Surgical therapy of severe acute pancreatitis (SAP) has been developed through several stages.The initial active surgery was replaced by conservative treatment followed by selective surgical intervention.Surgical procedures changed from pancreatic capsule incision and pancreatectomy at the early stage to necrosectomy at the later stage.Recently,planned minimally invasive necrosectomy was used to treat SAP patients.Some patients received ultrasound or CT guided drainage initially were finally cured by definitive open necrosectomy.In recent years,more advanced management of SAP developed in multidisiplinary treatment.Therefore,comprehensive treatment of SAP including the indication of surgical intervention at early stage and the optimal timing and the rational method of surgery at the late stage of SAP was discussed.

Objective To explore the changes of plasma endotoxin and D-lactate during intestinal mucosal barrier injury of acute pancreatitis.Methods Wistar rats were randomly divided into sham-operation(SO)group,and severe acute pancreatitis(SAP)group.Plasma endotoxin and D-lactate were determined at 1,3,6 and 12 hour after operations.Results The plasma endotoxin and D-lactate in SAP group increased obviously with time,and the difference betueen the 2 groups was significante(P

Objective To explore the role of inflammatory mediators in the pathogenesis of acute pancreatitis(AP).Methods Observation the relationship betweent the changes in serum TNF and IL-6 and(histopathology) of the pancreas in AP rats.Results(1)Rats in sham operation group survived throughout the experiment.Compared with of sham operation group,in AP group survival time shortened significantly(P

Objective To explore the role of apoptosis in the pathogenesis of acute pancreatitis(AP)and to (investigate) the effect of ligustrazin(LGT) on the apoptosis in acute pancreatitis .Methods Experimental animals were divided into three groups randomly: (1) AP group, (2) comparison group,and (3) therapy group. Pathologic score and TUNEL method were used to detect the pathologic mophology of pancreatic tissue and the pancreatic cell apoptosis index in the 3 groups. Results In the early stage of AP,the majority of cells are apototic and the degree of AP is slight.In the late stage of AP,the majority of cells show necrosis,and the degree of AP is severe.The (induction) of cell apoptosis can lessen the pathologic state of AP. Conclusions The degree of pathologic changes in AP can be lessened by the induction of cell apoptosis,but there is a definte time limit.

Presently,tremendous progress has been achieved in the research of acute pancreatitis (AP),which lead to significant changes in many important aspects of the diagnosis and treatment for AP.In 2014,the Pancreatic Surgery Group of Surgery Branch of Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Severe Acute Pancreatitis which was published in 2007.In the revised guidelines,the severity of AP is classified as mild acute pancreatitis (MAP),moderately severe acutepancreatitis (MSAP) and severe acute pancreatitis (SAP).The definition of SAP or MSAP depends on the duration of organ failure,which is persistent (＞48 hours) in SAP but is transient (≤48 hours) in MSAP.Modified CT severity index (MCTSI) is used as the imaging evaluation.Acute peripancreatic fluid collection (APFC),acute necrotic collection (ANC),walled-off necrosis (WON) and pancreatic pseudocyst are the local complications.The disease course is divided into 3 stages,including early stage (acute phase),middle stage (evolution phase) and late stage (infection phase).Infected necrosis is an indication for the surgical treatment,but the surgery should not be performed in sterile necrosis.Meanwhile,surgical treatment should follow the delayed principle.Surgical methods that include percutaneous drainage (PCD),minimally invasive surgery and open surgery could be selected separately orjointly.

Because of the complex pathogenesis and progressive development,it is difficult to define the optimal surgical time and procedure for chronic pancreatitis.The individualized treatment of chronic pancreatitis should resect the inflammatory mass of the head of the pancreas and preserve the pancreatic parenchyma to postpone the injury of pancreatic function and improve life quality as well as decrease the risk for carcinogenesis of pancreatic cancer.Conservative and endoscopic treatment can be considered in the early stage,while surgical intervention should be applied for chronic pancreatitis with stenosis or obstruction of pancreatic duct and calcification of the pancreatic parenchyma.Frey procedure can be performed on patients only with stone in or dilation of pancreatic duct ; patients with obvious inflammatory mass or calcification of the head of the pancreas should receive Beger procedure to decrease the morbidity of pancreatic cancer.

Objective To explore the means of treating postoperative gastrointestinal fistulas in patients with severe acute pancreatitis(SAP). Methods A retrospective study was carried out on the clinical data of 28 cases of postoperative gastrointestinal fistulas(PGF) in patients with severe acute pancreatitis admitted in our department between 1996 and 1999.Results The amount of drainage decreased significantly by using somatostatin(SS) and growth hormone(GH). All the patients were recovered, the average disappearred time of the fistula was (52?16) days(24～227 days).85.7% of the fistula were cured by non operative treatment.Conclusions Non-operative treatment is suitable to most of SAP patients with PGF. SS and GH can accelerate the healing of gastrointestinal fistulas.

Objective To investigate the role of smear examination of wound secretion in early diagnosis and treatment of gaseous gangrene after trauma.Methods The data of 10 881 patients,who were carried to our hospital more than one hour after injuries from April 2003 to April 2006,were collected.Smear examination of wound secretion had been performed in these patients.Results Among the 10 881 wounded patients,11 patients developed gaseous gangrene,taking up 0.10%.Among the 11 gaseous gangrene patients,5 were caused by vehicle crash,3 by machine,2 by stone,1 by gun-shot injury.As for the wounded locations,7(63.6%)patients were in lower extremity,and 3(27.3%)patients in upper extremity,and 1 patient in mandible with head and neck wounds.The onset time of gaseous gangrene was(3.3?2.2)d.The 11 patients were completely cured.Seven patients with open comminuted fracture and lost limb function were performed with wound limb amputation,3 patients with injuries without fractures and 1 patient with mandible combined head and neck wounds were immediately treated with surgical debridement,cephalosporins,and hyperbaric oxygen(HBO). Conclusion Gas gangrene was extremely rare in injury patients but it was life-threatening,so doctors should pay more attention.Cleaning-up the wounds and debridement were critical for prevention of infection,and HBO might serve as an useful assistant method.Smear examination of wound secretion was helpful in early diagnosis and treatment of gaseous gangrene after trauma.

Objective To investigate the inducible effect of immature dendritic cells (DC) on immune tolerance in coordination islet xenotransplantation.Methods Mature and immature DC were cultured from BALB/c mice with 20 ?g/L GM-CSF and 500 ?g/L GM-CSF+ 200 ?g/L IL-4, respectively, then loaded with major histocompatibility complex (MHC) antigen of Wistar rat. Mature and immature DC were injected into the mice with diabetes. After a week, the islets of Wistar rat or SD rat were transplanted under the envelop of left renal of the diabetes mice. The survival time of grafts was monitored. The immune reactivity of T cell was evaluated by mixed lymphocyte culture. Results Grafts in BALB/c mice pretreated with mature DC rejected quickly, while the survival time of grafts was significantly prolonged in the mice pretreated with immature DC. However, whether pretreated with mature DC or immature DC, grafts from SD rat were rejected soon. The splenocytes of tolerant mice showed mild proliferation. Conclusion The recipient pretreated with immature DC will lead to the anergy of T lymphocyte, and prolong the survival time of xeno-islet.

Objective:To investigate the effect of host derived immune deficient dendritic cell(DC) on immune tolerance in transplantation of xenoislet.Methods:Mature or immune deficient DC were cultured from BALB/c mice and loaded with MHC antigen of Wistar rat. The DC were injected into the diabetes mice through tail venous, then islets of Wistar or SD rats were implanted beneath the capsule of renal after one week. Survival time of grafts was monitored. Mixed lymphocyte culture and Th1/Th2 cytokine were performed.Results:Surviving time of Grafts in normal group was 8.2?1.1 d, and that of mature DC treated group was 6.1?1.1 d(P