Objective To evaluate the non-operation treatment of the severe acute pancreatitis(SAP).Methods 218 cases of SAP were analyzed retrospectively.Early operation was adopted before 1998(n=96)and early non-operation treatment was applied after 1998(n=122).Results 25 of 96 cases in operation group died (26.1%),while 9 of 122 cases in non-operation group died(7.4%).The complications was higher than in non-operation group(P＜0.01).Conclusion Early non-operation treatment is necessary for the early stage of SAP.

Objective To evaluate the effect of TILs treatment on postoperative patients with hepatocellular carcinoma (HCC) and the in vitro and in vivo hepatic targeting tendency of a compound of Galactosyl-Anti-CD_3McAb-TILs.Methods Thirty postoperative HCC patients were treated with TILs plus rIL-2. A hepatic targeting carrier, Galactosyl-Anti-mouse-CD_3-monoclonal antibody (Gal-Anti-CD_3-McAb), was synthesized.Result It was found that the peripheral blood level of IL-2 and T cell subset increased in all the 30 patients treated by TILs.24 HCC cases undergoing hepatectomy were treated by TILs therapy, and follow-up of 6 to 48 months found no recurrence. In an murine experiment a combination of TIL & Galactosyl-Anti-CD_3McAb-TIL tended to aggregate in lung while infused from peripheral vein. Its hepatic targeting tendency was unremarkable. Conclusion Postoperative use of TILs increased patients’ antitumor immunity, prolongs the survival, while galactosyl-anti-CD_3McAb-TIL does not show a satisfactory hepatic target tendency.

Objective To compare the efficacies of extended and standard radical pancreatoduodenectomy (RPD) for the treatment of pancreatic cancer in head of pancreas.Methods The clinical data of 96 patients with pancreatic cancer in head of pancreas who were admitted to the West China Hospital of Sichuan University from 2001 to 2011 were retrospectively analyzed.Forty-one patients who received extended RPD were in the extended group and 55 patients who received standard RPD were in the standard group.Blood loss,operation time,hospital stay,surgical complications,severity of complication,1-,3-,5-year survival rate,median survival time,time and location of tumor recurrence and 1-year quality of life of the patients in the 2 groups were compared.All data were analyzed by using rank sum test and analysis of variance.The survival rate was calculated by Kaplan-Meier method and was analyzed by Log-rank test.Results There were no significant differences in the age,diameter and differentiation of the tumor,and number of metastatic lymph nodes between the 2 groups.The operation time,operative blood loss,postoperative hospital stay were 364 minutes (310-650 minutes),680 ml (0-1800 ml) and 13.5 days (10-76 days) in the extended group,which were significantly higher than 315 minutes (260-306 minutes),305 ml (0-1000 ml) and 9.2 days (7-30 days) in the standard group (F=7.15,4.22,3.82,P＜0.05).The incidences of complications in grade 1 and 2 were 5％ (2/41) and 20％ (8/41) in the extended group,which were significantly lower than 25％ ( 14/55 ) and 49％ (27/55) in the standard group ( x2 =5.76,8.87,P ＜ 0.05).The incidence of complications in grade 3a was 41％ ( 17/41 ) in the extended group,which was significantly higher than 7％ (4/55) in the standard group ( x2 =14.10,P ＜ 0.05 ).There were no significant differences in the incidence of complications in grade 3b and 4a between the 2 groups ( x2 =1.44,0.88,P ＞ 0.05 ).There were no significant difference in the 1-,3-,5-year survival rate,median survival time,postoperative quality of life and time of tumor recurrence between the 2 groups ( x2 =0,0.13,0; F =0.49,1.03,t =0.32,P ＞ 0.05 ).Conclusion Standard RPD is optimal for patients with ordinary pancreatic cancer in head of pancreas.Extended RPD could be applied for patients with enlargement of group 16 lymph nodes and could receive R0 resection.

Objective To analyse clinical efficacy of Frey and Bger procedures for chronic pancreatitis. Methods Clinical data of seventy patients of chronic pancreatitis undergoing Frey (32 cases) and Beger Procedures (38 cases) in our hospital from January 1999 to June 2009 were retrospectively analyzed,the rate of pain relief and endocrine and exocrine function of the pancreas in longterm follow-up were compared with each other. Results Overall perioperative morbidity for Frey group and Beger group was 12. 5% and 7.9% respectively (P =0. 52); Total pain relief rate in long-term follow-up was 96. 8% and 94. 7% respectively (P =0. 57). Postoperative de novo diabetes mellitus was 12. 5% and 21% ( x2 = 0. 90, P = 0. 34), Rate of steatorrhea was 12. 5% and 18.6% respectively ( x2 = 0. 15, P =0. 70). Conclusions Frey and Beger procedures were equally effective in improving symptoms of chronic pancreatitis and there were no significant differences in perioperative morbidity, rate of pain relief and function of endocrine and exocrine of the pancreas.

Objectives The study aims were to analyze the clinical features and to explore the management of intrapancreatic pseudocysts after acute pancreatitis.Methods A retrospective study was conducted on 151 patients who received surgical treatment from Dec,2008 to Feb,2012 after acute pancreatitis.Based on CT/MRI findings and clinical data,there were 17 patients with intrapancreatic pseudocysts (11.3％).The clinical manifestations,diagnoses and treatments for these 17 patients were retrospectively analyzed,and the outcome after operations were followed.Results For the 17 patients,obstructive jaundice was present in 3 patients,pancreatic portal hypertension (PPH) in 7,pseudoaneurysm in 2.All 17 patients underwent operation.The surgical procedures included internal drainage (n=8),external drainage (n=5),distal pancreatic resection with splenectomy (n=3),and local resection (n=1).All patients recovered after the operations.Conclusions Intrapancreatic pseudocysts after acute pancreatitis had a high incidence of local complication.The diagnosis of these pseudocysts was difficult.The treatment should be performed early for those patients who had developed complications.

Chronic pancreatitis (CP) is a kind of disease with the sustainable and irreversible damage of the tissue structure and function of pancreas,which may be caused by alcohol,gene,gallstone,metabolism,deformity and other factors.The clinical manifestations are intractable abdominal pain and disorder of the internal and external secretion of pancreas.At present,the main purpose of the treatment for chronic pancreatitis is to relieve patients' pain,and to maintain the secretion function of pancreas as far as possible.The main surgical procedures for chronic pancreatitis includes the pancreatic resection,nerve block and decompression drainage of the pancreatic duct.In recent years,people hve paid more attenntion to the whole pancreas resection combined autologous transplantation due to retaining some functions of the islet cells.After whole pancreas resection combined autologous transplantation,the abdominal pain will relieve and the life quality will improved significantly.At the same time,it will effectively reduce the occurrence of pancretogenic diabetes since the surgery retains some function of the islet cells.

Objective To investigate and summarize the clinical characteristic of autoimmune pancreati-tis(AIP).Methods Clinical data of 13 patients with AIP, admitted to the West China Hospital from 2009 to 2013, were retrospectively analyzed .Results The median age of the 13 patients was 48 years old.The main clinical manifestations included epigastric pain or discomfort (8 cases), obstructive jaundice(7 cases)and weight loss(10 cases).Diffuse enlargement of pancreas and localized pancreatic enlargement were observed in 6 cases, pseudocyst and pancreatic stones were observed in 1 case.Dilation of pancreatic duct was found in 4 cases.Bili-ary stricture and thickened wall of bile duct were detected in 8 cases, dilated gallbladder with delayed enhance-ment of the thickened wall in 7 cases, retroperitoneal fibrosis surrounding the aorta in 1 case, abdominal lymph-adenopathy in 6 cases, stenosis of splenic vein in 4 cases, and Sjogren's disease and ulcerative colitis in 1 case. The positive rate of serum IgG, RF, ANA was 71.43%(5/7), 42.86%(3/7), and 42.86%(3/7), respec-tively.8 patients were misdiagnosed and underwent surgery .Steroid therapy was administered in all patients with satisfactory response.Conclusions AIP is a rare and autoimmune disease ,without speci? c symptoms,and often be misdiagnosed as pancreatic cancer or bile duct carcinoma .We must give more attention to AIP and keep pa-tients from undergoing unnecessary surgery .

Objective To investigate the influence of synangio-excision-restruction in pancreatic cancer radical operation on the complications,living quality and survival status in the patients with pancreatic cancer.Methods A total of 255 patients with pancreatic cancer in our hospitals from January 2010 to October 2015 were selected and divided into 3 groups according to different operation modes:41 cases in the Synangio-excision-restruction group(A),113 cases in the non-synangio-excision-restruction group (B) and 101 cases in the palliative by-pass operation group(C).The clinical data in 3 groups were analyzed.The influence of Synangio-excision-restruction on operative complications,living quality and survival status was investigated.Results The incidence rate of complications in the group A was 56.10％,which was obviously higer than 34.51％ in the group 1β and 20.79％ in the group C,and the difference was statistically significant(P＜0.05).In the group A,the incidence rates of belly ache and body weight gain were 36.59％ and 51.22％ respectively,which comparing with 91.09％ and 9.09％ in the group C showed statistically significant difference(P＜0.05).The median survival time(MST) in the group A was 11.83 months,which in the group B and C were 15.43 months and 7.50 months,the difference between the group A and C was statistically significant(x2 =4.27,P＜0.05);while the difference between the group A and B was not statistically significant(x2=3.67,P＞0.05).Conclusion For the pancreatic cancer patients with affected portal vein and inferior mesenteric vein,the synangio-excision-restruction radical operation can obviously prolong the patients' survival time and improves their living quality.

OBJECTIVETo evaluate the outcomes of T3a prostate cancer with unfavorable prognostic factors treated with permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy.

METHODSFrom January 2003 to December 2008, 38 patients classified as T3a prostate cancer with unfavorable prognostic factors were treated with trimodality therapy (brachytherapy + external radiotherapy + hormone therapy). The prescription dose of brachytherapy and external radiotherapy were 110 Gy and 45 Gy, respectively. The duration of hormone therapy was 2-3 years. The endpoints of this study included biochemical failure-free survival (BFFS), distant metastasis-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS). Survival curves were calculated using the Kaplan-Meier method. The Log-rank test was used to identify the prognostic predictors for univariate analysis.

RESULTSThe median follow-up was 71 months. The serum pre-treatment prostate-specific antigen (PSA) level ranged from 10.0 to 99.8 ng/ml (mean 56.3 ng/ml), the Gleason score ranged from 5 to 9 (median 8), and the percentage of positive biopsy cores ranged from 10% to 100% (mean 65%). The 5-year BFFS, DMFS, CSS, and OS rates were 44%, 69%, 82%, and 76%, respectively. All biochemical failures occurred within 40 months. The percentage of positive biopsy cores was significantly correlated with BFFS, DMFS, and OS (all P=0.000), and the Gleason score with DMFS (P=0.000) and OS (P=0.001).

CONCLUSIONST3a prostate cancer with unfavorable prognostic factors presents not so optimistic outcome. Hormone therapy should be applied to prolong the biochemical progression-free or metastasis-free survival. The percentage of positive biopsy cores and the Gleason score are significant prognostic factors.

Androgen Antagonists ; therapeutic use ; Brachytherapy ; Combined Modality Therapy ; Gonadotropin-Releasing Hormone ; agonists ; Humans ; Male ; Neoplasm Grading ; Prognosis ; Prostatic Neoplasms ; mortality ; pathology ; therapy ; Treatment Outcome

Objective To investigate the clinical efficacy of pancreaticoduodenectomy with vein resection (PD + VR) via inferior mesenteric vein(IMV) for tumors in the head and neck of pancreas.Methods The clinical data of 62 patients who underwent modified PD + VR for tumors in the head and neck of pancreas at the West China Hospital of Sichuan University between January 2006 to December 2013 were retrospectively analyzed.Twenty-eight patients undergoing Whipple procedure via inferior mesenteric vein were allocated to the WATIMV group,and 34 patients with pancreatic transection as central pancreatectomy undergoing PD + VR were allocated to the c-PD + VR group.The operation time,volume of intraoperative blood loss,rate of patients with intraoperative blood loss ＞ 800 mL,rate of intraoperative blood transfusion,length of vein resection,R1 resection rate,site of positive margin,incidence of complications,classification of complications and duration of postoperative hospital stay were compared between the 2 groups.Patients were followed up via outpatient examination and telephone interview till December 2014.Count data of ratio and proportion were compared by the chi-square test.Measurement data with normal distribution were presented as (x) ± s and analyzed by independent sample t test.Results All the 62 patients underwent operation successfully without perioperative death.The operation time,rate of intraoperative blood transfusion,length of vein resection,incidence of complications,incidence of grade 1,2,3,4,5 complication,duration of postoperative hospital stay were (325 ± 50) minutes,35.7 ％ (10/28),(25 ± 5) mm,46.4％ (13/28),14.3％ (4/28),17.9％ (5/28),14.3％ (4/28),0,0,(15 ± 7) days in the WATIMV group,and (346 ± 97) minutes,58.8％ (20/34),(24 ±5)mm,50.0％ (17/34),14.7％ (5/34),23.5％ (8/34),8.8％ (3/34),0,2.9％ (1/34),(19 ± 11) days in the c-PD + VR group,respectively,showing no significant difference between the 2 groups (t =0.866,x2 =3.283,t =0.647,x2 =0.078,1.883,t =1.666,P ＞ 0.05).The volume of intraoperative blood loss,rate of patients with intraoperative blood loss ＞ 800 mL,R1 resection rate,rate of positive margin in pancreas and retroperitoneal positive margin were (534 ± 277) mL,46.4％ (13/28),3.6％ (1/28),0,3.6％ (1/28) in the WATIMV group,and (796 ± 567) mL,67.6％ (23/34),23.5％ (8/34),8.8％ (3/34),14.7％ (5/34) in the c-PD + VR group,respectively,showing significant differences between the 2 groups (t =2.374,x2 =2.839,4.929,6.507,P ＜ 0.05).Fifty-nine patients were followed up for 15.2 months (range,8.0-23.0 months) with a follow-up rate of 95.2％ (59/62).No patient was complicated with portal vein thrombosis during the follow-up.Conclusion WATIMV is safe and feasible for treatment of tumors in the head and neck of pancreas,helping to improve radical resection rate of carcinoma and operation safety.