2015年 · 第53卷第04期

The incidence of chronic pancreatitis is increasing year by year. In order to standardize the diagnosis and treatment of chronic pancreatitis and improve the level of multidisciplinary comprehensive diagnosis and treatment, the Pancreatic Surgery Group of Surgery Branch of Chinese Medical Association revised the Guidelines for Diagnosis and Treatment of Chronic Pancreatitis (Discussion Draft) formulated in 2008. On the basis of the original version, with reference to relevant international guidelines and the latest research results, epidemiological data, evidence-based medical evidence and clinical basic research results, combined with the progress in the field of diagnosis and treatment of chronic pancreatitis at home and abroad in recent years, all members of the classical classics group discussed and reviewed together, and extensively solicited opinions through guide interpretation tour, group discussion and other forms, continuously revised and improved, and the final draft was completed. It is hoped that this guideline will be continuously improved in clinical practice, and you are welcome to put forward valuable opinions and suggestions to further improve the diagnosis and treatment of chronic pancreatitis in China.

In order to standardize the diagnosis and treatment of chronic pancreatitis, the Pancreatic Surgery Group of Surgery Branch of Chinese Medical Association formulated the Guidelines for Diagnosis and Treatment of Chronic Pancreatitis (Discussion Draft) in 2008. In recent years, with the increasing incidence of chronic pancreatitis and the increasing research in its basic and clinical fields, the 2008 edition of the guidelines can no longer meet the needs of clinical diagnosis and treatment. According to the latest research results and evidence-based medical evidence, the pancreatic surgery group revised the existing guidelines with reference to relevant international guidelines. All members of the classical classics group discussed and reviewed them together, and extensively solicited opinions through group discussion, interpretation and lecture tour, etc. At the end of 2014, the Guidelines for the Diagnosis and Treatment of Chronic Pancreatitis (2014) (hereinafter referred to as the "Guidelines") were finalized. Now, the main contents of the "Guide", especially the updated part, will be interpreted, and you are welcome to correct.

A 54-year-old male was admitted to the hospital on 4 July 2012 for "cough with exertion dyspnea for 3 months". Past smoking history for more than 30 years, about 1 pack/d. Enhanced chest CT scan was performed in an external hospital before admission, which revealed "peripheral lung cancer of the lower lobe of the right lung, invading the posterior chest wall and ribs; with giant hilar fusion lymph nodes, invading the main pulmonary artery and the initiation of the pulmonary vein atrium; and diffuse lobular central emphysema of both lungs" (Figure 1)。 After admission, the whole body bone scan, head MRI, abdominal CT and neck B-ultrasound were further examined, and no abnormalities were found. The clinical diagnosis was locally advanced lung cancer (T4N1M0). Considering that the giant lymph node of hilar fusion completely compressed and blocked the right pulmonary artery trunk and pulmonary vein root, it was difficult for chemotherapeutic drugs to reach the tumor area through the pulmonary circulation, so preoperative chemotherapy was not performed. On July 13, 2012, the patient underwent extended radical surgery for lung cancer under general anesthesia, cardiopulmonary bypass (femoral arteriovenous bypass) assisted by resection of right whole lung, part of left atrium and part of chest wall, and dissection of mediastinal lymph node system. The patient recovered smoothly after operation and was discharged 15 days after operation. The postoperative pathology showed that the primary tumor was 11.0 cm ×6.0 cm, the hilar fusion lymph nodes were 7.0 cm ×6.5 cm, and the mediastinal lymph nodes were (-). The postoperative pathological stage was also T4N1M0 (Figure 2)。

A 51-year-old male was admitted to the hospital on 25 June 2013 for "1 week of right eye protrusion with intracranial murmur 1 month after craniocerebral trauma". The patient suffered from frontal and ethmoid sinus fractures due to a car accident one month ago. He was treated conservatively and discharged from hospital with good recovery. Right exophthalmos and intracranial murmur occurred 1 week ago. Physical examination: visual acuity of right eye 0.5, right eyeball protruding outward with conjunctival congestion; Fundus examination showed venous congestion and edema; A blow-like murmur consistent with heart rate could be heard in the right orbit and temporal region. FLAIR sequence of head MRI showed hyperintensity edema on the right side of the pons. Digital subtraction angiography of the head showed cavernous sinus arterial phase development, drainage through ophthalmic vein, and simultaneous drainage through inferior petrosal sinus and slope venous plexus; A dilated vein is seen in front of the brainstem, draining through the basilar vein to the Galen vein to the straight sinus; The occlusion of the suprapetrosal sinus was not developed. Compressing the right carotid artery and performing left internal carotid artery angiography showed good collateral circulation and no delay in the right middle cerebral artery (Figure 1)。 A traumatic carotid cavernous fistulae (TCCF) was diagnosed and a neck compression test was administered to further facilitate the establishment of collateral circulation. After 5 d, the patient developed left limb paralysis, muscle strength grade 2, and pathological signs. Reexamination MRI showed aggravation of brainstem edema (Figure 2)。 TCCF balloon embolization was performed in the emergency department. The TCCF embolization was satisfactory, the internal carotid artery was patent, and the cavernous sinus was not developed (Figure 3)。 After operation, the patient's ocular symptoms gradually relieved, the murmur disappeared, and the paralysis of the left limb gradually recovered. One week after surgery, MRI revealed a reduction in brainstem edema. After 1 month follow-up, the clinical symptoms disappeared, the limb paralysis completely recovered, and the brainstem edema basically disappeared after MRI reexamination. Continued follow-up for 1 year, the patient had no discomfort and lived normally.