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Chronic pancreatitis-diagnosis and treatment:Ulm Experience

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中华肝胆外科杂志 2002年第12期8卷 709-716页

作者： Wolfgang Schlosser MarcoSiech hans g.beger 杨尹默 89075 Ulm

慢性胰腺炎以累及胰腺内外分泌组织的渐进性改变为主要特点 ,在西方国家多由酗酒所致。 10 %～ 30 %的病人表现为胰头炎性包块并致胰头部增大 ,上腹部阵发或持续性疼痛为主要临床表现 ,还可因炎性肿物压迫胰管、胆总管、十二指肠、门静... 详细信息

慢性胰腺炎以累及胰腺内外分泌组织的渐进性改变为主要特点 ,在西方国家多由酗酒所致。 10 %～ 30 %的病人表现为胰头炎性包块并致胰头部增大 ,上腹部阵发或持续性疼痛为主要临床表现 ,还可因炎性肿物压迫胰管、胆总管、十二指肠、门静脉而致相应症状 ,亦为外科治疗的主要适应证。保留十二指肠的胰头切除 (次全切除胰腺头部 ) ,保留了胃十二指肠、胆囊及胆总管 ,并最大限度地保留胰腺。手术主要包括显露胰头、胰头次全切除及消化道重建三个方面。如胆管下端炎性狭窄明显可打开胆管并与空肠袢吻合 ,如胰管狭窄扩张明显可同时纵行切开胰管至体尾部并行胰肠侧侧吻合。Partington Rochelle手术 (胰肠侧侧吻合引流 )常因减压效果不佳、合并胆管狭窄、最终形成胰头炎性包块或胰腺癌而失败 ,故胰腺空肠侧侧吻合仅适于胰头无炎性占位且胰管显著扩张者 ;Frey手术胰头部切除范围过小 ,实际为改良的引流术式 ;Kausch Whipple手术或保留幽门的胰十二指肠切除对慢性胰腺炎病人而言术式过大。与Whipple术及保留幽门的胰十二指肠切除术比较 ,保留十二指肠的胰头切除病人在术后疼痛缓解、体重增加、内外分泌功能等方面均显著优于前者。在为期 14年的随访中 ,行保留十二指肠的胰头切除病人 90 %疼痛完全缓解 ;急性发作率?

关键词：慢性胰腺炎临床表现手术治疗适应症生活质量

保留十二指肠的胰头切除术治疗良性肿瘤、囊性肿瘤及神经内分泌瘤的系统分析

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中华外科杂志 2021年第7期59卷 608-617页

作者： hans g.beger Benjamin Mayer Yinmo Yang Bertram Poch c/o University of Ulm Albert-Einstein-Allee 2389081 UlmGermany Institute for Epidemiology and Medical Biometry University of UlmGermany Department of Surgery Peking University First HospitalBeijing 100034China Center for Oncologic Endocrine and Minimal Invasive SurgeryDonau-Klinikum Neu-UlmGermany

背景保留十二指肠的胰头切除术是替代胰十二指肠切除术治疗良性肿瘤、囊性肿瘤及神经内分泌瘤的可行之选。方法检索Pubmed、Embase及Cochrane数据库中保留十二指肠胰头切除术的研究结果。根据手术指征、围手术期并发症及微创应用等纳入1... 详细信息

背景保留十二指肠的胰头切除术是替代胰十二指肠切除术治疗良性肿瘤、囊性肿瘤及神经内分泌瘤的可行之选。方法检索Pubmed、Embase及Cochrane数据库中保留十二指肠胰头切除术的研究结果。根据手术指征、围手术期并发症及微创应用等纳入1994年1月至2021年3月的38项队列研究共702例患者的临床资料。结果共702例患者分别因良性肿瘤、癌前病变、囊性肿瘤、胰腺神经内分泌肿瘤、十二指肠乳头周围腺瘤等行保留十二指肠的胰头切除术。702例患者中,214例(30.5%)行保留十二指肠的部分胰头切除术,488例(69.5%)行保留十二指肠的全胰头切除术,后者中微创手术占17.3%。两种术式的术后早期严重并发症发生率(术后B及C级胰瘘、胆瘘、腹腔出血及腹腔脓肿)均2 cm的有或无功能的良性内分泌肿瘤外科治疗的首选术式。

关键词：胰腺肿瘤外科手术系统分析

Severe acute pancreatitis: Clinical course and management

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World Journal of gastroenterology 2007年第38期13卷 5043-5051页

作者： hans g.beger Bettina M Rau Department of general Surgery Department of Viszeralsurgery University of Ulm (1982-2001) Donau-Klinikum Neu-Ulm Germany Department of general Viszeral Vascular and Pediatric Surgery Universit?tsklinikum des Saarlandes Homburg/ Saar Germany

Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis- Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.

关键词：急性胰腺炎综合症临床治疗措施

Patient-centered developments in colon-and rectal cancer with a multidisciplinary international team:From translational research to national guidelines

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World Journal of gastrointestinal Surgery 2021年第12期13卷 1597-1614页

作者： Karl-Heinrich Link Marko Kornmann Ludger Staib Ernst-Dietrich Kreuser Wilhelm gaus Erwin Röttinger Peter Suhr Catharina Maulbecker-Armstrong Peter Danenberg Kathleen Danenberg Miriam Schatz Silvia Sander Zhen-Ling Ji Jiang-Tao Li Shu-You Peng Reinhard Bittner hans günther beger Benno Traub Asklepios Tumor Center(ATC)and Surgical Center Asklepios Paulinen KlinikWiesbaden 65197Germany FOgT(Multidisciplinary Study group on Oncology of gastrointestinal Tumors) University of UlmUlm 89081Germany Department of general and Visceral Surgery University of UlmUlm 89081Germany Department of Biometry and Medical Documentation University of UlmUlm 89081Germany Department of Radiotherapy University of UlmUlm 89081Germany Fachbereich gesundheit Medizinisches ManagementSozialversicherungssystemeInternationales Versorgungsmanagemente-HealthTechnische Hochschule MittelhessenGiessen 35390Germany Department of Biochemistry and Molecular Medicine Keck-USC School of MedicineLos AngelesCA 90033United States Norris Comprehensive Cancer Center Keck-USC School of MedicineLos AngelesCA 90033United States Private Practice for Psychology Adelsdorf 91325Germany Department of general Surgery Southeast UniversityNanjing 210009Jiangsu ProvinceChina Department of Surgery The Second Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310009Zhejiang ProvinceChina Surgical Clinic MarienhospitalStuttgart 70177Germany

Rarely,scientific developments centered around the patient as a whole arepublished.Our multidisciplinary group,headed by gastrointestinal surgeons,applied this research philosophy considering the most important aspects of thediseases“colon-and rectal cancer”in the long-term developments.good expertcooperation/knowledge at the Comprehensive Cancer Center Ulm(CCCU)wereapplied in several phase III trials for multimodal treatments of primary tumors(MMT)and metastatic diseases(involving nearly 2000 patients and 64 centers),fortreatment individualization of MMT and of metastatic disease,for psychooncology/quality of life involving the patients’wishes,and for disease prevention.Most of the targets initially were heavily rejected/discussed in thescientific communities,but now have become standards in treatments andnational guidelines or are topics in modern translational research protocolsinvolving molecular biology for e.g.,“patient centered individualized treatment”.In this context we also describe the paths we had to tread in order to realize ournew goals,which at the end were highly beneficial for the patients from manypoints of view.This description is also important for students and youngresearchers who,with an actual view on our recent developments,might want toknow how medical progress was achieved.

关键词： Colon-and rectal cancer Translational research Interdisciplinary treatment Personalized treatment National guidelines

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肝破裂的外科治疗

德国医学 2000年第2期17卷 63-64页

作者： F.Safi Sandra Weiner B.Poch A.Schwarz H.-g.beger 张林 Klinik fr Allgemein-und Visceralchirurgie Hufeland-und SophienkrankenhausVan-de-Velde-Straβe 2D-99423 WeimarGermany 同济医科大学附属同济医院

肝脏创伤外科的历史起源于1870年,由Viktor第1次成功地进行了肝脏枪伤的外科手术。但是直到20世纪60年代人们才对肝脏外科和出血性休克的病理生理有了进一步的理论认识。尽管外科技术和理论有了很大的进展,实际上肝脏破裂的外科治疗问... 详细信息

肝脏创伤外科的历史起源于1870年,由Viktor第1次成功地进行了肝脏枪伤的外科手术。但是直到20世纪60年代人们才对肝脏外科和出血性休克的病理生理有了进一步的理论认识。尽管外科技术和理论有了很大的进展,实际上肝脏破裂的外科治疗问题仍然是个难题。本文回顾性分析已有资料的手术方式、发生率和死亡率,列出各种手术方式的优点和缺点,并和国际上同类文献比较,分析他们之间差异的原因,以此来探讨肝破裂治疗的新路。

关键词：肝破裂外科手术术式

不同pH值培养液对肝细胞一氧化氮合成的影响

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中华消化杂志 2000年第1期20卷 26-29页

作者：舒志军韩伏莅 Jung M beger Hg Nuessler AK 上海市中西医结合医院普外科 200082 上海市中西医结合医院神经内科 200082 Department of general Surgery University Clinicat Safranberg Department of general SurgeryUniversity Clinicat Safranberg

目的　探讨不同 pH值条件对肝细胞培养时一氧化氮 (NO)产生的影响及对肝细胞的损伤程度。方法　本研究首先将成年健康大鼠经静脉注射灭活有毒棒状杆菌 ,感染 4天后处死动物取肝脏作肝细胞分离并培养 ,2 4h后在培养液中加入L 精氨酸 ,同... 详细信息

目的　探讨不同 pH值条件对肝细胞培养时一氧化氮 (NO)产生的影响及对肝细胞的损伤程度。方法　本研究首先将成年健康大鼠经静脉注射灭活有毒棒状杆菌 ,感染 4天后处死动物取肝脏作肝细胞分离并培养 ,2 4h后在培养液中加入L 精氨酸 ,同时将培养液调节成pH7.0、pH7.4及 pH7.8三组 ,又在每一 pH处理组中分出对照组 (CP组 )、大肠杆菌内毒素刺激组 (CP +LPS组 )及单甲基精氨酸抑制组 (CP +LPS +NMA组 ) ,继续培养 2 4h。结果　CP组产生约 10 0 μmol/L的NO ,pH值的改变对其无明显影响。在CP +LPS处理的肝细胞 ,pH7.4及 pH7.8组的值分别为 (2 39.3± 18) μmol/L及(2 2 8.4± 14.7) μmol/L ,显著高于pH7.0组 ((16 3.2± 5 .7) μmol/L ,P <0 .0 1)。加用NMA后 ,一氧化氮的产生明显减少 ,但三组间差异无显著性。加用LPS后肝细胞的损伤加重 ,pH7.0组LDH及ALT值显著高于 pH7.4及pH7.8组。当应用NMA抑制NO生成时 ,培养液中乳酸脱氢酶 (LDH)和丙氨酸转氨酶 (ALT)值显著升高 ,并以酸性组为明显。在CP组肝细胞 ,iNOS的产生量在三种不同 pH处理间无明显差别 ,加用LPS刺激后 ,iNOS的合成明显增加 ,而且酸性或碱性情况下iNOS的合成较 pH7.4时更高。结论　对处于炎症状态的肝细胞 ,酸性环境会抑制一氧化氮合成。

关键词：一氧化氮合成肝细胞损害 pH值培养液

Metabolomics evaluation of the effects of green tea extract on acetaminophen-induced hepatotoxicity in mice

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中国药理学与毒理学杂志 2013年第3期 463-464页

作者： LU Yi-hong SUN Jin-chun Katya PETROVA YANg Xi James gREENHAW Laura K SCHNACKENBERg William SALMINEN Donna L MENDRICK Richard D beger Division of Systems Biology National Center for Toxicological ResearchUS Food and Drug AdministrationJeffersonAR 72079USA Jiangsu Institute for Food and Drug Control PAREXEL International BostonMAUSA

green tea has a considerable amount of polyphenolic catechins and has been promoted to have beneficial effects on health including protective effects against oxidative stress.Acetaminophen(APAP) is a widely used analgesic drug which is usually safe at recommended therapeutic doses but overdose can cause acute liver injury.These studies explored the effects of green tea extract(gTE) on APAP-induced hepatotoxicity using UPLC /MS-and NMR-based metabolomic approaches.Male B6C3F1 mice were orally administered gTE under three scenarios either prior to or after a single dose of APAP.UPLC /MS and NMR were employed for metabolomics analysis of the biochemical changes in mice livers with gTE pretreatment 3 h or 3 d prior to APAP exposure or gTE exposure 6 h after APAP.Based upon the data,gTE given prior to APAP ameliorated the APAP-induced hepatotoxicity in a dose dependent manner whereas gTE given after APAP potentiated the toxicity.Metabolites belonging to multiple classes including but not limited to acylcarnitines,energy metabolism,bile acids,and lysoPCs were identified and semi-quantified.These metabolites were significantly altered by APAP exposure alone compared to control.gTE pretreatment generally resulted in these metabolite levels returning to control levels or being less altered.gTE given after APAP,however,caused more changes in the metabolites over what was induced by APAP alone indicating more severe hepatotoxicity.Combined with biochemistry and histopathology results,the changes in liver metabolites indicated perturbations of fatty acid metabolism,energy metabolism,bile acids metabolism and phospholipids metabolism induced by APAP with differing effects on these metabolites depending upon the time of gTE exposure.The results indicate that the time at which gTE was given highly influenced the severity of APAPinduced toxicity.These studies clearly highlight the need to understand the interactions between herbs and other dietary supplements with commonly used over-the-counter or prescription drugs.

关键词： green tea extract acetaminophen hepatotoxicity metabolic profiling