胰管栓塞术动物实验及临床应用
摘要
传统的胰十二指肠切除术约有9-25％胰瘘。多年来外科医生一直在致力于探索一种简便、安全的胰空肠吻合方式，但成效甚少。1977年Little首创胰管栓塞术(Pancreatic Ouct Obstruction，简称POOI，该方法以其简便、安全、可靠的特点很快在临床得到多方面的应用，包括以预防胰瘘为目的应用于胰十二指肠切除术中的残胰胰管栓塞方法。作者1986—1989年开展胰管栓塞术(POO)的动物实验和临床应用研究。动物实验共16只狗，分POO组(12只)和对照组(4只)。观察POO手术前后血淀粉酶、血糖、胰岛素及脂溶性维生素A、E的动态变化。并手术后每两个月处死两只狗，取胰腺组织观察光镜和电镜下病理形态学变化。以后进一步应用于临床12例胰十二指肠切除术和1例慢性胰腺炎行Oddi括约肌切开成形术患者，并与同期的14例传统胰空肠套入式吻合方法比较各自的胰瘘发生情况、观察各组血糖、淀粉酶、胰岛素动态变化。本组观察结果表明：胰十二指肠切除术中胰管栓塞附加胰肠吻合的方法可以有效地防止胰瘘，但不附加胰肠吻合时有
The occurance of pancreatic fistula in classical pan -creaoduodenectomy is usually about 9-25%. Revised simple and safe operative methods have been technically researched in the recent years , but little advance resulted.In 1977 ,J. M. Little introduced a new technique : pancreatic duct obstruction (PDO)with acrylate glue ,and this technique has been generally applied since then for its simplicity and reliability.
Animal experiments have been performed in this Cancer Hospital with 12 dogs ,it demonstrated the feasibility of forming pancreatic duct obstruct ion with SYS-liquid silicon rubber.Under low pressure the embolizing agent was injected into the pancreatic duct and a reproducible atrophy of the gland produced subsequently .Four abdominal explored dogs were used as control in this study. The animal' s serum amylase, blood sugar, plasma insulin and vitamin A and E were analyzed before and after PDO operation. In this study,
The occurance of pancreatic fistula in classical pan -creaoduodenectomy is usually about 9-25%. Revised simple and safe operative methods have been technically researched in the recent years , but little advance resulted.In 1977 ,J. M. Little introduced a new technique : pancreatic duct obstruction (PDO)with acrylate glue ,and this technique has been generally applied since then for its simplicity and reliability.
Animal experiments have been performed in this Cancer Hospital with 12 dogs ,it demonstrated the feasibility of forming pancreatic duct obstruct ion with SYS-liquid silicon rubber.Under low pressure the embolizing agent was injected into the pancreatic duct and a reproducible atrophy of the gland produced subsequently .Four abdominal explored dogs were used as control in this study. The animal' s serum amylase, blood sugar, plasma insulin and vitamin A and E were analyzed before and after PDO operation. In this study,
引文
1、Papachristou DN: Pancreatic fistula Complicating Pancreatectomy for Matignant Diseases. Br.J.Surg. 1981; 68: 238
2、钟守先等：胰十二指肠切除术若干问题探讨。中华外科杂志 1985，23(12)：721—6
3、Little JM.: Pancreatic Duct Obstruction with an Acrytate Glue, A NewMethod for Producing Pancreatic Exocrine Atrophy. Surgery 1977; 81(3), 243—9
4、Little JM.: Duct Obstruction with an Acrytate Glue for Treatment of Chronic Atcohotic Pancreatitis. The Lancet. 1979; 2: 8142
5、Oubernard JM., A New Method of Preparation of Segmental Pancreatic Grafts for Transplantation, Trials in Dogs and in Man. Surgery 1987: 84(5), 633—9
6、Wittrin G．：癌手术作部分十二指肠胰腺切除术时施行胰管阻塞。(德文，Chirurg 1981；52(3)：157)国外医学外科学分册 1982，3：179
7、吴树强等。用不透X线液态硅橡胶行胰管栓塞的实验观察。中华外科杂志 1985，23(2)：84—68、Schneider MU．：慢性胰腺炎时的治疗性胰管闭塞术。观察十二个月的临床．内分泌及外分泌结果。(德文 Langenbecks Arch Chir 1985；363(3)。149) 国外医学外科学分册 1986，1：27—29
9、刘彤华等：糖尿病患者胰岛细胞量的测定。中华医学杂志1989．69(2)：83—5
10、李捷雷等。胰十二指肠切除术后残胰的外分泌功能。中华实验外科杂志 1989．6(2)：49—50
11、杨秋萍等。血浆中维生素AE类胡萝卜素的微量快速高压液相色谱测定法。中华预防医学杂志 1987．21(1)。47—8
12、Kerremans RF., Subtotal Pancreatic Head Resection Combined with LeftPancreatic Duct Obstruction in Chronic Pancreatitis. Acta Gastro-Enterotogica Betqica 1985; 18, 603—6
13、秦兆寅等：胰管栓塞术在胰十二指肠切除术中的应用。中华外科杂志 1985，23(12)：727—8
14、Hegstel DM．著：现代营养学知识 侯祥川等译，人民卫生出版社 第四版
15、Shatimor AA., Occtusion of the Pancreatic Duct. Vestn. Khir. 1984, 132(1), 42—7
16、Gall FP., Resutts of Partiat and Totat Pancreaticodu odenectomy in 117 patients with Chronic Pancreatitis.??World J. Surg. 1981, 5(2),269-270
17、 Cynthia K. Abrama, Role of Nonpancreatic Lipolytic Activity in Exocrine Pancreatic Insufficiency. Gastroenterology 1987,92(1),125-7
18, Inoue K., Relationship Between Development of Fibros is and Hemodynamic Changes of the Pancreas in Dogs. Gastroen terology 1981, 81,37-8
2、钟守先等：胰十二指肠切除术若干问题探讨。中华外科杂志 1985，23(12)：721—6
3、Little JM.: Pancreatic Duct Obstruction with an Acrytate Glue, A NewMethod for Producing Pancreatic Exocrine Atrophy. Surgery 1977; 81(3), 243—9
4、Little JM.: Duct Obstruction with an Acrytate Glue for Treatment of Chronic Atcohotic Pancreatitis. The Lancet. 1979; 2: 8142
5、Oubernard JM., A New Method of Preparation of Segmental Pancreatic Grafts for Transplantation, Trials in Dogs and in Man. Surgery 1987: 84(5), 633—9
6、Wittrin G．：癌手术作部分十二指肠胰腺切除术时施行胰管阻塞。(德文，Chirurg 1981；52(3)：157)国外医学外科学分册 1982，3：179
7、吴树强等。用不透X线液态硅橡胶行胰管栓塞的实验观察。中华外科杂志 1985，23(2)：84—68、Schneider MU．：慢性胰腺炎时的治疗性胰管闭塞术。观察十二个月的临床．内分泌及外分泌结果。(德文 Langenbecks Arch Chir 1985；363(3)。149) 国外医学外科学分册 1986，1：27—29
9、刘彤华等：糖尿病患者胰岛细胞量的测定。中华医学杂志1989．69(2)：83—5
10、李捷雷等。胰十二指肠切除术后残胰的外分泌功能。中华实验外科杂志 1989．6(2)：49—50
11、杨秋萍等。血浆中维生素AE类胡萝卜素的微量快速高压液相色谱测定法。中华预防医学杂志 1987．21(1)。47—8
12、Kerremans RF., Subtotal Pancreatic Head Resection Combined with LeftPancreatic Duct Obstruction in Chronic Pancreatitis. Acta Gastro-Enterotogica Betqica 1985; 18, 603—6
13、秦兆寅等：胰管栓塞术在胰十二指肠切除术中的应用。中华外科杂志 1985，23(12)：727—8
14、Hegstel DM．著：现代营养学知识 侯祥川等译，人民卫生出版社 第四版
15、Shatimor AA., Occtusion of the Pancreatic Duct. Vestn. Khir. 1984, 132(1), 42—7
16、Gall FP., Resutts of Partiat and Totat Pancreaticodu odenectomy in 117 patients with Chronic Pancreatitis.??World J. Surg. 1981, 5(2),269-270
17、 Cynthia K. Abrama, Role of Nonpancreatic Lipolytic Activity in Exocrine Pancreatic Insufficiency. Gastroenterology 1987,92(1),125-7
18, Inoue K., Relationship Between Development of Fibros is and Hemodynamic Changes of the Pancreas in Dogs. Gastroen terology 1981, 81,37-8