ABSTRACT
Objective To investigates the role of duodenum and bile duct preserving pancreatic head resection (DBPPHR) in treatment of benign or low-grade malignant diseases located in the head of pancreas.Methods The clinical data of 31 patients who underwent DBPPHR between April 2012 to May 2016 in Zhejiang Provincial People's Hospital and Zhangzhou Municipal Hospital of Fujian Province were analyzed retrospectively.Results Of the 31 patients,4 patients underwent laparoscopic DBPPHR.One patient in the open group was converted to pancreaticoduodenectomy.For the open group,the mean operation time was (165.3 ±63.6) min;the mean estimated blood loss was (258.1 ± 156.9) ml;and the mean postoperative stay was (11.7 ± 6.3) days.The postoperative complications included 1 reoperation due to postoperative bleeding,1 bile leakage and 13 patients developed grade A pancreatic fistula (48.2％).For the laparoscopic group,the mean operation time was 350.0 (280.0 ～ 450.0) min;the mean estimated blood loss was 425.0 (250.0 ～600.0) ml;and the mean postoperative stay was 14 days.Three patients developed postoperative pancreatic fistula (grade A).The pathological diagnosis were:12 patients with pancreatolithiasis,8 patients with serous cystadenoma,4 patients with branched intraductal papillary mucinous neoplasm,5 patients with neuroendocrine tumor and 2 patients with mucinous cystadenoma.The follow-up period was 1 ～ 48 month,and there was no patient with diabetes or diarrhea.Conclusions DBPPHR was safe and efficacious.It is less invasive to treat benign or low-grade malignant diseases located in the head of pancreas.
ABSTRACT
Objective To explore the relationship between promoter methylation of RASSF1 A gene and clinico-pathological characteristics in hepatocellular carcinoma.Methods MS-PCR was used for analyzing the status of aberrant promoter methylation of RASSF1A in 100 primary HCC samples and adjacent noncancerous tissues,10 normal liver tissues,and six HCC cell lines.RT-PCR was used to assess reactivation of RASSF1A expression after HCC cell lines treated with demethylating agent 5'-aza-2' deoxycytideing.Results Abnormal promoter methylation of RASSF1A gene was found in 69(69％) cases of HCC,15 (15％) cases of adjacent normal tissues,and no abnormal promoter methylation of RASSF1A gene was found in normal liver tissues,and the difference was statistically significant (x2 =67.75,P ＜0.001).The methylation of RASSF1A gene was correlated to HBsAg (x2 =11.341,P ＜ 0.05) and histological differentiation(x2 =10.575,P ＜ 0.05).Four cell lines with abnormal CpG island methylation of RASSF1A gene were all re-expressed after treated with 5'-Aza-CdR.Conclusions RASSF1A gene promoter methylation was correlated to HBsAg and histological differentiation and this is one of the most important mechanism for low expression of RASSF1A in HCC.
ABSTRACT
Objective To investigate the expressions of RUNX3 and CyclinDl in pancreatic carcinoma and their significance. Methods Expressions of RUNX3, CyclinD1 in 47 cases with pancreatic carcinoma, 18 cases with cystadenoma of pancreas and 12 normal pancreas cases were detected by immunohistochemistry, and the relationship between their expressions and clinicopathological parameters was analyzed. Results The positive expression rates of RUNX3 in pancreatic carcinoma, cystadenoma of pancreas, normal pancreas cases were 57.4％ (27/47), 94.4％ (17/18), 100％ (12/12); the positive expression rates of CyclinD1 in pancreatic carcinoma, cystadenoma of pancreas, normal pancreas cases were 72.3％ (34/47), 44.4％(8/18), 8.3％ (1/12). RUNX3 expression was not related to the age and sex, but it was negatively associated with clinical staging, lymph node metastasis, the differentiation degree (P ＜0.05 ). CyclinD1 expression was not related to the age and sex, but it was positively associated with clinical staging, lymph node metastasis, the differentiation degree (P ＜0.05 ). The expression of RUNX3 and CyclinD1 was negatively associated (r = - 0.375, P = 0.009). Conclusions The expression of RUNX3 is decreased in pancreatic carcinoma. The expression of CyclinD1 is increased in pancreatic carcinoma. They may play an important role in the carcinogenesis and progression of pancreatic carcinoma.
ABSTRACT
Objective To investigate the evolution of pancreaticoduodenectomy and its significance in different time periods. Methods The clinical data of 165 patients from 1988 to 2008 in the department of general surgery, Zhangzhou Municipal Hospital with pancreaticoduodenectomy were retrospectively analyzed.Among 165 cases, simple pancreatoduodenectomy (PD) were performed in 138 cases, pylorus preserving pancreatoduodenectomy (PPPD) were performed in 14 cases, and extended pancreaticoduodenectomy were performed in 13 cases. The methods of pancreato-enteric reconstruction in pancreaticoduodenectomy included 68 cases with binding pancreaticojejunostomy (Peng's type Ⅰ ); 61 cases with pancreaticogastrostomy; 30 cases with traditional pancreaticojejunostomy; and 6 cases with duct-to-mucous pancreaticojejunostomy.Results From 1988 to 1998 (the first 10 years), 50 patients underwent pancreaticoduodenectomy, including 42 cases of PD and 8 cases of PPPD, and no case of extended pancreaticoduodenectomy. The mean amount of blood loss was (620 ± 180)ml, mean amount of blood transfusion was (530 ± 120)ml, the mean operation time was (6.5 ±3.5)h. Anastomotic fistula occurred in 7 cases, the incidence of anastomotic fistula was 14.0%(7/50); and 2 cases died during perioperative period with a mortality rate of 4.0% (2/50). From 1999 to 2008 (the latter 10 years), 115 patients underwent pancreaticoduodenectomy, including 96 cases of PD, 6 cases of PPPD, and 13 cases of extended PD. The mean amount of blood loss was (360 ± 110)ml, mean amount of blood transfusion was (400 ± 6 ) ml, the mean operation time was ( 3.0 ± 2.5 ) h, Anastomotic fistula occurred in 4 cases with an incidence of 3.5% ( 4/115 ); and one case during perioperative period with a mortality rate of 0.61%. The postoperative follow up time was ranging from 6 months to 5 years in 109 patients, the 1, 3,5 year survival rate was 87.2%, 54.1% and 39.5%. Conclusions In the latter 10 years, the amount of blood loss, the operation time, the mortality, and the incidence of pancreatic fistula have decreased significantly compared to the first 10 years.
ABSTRACT
Objective To evaluate a combination hemihepatectomy and hilar blood vessel resection plus reconstruction for hilar cholangiocarcinoma. Methods Ten cases of hilar cholangiocarcinoma at the stage of Ⅲa, Ⅲb, and Ⅳ, underwent this surgical procedure including right - hemihepatectomy + pancreatoduodenectomy + right portal vein branch resection and reconstruction (1case), right - hemihepatectomy + right portal vein branch resection and reconstruction (5cases), left - hemihepatectomy + left caudectomy + left portal vein branch resection and reconstruction + left hepatic artery resection (1case), and left - hemihepatectomy + left caudectomy + left portal vein branch resection plus and reconstruction (3cases). Results There was no postoperative mortality and severe complications. All the 10 cases were followed up with 1,2,3-year survival rate of 50%,30%and 20%, respectively. Conclusion Hepatectomy plus hilar blood vessel resection and reconstruction helps to increase the resection rate in cases of hilar cholangiocarcinoma and prolong patients' survival.