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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： Severe acute pancreatitis Multiorgan failure syndrome Infected necrosis Fluid replacement Enteral feeding Surgical and interventional debridement

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

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

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 *** 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 *** 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 *** 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 *** 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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急性胰腺炎的外科治疗

中华外科杂志 2001年第4期39卷 329-331页

作者： hans guenther beger Bettina Rau Rainer Isenmann Jens Mayer 刘斌吴在德 Professor of Surgery 同济医科大学同济医院

100年前,波士顿的Reginald　Fitz　认为,急性胰腺炎的严重程度主要取决于炎症及其相关形态学变化的程度。急性胰腺炎的病程涉及几个相关器官及其临床、病理、放射学、生化和细菌学检查结果,每种变化都要求有特殊的治疗方法。临床表现包... 详细信息

100年前,波士顿的Reginald　Fitz　认为,急性胰腺炎的严重程度主要取决于炎症及其相关形态学变化的程度。急性胰腺炎的病程涉及几个相关器官及其临床、病理、放射学、生化和细菌学检查结果,每种变化都要求有特殊的治疗方法。临床表现包括轻度的局限性疾病、感染形成及由此所致的严重的局限性和全身性并发症。相应的病理变化包括限制性肠性水肿，至胰腺及周围组织坏死,直至累及远处器官。　　　　

关键词：急性胰腺炎外科手术感染病死率