Objective To evaluate the effect of p reoperative regional intra-arterial infusion chemotherapy on the prognosis of a dvanced gastric cancer. Methods The clinical data of 80 patients who u nderwent curative resection for advanced gastric cancers were summarized.Among t hem,33 patients carried out preoperative regional intra-arterial infusion chemo therapy were as the interventional chemotherapy group,and the remaining 47 patie nts were the control group.Eleven factors including clinical and pathological da ta,treatment procedures and molecular biological makers that contributed to the long-term survival rate were analyzed by Cox multivariate regression analysis.Results The 5-year survival rate of the interv entional group was 59.3%,and the control group 47.6% .There was significant difference between two groups ( P

Objective To investigate the endoscopic diagnosis and therapy for patient with relapsing pancreatitis after cholecystectomy. Methods The clinical data of 21 patients with relapsing pancreatitis after cholecystectomy underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) were analyzed. Results Nineteen out of 21 patients were diagnosed as sphincter of Oddi dysfunction (SOD), and remaining 2 patients as choledocholith iasis. The treatment outcome of EST for the 21 patients in short-term after EST was satisfactory, and there was no complication of EST. Conclusions ERCP has a great value in the diagnosis of the cause of relapsing pancreatitis after cholecystectomy.The treatment of EST for patients with relapsing pancreatitis after cholecystectomy is safe and effective.

Objective To explore the expression and clinical significance of Twist. E-cadherin and N-cadherin in gallbladder carcinoma. Methods From 2000 to 2008, in Zhejiang Provincial People's Hospital, the expression of Twist, E-cadherin and N-cadherin protein were detected in 79 surgically removed gallbladder carcinoma tissue specimens in paraffin blocks and 20 normal gallbladder tissue specimens by tissue microarray technique and immunohistochemistry. Results Compared with normal gallbladder tissues, the expression of Twist and N-cadherin was up-regulated in gallbladder carcinoma tissues and the positive percentage was 68.3％ and 49.4％ respectively, while which both were 1/20 in normal gallbladder tissues. The percentage of high E-cadherin expression in gallbladder carcinoma tissues was only 27.8 ％, which was significantly lower than that in normal gallbladder tissues (20/20;X2 ＝29.31, P＜0. 05). The expression of Twist was correlated with T classification, lymph node metastasis, distant organ metastasis, hepatoduodenal ligament invasion, lymphatic invasion and UICC stage of gallbladder carcinoma (P＜0.05). The expression of E-cadherin was correlated with T classification, distant organ metastasis, hepatoduodenal ligament invasion, differentiation degree and UICC stage of gallbladder carcinoma (P＜0.05). The expression of N-cadherin was only correlated with lymphatic invasion of gallbladder carcinoma (P ＜0.05 ). There was significant negative correlation between Twist and E-cadherin expression (P＜0. 01). All the 79 gallbladder carcinoma patients were followed up after the surgery, the mean follow-up time was 30.6±14.3months. The 3-year survival rates of patients with low or high Twist expressions were 66％ and 7％ respectively,there was significant difference between the two groups(P＜0. 01). The 3-year survival rates of patients with low or high E-cadherin expressions were 25 ％ and 86 ％ respectively, the difference of two groups was significant(P＜0.01). The 3-year survival rates of patients with low or high Ncadherin expressions were 39％ and 41％ respectively, there was no significant difference between the two groups(P＞0.05). The multivariate analysis indicated that the Twist expression was one of independent prognostic factors of gallbladder carcinoma. Conclusion The abnormal expression of Twist and E-cadherin was correlated with the development and progression of gallbladder carcinoma,and Twist expression was one of the independent prognostic factors of gallbladder carcinoma.

0.05). The time for fever reduced to normal level and for abscesses disappeared in Group A were significantly shorter than those in Group B(all P

Objective To explore the cause of and treatment for superior mesenteric artery syndrome (SMAS). Methods Clinical data of 21 patients from 1992 to 2002 with SMAS were analyzed retrospectively. Results Three cases of SMAS recovered with nonoperative treatments, eighteen recovered after surgical therapy including lysis and downward movement of the ligament of Treitz and extensive mobilization of the duodenum in 4 cases (Type Ⅰ), lysis and Roux-en-Y duodenojejunostomy in 9 cases (Type Ⅱ), side to side duodenojejunostomy in one (Type Ⅲ), and Billroth-Ⅱ gastrectomy in 2 cases (Type Ⅳ), and anterior side to side duodenojejunostomy or Roux-en-Y reconstruction in 2 cases (Type Ⅴ). Conclusion Correct diagnosis and appropriate surgery for SMAS lead to satisfactory outcomes.

Objective To assess the effect of three different liver vascular exclusions on prognosis of patients undergoing hemihepatectomy.Methods Clinical data of 216 patients undergoing hemihepatectomy were analyzed retrospectively.Ninety-eight out of 216 patients received Pringle maneuver during hepatectomy in group A,71 patients of selective liver inflow and outflow vascular exclusions in group B,47 patients using liver hanging maneuver combining with selective liver inflow and outflow vascular exclusions were in group C.Results There was no difference in operation time between the three groups ( t =0.72,0.83,and 0.67,P ＞ 0.05 ).The intraoperative blood loss and transfusion in group B and C were less than that in group A (t =3.72,3.83 and 4.11,4.07,P ＜0.05).Serum albumin level on day 1 and day 3 in group B and C were higher than that in group A (t =3.65,3.77,and 3.90,3.74,P ＜0.05 ).Serum total bilirubin level on day 3 and 5 in group B and C were lower than that in group A ( t =4.13,5.01,and 4.09,3.99,P ＜0.05).Serum alanine aminotransferase on day 1,3 and 5 in group B and C were lower than that in group A ( t =5.36,6.14,and 5.70,7.01,and 4.94,3.98,P ＜ 0.05 ).Postoperative complication rate in group A was higher than that in group B and C ( x2 =13.71 and 23.56,P ＜ 0.05 ).The 3-year survival rate of patients with malignant tumor in the three groups were not significantly different (t =2.38,P ＞ 0.05 ).Conclusions Intraoperative blood loss and transfusion and postoperative complication rate can be reduced,and liver injury can be diminished in hemihepatectomy using selective liver inflow and outflow vascular exclusion alone and or in combination with a liver hanging maneuver.

Objective To evaluate the clinical significance of re operation for postoperative recurrent gastric carcinoma. Methods From 1986 to 2001, fifty one patients with postoperative local recurrence of gastric carcinoma were admitted into our hospital. The clinical data were analyzed retrospectively. Results Of 51 cases, there were 31 cases with recurrence within the stump stomach and 20 with local and metastatic recurrence. Twenty seven cases were treated by radical resection, 3 cases by palliative residual stomach resection, 15 cases by gastrojejunostomy or gastroenterostomy, 6 cases by simple exploration. Pathological examination of 30 cases revealed perianastomosis recurrence in 10 cases, stump stomach carcinoma in 20 cases. The 1,3,5 year survival rate of 27 cases after radical resection was 88%, 58%, 19% respectively. The survival time of palliative and comprehensive treatment group was 6 to 24 months and mean survival time was 16 months, while all patients undergoing simple exploration and abdominal cavity chemotherapy died after 2 to 7 months. Conclusion Most postoperative recurrent gastric carcinoma are within the residual stomach and hence could be treated by reoperative resection.

Objective To observe the effects of total flavone from litchi chinensis sonn (TFL) on the liver function in-cluding p16 protein, pro collagen type 3 (PC3) and pro collagen typeⅠ(PCⅠ) in model rats with liver fibrosis induced by bile duct ligation. Methods Forty rats were randomly divided into four groups:sham operation (SO) group, bile duct liga-tion (BDL) group, TFL group and silibinin (SIL) group. Rats were gavaged with saline (5 mL·kg-1·d-1) in SO and BDL group, rats were gavaged with TFL (200 mL·kg-1·d-1) in TFL group and rats were gavaged with SIL (5 mL·kg-1·d-1) in SIL group for four weeks. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin direct (BILD) and bilirubin total (BILT) were detected in four groups. The liver tissues were stained by HE and Masson methods. The ex-pression levels of p16, PC3 and PCⅠin liver tissues were determined by Western blot assay. Results The serum levels of ALT (44.6 IU/L±8.0 IU/L), AST (103.8 IU/L±18.1 IU/L), BILD (0.76 μmol/L±0.28μmol/L) and BILT (1.48μmol/L±0.35μmol/L) were lower in SO group. There was a higher level of ALT in BDL group (147.4 IU/L±86.3 IU/L) than that of TFL group (92.9 IU/L±47.3 IU/L). The serum level of ALT was higher in AST group (362.7 IU/L±106.6 IU/L) than that of TFL group (290.1 IU/L ± 171.7 IU/L) and SIL group (250.2 IU/L ± 54.9 IU/L). The serum level of BILD was lower in BDL group (99.71μmol/L±40.87μmol/L) than that of SIL group (137.01μmol/L±38.86μmol/L). The serum levels of BILD and BILT were significantly lower in TFL group (81.48μmol/L±47.50μmol/L, 106.64μmol/L±61.04μmol/L) than those of SIL group (P<0.05). There were small amount of new bile duct and no obvious cells degeneration, small amount of infiltration of in-flammatory cells and collagen deposition in TFL group. The liver fibrosis improved significantly in TFL group than that of BDL group. There were more new bile duct in hepatic portal area in SIL group than those of TFL group. The expression levels of p16, PC3 and PCⅠwere significantly higher in BDL group than those of TFL group. The expression level of PC3 was significantly lower in BDL group than that of SIL group. The expression level of PCⅠwas significantly higher in BDL group than that of SIL group (P<0.05). There was no significant difference in the expression level of p16 between BDL group and SIL group. The expression levels of PC16 and PC3 were significantly lower in TFL group than those of SIL group (P<0.05). There was no significant difference in the ex-pression level of PCⅠbetween TFL group and SIL group. Conclusion TFL can improve the liver function in model rats with choles-tatic liver fibrosis and reduce liver fibrosis, which may be related with inhibitory effects on the expressions of p 16, PC3 and PCⅠ.

Objective To study the causes of and management for reoperative surgery in patients of congenital choledochal cyst. Methods The clinical data of 41 patients of congenital choledochal cysts undergoing reoperative surgeries were reviewed. Results There were 32 cases of type Ⅰ , 1 of type Ⅱ ,3 of type Ⅳ, and 5 of type Ⅴ according to Todani classification of congenital choledochal cyst. Thirty patients experienced one previous biliary tract surgery, 8 had a history of 2 surgeries and 3 experienced three times of operations previously. Among the 41 patients, 40 presented bile duct stones, 33 suffered from biliary infections, 7 had hilar hepatic duct strictures, 6 had strictures of previous hepatoenteric anastomosis, 5 had carcinomas arising in cysts. The reoperative surgeries for the 41 patients consisted of excisions of extre-hepatic bile cyst and hepato-jejunal anastomosis by Roux-Y fashion (combining with hepatoduodenal ligament dissection and regional lymphadenectomy for two patients with cholangiocarcinoma) in 32 cases, hepatectomies combined with excisions of choledochal cyst and hepato-jejunal anastomosis in 8 cases, reconstruction of hepatoenteric anastomosis by excision of stenosis in one. All patients were followed up with mean time of 53. 7 ± 32. 1 months, ranging from 3 months to 10 years. Intermittent biliary infection was experienced in 4 cases during follow-up period, and there was no anastomotic stricture and stone recurrence. Conclusion The main causes of reoperation for congenital choledochal cyst patients with a history of previous surgery are complications arising from incorrect surgical procedure and misdiagnosis. Complete excision of extra hepatic bile cyst combined with Roux-en-Y hepatojejunal anastomosis benefits patients who had a failed previous surgery.

Objective To evaluate hepatic vein exclusion (HVE) outside the liver in the resection of giant hepatic hemangioma near the second hepatic hilum. Methods From January 2003 to December 2009, giant hepatic hemangiomas near the second hepatic hilum were resected in 19 cases. Preoperatively 19 cases were divided into two groups: HVE group (9 cases) and IVE group ( 10 cases). Data regarding the intra-operative and postoperative courses of the patients were analyzed. Results There was no difference between the 2 groups regarding the age, sex and tumor size. No damage of hepatic vein was happened in HVE group. Resection of the hemangioma was applied in all cases of HVE group, and 1 case in IVE group had right hemi-hepatectomy. Hepatic veins rupture occurred in 4 cases in IVE group and 2 cases of them had massive bleeding, while in HVE group hepatic veins rupture occurred in 5 cases but no massive bleeding occurred. Intra-operative blood loss was significantly less in HVE group than IVE group. The serum ALT value in postoperative day 1 and total bilirubin in postoperative day 3 in HVE group was significantly lower than that of the IVE group. The mean drainage volume in HVE group was significantly less than that of the IVE group on postoperative day 1 and day 2. The total cost of patient in HVE group were significant less than in IVE group. Conclusions The use of hepatic vein exclusion reduces the risk in the resection of giant hepatic hemangioma near the second hepatic hilum.