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Objective:To investigate the diagnosis, classification and treatment of pancreatic duct stones (PDS) .Methods:Clinical data and prognosis of 32 patients with PDS treated in our hospital from Jan. 2010 to Dec. 2019 were retrospectively analyzed. The treatment methods were summarized.Results:All 32 cases were diagnosed with PDS by imaging examinations such as B ultrasonography, CT, endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) . The diagnosis accuracy was 81.3% (26/32) for B-ultrasound, 86.2% (25/29) for CT, 90.4% (19/21) for MRCP, and 100% (8/8) for ERCP. According to the location of stones and intraoperative exploration, the 32 patients were divided into 3 groups: Type I, 17 patients, the stones were located in the main pancreatic duct; TypeⅡ, 11 patients, the stones were located in both main and branch pancreatic duct; Type Ⅲ, 4 patients, the stones were located in the branch pancreatic duct. Different treatment methods were employed according to the different types. No patient died in the perioperative period. 11 (34.3%) patients had postoperative complications. 3 (9.3%) patients had postoperative residual stones. 32 cases were followed up for a period of 6 to 60 months. The abdominal pain and steatorrhea disappeared or significantly improved postoperatively. 2 patients complicated with pancreatic cancer died 12 to 35 months after operation.Conclusions:The treatment and diagnosis of the PDS still remains complicated. Imaging examinations are the main methods for diagnosis of PDS. The accurate classification and individual treatment are important. Surgery is the most commonly used method for PDS.
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Objective To investigate the relationship between the expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells,to observe the inhibitory effect of 5-Aza-CdR on the growth of gastric cancer cells,to observe the effect of demethylation on the expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells,and to explore the molecular mechanism of gastric cancer.Methods Real-time PCR was used to detect the expression of ASPP2 mRNA in two gastric cancer cells and normal gastric epithelial cells.BSP was used to detect the methylation of ASPP2 gene in two gastric cancer cells and normal gastric epithelial cells.CCK-8 was used to detect the growth inhibition rate of gastric cancer cells treated with 5-Aza-CdR of different concentrations,then they were used to detect expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells again after the demethylation.Results ① The expression of ASPP2 mRNA in MKN-45 cells was significantly lower than that in GES-1 cells(P＜0.01).The expression of ASPP2 mRNA in MGC-803 cells was significantly lower than that in GES-1 cells (P＜0.01).There was no significant difference in MGC-803 cells and MKN-45 cells(P＞0.05).② The methylation rate of ASPP2 in MKN-45 cells was significantly higher than that in GES-1 cells (P＜0.01).The methylation rate of ASPP2 in MGC-803 cells was not significantly different from that in GES-1 cells (P＞0.05).The methylation rate of ASPP2 in MKN-45 cells was significantly higher than that in MGC-803 cells (P＜0.01).③ At the same time,the growth inhibition rate of each 5-Aza-CdR concentration group increased as the drug concentration depended.4.The expression of ASPP2 mRNA in MKN-45 cells was significantly higher than that before treatment (P＜0.01),the expression of ASPP2 mRNA in MGC-803 cells was not significantly different from that before treatment(P＞0.05).The methylation rate of ASPP2 in MKN-45 cells was significantly lower than that before treatment (P＜0.01).The methylation rate of ASPP2 in MGC-803 cells was not significantly different from that before treatment (P＞0.05).Conclusion ① Abnormal hypermethylation of ASPP2 gene in MKN-45 cells may be a molecular mechanism of decreased ASPP2 mRNA expression.② 5-Aza-CdR can inhibit the growth of MKN-45 and MGC-803 cells,and it can enhance the expression of ASPP2 mRNA in MKN-45 cells.Reversal of methylation in the promoter region of ASPP2 gene is the possible mechanism.③ Abnormal hypermethylation of the promoter region of ASPP2 gene may lead to silencing of mRNA expression that may be associated with gastric cancer.
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Objective To investigate the relationship between peri-menopausal women blood lipid level and the gallstone disease in order to provide theoretical basis for the prevention of gallbladder stone.Methods Seventy-two patients with gallbladder calculus from Department of Hepatobiliary Surgery Jinshan District Central Hospital of Shanghai and 52 healthy women coming for physical examination as the control group.Participants were divided into five age groups (20-29,30-39,40-49,50-59 and 60-69 years old) and two age stages (young period (30-40 years old) and peri-menopausal period (45-55 years old)),total cholesterol (TC),triglyceride (TG),high density lipoprotein (HDL-C),low-density lipoproteins (LDL-C) and Body Mass Index (BMI) were determined and compared between the stone group and the control group at different age stages.Results In comparison of the menopausal transition period,the stone group had significantly lower blood TC,HDL-C and LDL-C levels than the control group (TC:(4.58 ± 0.27) mmol/L vs.(5.15 ± 0.26) mmol/L,t=3.112,P ＜0.01 ;HDL-C:(1.17 ±0.11) mmol/L vs.(1.40 ±0.08) mmol/L,t =3.351,P ＜0.01 ;LDL-C:(2.71 ± 0.30) mmol/L vs.(3.15 ± 0.26) mmol/L,t =2.437,P ＜ 0.05).For the young period,there were no significant difference on blood lipid level and BMI was observed between the stone group and the control group (P ＞ 0.05).The fat HDL-C level in blood was significantly lower in the stone group in the menopausal transition period than in the young period ((1.17 ± 0.11) mmol/L vs.(1.33 ± 0.07) mmol/L,t =2.455,P ＜ 0.05).The control group had significantly higher peri-menopausal TC,TG,LDL-C levels in blood and BMI than those in the control group young period (P ＜ 0.05) ; And HDL-C level,no significant difference (TC:(5.15 ± 0.26)mmol/L vs.(4.47 ± 0.34) mmol/L,t =3.175,P ＜ 0.01 ; TG:(1.88 ± 0.39) mmol/L vs.(1.10 ± 0.24)mmol/L,t=3.066,P＜0.01;LDL-C:(3.15 ±0.26) mmol/L vs.(2.71 ±0.31) mmol/L,t =2.261,P＜0.05;BMI:(24.75±0.99) kg/m2vs.(21.73±1.11) kg/m2,t=4.217,P＜0.01).Conclnsion For perimenopausal (45-55 years old) females,decline of serum TC,HDL-C and LDL-C levels may be related to the formation of cholesterol stone.Lower HDL-C level is closely associated with formation of cholesterol stone,indicating that it may be one of the measures to prevent gallbladder stone by adjusting blood fat in perimenopausal women.
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Objective To investigate the causes of repeated operations in patients with biliary diseases.Methods The clinical data of 265 patients who received repeated operations at the Jinshan Branch of Shanghai Sixth People's Hospital from January 2005 to June 2011 were retrospectively analyzed.The causes of repeated operations were analyzed. The first reoperation aimed at removing the calculi completely,repairing the injured biliary ducts and managing malignant tumors. The primary surgical procesures of the first reoperation included choledochotomy + T tube drainage,choledochotomy + Roux-en-Y choledochojejunostomy,endoscopic retrograde cholangiopancreatography + endoscopic sphincterotomy,choledochotomy + hepatectomy + T tube drainage or Rouxen-Y choledochojejunostomy,choledochotomy + biliary-endo-drainage,end-to-end anastomosis of bile duct + T tube drainage,radical or palliative resection of tumor,endoscopic biliary stent drainage or exploratory laparotomy.The second and multiple reoperations aimed at reconstructing the passage for biliary drainage. All data were analyzed using the chi-square test.Results A total of 69.8％ (120/172) of patients who had recurrent or retained calculi received first reoperation,which was significantly higher than 31.2％ ( 29/93 ) of those who received second or multiple reoperations (x2 =36.51,P ＜ 0.05 ).A total of 58.1％ (54/93) of patients who had benign stenosis of bilioenteric anastomosis received multiple reoperations,which was significantly higher than 4.1％ (7/172) than those who received first reoperation (x2 ＝ 99.32,P ＜ 0.05 ).Of the 265 patients,46 had complications.The incidence of complications of patients who receive first reoperation was 10.5％ ( 18/172),which was significantly lower than 30.1％ (28/93) of patients who received second or multiple reoperations ( x2 =13.61,P ＜ 0.05 ).Six patients died of hemorrhagic shock or multiple organ syndrome dysfunction postoperatively.The mortality rates for patients who received first reoperation and second or multiple reoperations were 1.7％(3/172) and 3.2％ (3/93),respectively,with no significant difference ( x2 ＝ 0.59,P ＞ 0.05 ).Conclusions The causes for reoperation of biliary disease are muhifactorial.Full assessment of the status of biliary diseases and ample preperation preoperatively,careful operation and precise and rational selection of operative procedures are keys to decrease the reoperative rates and perioperative complications.
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Objective To study the etiological factors,clinical characteristics and diagnosis of acute pancreatitis (AP).Methods The clinical data of 217 patients with AP treated from January 2005to December 2010 in our hospital were studied retrospectively.Results The majority of patients were male (60.4％).The average age was 52.5 years.Cholelithiasiss,hyperlipidemia and trauma were the most frequent etiologic causes of AP.There were 164 patients with mild (75.6％) and 53 patients with severe (24.4％) AP.151 patients underwent surgical or endoscopical treatment (69.6 ％) while 66 patients underwent non-operative treatment (30.4 ％).14 of 53 patients with severe AP died.Conclusions AP should be treated according to the cause and the type.The key to reduce complications and increase cure rate is to find the cause of AP and then treat the underlying disease.