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Objective@#To study the correlation between pancreatic duct stent placement and postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy.@*Methods@#We performed a retrospective review on 298 patients who underwent pancreaticoduodenectomy from Jan 2011 to Dec 2016. Patients were divided into none stent group, external stent group and internal stent group according to the placement and drainage of the pancreatic duct stent.@*Results@#There were 60 cases in none stent group, 103 cases in external stent group and 135 cases in internal stent group. Altogether there were 52 cases suffering from biochemical pancreatic fistula, 52 cases of grade B fistula and 9 cases of grade C pancreatic fistula. There were three factors with statistical significance: 1, the operative method (χ2=20.947, P=0.000), 2, the diameter of main pancreatic duct (χ2=8.662, P=0.013), and 3, the intraoperative blood loss (χ2=14.03, P=0.001). There were no statistical significance difference between no stenting group and external/ internal stent group in the incidence of pancreatic fistula (P>0.05). The difference between internal stent group and external stent group was of statistical significance (χ2=9.948, P=0.019). The incidence of clinically relevant pancreatic fistula in external stent group was lower than the internal stent group (14.5% vs. 26.6%)(χ2=9.777, P=0.002).@*Conclusions@#The pancreatic duct stenting is not a risk factor for pancreatic fistula. The external drainage of pancreatic juice is associated with a lower incidence of pancreatic fistula compared to the internal drainage.
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Objective To study the correlation between pancreatic duct stent placement and postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy.Methods We performed a retrospective review on 298 patients who underwent pancreaticoduodenectomy from Jan 2011 to Dec 2016.Patients were divided into none stent group,external stent group and internal stent group according to the placement and drainage of the pancreatic duct stent.Results There were 60 cases in none stent group,103 cases in external stent group and 135 cases in internal stent group.Altogether there were 52 cases suffering from biochemical pancreatic fistula,52 cases of grade B fistula and 9 cases of grade C pancreatic fistula.There were three factors with statistical significance:1,the operative method (x2 =20.947,P =0.000),2,the diameter of main pancreatic duct (x2 =8.662,P =0.013),and 3,the intraoperative blood loss (x2 =14.03,P =0.001).There were no statistical significance difference between no stenting group and external/ internal stent group in the incidence of pancreatic fistula (P ＞ 0.05).The difference between internal stent group and external stent group was of statistical significance (x2 =9.948,P =0.019).The incidence of clinically relevant pancreatic fistula in external stent group was lower than the internal stent group (14.5％ vs.26.6％)(x2 =9.777,P =0.002).Conclusions The pancreatic duct stenting is not a risk factor for pancreatic fistula.The external drainage of pancreatic juice is associated with a lower incidence of pancreatic fistula compared to the internal drainage.
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Objective@#To explore the reasons and clinical treatment process of postoperative internal hernia in cases of gastric cancer, and improve the diagnosis and treatment level postoperative acute abdomen pain of gastric cancer patients.@*Methods@#A retrospective analysis was carried out to study the data of clinical diagnosis and treatment in 7 patients, who were performed an emergency operation within the First Affiliated Hospital of Soochow University from January, 2013 to August, 2016 caused by postoperative internal hernias of gastric cancer.@*Results@#Among the 7 postoperative gastric cancer patients, 2 cases had taken surgery of radical full gastric resection, 3 cases had taken surgery of radical distal gastric resection, and 2 cases had taken surgery of radical proximal gastric resection. All the 7 cases were confirmed to be incarcerated intestinal obstruction caused by internal hernia during emergency operation. Only 1 case was diagnosed to be internal hernia before surgery, while 3 cases were diagnosed as volvulus, 2 cases were diagnosed as perforation and 1 case was diagnosed as gastrolplegia. The small intestinal obstruction of all cases was caused by incarcerated intestinal. All the patients recovered well, and no complications occurred.@*Conclusions@#Internal hernias of the postoperative gastric cancer patients, which is often characterized by small intestinal obstruction symptoms, is difficult to diagnose before operation. Emergency operation in time for the postoperative gastric cancer patients with continuous acute abdominal pain may help to reduce the severe complications and improve patient′s prognosis.
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Objective To discuss the diagnosis and treatment of the benign tumors of pancreas,especially the surgical options and the prevention and cure of the postoperative complications.Methods Clinical data of 23 patients with benign lesions of the pancreas were retrospectively analyzed in our hospital from Jan.2004 to Dec.2009.All of the patients underwent surgical operation.Five patients were treated with pancreatic enucleation,8 patients were treated with distal pancreatectomy with splenectomy,1 patient was treated with central pancreatectomy,5 patients were treated with pancreaticoduodenectomy,4 patients were treated with pancreatic cyst- jejunum R-Y anastomosis.Eighteen patients were treated with somatostatin analogue.Results The pathological diagnosis included pancreatic cyst in 8,islet cell tumor in 4,mucous cystadenomas in 6,serous cystadenomas in 3,solid-pseudopapillary tumor in 2.Seven of 10 cases having pancreatic leak occoured secondary abdominal infection.One patient died of multiple organ dysfunction syndrome after pancreaticoduodenectomy.Conclusion There is no specific symptoms and serologic laboratory examinations for pancreatic benign tumors.CT and ERCP is very helpful for diagnosis and treatment.Surgical option is according to the location of the lesion and the judgement of the tumor whether being benign or malignant.Pancreaticoduodenectomy,central pancreatectomy,distal pancreatectomy with or without splenectomy and pancreatic enucleation is the reasonable surgical option.Pancreatic leakage is the main post-operation complication.Ligation the pancreatic duct reliably,treating the pancreatic raw surface appropriately,external drainage of the pancreatic fluid can reduce the rate of pancreatic leakage.
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Objective To investigate the inhibitory effects of RNA interference on expression of matrix metalloproteinase-2(MMP-2)gene and invasiveness of human pancreatic cancer cell line PANC-1 in vitro.Methods Small interference RNA targeting MMP-2 gene was designed and constructed to plasmid pGCsi-U6.Recombinant plasmids were transfected to pancreatic carcinoma PANC1 cells with Lipofectamine 2000.The efficiency of transfection was evaluated by flow cytometry.RQPCR was used to detect the expression of MMP-2 mRNA.The expression of MMP-2 protein was determined by ELISA.The invasiveness of PANC-1 cells was measured by transwell chamber experiment.MTT assay was used to detect the proliferation and growth of PANC-1 cells.Results Sequencing confirmed that the MMP-2 siRNA plasmid was successfully constructed.The best efficiency of transfecting recombinant plasmid was 82.1%.After transfection of the MMP-2 siRNA plasmid, the MMP-2 gene expression of PANC-1 cells was suppressed to 71.74 %(P＜0.05),and protein expression of MMP-2 fell to 49.82%(P＜0.05).The corresponding inhibition ratio of invasiveness was 33.0%(P＜0.05).There was no marked difference in proliferation rate measured by MTT assay among different groups(P＞0.05).Conclusions RNAi targeting MMP-2 can suppress invasiveness of PANC-1 cells in vitro.This suggests that MMP-2 could be a target for gene therapy of pancreatic carcinoma.RNAi is expected to open up a new prospect for tumor therapy.
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Objective To investigate the expression of matrix metalloproteinase-2 (MMP-2)in pancreatic carcinoma and the relationship between MMP-2 with tumour clinicopatholngical features. Methods The expression of MMP-2 was detected by S-P immunohistochemistry in 36 cases with pancreatic carcinoma and 14 normal pancreat-ic tissues. Results The positive expression rate of MMP-2 was 66.7% (24/36) in pancreatic carcinoma tissue and 14.3% (2/14) in normal pancreatic tissues (χ2 = 3. 587, P < 0.01 ) ;The expression rate of MMP-2 in pancreatic carcinoma tissue with positive-node was 86.7% ( 13/15 ) ,which was higher than that with negative-node,which was 52.4% ( 11/21 ) ( P < 0.05 ) ; As to TNM staging in pancreatic carcinoma, the expression rate of MMP-2 was 41.2% (7/17) with Ⅰ,Ⅱ staging and 89.5% (17/19) with Ⅲ,Ⅳ staging(χ2=9.418,P <0. 01 ) ;The expression rate of MMP-2 was 50.0% (5/10) ,66.7% (10/15) and 72.8% (8/11) in highly,moderately and poorly differentiated pancreatic carcinoma(P > 0.05 ). Conclusions The expression of MMP-2 is strengthened significantly in pancreatic carcinoma tissue and involved in turnout invasion and metastasis features; MMP-2 might be regarded as one more marker for the invasive properties of pancreatic carcinoma.
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Objective To study the effect of PUMA gene mediated by recombinant adenovirus vector combined with radiation on the pancreatic carcinoma. Methods The PANC-1 cells were infected with Ad-PUMA (MOI = 10, 50 and 100, respectively) for 48 h. The expression of PUMA mRNA and protein was detected by RT-PCR and Western blot, respectively. PANC-1 cells were divided into 4 groups: control group, transfection group, irradiation group and combined treatment group. The cell growth inhibition rate and apoptotic rate of PANC-1 cells were assessed by MTT assay and flow cytometry. Human pancreatic carcinomas were transplanted subcutaneously in nude mice, which were randomized into 4 groups: control group, transfection group, irradiation group and combined treatment group. Tumor growth rate and apoptotie index at different time points were recorded in 35 days. Results The expression of PUMA mRNA and protein was increased with the increase of MOI of Ad-PUMA, which was does-dependant (MOI = 10, mRNA = 0.46 ± 0.02, protein = 0. 75 ±0.09;MOI=50, mRNA= 1.12±0.09, protein = 1.01 ±0.18;MOI= 100, mRNA= 1.50±0.08, protein=1.80 ± 0.15 ;P < 0.05). The proliferation of PANC-1 cells was suppressed significantly when transfected by Ad-PUMA in a dose-dependent manner(r = -0.986 55), which was more significant combined with radiation (r = -0.971 26, P < 0.05). Meanwhile, the apoptotie rate was increased in the same manner [for pre- and post-irradiation,which was (45.4 ± 5.26) % and (73.2 ± 6.62) %, respectively, P < 0.05]. From 7 to 35 d after PUMA gene transfection and radiotherapy, the tumor growth was significantly slower than those of irradiation group, transfection group and control group [35 d after therapy, the volume of tumor was (19.82 ± 6.45)mm3 ,(39.5 ± 9.23)mm3 , (33.6 ±3 10.3)mm3 and (52.0 ± 11.43)mm3 , respectively, P < 0.05]. And the apoptotic index was increased in the same manner (AI = 0.43 ± 0.05, 0.29 ± 0.10, 0.24 ± 0.05 and 0.00 ± 0.00, respectively, P < 0.05). Conclusions Recombinant adenoviral-mediated PUMA gene combined with irradiation could increase the cell-killing effect on pancreatic carcinoma. It is better than that of either one kind of therapy.
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Background and purpose:Members of the NF-kappaB family of transcription factors could activate bcl-2 anti-apoptotic genes at the transcriptional level and then regulate cell apoptosis.The p53 tumor suppressor gene has a clear role!in both the regulation of cell cycle and expression of apoptosis-related bcl-2 family.There were few reports about the expression of NF-?Bp65,bcl-2,bcl-xL and their relationships with p53 and cell apoptosis in pancreatic cancer.The present study was designed to analyze the expression of the antiapoptotic molecules nuclear factor kappaB(NF-?Bp65),bcl-2 and bcl-xL in pancreatic ductal carcinoma(PC) and their correlations to the apoptosis index and p53 expression.Methods:Immunohistochemical analyses of P53 protein was performed on 25 cases of pancreatic ductal carcinoma and 9 cases of normal pancreas;Western blot was used to evaluate NF-?Bp65 protein and RT-PCR for bcl-2 mRNA and bcl-xL mRNA of 25 cases of pancreatic ductal carcinoma and 9 NP cases.The apoptosis was determined by TUNEL.Results:The positive rate of P53 protein was 56%(14/25)in PC tissues,significantly higher than that in NP tissues(P
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Objective:To investigate whether PUMA gene transfection can increase sensitivity of pancreatic cancer cells (PC) to 5-FU-induced apoptosis. Methods: PUMA-pCEP4 containing full length PUMA cDNA or pCEP4 was transfected into human pancreatic cancer cell line AsPC-1 by lipofectamine transfection, G418 selection was used to select positive cells. AsPC-1, AsPC-1/PUMA and AsPC-1/pCEP4 cells were separately treated with serial concentrations of 5-FU(0.01-100 ?mol/L). MTT assay was used to determine the cell survival rate in each group and IC50 of 5-FU was calculated. TUNEL,FCM and DNA ladder observation were employed to study cell apoptosis. Western blotting was performed to detect the expression of PUMA protein. Results: The 5-FU IC50 values of AsPC-1, AsPC-1/PUMA and AsPC-1/pCEP4 cells were (12?1.9)?mol/L,(1.6?0.4)?mol/L and (10.4?1.6) ?mol/L, respectively, with the sensitivity of AsPC-1/PUMA cells increased by 7.5 folds. 5-FU induced cell apoptosis of AsPC-1 cells in a dose-dependent manner, with the apoptosis of AsPC-1/PUMA cells more prominent than those of AsPC-1 and AsPC-1/pCEP4 cells. Low concentration of 5-FU (0.1 ?mol/L) induced few apoptosis of AsPC-1/pCEP4 cells([1.14?0.28]%) and AsPC-1 cells ([0.9?0.23]%), and induced apoptosis in AsPC-1/PUMA cells([6.47?1.42]%). High concentration of 5-FU (1.0 ?mol/L) induced apoptosis in all groups, with that in AsPC-1/PUMA cells([34.54?9.36]%) significantly higher than those in AsPC-1/pCEP4 cells([15.8?5.15]%) and AsPC-1 cells ([12.8?3.74]%, both P