Prognostic analysis of robotic and open pancreatoduodenectomy for pancreatic cancer / 中华消化外科杂志

Objective:To investigate the prognosis of robotic pancreatoduodenectomy after the learning curve and open pancreatoduodenectomy for pancreatic cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 396 patients who underwent curative pancreatoduodenectomy for pancreatic duct adenocar-cinoma in Ruijin Hospital of Shanghai Jiaotong University School of Medicine from January 2017 to December 2018 were collected. There were 244 males and 152 females, aged 64(range, 36?92)years. Of 396 patients, 86 cases undergoing robotic pancreatoduodenectomy were divided into robotic group, 310 cases undergoing open pancreatoduodenectomy were divided into open group. Observa-tion indicators: (1) propensity score matching and comparison of general data between the two groups after matching; (2) follow-up and survival analysis. Follow-up was conducted by telephone interview or outpatient examinations including tumor markers and abdominal imaging examina-tions to detect survival of patients up to March 2022. Overall survival was defined as the time from the surgery date to death or the last follow-up. Disease-free survival was defined as the time from the surgery date to tumor recurrence or the last follow-up. The propensity score matching was conducted by 1∶1 matching using the nearest neighbor method. Normality of measurement data was examined using the Shapiro-Wilk test. Measurement data with skewed distribution were described as M(range), and comparison between groups was analyzed using the Mann-Whitney rank-sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-Rank test was used for survival analysis. An intent-to-treat analysis was performed in this study, patients who were converted to laparotomy from robotic surgery were still divided into the robotic group. Results:(1) Propensity score matching and comparison of general data between the two groups after matching: 164 of 396 patients had successful matching, including 82 cases in robotic group and open group, respectively. Before propensity score matching, the body mass index, cases in stage T1, T2, T3, T4, cases in N0, N1, N2 were 23.4(range, 21.4?25.3)kg/m 2,24, 41, 10, 11, 52, 27, 7 for the robotic group, versus 22.4(range,20.3?23.9)kg/m 2,57, 144, 22, 87, 131, 132, 47 for the open group, showing significant differences in the above indicators between the two groups ( Z=3.01, 2.63, 3.03, P<0.05). After propensity score matching, cases of males, age, body mass index, cases with American Society of Anesthesiologists (ASA) score as 1, 2, 3, CA19-9, cases with preoperative biliary drainage, cases with portal vein resection, cases with pancreatic resection margin <1 mm, cases in stage T1, T2, T3, T4, cases in stage N0, N1, N2, cases with nerve invasion, cases with tumor differentiation as high-medium differentiation, medium-low differentiation, low differentiation, cases with adjuvant chemotherapy were 51, 65(range, 59?69)years, 23.0(range, 21.0?25.2)kg/m 2, 32, 41, 9, 160.4(range, 46.7?377.2)U/mL, 21, 9, 8, 21, 40, 10, 11, 48, 27, 7, 76, 26, 47, 9, 53 for the robotic group, versus 58, 65(range, 58?69)years, 23.3(range, 21.4?25.3)kg/m 2, 35, 39, 8, 172.0(range, 69.7?402.9)U/mL, 26, 9, 10, 24, 40, 7, 11, 49, 28, 5, 76, 22, 49, 11, 57 for the open group, showing no significant difference in the above indicators between the two groups ( χ2=1.34, Z=0.18, 0.34, 0.49, 0.51, χ2=0.75, 0.00,0.25, Z=0.59, 0.27, χ2=0.00, Z=0.76, χ2=0.44, P>0.05). (2) Follow-up and survival analysis: after propensity score matching, 164 patients were followed up for 54(range, 1?67)months. The follow-up time of patients was 55(range, 51?59)months for the robotic group, versus 54(range, 50?58)months for the open group, respectively, showing no significant difference between the two groups ( Z=0.48, P>0.05). During the follow-up, the 1-year overall survival rate, 3-year overall survival rate, the median survival time, 1-year disease-free survival rate, 3-year disease-free survival rate, the median disease-free survival time, tumor recurrence rate, cases with recurrence pattern as local recurrence, liver recurrence, other distant recurrence, local and distant recurrence were 81.7%, 39.0%, 27 months(95% confidence interval as 19?33 months), 61.0%, 34.2%, 15 months(95% confidence interval as 12?18 months), 54.9%(45/82), 12, 16, 9, 8 for the robotic group. The above indicators were 79.3%, 36.0%, 24 months(95% confidence interval as 19?31 months), 59.8%, 27.5%, 15 months(95% confidence interval as 10?20 months), 58.5% (48/82), 10, 22, 6, 10 for the open group. There was no significant difference in overall survival or disease-free survival between the two groups ( χ2=0.39, 0.47, P>0.05). There was no significant difference in tumor recurrence rate or tumor recurrence site between the two groups either ( χ2=0.22, 1.86, P>0.05). Conclusion:After the learning curve, robotic pancreato-duodenectomy has non-inferior prognosis compared with open pancreatoduodenectomy.

Correlation between PD-L1 and Tregs in tumor immunity and immunotherapy / 国际肿瘤学杂志

Programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1) are important co-inhibitory molecules, while regulatory T cells (Tregs) are important suppressor cells. The increase of them in tumor microenvironment is closely related to tumor immune escape and tumor development. PD-L1 plays an important role in the development and function of Tregs. The application of PD-1/PD-L1 blockade also affects the proliferation and function of Tregs, which further participates in the occurrence of drug resistance and hyperprogressive disease. Further understanding of the role and correlation of PD-L1 and Tregs in tumor immunity and immunotherapy can provide new ideas for improving the efficacy of PD-1/PD-L1 blockade.

Preparation of chitosan-gelatin porous microspheres by high voltage electrostatic method combined with freeze-drying and ionic cross-linking method / 上海交通大学学报（医学版）

Objective·To prepare chitosan-gelatin porous microspheres by high voltage electrostatic method combined with freeze-drying and ionic cross-linking method and investigate the factors that influence the formation of porous medium.Methods·Porous chitosan microspheres and chitosangelatin porous microspheres were prepared using high voltage electrostatic method combined with freeze-drying and ionic cross-linking method,with sodium tripolyphosphate (STPP) as crosslinking agent.Factors that affect the porous structure and pore size of porous microspheres were compared,such as different chitosan-gelatin ratio,freezing temperature,curing time with saturated STPP in 85％ ethanol solution.The morphology,surface and internal structure,particle size of the porous chitosan microspheres and chitosan-gelatin porous microspheres were observe by using light microscope,scanning electron microscope and hematoxylin-eosin staining.Results·Microspheres prepared by freeze-drying with an electrostatic and ionic cross-linking method have open,interconnected and highly macroporous,with good spherical surface.Saturated STPP ethanol solution (85％ ethanol) was chosen as the crosslinking agent to prevent destruction of the porous structure.The order of freeze and crosslinking,cross-linking time and the second freezing temperature,can influence the pore size of porous microspheres.Gelatin and chitosan can form polyelectrolyte complexes,and can also be used as porogen in porous structure.Conclusion·The preparation of porous chitosan-gelatin microspheres via this method has a large pore size (diameter 100-200 μm),suitable for cell growth and the migration.

Effect of preoperative transarterial chemoembolization on perioperative safety of patients with resectable hepatocellular carcinoma: a Meta-analysis / 中华消化外科杂志

Objective To systematically evaluate the effect of preoperative transarterial chemoembolization (TACE) on perioperative safety of patients with resectable hepatocellular carcinoma (HCC).Methods Literatures were researched using Chinese Journal Full-text Database,Wanfang database,VIP database,PubMed,Medline from December 1,1994 to May 30,2016 with the key words including “肝细胞癌,肝切除,术前化疗栓塞,经动脉化疗栓塞,liver cancer,hepatocellular carcinoma,liver resection,hepatectomy,transcatheter arterial chemoembolization,transarterial chemoembolization,preoperative” Manual retrieval was also conducted simultaneously.The randomized controlled trials (RCTs) about TACE on perioperative safety of patients with resectable HCC were received and enrolled.Patients undergoing surgery after preoperative TACE were allocated into the case group and patients undergoing first-stage resection were allocated into the control group.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as relative risk (RR) and 95％ confidence interval (CI).Measurement data were represented as standardized mean difference (SMD) and 95％CI.The heterogeneity of the studies was analyzed using the I2 test.Results Five RCTs were enrolled in the Meta analysis,and the total sample size was 430 cases including 212 in the case group and 218 in the control group.Results of Meta analysis showed that there was no statistically significant difference in the hemihepatic resection rate between the 2 groups (RR=0.99,95％CI:0.81～ 1.20,P＞0.05).The combined resection rate of perihepatic organs in the case group was significantly higher than that in the control group (RR=3.42,95％CI:1.91-6.12,P＜0.05).Results of subgroup analysis showed that operation time and incidence of postoperative complications of patients with an average tumor diameter ＞5 cm in the case group were respectively longer and higher than these in the control group (SMD=0.31,RR=1.65,95％CI:0.06-0.57,1.01-2.69,P＜0.05).Conclusion There is no obvious effect of preoperative TACE on resectable HCC,and it can evaluated combined resection rate of perihepatic organs,operation time and incidence of postoperative complications of patients with resectable HCC and an average tumor diameter ＞ 5 cm,and also reduce the perioperative safety.

Techniques of pancreas dissection / 中华消化外科杂志

Pancreatic dissection involved in all types of pancreatic surgery.Several aspects of pancreatic dissection remain unknown or undervalued,although it seems easy to manipulate.In this article,how to improve the surgical techniques of pancreatic dissection and improve the efficacies were introduced,which included the following aspects:surgical instruments selection,selection of sharpening dissection or electrosurgical instrument dissection,management of blood vessels and pancreatic duets in the neck and body of pancreas,search of the opening of the pancreatic ducts,methods for the management of the cutting plane of pancreas,managing methods for pancreas with different textures,and regional dissection of pancreas.

Risk factors of pancreatic fistula after pancreaticoduodenectomy / 中华消化外科杂志

Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 310 patients who received pancreaticoduodenectomy at the Ruijin Hospital of Shanghai Jiaotong University from January 2005 to May 2013 were retrospectively analyzed.The risk factors associated with the interoperative pancreatic fistula were analyzed.The univariate and multivariate analysis were done using the Pearson chi-square test and non-conditional Logistic regression model.Results A total of 134 patients had postoperative complications,including 103 (33.23％) with pancreatic fistula,among them 40 patients developed additional complications.The results of univariate analysis showed that preoperative levels of hemoglobin,total bilirubin,diameter of the pancreatic duct and postoperative level of albumin were risk factors of pancreatic fistula after pancreaticoduodenectomy (x2 ＝ 4.543,6.087,6.265,5.311,P ＜ 0.05).The results of multivariate analysis showed that preoperative level of total bilirubin equal to or above 34.2 μmol/L,the diameter of the pancreatic duct under 3 mm and the level of postoperative albumin under 28 g/L were the independent risk factors of pancreatic fistula (OR =1.806,1.936,1.780; 95％ confidence interval:1.107-2.948,1.170-3.206,1.002-3.165,P ＜ 0.05).Conclusion Preoperative jaundice (the level of total bilirubin ≥ 34.2 umol/L),pancreatic duct diameter ＜ 3 mm and postoperative malnutrition (albumin ＜ 28 g/L) indicate a higher incidence of postoperative pancreatic fistula.

Precision hepatectomy for the treatment of huge tumor in the caudate lobe / 中华消化外科杂志

Tumor in the caudate lobe is difficult for surgical treatment due to its unusual local anatomy.As the development of surgical techniques,the success rate of caudate lobectomy is increased.In recent years,the concept of precision hepatectomy aiming to reduce the iatrogenic damage from hepatectomy and improving the recovery of patients on the basis of radical treatment has been raised.This article summarized the experiences of precision hepatectomy for the treatment of huge tumor in the caudate lobe which was performed in the Ruijin Hospital of Shanghai Jiaotong University.With the help of precision hepatectomy concept and techniques,a more satisfactory result both in safety and prognosis was achieved.

Protective effect of polymyxin B in liver transplantation in rats / 中华器官移植杂志

Objective To investigate the protective effect of polymyxin B (PMB) to the liver graft after liver transplantation and the underlying mechanism in rats.Methods Male SD rats were selected as the donors and recipients.Non-artery whole liver transplantation model was established in rats according to Kamada's two-cuff method.The rats were divided into two groups by the way of random number table method:control group (normal saline,0.5 ml) and PMB group (PMB,1 mg/ml,0.4 mg/kg+ normal saline 0.5 ml).The levels of portal vein plasma endtotoxin (EU/ml)were determined by endotoxin-analyzing machine of BET-24A. ALT,BUN,and TNF-α,IL-6 in serum were measured by using machine of Automatic Analyzer and ELISA,respectively.The CD14,TLR4,NFκB and AP-1 in the grafts were measured by RT-PCR and Western blotting,and pathological changes were observed. Results PMB decreased the levels of portal vein plasma endotoxin 1 h after reperfusion in PMB group as compared with control group (P＜0.05),and the levels of portal vein plasma endotoxin returned to the normal levels 6 h after reperfusion in both two groups (P＞0.05).After operation,the levels of ALT,TNFα and IL-6 in serum were significantly reduced (P＜0.05),the expression of CD14 and TLR4 mRNA in the grafts was significantly decreased (P＜0.05),the expression of Hsp60 protein and mRNA,and NF-κB and AP1 proteins in the grafts were reduced (P＜0.05),and the pathological damage to the grafts was significantly alleviated in PMB group as compared with control group.Conclusion PMB reduced the levels of portal vein plasma endotoxin after reperfusion in liver transplantation in rats.PMB improved liver function,reduced the injury of inflammatory response,decreased the levels of endotoxin signal pathway markers and alleviated the pathological damage to the grafts.

Relationship between hepatic arterial buffer response and early biliary complications and small-for-size syndrome after living donor liver transplantation / 中华肝胆外科杂志

Objective To study the relationship between hepatic arterial buffer response (HABR),recovery of liver function,early biliary complications and small-for-size syndrome (SFSS).Methods Early hepatic hemodynamic parameters (including hepatic arterial flow (HAF),portal venous flow (PVF) were measured using duplex Doppler sonography in 34 patients who received living donor liver transplantation (preoperatively n＝26,intraoperatively n=26) and on postoperative days 1,2,3,and 7.Alanine aminotransferase (ALT),aspartate aminotransferase (AST) and total bilirubin (TBIL) level were measured preoperatively and on postoperative days 1,2,3,7,14,21,and 28.If TBIL level was elevated,we used B ultrasonography or CT and even ERCP to diagnose early biliary complications.The days taken for AST,AI T and TBIL to recover and the number of patients with early (＜60 days) biliary complications (bile leakage or bile stricture) and with small-for-size syndrome (SFSS) were recorded.Results Passive hepatic artery buffer response (HABR) was present in 11 patients early after living donor liver transplantation (group 1) and it disappeared in 23 patients (group 2).The recovery in days taken for normalization of AST (10.6± 8.8),AIT (11.6±9.0) and TBlL (average of 29) in group 1 were shorter than in group 2.However,the differences did not reach statistics difference (P＞0.05).The overall incidences of early biliary complications and small-for-size syndrome (SFSS) in group 1 were significantly lower than in group 2 (P=0.04).The survival rate in group 1 was 82 ％,compared with 74 ％ in group 2.Conclusions Passive hepatic arterial buffer response (HABR) disappeared in some patients early after living donor liver transplantation.There were high incidences of early biliary complications and small-for-size syndrome (SFSS) in these patients.Measurcment of hepatic buffer response in the early stage after living donor liver tranaplanta tion is valuable for predition of early biliary complications and small-for-size syndrome (SFSS),thus helping to prevent failure in transplantation.

Clinical research of Hangzhou domestic tacrolimus in liver transplantation / 中华器官移植杂志

ObjectiveTo demonstrate the efficacy and safety of Hangzhou tacrolimus capsule (Saishi Tac capsule,Hangzhou Zbongmei Huadong Pharmaceutical Co.Ltd,China) in Chinese liver transplant recipients.MethodsMulticenter,randomized open-labeled,prospective controlled clinical trial was performed in de novo Chinese liver transplant recipients.According to inclusive and exclusive criterion,83 liver recipients from 11transplant centers were enrolled.The recipients accepted Saishi Tac capsule,mycopheolate and steroid 48 h post-operation.The initial dose of Tac was 0.1-0.15 mg kg-1day-1and C0 was 8-12 ng/ml in the first 60 days,followed by 5-10 ng/ml until the terminal observation time poiut (12 weeks after transplantation).The efficacy and safety were estimated during the period.The primary efficacy endpoint of the study was the incidence of biopsy-confirmed acute rejection.Graft survival was the secondary endpoint.Safety was assessed by monitoring laboratory parameters and adverse events reported over the course of the study,such as infection,renal damage,hypertension,hyperlipema and diabetes mellitus and other adverse affairs.ResultsThe dose of Tac at 1st,2nd,4th and 8th week post-operation was (4.1±1.9),(4.5±2.1),(4.5±2.1),(4.4±1.8) and (4.1±2.1) mg,and correspondjng values to the C0 were (8.1±4.5),(8.9±4.5),(8.8±4.3),(8.8±4.1) and (8.0±2.8) ng/ml.During 12 weeks of follow-up,the incidence of biopsy-confirmed acute rejection was 4.8％ (4/83),and all of cases were reversed by implosive therapy.The survival rate of graft hver was 100％.The incidence of lung infection and diabetes mellitus was both 6.02％.ConclusionSaishi Tac capsule was safe and effective to Chinese liver transplant recipients.

The role of p53 in induction of growth arrest DNA damage-inducible gene 45β in human hepatoma cells by oxaliplatin / 中华肝胆外科杂志

Objective To identify the role of p53 in the induction of growth arrest DNA damage-inducible gene 45β (GADD45β) in HCC cells by Oxaliplatin.Methods A Hep3B+p53 clone was established by transfection of the full-length p53 sequence to Hep3B.Following oxaliplatin administration,quantitative real-time PCR was employed to validate the expression changes of GADD45β.pGL3 basic luciferase plasmids including promoter fragments were synthesized in vitro and transfected into cells.The effects on promoter activity,cell growth and the cleavage of Caspase-3 were further focused on.Results Hep3B+p53 expressed p53 protein stably.The transfection of p553 enhanced the induction of GADD45β in Hep3B by Oxaliplatin.The promoter activity of fragments constructed NF-κB and E2F-1 binding sites was induced about 1.5 and 0.8 folds by transfection of p53.The colony formation and DNA syntheses were inhibited apparently in Hep3B+p53 with p53 by Oxaliplatin (30.41％ and 75.60％ by 100 μmol/L Oxaliplatin,respectively).Moreover,p53 transfection triggered cleavage of Caspase-3 more rapidly.Conclusion p53 played a role in the induction of GADD45β in Hep3B by Oxaliplatin.

Efficacy of pancreaticoduodenectomy by da Vinci robotic surgical system / 中华消化外科杂志

Objective To investigate the efficacy of pancreaticoduodenectomy by using the da Vinci robotic system.Methods The clinical data of 10 patients who received pancreaticoduodenectomy (PD) by the da Vinci robotic surgical system at the Ruijin Hospital from March 2010 to March 2011 were retrospectively analyzed.The perioperative condition of the patients,incidence of complications and postoperative survival were observed.Results Operations were successfully performed on all the patients,and there was no conversion to open surgery.Nine patients received pancreaticojejunostomy,and 1 received pancreaticogastrostomy.The mean operation time,operative blood loss and postoperative duration of hospital stay were 449.5 minutes (range,405-510 minutes),614 ml (range,340-1100 ml) and 22.7 days (range,14-39 days),respectively.One patient developed pancreatic obstruction which was alleviated by operation.Two patients developed pancreatic fistula and were cured by conservative treatment.One patient developed anastomotic bleeding and was cured by conservative treatment.The results of pathological examination confirmed that 3 patients were diagnosed as with pancreatic ductal adenocarcinoma,2 with duodenal papillary adenocarcinoma,1 with ampullary adenocarcinoma,2 with serous cystadenocarcinoma,1 with carcinoid tumor and 1 with pancreatic duct stone and inflammatory mass.All patients were followed up for 6-12 months.The prognosis of the 9 patients was good,except for 1 patient who had tumor recurrence at the sixth month after operation.No mortality was observed.Conclusion PD performed with the da Vinci robotic surgical system is safe,and its efficacy is comparable to that of open surgery.

Appropriate choice of surgical strategies in managing hilar cholangiocarcinoma / 中华消化外科杂志

Hilar cholangiocarcinoma is a rare tumor with a poor prognosis.Due to advances in preoperative imaging and enhanced comprehension of tumor biological behavior,surgical management of hilar cholangiocarcinoma has evolved since its original description.Currently,it has been accepted that complete surgical resection provides the only possibility for cure or long-term survival,however,the surgical management of hilar cholangiocarcinoma is extremely challenging because of its anatomical location and vascular proximity.In order to achieve complete resection, several surgical approaches have been investigated and evaluated regarding major hepatic resection,lymph node dissection,vascular resection,extended resection and liver transplantation,however,there are still many disputations. Furthermore,many surgical technical difficulties exist in biliary reconstruction after resection owing to anatomical problems.Focusing on the disputes and problems mentioned above,we herein review and discuss surgical strategies in managing hilar cholangiocarcinoma.

Morphological changes of pancreatic cancer cells transfected by dendrimer modified carbon nanotubes / 中华胰腺病杂志

Objective To observe the process of polyamidoamine dendrimer modified single walled carbon nanotubes complexes (CNT-PAMAM-D) entering into pancreatic cancer BxPC3 cells, and to evaluate its safety as a vector. Methods The CNT-PAMAM-D were prepared by ultrasound, mixing and rinsing, and the morphology was characterized by atom force microscopy and transmission electron microscope. Then the prepared CNT-PAMAM-D was incubated with human pancreatic cancer cell line BxPC3 cells for 12, 48, 72hours, and then the cells were collected. Distribution of CNT-PAMAM-D in cells and cell ultrastructure was observed by transmission electron microscopy. Results After the combination of PAMAM-D and CNT, the surface of CNT was surrounded by dendrimer and nanocomposite particles with a size of 20 nm was formed. It was showed that CNT-PAMAM-D could be transfected into human pancreatic cancer cells by cell pinocytotic way, and it entered cytoplasm at 12 h. With the extension of the transfecting time, CNT-PAMAM-D could enter lysosomal and nucleus, but the morphology and ultrastructure ocf BxPC 3 cells was not significantly changed. Conclusions The CNT-PAMAM-D is a highly effective and safe nano vector.

Progress in models of pancreatic cancer / 国际外科学杂志

Pancreatic cancer is a highly malignant tumor. Animal models of pancreatic cancer included xenograft models, carcinogen induced models, genetically engineered models. Xenograft models are relatively reliable and feasible, but the growth pattern is different between serve immunodeficienct animals and human beings. Carcinogens induced models simulated the environmental factors to reconstruct the development of pancreatic cancer. But carcinogens could have other biological effects. Genetically engineered models could make the occurrence of pancreatic cancer at the molecular level. But it is difficult to control the transgenic product accurately. No model could meet all the needs of different experiments. It is important to choose a suitable animal model in different experiments.

Development of human tumor cells microencapsulation and its application / 国际外科学杂志

A microcapsule is a spherical, with a diameter that can be controlled in the range of 200 -1500 μm and biocompatible semipermeable membrane, which allows the bidirectional diffusion of nutrients,oxygen, secreted therapeutic product, and waste but prevents the penetration of high molecular weight substances from the microcapsule, such as antibodies and immunocytes. In comparison to monolayer culture and multicellular tumor spheroid model, orthotopic injection of microencapsulated tumor cells has uncomparable advantages in cell proliferation, mimicking the in vivo situation, making orthotopic tumor model and distant organ metastases model. Microencapsulated tumor assay has the potential of being widely used for in vitro anticancer drug screening and evaluation of the effects. This article mainly reviews the advantages of microencapsulated tumor assay and its application.

Surgical management of left upper abdominal malignant tumors complicating regional portal hypertension / 中华普通外科杂志

ObjectiveTo investigate the etiology, clinical characteristics, diagnosis and treatment of regional portal hypertension caused by left upper abdominal malignant tumors.MethodsFrom January 2006 to December 2009, a total of 8 patients presenting regional portal hypertension were treated at our hospital, whose clinical data were analyzed retrospectively. ResultsPancreatic tumors (5/8) and retroperitoneal tumors(3/8)were the primary etiology,andthe main symptoms included upper gastrointestinal bleeding and irregular left upper abdominal pain.Isolated gastric varices were the most distinct clinical features. All patients underwent multi-visceral resection including pancreatic body and tail and spleen. Tumor involved stomach, left kidney, left adrenal and splenic flexure of colon were also removed en bloc. During the follow-up period there was no recurrent upper gastrointestinal bleeding, one patient died and two patients developed metastasis or tumor local recurrence.ConclusionRegional portal hypertension caused by malignant tumor was relatively rare,aggressive resection of multi-viscera combined with devascularization was an effective therapy.

Status and prospects in clinical application of robotic assisted surgery system / 中华肝胆外科杂志

Robotic assisted surgery system as an advanced technique gains particular attention over the world.We hereby introduce the history of Robotic assisted surgery system, and induce the advantage or existing problems of this technique. We also compared the new technique with traditional surgery and laparoscopic surgery. The future of this novel technique is assessed with the recent development application at home and abroad.

Physio-chemical progress and clinical application of microencapsulated hepatocytes / 中国组织工程研究

With the development of cell separation technique, hepatocyte transplantation becomes a hot topic; however, the application is limited by donor deficiency and immunological rejection. Microencapsulated hepatocytes contribute to the promotion and application for liver cell transplantation, for which provide a large amount of high activity and good function of liver cells, in this paper, liver cell microencapsulation technology and its progress in applications were reviewed, providing prospective way for large-scale and high-active culture in vitro and long-term cryopreservation.

In vitro blood compatibility of polyacrylamide grafted polypropylene membrane / 中国组织工程研究

BACKGROUND: Contacting with blood, most of polymer materials lead to different extents of blood coagulation, which limits their clinical application. Therefore, developing polymer materials with excellent anticoagulant property has become a key to clinical study of bioartificial liver materials.OBJECTIVE: To in vitro detect the blood dompatibility of polyacrylamide grafted polypropylene (PP) membrane (PP-g-AAm), a novel artificial liver reactor material.METHODS: Prior to and after modification, hemolytic test, prothrombin time and activated partial thromboplastin time tests of PP membrane were performed; blood platelet CD62P and CD63 expression rates were determined by flow cytometry, and platelet adhesion on PP and PP-g-AAm membranes by scanning electron microscopy.RESULTS AND CONCLUSION: The hemolysis ratio of PP and PP-g-AAm membranes was 1.32% and 1.46%, respectively.Compared with PP-g-AAm membrane, prothrombin time and activated partial thromboplastin time of PP membrane weremarkedly shorter (P < 0.05). CD62P and CD63 expression rates in the PP-g-AAm membrane were significantly lower than PP membrane (P < 0.05). Scanning electron microscopy results revealed that there were obvious changes of platelets adhering to these two membranes, but platelets adhering to PP-g-AAm membrane were fewer than PP membrane. These results indicate that PP-g-AAm membrane exhibits good blood compatibility.