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With the support of the Shanghai Municipal Science and Technology Commission, World Science and the "The Paper" platform jointly planned the "Approaching Science" column to popularize science and report on the achievements that have won national and Shanghai science and technology awards. This article focuses on the first prize of the 2022 Shanghai Science and Technology Progress Award "Research and Application of Key Technologies for the Clinical Diagnosis and Treatment of Chronic Pancreatitis", which was won by a team led by Professor Liao Zhuan, President of the First Affiliated Hospital of the Naval Medical University (Shanghai Changhai Hospital).
Guide
In the human body, the "pancreas" is an inconspicuous organ, weighing only about 200 grams, but it is one of the most important organs in the human body. Pancreatic cancer, known as the "king of cancer", and "acute pancreatitis", which has a high mortality rate, are both related to it. But few people know about the existence of the disease "chronic pancreatitis", many years ago, there was no cure for this painful disease, patients can only rely on painkillers to alleviate, and then gradually become addicted to painkillers, the body becomes emaciated, and this disease also has the risk of cancer. At that time, chronic pancreatitis was also recognized worldwide as a major problem that was difficult to treat.
After more than 20 years of hard work, the team of Professor Liao Zhuan, President of the First Affiliated Hospital of the Naval Medical University (Shanghai Changhai Hospital), has overcome this world-class problem, using the shock wave to break the stones in the pancreas, playing the role of "fighting cattle across the mountains", achieving good treatment results, and winning wide praise from patients. The project "Research and Application of Key Technologies for Clinical Diagnosis and Treatment of Chronic Pancreatitis" won the first prize of the 2022 Shanghai Science and Technology Progress Award.
Chronic pancreatitis, a worldwide intractable disease
Painful and helpless, a medical problem that has plagued the world for many years
The food we ingest enters the mouth, throat, esophagus, stomach, small intestine, and large intestine in turn. The small intestine is further divided into duodenum, jejunum, and ileum. The duodenum with a length of 20~25 cm is a special existence, where the duct entrance of the pancreas and the duct entrance of the biliary tract, from which the digestive juices secreted by the two organs flow into the small intestine to digest food, absorb nutrients, and provide the energy needed for the survival of the human body.
The main function of the pancreas is to secrete digestive enzymes, which are both exocrine and endocrine glands. Endocrine glands secrete insulin, which plays an important role in blood sugar regulation in the body. The exocrine glands are made up of acinar and glandular ducts and mainly secrete pancreatic enzymes such as lipase, protease, and amylase. Deceptively simple, but complex, there are precise assembly lines inside the exocrine glands. Liao Zhuan introduced:
Acinar secretes pancreatic enzymes, which are inactive when transported in the pancreatic duct, in a quiescent phase, after entering the duodenum in the small intestine, because the small intestine will secrete enterokinase, it will activate lipase, protease, amylase, etc., to break down and absorb food in the small intestine. ”
The pancreatic duct can be seen as a river, the pancreatic acinar is a "chemical factory" upstream of the river, and the small intestine is the final "assembly factory", through which these enzymes are transported to the small intestine to reassemble and function. But if something goes wrong with this process, the disease will appear.
The pancreas is an important organ of the human body, which has both internal and external secretion functions
"The occurrence of acute pancreatitis is usually related to excessive alcohol consumption or bile caused by gallstones flowing into the pancreatic duct, which will activate inactive pancreatic enzymes in the pancreatic duct, start digestive function, open dangerous 'self-digestion', produce amino acids, and activate more pancreatic enzymes, forming a chain reaction. This is the pathogenesis behind severe acute pancreatitis, which has a very high mortality rate. The reason why the small intestine and stomach don't have the dreaded 'self-digestion' happens is because they both have a mucosal barrier, and their main components are bicarbonate and mucus. The pancreatic duct is not protected by this substance. ”
If acute pancreatitis is a "big fire" type of disease, then chronic pancreatitis is a "low heat and slow cooking".
Imaging and gross pathological manifestations of chronic pancreatitis
The most important feature of chronic pancreatitis is that the inflammatory response occurs at a certain frequency, resulting in fibrosis of the inside of the pancreatic duct. This fibrosis is also the self-protection of the organs, because the location of the pancreas is relatively special, in the posterior part of the peritoneum, close to the abdominal aorta and portal vein, there are many adjacent organs around, and the space is relatively narrow.
A certain part of the human body will scab over after injury, and the same is true for fibrosis inside the organs, and the shell will become larger and larger after multiple fibrosis. The protease secreted by the pancreas contains calcium ions, and the epithelial cells of the pancreatic duct secrete water and bicarbonate ions, which originally played a role in promoting "transport" and maintaining the alkaline environment of the pancreatic duct, but under the stimulation of this special inflammatory response, the combination of the two components forms calcium carbonate, which is the main component of "pearl". This is how pancreatic stones are formed. After the occurrence of stones, the pancreatic ducts begin to swell and the secretion of pancreatic enzymes increases, leading to a worsening condition.
About 10% of patients with chronic pancreatitis have pancreatic atrophy and lack of pancreatic enzyme secretion, and in vitro alternative therapy can be carried out, and lifelong medication can restore digestive function and carbohydrate metabolism. The other 90% of patients have pancreatic stones. 廖专 says:
The pancreatic duct of the pancreas is very narrow, and the diameter of the pancreatic duct in adults is about 3~4 mm. In the past, there was only one way to perform pancreatic surgery, and pancreatic surgery is recognized as one of the most difficult surgeries in the world, with many surgical complications. In addition, after pancreatic stone surgery, internal stones will appear due to trauma. The patient will still suffer excesses, but only painkillers can be used to relieve them. ”
Uniquely let the shockwave "help" to achieve a satisfactory healing effect
Overcoming the problem of treating chronic pancreatitis is the scientific research direction formulated by Li Zhaoshen, an academician of the Chinese Academy of Engineering, to Liao Zhuan, who joined the school, 21 years ago. At that time, Liao Zhuan was still a master's student of Academician Li.
At that time, a "shock wave" technique was tried to be used in the treatment of "extracorporeal shock wave lithotripsy" for kidney stones. One of the characteristics of the shock wave is that it will not have an effect if it "travels" through an environment of the same density, but it will have a destructive effect when it encounters an environment of different densities. In the early medical experiments of shockwave treatment for kidney stones, doctors would make patients sit in a bathtub with a shockwave emitting device, and the density of kidney stones was much higher than that of the human body, so the shockwave could break the stones during the treatment and achieve the effect of treatment.
Liao Zhuan and his colleagues began to think about whether the shock wave therapy technology in the "extracorporeal shock wave lithotripsy" of kidney stones could also be applied to the treatment of chronic pancreatitis. The idea is good, but the road is difficult.
"We took some patients to the medical unit for the treatment of kidney stones, but they all failed several times in a row, because unlike other stones, pancreatic stones will stick tightly to the wall of the pancreatic duct, just like the pancreatic duct has 'teeth', which is particularly strong and difficult to peel off. ”
Liao Zhuan and his colleagues began to find ways to solve various problems one by one. The team used X-rays to pinpoint the stones, and used anesthesia techniques to have the patient perform lithotripsy from the front of the body under general anesthesia, and also injected sedatives, which was particularly effective. Many lithotriples fall directly into the small intestine, and as the digestive juices decompose, they are directly excreted from the body, and the painful symptoms disappear immediately.
Some pancreatic duct stones are broken and scattered in the pancreatic duct, which will block the pancreatic enzyme operation and easily cause inflammation again, which is the biggest complication in the treatment of "fighting cattle across the mountain". Therefore, the team prepared indomethacin suppositories (indomethacin) for patients to use in advance for effective prevention. In order to improve the effect of "fighting cattle across the mountain", the team has also formulated special technical specifications and guidelines, which have detailed provisions on the frequency, energy level and use method of shock wave to ensure the scientific and standardized technology. A world-class major problem has been fully overcome!
Minimally invasive treatment of pancreatic duct stones in chronic pancreatitis
Professor Liao performed extracorporeal vibration wave lithotripsy for chronic pancreatitis
Today, chronic pancreatic duct treatment has become a unique skill of Shanghai Changhai Hospital, and patients from all over the country and the world flock to it. At present, Liao's scientific research team has treated 10,000 cases in total, with a success rate of nearly 100%, and hospitals from all over the world and hospitals in China have also come to learn. Patients with chronic pancreatitis no longer have to endure pain, they only need to spend about 20,000 yuan for treatment, and they can be cured and discharged from the hospital in just one week. After follow-up, it was found that the recurrence rate of chronic pancreatitis treated with this method was also very low.
The occurrence of chronic pancreatitis is also related to human gene mutations. In some patients, the occurrence of chronic pancreatitis is associated with long-term alcohol consumption and overeating, and excessive bile secretion stimulates the pancreas. But why do some patients still have such diseases because they have better living habits? Liao's team conducted in-depth research on the biological basis of chronic pancreatitis, and they found that the occurrence of chronic pancreatitis is related to genetic mutations in the human body.
"Some gene mutations will secrete a large amount of pancreatic protinium, and some gene functions are originally like 'police', not to let the zymogen be overproduced, but the function is lost after the gene mutation, we found that there are more than 10 genes involved, and the repair of the 'SPINK1' gene mutation unique to chronic pancreatitis, the most common in Chinese, is currently being carried out, hoping to relieve the patient's pain from the root." ”
We have developed a "capsule robot" to provide unprecedented diagnosis and treatment in the river of life
If the human digestive tract is compared to the river of life, the pancreas is an important tributary, the vision of Liao's scientific research team is not limited to the tributaries, he hopes to explore freely in the entire "river of life", which is also the second topic given to him by Academician Li Zhaoshen that year: breaking through the technical limitations of endoscopy in medical technology.
More than 20 years ago, although there was gastroscopy technology and colonoscopy technology, there was a section of the digestive tract that was still a "blind spot" for human beings, a "black box" that could not be touched, whether it was through gastroscopy or imaging CT, we could not see it, that is, the small intestine up to 5~7 meters long, such as the ulcer symptoms of Crohn's disease appeared on the inner wall of the small intestine.
The magnetron capsule robot realizes a painless and comprehensive examination of the digestive tract
The purpose of the first generation of capsule robots created by Liao's team is to "see clearly" the situation inside the small intestine. Later, the team had a larger academic goal, which was to create a capsule endoscope that could "walk on long legs" throughout the digestive tract system, and medical staff could control it.
Based on the principle of magnets, the team built the second-generation capsule robot, the magnetron capsule robot, which allows the patient to lie on top of a detection device with a magnet underneath to form a magnetic field. A capsule robot the size of a small fingernail enters the patient's body from the esophagus, like a "remote sensing satellite", and the doctor can adjust the direction of advance and retreat as needed, and completely see the state in the "nooks and corners" of the stomach and intestines.
It can not only be used to check for esophageal varices, observe esophageal damage after taking aspirin, etc., but also screen for tumors in the digestive tract at an early stage. The device obtained a medical device production license in 2014 and has been used in more than 1,000 medical institutions around the world, and ordinary people can spend only 3,000 yuan to carry out a comprehensive "physical examination" of the digestive tract.
At present, the Liao team is developing the third generation of capsule robots, which not only have detection functions, but also treatment functions. Liao Zhuan revealed that a special capsule robot developed by the team was recently put on the market, which entered the digestive tract and began to perform "vibration massage" in the colon part, which can treat intractable constipation, and the cost is only a few hundred yuan at a time.
The road to innovation in three generations of capsule endoscopy
In addition, Liao's team is using the third-generation capsule robot to detect the digestive tract flora in the body. According to Liao Zhuan's introduction: "This is a very interesting scientific research direction, the digestive tract is known as the second brain of the human body, there are many 'neurons' that are not controlled by the brain, the flora of each part of the digestive tract is different, the flora between each individual is different, and the intestinal flora of people in various regions is also very different." The microbiota is also a therapeutic target, and scientists have confirmed that transplanted microbiota has a role in the treatment of autism. "In the future, the third-generation capsule robot will not only extract the microflora, but also release some special drugs at designated points to treat various diseases and even cancer, which I believe will definitely benefit more patients.
-The author of this article, Wu Yiting, is the chief reporter of Shanghai Science and Technology News, a director of the Science and Technology Communication Theory Research Committee of the China Science and Technology News Society, a distinguished science popularization expert of China Science and Technology Press, and a member of the Shanghai Science Writers Association.
END
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