Objective To investigate the role of individualized and staged enteral nutrition in the treatment of severe acute pancreatitis(SAP).Methods The clinical data of 204 cases of SAP treated with individualized stage enteral nutrition in our hospital from January 2000 to March 2008 were retro-spectively analyzed, Results The liver function and serum lipid and diet returned to the normal level after the treatment.Pancreatic encephalopathy disappeared.The patients recovered and were dis-charged from the hospital with the extraction of feeding tube.Enteral nutrition was adjusted based on the monitoring results in the hospitalization period that brought less effect to the pseudocyst of pancre-as, and then discharged from the hospital with the feeding tube.The pseudocyst in 49 cases disap-peared spontaneously and it was cured with internal drainage for 3 months in other 32.The time of en-teral nutrition was 20-95 d.Conclusion Enteral nutrition is safe and necessary after the acute stage of SAP.To ensure the enteral nutrition to play a more important role in the treatment of SAP, we must pay more attention on the individualization and stage of enteral nutrition.

Objective To improve the management of blunt pancreatic trauma, and to explore the strategy of preserving the pancreatic endocrine and exocrine function to the full extent. Methods 20 cases of blunt pancreatic trauma were reviewed and analyzed retrospectively. The methods of operative treatment were analysed. Results All patients were cured. Depending on the general condition, abnomial signs and main pancreatic duct(MPD) injuries at the time of admission, patients received immediate operation or nonoperative treatment. Because of severe peritonitis and demonstrated MPD injury, 10 patients underwent immediate operations, including simple drainage in 6 cases, distal pancreatectomy in 1 patient, external drainage of the injured pancreatic duct for the second operation in 3 cases. Without the demonstrated MPD injury or clinical deterioration, 10 patients received nonoperative treatment under strict observation initially. 3 patients completed the nonoperative course and 7 patients underwent delayed operations, including Roux-en-Y pancreatic cyst-jejunostomy in 3 cases, external drainage of pseudocyst in e cases, pancreaticoduodenectomy in 1 patient because of the expanded hematoma in pancreatic head. Conclusions Blunt pancreatic trauma could receive individual pancreas-preserving treatment, which could improve the operational safety, avoid the resection of pancreas and preserve the pancreatic endocrine and exocrine function to the full extent.

Objective To explore the role of IL-1β in capillary leak syndrome by observing the alterations of AQP-1 expression,apoptosis,and ultrastructural of vascular endothelial cells under the action of IL-1β.Methods Umbilical vein endothelial cells (UVEC) in vitro were randomly allocated into 3 groups:time,concentration,and control.In the time group,UVECs were treated with culture medium containing 20 μg/L IL-1β for3 h(T1),8 h(T2),12 h(T3) and 24 h(T4).In the concentration group,UVECs were treated with culture medium containing 0.2 μg/L(C1),2 μg/L(C2) and 20 μg/L(C3) IL-1β for 24 h.In the control group,UVECs were treated with culture medium without IL-1β for 24 h.The changes of AQP-1 mRNA and protein expression were detected by real-time PCR and Western blot.Apoptosis was detected by flow cytometry,and cell ultrastructural changes were observed by electron microscopy.Results AQP-1 mRNA and protein expression of T1-T4 in the time group and C1-C3 in the concentration group were lower than those of the control group (P ＜ 0.05).The apoptotic rate was increased,and mitochondrial swelling,vacuolar degeneration,karyolysis and necrosis were observed under electron microscopy.These were more pronounced with time or concentration increases.Conclusions IL-1β can cause a decrease of AQP-1 mRNA and protein expression,increase in apoptotic rate and increase in damage to the cells'ultrastructure.This is an important reason for damage to the vascular endothelial barrier and may be associated with capillary leak syndrome.

ObjectiveTo evaluate the clinical application of Kugel hernioplasty via anterior approach for inguinal hernia repair.MethodsA retrospective study was made to analyze the clinical data of 851 cases(956 hernias) treated with Kugel hernioplasty via anterior approach for inguinal hernias from November 2005 to May 2011.ResultsOperative duration was(42 ± 11) minutes.The postoperative complications were detected on 21 hernias of seroma,8 hernias of hematoma,12 hernias of sub dermal ecchymosis,26 hernias of foreign body sensation and 5 hernias of recurrence.No incision infection occurred.Conclusions Kugel hernioplasty via anterior approach can repair and strengthen the whole anatomy area of myopectineal orifice.It is available for various kinds of inguinal hernias.

Objective To explore the factors affecting the prognosis of pancreatic cancer patients,using COX risk model to carry on the statistical analysis of 154 cases of pancreatic carcinoma.Methods Retrospectively analyzed 154 pancreatic cancer cases' history date treated in April 2001-April 2008 of Fujian Medical University Union Hospital.Survival rate was caculated by Kaplan-Meier estimation while survival cruve was analysed by Log-rank test.Prognostic factors were studied by multivariate analysis with COX proportional hazards survival model.Results In this group,survival time was from 1 to 106 months and the median survival time was 8 months.Overall survival rates at 6 months,12 months,18 months,36 months were 58.4％,29.2％,16.3％ and 3.7％ respectively.Multivariate revealed that independent prognostic factors were follows:TNM tumor staging,operation mode and synthetic therapy.Conclusions The prognosis of patients with pancreatic carcinoma is determined by multiple factors.Patients of advanced TNM staging have a poorer prognosis.Radical resection and comprehensive treatment of patients prognosis is better.

Objective To evaluate clinical application of Kngel patch in treating recurrent inguinal her-nia. Methods The clinical data of 65 patients with 77 sides recurrent inguinal hernia performed open preperitoneal inguinal hernia repairs from January 2005 to June 2009 were analyzed retrospectively. Kugel hernia patches were used in the operations. Results The operating time for unilateral hernia expended 40 ～ 150(76.5±20. 4) min. Postoperative pain was minimal and no incision infection appeared. The postopera-tive complications were 4 cases of uroschesis,6 cases of inguinoscrotal seroma, 2 cases of inguinoscrotal he-matoma and 3 cases of serotal hydrops. No serious complications such as sensation of foreign body, inguinal chronic pain and recurrence were observed during the follow-up of 3 to 54 months. Conclusions Open preperitoneal hernia repair with Kngel patch for adult recurrent inguinal hernia reparation is rational and fea-sible.

Objective To investigate the clinical efficacy of total pancreaticoduodenectomy for the pancreatic head adenocarcinoma with positive neck margin.Methods The clinical data of 15 patients with pancreatic head adenocarcinoma and had positive neck margin who received total pancreaticoduodenectomy at the Union Hospital of Fujian Medical University from August 2009 to May 2014 were retrospectively analyzed.Patients were followed up by out-patient examination or telephone interview till August 2014.Results Total pancreaticoduodenectomy was successfully carried out on the 15 patients.The operation time was 4.0-10.0 hours (mean,6.5 hours),and the volume of blood loss was 300-2 000 mL (mean,800 mL).The duration of postoperative hospital stay was 13.0-35.0 days (mean,22.3 days).The main postoperative complications included pulmonary infection (3 cases),abdominal infection (2 cases)and low blood glucose (2 cases).No interoperative death,bile leakage or gastrointestinal anastomotic fistula occurred.The blood glucose of most of the patients was controlled by insulin or pancreatin.No stomachache,steatorrhea or malnutrition occurred in all the patients.The mean time of postoperative follow-up was 21 months (range,3 months to 5 years).Three patients survived within 1 year,2 survived for 1-2 years,5 survived for more than 2 years and 1 survived for more than 5 years.Four patients with follow-up time under 6 months survived till now.Five patients had liver metastasis at postoperative month 6.Conclusion Total pancreaticoduodenectomy might be necessary for the pancreatic head adenocarcinoma with positive neck margin to achieve R0 resection.

Objective To investigate the correlation between disease severity and pleural effu sion in patients with acute pancreatitis(AP).Methods A retrospective analysis was conducted on a prospectively collected database.The demographic,clinical,and laboratory data of 246 consecutive cases of AP in patients admitted to the Affiliated Union Hospital of Fujian Medical University between January 2008 to December 2012 were reviewed.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and computed tomography severity index (CTSI) were used to evaluate the disease severity of AP.The relationship between the severity and pleural effusion was analyzed.Receiver operator characteristic (ROC) curve was used to compare the values of APACHE Ⅱ score and CTSI in predicting the prognosis of patients with pleural effusion.Results Among the 246 patients,there were 184 patients with pleural effusion and 62 patients without pleural effusion.The incidence of pleu ral effusion in AP was 74.8％.Further study showed that the difference in the incidences of pleural effusion between the severe group and the mild group was significant (P＜0.01).There was a trend that the more serious the patient's condition,the more the pleural effusion.Moreover,the levels of pleural effusion were significantly and positively correlated with the APACHE Ⅱ score (r=0.775,P＜0.01) and CTSI (r=0.525,P＜0.05).Logistic regression analysis showed that the factors significantly associated with pleural effusion formation were a high APACHE Ⅱ score and a high CTSI.Areas under the ROC curve of the APACHE Ⅱ score,CTSI and combined assessment were 0.798,0.687 and 0.812 for predicting mortality of the patients with pleural effusion.Through comparison of the areas under the ROC curve,there was a significant difference between the APACHE Ⅱ score and CTSI as well as combined assessment and CTSI (P＜0.05).Conclusions The disease severity was closely related to pleural effusion in patients with AP.Combining the two scoring systems to evaluate the disease severity and providing active treatment were important to improve the prognosis of patients with pleural effusion.

Objective To investigate the effect of ulinastatin (UTI) on peripheral CD4 + CD25 + Foxp3 + Treg cells in patients with acute pancreatitis (AP).Methods Between October 2014 to August 2016,127 patients with AP including three types of severity (MAP,MSAP,SAP) admitted to the Affiliated Union Hospital of Fujian Medical University consecutively were divided into two groups (the UTI group and control group).UTI was added to patients in UTI group.Treg cells were measured by flow cytometry,and the levels of IL-10 were detected by enzyme-linked immunosorbent assay (ELISA).Results On the third and seventh day,the percentage of Treg in UTI group (MAP:2.72％ ±0.76％,2.26％ ±0.61％;MSAP:3.04％ ±0.74％,4.12％ ± 1.10％;SAP:4.41％ ±0.86％,5.38％ ± 1.13％) were higher than that of control group (MAP:2.08％ ±0.50％,1.83％ ±0.67％;MSAP:2.24％ ±0.89％,3.25％ ±0.70％;SAP:3.35％ ±0.85％,4.56％ ±0.73％),all P ＜0.05.For patients with MAP,the levels of IL-10 in UTI group (48.85 ± 15.46) were higher than control group (37.43 ± 13.36) only on the third day.For patients with MSAP and SAP,the levels of IL-10 in UTI groups (MSAP:32.95 ± 10.72,59.79 ± 20.09;SAP:22.48 ±3.67,30.91 ±8.74) were higher than control groups (MSAP:25.15 ± 10.05,36.66 ± 16.80;SAP:18.73 ±2.69,23.72 ±5.73) both on the third and seventh day (P ＜0.05).The effective ratio of the treatment in UTI groups were higher than control groups (92.2％ vs.79.4％).Conclusions Ulinastatin regulates the immune function and alleviates inflammatory response during AP by inducing the expansion of Treg cells.

Objective: To compare the short-term clinical outcomes and cost differences of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP). Methods: The retrospective descriptive study was adopted.The clinical data of 158 patients underwent minimally invasive distal pancreatectomy who were admitted to Fujian Medical University Union Hospital between January 2016 and July 2018 were collected.A 1∶1 matched propensity score (PSM) analysis was performed for the RDP group and the LDP group.Observed indexes included operative time, blood loss, spleen-preserving rate, postoperative hospital stay, morbidity, incidence of pancreatic fistula and hospital costs. T test or rank sum test was used to compare measurement data, χ² test or Fisher exact test was used to compare count data. Results: A well-balanced cohort of 41 patients was analyzed.There were 14 males and 27 females in the RDP group, aged (45.2±16.4)years. There were 15 males and 26 females in the LDP group, aged (47.4±14.9) years.The operation time was (209.7±52.9) minutes for the RDP group and (186.5±56.7) minutes for the LDP group (P=0.073). Median blood loss was less in RDP (50(15-175)ml) compared with LDP (100(50-350)ml) (Z=-2.689, P=0.007). Thirty-eight cases of non-malignant diseases were observed in each group and spleen-preserving rate was higher in RDP (76.3%) compared to LDP(44.7%) (χ²=7.930, P=0.005).Postoperative hospital stay was similar in the RDP group and the LDP group (RDP: 9.4 days vs. LDP: 10.6 days; P=0.372). The overall morbidity and incidence of pancreatic fistula major complication rates (RDP: 12.2% vs. LDP: 14.6%, P=0.746; RDP: 7.3% vs. LDP: 9.8%, P=1.000) were similar.Total cost of RDP group was higher than that of LDP group ((80 563.7±10 641.8) yuan vs. (57 792.8±8 943.0) yuan, t=4.515, P<0.01). Conclusions Both RDP and LDP are safe and feasible procedures. RDP is more expensive, but RDP is associated with significantly less blood loss and higher spleen-preserving rate, which is more suitable for the non-malignant diseases of pancreatic body and tail with an expectation of splenic preservation.