Cholangiocarcinoma is a type of malignant tumor with high destruction.Due to its low diagnostic rate and high fatality rate,the operation is the unique therapeutic methods for the radical cure.However,the diagnosis and treatment for the disease were always in the phase of progression,so currently,the radical therapeutic rate is quite low,while the recurrence rate of the operation is extremely high.If the correlated mechanism of perineural invasion of cholangiocarcinoma could be understood,then interrupted its perineural invasion in the early period,that could greatly enhance the prognosis of cholangiocarcinoma patients.This article systematically reviews the progress of cholangiocarcinoma neural invasion related molecules and possible mechanism.

OBJECTIVE:To establish the method for the determination of plasma concentration of magnesium isoglycyrrhiz-inate in portal vein and peripheral venous blood of patients underwent liver resection,to further validate and evaluate pharmacoki-netic characteristics,rational and safe use of drugs in the clinic. METHODS:31 patients underwent liver resection in our hospital during Oct. 2014-Mar. 2015 were given magnesium isoglycyrrhizinate intravenously at the beginning of surgery. Portal vein and pe-ripheral venous blood of patients were drawn at 1 hour after drug use,and HPLC-UV detection method was used to determine the plasma concentration of drug. RESULTS:The retention time of isoglycyrrhizinate magnesium was 4.5 min,which showed a good peak shape,and was not interfered with the determination by plasma endogenous peak. The plasma concentration ranged from 0.55 to 55.00 mg/L. The minimum quantitative concentration was 0.55 mg/L. The extraction recoveries were 84.7%-87.1%,and method recoveries were 101.2%-105.4%,and RSDs of intra-day and inter-day were less than 6%. Plasma concentration of magnesium iso-glycyrrhizinate in portal vein blood was significantly higher than in peripheral vein blood of patients underwent liver resection (close to 2 times);and plasma concentration was not affected by primary liver diseases and underlying diseases such as cirrhosis. CONCLUSIONS:The method is simple and has high recovery rate of extraction,high accuracy and high sensitivity. It can meet the needs of pharmacokinetic study. After the application of magnesium isoglycyrrhizinate during liver resection,there is higher blood concentration of magnesium isoglycyrrhizinate in portal vein,which is beneficial to protect liver cells and improve liver func-tion. It is suitable during perioperative period of liver.

Objective To compare the clinical result of Da Vinci robot-assisted distal pancreatectomy(RDP) and laparoscopic distal pancreatectomy(LDP), and to evaluate the clinical application experience of Da Vinci robotassisted spleen-preserving distal pancreatectomy.Methods From March 2013 to June 2015, totally 12 patients undergone RDP and 22 patients undergone LDP in our department were analyzed retrospectively.Results Intraoperative blood loss, hospitalization duration and postoperative fast time in RDP group was less than that in LDP group, the spleen-preserving rate and hospitalization expenses were higher in RDP group(P ＜ 0.05).There was no statistically significant difference in the rate of surgery duration and incidence of postoperative complication between two groups (P ＞ 0.05).The following-up period was 1-28 months with a mean of (9.94 ± 8.99) months, 1 case of peritoneal infection occurred in RDP group, 1 case of survival with tumor recurrence and 3 case suffered peritoneal infection in LDP group.Others were no metastasis, recurrence or death.Conclusions RDP is safe and feasible, the short-term prognosis is better than that of LDP.It has advantages of cleat 3 D visual field, stability in control,less invasive,and quick recovery.It is worth further clinical use.

Objective To investigate the effect of palliative surgical treatment and minimally invasive biliary drainage of hilar cholangiocarcinoma.Methods Retrospectively collected 244 hilar cholangiocarcinoma patients clinical data in Affiliated Hospital of Qiingdao University between Jan.1,2008 to Dec.31,2011.Survival accoding to different treatment methods was compared using Kaplan-Meier method.The continuous measurement data were analyzed using the one-way ANOVA and the U test.The categorical variable were analyzed using the chi-square test or Fisher exact test.Result Among 244 patients, the R1/R2 resection group in 93 patients, the endoscopic retrograde biviar drainage group in 69 patients, the percutaneous transhepatic cholangial drainage group in 82 patiens.Three groups of median survival time and l-, 2-, 3-year survival rate and median survival time were (13.5 months, 8.9 months, 8.6 months), (63.0％, 24.7％, 7.4％), (33.3％, 3.3％, 0), (32.4％,4.2％, 0), respectively.There was significant difference in the survival time between R1/R2-resections and endoscopic retrograde biviary drainage treatments (P ＜ 0.001).R1/R2-resections and percutaneous transhepatic cholangial drainage treatments were statistical differences in survival time (P ＜ 0.001).Endoscopic retrograde biviary drainage and percutaneous transhepatic cholangial drainage treatments were no statistical differences in survival time (P =0.971).Conclusions Palliative surgical treatment for hilar cholangiocarcinoma patients had a more significant effect.Endoscopic retrograde biviary drainage and percutaneous transhepatic cholangial drainage of minimally invasive jaundice reducing method for prognosis in patients with hilar cholangiocarcinoma was same.

Objective To investigate the expression changes of nuclear factor kappa B (NF-?B) and matrix metalloproteinase-9 (MMP-9) in the cultured hepatocellular carcinoma cells 9204 (HCC9204) transfected with inhibitory kappa B alpha(I?B-?)vector. Methods After pcDNA3-I?B-? vector and pcDNA3 were transfected into HCC9204 by lipofectamine method, Western-blot and RT-PCR analysis were used to detect the expressions of NF-?B and MMP-9. Migration and invasion of tumor cells were assayed by fundus membrane invaded by them. Results When pcDNA3-I?B-? was transfected into HCC9204, the expression of NF-?B was decreased at the protein level, and the expression of MMP-9 mRNA and the invision and metastasis ability of transfected cells were obviously decreased. Conclusion When the activity of NF-?B is inhibited, the ability of invasion and metastasis in HCC9204 cells decrease, which could be related to the decreased the expression of MMP-9.

Objective Through studying the apoptosis induced by stichopus japonicus acid mucopoly saccharide in the hepatocellular carcinoma cell line HepG2 in vitro, analysing the expression of Bcl-2 and nm-23in HepG2, to provide the theory foundation and its feasibility on whether it can be used for the chemotherapy of hepetocellular carcinoma. Methods The cells of HepG2 were cultured in vitro and treated with SJAMP at different doses(0.25,0. 5,1.0,2.0,4.0 g/L). MTT was used to observe the inhibitory effects of SJAMP on cell growth, Western blotting was used to detect apoptosis, and the apoptosis related change of expression of protein Bcl-2 and nm23-H1. Results (1) MTT identified that SJAMP produced an obvious time-and-dose-dependent inhibitory effect on the HlepG2 cells. (2) Western blot showed that SJAMP could induce the apoptosis of HepG2 cells through changing the expression of the protein of Bcl-2 and nn23-H1 (P<0.05). Conclusion (1)SJAMP produced obvious inhibitory effects on HepG2 cells and induce HepG2 apoptosis. (2)SJAMP can enduce the anti-tumor function in the method of changing the expression of protein Bcl-2 and nm23-H1.

Objective To explore the experiment condition and method for the application of in vitro in vasive Transwell chamber and to observe muscarinicreceptor stimulant and muscarinicreceptor antagonist's influence to cholangiocarcinoma's invasiveness.Methods Two hundred microliter cell suspension of various concentrations(0.5×105/mL,1.0×105/mL,1.5×105/mL and 2.0×105/mL)was added into the upper chamber of the Transwell chamber,and the cells were allowed to penetrate the matrigel for 12,18,24and 48 hours respectively.The numbers was gotten as the invasive cells on the under surface of the membrane.After optimal cell concentration and time were gotten,pilocarpine of various concentrations(0 mmol/L,0.1 mmol/L,0.3 mmol/L and 0.5 mmoL/L)was added into the upper chamber of the Transwell chamber,then the cells on the matrigel were stained and counted.So did the cells when atropine of various concentrations(0.01 mmol/L,0.01 mmol/L,0.05 mmoVL and 0.1 mmol/L)were added into the upper chamher of the Transwell chamber in according to pilocarpine of various concentrations(0 mmol/L,0.3 mmol/L,0.3 mmol/L and 0.3mmol/L).Results With the increase of the time and cell concentrations，the cells couts that penetrated the matrigel increased，while the increase tended to he stable when the culture time exceeded 36 hous and the cell concentration Was over 1.0×105/mL.By adding pilocarpine,there were significant differences between the control and experimental groups(P＜0.05)，but there were no significant differences in experimental groups with various concentrations.There were no significant differences in blank group and experimental groups with atropine added(P＞0.05).When added pilocarpine and atropine,there were significant differences between blank and experimental groups(P＜0.05)，but there were no significant differences in experimental groups with various concentrations.Conclusions Thirty-six hours as invasive time,and one cell concentration 1.0 × 105/mL were optimal to test invasion abilities of cholangiocarcingma cells to different medicines or reagents.There is the possibility that museariniereceptor exists in cholangiocarcinoma cells，and may play an important role in cholangiocarcinoma's invasiveness and metastasis.

Objective To evaluate the efficacy of fibercholedochoscopy for the removal of residual stones after a surgical choledochostomy. Methods Two hundred and twenty cases of cholelithiasis underwent fibercholedochoscopy through a surgically formed T tube fistulae for residual stones from Sept. 1993 to Feb. 2002. Results A total of 572 times of fibercholedochoscopy was performed with residual stones totally evacuated in 201 cases (91.4%). Complications developed in 84 cases with no mortality. Conclusion Postoperative fibercholedochoscopy through a T tube fistulae is less traumatic and effective remedy for postoperatively retained common bile duct stones.

Objective To compare early enteral with parenteral nutrional support in patients after hepatectomy. Methods In this study, 59 patients were randomized into 2 groups to respectively receive enteral or parenteral nutritional support beginning the first day post-op for a week. The general nutrition condition, liver function, gut function, dosage of albumin, mortality, complication rate and expense were recorded. Results Patients were given same quantity of heat and nitrogen. At the end of the study, serum albumin, body weight and upper arm circumference had not reached the preoperative level in patients receiving enteral mutrition while all except for serum prealbumin had not reached the level in parenterally nutritional patients. Furthermore, the time of gut begins functional (29?12) h in enterally nutritional patients was shorter than in parenterally nutritional patients (38?14) h. Enteral nutrition was more economic than parenteral nutrition (P

ObjectiveTo evaluate the efficacy and feasibility of extraperitoneal approach (EPA) for the resection of primary retroperitoneal tumors (PRT). MethodsForty six cases undergoing resection of PRT were analyzed retrospectively, of which, 26 cases were through transabdominal approach (TAA group) and 20 through EPA. ResultsThe postoperative complications in EPA group was lower than in TAA group (2/20 vs. 11/26, P