Objective: To investigate the clinical efficacy and safety of debridement of necrotic pancreatic tissue and drainage via retroperitoneal approach in management of infected pancreatic necrosis. Methods: Forty-four patients with infected pancreatic necrosis undergoing necrosectomy and drainage via retroperitoneal approach during 2013 to 2015 were enrolled as observational group, and previous 56 patients with the same condition undergoing necrosectomy via abdominal incision and then closed continuous irrigation served as control group. The treatment results between the two groups of patients were compared. Results: The general data and all laboratory indexes before operation between the two groups had no statistical difference (all P>0.05). The levels of serum amylase, urine amylase, blood sugar, procalcitonin, TNF-α and IL-8 in observational group were all significantly lower than those in control group after operation (all P<0.05). The operative time and length of hospital stay in observational group were significantly reduced compared with control group (both P<0.05). The rate of reoperation and death or treatment abandonment had no statistical difference between the two groups (both P>0.05). In observational group compared with control group, the effective rate was increased (75.0% vs. 58.9%) and incidence of surgical complications was decreased (15.9% vs. 33.9%), but both differences did not reach statistical significance (both P>0.05). Conclusion: Necrosectomy and drainage via retroperitoneal approach for infected pancreatic necrosis has reliable efficacy, and with faster recovery and less invasiveness than open surgery.

Objective: To investigate the influences of enteral nutrition supports of different formulas on nutritional status, intestinal barrier function and systemic inflammatory responses in patients with severe acute pancreatitis (SAP). Methods: One-hundred and twenty SAP patients were equally randomized into 3 groups, and then underwent immune-enhancing enteral nutrition (IN group), elemental enteral nutrition (EN group) and ecological immune enteral nutrition (EIN group), respectively. The nutrition indicators, peripheral blood endotoxin concentrations and parameters of oxidative stress and inflammatory responses before and at 7 and 17 after treatment among the three groups were compared. Results: There was no statistical difference in any of the studied indexes among the three groups before treatment, which were all significantly improved after treatment and progressively with time (all P<0.05). Results of intergroup comparison showed that serum levels of hemoglobin, albumin, transferrin, prealbumin and levels of IL-10 and superoxide dismutase (SOD) were significantly higher, while the serum levels of diamine oxidase (DAO), endotoxins, malondialdehyde (MDA), high-sensitivity C-reactive protein (hs-CRP), IL-6 and TNF-α were significantly lower in EIN group than those in either IN group or EN group at 7 and 14 d after treatment (all P<0.05); all indexes at the same time point showed no statistical difference between IN and EN group (all P>0.05). Conclusion: For SAP patients, ecological immune enteral nutrition can effectively improve the nutritional status, protect intestinal barrier function, lower the levels of oxygen free radicals and serum endotoxins, so it is beneficial to improving the outcome and prognosis of these patients.

Objective: To investigate the expression of tumor suppressor factor cylindromatosis (CYLD) in alveolar macrophages (AMs) and its relation with NF-κB-dependent inflammatory signaling pathway during acute lung injury (ALI) caused by acute pancreatitis (AP). Methods: Sixty adult SD rats were equally randomized into experimental group and control group. AMs were harvested by bronchoalveolar lavage, which were treated with TNF-α (for simulation of AP-induced ALI in vitro) in experimental group, and treated with the same amount of normal saline in control group, respectively. In these AMs, the levels of inflammatory factors and the expressions of CYLD, NF-κBp65, NF-κB-essential modulator (NEMO) and IκBα were determined at 0, 1, 3, 6 and 12 h after treatment. Results: At each time point, the releasing levels of all the determined inflammatory factors and expression levels of CYLD and NF-κB pathway-related proteins showed no significant change in control group (all P>0.05). In experimental group compared with control group, all parameters showed no significant difference at 0-h time point (all P>0.05), but had statistical difference at all the later time points (all P<0.05); the releasing levels of TNF-α, IL-1β, IL-6 and NO were all significantly increased and reached their peak values at 1-h time point and then gradually decreased; from 1-h time point, the CYLD expression was significantly down-regulated, while the expressions of NF-κBp65 and IκBα were significantly up-regulated, and then all were slightly recovered later; the NEMO expression was significantly up-regulated at 1-h time point, and declined at 3-h time point, and was elevated again at 6- and 12-h time point. CYLD expression had significantly negative correlation with the expressions of NF-κBp65, NEMO and IκBα in the AMs of experimental group (r=–0.759, –0.849, and –0.813, all P<0.05) respectively. Conclusion: CYLD expression may be decreased in the AMs during ALI secondary to AP, thus its inhibition to NF-κB-dependent inflammatory signaling pathway is lessened. Up-regulating CYLD expression may probably be an effective approach for alleviating AP-induced ALI.

Objective: To investigate the effects of two different decompression tube placement methods on pancreatic fistula after pancreaticoduodenectomy (PD). Methods: The clinical data of 125 patients undergoing PD from January 2012 to October 2014 were retrospectively analyzed. Of the patients, 68 cases underwent decompression by insertion of a drainage tube into the main pancreatic duct (pancreatic duct group), and 57 cases underwent decompression by insertion of a drainage tube into the distal part of the blind end of the pancreatic jejunal anastomosis (blind loop group). The incidence of postoperative pancreatic fistula and other clinical variables between the two groups were compared. Results: Pancreatic fistula occurred in 9 cases (7.2%) in the entire group, with one case (1.8%) in blind loop group and 8 cases (11.8%) in pancreatic group, and all cases were cured by conservative treatment and discharged from hospital. The incidence of pancreatic fistula in blind loop group was significantly lower than that in pancreatic duct group (P<0.05), but there was no statistical difference in incidence of other complications between the two groups (all P>0.05). In blind loop group compared with pancreatic duct group, the length of hospital stay (20.38 d vs. 27.46 d) and hospitalization cost (56 420 yuan vs. 66 020 yuan) were significantly reduced (both P<0.05). No statistical difference was noted in postoperative 1-year tumor recurrence and survival rate between the two groups (both P>0.05). Conclusion: The decompression tube placement via blind loop can effectively reduce the incidence of postoperative fistula after PD.