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.

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.

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 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 evaluate the result of multiple segmentectomy under selective occlusion of hepatic inflow for complicated intrahepatic cholangiolithiasis. Methods In this study 12 cases of complicated intrahepatic cholangiolithiasis receiving multiple segmentectomy under selective occlusion of hepatic inflow during 2004. 1 - 2010. 10 were reviewed retrospectively. The short-term and long-term outcomes of the patients were analyzed. Results There was no surgical mortality in this group. The segmentectomy performed were Ⅱ + Ⅲ + Ⅴ in 1 case; Ⅱ + Ⅲ + Ⅵ in 2 cases; Ⅱ + Ⅲ + Ⅴ + Ⅵ in 1 case;Ⅱ +Ⅲ+Ⅵ +Ⅶ in4 cases; Ⅱ +Ⅲ +Ⅳ +Ⅵ in 3 cases and Ⅱ + Ⅲ +Ⅳ +Ⅵ +Ⅶ in 1 case. The average intraoperative blood loss was 560 ± 291 ml. Postoperative complications were wound infection in 2 cases, bile leakage in 1 case, abdominal infection in 1 case. There were no liver failure, intrabdominal hemorrhage or hemobilia; stone clearance rate at 10 days after operation was 83% (10/12) and 92%(11/12) at 6 weeks after operation following postoperative choledochoscopic lithotripsy. 92% (11/12) cases were followed-up with the median follow-up period of 31 months. The result was excellent or good in 92% (11/12) cases. Conclusions Multiple segmentectomy was the choice for complicated intrahepatic cholangiolithasis, and the procedure could be safely performed under selective occlusion of the hepatic inflow.

Objective To evaluate right hepatic veins exclusion in the prevention of massive bleeding and air embolism during the resection of huge hepatic cavernous hemangioma near the second hepatic portal. Method This is a retrospective study on the clinical data of 12 hepatic hemangioma patients at the Live Surgery Department of Zhejiang Provincial People's Hospital from 2004. 1 to 2010.3. In all patients the huge hepatic cavernous hemangioma was adjoining the second hepatic portal. Block webbing or vascular clamp were used to exclude the right hepatic veins. Among the 11 patients without hepatic cirrhosis Pringle maneuvre was applied in 5 cases and selective hepatic inflow occlusion in 6 cases. Patients with hepatic cirrhosis used hemi-hepatic blood inflow occlusion. Results During the surgery no rupture of right hepatic vein happened. Nine patients used vascular block webbing and 3 patients used vascular clamp.Six patients without cirrhosis used the complete hepatic inflow occlusion and other patients without cirrhosis used hemi-hepatic blood inflow occlusion. Cirrhotic patients used hemi-hepatic blood inflow occlusion. All the operations were successful. Intraoperative blood loss ranged from 200 - 5800 ml, averaging 680 ml. Three patients needed not blood transfusion. There was no right hepatic vein rupture or air embolism. Conclusion Right hepatic veins exclusion is a useful technique to prevent massive bleeding and air embolism caused by the rupture of right hepatic vein during the resection of huge hepatic cavernous hemangioma.

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.