.2),P>0.002].Smoking and number of packyears were additionally associated with low zinc levels.The risk of zinc deficiency in current smokers and smokers with≥20 pack-years was approximately three times higher compared to those who had never smoked.Gender,body mass index,etiology of CP,presence of di 展开更多
关键词 Zinc PANCREAS PANCREATIC EXOCRINE INSUFFICIENCY Chronic PANCREATITIS MALNUTRITION
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内镜下逆行性胰胆管造影术后急性胰腺的危险因素分析
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作者 陈文华 林军 +4 位作者 王红玲 王剑屏 杨晟 胡腾腾 赵秋 《中华全科医师杂志》 2019年第3期256-260,共5页
目的探讨内镜下逆行性胰胆管造影术(ERCP)后引起急性胰腺炎(PEP)的危险因素。方法收集武汉大学中南医院2016年1月至2017年8月消化内科住院行ERCP治疗的1 041例患者的临床特征、手术操作、术后消化道表现及实验室指标。依患者术后临床表... 目的探讨内镜下逆行性胰胆管造影术(ERCP)后引起急性胰腺炎(PEP)的危险因素。方法收集武汉大学中南医院2016年1月至2017年8月消化内科住院行ERCP治疗的1 041例患者的临床特征、手术操作、术后消化道表现及实验室指标。依患者术后临床表现及淀粉酶、脂肪酶、腹部影像学等指标将患者分为术后发生PEP组和未发生PEP组,采用SPSS 22.0进行t检验、U检验、χ^2检验和秩和检验比较两组的临床特征及实验室数据,用logistic回归分析PEP的危险因素。结果PEP组患者53例,未发生PEP组988例,PEP总体发生率5.09%。两组术后白细胞计数[8.56(5.43,12.23)×10^9/L比7.12(5.58,9.20)×10^9/L,Z=-2.122]、中性粒细胞比值(0.82±0.11比0.76±0.12,t=-3.612)、术中乳头括约肌切开[60.37%(32/53)比43.72%(432/988),χ^2=5.646]、胆管球囊扩张[50.94%(27/53)比33.00%(326/988),χ^2=7.230]及乳头旁憩室[35.85%(19/53)比52.98%(523/988),χ^2=4.619]发生率比较,差异有统计学意义(均P<0.05)。logistic回归分析提示术后中性粒细胞比值是发生PEP的独立危险因素(OR=1.058,95%CI:1.019~1.098,P=0.003)。结论术后白细胞数、中性粒细胞比值、术中乳头括约肌切开、胆管球囊扩张及乳头旁憩室与PEP发生相关,其中术后中性粒细胞比值是其独立危险因素。 展开更多
关键词 胰胆管造影术 内窥镜逆行 胰腺炎 危险因素
不同肿瘤与并发胰腺炎患者血清AMY和LPS的分布水平及实验诊断价值研究 预览
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作者 祖瑞铃 叶波 《现代检验医学杂志》 CAS 2019年第1期76-78,82共4页
目的探讨不同肿瘤患者血清淀粉酶(amylase,AMY)和脂肪酶(lipase,LPS)水平,以及AMY和LPS诊断肿瘤患者胰腺炎的价值,为临床医生诊断或排除肿瘤病人胰腺炎提供实验室依据。方法收集四川省肿瘤医院2018年1月~2018年6月体检健康人群49例,肿... 目的探讨不同肿瘤患者血清淀粉酶(amylase,AMY)和脂肪酶(lipase,LPS)水平,以及AMY和LPS诊断肿瘤患者胰腺炎的价值,为临床医生诊断或排除肿瘤病人胰腺炎提供实验室依据。方法收集四川省肿瘤医院2018年1月~2018年6月体检健康人群49例,肿瘤病人80例,另外收集胰腺炎患者6例和肿瘤并发胰腺炎患者16例。检测所有纳入人群的AMY和LPS并进行统计分析,同时利用ROC曲线分析诊断价值。结果肿瘤患者的AMY(109.78±136.04 U/L)高于健康对照(77.67±26.97 U/L),且肿瘤患者的LPS(64.35±70.80 U/L)也高于健康对照(36.43±2 1.71 U/L),差异均具有统计学意义(t=2.046,3.284,均P<0.05)。肺癌患者的AN Y(183.43±210.32 U/L)高于健康对照,卵巢癌的LPS(111.57±109.88 U/L)高于健康对照,差异具有统计学意义(t=1.329,1.804,均P<0.05)。AMY诊断非肿瘤人群的胰腺炎患者的AUC为0.993,诊断肿瘤人群的胰腺炎患者的AUC为0.864。LPS诊断非肿瘤人群的胰腺炎患者的AUC为1.000,诊断肿瘤人群的胰腺炎患者的AUC为0.982。结论血清AMY和LPS水平在肿瘤人群中显著升高,可能导致胰腺炎的误诊。 展开更多
关键词 淀粉酶 脂肪酶 胰腺炎 肿瘤
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血必净注射液联合奥曲肽、乌司他丁治疗急性重症胰腺炎的疗效及对免疫功能的影响
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作者 展懿 徐芬 方志 《中华中医药学刊》 CAS 北大核心 2019年第5期1262-1266,共5页
目的:探讨血必净注射液联合奥曲肽、乌司他丁治疗急性重症胰腺炎的疗效及对免疫功能的影响。方法:急性重症胰腺炎患者78例,按照随机数字的方法将患者分为对照组和观察组,每组均为39例,对照组在常规治疗的基础上使用奥曲肽联合乌司他丁... 目的:探讨血必净注射液联合奥曲肽、乌司他丁治疗急性重症胰腺炎的疗效及对免疫功能的影响。方法:急性重症胰腺炎患者78例,按照随机数字的方法将患者分为对照组和观察组,每组均为39例,对照组在常规治疗的基础上使用奥曲肽联合乌司他丁的方法进行治疗,观察组在对照组治疗方法的基础上联合使用血必净注射液进行治疗,对治疗的效果进行对比。结果:经过治疗后,对照组的白细胞计数(WBC)、血清C反应蛋白(CRP)浓度、白细胞介素-6(IL-6)浓度和肿瘤坏死因子-α(TNF-α)浓度分别从(26.37±3.86)×10^9/L、(255.36±38.69)mg/L、(75.39±7.43)ng/L、(87.49±6.27)ng/L下降到(15.38±4.27)×10^9/L、(27.38±5.55)mg/L、(35.17±4.29)ng/L、(45.52±7.28)ng/L。观察组的WBC、血清CRP浓度、IL-6浓度和TNF-α浓度分别从(26.84±4.01)×10^9/L、(263.84±39.58)mg/L、(76.28±6.47)ng/L、(88.06±5.94)ng/L,下降到(11.08±3.66)×10^9/L、(9.38±2.39)mg/L、(25.16±5.12)ng/L、(27.25±3.64)ng/L。各项数据的下降幅度均为观察组大于对照组,数据差异均具有统计学意义(t=4.775,18.603,9.359,14.018,P<0.05),观察组的腹痛消失时间[(5.53±1.02)d VS(3.25±0.81)d]、体温恢复正常时间[(7.08±2.12)d VS(4.68±1.21)d]、腹胀恢复正常时间[(5.21±0.98)d VS(3.02±1.08)d]、恶心呕吐恢复正常时间[(4.82±1.32)d VS(3.38±0.81)d]、上腹部压痛恢复时间均短于对照组[(7.36±1.82)d VS(4.41±1.51)d],数据差异均具有统计学意义(t=10.932,6.140,9.378,5.807,7.790,P<0.05),观察组的治疗效果优于对照组,数据差异具有统计学意义(z=-5.090,P<0.05),观察组出现呼吸窘迫综合征、肾衰竭、休克的比例低于对照组,数据差异具有统计学意义(χ^2=5.014,6.500,6.155,P<0.05),两组的多脏器衰竭,败血症的发生比例数据差异不具有统计学意义(χ^2=1.013,0.214,P>0.05)。结论:使用血必净注射液联合奥曲肽、乌司他丁治疗急性重症胰腺炎的患者,可以改善患者� 展开更多
关键词 奥曲肽 乌司他丁 胰腺炎 炎性细胞因子
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