Abstract:

Objective:To investigate the effect of gemcitabine plus gimeracil and oteracil porassium capsules (S-1) in pancreatic cancer patients after curative resection of pancreatic cancer.
Methods:Patients admitted for curative resecton for pancreatic cancer received adjuvant chemotherapy with 10 cycles of gemcitabine plus S-1 every 2 weeks. Each chemotherapy cycle consisted of intravenous gemcitabine, 700 mg/m2, on day 1 and orally administered S-1, 50  mg/m2, for 7 consecutive days, after which there was a 1-week pause of chemotherapy (adjavant chemotherapy group). The treatment results were compared wiht other 20 patients who only underwent radical operation (control group).
Results:The survival rate in adjuvant chemotherapy group(median survival time=33 months)was significantly better than that in control group(median survival time=21 months)(P＜0.05). The 2- and 3- year cumulative survival rate in adjuvant chemotherapy group was 67.4% and 39.8%, respectively, which was significantly better than those in the control group  (344% and 15.3%) (P＜0.05). The WHO toxicities grade of adjuvant chemotherapy group generally were WHO I and II， and no WHO IV toxic event was observed.
Conclusions:Adjuvant gemcitabine plus S-1 chemotherapy can increase the survival rate and appears to be a beneficial treatment for patients with pancreatic cancer  after surgical resection.

Abstract:

Objective:To explore the value of duodenum-preserving near-total pancreatic head resection (DPNTPHR) without segmental duodenectomy for treating benign benign tumor of pancreatic head (BTPH).
Methods:The clinical data of 4 patients with BTPH, treated by DPNTPHR from January 2004 to December 2009, were retrospectively analyzed. The operation carried out was near total resection of pancreatic head while preserving the integrity of gastrointestinal tract, extrahepatic bile duct, gallbladder and the sphincter of Oddi. A small amount of pancreatic tissue was left intact around the papilla of Vater and behind the bile duct.
Results: Histology confirmed one patient had intraductal papillary mucinous neoplasm, one endocrine tumor and two solid pseudopapillary tumors. No mortality occurred in the perioperative period. Pancreatic leakage occurred in two cases and was treated successfully with conservative method. For 8-20 months Follow-up, all the 4 patients are no sign of recurrence.
Conclusions:Duodenum-preserving near-total pancreatic head resection is a proper option for benign tumors in the head of pancreas, especially when pancreatic enucleation is difficult. 

Abstract:

Objective:To study the efficacy of local resection for tumor of ampalla of Vater.
Methods: The clinical data of 28 patients with ampullary tumors treated by local resection from January 2000 to January 2010 were reviewed retrospectively.
Results:There were no deaths during perioperative period. Postoperative complications included one case of duodenal leakage, 1 pancreatic leakage and 1 wound infection respectively, which were cured after comservative treatments; the morbidity rate of postoperative complications was 10.7%.Follow-up survey of 25 patients at 1 to 9 years after operation showed that the 1 year and 5 year survival rate was 92% and 32%, respectively.
Conclusions:Local resection of ampullary tumor could achieve a radical resection effect in a subset of patients and could be a therapeutic choice for patients with early tumor of ampulla of Vater who are of high-risk due to old age, poor general condition or severe concurrent diseases.

Abstract:

Objective:To analyze the clinical features and appropriate surgical treatment methods of pancreatic endocrine tumors.
Methods:The clinical data of 33 cases of pancreatic endocrine tumors treated in our hospital during February 1989 to February 2008 were retrospectively anslyzed.
Results:There were 18 cases of insulinoma, 9 of nonfunctional islet cell tumor, 4 of gastrinoma and 2 of glucagonoma. In a total of 33 cases, 29 patients underwent radical resection,and 4 patients with unresectable tumors did not undergo resection. The overall resection rate was 87.8%, with postoperative complications of pancreatic leakages in 5 cases and  intestionol obstruction  in 2 cases.  There were no hospital deaths. The mean follow-up of 26 pationts was (4.7±3.5) years(9 months to 14 years).The 1- and 3- year  survival rate of 14 malignant cases was 71.4% and 50.0%, respectively; all of the 19 patients  with benign tumors survived.
Conclusions:The best choice for treatment of pancreatic endocrine tumors is complete surgical resection.  Pre-operative localization diagnosis of the tumor should be emphasized. At operation, careful palpation and ultrasonography is the key to accurately locate the tumor. The choice of proper operative procedure can help to avoid the occurrence of complications.

Abstract:

Objective:To evaluate the effect of an improvement of operation technological process and method  in pancraticoduodenectomy(PD). 
Methods:Twenty-two modified PD cases were performed by improvement of the operation technological process and method, and compared to the traditional PD in regard to operation time, postoperation complications, hospital stay after surgery and hospitalization costs.  
Results:All cases had PD performed successfully. Compared to the tradional group, the modified guoup had significantly shorter operation time, and decrease of pancreatic fistula, hospital stay after surgery and hospitalization costs (all P<0.05). 
Conclusions:Modified PD has the advantages of easier operation, decrease operation time, less complications, shorter hospital stay and lower hospitalization costs,and  is an effective improvement of PD．

Abstract:

Objective:To study the effect of different medthods of pancreatic duct drainage on prevention of pancreatic fistula after pancreaticoduodenectomy.
Methods:The clinical records of 122 patients who underwent standard pancreaticoduodenectomy were analyzed, retrospectively.  The stented drainage of pancreatic duct was used in 103 of 122patients,  including stented external drainage of pancreatic duct in 36 patients, and stented internal drainage of pancreatic duct in 67 patients; and without stented drainage in 19 patients.
Results:Pancreatic fistula was identified in 21of 103 patients in the drained group (4 in the stented external drainaged group and 17 in the stented internal drainaged group), and in 5 of 19 patients in the nondrained group.The incidence of pancreatic fistula in the drained group (20.4%) had no significant difference compared with the nondrained group (26.3%,P＞0.05), and the incidence of pancreatic fistula in the stented external drained group (11.1%) had no significant differenced compared with the stented internal drained group (25.4%,P＞0.05).
Conclusions:Comparing the incidence of pancreatic fistula from both groups,the authors believe that the stented drainage of pancreatic duct does not significantly reduce the incidence of pancreatic fistula after pancreaticoduodenectomy.

Abstract:

Objective:To investigate the risk factors of pancreatic fistula (PF) after pancreaticoduodenectomy (PD).
Methods:One hundred and thirty-seven patients who underwent PD consectively at the second Xiangya hospital from January 2003 to January 2008 were reviewed retrospectively. The management and outcomes of patients with PF were also evaluated. Eighteen factors which potentially affect the occurrence of PF were analyzed with univariate and multivariate Logistic regression model.
Results:Of  the 137 patients, the overall morbidity and hospital mortality was 32.1% (44/137) and 6.57% (9/137)respectively, and PF occurred in 18 patients (13.1%). PF accounted for 41% of the overall morbidity. Multivariate Logistic regression analysis  revealed that previous surgery in upper abdomen (OR=6.741), pre-operative TIBL≥171μmol/L (OR=3.308), soft texture of the pancreas (OR=3.556) and pancreatic duct diameter ＜3 mm (OR= 6.106) were independent risk factors for pancreatic fistula. 
Conclusions:Pre-operative TIBL≥171 μmol/L, previous upper abdomenal  surgery, small pancreatic duct diameter and soft texture of pancreas predict a high probability of  pancreatic fistula after PD.

Abstract:

Objective:To investigate the causes, clinical manifestation, treatment and therapeutic effect of the complications of therapeutic endoscopic retrograde cholangiopancreatography (ERCP). 
Methods:The clinical datas of 4 810 cases of therapeutic ERCP performed in our center from May 2003 to December 2008 were analyzed retrospectively. 
Results:Among the 4 810 cases of ERCP, 245 cases were accompanied with complications, including 113 cases of acute pancreatitis, 76 cases of acute cholangitis,  33 cases of alimentary tract hemorrhage; 1 death from multiple organ failure caused by duodenum perforation after EST, and 1 death from acute cholangiolitis accompanied by liver function failure. The mortality and the occurrence rate of complications after therapeutic ERCP was 0.04% and 5.2%, respectively. 
Conclusions:Strictly adhering to the indications and contraindications of ERCP and EST, skillful manipulation, adequate drainage of biliary tract and close observation of changes in patients′candition after ERCP, could diminish the complications and improve the safety of therapeutic ERCP.

Abstract:

Objective:To explore the optimal therapeutic strategy for acute biliary pancreatitis (ABP).
Methods:The clinical data of 159 patients with acute biliary pancreatitis treated in our hospital over a period of five years were retrospectively analyzed. The cases were divided into four types according to severity of disease and bile duct obstruction: Mild cases without bile duct obstruction (n=68); mild cases with bile duct obstruction (n=43); severe cases without bile duct obstruction (n=27); and severe cases with bile duct obstruction  (n=21). All cases received conservative treatment soon after admission. There were 64 cases with bile duct obstruction who underwent therapeutic endoscopy or open surgery to relieve bile duct obstruction.The time to relief of abdominal pain, the time of serum amylase returned to normal level，days of hospital stay，recovery rate，incidence of complications and fatality rate in the four groups with different therapeutic protocol were analyzed and compared.
Results:The clinical manifeslations of 95 cases without bile duct obstruction were improved after receiving conservative treatment, and there was no significant difference of the tested  indexes between the mild group and severe group (P＞0.05). All of the 64 cases with bile duct obstruction undergoing emergency operation, there was significant improvement of monitored indexes in the endoscopic therapy group (38 cases) in comparison with the open surgery group (26 cases) (P＜0.05).
Conclusions:The treatment of ABP should be selected according to the type of ABP. The non-operation protocol is effective for mild cases without bile duct obstruction; for the cases with bile duct obstruction, conservative treatment should be followed by either endoscopic biliary drainage or open surgery, and the endoscopic drainage should be preferred because of its mini-invasive advantage.

Abstract:

Objective:To discuss the diagnosis and treatment of acute pancreatitis in elderly patients.
Methods:The data of 254 consecutive elderly patients with acute pancreatitis treated in our hospital in recent 5 years were analysed, retrospectively, and compared with another 258 non-elderly patients with acute pancreatitis (control group).
Results:Among the elderly patients（≥60 years old） with acute pancreatitis, 112 of them were male and 142 were female. In elderly group, 218 cases had mild acute pancreatitis (MAP), 2 of whom died; and 36 cases had severe acute pancreatitis (SAP), 13 of whom died. There was a positive relationship between mortality and age （P＜0.01）.The rate of the acute pancreatitis caused by biliary diseases was 70.9%. Compared to control group, in the elderly group the levels of blood amylase （1 054.97±775.60）U/L and serum total bilirubin (40.97±37.11) μmol/L were much higher （P＜0.05）; and the diagnostic rate of CT（68.9%） was obviously higher than that of ultrasound（22.8%）（P＜0.01）. Surgical treatment was applied to 65 elderly patients, and 46 of them underwent endoscopic treatment.  In elderly group, 35 patients(13.8%) suffered various complications; but only 20 patients (78%) had complications in control group（P＜0.05）. 
Conclusions:The cause of acute pancreatitis  in elderly patients is usually related to biliary factors. Marked elevation of blood amylase and serum total bilirubin is significant in these patients, and they have more complications and a high mortality. CT should be the first method used for the diagnosis of acute pancreatitis in the elderly, and combined therapeutic measures should be employed.  ERCP can be indicated for the elderly patients with acute pancreatitis caused by  obstruction and infection of bile duct. Mortality of acute pancreatitis in the elderly is high and it increases with increasing age of the patient.

Abstract:

Objective:To study the expression of MAP3K10 in human pancreatic carcinoma (PC), and the relationship between MAP3K10 and human PC.
Methods:The expressions of MAP3K10 protein and mRNA in PC and adjacent non-tumorous tissues were detected by immunohistochemical staining, Western blot and quantitative Real-time PCR.
Results:(1)Immunohistochemical staining demonstrated that the number of positive staining cells in pancreatic carcinoma (100% strong positive) was notablely higher than that in matched adjacent non-tumorous tissues (only 25% weak posive) (P＜0.05);(2)Western blot proved that the expression of MAP3K10 protein in 91.7% of PC, which was higher than that in matched adjacent non-tumorous tissues; (3)qRT-PCR showed that the expression of MAP3K10 mRNA in PC was significantly higher than that in matched adjacent non-tumorous tissues（P＜0.01）.
Conclusions:MAP3K10 is abnormally activated in pancreatic carcinoma, might play an important role in the carcinogenesis and progress of pancreatic carcinoma, and is expected to become a new therapeutic target for pancreatic carcinoma.

Abstract:

Objective:To explore the expression of AnnexinⅠ in pancreatic cancer and its clinical significance.
Methods: Immunohistochemical method and the Western blot method were used to examine the expression of AnnexinⅠ in pancreatic cancer tissues, tumoral adjacent tissues, and normal pancreatic tissues obtained during operation from 40 pancreatic carcinoma patients and 20 patients with normal pancreas. The relationships with pathological grade, clinical stage and metastasis of pancreatic cancer were statistically analyzed.
Results:The percentage of positive cells that expressed AnnexinⅠ protein in human pancreatic tissues, tumor  adjacent tissues and normal tissues was 72.5%, 37.5% and 20.0%, respectively, with the protein expression level of AnnexinⅠ showing gradual decline from cancer to normal tissue (P＜005). The highly expressed AnnexinⅠ correlated significantly with the degree of tumor differentiation, advanced TNM stage and lymph node metastasis. Similar results were obtained by Western blot test.
Conclusions:AnnexinⅠ has high expression in pancreatic cancer tissues. AnnexinⅠ expression has a close relationship with pathological grades of pancreatic cancer, suggesting that AnnexinⅠ might play an important role in the development and progression of pancreatic cancer through immunologic mechanism.

Abstract:

Objective:To evaluate the influences on oxygen free radicals  of  SIRS due to abdominal infection treated by Salvia Miltiorrhiza  and Shengmai injection.
Methods:Fifty patients with SIRS due to abdominal infection were divided into 2 groups：Group A,  treated by  combined western medicine (n=25); Group B, treated by combined  western medicine plus Salvia Miltiorrhiza and  Shengmai injection (n=25). Plasma malondialdehyde(MDA) and Superoxide dismutase（SOD） were measured before treatment and on day  2 and day 4 after treatment.
Results:The serum levels of  MDA in group B decreased more rapidly than those in group A, and  the serum levels of  SOD  in group B increased more rapidly than those in group A.
Conclusions:On the basis of combined western medicine treatment, addition of Salvia Miltiorrhiza and Shengmai injection has therapeutic effect on SIRS by decreasing the harmful MDA factor and increasing the defensive SOD factors, and thereby can alleviate inflammatory injury and prevent further MODS.

Abstract:

Objective:To study the expression of ALDH1 in colon cancer and its clinical significance.
Methods:The expression of ALDH1 was examined in 98 surgical specimens of primary colonic carcinoma and 15 adjacent cancer tissues with immunohistochemistry method. The correlations of the ALDH1 expression with clinicopathological parameters and prognosis of colon cancer were analyzed．
Results:The positive rate of expression of ALDH1 was 76.5%(75/98) in cancer tissues and 13.3%(2/15) in adjacent cancer tissues. There was an obvious statistical difference (P＜0.05) between the two groups. The ALDH1 expression was significantly correlated with the histological grade, TNM stages and lymph node metastasis of colon cancer (P＜0.05). It was also related with patients′survival time, and those with positive expressions had a poor prognosis (P＜0.05).
Conclusions:The results suggest that the overexpression of ALDH1 plays important role in development and progression of colon cancer, and ALDH1 may be a valuable marker to predict the biological behavior and trend of metastasis of colon cancer．

Abstract:

Objective:To study the etiology, prevention and treatment of post-cholecystectomy syndrome.
Methods:A total of 253 patients with cholelithiasis treated in our hospital between 1998 and 2008 were surveyed. Of these patients, 133 underwent endoscopic minimally invasive gallbladder-preserving cholecystolithotomy, 25 patients laparoscopic cholecystectomy and 95 patients open cholecystectomy.
Results:Among the 120 patients who underwent cholecystectomy, non-organic post-cholecystectomy syndrome occurred in 11 patients(9.2%), and non-organic post-gallbladder-preserving operation syndrome occurred in 11 of 133 cases (8.3%). There was no significant differences in the rate of non-organic postoperative syndrome between cholecystectomy group and endoscopic minimally invasive gallbladder-preserving cholecystolithotomy group.
Conclusions:Postcholecystectomy syndrome is not related to whethar or not cholecystectomy is perforned.  The decreasing of biliary compliance caused by bile duct pressure changes and long-term bland diet may be the etiology of postoperative syndrome.  Gallbladder-preservation is important for buffering and maintaining normal bile duct pressure. Recovery training of biliary function can decrease the rate of postoperative syndrome.

Abstract:

Objective:To compare the therapeutic effects of modified  loop choledochojejunostomy and  the Roux-en-Y choledochojejunostomy.
Methods:Clinical data of 39 cases of modified loop choledochojejunostomy (ML) and 45 cases of Roux-en-Y choledochojejunostomy (R-Y) were analysed and compared, The patients of the 2 groups were followed-up for 1 to 2 years. The operation time, time to recovery of bowel function,  serum level of total bilirubin and the morbidity  of cholangitis between the 2 groups were compared.
Results:The postoperative serum level of total bilirubin decreased to the same level in both groups (P>0.05). Im ML grpup and R-Y group, the operation time were （53±11.2）min and (72.4±9.5)min, the time to recovery of bowel flatus （79.2±4.4）h and（93±6.5）h， and the morbidity  of cholangitis were 5.1% and 13.3%, srespectiveely. The observed indexes in the ML group were statistically better than those  in the R-Y group (P＜0.05).
Conclusions:The short-term and long-term therapeutic effects of modified loop choledochojejunostomy are good; the modified operation can be the method of choice for choledochojejunostomy.

Abstract:

Objective:To evaluate the efficacy and application of combined laparoscopic and duodenoscopic transcystic duct for common bile duct (CBD) exploration and stone extraction (LTCBDE).
Methods:Eighty-two patients, diagnosed as gallbladder and CBD stone(s) by MRCP before operation,  were treated by LTCBDE.
Results:LTCBDE was successfully carried out in all the cases and no case was converted to laparotomy. The amount of hemorrhage during operation varied from 30 to 80mL. There were no serious complictions, and hospital stay was 4-6 d. Follow-up of the 82 cases for 3 months to 1 year showed no case of bile duct stricture or recurrent stones.
Conclusions:LTCBDE is the best operation to treat cholecysto-and choledocholithiasis when the suituble indications are followed

Abstract:

Objective:To investigate the value of applying the procedure of laparoscopic splenectomy (LS) in open splenectomy.
Methods:We summarized the features of LS and designed an improved procedure of open splenectomy. Sixty-one cases were divided into traditional splenectomy group(TS) and improved splenectomy group(IS).  The operation time(OT), volume of bleeding during splenectomy(VB), anount of drainage of first day after operation(DF), length of hospital stay after operation(LS) and operation cost(OC) were compared between the 2 groups. 
Results:Traditional group: OT(97.3±23.6)min, VB(264.4±466)mL and DF(285.5±76.5)mL. Improved group: OT(52±13.7)min, VB(105.0±31.0)mL and DF(110.3±39.5)mL; there was significant  difference between the 2 groups in OT,VB and DF. There were no cases with severe bleeding or pancreatic fistula in improved group. The improved group had higher OC（P＜0.05）. There was no difference in LS（P＞0.05）.
Conclusions:Improved open splenectomy has a certain advantage in operation time and blood loss. This experience suggests that with the use of advanced surgical instruments, open splenectomy can be performed with the concept of mininal trauma.