Abstract:Abstract:Objective：To discuss clinical effects of combined use of duodenoscopy and laparoscopy in the treatment of acute billiary pancreatitis (ABP).
Methods ：The clinical data of 94 ABP patients who underwent minimally invasive treatment from February 2001 to Feburary 2006 were retrospectively reviewed. Among 94 ABP patients, 59 patients had gallbladder stones were given laparoscopic cholecystectomy (LC) alone; 14 patients had common bile duct stones received endoscopic nasobiliary drainage (ENBD), combined endoscopic sphincterotomy (EST) and LC; 21 patients had both gallbladder and common bile duct stones received combined EST and LC.
Results：Postoperatively, in the whole group, only one patient had recurrent pancreatitis, one patient had hemobilia,and both cases followed ERCP+EST; two cases had lung infection,and one case had infection of abdominal incision. All of the 5 cases with postoperative compllcations were successfully treated by conservative therapy. The effective rate for the whole group was 100%.
Conclusions：Combined use of duodenoscopy and laparoscopy is significantly effective for treatment of acute biliary pancreatitis and this minimally invasive treatment is the ideal therapy for acute biliary pancreatitis.

Abstract:Abstract:Objective :To explore the early treatment of severe acute non-obstructive biliary pancreatitis (ANOBP).
Methods :One hundred and seventy five cases of severe acute non-obstructive biliary pancreatitis were admitted to our hospital in recent 9 years. Among them, 63 cases recevied operative treatment within 3 days after the disease occurred, and other 112 cases had nonoperative treatment. Restrospectively analyse of the therapeutic results of the 2 groups were made .
Results :In the group operated within 3 days, severe complications occurred in 21 cases(33.3%) and 16 cases died(25.4%). In the 112 cases who had non-operative treatment within the first two weeks of disease, severe complications occurred in 19 cases(16.9%) and 14 cases died(12.5%). The treatment results were significant difference between the two groups(P＜0.05).
Conclusions :It is proper to adopt non-obstructive treatment in the early phase (within 2 weeks) of severe acute non-obstructive biliary pancreatitis, and too early operation is not suritable.

Abstract:Abstract:Objective:To study the significance of change of high mobility group box 1 (HMGB1) level of pancreas in acute necrotizing pancreatitis (ANP) in rats.
Methods :ANP model was induced by retrograde injection of sodium taurocholate in pancreatic duct. Animals were divided randomly into three groups: control group, ANP group, and sodium butyrate treatment group (treatment group). The serum levels of TNF-α and IL-1β were measured by ELISA. The HMGB1 mRNA level of pancreas was detected by RT-PCR.
Results:The serum levels of TNF-α and IL-1β were quickly increased after the model was induced, and reached a peak at 6h, but decreased at 12h. The HMGB1 mRNA level of pancreas was increased significantly at 12h, and maintained to 24h. Whereas in treatment group, the HMGB1 level of pancreas was lower than ANP group (P<0.05) and injury of pancreas was milder than that of ANP group (P<0.05).
Conclusions:HMGB1 seems to act as a late mediator in ANP. Sodium butyrate treatment could decrease HMGB1 levels of ANP rats.

Abstract:Abstract:Objective:To investigate the possible role of early growth response factor -1(EGR-1) in liver injury acute pancreatitis in rats.
Methods :Twenty-four male Wistar rats were randomly divided into 4 groups: Group A,B,C and D. Normal saline was injected into common bile duct(CBD) of group A, and different concentrations of taurocholate sodium solutions were injected into CBD of group B,C and D. Three hours after injection, all animals were sacrificed and blood and liver were harvested. Other 30 male Wistar rats were randomly divided into 5 groups: Group E,F,G,H and I, These rats were sacrificed 1h,3h,6h,12h and 24h after injection respectively. Serum levels of AST,LDH,TNF-α and IL-1β　were measured, and immunohistochemistry staining of EGR-1 on liver was observed and assayed.
Results:(1) Accompanying the stepwise rising concentrations of taurocholate sodium, the levels of AST,LDH,TNF-α and IL-1β were progressively increased. (2) Positive staining of EGR-1 in liver was more intense with increased severity of acute pancreatitis models, and EGR-1 staining sites were different among models of acute pancreatitis of different severity. The positive staining cells and intracellular sites of EGR-1 displayed notable differences in livers harvested at different times after pancreatitis induction.
Conclusions:EGR-1 may play an important role in liver injury during acute pancreatitis, and the possible mechanism may be related to its mediated production of inflammatory cytokines.

Abstract:Abstract:Objective:To investigate the levels of C peptide, insulin, glucagon and glucose and the function of islet endocrine cells in rats with acute pancreatitis. Methods:one hundred and tweenty rats were randomly divided to two groups: Group A (acute pancreatitis,AP) and Group B (sham operation,SO). Blood C peptide, insulin, glucagon and glucose were determined. The pancreatic morphology was observed after laparotomy. Pancreas tissue was excised to be observed in terms of histopathology.
Results:The levels of C peptide, insulin and glucagon in group A were significantly higher than those in the group B at 9h, 15h and 12h after the procedure respectively (P<0.01,P<0.05 and P<0.05, respectively). Histopathologjcally, the rats in group A had severe acute pancreatitis at 9h after the procedure. Conclusions:(1)The islet endocrine cells function of rats with acute pancreatitis is impaired, the levels of C-peptide and insulin in serum can reflect the function of islet B cells. C-peptide can more accurately and more quickly reflect the degree of B cells injury, and its changes are synchronous with the histopathological changes in B cells. (2)The level of glucagon can reflect the function of pancreas A cells. The islet A cells may be more susceptible than B cells to be damaged in acute pancreatitis.

Abstract:Abstract:Objective:To explore the effects of heat shock protein 27 (HSP27) expression on adhesion junction of cells during severe acute pancreatitis (SAP) and mild acute pancreatitis (MAP) in rats.
Methods:Ninty male Wistar rats were divided randomly into three groups: Group A (SAP), Group B (MAP) and group C (control) . Rats in the three groups were killed at 1h, 3h.and 8h after model made respectively. The levels of serum amylase (SAM) and histopathology score were measured. Changes of adhesion junctions were examined by electron microscopy. HSP27 and its phosphorylation were measured by Western-blotting. The expression of HSP27 mRNA was determined by RT-PCR.
Results:Levels of SAM increased in group A and group B, but was markedly lower in Group B (P<0.05) . In group A, there was a rapid and sustained increase in levels of pancreatic indexes, and severe interstitial edema (P<0.05), and damages of adhesion junctions were observed. In group B, there was moderate pancreatic edema and disruption of adhesion junctions. The expression of HSP27, its mRNA and its phosphorylation levels were lower in group A than those in group B（P<0.05）.
Conclusions:Alterations of adhesion junction are a common feature of AP, but the damage of HSP27 and its phosphorylation which regulate adhesion junctions were more severe during SAP. The results suggest that HSP plays an important role in the onset and development of AP.

Abstract:Abstract:Objective:To study the difference of expression of proteins in pancreatic cancer and adjacent fissue.
Methods :Proteomes of eight pairs of pancreatic ductal adenocarcinoma tissue samples and adjacent tissue samples were obtained by high resolution two-dimensional gel electrophoresis (2-DE). Comprehensive analyses of proteins were focused on total protein spots exhibiting statistical alternations between the two groups. Protein identification was done by peptide mass fingerprinting with tandem mass spectrometry （MS/MS）. In addition, Western blotting and immunohistochemistry were performed to verify the expression of certain candidate protein.
Results:A total of 28 protein spot-features were found to be significantly increased and 17 significantly decreased in tumor tissues. Thirty of these protein spots were identified, which included enzymes, antioxidant proteins, signal transduction proteins, calcium-binding protein, structural proteins, chaperones and others. Western blotting and IHC further validated up-regulated expressions of one candidate protein (annexin II) in tumor tissues.
Conclusions:The analysis of proteomics with 2-DE on human tissue is a useful method for discovering valuable cancer marker candidates. These differential expressed proteins may serve as biomarkers for early detection and therapeutic targets to pancreatic cancer.

Abstract:Abstract:Objective:To investigate the expression of Pin1 and cyclin D1 in human pancreatic carcinoma and to discuss its role in oncogenesis of pancreatic cancer.
Methods :The mRNA expression of Pin1 and cyclinD1 in pancreatic tumor tissues and corresponding adjacent nontumor tissues 27 patients was detected by the real-time quantitative reverse transcription-polymerase chain reaction (RQ-RT-PCR). The results of RQ-RT-PCR were analyzed by one- way ANOVA and Fisher′s exact probabilities test.
Results:Cyclin D1 and Pin1 were overexpressed at mRNA level in pancreatic carcinoma tissues compared with their adjacent nontumor tissues. Cyclin D1 overexpression were found in 14 of 20 pancreatic carcinoma tissue specimens and Pin1 overexpression in 13 of 20 carcinoma tissue specimens. The expression of cyclin D1 and Pin1 in pancreatic cystadenoma tissues was not different than that of corresponding adjacent nontumor pancreatic tissue. Pin1 overexpression positively correlated with an increase in cyclin D1 levels as shown by Fisher′s exact probabilities test. However, Pin1 and cyclin D1 expression was not correlated with clinical stage and pathological parameters.
Conclusions:The overexpression of Pin1 in pancreatic carcinoma tissues could promote cyclin D1 expression, which might be a critical event in oncogenesis of pancreatic carcinoma. Pin1 may play a key role in pancreatic carcinoma.

Abstract:Abstract:Objective:To study the cotransfection mB7-1 and mCD1D gene into pancreatic cancer cells of rats and to observe its anti-tmor responses.
Methods :Recombinant retroviral vectors expressing mB7-1and mCD1D gene were packaged into GP2-293 cell lines and transfected. The expressions of mB7-1 and mCD1D were detected with PCR and Western blot. The positive cells of mB7-1 and mCD1D were used to induce the anti-tumor immunity in vitro.
Results: Anti-tumor immunity was induced after B7-1 and CD1D positive cells were coinoculated in syngeneic mice. Furthermore, the growth of tumor was inhibited.
Conclusions:Cotransfection of B7-1 and CD1D could induce anti-tumor effect. This study provide a foundation for the application of B7-1 and CD1D gene therapy in tumor.

Abstract:Abstract:Objective:To investigate aberrant methylation in the promoter area of p16 gene and p16 protein expression in human pancreatic carcinoma and in the corresponding tumor-adjacent tissues, and evaluate their role in the carcinogenesis and progression of tumor and its clinical significance.
Methods :Immunohistochemistry and MSP(methylation-specific PCR) were performed on 46 samples of pancreatic carcinoma and their corresponding tumor-adjacent tissue specimens for p16 and its methylation.
Results:Expression rate of p16 protein was 41.3%(19/46) in pancreatic carcinomas, 95.7%(44/46) in corresponding tumor-adiucent tissues. Through MSP, the methylation rate in pancreatic carcinomas was 39.1%.No gene methylation was found in 19 cases expressing p16 protein.p16 gene methylation was closely related to p16 protein expression in pancreatic carcinoma(P<0.05). The expression of p16,the aberrant methylation in the promoter area of p16 gene were no relationship with clinicopathological characteristics, such as tumor size, patient′s sex and age (P>0.05); but were significantly related to the PTNM staging, histological differentiation, distant metastasis and lymph node metastasis(P<0.05).
Conclusions:Methylation in the promoter of p16 gene and p16 protein expression were associated with the development of pancreatic carcinoma and could be used as a putative prognostic indicator for malignancy.

Abstract:Abstract:Objective:To identify the effect of peptide nucleic acid of CC chemokine receptor 5 on acute rejection of islet allograft.
Methods :Mice islet transplant models were used to test the effect of PNA CCR5 by targeting CCR5 in acute allograft rejection. In vitro T cell proliferative responses were assessed by mixed lymphocyte response(MLR). RT-PCR and Western blot were used to detect the expression of mRNA and protein.
Results:PNA CCR5-treated recipients demonstrated statistically significant prolongation［(12.00±1.75)d］ in functional allograft survival when compared with saline［(6.50±0.58)d］ or PNA mismatch-treated recipients［(6.50±0.50) d］. The CCR5 mRNA expression level of PNA CCR5, control, and PNA mismatch treatment recipients at day 7 posttransplant was 0.56±0.05, 1.68±0.07 and 1.80±0.14, respectively. The data showed that CCR5 protein was significantly down-regulated in PNA CCR5 treatment allografts compared with saline and PNA mismatch treatment allografts(P＜0.01, P＜0.01). Lymphocytes from PNA CCR5 treatment mice also exhibited a reduced degree of proliferation.
Conclusions:The present study indicates that PNA CCR5 can prolong the survival time of islet allograft, and has a potential therapeutic effect on inhibiting acute allograft rejection.

Abstract:Abstract:Objective:To investigate the effect of ulinastatin on Oddi sphincter after pancreatic transplantation in the dog.
Methods :Ten thousand and thirty thousand units ulinastatin were injected into normal dogs and dogs undergoing pancreatic transplantation, and then the pressure of Oddi sphincter was measured.
Results:In normal dogs, there was no significant difference between basic pressure and contraction pressure (P>0.05),but the contraction frequency and kinetic index were both decreased(P<0.01). The kinetic index when injecting ten thousand units ulinastatin was stastically different to that when injecting thirty thousand units ulinastatin(P<0.01),but there was no difference in contraction frequency(P>0.05). In pancreas transplantation dogs, the basic pressure,contraction frequency and kinetic index were all decreased with usage of ulinastatin(P<0.01) and there was a difference between the ulinastatin dosage of ten thousand units and that of thirty thousand units (P<0.05).
Conclusions:Ulinastatin could restrain the movement of Oddi sphincter,and this effect had a positive correlation with dosage,especially after pancreatic transplantation. Ulinastatin can effectively reduce basal sphincter pressure, improve the drainage of pancreatic fluid and is conducive to prevention and treatment of pancreatitis after transplantation.

Abstract:Abstract:Objective:To investigate the arterial blood supply of the pancreas head and provide a theoretical basis for the gastroduodenal artery reconstruction in pancreatic transplantation (PT).
Methods :Photograms of digital subtraction artery (DSA) which performing on 300 patients were analyzed to recognize the aberrations of arterial blood supply of pancreatic head.
Results:In 300 DSA photograms, the gastroduodenal artery (GD.a) was identified in 131 cases, and the anterior superior pancreaicduodenal artery (ASPD.a) and posterior superior pancreaicduodenal artery (PSPD.a) in 79 cases. The rate of aberrant origin of pancreatic transverse artery (PT.a) from GD.a was 12.98℅. There are some minor sources of blood supply to the pancreas head from GD.a. The rate of absence of an ASPD.a-AIPD.a anastomosis and PSPD.a-PIPD.a anastomosis was 15.19℅and 24.05℅, respectively.
Conclusions:The reconstruction of gastroduodenal artery can ensure a complete blood supply to the pancreatic head and duodenum in PT.

Abstract:Abstract:Objective:To study the clinicopathological features of chronic inflammatory mass lesion of the pancreas.
Methods : The clinical data of 37 patients with focal chronic inflammatory mass lesion of the pancreas were retrospectively studied. Seventeen cases congruent with the standard clinical diagnostic of chronic pancreatitis were separated into group A; and Whipple procedure was carried out in two cases, resection of the body and tail of the pancreas in 2 cases, local resection in one case, and choledochojejunostomy in 12 cases. Those without the stander clnical features of Group A but with the features of pancreatic tumor were separated into Group B; and Whipple procedure was carried out in 4 cases, choledochojejunostomy in 16 cases.
Results: In group A, except for the local mass lesion, sclerosis of the whole pancreas was found in 88.2% of cases. Pathological examination showed proliferation of fibrous tissue with associated inflammation, as well as acinar atrophy, remnant islet cells, and ductular dilatation and focal calcification. While in Group B, only a local mass lesion of the pancreas was found in 19 cases. The pathological features were characterized histologically by proliferation of fibrous tissue with associated moderate or marked inflammation. No pancreatic carcinoma was found during 1 to 12 years follow-up of 33 cases.
Conclusions:Chronic inflammatory mass lesion of the pancreas showed the clinicopathological features of pseudotumoral pancreatitis. Internal drainage by choledochojejunostomy is suggested as its effective management.

Abstract:Abstract:Objective:To investigate a modified technique of pancreaticojejunostomy in pancreaticoduodenectomy ( PD )．
Methods :The clinical data of 72 patients of PD using the modified technique of duct-to-mucosa pancreaticojejunostomy for treatment of benign or malignant tumor of pancreas or duodenum was retrospectively analyzed.
Results:There were no operative deaths; 2 of the 72 patients (2.78%) had postoperative pancreatic fistula. 63 patients were followed up. Of the 63 cases, the digestion and absorption functions of gastrointestine were normal in 60 patients and they were well nourished,but 3 patients suffered from chronic steatorrhea and malnutrition．
Conclusions:The modified duct-to-mucosa pancreaticojejunostomy is a simple and safe technique. With this technique, the rate of pancreatic fistula or leakage is relatively low and the function of the remnant pancreatic is well preserved.

Abstract:Abstract:Objective:To evaluate the therapeutic effects of gemcitabine regional artery perfusion combined with systemic chemotherapy for late-stage cancer of pancreas.
Methods :Thirteen cases of late-stage cancer of pancreas proven by operation and pathology were treated with 5-FU+MMC as a combined system chemotherapy, and use of gemcitabine for regional artery perfusion chemotherapy.
Results:Among the 13 patients who could be evaluated for therapeutic effect, four cases had partial response (PR), six cases had (SD), three cases were PD, and the effective rate of the clinical benifical-reflected evaluation was 76.9%, pain releive rate 75.0% the median survival time was 6.3 months. None of the patients have had serious toxious side-effects.
Conclusions:The gemcitabine regional artery perfusion combined with systemic chemotherapy can relieve the cancer pain of patients with late-stage cancer of pancreas, improve their general condition, increase the survival quality of life, prolong the survival time. The drug tolerance of the patients is good.

Abstract:Abstract:Objective:To discuss the causes and treatment methods for operative and postoperative bleeding of pancreatoduodenectomy.
Methods :The clinical data of 260 cases of pancreatoduodenectomy were retrospectively analysed.
Results:Twelve cases had massive bleeding during the operation and one patient died. The primary cause of bleeding was the injury of portal vein or superior mesenteric vein(10 cases) and superior mesenteric artery(2 cases).26 cases had massive postoperative bleeding and one patient died.The main causes were pancreaticogastrostomic anastomosis bleeding (17 cases) and gastrojejunostomic anastomosis bleeding(9 cases).
Conclusions:Careful preoperative assessment and meticulous surgical procedure are the key points to avoid severe bleeding during operation. The use of vascular surgical materials and techniques can effectively control severe bleeding during operation. Improvement of operative technique and peri-operative treatment can reduce the incidence of postoperative bleeding.

Abstract:Abstract:Objective:To discuss the diagnosis and treatment strategy of cystadenocarcinoma of pancreas.
Methods :The clinical records of 13 cases of cystadenocarcinoma of pancreas were reviewed retrospectively.
Results:Twelve cases showed abdominal pain and distention, and an upper abdominal mass was palpated in 4 cases. The course of disease lasted from one month to five years. On B ultrasound examination, 10 cases showed multiple loculated cystic or cystic solid mass of pancreas, with non-homogeneous echo inside. CT scanning was done in 9 cases, it showed cystic and systic-solid lesion of pancreas and the enhanced image showed cyst wall with partial enhancement, and cyst wall calcified in two cases. Six cases of cystadenocarcinoma were located in the head and neck of pancreas, five in the body and tail, and two involved the whole pancreas. Correct preoperative diagnosis was made in two cases. The excision rate was 69%(10/13) and mortality rate 7.7%（1/13）.All were mucinous cystadenocarcinoma pathologically. One patient died from pancreas fistula. Eight cases were followed up, but four were lost to followup. The survival time was ten months to ten years.
Conclusions:Correct diagnosis of cystadenocarcinoma of pancreas is rather difficult, and the rate of misdiagnosis is high.However, imaging and CA15-3 examination are helpful for diagnosis. With aggressive surgery and combined therapy, a better prognosis can be expected.

Abstract:Abstract:Objective:To study the methods for diagnosis and treatment of insulinoma.
Methods :The clinical data of 120 patients with insulinoma who had been admitted to our hospital in the last 40 years were retrospectively reviewed.
Results:Fasting blood glucose values were less than 2.75 mmol/L in all the patients.Fasting serum insulin values in 75 patients were higher than 25 μU/mL,and the average was (65 ±6.0)μU/mL.Before operation,tumor was detected in 2 of 60 patients by ultrasound scan,and in 10 of 50 by CT. Among 18 patients who had intraoperative Bultrasound examination, 16 positive cases were verified by intraoperative exploration; and one case the tumor was not palpable but was found by intraoperative Bultrasound examination.The operations included enucleation of insulinoma(70 patients),insulinoma resection and distal resection of the pancreas(44),distal resection of the pancreas(4),and biopsy(2).The low blood glucose symptoms disappeared after the first operation in 111 of the 112 patients who had benign tumor.One case with benign tumor was cured by a second operation.Twenty patients developed pancreatic fistula after tumor enacleation, of them,14 healed uneventfully after drainage,5 were cured by operation,and 1 died of peritoneal infection.
Conclusions:Preoperative localization of insulinomas is difficult. Intraoperative exploration and ultrasound scan are the chief methods for the localization of insulinoma.Enucleation of insulinoma should be selected for benign tumor. Resections of the pancreatic body and tail is required for large,deep or multiple tumors.