Current status and hotspot of minimally invasive surgery for pancreatic head carcinoma / 中华外科杂志

With the improvement of laparoscopic equipment and surgical technology,pancreatic surgery has entered the "minimally invasive era".However,the use of minimally invasive pancreaticoduodenectomy in patients with pancreatic head cancer remains controversial.In recent years,China's pancreatic surgeons have been at the forefront of the world in terms of surgical technology,however,surgical philosophy, selection of indication,and perioperative management should be further stregthened. Additionally, the development of medical standards in various regions of China is seriously uneven,and minimally invasive pancreaticoduodenectomy still needs to be further standardized and popularized.Through this article,the author discusses the development status of minimally invasive surgery for pancreatic head cancer and related hot topics with fellow surgeons,in order to further improve the standard diagnosis and treatment of pancreatic cancer in China.

Basic principles of surgical suture technology and selection of suture materials in general surgery / 中国实用外科杂志

The selection of suturing techniques and suture materials is a common problem in general surgery. In 2008,the Chinse Society of Surgery of Chinese Medical Association draw up the first edition of The Chinese Consensus Statement on General surgical suture technique and suture material. In the last ten years, it has appeared antibacterial sutures, drug elution lines, barbed lines, anti-leakage needles, stabresistant needles, bio-3D staplers in suture materials, which promoted the development of general surgery. At the same time, with the advancement of surgical techniques and the application of laparoscopic and robotic surgery, suture techniques such as triangular anastomosis and nondisconnected Roux-en-Y anastomosis have appeared. This article reviews the progress of new suture materials, introduces the achievements of suturing technique in general surgery, and discusses the significance of the 2018 edition of The Chinese Consensus Statement on General Surgical Suture Technique and Suture Material.

Comprehensive treatment of liver metastasis of pancreatic neuroendocrine neoplasms / 中国实用外科杂志

Pancreatic neuroendocrine neoplasms(p NENs)are noted for its great variety and wide heterogeneity.The incidence is increasing gradually.Liver metastasis is not the contraindication of surgery of p NENs.Surgery is consider as a significant role in the multi-disciplinary team about treating p NENs.Although p NENs liver metastasis is relatively rare,its overall prognosis is significantly better than that of patients with pancreatic cancer liver metastasis.It is of great significance to grasp the indications and principles of surgical treatment for improving the survival of patients.Despite the relevant guidelines for diagnosis and treatment,the choice of surgical treatment options and the grasp of surgical indications for p NENs liver metastasis are still controversial.All pancreatic centers should give full play to the advantages of MDT and formulate individualized treatment plans for patients.Meanwhile,hospitals at all levels should strengthen cooperation to reduce missed diagnosis,misdiagnosis and mistreatment,and further standardize the surgical diagnosis and treatment of p NENs liver metastasis in China.

Plasminogen Activator Inhibitor 1 as a Poor Prognostic Indicator in Resectable Pancreatic Ductal Adenocarcinoma / 中华医学杂志(英文版)

Background@#Plasminogen activator inhibitor 1 (PAI-1) was previously established to impact several phenotypes in many kinds of cancer, including pancreatic cancer. However, its prognostic significance in pancreatic ductal adenocarcinoma (PDAC) needs support of further evidence. This study was designed to address the issue.@*Methods@#PAI-1 expression was detected by tissue microarray-based immunohistochemical staining in formalin-fixed paraffin-embedded specimens from 93 PDAC patients with surgical resection from September 2004 to December 2008. Its relationships with clinicopathologic variables and tumor-specific survival (TSS) were further evaluated using Chi-square, Kaplan-Meier, log-rank, as well as Cox regression analyses.@*Results@#Expression of PAI-1 was much higher in tumor than that in nontumor tissues, based on comparison of all samples and 74 matched ones (95 [47.5, 180] vs. 80 [45, 95], Z = -2.439, P = 0.015 and 100 [46.9, 182.5] vs. 80 [45, 95], Z = -2.594, P = 0.009, respectively). In addition, tumoral PAI-1 expression was positively associated with N stage (22/35 for N1 vs. 21/51 for N0, χ = 3.903, P = 0.048). Univariate analyses showed that TSS of patients with high PAI-1 tumors was significantly poorer than that of those with low PAI-1 tumors (log rank value = 19.00, P < 0.0001). In multivariate Cox regression test, PAI-1 expression was identified as an independent predictor for long-term prognosis of resectable PDAC (hazard ratio = 2.559, 95% confidence interval = 1.499-4.367, P = 0.001).@*Conclusion@#These results suggest that expression of PAI-1 is upregulated in PDAC and might serve as a poor prognostic indicator.

The role of perioperative enteral and parenteral nutrition treatment in pancreatic cancer: a multicenter, prospective randomized controlled trial / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the two different nutritional supports, enteral nutrition and parenteral nutrition in the aspects of nutritional conditions, immune status, the incidence of perioperative complications and quality of life impacts in pancreatic cancer.</p><p><b>METHODS</b>For the pancreatic cancer patients which pancreaticoduodenectomy were performed from January 2007 to December 2008 in five high-volume medical centres, prospective, randomized controlled study was carried out. The enrolled patients were randomly divided into enteral nutritional group (EN group) and parenteral nutritional group (PN group). Related indicators, such as nutritional conditions, immune status, incidence of complications, general status and quality of life were assessed.</p><p><b>RESULTS</b>The 200 patients were enrolled, while 178 cases which 90 patients in EN group and 88 patients in PN group were qualified to evaluate. The 22 cases were dropped out. For the mean hospital stay ((23 ± 13) days and (27 ± 24) days respcectively), Karnofsky score and the life quality scoring, there are no statistical differences between the two groups. In post-operation day 7 and day 10, the prealbumin was (69 ± 16) mg/L and (80 ± 22) mg/L in EN group and it was (67 ± 19) mg/L and (70 ± 11) mg/L in PN group, which are all significantly decreased than preoperational levels ((186 ± 38) mg/L for enteral group and (179 ± 37) mg/L for parenteral group, t = -2.24, -2.13, -2.23, -2.20, all P < 0.05), but there was no statistically significant between the 2 groups (P > 0.05). Other general indicators such as the albumin, hemoglobin, total bilirubin, blood urea nitrogen, serum creatinine, serum potassium and serum sodium, revealed no statistical differences in the 2 groups (P > 0.05); The total lymphocytes, CD(+)3CD(+)4 and CD(+)3CD(+)8 lymphocytes in PN group was (0.687 ± 0.065)×10(9)/L, (0.363 ± 0.029)×10(9)/L, and (0.183 ± 0.018)×10(9)/L respectively in post-operation day 10, which they are significantly decreased than in preoperational levels of PN group and the respective counterpart of EN group in post-operation day10 (t = -2.04-2.83, P < 0.05). The 35 patients were suffered from different complications in the 2 groups, but there was no statistical differences among them (P > 0.05).</p><p><b>CONCLUSIONS</b>Enteral nutritional support could not decrease the incidence of perioperative complications in pancreatic cancer patient, but it can improve the immunonutrition status in comparison with parenteral nutrition.</p>

Pancreatic acinar cell carcinoma: diagnostic and surgical treatment strategy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features, diagnostic and therapeutic strategy of pancreatic acinar cell carcinoma.</p><p><b>METHODS</b>The data of pancreatic acinar cell carcinoma patients who underwent surgical operations from January 2002 to January 2012 were retrospectively reviewed.</p><p><b>RESULTS</b>Six cases of pancreatic acinar cell carcinoma, identified with pathology were collected, including 3 males and 3 females with the average of 47.8 yeas old. Upper abdominal pain was present in 5 cases, weight loss was present in 4 cases with the average of 12.5 kg. Other symptoms included nausea/vomiting, back pain and obstructive jaundice. The serum CA19-9 and CA24-2 level were significantly elevated in 2 cases. CT scan, MRI and DSA were the main imaging methods to diagnose this disease. However, no case was diagnosed as pancreatic acinar cell carcinoma before operation. All cases were confirmed by the pathological examination. Relatively high rates of surgical resection, long operative time, more blood loss and combined multi-organ resection were the characteristics of this disease's operative surgical procedures. The average period of postoperative follow-up process was 60 months, and the mean survival time was (32 ± 8) months.</p><p><b>CONCLUSIONS</b>The clinical features and biological behavior of pancreatic acinar cell carcinoma are different from those of ductal adenocarcinoma, while the relatively specific clinical manifestations and imaging changes will be helpful for qualitative diagnosis before operation. As it has high rate of resection and better prognosis, more radical surgical strategies should be carried out for patients of this disease.</p>

Clinical characteristics of hereditary and sporadic medullary thyroid carcinoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the clinical characteristics and outcomes of the hereditary medullary thyroid carcinoma (HMTC) and the sporadic medullary thyroid carcinoma (SMTC).</p><p><b>METHODS</b>The clinical data of 78 patients with medullary thyroid carcinoma who underwent surgery in our hospital between July 1980 and May 2011 were retrospectively analyzed.</p><p><b>RESULTS</b>Of these 78 patients, there were 23 HMTC cases and 55 SMTC cases. The HMTC group was significantly younger age of onset [(36.4±13.5) years vs. (46.6±11.2) years, P<0.01] and a lower pre/post-operative serum calcitonin levels [(850.4±110.20) ng/L vs. (1450.4±118.3) ng/L, P<0.01 and (410.8±133.2) ng/L vs. (1585.4±129.5) ng/L, P<0.01] than the SMTC group. In addition, the mean tumor diameter was also significantly smaller in the HMTC group (14.3 mm vs. 21.0 mm in SMTC group, P<0.05). Tumor multifocality was seen in a significantly higher proportion of HMTC cases compared with the SMTC cases (56.6% vs. 29.1%, P<0.05). The overall 10-year survival was 100% in HMTC group and 80.2% in SMTC group (P<0.05).</p><p><b>CONCLUSION</b>HMTC has a better prognosis than SMTC.</p>

Validation of candidate immunogenic membrane antigens of human pancreatic cancer screened by proteomics / 中华外科杂志

<p><b>OBJECTIVE</b>To validate those obtained immunogenic membrane antigens candidate of human pancreatic cancer in the performed research.</p><p><b>METHODS</b>In the pre-studies, serum IgG purified from clinically collected sera of pancreatic cancer patients underwent immunoblot with human pancreatic cancer cell line SW1990 membrane protein, totally obtained 9 positive protein spots. Number 5 and 6 positive dots of immunoblot were identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry and peptide mass fingerprinting matching. The candidate membrane antigens were further validated in cell lines by RT-PCR and real-time PCR. RNA of human normal pancreatic tissue and pancreatic cancer tissue was extracted respectively, different gene expression level of prohibitin 2 was studied by real-time PCR.</p><p><b>RESULTS</b>Number 5 and 6 positive dots were identified as prohibitin 2 and prohibitin. RT-PCR and real-time PCR all showed that gene of prohibitin 2 and prohibitin were expressed in the human pancreatic cancer cell line SW1990, AsPc and P3 respectively, especially in P3 cell with highest expression (t = 7.442, P < 0.01). In addition, gene expression level of prohibitin 2 was significant higher in human pancreatic cancer than that of normal pancreatic tissue (t = 0.893, P < 0.01).</p><p><b>CONCLUSIONS</b>Prohibitin 2 and prohibitin are both differently expressed in the pancreatic cancer cell line SW1990, AsPc and P3. Prohibitin 2 is obvious highly expressed in human pancreatic cancer tissue. Prohibitin 2 and prohibitin might be the candidate immunogenic membrane antigens of human pancreatic cancer.</p>

Clinical characters of gastrointestinal lesions in intestinal Behcet's disease / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the clinical features, diagnosis methods, therapeutic principles of intestinal Behcet's disease.</p><p><b>METHODS</b>king Union Medical College Hospital from August 1998 to April 2010 were retrospectively analyzed.</p><p><b>RESULTS</b>The clinical courses of patients with intestinal Behcet's disease were from 26 days to 33 years, and the average duration was 6.32 +/- 1.01 years. The appearance of extra-gastrointestinal symptoms was significantly earlier than that of gastrointestinal symptoms (7.35 +/- 1.39 years vs. 3.24 +/- 0.82 years, P<0.05). The predominant gastrointestinal manifestations were right lower quadrant pain (95.56%) and hematochezia or melena (40.00%). Misdiagnosis occurred in 17 cases. In patients without systemic medicine therapy before surgery, the incidence of postoperative infection of incision site and abdominal cavity was significantly higher than that in those undergoing systemic medicine therapy (80.00% vs. 0%, P<0.05).</p><p><b>CONCLUSIONS</b>Because of the diversity of gastrointestinal manifestations, intestinal Behcet's disease is easily misdiagnosed. The systemic medical therapy before surgery could decrease the incidence of infection of incision and abdominal cavity.</p>

The expression of catechol O-methyltransferase gene in colorectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To study the expression of the gene and coding protein of catechol o-methyltransferase (COMT) in the colorectal cancer and distant normal mucosa.</p><p><b>METHODS</b>The tumor tissues and distant normal mucosa of 22 patients with colorectal cancer received surgical treatment from January to August 2009 were collected. Total RNA and protein were extracted and tested using reverse transcription polymerase chain reaction (RT-PCR), Western blot was used to detect the expression of COMT in the tumor tissue and normal mucosa. Tissue array was performed to verify the COMT protein expression. The gray scale scan was used to differentiate the COMT expression level of the mRNA and protein between the two groups.</p><p><b>RESULTS</b>The tested mean light density of COMT mRNA was 53 514 +/- 15 513 in the tumor tissue group and 4529 +/- 1698 in the normal mucosa group, the expression of COMT gene in colorectal cancer tissue was significantly higher than that in the normal mucosa (P < 0.05). Western blot results showed that the expression level of soluble COMT protein in the colorectal cancer tissue was significantly higher than that in the corresponding distant normal mucosa (mean light density 54 967 +/- 11 919 vs. 25 962 +/- 6713) (P < 0.05), but the expression of membrane-bound COMT protein was not statistically different between the two groups. Tissue array revealed that the COMT protein mainly located in the cytoplasm, and it was significantly over-expressed in the colorectal cancer tissue than in the normal mucosa (P < 0.05).</p><p><b>CONCLUSIONS</b>The COMT gene and encoding protein is over-expressed in the colorectal cancer tissue than in the distant normal mucosa. The COMT gene might be involved in the biological behavior of the colorectal cancer.</p>

Surgical treatment strategy for malignant pancreatic neuroendocrine tumor / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the surgical options for the malignant pancreatic neuroendocrine tumor (PNETs).</p><p><b>METHODS</b>The clinic data of 32 patients with malignant pancreatic neuroendocrine tumors who were admitted between January 2003 and December 2009 were summarized. There were 19 male and 13 female, aging from 17 to 71 years (mean age, 46.3 years). The general information, postoperative pathology results, surgical options and followup were also collected.</p><p><b>RESULTS</b>There were 32 cases of malignant PNETs including functional malignant PNETs in 12 cases and nonfunctional malignant PNETs in 20 cases. Thirty-one patients accepted surgical treatments which included local resections in 4 patients, Whipple procedures in 7 patients, distal pancreatectomy in 17 patients and laparotomy in 3 patients. One patient accepted CT guided biopsy. Follow up were lost in two patients after operations. Five patients died in the first year after operations. Twenty-two patients still survived after mean follow up of 28 months (4 - 83 months). The survival rate for this group of patients was 83.5% in the first year, 72.6% in the second year and 54.4% in the fifth year.</p><p><b>CONCLUSIONS</b>Malignant PNETs is the proper indication for surgical treatments. More accumulation of clinical data is needed to evaluate the significance of local resection of malignant PNETs in pancreatic head and cytoreductive surgery.</p>

Candidate immunogenic membrane antigens of human pancreatic cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To verify the obtained immunogenic membrane antigens candidate of pancreatic cancer in the performed research.</p><p><b>METHODS</b>Pancreatic cancer cell line SW1990 membrane protein underwent immunoblot with serum IgG purified from clinically collected sera of 66 pancreatic cancer patients. Number 3 and number 8 positive dots of immunoblot were identified by MALDI-TOF mass spectrometry and peptide mass fingerprinting matching. The candidate membrane antigens were further validated in cell lines by RT-PCR, real-time PCR and Western blot, and their different expression level of gene and protein in pancreatic cancer cell lines were contrastly studied.</p><p><b>RESULTS</b>Number 3 and number 8 positive dots were identified as: voltage-dependent anion channel (VDAC3) and catechol-o-methyltransferase (COMT). RT-PCR, real-time PCR and Western blot showed that gene and protein of VDAC3 and COMT were expressed in the pancreatic cancer cell line SW1990, AsPc and P3 respectively.</p><p><b>CONCLUSION</b>VDAC3 and COMT might be the candidate immunogenic membrane antigens of human pancreatic cancer, and their gene and protein are differently expressed in the pancreatic cancer cell line SW1990, AsPc and P3.</p>

Proteomic analysis of membrane proteins of endomembrane system in human pancreatic cancer cell / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze and identify the membrane proteins of endomembrane system in human pancreatic cancer cell by proteomics.</p><p><b>METHODS</b>Membrane protein was extracted from pancreatic cancer cell lines Capan-1, MiaPaCa-2, Panc-1. The membrane protein mixture of the three pancreatic cancer cell lines were separated by two-dimensional electrophoresis (2-DE). Positive dots of staining 2-DE gel were identified by MALDI-TOF mass spectrometry and PMF matching, and then evaluated by bio-informatics searching in NCBI and ExPASy databases. Information of membrane proteins were acquired like sequence, molecular weight, isoelectric point, location and biological functions.</p><p><b>RESULTS</b>Forty-nine membrane proteins out of 166 protein dots which could be seen on the 2-DE gel were identified as channel carrier proteins (4 proteins), signal transduction proteins (5 proteins), transcription regulatory and translation modification protein (7 proteins), proliferation and apoptosis related proteins (4 proteins), invasion and migration associated proteins (2 proteins), cytoskeleton proteins (3 proteins), metabolism pathway proteins (14 proteins), and function unknown protein (10 proteins).</p><p><b>CONCLUSIONS</b>Endomembrane proteins of pancreatic cancer cell play key roles in tumor malignant behavior like proliferation, metabolism, motility, adhesion and migration. These membrane proteins might become candidate biomarkers or targets of therapy of pancreatic cancer.</p>

Noninvasive examinations for localization of insulinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the value of the noninvasive examinations for localization of insulinoma.</p><p><b>METHODS</b>The clinical materials of 88 cases of insulinoma treated in Peking Union Medical College Hospital between January 2005 and November 2008 were analyzed retrospectively. There were 40 males and 48 females aged from 15 to 74 years old (averaged, 46.5 years old).</p><p><b>RESULTS</b>The positive rates for localization were 19.3% (17/88), 52.4% (11/21), 95.5% (64/67), 1/6, 30.0% (6/20), 83.9% (26/31), 8/8 and 5/5 respectively in transabdominal ultrasound, enhanced CT, multislice spiral CT pancreatic perfusion, MRI, somatostatin receptor scintigraphy, endoscopic ultrasound, laparoscopic ultrasound and intraoperative ultrasound. Thirty-one multiple tumors in 8 patients were resected. The positive rates of locating the multiple insulinomas of multislice spiral CT pancreatic perfusion and Intraoperative Ultrasound were 48.4% (15/31) and 100% (14/14) respectively.</p><p><b>CONCLUSIONS</b>The locating diagnosis of insulinoma has came to noninvasive examination era. Multislice spiral CT pancreatic perfusion is the first choice for localization. Intraoperative ultrasound might play an important role in locating tumors for patients with multiple insulinomas.</p>

Evaluation of RCAS1 as serum tumor marker for pancreatic cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of receptor-binding cancer antigen expressed on SiSO cells (RCAS1) as serum tumor marker on the diagnosis of pancreatic cancer.</p><p><b>METHODS</b>Receiver-operating characteristics (ROC) curve methods were used to assay the serum content of RCAS1, CA19-9 and CA242 in 46 patients with pancreatic cancer, 18 patients and 20 normal tissues of chronic pancreatitis detected by enzyme linked immunosorbent assay (ELISA), and the results were analyzed by statistics methods. The expressions of RCAS1 protein were analyzed by immunohistochemical method in 32 patients with pancreatic cancer, 10 patients with chronic pancreatitis and 6 cases of normal pancreatic specimens.</p><p><b>RESULTS</b>The serum levels of RCAS1, CA19-9 and CA242 in pancreatic cancer were higher than that in chronic pancreatitis respectively (P < 0.01). The area under curve of RCAS1, CA19-9 and CA242 were 0.826, 0.804 and 0.737, respectively. Subgroup analysis indicated that the RCAS1 and CA19-9 levels of pancreatic cancer patients without obstructive jaundice were lower than those for patients with obstructive jaundice (P < 0.01). CA19-9 levels of patients with resectable pancreatic cancer were lower than those with unresectable pancreatic cancer (P < 0.01). Immunohistochemistry showed that the expression rates of RCAS1 in pancreatic cancer and chronic pancreatitis were 87.5% and 40.0%, respectively (P < 0.05).</p><p><b>CONCLUSIONS</b>In diagnosis of pancreatic cancer, the clinical value of RCAS1 is available. And the combination test of RCAS1 and CA19-9 have clinical value to evaluate if the pancreatic cancer can be resected before operation.</p>

Clinical experience in diagnosis and treatment of glucagonoma / 中华外科杂志

<p><b>OBJECTIVE</b>To study the diagnosis and treatment of glucagonoma.</p><p><b>METHODS</b>A retrospective review of glucagonoma cases was committed between June 1993 and July 2008 in Peking Union Medical College Hospital. It was measured by sex, age, misdiagnosis, clinical symptoms, laboratory data, imaging studies, diagnosis, treatment procedures and so on.</p><p><b>RESULTS</b>The tumors of eleven cases were found in the tail, and one case was in the head of the pancreas at the same time. Ten had solitary lesion, one had multiple lesions. The average diameter of the lesions was 3.9 cm. Nine patients had the metastasis out of pancreas and all of them had the liver metastasis. One case was a member of multiple endocrine neoplasia type 1 (MEN-1) syndromes. Eight patients being treated with operation had the detailed pathological reports. The glucagon was detected by immunohistochemistry and was positive in five patients. Six patients were pathologically malignant. Multimodal treatments included tumor resection, chemoembolization, treated with somatostatin analogues and (or) radionuclides and so on were applied to all patients.</p><p><b>CONCLUSIONS</b>Glucagonoma is a rare pancreatic endocrine tumor. Radical tumor surgery is used as the first choice. Multimodal approach may improve the prognosis.</p>

The utility of stapler in distal pancreatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the influence of hand-sewn and stapler in distal pancreatectomy on the postoperative complication.</p><p><b>METHODS</b>Clinical data of 109 patients after distal pancreatectomy from January 2003 to December 2006 were analyzed retrospectively.</p><p><b>RESULTS</b>The surgical techniques used for closure of the pancreatic stump after distal pancreatectomy were categorized into hand-sewn closure group (n = 53) and stapler closure group (n = 56). In stapler closure group, 25 patients accepted laparoscopic operation. The incidences of abdominal infection and pancreatic fistulae in stapler closure group were lower than hand-sewn closure group. The operation time, blood infusion, postoperative bleeding and medical costs were similar between two groups.</p><p><b>CONCLUSION</b>Stapler closure in distal pancreatectomy could decrease the incidence of pancreatic fistula and abdominal infections.</p>

Acute mesenteric venous thrombosis: experience of 27 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the diagnostic and therapeutic experiences of acute mesenteric venous thrombosis (MVT).</p><p><b>METHODS</b>The clinical data of 27 cases of acute MVT treated between 1983 and July 2007 were analyzed retrospectively.</p><p><b>RESULTS</b>The courses of disease were from 1 to 14 days (mean, 6.1 days). Eighteen cases (66.7%) had the history of portal hypertension, deep vein thrombosis, acute MVT or other hypercoagulability. The diagnostic sensitivity of ultrasonography, CT, angiography and serum D-Dimer level were 70.6% (12/17), 75.0% (6/8), 100% (6/6), 100% (6/6), respectively. Bowel necrosis occurred in all the 16 cases with bloody ascites. The thrombolytic and anticoagulation therapy are effective in 36.4% of cases (4/11). Twenty-two cases received operation, and resection of necrotic bowel was performed in all and thrombectomy in 3 cases. The main postoperative complications included 3 cases of deep vein thrombosis, 1 acute cardiac infarction, 3 short bowel syndrome. MVT recurred in 4 cases within a week after operation. Eight patients died within a month after confirmed with acute MVT, in which 7 patients died after operation. Anticoagulation medication was implemented in all the 19 survived patients. Fifteen patients were followed-up for 1-120 months (mean, 39.2 months), 7 of them continued the anticoagulation therapy during this period.</p><p><b>CONCLUSIONS</b>The determination of serum D-Dimer level and such adjuvant examinations as ultrasonography, CT and angiography are important diagnostic means for acute MVT. Anticoagulation and thrombolysis should be considered firstly if there is no active bleeding and bowel necrosis. We recommend laparotomy when bowel necrosis is suspected.</p>

Establishing the method of collagen-gel droplet embedded culture drug sensitivity test with rat tail collagen / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical application of collagen-gel droplet embedded-culture drug sensitivity test (CD-DST) in the malignant tumors.</p><p><b>METHODS</b>CD-DST was established with rat tail collagen. Three pancreatic cancer cell lines, surgical resection specimens including 15 cases of pancreatic cancer and 10 cases of gastrointestinal cancer were examined using CD-DST.</p><p><b>RESULTS</b>The overall achievement ratio of CD-DST for clinical tumor specimens was 80% (20/25). In vitro chemosensitivities of pancreatic carcinoma cells to 5-FU, gemcitabine and oxaliplatin were lower than those of gastrointestinal carcinoma.</p><p><b>CONCLUSIONS</b>CD-DST with rat tail collagen is a valuable chemosensitivity testing method for malignant tumors. It can be used to realize individualized anticancer chemotherapy.</p>

Clinical study of the improvement gastrostomy in pancreaticoduodenectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical significance of improvement gastrostomy in pancreaticoduodenectomy.</p><p><b>METHODS</b>Clinical data of 82 patients who underwent pancreaticoduodenectomy and jejunostomy from November 2004 to December 2006 were collected, among which 36 patients received improvement gastrostomy (treatment group), 24 patients accepted traditionary gastrostomy (control group 1) and 22 patients without any gastrostomy (control group 2). Operative time, postoperative duration of gastrointestinal decompression tube, postoperative gastroparesis, pancreatic fistula, biliary fistula, and abdominal cavity infection were compared.</p><p><b>RESULTS</b>The incidence of postoperative gastroparesis in the treatment group and control group 2 were can significantly lower than that in the control group 1 (P < 0.05). The postoperative duration of gastrointestinal decompression tube of the treatment group was significant shorter than that of control group 2 (P < 0.01). There were no significant difference in other items.</p><p><b>CONCLUSIONS</b>The improvement gastrostomy in pancreaticoduodenectomy is simple and secure. It can significantly shorten the postoperative duration of gastrointestinal decompression tube and also obviously reduce the incidence of postoperative gastroparesis compared with traditionary gastrostomy.</p>