Abstract:

Objective:To systematically assess the detection of K-ras gene mutation at codon 12 in pancreatic juice for diagnosis of pancreatic cancer.
Methods:A comprehensive electronic searching was performed to retrieve relevant studies on K-ras gene mutation in pancreatic juice for diagnosis of pancreatic cancer. Data on accuracy of included studies were extracted, Meta-DiSc1.4, Stata10.0, was applied for further heterogeneity exploring, meta-analysis and publication bias testing.
Results:Fifteen studies met the inclusion criteria. Heterogeneity was not found among these studies, including threshold effect, different test methods, randomization and blind. Pooled accuracy indicators like sensitivity, specificity and diagnostic odds ratio (DOR) were 0.61(95％CI 0.56-0.66), 0.82(95％CI 0.77-0.86) and 6.28(95％CI 4.42-8.91), respectively. Area under curve (AUC) of SROC (summary receiver operating characteristics) was 0.8207 and Q index was 0.7542. Publication bias had little influence on meta-analysis with the fail-safe number of 694.0108.
Conclusions:This meta-analysis demonstrates that the detection of K-ras gene mutation in pancreatic juice has moderate effect for diagnosis of pancreatic cancer. It is not enough to be an early diagnosing or screening indicator for pancreatic cancer, but it can be used clinically as an important adjunct to cytology, imageology and enzymology in the diagnosis of pancreatic cancer.

Abstract:

Objective:To investigate the significance of pancreatic cancer cells resistance to chemoradiotherapy induces EMT.
Methods:Several pancreatic cancer cell lines were exposed to gemzar while radiotherapy was given at the same time. After about two weeks,when 90% pancertic cancer cells were killed, a small number of cells resistant to chemoradiotherapy was obtained, and their morphological changes were observed by microscopy; transwell test was used to detect invasiveness, and western-blot was used to detect expression of epithelial marker E-cad and mesenchymal marker vimentin.
Results:Pancreatic cancer cells resistance to chemoradiotherapy showed phenotypic changes consistent with EMT: spindle-cell shape,loss of polarity, and pseudopodia formation.BxPC3,jf305 and pc3  cells resistance to chemoradiotherapy exhibited an increase in migrating and invading (P﹤0.05, respectively). Pancreatic cancer cells resistance to chemoradiotherapy also had decreased expression of E-cadherin and an increase in vimentin.
Conclusions:Pancreatic cancer cells resistance to chemoradiotherapy can induce epithelial-mesenchymal transition(EMT),and EMT may be related to resistance of chemoradiotherapy of pancreatic cancer.

Abstract:

Objective:To discuss the value of preoperative CT and intraoperative exploration in choice of surgical procedure for solid-pseudopapillary tumors of pancreas (SPTP).
Methods:The clinical data of 17 cases of SPTP treated in the Affiliated First Hospital of Fujian Medical University and three other hospitals over the past 10 years were retrospectively analyzed. The relationship between the opinion from preoperative CT, the detection at intraoperative exploration and the postoperative pathological features were analyzed.
Results:Preoperative CT imaging and intraoperative exploration could accurately estimate the tumor′s size, location and statas of invasion. All patients underwent surgical resection. Eight patients underwent local tumor resection, one underwent distal pancreatectomy, six had distal pancreatectomy with splenectomy, and pancreaticoduodenectomy was performed in the other two patients. Postoperative pancreatic fistula developed in 17.6% of patients. The mean follow-up period was 19.3 months; no recurrence was found.
Conclusions:The rate of resection in SPTP is high. The surgical approach should be based on the findings of pre-operative CT imaging and intraoperative exploration of the nature, size, location, capsular integrity of the tumor and infringement of surrounding tissue. Aggressive and complete resection of SPTP can result in good prognosis.

Abstract:

Objective:To study the risk factors of early complications and methods of treatment after pancreaticoduodenectomy(PD).
Methods:There were 79 patients who undercoent PD at our hospital between January 1998 and December 2007. All of the patients were divided into complication group and non-complication group according to the outcomes. Their clinical features, preoperative tests, and surgical factors were retrospectively analyzed.
Results:The postoperative complication rate was 58.2%,and the hospital mortality was13.9%.Logistic regression showed that the level of total bilirubin and liver function classification were the independent risk factors(P＜0.05).Age, serum-albumin level, fasting serum glucose, hemoglobin, giving enteral nutrition or not postoperatively, the size of tumor, benign or malignant tumor,and method of pancreaticojejunal anastomosis  had no relation with early  postoperative complications(P>0.05).
Conclusions:The early complications after PD are closely related to the preoperative level of serum bilirubin and liver function. Proper periopertive management can effectively decrease the occurrence of pancreatic leakage and other postoperative compliccations.

Abstract:

Objective:To investigate the diagnosis and treatment of insulinoma.
Methods:The clinical data of 33 patients with insulinoma were retrospectively analysed.
Results:The sensitivity of tumor localization with computed tomography scan(CT), magnetic resonance imaging(MRI), selective angiography(SAOG), preoperative ultrasonography(US), IRI/G and intraoperative ultrasonography（IOUS）, was 64.71%, 50%, 42.86%, 15.38%，94.74% and 100%, respectively. The pre-operative diagnosis rate was 54.55% in this series. Intraoperative positive palpation rate was 90.91%. Surgical enucleation was performed in 24 cases and distal pancreatectomy in 9 cases. The cure rate was 90.91%, the surgical complication rate was 33.33%，and the surgical mortality rate was 3.03%.
Conclusions:The topogaphic diagnosis by a combination of intraoperative palpation and IOUS is essential for selection of surgical treatment modalities and successful therapeutic efficacy in patients with insulinoma.

Abstract:

Objective:To investigate the choice of  different internal drainage procedures for the treatment of pancreatic pseudocyst.
Methods:The clinical data of 62 cases diagnosed as pancreatic pseudocyst and treated by surgical internal drainage in the past 13 years were retrospectively analyzed.
Results:The diagnosis of pancreatic pseudocyst was confirmed by B-US and/or CT before operation,and confirmed by  biopsy after operation in all of the cases. Thirty-one cases underwent Roux-en-Y cystojejunostomy with 9.7% incidence of postoperative infection of pseudocyst (3/31), 3.2% incidence of postoperative gastrointestinal bleeding(1/31), and no deaths. Sixteen cases underwent cystogastrostomy with12.5% incidence of postoperative infection of pseudocyst (2/16),  37.5% incidence of postoperative gastrointestinal bleeding(6/16), and 6.25% case fatality(1/16). Fifteen cases underwent sequential external and internal drainage with 6.7% incidence of postoperative infection of pseudocyst (1/15),  13.3% incidence of postoperative gastrointestinal bleeding(2/15), and no deaths.
Conclusions:Roux-en-Y cystojejunostomy is a safe and rational procedure for treatment of pancreatic pseudocyst. If the pseudocyst is suitable for cystogastrostomy, sequential external and internal drainage should be adopted instead of cystogastrostomy.

Abstract:

Objective:To investigate  the effect of ultrasound-guided percutaneous drainage（UGPD）for patients with traumatic pseudocyst of pancreas (TPP).
Methods:Retrospective analysis of the clinic feature, treatments and the effect of 45 cases of TPP treated in our hospital in recent six years were made.
Results:Of the 45 cases,40 cases were caused by abdominal trauma,5 cases were caused by injury in the operation of splenectomy for patients with portal hypertension. The TPPs were found from 6 days to 60 days (average: 31days) after the injury of pancreas. The diameters of TPP were from 5 to 13 cm with average of (9.2±2.3)cm. All the 45 patients underwent UGPH. The drainage time was 7 to 86 days with average time of 37 days. The drainage fluids were 20 to 500 ml every day. Forty-one (91.1%) patients were cured by UGPH; and four (8.9%) patients were changed to perform operation because of ERCP showing breaking of the pancreatic duct after two weeks drainage. All patients were recovered with no complication and no recurrence for 3 months to one year follow-up.
Conclusions:UGPD was effective method for patients with TPP, and most of the patients can get a good prognosis.

Abstract:

Objective:To investigate the effect of enteral microecopharmaceutics nutrition(EMN) therapy on the inflammatory reaction and intestinal mucosal lesion in the early phase in severe acute pancreatitis(SAP) rats.
Methods:Sixty rats were divided randomly into control group(C group, n=20), traditional enteral nutrition group (EN group, n=20) and EMN group (n=20). The nutrition was given 8 h after modeling. Animals were killed at 12,24,48 and 72h after modeling, MIF level was measured in serum and the histopathological changes were checked. The expression of TLR4 mRNA in the small intestinal tissue was detected by reverse-transcription polymerase chain reaction (RT-PCR).
Results:(1)At 12 h after modeling, serum MIF level was increased higher in EN group and EMN group than C group(P＜0.01). At 72h, MIF level was decreased to varying degrees between three groups; EMN group was significantly lower than the EN group［(95.33±1.96) vs. (117.59±1.86),P＜0.05］. (2) On histopathologic examination of the small intestinal mucosa，no changes were observed in the C group wihle damage was seen in EN and EMN group, but the degree of damage was less severe in EMN group than EN group.(3)Compared with control group, TLR4 mRNA level markedly increased 12 h after modeling in EMN group and EN group(P＜0.01), and was significantly lower in EMN group than EN group after 72 h of modeling［(0.56±0.33)vs.(0.71±0.51),P＜0.01］.
Conclusions:EMN can be effectively regulate the levels of cytokines in SAP rats, alleviate the damage of intestinal mucosal barrier and enhance immune function.

Abstract:

Objective:To discuss the role of activation of nuclear factor κappa B (NF-κB) in apoptosis of alveolar macrophages (AM) induced by gadolinium chloride (GdCl3) in acute necrotizing pancreatitis(ANP).
Methods :Thirty sixty adult SD rats were randomized into three groups: normal control group, ANP group and the group treated by GdCl3. ANP was induced by intraductal administration of 5% sodium taurocholate, while the normal control rats received an infusion of normal saline. In GdCl3 treatment group,GdCl3 was injected into dorsal vein of penis right after ANP model was established. AM were harvested by bronchoalveolar lavage six hours after model was established. The generation of TNF-α and IL-1β in bronchoalveolar lavage fluid(BALF)，and the level of myeloperoxidase in lung tissue were evaluated. The expression of NF-κB protein in AM was determined by western blot. The apoptosis of AM was detected by agarose gel electrophoresis and flow cytometer. The histological examination of lung tissue was checked.
Results:The levels of TNF-α and IL-1β in ANP group were significantly higher than the control group and GdCl3 treatment group（P<0.05）. Agarose gel electrophoresis showed the typical apoptotic DNA ladder only seeing in GdCl3 treatment group. The rates of apoptosis of AM in the control group, ANP group and GdCl3 treatment group were （10.81±0.86）%,（6.47±1.52）%，and（17.41±3.36）% respectively, with statistical significance between the different groups（P<0.05）. The relative gray scale of NF-κB was （0.80±0.05）,（1.96±0.15），and（1.42±0.10）respectively, with statistical significance between the different groups（P<0.05）. The apoptotic rate of AM had negative correlation （r＝-0.554，P=0.005）with the positive expression of NF-κB.
Conclusions:GdCl3 could induce the apoptosis of AM by inhibiting expression of NF-κB, and then ameliorate the lung injury of ANP rats.

Abstract:

Objective:To study the effect of immunomodulation on improvement of immune function and prognosis in sepsis  in rats, and its mechanism.
Methods:Experimental part: cecal ligation-perforation (CLP) models were divided into three groups including sham group (n=20), control group(n=20) and experimental group(n=20).Control group only used antibiotic and experimental group used antibiotic plus immunomodulation. Blood collections were made after CLP model at 3, 12, 48 and 72hr. Lymphocyte counting, CD4+, CD8+ T lymphocyte and CD4/CD8 ratio were checked. The apoptosis of lymphocyte in thymus and spleen and survival rate were checked. Clinical part: Prospective analysis of seventy patients who conformed to the sepsis standard. They were divided into two groups randomly. One was control group with regular therapy,  and the therapy group with ulinastatin plus thymosin-α1 for 7days. The immune index before and after therapy at 0, 1d, 3d, and 7d was observed, including the clinical changes and survival data.
Results:Experimental part: Lymphocytes, CD4+ T lymphocytes and CD4/CD8 ratio in experimental group increased more significantly than in control group(P＜0.05). Lymphocyte apoptosis index of thymus and spleen in control group increased more significantly than in experimental group(P＜0.05).Seventy-two hour survival in experimental group was longer than in control group. Clinical part: CD4+T lymphocytes, lymphocytes and monocytes HLA-DR CD14+ were more significantly increased in therapy group than that in control group(P＜0.05).During hospitalization, twenty patients died in the control group and thirteen patients died in the therapy group(P＜0.05).
Conclusions:Immunomodulation in septic rat can improve immune function, alleviate the lymphocyte apoptosis of thymus and spleen and increase the survival time. Immunomodulation in septic patients can improve the immune paralysis and prolong survival.

Abstract:Objective:To explore the production of medical polypropylene anti-bacterial mesh coated with triclosan，and study the properties of its controlled-release drugs, as well as the efficiency of the mesh coated with triclosan. Methods :A medical polypropylene anti-bacterial mesh coated with triclosan was produced by the method of solvent evaporation,with triclosan as antibacterial agent and ethylene-vinyl alcohol copolymer as carrier. The meshes were divided into four groups: A,B,C and D. The meshes in A,B and C (experimental) groups were coated with triclosan, and D group was control group. The ultrastructure of meshes of the 4 groups was observed under electron microscope.The slip diffusion method was used to observe the diameter of bacteriostasis-rings in different time periods. At the same time, we observed the maximum tensile strength of the mesh in transverse and longitudinal axis when they were pulled off before and after the experiment. Results:The surfaces of B group were uniform and smooth, and the coating could continuously release drugs during 7 days in sodium chloride. The diameter of bacteriostasis-rings in B group was significantly larger than that in control group (P<0.05) at 1d、3d、5d and 7d,but the maximum tensile strength of the meshes in transverse and longitudinal axis was not sigmificantly changed in the two groups. Conclusions:The medical polypropylene anti-bacterial mesh coated with triclosan by the method of solvent evaporation has the properties of controlled-release drugs and obvious anti-bacterial function. The biomechanics of the mesh remained the same essentially before and after the experiment. The study provides a new method and route for the clinical management of prosthetic patch infection after tension-free hernia repair.

Abstract:

Objective:To introduce and summarize the use of choledochoscope in the treatment of severe acute pancreatitis(SAP).
Methods:In cases of SAP with severe pancreatic and peripancreatic infection,open surgical debridement and drainage was done,and, about one week later, the drainage tubes were removed and a choledoscope was then used repeatedly to debride and wash out the necrotic and infected foci that were hard to drain out.
Results:In all the 31 patients treated by the method mentioned above, the pancreatic and peripancreatic necrotic tissue and fluid collections were effectively drained or removed. Of them, one patient died of respiratory function failure after 18 postoperative days.
Conclusions:The use of choledoscope for repeated debicdement and removal of pancreatic and peripancrcatic infectious foci is simple and safe, with reliable clinical effects, and is a novel  treatment for pancreatic and peripancreatic infections secondary to severe acute pancreatitis.

Abstract:

Objective:To investigate the value of emergency ERCP in patients with acute biliary-pancreatic diseases.
Methods:Retrospective analysis was made on the clinical data of 51 patients with acute biliary-pancreatic diseases who were treated by emergency ERCP during two years. According to patients′condition, the examination of ERCP plus endoscopic nasobiliary drainage (ENBD) or endoscopic sphincterotomy(EST) was performed. The papilla sphincter was slivered by needle knife in the circumstance of stone impaction in the papilla, or in certain conditions, the calculus was removed by net basket, then, ENBD and endoscopic retrograde biliary stent (ERBS) were undertaken. The therapeutic effect, rate of postoperative complications and mortality rate were observed.
Results:Of the 51 cases, emergency ERCP treatment was successful in 49 cases. The total success rate of endoscopic treatment was 96.1%. Among the 49 cases,7 cases (13.7%) were treated with ERCP and ENBD, 3 cases (5.9%) were treated with ERCP, needle knife sliver of the papilla sphincter and ENBS;29 cases (56.9%) were treated with ERCP, calculus removal and ENBD; 5 cases (9.8%) were treated with ERCP, EST and ENBD; and 5 cases (9.8%) were treated with ERCP and ERBS. Clinical symptoms were obviously relieved within 24 h after ERCP treatment, and with no complications such as enteral perforation, acute severe pancreatitis or hemorrhage. Of the 51 cases, 2 failure cases were treated with open operation; 1 case died of postoperative multiple organ failure(MOF) due to acute obstructive suppurative cholangitis (AOSC).
Conclusions:Emergency ERCP is simple, safe and effective in diagnosis and treatment of acute biliary-pancreatic diseases, which should be the treatment of first choice. ERCP is especially suitable for emergent, critical and severe patients. Emergency ERCP is worthy of widespread clinicaluse.

Abstract:

Objective:To explore the methods for early diagnosis and treatment of  blunt pancreatic injury.
Methods:The clinical data of 32 patients with blunt pancreatic injury treated in our hospital from Janurery 2004 to Janurery 2009 were retrospectively analyzed.
Results:The conformity diagnosis rate of CT was 79.3%. Four cases received nonoperative treatment including 3 cases of grade  I and 1 of grade II injury. A total of 28 cases with blunt pancreatic injury underwent operation: 5 grade I and 7 grade II cases underwent debridement and drainage; among the patients with grade Ⅲ injury, 4 underwent distal pancreatectomy in combination with splenectomy, and 2 pancreatectomy with spleen preservation; amongst the 5 patients with grade Ⅳ injury, 4 underwent Roux-en-Y pancreaticojejunostomy and 1 underwent distal pancreatectomy in combination with splenectomy; of the 5 patients with grade Ⅴ injury，1 case was operated on using duodenorrhaphy and diverticulization,2 underwent the Whipple′s procedare and 2 had damage control surgery. Three patients died of multiple organ failure，and complications occurred in 19(76.0%). Pancreatic fistula and pancreatic pseudocysts were the main complications.
Conclusions:In the absence of major pancreatic ductal injury, and the clinical conditions were stable, pancreatic injuries can be treated with nonoperative management. Operative treatment is suitable for severe blunt pancreatic injury. Appropriate operation, based on patient condition and the classification of pancrecatic trauma, is the key to increase the cure rate and decrease mortality rate.

Abstract:

Objective:To study the predictive factors of effect on idiopathic thrombocytopenic purpura (ITP) after laparoscopic splenectomy(LS).
Methods:The clinical records of 25 patients with ITP treated by LS during Jan.2000 to Oct.2007 were retrospectively analyzed.
Results:There was no mortality or severe complication during LS. All these patients were successfully operated by LS,including 2 cases operated by LS assisted with short incision. The median follow-up was 3.5 years(1～7years),The postoprative remission rate was 80%（20/25），and the 2-year remission rate was 72%（18/25）,including 2 remission patients who had severe anemia from a bleeding gastric ulcer and side effects of high dose and long-term corticosteroid treatment before LS.Multivariated analyses showed younger patients(≤50 y) responded more positively than older patients(>50 y) to LS（P＜0.05）.Likewise, platelet counts on 7th postoperative day coincided with those at 2-year follow up. Average platelet counts in remission and no remission patients with ITP were 307×109/L and 103×109/L on 7th postoperative day respectively（P＜0.05）.
Conclusions:LS is a safe and effective therapy for patient with ITP. Young Patients (≤50 y) with need high dose of corticosteroids or are resistant to corticosteroids should undergo LS.Age at surgery (≤50 y) and platelet counts on 7th postoperative day might predict the effect of laparoscopic splenectomy.

Abstract:

Objective:To analyze the main clinical manifestations of intestinal lipoma and discuss the treatment of intestinal lipoma.
Methods :The clinical data of 19 patients with intestinal lipoma treated in our hospital in recent 15 years were analyzed retrospectively. CT, ultrasonography, and colonoscopy were used in diagnosis. Local intestinal resection by laparoscopy and laparotomy were employde.
Results:Intestinal lipoma presented with a variety of symptoms including intestinal bleeding，abdominal pain，anemia，intussusception，and bowel obstruction. In 17 of the intestinal lipoma patients, the main clinical manifestations were change of  bowel habits, abdominal pain and bloody stool; 13 of them had intestinal intussusception or obstruction,  and two patients were asymptomatic. Sixteen patients underwent colonoscopy，and seven of them were correctly diagnosed.Seventeen patients received surgical resection and recovered.The diameter of mass was 3-6.5 cm. The pathologic exam showed submucosal lipoma in 12 cases, two cases showed ulcer formation with erosion, 2 cases had intermural lipoma and one case had atypical lipoma with potential  malignant transformation.Two asymptomatic patients diagnosed by colonoscopic biopsy werre only followed up at regular intervals.
Conclusions:Imaging diagnosis and colonoscopy are helpful in the preoperative diagnosis of intestinal lipoma.The method of treatment is based on the size of the tumor and presence or absence of pedicle. Endoscopic electrosection is often used for tumor mass less than 3 cm in diameter, otherwise local intestinal resection is the treatment of chocie.

Abstract:

Objective:To discuss the clinical effects of preoperative arterial infusion chemotherapy with oxaliplatin (OXA) and 5-fluorouracil (5-FU) in patients with advanced gastric cancer.
Methods :Forty-eight patients of advanced gastric cancer (Phase II plus) received regional intra-arterial infusion chemotherapy before operation (Group A). The regimen consisted of  one dose of OXA130mg/m and 5-FU750mg/m, administrated through the femoral artery catheterization, and  operation 8 to 12 days later. During the same period, other 48 cases of gastric cancer in the same clinical stage (Group B) were given surgery directly. All 96 patients were treated with postoperative chemotherapy intravenously by use of OXA/leucovorin/5-FU for six cycles.
Results:In group A, 38 patients (79.2%) received radical resection (R0 resection). Microscopically, 32 cases (66.7％) showed varied histopathological changes, which included tumor necrosis, lymphocyte infiltration, residual cancer cells apoptosis, interstitial edema, and fibrosis. In group B, 30 patients (62.5%) unclerwent R0 resection，which was lower than that of group A (P<0.05), but no similar pathological changes of group A were observed.The toxicities of preoperative arterial infusion chemotherapy were well tolerated and restricted to GradeⅠ～Ⅱ. There was no difference in postoperative complications between the two groups. The median survival period of group A was 36.0 months, and the 1, 2 and 3-year overall survival rate was 79.2%, 62.5% and 52.1%, respectively. In group B, the median survival time was 21.5 months, and the 1, 2, 3-year overall survival rate was 66.7%, 45.8% (P<0.05) and 35.4% (P<0.05), respectively.
Conclusions:Preoperative arterial infusion chemotherapy with OXA and 5-FU can cause significant histopathological changes that can improve the R0 resection rate and improve the 2-3 year overall survival of advanced gastric cancer.

Abstract:

Objective:To investigate the clinical value of combined general surgical and gynecological laparoscopy.
Methods:During 7 years, 229 patients with abdominal and gynecological diseases were treated with laparoscopy, including laparoscopic cholecystectomy (LC)+salpingostomy in 5, LC+ovarian cystectomy in 28 cases, LC+hysteromyomectomy in 25, LC+subtotal hysterectomy in 39, LC+total hysterectomy in 26, LC+treatment of endometriosis in 6, laparoscopic appendectomy (LA)+salpingostomy in 38, LA+ovarian cystectomy in 32, LA+subtotal hysterectomy and total hysterectomy in 24, and fenestration of liver cysts+ovarian cystectomy in 6.
Results:Laparoscopic procedures were completed in all the 229 cases without conversion to open surgery. The operation time ranged from 40 to 220 min (mean, 120 min), and postoperative hospital stay ranged from 1 to 6 days(mean 3.4 days),  only 1 patient developed vaginal stump hemorrhage 10 days after the operation and was cured by conservative therapy. Among the 229 cases, 175 were followed up for 3 to 24 months(mean 19.5 months),1 experienced polyp at vaginal stump 2 months postoperation and underwent polyp resection.
Conclusions:Combined general surgical and gynecological laparoscopy is a promising method for patients with abdominal diseases complicated with gynecological diseases. It is important for surgeons to deeply understand the indications of laparoscopy, and get good co-operation with doctors from different departments. Patients must have adequate preoperative preparation.