课件：胰十二指肠切除术有关问题讨论.ppt

* 生长抑素通过与细胞表面的一种或几种生长抑素受体（５种不同受体，SSTR1-SSTR5）结合而起作用．一旦生长抑素与某一受体结合，就激活了细胞内的一种或几种抑制Ｇ蛋白，并启动了抑制反应的级联生化信号传递系统． 思他宁连续使用不会出现效力下降（“脱敏”现象），反而可上调SSTR数量，而且与5种受体结合是达到这一效应的必需条件 ．而奥曲肽在使用会出现脱敏现象． * 除中枢神经系统外，生长抑素在胃肠道和胰腺大量分泌。 思他宁可以减少内腔循环和侧枝循环血流量、降低门脉压力及食管下段括约肌压力，从而治疗急性食管静脉曲张出血。 思他宁还可以减少胰脏的内外分泌、松弛oddi括约肌、同时对胰腺细胞有保护作用，从而预防胰腺术后损伤。 另外减少胆、胰及肠瘘的过量分泌，辅助治疗术后并发肠瘘等。 * Distal pancreatectomy involves removal of the tail or plus a portion of the pancreas. Total pancreatectomy means removal of the whole pancreas. The Whipple’s procedure is the most widely used procedure – it removes the head of pancreas as well as clearing the lymph nodes near the pancreas, removes part of stomach, the entire duodenum, a small part of jejunum, entire gall bladder and part of the common bile duct. The remnant bile duct is then attached to the small intestine so that bile from the liver can continue to enter the small intestine. * The combination of pancreatic consistency and exocrine secretions make effective anastomosis between the pancreatic stump and the stomach or jejunum difficult to achieve and potentially prone to failure. * The corrosive nature of pancreatic secretions (frequently compounded by infection) is responsible for most of major complications. External fistulas cause substantial patient disability and distress, and require re-operation and prolonged hospital care. * Patients with a parenchyma of soft to intermediate consistency produce a larger amount of pancreatic juice and face a higher risk of pancreatic leakage than those with parenchyma of a hard consistency1. Whipple’s procedure is now being used increasingly to treat a variety of malignant and benign diseases of the pancreas. The combination of factors related to the physiology of chronic pancreatitis is thought to account for the reduction in anastomotic failure following surgery, and the significant lowering of the rate of fistula formation in comparison with malignant disease. References:1. Hamanaka Y, Nishihara K, Hamasak