Abstract:

胰腺疾病的诊治在临床上一直是一个难点。在过去的几年中我们见证了放射学和核医学成像的技术进步。考虑到这一点，我们尝试描述超声内镜（EUS）在胰腺癌（PC）诊断及分期的过程中新的角色。到目前为止对于PC最准确的成像技术是对比增强计算机断层扫描（CT）和EUS。后者在检测微小病灶及评估肿瘤大小和淋巴结情况时具有最高的精度，但对于一个可疑的胰腺病变的患者而言，螺旋CT或最新的磁共振成像（MRI）仍是首要的选择。如在CT、MRI扫描为阴性结果而临床上高度怀疑PC，或是CT/MRI扫描后可疑病变需细胞组织学确认时，可应用EUS。相信在不久的将来用于诊断和治疗胰腺疾病的EUS将有更大的发展空间，并且病理结果将为其提供最好的应用证据。

Abstract:

Objective: To investigate the clinical efficacy of middle pancreatectomy (MP) for benign or low-grade malignant tumors of the pancreatic neck and body. Methods: The clinical data of 32 patients undergoing MP for benign or low-grade malignant tumor of the pancreatic neck body (MP group) from August 2005 to February 2013 were retrospectively analyzed, and were also compared with the data of 30 patients undergoing pancreaticoduodenectomy (PD group) and 36 patients undergoing distal pancreatectomy (DP group) for benign or low-grade malignant pancreatic tumor during the same time period. Results: In MP, PD and DP group, the average operative time was (180.8±56.4), (279.6±79.2) and (190.4±62.3) min, average intraoperative blood loss was (196.5±185.7), (482.6±288.5) and (320.7±240.3) mL, time to bowel function recovery was (3.6±1.6), (5.2±2.3) and (4.1±1.9) d, number of newly developed diabetetic cases was 1, 5 and 9, and number of cases with postoperative pancreatic enzyme requirement was 0, 8 and 5, respectively. The differences in all above parameters among the three groups had statistical significance (all P<0.05). The incidence of postoperative pancreatic fistula in MP, PD and DP group was 18.8%, 12.5% and 25.0% respectively, which along with other perioperative variables among the three groups showed no statistical difference (all P>0.05). During the average follow-up period of 38 months, no tumor recurrence was noted in any of the groups. Conclusion: MP is a proper procedure for benign or low-grade malignant tumors in the neck and body of the pancreas, which allows better preservation of both exocrine and endocrine functions of the pancreas.

Abstract:Objective: To assess the value of local resection in treatment of carcinoma of the ampulla of Vater. Methods: The clinical data of 63 patients with T1 or T2 ampullary carcinoma treated between the years of 1997 and 2005 were retrospectively analyzed. Of the patients, 21 cases underwent local resection (observational group), while 42 cases were subjected to pancreaticoduodenectomy (control group). The operative time, intraoperative blood loss, intraoperative blood transfusion, incidence of postoperative complications, and length of hospital stay as well as postoperative survival between the two groups were compared. Results: The clinicopathologic data of the two groups were comparable (all P>0.05). In observational group compared with control group, the average operative time, intraoperative blood loss, intraoperative blood transfusion, and incidence of postoperative complications were significantly reduced (all P<0.05), while the average length of hospital stay showed no statistical difference (P>0.05). There was no statistical difference between the two groups in postoperative survival (P=0.131). Conclusion: Local resection causes less trauma and has a lower incidence of postoperative complications than pancreaticoduodenectomy in treatment of T1 or T2 ampullary carcinoma, and with favorable postoperative survival.

Abstract:Objective: To analyze the value of duodenum-preserving pancreatic head resection (DPPHR) for benign tumors of the pancreatic head. Methods: The clinical data of two DPPHR cases performed in the First Affiliated Hospital of China Medical University in the year 2011 were presented. Together with the data of 66 DPPHR cases described in 9 literature reports over the recent 10 years in China, the complications and surgical efficacy of all the 68 DPPHR cases were retrospectively analyzed. Results: Of the 68 patients, postoperative complications occurred in 13 cases (19.2%), which comprised pancreatic fistula in 10 cases (14.7%), duodenal fistula in 1 case (1.5%), gastroparesis in 1 case (1.5%), and biliary infection in 1 case (1.5%), and all of them were successfully treated by non-surgical treatment. The length of hospital stay ranged from 11 to 57 d with average of 17 d, and no death occurred during hospitalization. Follow-up data were available in 44 cases with the follow-up period of 3 months to 6 years, and no recurrence occurred in any of them. Conclusion: DPPHR is a safe and effective treatment method for benign tumors in the head of the pancreas.

Abstract:Objective: To investigate the feasibility and effectiveness of pancreaticoduodenectomy (PD) or PD with vessel resection via superior mesenteric artery (SMA) approach. Methods: From September 2012 to February 2014, pancreaticoduodenectomy via SMA approach was performed in 16 cases for pancreatic head or periampullary carcinoma, and 5 of them underwent portal vein (PV)/superior mesenteric vein (SMV) resection and reconstruction. In all patients, the SMA and SMV were exposed and isolated, and neural and lymphatic tissues were resected, then, a retropancreatic tunnel was created and the neck of the pancreas was divided, and finally, the resection of uncinate process of pancreas or combined excision of the involved PV and SMV was performed. Results: Fifteen patients recovered after surgery and were discharged from hospital, and one patient who developed renal failure and lung infection after surgery refused treatment and left the hospital against medical advice. The average intraoperative blood loss was 470 mL and operative time was 4.5 h, and no operative or postoperative death occurred. Five cases developed postoperative complications such as pancreatic fistula, which were all resolved by conservative treatment. The pathological sections of the excised specimen margins were all negative, and the positive detection rate in lymph nodes, and retroperitoneal neural and lymphatic tissues was high. Conclusion: PD via superior mesenteric artery approach for pancreatic head or periampullary carcinoma is safe and feasible, and it can also improve the R0 resection rate.

Abstract:Objective: To review the etiological characteristics and prognosis of acute pancreatitis during pregnancy (APP) as well as its changing trend in the recent 20 years, and investigate the essentials for the clinical diagnosis and treatment of this condition. Methods: The clinical data of 52 APP patients treated in Xiangya Hospital of Central South University over the recent 20 years (1994 to 2013) were retrospectively analyzed. Results: Of the 52 APP patients, 3 cases occurred in early pregnancy (5.8%), 12 cases occurred in mid-pregnancy (23.0%) and 37 cases occurred in late pregnancy (71.2%); 26 cases (50.0%) were mild pancreatitis, 13 cases (25.0%) were moderately severe pancreatitis and 13 cases were severe pancreatitis (25.0%). As for the causes of APP, 28 cases (53.8%) were hyperlipidemic pancreatitis, 14 cases (27.0%) were biliary pancreatitis and 10 cases (19.2%) were idiopathic pancreatitis. In the entire group, the maternal death was 0, but the fetal mortality reached 19.2% (10/52), which included 2 cases of intrauterine death, 4 cases of neonatal distress after premature delivery and 4 cases of artificial abortion on consideration of the potientially adverse effects exerted by medication. Conclusion: The prevalence of APP has shown an increasing trend in recent 20 years, and most of the cases occur in late pregnancy. Hyperlipidemia and especially biliary disease are the main causes for APP. APP is still associated with relatively high fetal mortality, and further standardized therapy and enhanced perinatal care are of important value for improving the overall outcome of APP.

Abstract:Objective: To observe the influence of hemoperfusion plus hemodialysis on CD8+CD28– T cells and systemic inflammatory state in patients with severe acute pancreatitis (SAP). Methods: Fifty-two patients who were admitted from February to September 2013 with confirmed SAP were selected, and equally randomized into observational group and control group. Patients in control group received routine treatment, while those in observational group underwent hemoperfusion plus hemodialysis in addition to receiving routine treatment. The serum levels of CD8+CD28– T cells, inflammatory factors and amylase after 24-h treatment, and the recovery patterns of clinical symptoms between the two groups were compared. Results: There was no statistical difference in the laboratory parameters between the two groups before treatment (all P>0.05). After 24-h treatment, the serum levels of CD8+CD28– T cells and anti-inflammatory cytokines were significantly increased, while the levels of pro-inflammatory cytokines and amylase were significantly decreased in both groups, but all the degrees of improvement in all the parameters in observational group were greater than those in control group (all P<0.05). The time to disappearance of clinical symptoms and bowel function recovery, and the length of hospital stay in observational group were all shorter than those in control group (all P<0.05), while no statistical difference was found in the time for body temperature recovery between the two groups (P>0.05). Conclusion: Application of hemoperfusion plus hemodialysis can effectively heighten the levels of CD8+CD28– T cells and inhibit the systemic inflammatory response in SAP patients, and thereby accelerate the recovery of the patients.

Abstract:Objective: To investigate the clinical efficacy of double-filtration plasmapheresis (DFPP) in treatment of hyperlipidemic severe acute pancreatitis (HL-SAP). Methods: Fifty-one HL-SAP patients were randomly designated to observational group (26 cases) and control group (25 cases). Patients in control group received standard routine treatment, while those in observational group underwent DFPP in addition to receiving routine treatment protocol. The treatment efficacy variables on day 2 and 7 of treatment and incidence of complications between the two groups were compared. Results: On day 2 of treatment compared with pretreatment values, the triglyceride (TG) and serum and urine amylase levels were significantly reduced, most of the hemorheological parameters were significantly improved, levels of inflammatory factors were lessened while prealbumin was elevated significantly, and the SIRS, APACHE II and Ranson’s scores were significantly decreased in observational group (all P<0.05); in control group, except for Ranson’s score that was significantly decreased (P<0.05), all the other parameters showed no significant change (all P>0.05). On day 7 of treatment, all the above parameters in observational group were further improved, and most of them in control group were significantly improved compared with pretreatment values (all P<0.05). In comparison, at the same time point after treatment, the degrees of improvement of all the parameters in observational group were significantly greater than those in control group (all P<0.05). The incidence of complications in observational group was significantly lower than that in control group (P<0.05). Conclusion: DFPP can effectively decrease TG level, improve microcirculation, and maintain the balance between anti-inflammatory and proinflammatory responses, and thereby improve the prognosis of HL-SAP patients.

Abstract:Objective: To investigate the indications and optimal time of surgery in fulminant acute pancreatitis (FAP). Methods: The clinical data of 32 FAP patients undergoing surgical treatment from August 2004 to August 2012 were retrospectively analyzed. Results: All the 32 FAP patients underwent surgical management for different reasons, which in 13 cases was due to the persistence of multiple organ dysfunction without any evidence of improvement after receiving 10- to 14-d full ICU care, in 8 cases was ascribed to no improvement but even rapid worsening of multiple organ functions after receiving 3- to 5-d full ICU care; and in 11 cases was attributed to sustained intra-abdominal pressure above 30 cmH2O (1 cmH2O=0.098 kPa) after a series of non-surgical procedures. The cure rate for the entire group of patients was 78.1% (25/32), and the mortality was 21.9% (7/32). Ninety patients were followed-up for 4 to 50 months, and 5 cases developed pancreatic pseudocyst, which were resolved by a second operation. Conclusion: Aggressive surgical intervention is justified in FAP patients with no evidence of improvement or even deterioration of multiple organ functions after full ICU care, or having sustained intra-abdominal hypertension without signs of relief after non-surgical treatment.

Abstract:Objective: To investigate the therapeutic effect of rutecarpine on rats with severe acute pancreatitis (SAP) and its mechanism. Methods: Fifty SD rats were equally randomized into sham operation group and 4 experimental groups. Rats in experimental groups underwent retrograde cholangiopancreatic duct injection of 5% sodium taurocholate to induce SAP model, and then were given the treatment with normal saline, ulinastatin, rutecarpine, or ulinastatin plus rutecarpine, respectively. Twenty-four hours after operation in each group, the pathological examination was performed, the serum amylase activity was measured, and the levels of endothelin 1 (ET-1) and calcitonin gene related peptide (CGRP) in the plasma and pancreatic tissue were determined. Results: Except in sham operation group, all the experimental groups exhibited the pathological profiles of pancreatitis of varying degrees in the pancreatic tissue. Compared with sham operation group, the serum amylase activity, and levels of ET-1 in the plasma and pancreatic tissue in all experimental groups were increased with different degrees, while the contents of CGRP in plasma and pancreatic tissue were significantly increased in rutecarpine treatment group and combination treatment group (all P<0.05), and showed no obvious change in the remaining experimental groups (all P>0.05). Among experimental groups, the pancreatic damage was less severe, and serum amylase activity as well as the levels of ET-1 in plasma and pancreatic tissue were significantly decreased in the groups that received drug treatment, especially combination drug treatment, compared with the model group treated with saline (all P<0.05). Conclusion: Rutecarpine has protective effect against SAP in rats, which may be associated with its increasing CGRP level and thereby improving the microcirculation of pancreatic tissue.

Abstract:Objective: To review the ultrasonographic characteristics and causes of severe acute pancreatitis (SAP) in children. Methods: The ultrasonographic findings and clinical data of 65 children with SAP that was confirmed by clinical diagnosis or autopsy were retrospectively analyzed. Results: Ultrasonographic manifestations of SAP in children were demonstrated as follows: the pancreases were enlarged to varying degrees, or even to an abnormal shape, with irregular or ill-defined margins; the echo patterns of the pancreas were diverse which included hyperechogenicity, hypoechogenicity or heterogeneous echogenicity; fluid collections in the peripancreatic space and spaces in the abdominal cavity as well as pseudocyst formation were frequently seen; the pancreas of primary SAP presented an abnormal shape and diffuse swelling, with heterogeneous or decreased but no increased echogenicity, and was frequently associated with pseudocyst formation; in secondary SAP, with exception of traumatic SAP, the pancreas had no abnormal shape but showed the presence of localized swelling , with enhanced but no decreased echogenicity, and was not complicated by pseudocyst formation. Among the 65 children, the csuse of SAP was trauma in 28 cases (43.1%), infections in 18 cases (27.6%), idiopathy in 15 cases (23.2%), systemic non-infectious diseases in 3 cases (4.6%), and post-operative stress response in 1 case (1.5%). Conclusion: Ultrasonography can accurately find the imaging changes of the pancreas in children with SAP, which can help make an early diagnosis and judgment of its causes, and thereby effectively reduce the mortality in these children.

Abstract:Objective: To investigate the relationship between ABCG2 expression induction and chemoresistance of gemcitabine in pancreatic cancer cells. Methods: The inhibition ratio of the pancreatic cancer SW1990 cells was measured by CCK-8 assay after exposure to different concentrations of gemcitabine for different time periods, and the half maximal inhibitory concentrations (IC50) of gemcitabine for SW1990 cells at different incubation times were determined. SW1990 cells were exposed to a proper concentration of gemcitabine chosen according to the IC50 values for 24, 48 and 72 h respectively, and then, the apoptosis rates of the cells were examined by flow cytometry, and the protein and mRNA expressions of ABCG2 were detected by Western blot and RT-PCR, respectively. Results: The proliferation of SW1990 cells was significantly inhibited by gemcitabine treatment, in a concentration- and time-dependent manner, but the IC50 value of gemcitabine showed a time-dependent increase (all P<0.05 ). After exposure to 3.9 mg/mL gemcitabine for 24, 48 and 72 h, the total apoptosis rate of SW1990 cells was gradually increased but their late apoptosis rate showed a decreasing trend; both protein and mRNA expressions of ABCG2 in SW1990 cells were significantly elevated in a time-dependent manner (all P<0.05). Conclusion: Gemcitabine can inhibit the growth of pancreatic cancer SW1990 cells, but its effect weakens with time, which may probably be associated with the up-regulation of ABCG2 expression induced by gemcitabine.

Abstract:Objective: To investigate the survivin expression in pancreatic carcinoma and its relation with prognosis of the patients. Methods: The survivin expression in the primary pancreatic cancer and their adjacent non-tumorous tissues resected from 55 patients were detected by immunohistochemical staining. The relations of survivin expression with the clinicopathologic factors and survival of the patients were analyzed. Results: The high survivin expression rate in the pancreatic cancer tissues was 65.5% (36/55), and all the adjacent non-tumorous pancreatic tissues presented low survivin expression. The 1-, 3- and 5-year overall survival rate for the entire group of patients was 50.9%, 30.9% and 1.8%, respectively. The survivin expression was not related to gender, age, or tumor location and size (all P>0.05), while it was significantly associated with degree of differentiation, lymph node metastasis and TNM stages (all P<0.05). Cox proportional hazards regression analysis identified that survivin expression along with degree of differentiation and lymph node metastasis were independent risk factors affecting prognosis of the patients (all P<0.05). Survival analysis demonstrated that the survival rate in group of patients with high survivin expression was significantly lower than that in group of patients with low survivin expression (P<0.05). Conclusion: The survivin expression is closely related to the prognosis of the pancreatic cancer patients, and those with high survivin face a poor prognosis.

Abstract:Objective: To investigate the p28GANK expression in pancreatic ductal carcinoma and its clinical significance. Methods: The p28GANK expression in pancreatic ductal cancer and matched adjacent non-cancerous tissues from 47 patients were determined by immunohistochemical staining. The relations of p28GANK expression in pancreatic ductal cancer with the clinicopathologic factors and postoperative survival of the patients were analyzed. Results: The p28GANK expression in pancreatic ductal cancer tissues was significantly higher than that in their adjacent non-cancerous tissues (P<0.01). The high p28GANK expression in tumor tissue was significantly associated with advanced TNM stage, low differentiation, and metastases(all P<0.05), but was irrelevant to age and gender of the patients (both P>0.05).The 3-year postoperative survival rate in patients with p28GANK positive expression was significantly lower than that in those with p28GANK negative expression (P=0.01). Conclusion: p28GANK expression is up-regulated in pancreatic ductal carcinoma, and high p28GANK expression is closely related to the progress of malignancy stage.

Abstract:Objective: To investigate the Grb2 expression in pancreatic carcinoma and its clinical significance. Methods: The Grb2 gene and protein expressions in 6 types of pancreatic cancer cell lines were detected by real-time PCR and Western blot, respectively. The Grb2 protein expressions in pancreatic cancer tissues and their adjacent normal tissues from 80 cases were determined by tissue microarray technique, and the relations of Grb2 expression status with clinicopathologic profiles of the pancreatic cancer patients were analyzed. Results: Both the Grb2 mRNA and protein showed relatively high expression level in the highly invasive and poorly differentiated pancreatic cell lines PANC-1, MIA-PaCa-2 and AsPC-1, but presented relatively low expression level in the less invasive and well differentiated pancreatic cell lines BxPC-3, SW1990 and capan-2. The Grb2 expression was detected in all tested pancreatic cancer tissues, but no or weak Grb2 expression was found in their adjacent normal pancreatic tissues. Statistical analysis showed that high Grb2 expression was associated with poor differentiation of the tumor and lymph node or distant metastasis (both P<0.05). Conclusion: Grb2 expression is closely related to the degree of differentiation and ability of invasion and metastasis of pancreatic cancer, and high Grb2 expression may predict highly malignant tumor grades and poor outcome.

Abstract:Objective: To assess the value of abdominal vacuum sealing drainage (VSD) in treatment of severe pancreatic-duodenal injuries. Methods: The clinical data of 16 patients with severe pancreatic-duodenal injury admitted during January 1998 and January 2013 were retrospectively analyzed. Injuries of the patients were graded according to AAST injury grading system as grade III in 10 cases, grade IV in 4 cases, and grade V in 2 cases, respectively. Results: The patients were subject to only debridement and hemostasis of wound surface for pancreatic lacerations, one-layered suture closure of duodenal lacerations, relevant treatments for the associated injuries, and then VSD of the area around the pancreatic transection and duodenal injury. The operative time ranged from 65 to 235 min with an average of 126 min. There was no operative death, while one patient was transferred to another hospital due to abdominal bleeding after operation, and the length of hospital stay for abdominal injury in the remaining 15 cases ranged from 16 to 45 d. Of the patients with grade III injury, postoperative duodenal fistula occurred in 5 cases and pancreatic fistula occurred in 3 cases, and all of them closed spontaneously after VSD. In patients with grade IV and V injury, pancreatic and duodenal secretions were continuously drained from VSD tube until the formation of a complete fistula tract around the VSD tube, and then a Roux-en-Y anastomosis between the fistula tract and jejunum was performed. Follow-up was variable from 6 months to 15 years, during which, no complications such as intra-abdominal infections, abdominal effusion, pancreatic pseudocyst, or intestinal obstruction were noted. Conclusion: For patients with severe pancreatic-duodenal injury who are in critical condition, or would not tolerate complex surgery, simple treatment of the pancreatic-duodenal wound surface combined with VSD is recommended.

Abstract:Objective: To determine the risk factors for occurrence of gallbladder polyps. Methods: The medical records of 1 1007 cases undergoing health maintenance examination from May 2008 to May 2013 were retrospectively studied. Among these cases, 764 cases were found to have gallbladder polyps (602 cases were male, and 162 cases were female), with an average age of (44.35±10.23) years. The gallbladder polyp patients were taken as study group and the remaining 10 243 cases without gallbladder polyp served as control group, and then, the risk factors for occurrence of gallbladder polyps were determined by univariate and multivariate statistical analyses. Results: Univariate analysis showed that male gender, gallbladder wall thickening (asymptomatic cholecystitis), and hepatitis B virus (HBV) infection were associated with gallbladder polyps (all P<0.05); multivariate Logistic regression analysis revealed that male gender (OR=2.026), gallbladder wall thickening (asymptomatic cholecystitis) (OR=2.078), HBsAg (+)/anti-HBC (+) (OR=2.894), and HBsAg (–)/anti-HBC (+) (OR=2.446) were all the risk factors for ocurrence of gallbladder polyps (all P<0.05). Conclusion: Male gender, gallbladder wall thickening (asymptomatic cholecystitis), and HBV infection are the risk factors for ocurrence of gallbladder polyps.

Abstract:Objective: To investigate the clinical characteristics, diagnosis and treatment methods of duodenal gastrointestinal stromal tumors (GIST). Methods: Data of 29 patients with pathologically proven duodenal GIST undergoing surgery from May 2000 to April 2012 were collected. The onset of the disease, clinical manifestations, imageological findings, treatment methods, pathological results and prognosis of these patients were retrospectively analyzed. Results: Of the patients, 14 were male and 15 were female with an average age of 51.95 years. The lesions were located in the bulb (2 cases), descending part (16 cases), horizontal part (8 cases), and ascending part (3 cases) of the duodenum, respectively. The initial symptoms were melena in 15 cases, hematemesis combined with melena in 2 cases, bloating and pain in upper abdomen in 7 cases, and general fatigue in 2 cases, while 3 cases demonstrated no overt symptoms. The tumor size ranged from 1.5 to 15.5 cm with an average of 6.9 cm, which was 1.5-5.0 cm in 19 cases, 5.0-10.0 cm in 7 cases, and >10 cm in 3 cases. The preoperative examinations comprised CT scan and/or MRI, gastroduodenoscopy, upper gastrointestinal contrast, and endoscopic ultrasonography. All patients underwent surgical treatment that included pancreaticoduodenectomy in 7 cases, segmental duodenal resection in 10 cases, local duodenal resection in 10 cases, and duodenal bulb plus gastric antral resection in 10 cases; 10 patients were treated with imatinib after surgery. According to Fletcher's risk classification, tumors in 2 cases were very low risk, in 11 cases were low risk, in 9 cases were intermediate risk, and 7 cases were high risk. Immunohistochemical results showed tumors in 23 cases were CD34 positive and in 27 cases were CD117 positive. Follow-up in 27 patients was obtained for 12 to 156 months, with an average of 54 months. Recurrence occurred in 5 patients, of whom 2 cases developed liver metastases and 3 had local recurrence. Two of the recurrent cases received no further treatment and died 30 months and 42 months later, respectively. Conclusion: Radical resection is effective treatment for duodenal GIST. The procedure used depends on the the size and location of the tumor. Better results can be expected under the premise of a negative surgical margin.

Abstract:Objective: To investigate the clinical efficacy of single loop jejunal interposition following laparoscopic radical gastrectomy for advanced gastric cancer. Methods: The data of 21 patients with advanced gastric cancer treated from January 2011 to June 2013 were reviewed. All patients underwent total gastrectomy followed by single loop jejunal interposition for digestive tract reconstruction, and the clinical variables that included postoperative complications, postoperative nutritional status and gastrointestinal symptoms were analyzed. Results: Operations were successfully completed in the 21 patients, and all of them were discharged from hospital after recovery. No postoperative complications such as anastomotic fistula, dumping syndrome or reflux esophagitis occurred. Six months after surgery, gastroscopy and upper gastrointestinal tract contrast examination showed that the anastomotic stomas of the patients were smooth and patent, and the patients had satisfactory nutritional status and favorable quality of life. Conclusion: Single loop jejunal interposition after laparoscopic radical gastromy for advanced gastric cancer is an ideal reconstruction with respect to improving the postoperative gastrointestinal symptoms and quality of life.

Abstract:

Pancreatogenic hypoglycemia is a condition of relatively low prevalence but, once detected, it should be treated promptly to prevent irreversible brain damage, and surgery remains the first option in treatment of this condition. At present, the modalities in preoperative diagnosis of this condition, especially in localization techniques is continually evolving, and the treatment methods, except for surgical resection, include anhydrous alcohol injection, radiofrequency ablation, interventional embolization, and most recently, high-intensity focused ultrasound ablation therapy also achieved favorable results in treatment of pancreatogenic hypoglycemia. In this paper, the authors present the progress on surgical diagnosis and treatment of this condition, and propose the direction of future research.

Abstract:Pancreatic cancer is one of the most lethal cancers because of its nearly identical mortality and morbidity rates, and how to improve the early detection rate, treatment and prognosis of this disease is presently an urgent issue. Aberrant expression of microRNAs (miRNAs) have been found in pancreatic cancer at its early stage, so miRNAs may be used as tumor markers for early detection of pancreatic cancer. In this paper, the authors, after reviewing the advances and current problems in early diagnosis of pancreatic cancer, address the potentially important role of miRNAs in early diagnosis of pancreatic cancer.

Abstract:Peritoneal adhesion is generally considered a common complication triggered by peritoneum damage after abdominal surgery. Clinical and experimental studies have confirmed that the use of anti-adhesion drugs and materials, and minimally traumatic instruments are unable to effectively prevent postoperative adhesion formation. In order to reduce the incidence of adhesions, scholars all over the world have, from different perspectives, engaged in the study on the pathogenesis of peritoneal adhesion, and accumulated voluminous literature. Studies on the effects of immunity and inflammation in the pathophysiological process of peritoneal adhesions has been given more attention. Based on the systematic analysis of the relevant research literature of foreign scholars, in this paper, the authors have aimed to clarify the relationship of inflammation and immunity to peritoneal adhesions, and provide new targets and routes for clinical prevention and treatment of peritoneal adhesions.