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Objective To study the diagnostic value of endoscopic ultrasonography (EUS) in patients with cholangiopancreatic duct dilatation (CPDD).Methods Forty-five patients with CPDD and without any visual or detected obstructive lesions after traditional uhrasonography (US) were re-examined by EUS,CT and MRI.The diagnostic rates of EUS and the other imaging technologies were compared.Results All the 45 patients underwent successful EUS examination.Among them,there were 18 patients with periampullary tumor,10 patients with lower common bile duct stones,1 patient with pancreatic duct stones,3 patients with chronic pancreatitis,1 patient with an intrapancreatic choledochal cyst,4 patients with inflammatory strictures of papilla of duodenum and 2 patients with terminal bile duct inflammatory stenosis.However,1 patient with a lower common bile duct tumor,1 patient with a small pancreatic head carcinoma and 1 patient with sphincter of Oddi dysfunction (SOD) were not diagnosed.The diagnostic rates of obstructive lesions by US,EUS,CT and MRI were 7.1％,92.9％,33.3％,31.0％,respectively.The diagnostic rates of tumor were 10.0％,90.0％,35.0％,25.0％,respectively.As compared with the other examination methods,EUS was best in detecting small carcinoma.Conclusion EUS plays an important role in the diagnosis of lesions causing cholangiopancreatic duct dilatation.
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Objective To study the feasibility and safety of individual laparoscopic pancreatectomy for patients with pancreatic neuroendocrine neoplasm(pNEN).Methods 16 patients with pNEN admitted from Jan.2007 to Nov.2016 undergoing individual laparoscopic pancreatectomy were retrospectively analyzed.Results The operations were successfully accomplished in all the 16 patients,including 2 cases of local excision,2 cases of bundling method excision,2 cases of central pancreatectomy and pancreaticojejunostomy,4 cases of spleen-preserving distal pancreatectomy and 6 cases of distal pancreatectomy combined with splenectomy.The operation time was ranging from 60 to 260 mins,and the blood loss was from 50 to 300 ml.Three cases suffered from level A postoperative pancreatic leakage.The cases of grade G1,G2,G3 were 10,5,1,respectively.The follow-up period was from 3 to 121 months.One case of grade G2 died 46 months postoperatively and 1 case of grade G3 died 36 months postoperatively.Conclusion Individual laparoscopic pancreatectomy is safe and feasible for early pNEN.
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The fabrication system for the electrochemical microfluidic device was set up based on the pulse driving and controlling of microfluids technology.The nano silver ink and glycerol solution were jetted on the glass substrates to form the microelectrode pattern and the liquid mold pattern for the microchannel.Then the microelectrode and microchannel were obtained through a sintering process and a molding process, respectively.The electrochemical mircrofluidic device was Finally prepared through a bonding process with the microelectrode and the microchannel.The influences of the system parameters on the formation of the droplet were studied, as well as the influences of the droplets diameter and the overlap on the formation of the liquid lines.The minimal width, the thickness and the resistance of the prepared microelectrode were 45 μm, 2.2 μm and 5.2 μΩ cm, respectively.The minimal width of the microelectrode was 35 μm and the surface was smooth.The electrochemical flow detection of glucose concentration was carried out with the device, and the results showed that the glucose concentration had a high linear correlation with the response current, which could be used in the quantitative detection of glucose concentration.The fabrication of the electrochemical microfluidic device based on the pulse driving and controlling of micro fluids technology has many advantages such as simple system structure, lower cost and higher accuracy of the micro droplet and can be used in the preparation of the devices in the biochemical analysis and biosensor areas.
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Objective To analyze the value of dynamic contrast-enhanced MRI(DCE-MRI) parameters of Extended Tofts and Exchange model in the differential diagnosis of hepatocellular carcinoma (HCC) and hepatic metastases of colorectal cancer. Methods A retrospective analysis of 40 pathologically confirmed cases was conducted , including 25 cases of HCC and 15 cases of hepatic metastases of colorectal cancer,all patients underwent DCE-MRI. Applying liver double blood supplement model , and respectively using Extended Tofts two-compartment model and Exchange model liver microvascular permeability parameters [volume transfer constant of the contrast agent(Ktrans), efflux rate from extracellular extravascular space to plasma(Kep), extravascular extracellular volume fraction(Ve)and blood plasma space volume fraction (Vp)] and the perfusion parameter hepatic arterial perfusion index(HPI) in the lesion parenchyma of HCC and metastases were calculated. We used t test to compare the differences of the parameters measured from the two types of tumors , statistically significant parameters between HCC and metastases were screened which compared with the gold standard of pathological findings in order to draw the ROC curves to evaluate the diagnostic efficacy of different model parameters, using χ2 test compared the diagnostic accuracy of optimal parameters between the two models. Results By using Extended Tofts and Exchange model , Ktrans value of HCC were (0.661 ± 0.402)/min and (0.604 ± 0.316)/min respectively, Ktrans value of hepatic metastases were (0.196±0.175)/min and (0.179±0.135)/min respectively;Vp value of HCC were (0.334±0.217) and (0.294± 0.098), Vp value of hepatic metastases were (0.089 ± 0.015) and (0.089 ± 0.022),respectively; HPI value of HCC were (0.680±0.281) and (0.769±0.245) , HPI value of hepatic metastases were (0.326±0.216), (0.373± 0.298), respectively. There were significant differences between HCC and hepatic metastases in Ktrans, Vp and HPI values in both models(P0.05).Drawn ROC curves of Ktrans, Vp, HPI , the Ktrans value (area under the curve of 0.869) among Extended Tofts model parameters was selected as optimal parameter to identify HCC and hepatic metastases; the HPI value (area under the curve of 0.845) among Exchange model parameters was selected as optimal parameter to differentiate these two types of tumors.The diagnostic accordance rate of Extended Tofts model and Exchange model were 80.0%(32/40), 82.5%(33/40), respectively ; There was no significant difference between them(χ2=0.082,P=0.775). Conclusions Parameters including Ktrans, Vp, HPI of the Extended Tofts model and Exchange model in DCE-MRI perfusion can be used to identify HCC and hepatic metastases of colorectal cancer. Among these parameters, Ktrans of Extended Tofts model and HPI of Exchange model have higher diagnostic value in differentiating HCC and hepatic metastases of colorectal cancer.
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Objective To compare the diagnostic value of endoscopic ultrasonography (EUS) versus intraoperative cholangiography (IOC) for suspected common bile duct stones (CBDS).Methods 324 patients with suspected CBDS who were admitted to the Hepatobiliary Pancreatic Surgery Department of Shaoxing People's Hospital between June 2010 and June 2014 were retrospectively studied.Either EUS or IOC was used and the diagnostic value of these two imaging modalities was compared.Results The sensitivity, specificity, positive predictive value and negative predictive value of IOC in diagnosing suspected CBDS were 90.6％, 98.4％, 9.5％ and 97.7％ respectively.Its consistency rate was 96.9％.The sensitivity, specificity, positive predictive value and negative predictive value of EUS in diagnosing suspected CBDS were 97.1％, 100％, 100％ and 99.1％ respectively.Its consistency rate was 99.3％.Conclusions In diagnosing suspected CBDS, the sensitivity, specificity, positive predictive value and negative predictive value of EUS were significantly higher than IOC.When compared with IOC, EUS was more sensitive to detect occult CBDS and avoided unnecessary ERCP or bile duct exploration.Patients with negative EUS were less likely to have retained CBDS.
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Pancreatic adenosquamous carcinoma is a rare exocrine pancreatic cancer,and surgical treatment is the only promising method in survival time extension and life quality enhancement.In July 2013,1 patient with pancreatic adenosquamous carcinoma and sarcomatoid change was admitted to the Shaoxing People's Hospital.A cauda pancreatis cystic nidus was detected by computed tomography 1 year ago,and no any other clinical symptoms were detected.The left upper quadrant of the patient was glutted and unwell,and the levels of CA19-9 and CA125 were 3 630 kU/L and 645 kU/L,respectively.The results of computed tomography and magnetic resonance imaging showed that a huge cystic and solid tumor was located between the cauda pancreatis,the stomach and the spleen;the tumor was mainly cystic and rooted in the tail of the pancreas;the spleen,stomach and surrounding tissues were infiltrated by the tumor.The results of postoperative pathological examination showed that the tumor was pancreatic adenocarcinoma with squamous epithelial differentiation and sarcomatoid change;the invasive squamous carcinoma dominated stomach wall,and the sarcomatoid change dominated spleen and lymph nodes with partial squamous epithelial differentiation and surrounding lymph nodes metastases.Although the surgical resection was complete and the postoperative thymosin injection and traditional Chinese medicine were implemented,tumor recurred at postoperative month 5,and the patient was dead due to cachexia and pernicious anemia at postoperative month 8.The prognosis of patients with pancreatic adenosquamous carcinoma is poor,early detection and surgery are key points for curative effect enhancement.
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Objective To review the diagnosis and treatment of primary gallbladder carcinoma in patients older than 70 years.Method The clinical data of 48 patients older than 70 years with primary gallbladder carcinoma treated in our hospital from 2003 to 2010 were retrospectively analyzed.Results The preoperative diagnostic rate was 60.4％.Of 48 patients with primary gallbladder carcinoma,9 received cholecystectomy,18 radical resection,7 extended radical resection,8 palliative operation,while the remaining 6 received biopsy because of metastasis. The 3-year survival rate was 20.8％ and the 5-year survival rate was 8.3％.Conclusions Regular B-ultrasonography,CT-scan and MRI are suggested for elderly patients with chronic diseases of the gallbladder.Radical resection is recommended if clinically possible. Chinese traditional medicine given postoperatively improved the prognosis.
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Objective To investigate the feasibility and technique in laparoscopic cholecystectomy and exploration of common bile duct (CBD) in patients who have previous subtotal gastrectomy.Methods From January 2001 to October 2010,22 patients who had a history of subtotal gastrectomy received laparoscopic cholecystectomy and CBD exploration in our hospital.In addition,these patients received cholangioscopic lithotomy,electrohydraulic lithotripsy,T-tube drainage,or primary suturing of the CBD wound.Results The procedures were completed successfully in 18 patients.In 4 patients,conversion to laparotomy was necessary because of multiple stones in a stenosed CBD (n=1),severely congested CBD wall with edema (n=1),CBD carcinoma associated with impacted stones (n=1) or Mirzzi syndrome (n =1).T tube drainage was employed in 16 patients,and primary suturing in 2 patients at the end of the operation.There was no hemorrhage,biliary leakage or abdominal infection.At a mean follow-up of 13 (range 3 to 60) months there was no residual stone,biliary stenosis or cholangitis.In 3 patients Stone recurred,and another 3 patients were lost to follow-up.Conclusions A history of subtotal gastrectomy is not a contradiction to laparoscopic cholecystectomy and CBD exploration.With choledocoscopy,surgery can be safe and feasible even for patients with previous gastectomy.
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Twenty five patients with incarcerated stone in distal common bile duct were treated with mini-blasting lithotrite under choledochoscope from June 2008 to September 2010.The clinical data of patients were retrospectively analyzed.The successful rate of surgery was 100％.The clearance rate of first procedure was 92％ (23/25),2 cases underwent second procedure and all were successful.There were no severe operative complications including bile duct injury,perforation,hemorrhage or bile leakage.Miniblasting lithotrite is a safe and effective method for treating incarcerated stone in distal common bile duct.
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0 05), and the postoperative pain degree score was (2 0?0 7) points and (2 5?0 8) points respectively (t=-3 02, P