Risk factor analysis of early complications after pancreaticoduodenectomy / 国际外科学杂志

Objective@#To analyse of risk factors for early complications after pancreaticoduodenectomy.@*Methods@#Retrospective analysis of 280 cases of pancreaticoduodenectomy in the First Affiliated Hospital, Sun Yat-sen University from January 1999 to October 2009, including 175 males and 105 females; the average age was 57 years, the range is 19 to 81 years old. Observe the perioperative condition and postoperative complications of the patient. Logistic regression analysis was used to analyze risk factors associated with early postoperative complications.@*Results@#Among the 280 patients, 81.1% had preoperative jaundice with obstructive jaundice, the median operation time was 5.5 h. the intraoperative blood loss was (558.0±35.0) ml, 16 patients underwent multiple organ resection. The total postoperative complications was 31.1%. Common postoperative complications were abdominal infection/abscess (10.4%), hemorrhage (7.1%), and pancreatic fistula (2.1%). The pancreaticoenterostomy was mainly performed with a nested end-to-end anastomosis (87.1%) and a bundled pancreaticojejunostomy (7.9%). Logistic regression analysis showed that age, comorbidity, jaundice, preoperative yellowing, pancreatic texture, pancreatic duct placement, prophylactic application of somatostatin, combined organ resection and pancreaticojejunostomy were not predictor of major postoperative complications.@*Conclusions@#The incidence of early abdominal complication after pancreaticoduodenectomy is high. There is no significant correlation between the common risk factors in perioperative period and the occurrence of serious complications in the early postoperative period.

Risk factor analysis of early complications after pancreaticoduodenectomy / 国际外科学杂志

Objective To analyse of risk factors for early complications after pancreaticoduodenectomy.Methods Retrospective analysis of 280 cases of pancreaticoduodenectomy in the First Affiliated Hospital,Sun Yat-sen University from January 1999 to October 2009,including 175 males and 105 females;the average age was 57 years,the range is 19 to 81 years old.Observe the perioperative condition and postoperative complications of the patient.Logistic regression analysis was used to analyze risk factors associated with early postoperative complications.Results Among the 280 patients,81.1％ had preoperative jaundice with obstructive jaundice,the median operation time was 5.5 h.the intraoperative blood loss was (558.0 ± 35.0) ml,16 patients underwent multiple organ resection.The total postoperative complications was 31.1％.Common postoperative complications were abdominal infection/abscess (10.4％),hemorrhage (7.1％),and pancreatic fistula (2.1％).The pancreaticoenterostomy was mainly performed with a nested end-to-end anastomosis (87.1％) and a bundled pancreaticojejunostomy (7.9％).Logistic regression analysis showed that age,comorbidity,jaundice,preoperative yellowing,pancreatic texture,pancreatic duct placement,prophylactic application of somatostatin,combined organ resection and pancreaticojejunostomy were not predictor of major postoperative complications.Conclusions The incidence of early abdominal complication after pancreaticoduodenectomy is high.There is no significant correlation between the common risk factors in perioperative period and the occurrence of serious complications in the early postoperative period.

Declined Preoperative Aspartate Aminotransferase to Neutrophil Ratio Index Predicts Poor Prognosis in Patients with Intrahepatic Cholangiocarcinoma after Hepatectomy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Various inflammation-based prognostic biomarkers such as the platelet to lymphocyte ratio and neutrophil to lymphocyte ratio, are related to poor survival in patients with intrahepatic cholangiocarcinoma (ICC). This study aims to investigate the prognostic value of the aspartate aminotransferase to neutrophil ratio index (ANRI) in ICC after hepatic resection. MATERIALS AND METHODS: Data of 184 patients with ICC after hepatectomy were retrospectively reviewed. The cut-off value of ANRI was determined by a receiver operating characteristic curve. Preoperative ANRI and clinicopathological variables were analyzed. The predictive value of preoperative ANRI for prognosis of ICC was identified by univariate and multivariate analyses. RESULTS: The optimal cut-off value of ANRI was 6.7. ANRI was associated with tumor size, tumor recurrence, white blood cell, neutrophil count, aspartate aminotransferase, and alanine transaminase. Univariate analysis showed that ANRI, sex, tumor number, tumor size, tumor differentiation, lymph node metastasis, resection margin, clinical TNM stage, neutrophil count, and carcinoembryonic antigen were markedly correlated with overall survival (OS) and disease-free survival (DFS) in patients with ICC. Multivariable analyses revealed that ANRI, a tumor size > 6 cm, poor tumor differentiation, and an R1 resection margin were independent prognostic factors for both OS and DFS. Additionally, preoperative ANRI also had a significant value to predict prognosis in various subgroups of ICC, including serum hepatitis B surface antigen‒negative and preoperative elevated carbohydrate antigen 19-9 patients. CONCLUSION: Preoperative declined ANRI is a noninvasive, simple, and effective predictor of poor prognosis in patients with ICC after hepatectomy.

The prognosis prediction value of the 8th edition of the American Joint Committee on Cancer Staging System in patients with resectable hepatocellular carcinoma / 中华普通外科杂志

Objective To compare the prognosis prediction value of the 8th edition with the 7th edition of the American Joint Committee on Cancer Staging System in patients with resectable hepatocellular carcinoma (HCC).Methods A total of 311 HCC patients after hepatectomy were retrospectively analysed.Patients were staged according to both the 7th edition (TNM-7) and 8th edition (TNM-8) AJCC TNM staging criteria.The survival rates were estimated using Kaplan-Meier methods.Multivariate analysis was assessed by Cox proportional hazards regression analysis.The predictive ability of staging systems was evaluated by receiver operating characteristic curve (ROC) and area under curve (AUC).Results When stratified according to the TNM-7 system,the overall survival(OS) of stage T1 was higher than that of stage T2,stage T2 higher than stage T3a,however,the 5-year OS rates of stage T4 (16.7％) was higher than those of stage T3a (14.3％) and T3b(10.9％).The difference in survival was significant between stages T1 and stage T3a,T3b,T4 (all P ＜0.05),and that between stages T2 and stage T3b,T4 (all P ＜0.05).When stratified according to the TNM-8 system,the survival rates decreased as the T stage going high.OS rates vary significantly between stagesT1a and stageT3,T4 (P =0.004,0.001),between stage T1b and stage T3,T4 (both P ＜ 0.001),and between stage T2 and stage T4 (P =0.009).The difference in disease free survival (DFS) rates was significant between stages T1a,T1b,T2 and stage T3,T4 (all P ＜0.01).Finally,the area under ROC of TNM-8 is bigger than that of TNM-7.Conclusions Compared with TNM-7 staging,new TNM-8 staging can predict more accurately the prognosis of patients with resectable hepatocellular carcinoma.

Role of up-regulated microRNA145 in viability, apoptosis, invasion and metastasis of hepatoma cells / 中国病理生理杂志

[ ABSTRACT] AIM:To investigate the effects of microRNA145 ( miRNA145 ) on the viability, apoptosis, inva-sion and metastasis of hepatoma HepG2 cells.METHODS: HepG2 cells were randomly allocated into 3 groups: blank control group, empty mimic transfected group and miRNA145 mimic transfected group.Under the induction of Lipofectami-neTM 2000, the recombinant was transfected into HepG2 cells.After transfection, the expression level of miRNA145 was detected by real-time PCR.The protein level of N-cadherin and the mRNA expression levels of miRNA145 and N-cadherin were detected by Western blot and real-time PCR.The cell viability was detected by MTS assay.The cell cycle and apopto-sis were analyzed by flow cytometry.Invasion and metastasis were detected by Transwell assay.RESULTS:Compared with negative control, miRNA145 expression was up-regulated significantly, while the expression of N-cadherin was down-regu-lated significantly.Meanwhile, the cell viability, cell cycle, apoptosis, invasion and metastasis of hepatoma HepG2 cells were all significantly inhibited (P<0.05).CONCLUSION:miRNA145 dramatically inhibits viability, apoptosis, inva-sion and metastasis of hepatoma cells.

Experimental study on concentrations and pharmacokinetics of antibiotics in bile and evaluation of their microbicidal potential / 中华外科杂志

<p><b>OBJECTIVE</b>To study the concentrations and pharmacokinetics of 6 different kinds of antibiotics in rabbit bile, and evaluate their microbicidal potential.</p><p><b>METHODS</b>Thirty-six health rabbits were randomly divided into 6 groups, and each group was 6 rabbits. After anaesthesia, the common bile duct of rabbit was isolated and cumulated with a silicone tube. The rabbits were administered intravenously with the equal-effect dose of antibiotics. Bile (1.5 ml) was collected at different time points after administration, and the concentration of antibiotics of bile was assayed by high performance liquid chromatography. The bile drug concentration-time data were processed by software to figure out the pharmacokinetic parameters such as maximum concentration (C(max)), peak time (T(max)), half-life time (T(1/2)), clearance (CL) and apparent volume of distribution (VD). The bile antibiotics concentration contrasted to the minimum inhibitory concentration (MIC), and attained the bactericidal index (C(max)/MIC) and the time when the drug concentration exceeded the MIC (T(>MIC)).</p><p><b>RESULTS</b>The C(max) and T1/2 of each antibiotic were as the followings: piperacillin (7 950 ± 3 023) mg/L and (1.97 ± 1.23) h, ceftriaxone (1 104 ± 248) mg/L and (3.14 ± 0.57) h, cefoperazone (5 215 ± 2 225) mg/L and (0.89 ± 0.13) h, meropenem (31.97 ± 12.44) mg/L and (0.36 ± 0.11) h, levofloxacin (66.3 ± 36.9) mg/L and (3.32 ± 2.57) h, metronidazole (28.2 ± 10.2) mg/L and (0.81 ± 0.33) h, respectively. Piperacillin/tazobactam and cefoperazone/sulbactam had the largest bactericidal index and the longest T(>MIC), and their bactericidal indexes were (62.1 ± 23.6) - (993.8 ± 377.9) and (164.8 ± 69.0) - (659.3 ± 275.9), their T(>MIC) were (6.00 ± 2.53) - (8.00 ± 0.00) h and (6.33 ± 1.97) - (8.00 ± 0.00) h. The bactericidal index and T(>MIC) of levofloxacin were the smallest, which were (2.1 ± 1.2) - (8.3 ± 4.6) and (0.54 ± 0.25) - (2.67 ± 1.03) h . Ceftriaxone and meropenem were as the medium, and their bactericidal indexes and T(>MIC) were (4.3 ± 1.0) - (69.2 ± 15.5) , (1.42 ± 0.65) - (8.00 ± 0.00) h and (2.0 ± 0.8) - (1 031.3 ± 401.4) , (0.29 ± 0.10) - (1.83 ± 0.26) h. The bactericidal index of metronidazole to anaerobic ranged from 7.4 to 294.9, and the T(>MIC) ranged from 1.88 to 5.00 h.</p><p><b>CONCLUSIONS</b>The bile concentrations of six antibiotics all exceed their effective bactericidal concentrations. The concentration-time curves of piperacillin, cefoperazone, meropenem and metronidazole conformed to one-compartment model, and ceftriaxone and levofloxacin are conformed to two-compartment model. Piperacillin/tazobactam and cefoperazone/sulbactam have the largest bactericidal index and the longest T(>MIC), so they can be chosen as the first choice for the therapy of hepatobiliary infection.For the anaerobic, the microbicidal potential of metronidazole is high.</p>

Analysis of complications after pancreaticoduodenectomy / 中华消化外科杂志

Objective To investigate the complications and the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 339 patients who underwent pancreaticoduodenectomy at the First Affiliated Hospital of Sun Yat-Sen University from January 2000 to Decembcr 2009 were retrospectively analyzed.The risk factors of pancreatic fistula were analyzed.The incidences of complications accured from 2000 to 2004 and from 2005 to 2009 were compared.All data were analyzed by the t test,chi-square test,Fisher exact probability or Logistic regression model.Results The incidence of complications of all patients was 33.0％ ( 112/339),and the incidence of pancreatic fistula was 8.6％ (29/339).Of the 29 patients complicated with pancreatic fistula,6 patients were in grade A,8 in grade B and 15 in grade C.Soft texture of remnant pancreas and the diameter of pancreatic duct smaller than 3 mm were the independent risk factors of pancreatic fistula( OR =1.75,3.75,P ＜ 0.05 ).The number of hospital death was 12,including 1 patient died during the first period (2000-2004) and 11 patients died during the second period (2005-2009).Three patients died of pancreatic fistula and abdominal hemorrhage,3 died of postoperative upper gastrointesitnal bleeding,2 died of cardiac insufficiency,1 died of respiratory failure,1 died of pancreatic fistula,abdominal infection and necrotic pancreatitis,1 died of abdominal hemorrhage and hepatic and renal failure,1 died of bililary fistula,abdominal infection and multiple organ dysfunction syndrome.Conclusions Soft texture of remnant pancreas and the diameter of the pancreatic duct smaller than 3 mm are important risk factors of postoperative pancreatic fistula.Pancreatic fistula is the main factor causing death after pancreaticoduodenectomy.

Expression and clinical significance of hepatocyte growth factor receptor and epidermal growth factor receptor in pancreatic cancer / 中华肝胆外科杂志

Objective To determine the clinical significance of hepatocyte growth factor receptor (Met) and epidermal growth factor receptor (EGFR) in the clinicopathology and prognosis of pancreatic cancer.Methods 70 patients admitted with pancreatic cancer from 1995 to 2005 were retrospectively analyzed with clinicopathological and follow-up data.Expression of Met and EGFR in cancer nest embedded with paraffin were detected by immunohislostaining (EnVision method) and correlation with clinicopathologic parameters and mutual correlation between these two receptors were further analyzed.Prognosis and related risk factors were analyzed by Kaplan-Meier survival analysis and Cox regression analysis,respectively.Results Both Met and EGFR significantly correlated with TNM staging,tumor size and superior mesenteric vessels invasion (P＜0.05).Expression level of Met positively correlated with that of EGFR (r9 =0.658,P＜0.05).Both Met and EGFR significantly correlated with patients' survival (P＜0.05) and Met was an independent prognostic risk factor for pancreatic cancer.Conclusions Both Met and EGFR significantly affect development and prognosis of pancreatic cancer and correlate with each other.Simultaneously targeting both Met and EGFR pathways may provide an advisable strategy of targeted therapy in pancreatic cancer.

A single surgeon's experience of pancreaticoduodenectomy on 169 patients / 中华肝胆外科杂志

Objective To investigate the complications and the risk factors for pancreatic leakage after pancreaticoduodenectomy.Methods One hundred and sixty-nine patients who received pancreaticoduodenectomy in our hospital between January 2000 and December 2009 were reviewed.Chisquare and logistic statistic analysis were performed to determine the risk factors for pancreatic leakage.The difference in complication rates between different periods were analyzed.Results The mortality was 2.4％.The morbidity was 34.9％,and the pancreatic leakage rate was 7.7％.Logistic analysis revealed significant risk factors for pancreatic leakage included intraoperative bleeding of more than 400 ml(OR=2.87; 95％ confidence interval:1.17-8.19; P=0.048),soft texture of remnant pancreas(OR =1.95 ; 95 ％ confidence interval:0.87-6.19 ； P =0.032)and pancreatic duct diameter smaller than 3 mm(OR=3.78 ; 95 ％ confidence interval:1.01-10.63 ； P =0.019).There was no significant difference in mortality,morbidity,pancreatic leakage,and upper gastric bleeding between the periods 2000-2004 and 2005-2009.However,re-operation rate and postoperative hospital stay were significantly higher in the period of 2005-2009.Conclusions Intraoperative bleeding,soft texture of remnant pancreas and pancreatic duct diameter smaller than 3mm were significant risk factors for postoperative pancreatic leakage.A pancreaticojejunostomy anastomotic technique familiar to the surgeon might reduce postoperative pancreatic leakage.

Application of 64-slice computed tomography and software-assisted image analysis in preoperative evaluation and surgical planning of hilar cholangiocarcinoma / 中华消化外科杂志

Objective To evaluate the application of 64-slice computed tomography (CT) and software-assisted image analysis in preoperative evaluation and surgical planning of hilar cholangiocarcinoma. Methods The clinical data of six patients with hilar cholangiocarcinoma who were admitted to The First Affiliated Hospital of Sun Yat-sen University from June to December, 2009 were retrospectively analyzed. All six patients underwent 64-slice CT scanning before the operation, and then three-dimensional (3D) reconstruction of the liver, tumor, blood vessels and bile ducts was achieved with the assistance of Myrian (R) XP-Hepatic software. The relationships of the tumor, blood vessels and bile ducts were illustrated in the 3D model. Virtual liver resection was carried out for surgical planning. Results The 3D models of the liver, tumor, blood vessels and bile ducts were successfully constructed . The 3D models were able to be rotated and magnified as necessary. Preoperative evaluation and surgical planning were in accordance with actual surgery. The relative accuracy of the software-assisted image analysis system for calculating the hepatic volume to be resected was 5%. Patients recovered well without occurrence of hepatic failure. Conclusion Sixty-four-slice CT scanning and software-assisted image analysis are important for preoperative evaluation and surgical planning of hilar cholangiocarcinoma.

Risk factors of postoperative morbidity after hepatectomy for intrahepatic stones / 中华肝胆外科杂志

Objective To study the risk factors of complications after hepatectomy for intrahepatic stone.Method Clinical data of 363 patients with hepatolithiasis receiving elected hepatic resection in past 4 years in our hospital were analyzed retrospectively.Postoperative complications were recorded.Possible risk factors pertaining to the development of complications were identified using univariate and multivariate analysis.Results the surgical mortality was 0.6%(2/363).Postoperative complications occurred in 110 of 363 patients(30.3%).The morbidity included wound infection/liquafication in 42 cases(11.6%),pleural effusion in 41(11.3%),subphrenic collection in 36 (9.9%),bile leakage in 21(5.8%),intra-abdominal collection/infection in 13(3.6%),gastrointestinal bleeding in 3(0.8%),biliary hemorrhage in 2(0.6%),hepatic function insufficiency in 1 (0.3%).The multivariate logistic regression analysis identified that previous history of biliary surgery (P=0.042,odds ratio[OR]=0.617,95%confidence interval[CI]:0.388 to 0.982)and operative time(P=0.0001,odds ratio[OR]=0.994,95%confidence interval[CI]:0.991 to 0.997)were the independent risk factors for development of complications after hepatoectomy for hepatolithiasis.Conclusion Previous history of biliary duct surgery and operative time are the independent risk factors for development of complications after hepatoectomy for intrahepatic stone.For patients with previous biliary surgery,adequate preoperative preparation,improving operative skills and shortening operative time are critical important to prevent occurrence of complications.

Early postoperative enteral nutrition compared with parenteral nutrition after hepatectomy:A prospective randomized study / 中华肝胆外科杂志

Objective To evaluate the impact of early enteral nutrition (EEN) compared with parenteral nutrition (PN) on patients after hepatectomy. Methods Seventy-eight patients undergoing liver resection were randomized prospectively into two groups: EEN group receiving early enteral nutrition (n=35) and PN group receiving parenteral nutrition (n=43). The patients in both groups received isocaloric and isonitrogenous nutritional formulas 24 h after operation and the formulas were stopped on postoperative day 7. The general conditions, liver function tests, clinical complications,and clinical nutritional variables at three time points that included preoperative phase, postoperative day 1 (POD 1) and postoperative day 8 (POD 8) were observed. Results No significant differences were found in length of hospital stay, liver function and clinical nutritional variables between the 2 groups. In the EEN group, the serum prealbumin level almost returned to the preoperative level on POD 8. The nutritional complication rate of the EEN group was increased significantly but it was milder than that of the PN group. The time of gut function recovery in the EEN group was shorter than that of the PN group. The costs of nutritional drugs showed a significant decrease in the EEN group.Conclusion Early enteral nutrition is safe, rational and effective in patients who have undergone hepatectomy. Early enteral nutrition is better than parenteral nutrition in promoting liver function recovery, liver protein synthesis, postoperative recovery of gut function and decreasing costs of nutritional drugs.

Interventional treatment of bile duct injury after laparoscopic cholecystectomy / 中华消化内镜杂志

Objective To investigate the value of interventional therapy in bile duct injury (BDI) due to laparoscopie cholecystectomy (LC). Methods Data of 24 BDI patients, who received interventional treatment after LC from June 1997 to May 2007, were retrospectively analyzed. Results According to Liu Yunyi criteria of BDI classification, there were 5 cases of type Ⅰ , 11 cases type Ⅱ , 2 type Ⅲ and 6 type Ⅳ. BDI was found during LC in 2 patients and the operation was switched to open cholecysteetomy, but bile duct infection was experienced 10 months and 2 years after the operation, respectively. BDI was diagnosed postoperatively in 22 patients, in which 13 eases occurred 3-12 days after LC, 7 cases 20-60 days after LC, and 2 cases 2 years after LC. Complete remission was achieved by interventional therapy in 5 patients, the other 19 patients received curative operation after control of cholangitis and jaundice. Among 13 patients who were diagnosed BDI 3-12 days after LC, 6 underwent emergency operation and failed. Of the 7 other patients who received interventional therapy, 3 were cured and the others underwent curative operation after cholangi-tis and jaundice were controlled. Conclusion Application of interventional therapy in BDI after LC can a-chieve successful bile duct support and drainage, and can obtain complete image of bile duct system, which is effective not only in control of cholangitis and jaundice for the safety of the following surgery, but also in cure of BDI.

Prognostic effect of modified loop choledochojejunostomy / 中华消化外科杂志

Objective To evaluate the long-term efficacy of modified loop choledochojejunostomy (MLC). Methods The clinical data of 259 patients who had underwent choledochojejunostomy in First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2006 were retrospectively analyzed. Of all the patients, 130 underwent MLC (MLC group) and 129 underwent Roux-en-Y choledochojejunostemy (RYC, RYC group). The changes in incidence of cholangitis and liver function between the 2 groups were compared. All the data were analyzed by t test, chi-square test or Fisher exact probability. Results The levels of alaninetransa-minase and alkaline phosphomonoesterase were (63±42) U/L and (147±147) U/L in MLC group, and (84±52)U/L and (256±201)U/L in RYC group, with statistical difference between the 2 groups (t=1.634, 1.655, P>0.05). The level of gamma-glutamyl transferase in MLC group was (116±91)U/L, which was signifieandy lower than (169±96)U/L in RYC group (t=2.461, P<0.05). Three patients (2.3%) in MLC group and 9 (7.0%) in RYC group suffered from acute cholangitis after operation, with no statistical difference in the incidence between the 2 groups (P>0.05). Of the 12 patients with acute cholangids, 1 in MLC group and 7 in RYC group were hospitalized, with statistical difference between the 2 groups (P<0.05). Conclusions The incidence of acute cholangitis in patients who underwent MLC is comparable to that of RYC. However, the procedure of MLC is simpler than RYC, and patients have milder symptom and lesser frequency of reflux cholangitis onset after MLC.

Bile duct injury during laparoscopic cholecystectomy / 中华普通外科杂志

Objective To investigate the cause,type,clinical manifestation,diagnosis and treatment of bile duct injury(BDI)during laparoscopic cholecystectomy(LC).Methods Data of 26 cases suffering from biliary injury during LC from 1997 to 2007 were retrospectively analyzed.Results Among 26 cases with BDI,5 cases suffered from type Ⅰ BDI,13 cases from typeⅡ,2 cases from typeⅢ,and 6 cases from type Ⅳ.Injuries were diagnosed as BDI intraoperatively in 3 cases,23 BDI cases were diagnosed postoperatively,including 13 cases diagnosed one week after LC,8 cases 20-60 days after LC,2 cases 2 years after LC.Twenty-four cases underwent interventional therapy,with 5 cases cured,19 cases were tideovered to operative treatment after cholangitis and jaundice were under control.Among all BDJ cases,20 cases underwent resection of impaired dile duct and hepatico-jejunostomy. Conclusion BDI is a serious complication of LC,temporary stent graft or bile dranage will help to put jaundice and cholangitis under control so as to buy a time for final definite surgical procedures.

Liver protection of prostaglandin E_1 in patients after hepatectomy / 中华普通外科杂志

Objective To investigate the effect on and mechansm by which prostaglandin E_1(PGE_1)protects liver functions after hepatectomy.Methods In this study,82 cases undergoing hepatectomy were divided randomly into control group with conventional therapy(41 cases),and PGE_1 treatment group(41 cases)treated with liposomal prostaglandin E_1 in addition to conventional therapy.Postoperative hospital days,urinary volume and abdominal drainage volume were observed.Pre-and postoperative liver functions were measured.Results Postoperative hospital days(median time 22 days)in PGE_1 treatment group were significantly shorter than those(median time 26 days)in control group.The postoperative levels of alanine transaminase,aspartic transaminase,total bilirubin and albumen in PGE_1 treatment group recovered to preoperative levels more quickly,than control group.Postoperative urinary volume in patients of PGE_1 treatment group was significantly more than that in control group,while abdominal drainage volume was markedly less,although there was no significant difference in prothrombin time between the two groups.Conclusion In patients undergoing hepatectomy,PGE_1 is very useful and safe to protect and improve hepatic function,decreasing the level of bilirubin,preventing ascites,formation shortening hospital days,without causing prolongation of prothrombin time remarkably.

Factors influencing the prognosis of 276 patients with pancreatic cancer / 中华消化外科杂志

Objective To analyze the factors influencing the prognosis of patients with pancreatic cancer.Methods The clinical data of 276 patients with pancreatic cancer who had been admitted to our department from September 1995 to August 2005 were retrospectively analyzed.Cox regression analysis was used to screen out independent risk factors influencing the prognosis of patients with pancreatic head cancer or pancreatic body and tail cancer,and Kaplan-Meier method to calculate the median survival time.The effects of tumor location on the prognosis were examined by Log-rank and Breslow test.Results Cox regression analysis showed that the diameter of tumor,invasion of the superior mesenteric vessel and treatment method were the independent risk factors influencing the prognosis of patients with pancreatic head cancer;while age,lymphadenectasis and treatment method were the independent risk factors influencing the prognosis of patients with pancreatic body and tail cancer.The median survival time of patients with pancreatic head cancer and pancreatic body and tail cancer after radical resection were 460 days and 480 days,which were significantly longer than 240 days and 200 days of patients who received palliative treatment or gave up treatment.The median survival time of patients with whole pancreatic cancer was 117 days,which was significantly shorter than 330 days of patients with pancreatic head cancer and 300 days of pancreatic body and tail cancer.Conclusions Radieal resection is currently the best choice for pancreatic cancer.The prognosis is poor for patients with pancreatic head cancer(diameter≥4 cm)and invasion of the superior mesenteric vessel.Patients with age≤60 and lymphadenectasis are the factors resulting in poor prognosis of pancreatic body and tail cancer.The prognosis of patients with pancreatic head cancer and pancreatic body and tail cancer are close.Patients with whole pancreatic cancer is in the terminal stage with the worst prognosis.

Effects of octreotide on DENA induced routine liver cancer / 中华普通外科杂志

Objective To investigate the effect and mechanism of oetreotide (OCT) on DENA related hepatoeareinogenesis in rats. Methods Fresh diethylnitrosamine (DENA) solution was given to induce the model of rat hepatoeellular carcinoma. The rats were divided randomly into two groups: OCT treatment group and control group. The survival rate and hepatoeareinogenesis rate were observed. SSTR2 mRNA and protein expression were measured. Results The survival rote of OCT treatment group (70.0%, 7/10) was significantly higher than that of control group (30.0%, 6/20) (X2 = 4.344, P<0.05). 16 weeks after DENA treatment, the difference of bepatoearcinogenesis rate between the two groups was not remarkable though the value of OCT treatment group (0%, 0/10) was lower than that of control groups (30.0%, 6/20)(X2 = 3.750, P＞0.05). However, 22 weeks after DENA treatment, hepatoeareinogenesis in control group (83.3%, 10/12) was markedly higher than that in OCT treatment group (22.2% , 2/9)(X2 =7.843, P<0.01). With liver cirrhosis progressing, the expressions of SSTR2 mRNA and protein increased, and reached the peak 16 weeks after DENA treatment, then began to decrease. The expressions of SSTR2 mRNA and protein in hepatocellular carcinoma were significantly lower than those in the liver 22 weeks after DENA treatment (F = 35.010 and 13. 386, P<0.01). The expression levels in OCT treatment group were similar to those in control group 8 and 16 weeks after DENA treatment. But the expression levels in OCT group 22 weeks after DENA treatment didn't lower markedly, and were higher significantly than those in control group (t = 2.806 and 4.498, P<0.05). Conclusion OCT can inhibit efficiently hepatocareinogenesis and reduce the mortality of rots treated with DENA possibly by a mechanism maintaining the expression levels of SSTR2.

Significance of Tissue Factor mRNA Over-Expression in Hepatocellular Carcinoma / 中国普外基础与临床杂志

Objective To detect the tissue factor (TF) mRNA expression in hepatocellular carcinoma and to elucidate its significance. Methods TF mRNA was detected by reverse transcription-polymerase chain reaction (RT-PCR) in 27 cases of human hepatocellular carcinoma tissue specimen with their adjacent tissues and in 27 non-tumorous process tissues. Then the relationship between mRNA expression and pathological data were analyzed. Results The expression and the relative expression intensity of TF in hepatocellular carcinoma tissues were 62.96(17/27) and 0.567?0.268 respectively, which were significantly higher than those in their adjacent tissues 〔33.33(9/27), 0.469?0.184〕 and in 27 non-tumorous process tissue 〔29.63(8/27), 0.353?0.121〕, P0.05). Conclusion Expression of TF mRNA were significantly higher in hepatocellular carcinoma and in the invasive and metastatic tissue, which indicated that TF may play an important role in carcinogenesis, invasion and metastasis of hepatocellular carcinoma.

Expressions of VEGF,ANG-1,ANG-2 and TSP-1 in cholangiocellular carcinoma and relationship with tumor angiogenesis,differentiation,invasion and metastasis / 中国病理生理杂志

AIM: To investigate the angiogenesis status,the expression of vascular endothelial growth factor(VEGF),angiopoietin-1(ANG-1),angiopoietin-2(ANG-2),thrombospondin-1(TSP-1) in cholangiocellular carcinoma(CCC) and relationship with tumor angiogenesis,differentiation,invasion and metastasis.METHODS: 33 specimen of surgically resected CCC were investigated.Immunohistochemical staining of CD34,VEGF,ANG-1,ANG-2 and TSP-1 was carried out.RESULTS: The mean MVD was(87.2?52.6)/mm2.VEGF positive expression was found in 75.6% cases;ANG-1 positive expression was observed in 36% cases;ANG-2 positive was detected in 57.6% cases and 45.5% cases exhibited positive TSP-1 expression.VEGF and ANG-2 expressions were found to be associated with significant higher level of MVD(P