Abstract:Consensus guidelines on severe acute pancreatitis released by the Italian Association for the Study of the Pancreas (AISP) in 2015 consists of three sections that include the definitions of complications of severe acute pancreatitis, and the conservative and interventional treatment of severe acute pancreatitis, with recommendations for a total of 54 detailed clinical questions, and the evidence level and recommendation grade according to the Oxford criteria also provided. The guidelines provide comprehensive information on the principles for diagnosis and management of severe acute pancreatitis, which reflects the current status of understanding and treatment strategies of this disease. They deserve to be used as reference and guidance.

Abstract:Objective: To investigate the best treatment choice for obstructive mild acute biliary pancreatitis (MABP). Methods: The clinical data of 132 patients with obstructive MABP treated during 2008 to 2014 were retrospectively analyzed. Of the patients, 35 cases underwent minimally invasive surgery based on endoscopic retrograde cholangiopancreatography (endoscopic group), 43 cases underwent laparoscopic cholecystectomy and common bile duct exploration (laparoscopic group) and 54 cases underwent open surgery (laparotomy group). The relevant clinical variable among the three groups were compared. Results: In endoscopic group, laparoscopic group and laparotomy group, the time to relief of abdominal pain (3.31 d vs. 3.84 d vs. 7.65 d) and time for white blood cells to return to normal level (4.20 d vs. 5.35 d vs. 8.72 d) were statistically different between each of them (all P<0.05); in endoscopic group and laparoscopic group, the time for recovery of blood amylase (3.26 d vs. 3.53 d) and length of hospital stay (9.49 d vs. 9.30 d) showed no statistical difference (both P>0.05), but were all shorter than that in laparotomy group (4.35 d and 9.30 d) (both P<0.05). In the 3 groups, the cure rate was 100% and no death occurred, and the incidence of complications showed no statistical difference between them (P>0.05); the incidence of recurrent pancreatitis within one year after operation in endoscopic group (42.86%) was significantly higher than that in laparoscopic group (0.00%) and laparotomy group (1.85%) (both P<0.05), but showed no statistical difference between the latter two groups (P>0.05). Conclusion: For most cases of obstruction MABP, the laparoscopic approach is the preferred method to relieve biliary obstruction.

Abstract:

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.

Abstract:Objective: To investigate the clinical efficacy of percutaneous catheter drainage (PCD) in the treatment of acute severe pancreatitis (SAP) complicated with peripancreatic necrosis and infection. Methods: The clinical data of 113 SAP patients with peripancreatic necrosis and infection (range of pancreatic necrosis<30%) undergoing surgical treatment were analyzed retrospectively. Of the patients, 54 cases received PCD treatment (PCD group), and 59 cases were subjected to direct open drainage (laparotomy group). The relevant clinical variables between the two groups of patients were compared. Results: There was no significant difference in white blood cell count, and levels of serum amylase, urine amylase, blood glucose and serum calcium between the two groups (all P>0.05), and all above parameters were significantly improved in both groups compared with their preoperative values (all P<0.05). Postoperative comparison showed that the levels of serum amylase, urine amylase and blood glucose in PCD group were significantly lower than those in laparotomy group (all P<0.05), and the length of hospital stay, hospitalization costs, mortality rate and treatment abandonment were significantly reduced in PCD group compared with laparotomy group (all P<0.05). The effective treatment rate (79.6% vs. 81.4%) and results of drainage fluid bacterial culture showed no significant difference between the two groups (all P>0.05). Conclusion: PCD has demonstrable efficacy in treatment of SAP complicated with peripancreatic necrosis and infection (range of pancreatic necrosis<30%), and also has advantages of short hospital stay and reduced hospitalization expense.

Abstract:

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.

Abstract:Objective: To review the clinical characteristics of pancreatic occupying lesions with initial presentation of acute pancreatitis (AP), for providing warnings of this condition. Methods: The data of 12 typical cases with above condition admitted between September 2010 and October 2014 were collected, and variables such as clinical findings, laboratory parameters and imaging features were comprehensively analyzed. Results: All of the 12 patients were admitted for AP; the male to female ratio was 11:1, which was remarkably higher than that (1.4:1) of pancreatic cancer. The urine amylase was markedly increased (>1 500 U/L) in all cases (100%), 8 cases (66.7%) were accompanied with evident radiating pain around the waist, 6 cases (50.0%) showed increased CA19-9 level, 6 cases (50.0%) had elevated serum bilirubin level and pancreatic duct dilation was found in 7 cases (58.3%). Five cases underwent radical surgery, and the other cases had non-surgical treatment or palliative operation due to loss of chance for radical surgery, and one of the cases (8.3%) undergoing palliative operation was pathologically proven to be chronic pancreatitis after operation. Conclusion: Among the AP patients, pancreatic occupying lesions should be taken into consideration in those with factors that include male sex, increased urine amylase, pancreatic duct dilation, and accompanied with pain radiating around the waist and persistent jaundice.

Abstract:Objective: To investigate the effect of liposomal clodronate(LC) on lung injury secondary to severe acute pancreatitis (SAP) in rats and its relations with Aktand MAPK (ERK1/2) pathways. Methods: Forty-eight SD rats were equally randomized into sham operation group, SAP model group (model group) and SAP model plus LC treatment group (LC group), and in the latter two groups, SAP model was created by injection of 5% sodium taurocholate beneath the pancreatic capsule, and after that were given naked liposome and LC respectively by tail vein injection. In each group at 2 and 6 h after operation, the serum levels of amylase (AMS), IL-6, and TNF-αwere measured, and pathological changes, as well as Akt and MAPK (ERK1/2) expressions in the lung tissue were observed. Results: In both model group and LC group compared with sham operation group, the serum levels of AMS, IL-6 and TNF-α,the pathological score, and the expression levels of Akt and MAPK (ERK1/2) were significantly increased, and all became evident as time went on (all P<0.05), but all above parameters in LC group were significantly lower than those in model group at each time point (all P<0.05). Conclusion: LC has alleviative effect against SAP-induced lung injury in rats, and the mechanism may be associated with reduced inflammatory factors that result from inhibition of Akt and MAPK (ERK1/2) signaling pathways after LC uptake by alveolar macrophages.

Abstract:

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.

Abstract:Objective: To investigate the effect of hydrogen-rich saline (HRS) on lung injury secondary to severe acute pancreatitis (SAP) in rats and its association with NOX2/ROS/NF-κB pathway. Methods: Seventy-two male Wistar rats were equally randomized into sham operation group, SAP model group (SAP group) and SAP model plus HRS treatment group (HRS group). SAP model was induced by retrograde infusion of 5% sodium taurocholate into the biliopancreatic duct. Five minutes after operation, rats in HRS group underwent tail vein injection of HRS (6 mL/kg), while those in sham operation group and SAP group were given the same volume of normal saline instead. Rats were sacrificed in four batches with equal number of animals at 3, 12 and 24 h after operation. Then, in each group of rats, the pathological examinations of pancreatic and lung tissues were performed, the serum levels of pancreatic enzymes, the malondialdehyde(MDA) content and superoxide dismutase (SOD) activity, and the expressions of NOX2, NF-κB, and TNF-α in lung tissue were measured. Results: Compared with sham operation group, rats in either SAP group or HRS group exhibited manifestations of SAP and lung injury, as evidenced by significantly increased pathological scores of the pancreatic and lung tissues, elevated serum pancreatic enzyme levels and lung MDA content, and reduced lung SOD activity (all P<0.05); but all these injury parameters in HRS group, except the pancreatic enzyme levels (all P>0.05), were significantly lower than those in SAP group (all P<0.05). Results of the immunohistochemical staining at 12 h after operation showed that the expression levels of NOX2, NF-κB and TNF-α in lung tissue were significantly increased in both SAP group and HRS group compared with sham operation group (all P<0.05), while all those in HRS group were significantly lower in HRS group versus SAP group (all P<0.05). Conclusion: HRS can alleviate SAP-induced lung injury in rats, and the mechanism may be associated with inhibition of the activation of NOX2/ROS/NF-κB pathway.

Abstract:Objective: To investigate the expression of Krüppel-like transcription factor 9 (KLF9) in pancreatic cancer tissue and its association with clinicopathologic features and prognosis of pancreatic cancer patients. Methods: The specimens of 200 paired pancreatic cancer and adjacent pancreatic tissues were collected. The KLF9 expressions in these specimens were determined by RT-PCR (28 pairs), Western blot (4 pairs), and immunohistochemical staining (all specimens), respectively, and the relations of KLF9 expressions with clinicopathologic features and postoperative survival of the patients were also analyzed. Results: The results of RT-PCR showed that the KLF9 mRNA expression level in pancreatic cancer tissue was remarkably lower than that in its adjacent pancreatic tissue in 21 of 28 paired specimens (75%). The results of Western blot showed that the KLF9 protein expression was obviously down-regulated in pancreatic cancer tissue compared with its adjacent pancreatic tissue. The results of immunohistochemical staining showed the KLF9 expression intensity was remarkably weaker in pancreatic cancer tissue than that in adjacent pancreatic tissue. The results of analyses of the relationship between KLF9 expression and clinicopathologic variables showed that the KLF9 expression level was significantly related to degree of tumor differentiation (P=0.008) and vascular invasion (P=0.006). Survival analysis showed that the 1-, 2- and 3-year overall survival rate in patients with positive KLF9 expression was significant higher than that in patients with negative KLF9 expression (41%, 31%, 16% vs. 18%, 6%, 6%), and the median survival time in patients with positive KLF9 expression was significant longer than that in patients with negative KLF9 expression (21.05 months vs. 11.82 months) (all P<0.05). Conclusion: KLF9 expression is decreased in pancreatic cancer, which is closely related to malignant unfavorable prognosis.

Abstract:Objective: To investigate the inhibitory effect of rapamycin on growth of pancreatic cancer in vivo, as well as its influence on cell derived factor 1α (SDF-1α). Methods: Twenty nude mice, after pancreatic injection of pancreatic cancer SW1990 cells, were equally randomized into experimental group and control group. Mice in experimental group underwent daily intraperitoneal injection of rapamycin (1.5 mg/kg), and those in control group were given the vehicle of the same volume instead in the same fashion. The tumors were harvested 3 weeks later, the growth of the tumor between the two groups were compared, immunohistochemistry was performed to detect the infiltration of monoclemacrophages and tumor-associated macrophages (TAMs) and the expression of p-mTOR, HIF-1α and SDF-1α in the tumor tissues, and Western blot and qRT-PCR were also performed to determine the mRNA and protein expression of p-mTOR, HIF-1α and SDF-1α in the tumor tissues. Results: In experimental group compared with control group, both tumor weight (0.3340 g vs. 1.7790 g) and volume (0.2375 mm3 vs. 1.2662 mm3) were significantly reduced (both P<0.05). Results of immunohistochemical staining showed that in experimental group versus control group, the count of monocyte-macrophages and TAMs was significantly lowered (both P<0.05), the expression rates of p-mTOR, HIF-1α and SDF-1α were all significantly decreased (all P<0.05), and there was a positive correlation between score of the SDF-1α expression score and TAM count in the tumor tissue (r=0.52, P<0.05). Results of Western blot and qRT-PCR showed that both protein and mRNA expressions of p-mTOR, HIF-1α and SDF-1α in experimental group were lower than those in control group, and except for the HIF-1α mRNA (P>0.05), all differences had statistical difference (all P>0.05). Conclusion: Rapamycin can suppress growth of pancreatic cancer in vivo, and the mechanism is probably associated with its inhibiting the activity of mTOR pathway which thereby down-regulates SDF-1α expression, and then reduces TAMs within the tumor microenvironment.

Abstract:Objective: To evaluate the clinical efficacy of pancreaticoduodenectomy (PD) combined portal vein (PV) and superior mesenteric vein (SMV) resection in treatment of cancer in the head of the pancreas. Methods: The clinical and postoperative follow-up data of 72 patients with cancer in the head of the pancreas undergoing surgical treatment from January 2010 to July 2013 were retrospectively analyzed. Of the patients, 40 cases without involvement of common hepatic artery, SMV or PV and without metastasis underwent simple pancreatoduodenectomy (PD group), and 32 cases having simple PV/SMV involvement underwent PD combined with PV/SMV resection (PV/SMV group). The perioperative variables and postoperative conditions between the two groups of patients were compared. Results: In PV/SMV group compared with PD group, the operative time (357.4 min vs. 289.3 min), and intraoperative blood loss (851.2 mL vs. 641.5 mL) were significantly increased (both P<0.05), while the volume of blood transfusion (700.0 mL vs. 650.5 mL), incidence of surgical complications (18.75% vs. 20.00%), and 1-, 2- and 3-year survival rate (50.00% vs. 57.50%, 31.25% vs. 37.50% and 21.86% vs. 25.00%) as well as the median survival time (15 months vs.18 months) showed no statistical difference (all P>0.05). Conclusion: For pancreatic head cancer, the appropriate surgical approach should be chosen based on the actual situation of the patients. PD with synchronous PV/SMV resection has reliable efficacy in treatment of pancreatic head cancer with simple PV/SVM involvement, with similar long-term postoperative results as those in patients with surgical indications for PD.

Abstract:Objective: To determine the predictive value of the symptoms of lumbar back pain for extrapancreatic neural plexus invasion in pancreatic cancer. Methods: The clinical and imaging data of 130 patients diagnosed as pancreatic cancer were retrospectively analyzed. Whether or not there was extrapancreatic neural plexus invasion was judged by CT in all patients, and the difference of the prediction of symptoms of lumbar back pain for extrapancreatic neural plexus invasion in pancreatic cancer and CT determination were analyzed. Results: Seventy-seven patients (59.2%) were judged to have extrapancreatic neural invasion by CT scan, wherein 38 cases (50.7%, 38/75) had cancer of the pancreatic head, 39 cases (70.9%, 39/55) had cancer of the pancreatic body and tail, and the percentage of the latter was significantly higher than that of the former (χ2=78.999, P=0.000); 87.0% of patients had tumor invasion around the celiac axis, which was significantly higher than those with tumor invasion in left celiac ganglion (57.1%) and right celiac ganglion (45.5%) (χ2=30.415, P=0.000). Of the 48 patients in lumbar back pain group, 47cases (97.9%) were diagnosed with extrapancreatic neural plexus invasion by CT scan. Compared with CT diagnosis, the sensitivity, specificity and positive predictive value of lumbar back pain for predicting extrapancreatic neural plexus invasion was 61%, 98.1% and 97.9%, respectively. Results of consistency check showed that there was a moderate consistency between the two methods (κ=0.545, P=0.000). Conclusion: There is a relationship between symptoms of lumbar back pain and extrapancreatic neural plexus invasion in pancreatic cancer, and lumbar back pain and CT image features have complementary roles in preoperative prediction of extrapancreatic neural plexus invasion in pancreatic cancer.

Abstract:Objective: To investigate the anatomical characteristics of the superiormesenteric vessels, so as to provide anatomical landmarks for reference during the performance of laparoscopic pancreaticoduodenectomy (PD) with uncinate process approach. Methods: Anatomical dissection in 4 adult human cadaveric specimens was performed, and the image data of computed tomography angiography (CTA) for upper abdomen using CT from 96 cases and video data of laparoscopic PD with uncinate process approach of 13 patients were analyzed. Results: Portal–superior mesenteric veins could be described as three portions that comprised the superior pancreatic portion, where the gastric coronary vein drained into its right side in some cases (22.1%), the pancreatic portion, presenting as a confluence of several vein tributaries such as gastrocolic trunk, posterior inferior pancreaticoduodenal vein and posterior pancreaticoduodenal vein, and the inferior mesenteric vein was also seen draining into its left side (7.5%), and the horizontal duodenal portion, where no vein branch was observed and the superior mesenteric artery was closely adjoined to the left side. The superior mesenteric artery was seen running alongside the superior mesenteric vein within the region of the head of the pancreas and the duodenum, with the inferior pancreaticoduodenal artery as its main branch, which was also found forming a common trunk with the first jejunal artery (33.0%). Replaced right hepatic artery arising from the superior mesenteric artery was found in two cases (1.8%). Conclusion: Adequate knowledge of the distribution and flowing courses of the superior mesenteric vessels and their associated vessels is of great clinical importance in laparoscopic PD, and the duodenal portion of superior mesenteric vein can be used as a main anatomical landmark for the uncinate process approach.

Abstract:Objective: Through comparing the short term efficacy of laparoscopy-assisted pancreaticoduodenectomy (LAPD) and open pancreaticoduodenectomy (OPD) to assess the feasibility of LAPD and its conformity to the principles of radical cancer surgery and minimal invasiveness. Methods: The clinical data of 79 patients undergoing pancreaticoduodenectomy (PD) from May 2012 to December 2014 were retrospective analyzed. Of the patients, 25 cases received LAPD (LAPD group) and 54 cases had open surgery (OPD group). The perioperative variables between the two groups were compared. Results: In LAPD group compared with OPD group, the operative time (474.6 min vs. 404.9 min), surgery cost (21 500 yuan vs. 18 700 yuan) were increased, while the intraoperative blood loss (265.5 mL vs. 380.8 mL), intraoperative transfusion rate (8.0% vs. 29.6%), times for postoperative analgesia demand (0.56 times vs. 1.6 times), time to first flatus passage (3.8 d vs. 5.7 d), time to first liquid intake (5.3 d vs. 7.6 d), length of ICU stay (0.74 d vs. 1.3 d), length of hospital stay (15.5 d vs. 19.0 d) and tumor size (2.0 cm vs. 3.9 cm) were all significantly reduced (all P<0.05). There was no significance between the two groups in incidence of overall or individual complications, mortality, R0 resection rate, the number of resected lymph nodes and the number of positive lymph nodes (all P>0.05). Conclusion: Although the procedure of LAPD is complicated and troublesome, it is safe, feasible and can follow the principles of radical cancer surgery and minimal invasiveness in some selected patients, for surgeons who have a full command of OPD technique and adequate laparoscopic experience after completion of certain learning curve.

Abstract:

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.

Abstract:Objective: To investigate the clinicopathologic features, and differential diagnosis and treatment method of the mixed acinar-neuroendocrine carcinoma (MANEC) of the pancreas. Methods: The clinical record of one patient with MANEC was retrospectively analyzed, in combination with domestic and foreign literature review, to summarize the clinical features, pathological features, differential diagnosis and treatment method for this disease. Results: Preoperative imaging examinations suggested that the patient had a tumor of descending duodenum, and then the patient underwent surgical treatment. The pathological diagnosis was pancreatic MANEC. The patient was discharged after operation and no tumor recurrence or metastasis was noted 20 months later. Conclusion: MANEC of the pancreas is extremely rare, usually without typical symptoms, and the final diagnosis depends on pathological findings. Its prognosis remains unclear to date, but early surgical treatment can significantly improve the overall survival.

Abstract:Objective: To determine the application value of using double U-suture invaginated pancreaticojejunostomy (PJ) with binding purse-string sutures in the treatment of pancreatic injury. Methods: The clinical data of 9 patients with grade IV and V pancreatic injury admitted from January 2011 to January 2015 were retrospectively analyzed. Results: Of the 7 patients with grade IV injury, 5 cases were cured by closure of the stump of the head of the pancreas (U type lock-stitch and continuous sutures), and double U-suture invaginated Roux-en-Y pancreaticojejunal internal drainage and binding purse-string sutures, and 2 cases with duodenal rupture were cured by pancreaticoduodenectomy (PD) and double U-suture invaginated PJ with binding purse-string sutures. Two patients with grade V pancreatic injury were both cured by PD and double U-suture invaginated PJ with binding purse-string sutures. No severe complications such as postoperative pancreatic fistula or anastomotic bleeding occurred in any of the 9 patients. All the patients were fellowed- up, and there were no diabetes, diarrhea or other complications, and no deaths. Conclusion: Double U-suture invaginated PJ with binding purse-string sutures is feasible in surgery for pancreatic injury, and it could effectively prevent the occurrence of postoperative pancreatic fistula.

Abstract:Objective: To investigate the early management of severe traumatic injuries of the pancreas. Methods: The clinical data 24 patients with traumatic injuries of the pancreas treated during January 2006 to April 2015 were retrospectively analyzed. Results: In the whole group of 24 patients, 5 cases with grade I injury and 6 cases with grade II injury underwent debridement of the devitalized tissue and regional drainage, 6 cases with grade III injury received distal pancreatectomy, and of 7 cases with grade IV injury, 2 cases had pancreaticoduodenectomy, 4 cases had Roux-en-Y pancreaticojejunostomy, and one case had debridement of devitalized tissue plus drainage, respectively. Of the entire group, 23 cases were cured and one case died of septic shock. Complications occurred in 15 cases (62.5%), which included pancreatic fistula in 9 cases, traumatic pancreatitis in 3 cases, pancreatic pseudocyst in 2 cases, infections in 2 cases, biliary fistula in one case, and hemorrhagic shock in one case, respectively. Conclusion: Continually adjusting the treatment plan according to the degree of the pancreatic damage, and choosing the appropriate operative procedure and timing, with adequate peripancreatic drainage and irrigation are critical for the successful treatment of traumatic injuries of the pancreas.

Abstract:Acute pancreatitis (AP) presenting as an acute abdomen is a common clinical condition. Acute inflammation causes varying degrees of necrosis of the pancreatic tissue. As the disease progresses, the pathological changes of pancreatic tissue also take a dynamic process. Pancreatic tissue repair is important for recovery of the function of the pancreas after AP. So investigations of the mechanism for pancreatic repair may provide theoretical help for the clinical therapy of AP.

Abstract:The incidence of the mass-forming chronic pancreatitis of the pancreatic head has increased with the increasing prevalence of chronic pancreatitis over the years. In clinical practice, the differential diagnosis between this type of chronic pancreatitis and pancreatic cancer is often difficult. However, the treatment strategies and outcomes of the two are completely different. Thus, increasing attention has been paid to this condition by clinical staff. The authors, in this article, address the diagnosis and surgical treatment of mass-forming chronic pancreatitis of the pancreatic head, so as to provide some reference in clinical practice.

Abstract:Total pancreatectomy with islet cell autotransplantation (TP-IAT) for chronic pancreatitis can effectively alleviate chronic pain so as to reduce the use of analgesic drugs, and maintain part of the endocrine function at the same time, and thereby reduce the insulin requirement. TP-IAT has become an ideal treatment method for cases of chronic pancreatitis, especially for those in the end-stage. The authors, in this paper, address the recent progress in TP-IAT therapy for chronic pancreatitis.

Abstract:Long non-coding RNAs (lncRNAs) are a class of RNA molecules with transcript length more than 200 nt and lack of protein coding capacity, which exert their actions by many layers at the epigenetic, transcription and posttranscription level. In addition, some newly discovered miRNA and circRNA are proven to interact with lncRNAs and thereby participate in the occurrence and development of cancer. In recent years, a large number of lncRNAs have been found exhibiting aberrant expression in pancreatic cancer tissue and cells, and playing a critical role in the occurrence and development of pancreatic cancer. Therefore, the authors address the issues concerning the effects and mechanisms of some lncRNAs that are aberrantly expressed in pancreatic cancer.

Abstract:Borderline resectable pancreatic cancer (BRPC) is an intermediate stage between resectable and unresectable pancreatic cancer, characterized by having a chance to achieve radical resection technically but with high risk of positive surgical margin. In this paper, the authors address the recent advances in aspects of prognotic evaluation and treatment of this condition.