Objective To discover the features of biliary obstruction in hepatocellular carcinoma (HCC) and evaluate the effectiveness of therapeutic ERCP in the management of such patients. Methods Two hundred and ninety two patients (male 234 and female 58) suffering from HCC with obstructive jaundice underwent 358 times of ERCPs between May 2000 and March 2003. The mean (SD) age and mean (SD) total serum bilirubin of these patients were 51. 9 ?10. 6 yrs and 232 ? 158?mol/L respectively. The profiles of cholangiographic changes were recorded. Two hundred and sixty cases received treatment under endosco-py. Then therapeutic techniques including sphinclerotomy and debris removal, naso-biliary drainage, plastic or metal stent placement or several procedures in combination were given to all patients except 32 cases in far advanced condition. The body temperature, amount of bile drained and changes in liver function test were observed within two weeks post-procedure and based on these data the therapeutic effectiveness was evaluated. Results According to the features of radiographic finding, five types of biliary obstruction were classified as: type Ⅰ - intrahepatic stricture or occlusion (5.9%); type Ⅱ - perihilar stricture or occlusion (19. 0% ) ; type Ⅲ - extrahepatic stricture or occlusion (18. 4% ) ; type Ⅳ - hilar intraductal tumor em-bolus (49. 4% ) ; and type Ⅴ - intraductal floating tumor debris (7. 3% ) . In 267 patients/times under follow-up, the symptomatic jaundice was improved in 82. 0% of the patients with significant reduction of serum bilirubin in 65. 5%. Conclusion ERCP plays an important role in both diagnosis and palliative management of the HCC patients with obstructive jaundice.

In order to obtain more experience of endoscopic retrograde cholangiopancreatography (ERCP) ,and in this way, more correct diagnosis and much more effective treartment were received ,we studied 1 257 cases of ERCP we had performed in last two years . The results were: In 1 25 7 cases of ERCP,1 229 cases(97. 77% ) were successful and 435 cases (34. 61% ) received treatment. Ninety-four cases received papillotomy and extraction, 309 cases received biliary drainage in therapeutic ERCP. lt in- dicated that the importance of gallbladder visualization and biliary drainage should be emphasised.

Objective To investigate the patterns of mesorectum lymph node (LN) metastases of rectal cancer. Methods Rectal cancer specimens obtained by total mesorectum excision were treated with lymph node revealing solution to retrieve all the nodes, and examined by routine pathology and immunohistochemical staining. Results A total of 443 LN in 26 specimens were harvested, with 128 nodes(28 9%)in 23 cases (88 5%) found positive. Positive nodes with the size less than 5 mm accounted for 59%. Among the 23 metastatic cases, there were 14 cases with tumors locating in the posterior wall, 69 out of 71 positive nodes were found along the superior rectal artery. In the other 9 cases, tumors were found in the lateral wall, 29 out of 57 positive nodes were found around ipsilateral branches of superior rectal artery,7 were around the contralateral branches, 4 were around the ipsilateral branches of middle rectal artery. Conclusions Most positive LN were less than 0 5 cm in diameter. LN metastasis of rectal cancer have close relationship with tumor location. Tumors in the posterior wall tend to spread upward along the superior rectal artery, while tumors in the lateral wall may have upward and lateral LN metastases simultaneously, with most metastatic LN found ipsilaterally.