Hepatectomy without portal triad clamping may decrease the incidence of liver injury; however, the effects of hepatectomy without portal triad clamping in the treatment of spontaneous rupture of hepatocellular carcinoma (SRHCC) remain unclear. The aims of the present study were to evaluate the therapeutic value of hepatectomy without portal triad clamping in the treatment of patients with SRHCC. The present study retrospectively reviewed patients with SRHCC who received hepatectomy without portal triad clamping (non-clamping group) and the therapeutic efficacy was compared with that of 20 patients with SRHCC undergoing the same surgery in the presence of portal triad clamping (clamping group). Following hepatectomy, the non-clamping group exhibited a significantly lower incidence of acute liver failure compared with the clamping group (P<0.05). No significant differences in operative time, intra-operative blood loss, disease-free or overall survival times between the two groups were identified (all P>0.05). At 1 week and 2 weeks after surgery, the non-clamping group exhibited significantly lower alanine aminotransferase, aspartate aminotransferase and total bilirubin serum levels compared with the clamping group (all P<0.05). Hepatectomy without portal triad clamping may decrease the incidence of liver injury and liver failure in patients with SRHCC, suggesting that it may be a safe and effective therapeutic strategy.

BACKGROUND AND AIMS:Pancreatic encephalopathy (PE) is a severe complication and significant cause of death in patients with severe acute pancreatitis (SAP). We have reported previously that low-molecular-weight heparin (LMWH) treatment could reduce incidence of PE in SAP patients. Our objective here was to investigate the protective effect of LMWH and its mechanism on PE in SAP rats. METHODS:SD rats were randomly divided into three groups: (1) Sham-operation (S) group, (2) SAP group, and (3) LMWH treatment (LMWH) group. LMWH was administrated 4 h after the SAP model conducted. The levels of serum amylase, myelin basic protein (MBP), tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), brain water content, occurrence of apoptosis, and pathological changes of pancreas and brain were measured at 1 day after models were set up in the SAP and S groups, and 1 day after LMWH treatment was administrated in the LMWH group. RESULTS:(1) The levels of serum amylase, TNF-α, and IL-6 in the SAP group were increased significantly more than those in the S and LMWH groups (all P < 0.001), as were the levels of serum MBP in the SAP group compared to those in the S and LMWH groups (P < 0.01, <0.05 respectively). However, while the level of serum amylase and IL-6 in the LMWH group were significantly increased compared to those in the S group (P < 0.05, <0.001 respectively), the levels of TNF-α and MBP showed no significant difference between the LMWH and S groups (all P > 0.05). (2) The brain water content in the SAP group was significantly increased compared to the S group and LMWH group (P < 0.01, <0.05 respectively). (3) Neuronal apoptosis, demyelination, and mitochondrial vacuolation in neuronal cells were observed in the SAP group; in contrast, in the LMWH group, significantly lower rates of neuronal apoptosis, demyelination and mitochondrial edema were observed in neuronal cells. CONCLUSIONS:The protective effect of LMWH on PE progression in SAP rats might result from inhibition of inflammatory activation and reduction of the occurrence of neuronal apoptosis.

OBJECTIVE:To investigate the simultaneous inhibition of X-linked inhibitor of apoptosis protein (XIAP) and survivin expression on epithelial-mesenchymal transition (EMT) and invasiion of pancreatic cancer cells Panc-1, and its mechanism.METHODS:On the established human pancreatic cancer cells Panc-1-XS, the expression of XIAP and survivin was inhibited simultaneously. Cell invasion and migration were detected by Transwell chamber experiments and scratch test, and the expression of epithelial marker E-cadherin, mesenchymal markers Slug, phosphatase and tensin homolog deleted on chromosome ten (PTEN) and P-Akt protein was determined by Western blot.RESULTS:Cell invasion and migration of Panc-1-XS cells decreased significantly, accompanied by significantly upregulated protein expression of E-cadherin, and significantly declined protein expression of the Slug, indicating increased mesenchymal-epithelial conversion (MET); and increased protein expression of PTEN, and declined protein expression of P-Akt.CONCLUSION:Simultaneously inhibiting the expression of XIAP and survivin can partially reverse EMT phenotype of pancreatic cancer Panc-1 cells, which then significantly reduces the cell invasion and migration of Panc-1 cell lines. This process may be regulated by PTEN/PI3K/Akt signaling pathway.

Cystic tumors of the pancreas are relatively rare,and are often misdiagnosed or neglected in clinical practice due to slow growth,deep location and the lack of typical symptoms and signs.With the development of pancreatic surgery and imaging techniques in recent years,as well as the continued investigation of pancreatic cystic tumors,considerable progress has been achieved in this field.These have promoted the early detection,treatment planning,and choice of surgical procedure and estimating the prognosis for pancreatic cystic tumors.This paper reviews the advances in clinical diagnosis and treatment of these diseases.

Objective To invesigate the effects of endovascular therapy on brachiocephalic pseudoaneurysm(BCPA) and carotid arteriovenous fistula(CVEF).Methods The clinical data of 7 patients with BCPA and 3 patients with CAVF,admitted to our department from September 2003 to March 2011,were analysed.Durations of the diseases ranged from 2 h to 40 years.The causes of pseudoaneurysm were traumatic and iatrogenic injury,of CAVF were 2 cases of congenital CAVF and 1 case of traumatic CAVF.The main clinical manifestation of both was pulsatile mass in the neck or infraclavicular region.Firstly,all patient underwent femoral artery puncture and angiography to identify the natnre,location and size of the lesion.Then,memberane-covered stents were inserted to seal the arterial perforations and repair the vessels.Results Eight cases of pseudoaneurysm or traumatic arteriovenous fistula and 1 case of congenital arteriovenous fistula achieved satisfactory curative effect;another case of congenital arteriovenous fistula was substantially improved as evidenced by the obviously decreased blood flow through the fistula.Conclusions Endovascular treatment with covered stent is a practically valuable method for brachiocephalic pseudoaneurysm and caroted arteriovenous fistula,this technique is simple,rapid,minimally invasive,safe and effective.

BACKGROUND:Non-recurrent laryngeal nerve, a rare anomaly, passes transversely into larynx with or without its recurrent branches directly arising from the vagus nerve. The paper investigates clinical significance of non-recurrent laryngeal nerve during thyroid surgery. Clinical data from 5 cases of non-recurrent laryngeal nerve and related literature reviews were made to acknowledge its incidence, variant types and matters concerned during thyroid operations.CASE REPORT:821 recurrent laryngeal nerves were anatomized during 2496 thyroid operations, from which 5 were confirmed to hold non-recurrent laryngeal nerves (0.61%). 3 patients were found to have non-recurrent laryngeal nerves during re-operation because of voice horse after the first operation which improved much after re-operation. The other two patients were recognized during the first operation. All 5 cases were not diagnosed preoperatively.CONCLUSIONS:Non-recurrent laryngeal nerve, a rare anomaly, is very vulnerable during thyroid surgery. It is helpful to avoid injuring non-recurrent laryngeal nerve that identification of the non-recurrent laryngeal nerve and its types.

Objective To investigate the diagnosis and treatment of thyroid carcinoma,and prevention of surgical complications.Methods Clinical data of 487 cases of thyroid carcinoma in our hospital from March 1990 to July 2006 were analyzed retrospectively.Results Among them,279(57.3%) and 162(33.3%) patients were diagnosed before and during operation respectively,and 46 patients were diagnosed after operation.Reoperation was performed in 140 patients(28.7%) and residual carcinoma was found in 79 patients(56.4%).No hospital deaths occurred in the 487 cases after operation.A total of 17 cases showed temporary vocal cord paralysis,2 cases showed permanent vocal cord paralysis,and 14 cases had convulsion or limb numbness due to hypocalcemia.Follow-up of 413 cases showed cervical lymph node tumor recurrence in 33 patients,local tumor recurrence in 24 patients and remote metastasis in 17 patients.The 5-year survival rate after operation of differentiated,medullary and undifferentiated thyroid carcinoma was 99.8%,95.8% and 87.0%,respectively.Conclusions The thyroid nodule with calcification should be considered to be thyroid carcinoma,and intra-operative frozen section is helpful for the diagnosis and the choice of operative method.The first thyroid operation should not be taken lightly.Patients should take thyroxine tablets for prophylaxis of tumor recurrence and metastasis.

Objective To investigate the clinicopathological features,surgical treatment and prognosis of incidental gallbladder carcinoma(IGC).Methods The clinical data of 37 IGC cases admitted to our hospital were retrospectively analysed,and the data were compared with other gallbalder carcinoma cases(GC group) admited over the same period of time.Results In both IGC and GC groups,the main symptom was abdominal pain located in the upper right quadrant(94.6% vs.93.3%) and some patients had jaundice(16.2% vs.31.5%).There were no significant differences between the two groups in several aspects,such as age(56±12 vs.57±9),proportion of female patients(78.4% vs.62.9%),positive ratio of CEA(25% vs.32.8%)and CA19-9(30% vs.68.3%),tumor location,pathological type,pathological grade,and postoperative complication rate(2.7% vs.6.7%)(All P>0.05).However,the percentage of patients with cholecystolithiassis was 86.5% in IGC group,and 50.6% in GC group(P=0.000).Besides the percentage of IA stage in IGC group(29.7%) was relatively higher than that(9.0%)in GC group(P=0.03);the surgical resection rate of tumor in IGC group was 56.8% and 32.6% in GC group(P=0.01).Nevertheless,the percentage of advance stage in IGC group(43.2%) was relatively lower than that in GC group(74.2%)(P=0.001).The overall 1,3,and 5-year survival rate of IGC group was 70.0%,31.2% and 26.8% repectively,and the mean survival time was17 months(51±13);which were significantly higher than those in GC group,in which the 1,3,5-year survival rate was 27.0%,17.7% and 15.1% repectively and the mean survival time was(25±8),5 months(all P=0.006).Single factor analysis showed that the survival time in IGC patients was influenced by the TNM stage(P=0.000),pT-category(P=0.000),operation-category(P=0.008);however,postoperative pathological grade(P=0.080),age(P=0.188) and sex(P=0.234) had no influence on survival rate.According to multivariate analysis,pT-category(P=0.000)was an independent factor for the survival time of IGC.Conclusions Comparing with GC group,IGC has a higher percentage of cholecystolithiassis,IA tumor stage and surgical resection rate,and thus,it has relatively better progonosis.pT-category is the vital independent prognostic factor in IGC.If a patient in ICG has been misdiagnosed during the primary operation,the patient should be re-operated for radical excision as soon as possible,except when the tumor is in stage Tis or T1a.

OBJECTIVE:To study the effect of lower-molecular weight heparin in the prevention of pancreatic encephalopathy (PE) in the patient with severe acute pancreatitis (SAP).METHODS:Two hundred sixty-five SAP patients were randomly divided into 2 groups: (1) conventional treatment group (C group, n = 130) and (2) conventional treatment plus lower-molecular weight heparin treatment group (LT group, n = 135). The clinical parameters, laboratory parameters and computed tomographic (CT) score of pancreatic necrosis (CTSPN), incidence of PE, and mortality in the 2 groups were compared.RESULTS:On admission, all the clinical parameters, laboratory parameters, and CTSPN in the 2 groups were not significantly different (P > 0.05). However, 1 to 2 weeks after treatment, the symptoms and signs improvement rate, the levels of blood and urine amylase, the CT score, and the Acute Physiology and Chronic Health Evaluation II score in the LT group were obviously lower than those in the C group (P < 0.05-0.01), and PE occurrence rate, mortality, and mean hospital stay in LT group were obviously lower than those in the C group (P < 0.05-0.01).CONCLUSIONS:Lower-molecular weight heparin can enhance the effect of conventional treatment of SAP and can markedly decrease the PE incidence and improve the survival rate of SAP. Lower-molecular weight heparin is a simple, safe, less expensive, and effective method for treatment of SAP. It can be used in every hospital.

Objective To explore the methods to prevent small-for-size syndrome(SFSS) in adult-to-adult living-related liver transplantation(A-A LDLT).Methods The clinical data of 6 cases of A-A LDLT performed in our hospital between February 2007 to October 2008 were retrospectively analyzed,including blood cell count,spleen thickness,diameter of portal vein in recipients before operation,graft recipient body weight ratio(GRWR),graft volume and standard liver volume ratio of receptor(GV/SLV),and hepatic vein reconstruction.ResultsOf the six grafts,the GV/SLV was more than 40%,the GRWR was always above 0.8% except one case was 0.74%.All the recipient grafts had good hepatic vein reconstruction,with no congestion in the grafts;of the six recipients no severe portal hypertension was observed,and no SFSS occurred in the six cases.Conclusions The occurrence of SFSS can be prevented by selecting the appropriate graft size,adequate venous blood drainage through hepatic veins,and control of the portal pressure.

Objective To investigate the clinical features,diagnosis and treatment of nonfunctioning islet cell tumors(NFIT).Methods The clinical data of 23 patients with NFIT,who were admitted to our hospital from Jan.2002 to Dec.2008,were retrospectively studied.Results The main clinical manifestations of NFIT included abdominal mass,abdominal pain and distension and obstructive jaundice.The diagnoses of pancreatic tumors were confirmed by imaging studies including ultrasonography,CT and MRI.The average diameterof the tumors was 9.5cm.Pancreaticoduodenectomy was performed in 47.8%(11/23),resection of pancreatic body and tail together with spleen was performed in 21.7%(5/23),and other procedures were performed in 31.5%(7/23) of patients.Tumors were malignant in 13.0%(3/23) and benign in 87.0%(20/23) according to postoperative pathology.The major postoperative complication was pancreatic fistula(13.0%),and it healed by nonoperative therapies in all of the cases.One of 3 patients with malignantNFIT died within 1 year after operation,while the other 2 had survived,without tumor recurrence,for 29 months and 8 months respectively on follow-up.Seventeen patients with benign NFIT had survived for 1 to 7 years on follow-up.Conclusions The diagnosis of NFIT should be based on clinical manifestations,lab data,imaging study findings,intraoperative exploration and postoperative pathology.The prognosis of surgicaltreatment is good.

肝细胞移植为肝衰竭提供了一种全新的治疗策略,成为急、慢性肝衰竭患者等待肝源向肝移植过渡的有效方法 .目前,肝细胞移植存在的主要问题是肝细胞来源紧缺,而如何利用临床上大量的人肝外科切除标本,从中有效获取高质量的成人肝细胞,用于临床研究及治疗,将是今后肝细胞移植的一个重要发展趋势.

OBJECTIVE:To study the effect of low molecular weight heparin (LMWH) in the treatment of severe acute pancreatitis (SAP). METHODS:A total of 265 SAP patients were randomly divided into two groups: firstly, the conventional treatment group (C group, n = 130; and secondly the conventional treatment plus the LMWH treatment group (LT group, n = 135). The clinical parameters, laboratory parameters and computed tomography (CT) score of pancreatic necrosis (CTSPN) in the two groups were compared. RESULTS:On admission, all the clinical parameters, laboratory parameters and CTSPN in the two groups were not significantly different (p > 0.05). However, after treatment, in LT group, the clinical presentation improvement rate and laboratory parameters improvement were significantly higher than those in C group (p < 0.05-0.01), and the acute physiology and chronic health evaluation (APACHE) II score, complication rate, mortality and mean hospital stay in LT group were obviously lower than those in C group (p < 0.05-0.01). The CT score in LT group was much lower than that in C group (p < 0.05). Two weeks after treatment FBI decreased obviously in C group, but not in LT group, and no haemorrhagic complications occurred. CONCLUSIONS:LMWH can enhance the effect of conventional treatment for SAP, and can markedly decrease the mortality of SAP. LMWH is a simple, safe, economic and effective method for treatment of SAP. It is can be used in every hospital.

目的改进腹主动脉瘤切除术中自体血管与人造血管吻合口技术。方法剪切人造血管一小段制成环状戒指戴在吻合口上防止吻合口渗血和假性动脉瘤形成。结果10例采用该方法手术者,手术时间和失血量明显少于此前的3 7例同类手术。结论腹主动脉瘤切除术中采用吻合口戴戒术是一种止血确切的方法,且能有效防止手术后吻合口的动脉瘤发生。

Objective To explore the mechanism of LMWH therapy for SAP.Methods 48 wistar rats were random divided into 3 groups,sham group(S group),severe acute pancreatitis group(SAP group)and LMWH therapy group(H group).Serum amylase,IL-6,acinar cell apoptosis and the activity of NF-κB were detected and compared.Results The expression of amylase and IL-6 in SAP group was significantly higher than that in H group(P＜0.01).The apoptosis index of acinar cell in SAP group wag significantly lower than that in H group(P＜0.01),while the activity of NF-κB in SAP groupwas stronger than that in H group.Conclusions LMWH therapy may ameliorate SAP by inducing acinar cell apoptosis through suppressing the activity of NF-κB.

Objective To comparatively study the treatment effects of three surgical approaches for saphenous vein varicosity.Methods During the past 5 years,180 cases of saphenous vein varicosity were treated by new stripper,traditional stripper,laser or radio-frequency respectively each group had 60 cases.The time of surgery,amount of bleeding,hospitalization fee,mean length of hospital stay and postoperative of complications of the 3 group were compared.Results Time of surgery and amount of bleeding were less with new stripper than that with traditional stripper(P0.01),hospitalization fee and mean length of hospital stay were similar.Time of surgery and hospitalization fee were also less with new stripper than that with laser or radio-frequency(P0.01),but amount of bleeding was more with new stripper and mean length of hospital stay was similar.Postoperative complication rate was similar in the three groups.Conclusions The therapeutic effect of surgery for saphenous vein varicosity with new stripper was better than that with traditional stripper,and as good as surgery with laser or radio-frequency,treatment.

Objective To explore the role of apoptosis and the expression of X-linked inhibitor of apoptosis protein(XIAP) in polymorphonuclear neutrophils(PMNs) during acute pancreatitis(AP).Methods Blood from normal control(NC,n=15),mild acute pancreatitis(MAP,n=15) and severe acute pancreatitis(SAP,n=15) were collected.PMNs apoptosis was detected by flow cytometry.PMNs were isolated from each group and XIAPmRNA and protein levels were assessed by RT-PCR and Western Blotting.Results PMNs apoptosis in SAP group was(2.15±0.40)%,MAP group was(4.16±0.14)%,NC group was(4.31±0.12)%.PMNs apoptosis rate in SAP and MAP groups was decreased compared to NC group(P<0.05),in SAP group was markedly decreased compared to MAP group(P<0.01).The expression of XIAP in SAP and MAP groups was increased as compared to NC group(P<0.01),and XIAP expressed in SAP was markedly increased compared to MAP group(P<0.01).Conclusions XIAP may contribute to the severity of acute pancreatitis through suppression of apoptosis of PMNs.

乙型肝炎病毒感染是原发性肝细胞癌的重要诱因,然而其具体致癌机制仍不清楚。近年来研究显示,乙型肝炎病毒X蛋白具有反式激活癌基因、调节细胞信号通路、抑制细胞凋亡、促进细胞增殖和保肝癌细胞侵袭转移等多种功能,在肝细胞癌发生、发展过程中发挥着重要作用。笔者就乙型肝炎病毒X蛋白的致癌机制研究进展进行综述。

Objective To compare the therapeutic effect of endovascular repair(EVAR) and open surgical repair(OSR) of abdominal aortic aneurysm,and discuss how to select a proper time and method of operation.Methods The clinical data of fifty-one patients with infrarenal abdominal aortic aneurysm who received surgical treatment in the recent four years were analyzed.The perioperative and short term advantages and disadvantages of OSR group(n=37) were compared with EVAR group(n=14).Results Compared to OSR group,the EVAR group had shorter time of operation and intensive care(P0.05),and shorter hospital stay after operation(P0.01),but the cost of hospitalization was far higher than that of OSR group[(137 000±47 000) vs.(34 000±7 000)].There was no statistically significant difference in short term postoperative complications between the two groups.Conclusions EVAR is safer and less traumatic method than OSR,and patients can recover more rapidly.But the cost of hospitalization of EVAR remains too exorbitant.Large randomized controlled trial is necessary to validate the long term effects of EVAR.

目的探讨门静脉高压症术后并发症的发生原因及其防治要点。方法回顾性分析近10年收治的810例门静脉高压症患者的临床资料。结果全组共发生术后并发症169例,发生率为20.9%。影响术后并发症的主要因素有:手术时机、肝功能分级等。结论减少术后并发症的关键是手术时机和手术方式的个体化选择,规范手术操作,注重围手术期处理,尽量避免急诊手术。