ObjectiveTo summarize the application of magnetic resonance imaging (MRI) in the evaluation of pancreatic exocrine function.MethodIn this paper, we reviewed and summarized the related literatures about the application of MRI in the field of pancreatic exocrine function evaluation in recent years.ResultsA variety of MRI techniques could be used to detect the pancreatic exocrine function. In addition to conventional MRI techniques, there were also MRI stimulated by pancreatic secretions, cine (dynamic) cholangiopancreatography based on space selective reverse recovery pulse, and so on.ConclusionThe new MRI techniques have potential for semi-quantitative and quantitative evaluation of pancreatic exocrine function.
Objective To summarize the CT, MRI, and positron emission computed tomography (PET) imaging findings of hematologic malignancies of the pancreas, so as to improve the capacity of its diagnosis. Methods After searching articles concerning radiological research about hematologic malignancies of the pancreas, summarizing its imaging characteristics. Results Hematologic malignancies of the pancreas include pancreatic lymphoma, pancreatic multiple myeloma, myeloid sarcoma, posttransplantation lymphoproliferative disorder, and giant lymph node hyperplasia. ① Pancreatic lymphoma: imaging features of pancreatic lymphoma are segmental or diffuse homogeneous enlargement of the pancreas, diameter of mass >5 cm, adenopathy below the level of renal veins, and lack of pancreatic duct dilation. Blurred margins of pancreas by lymphadenopathy is highly suggestive of lymphoma. ② Pancreatic multiple myeloma: pancreatic multiple myeloma are hyperintense on both T1- and T2-weighted images. ③ Pancreatic granulocytic sarcoma: pancreatic granulocytic sarcoma present as homogeneous hypoenhancing mass on CT, usually without pancreatic duct dilation. On MRI, the lesions are isointense and mildly hyperintense on T1- and T2-weighted images respectively. ④ Posttransplantation lymphoproliferative disorder: diameter of leison of posttransplantation lymphoproliferative disorder usually is >5 cm with poor enhancement. Lesions are mildly hyperintense on T2-weighted images and extremely hypermetabolic on PET images. ⑤ Giant lymph node hyperplasia: it mainly appear as solitary noninvasive masses. Punctate calcification and surrounding supply vessels are observed in hyaline vascular type. Plasma cell type demonstrate unapparent enhancement and less calcification. Conclusions Hematologic malignancies of the pancreas manifest different imaging features on CT, MRI, and PET. Familiarity with such characteristics helps to early recognize diseases and determine next-step measures.
Objective To summarize the imaging manifestation and identification of ectopic pancreas (EP), so as to improve clinicians and radiologists’ knowledge of EP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate and avoiding unnecessary surgery. Methods Combined with clinical experience and relevant literatures in recent years, the histopathology, common imaging manifestations and main differential diagnosis of ectopic pancreas were summarized. Results EP is a rare congenital developmental anomaly of pancreas, the most common location is the upper digestive system. At present, the commonly used imaging technology is computed tomography. The imaging findings of ectopic pancreas were similar to those of normal pancreas, and its density and enhancement characteristics were related to its histopathological composition. The specific signs of ectopic pancreas include “central umbilical sign” “ductal structure” and “flat/adherent sign”. Heterotopic pancreas should be differentiated from submucosal tumor of gastrointestinal tract. Conclusions The imaging findings of EP have certain characteristics. For some cases with atypical imaging findings, imaging diagnosis is difficult.
ObjectiveTo summarize the perioperative management experience and the treatment strategy of hyperkalemia after simultaneous pancreas and kidney transplantation (SPK).MethodThe clinical data of patients with diabetes combined with end-stage renal disease who accepted SPK in the Organ Transplantation Center of West China Hospital of Sichuan University from November 2017 to November 2019 were retrospectively analyzed.ResultsA total of 6 patients accepted SPK totally. The cold ischemia time of all allografts was less than 8 h. The levels of fasting blood glucose and serum creatinine were normal in the 5 surviving patients, and the diabetic complications were relieved or improved, except for 1 patient who died of cardiac arrest due to acute left heart failure. There were 1 case of delayed primary renal function recovery, 2 cases of bleeding in the surgical area of pancreas transplantation, 1 case of gastrointestinal bleeding, 3 cases of microthrombosis in the blood vessels of pancreas transplantation, 2 cases of perirenal effusion infection, 2 cases of pulmonary infection, and 1 case of ureterobladder anastomotic leakage, all of which were cured after symptomatic treatment. Only 2 patients occurred hyperkalemia after SPK (the highest level was 6.49 mmol/L and 6.67 mmol/L respectively), and transfusion of 10% glucose injection contain insulin, emergency dialysis and oral fludrocortisone were successively performed on them to restore the potassium density in 1 month and 2 months after surgery. There were no complications of perioperative surgical technical hemorrhage, intestinal leakage, large arteriovenous thrombosis, necrotizing pancreatitis, etc.ConclusionsSPK is the most effective treatment for patients with diabetes combined with end-stage renal disease. Transfusion of 10% glucose injection contain insulin, emergency dialysis, and oral fludrocortisone are effective strategies in treating hyperkalemia after SPK.
ObjectiveTo understand the research progress of treatment of hyperkalemia after simultaneous pancreas and kidney transplantation (SPK), and to provide the basis for the prevention and treatment of hyperkalemia after SPK.MethodThe relevant literatures about hyperkalemia after SPK in recent years were reviewed.ResultsThe pancreas and kidney that maintained the stability of serum potassium in different ways had been confirmed in current studies. The newly transplanted organ dysfunction after SPK and the use of drugs after SPK both caused hyperkalemia. The treatment principle of hyperkalemia after SPK was to take corresponding prevention and treatment measures according to different reasons.ConclusionsSPK is the best treatment for diabetic renal failure. Postoperative hyperkalemia is one of the most common complications, and timely and correct management is of great significance to the survival and prognosis of patients.
ObjectiveTo compare surgical safety and postoperative efficacy of total mesopancreas excision (TMpE) with pancreaticoduodenectomy (PD) and standard PD (Whipple).MethodsA total of 123 patients underwent PD in the Affiliated Hospital of Southwest Medical University from August 2013 to December 2017 were included, including 47 patients with pancreatic head carcinoma and 76 patients with periampullary carcinoma, then were divided into a TMpE group and a Whipple group respectively. The operative time, intraoperative blood loss, postoperative hospitalization time, postoperative recovery time of gastrointestinal function, postoperative complications, and postoperative survival of patients with the same site between the Whipple group and the TMpE group were retrospectively compared.Results① There were no significant differences in the baseline data between the TMpE group and the Whipple group in the pancreatic head carcinoma and periampullary carcinoma (P>0.05). ② For the patients with pancreatic head carcinoma, there were no significant differences in the operative time, postoperative hospitalization time, and postoperative gastrointestinal function recovery time between the TMpE group and the Whipple group (P>0.05), but the intraoperative blood loss in the TMpE group was significantly higher than that in the Whipple group (P=0.038); For the patients with periampullary carcinoma, the above indexes had no significant differences between the TMpE group and the Whipple group (P>0.05). ③ The total incidence of complications in the TMpE group was significantly higher than that in the Whipple group for the patients with pancreatic head carcinoma (χ2=6.595, P=0.010), which had no significant difference between the TMpE group and the Whipple group for the patients with periampullary carcinoma (P>0.05). ④ The cumulative survival curve in the TMpE group was better than that in the Whipple group for the patients with pancreatic head carcinoma (χ2=9.597, P=0.002), which had no significant difference between the TMpE group and the Whipple group for the patients with periampullary carcinoma (χ2=0.844, P=0.358).ConclusionsFor patients with pancreatic head cancer, comparing with standard Whipple, although TMpE PD increases intraoperative blood loss and overall incidence of complications, it could significantly improve long-term survival and there are no significant differences in postoperative recovery time and operative safety between Whipple and TMpE; For patients with periampullary carcinoma, there are no significant differences in surgical safety, long-term survival rate, and survival time between TMpE and Whipple.
【Abstract】 Objective To summarize the experience in radical excision of carcinoma of head of pancreas in order to improve the surgical skills and reduce the occurrence of postoperative complications. Methods The clinical material of 55 patients (ages: 32-72 years; mean age: 56.5 years) with carcinoma of head of pancreas who received radical excision from January 1996 to March 2005 were analyzed retrospectively. All the cases were pathologically verified as ductal adenocarcinoma of head of pancreas. The treatment time following the operations was divided into two phases by year 2002 ( phaseⅠ: 1996-2002; phaseⅡ: 2002-2005). Different surgical treatment groups were fixed and ICU and other measures were implemented during the second phase. Results All the patients, consisting of 31 males and 24 females, underwent consecutive extended resection. The radically curative rates of phaseⅠand phaseⅡ were 25.9%(29/112) and 34.7%(26/75), respectively, and the complication rates were 48.3%（14/29） and 19.2%（5/26）, respectively. A variety of surgical skills would improve the operation, including extended regional lymphadenectomy, resection of involved nerve plexus, combined vessel resection and comprehensive bleeding-control technique and so on. Conclusion The improvement of radically curative effect and the reduction of complication rate depend on the advancement of surgical skills and the further understanding of pathophysiology of carcinoma of head of pancreas.
ObjectiveTo assess the feasibility of the treatment of unresectable late pancreatic cancer with laparoscopic choledochojejunostomy and gastric bypass. MethodsFrom June 2000 to December 2003, laparoscopic choledochojejunostomy and gastric bypass were successfully performed in 15 patients with unresectable late pancreatic cancer. Endoscopic nosobiliary drainage (ENBD) was performed before the operation. ResultsAll procedures were completed laparoscopically. Jaundice and hepatic function of the patients were obviously improved after the bypass. Oral nutrition was recovered after operation. The mean operative time was (100±26) min (range 70-200 min); the mean operative blood loss was (60±15) ml (range 30-120 ml); the bowel function recovery was on the 3rd-5th postoperative day; the average hospital stay was (8.1±0.7) days (range 6-13 days). Incision infection ocurred in one patient. No operative complications occurred in other patients. ConclusionTreatment of unresectable late carcinoma of the pancreas with laparoscopic choledochojejunostomy and gastric bypass aided by ENBD is a minimally invasive technique with less postoperative pain，shorter hospital stay, lower procedurerelated morbidity,and better oral nutrition. The life quality of patients with late pancreatic cancer can be obviously improved.
ObjectiveTo summarize the current status of imaging in intraductal papillary mucinous neoplasms of the pancreas (IPMN).MethodThe related literatures of imaging about IPMN of the pancreas were searched in the PubMed, CNKI, VIP, and Wanfang Data databases, etc.ResultsA variety of imaging techniques could be used to diagnosis IPMN of the pancreas, including CT, MRI, EUS, and PET-CT. The CT and MRI had great performances to diagnose and differential diagnosis of benign and malignant IPMN of the pancreas. The MRI with new targeted nanoparticle contrast agents could be used to diagnosis the early IPMN of the pancreas. The EUS was very good at detecting the wall nodules in the IPMN of the pancreas. Compared with the CT and MRI, the ability of EUS to grade IPMN of the pancreas was uncertain. The PET-CT was of high performance for the differential diagnosis between the benign and malignant IPMN of the pancreas.ConclusionsVarious imaging technologies have their own advantages in diagnosing IPMN of pancreas. MRI is currently the optimal choice when condition is permit.
Objective To investigate differential points of clinical symptoms and pathology of solid-pseudopapillary tumor of the pancreas (SPTP) and islet cell tumor (ICT). Methods Fifteen cases of SPTP and twelve cases of ICT were studied in this retrospective research. Clinical symptom, pathologic feature and computed tomography (CT) image of patients with both tumors were analyzed, and the imaging features were compared with pathological results. Results The mean age of SPTP patients was 22.4 year-old. Twelve patients with SPTP presented a palpable abdominal mass as the initial symptom. It was observed that the tumor cells were located in a pseudopapillary pattern with a fibro-vascular core histologically. On the CT images, a mixture of solid and cystic structures could be seen in all the tumors. After taking enhanced CT scan, the solid portion was slightly enhanced in the arterial phase and the contrast intensity increased in the portal venous phase. On the other hand, the mean age of ICT patients was 39.3 year-old. The major symptom was due to the function of islet cell tumor, which was typical in 8 patients, presenting as Whipple triad. Histologically, cells demonstrated in trabecular, massive, acinar or solid patterns, and the blood supply of the tumor was abundant. On the CT images, most small tumors were difficulty to be detected. ICT could be markedly enhanced in the arterial phase and slightly enhanced in the portal venous phase on post-contrast CT scan. Conclusion Clinical symptom, pathologic feature and CT scanning are helpful to differentiate SPTP from ICT.