Objective To evaluate the procedure and the therapeutic efficacy of duodenumpreserving pancreatic head resection (DPPHR) in treating benign lesions in the head of the pancreas.Methods From February 2003 to August 2011,DPPHR was performed in 21 patients with benign lesions in the head of the pancreas.Thirteen patients were male and eight were female.Age ranged from 30 to 48 years,and the lesions ranged from 2.0 cm to 5.6 cm in diameter.Posterior superior pancreaticoduodenal artery was conserved in all patients.Results There was no hospital death.Pancreatic fistula was the main and the most often morbidity,occurring in 33.3％.After operation all patients with preoperative abdominal pain were completely pain free.Preoperative hypoglycemia in 2 patients turned to eugycemia.There was no recurrences report during following up.Concl~ions DPPHR was safe and effective in treating benign lesion in the head of pancreas.It was important in preserving blood supply to the duodenum by posterior superior pancreaticoduodenal artery.

Objective To discuss the diagnosis and surgical treatment of solid pseudopapillary tumor (SPTP) of the pancreatic head.Methods From January 2008 to August 2013,the clinicopathological data of 12 patients who were diagnosed and surgically treated in our hospital for this condition were analyzed retrospectively.Results There were 11 women and 1 man,the mean age was 28.7 years,with a range from 11 to 43.The mean diameter of the tumor was 7.5 cm(2 ～ 15 cm),6 of 12 of these tumors were more than 10 cm.Seven patients underwent pancreaticoduodenectomy,2 duodenum-preserving pancreatic head resection,2 local resection of tumor,1 palliative resection,1 pancreaticoduodenectomy combined with resection of part of the portal vein.All the diagnoses were confirmed by postoperative histopathology.In a follow-up which ranged from 3 to 65 months,all the patients were alive with no evidence of disease recurrence.Conclusions Most of the SPTPs of the pancreatic head were huge.The diagnosis was difficult.Complete tumor resection is the best treatment.

Objective To study the treatment of abdominal compartment syndrome(ACS) secondary to fulminant acute pancreatitis (FAP).Method A retrospective study was conducted from Jan.2009 to Dec.2011 to analyze the therapeutic results of 18 patients with ACS secondary to FAP.Results Three out of 7 patients who received non-operative therapy died (mortality rate 42.9％).Three out of 11 patients treated with early surgery died (mortality rate 27.3％),which was significantly better than those patients treated conservatively.Conclusion A reduction in intra-abdominal pressure improved the function of the viscera in the treatment of ACS secondary to FAP.The decompressive effects of early surgery was efficacious,and it reduced the mortality rate.

Objective To investigate the role of deferoxamine pretreatment for hepatic ischemia reperfusion injury in liver auto-transplantation in rats. Method Murine liver auto-transplantation model was established. Ninety six male Sprague-Dawley rats were randomly divided into three groups: 32 rats in deferoxamine pretreatment group (D), 32 rats in control group with aqua pro injection pretreatment(C) and 32 rats in sham-operation group (S). The animals were killed at 30 min, 2 h, 6 h, 24 h after operation respectively. ALT and AST level, superoxide dismutase (SOD) and malondialdehyde (MDA), liver histological change(HE), the protein expression of HIF-1α、TNF-α and IL-1 were measured. Results At 30 min, 2 h, 6 h, 24 h after operation, the levels of ALT,AST,MDA and the expression of IL-1 protein and TNF-α protein were higher in group C than group D significantly,while the expression of HIF-1α and SOD were higher in group D [SOD(411±70; 384±53; 379±46)、H1F-1α(0.0413±0.0040; 0.0684± 0.0032; 0.0583±0.0032; 0.0491±0.0026)] than group C significantly (P<0.01) [SOD(341±21; 323±25; 303±25)、HIF-1α (0.0254±0.0024; 0.0312±0.0022; 0.0381±0.0022; 0.0257± 0.0015)] (F>59.881;P<0.01). Conclusion The up-regulated expression of HIF-1α, decreased liver lipid peroxidation injury and TNF-α and IL-1 levels, may be involved in the mechanism hy which deferoxamine pretreatment protects liver from ischemia reperfusion injury in rats' liver auto-transplantation.

Objective To evaluate the efficacy and outcomes with the use of a saline-coupled bipolar sealer during liver resection.Methods 101 patients underwent liver resection for primary hepatic carcinoma at the People's Hospital Affiliated to Zhengzhou University from August 2015 to December 2016.The patients were divided into two groups according to whether the Aquamantys(R) system was used or not.In group A (n =62) the clamp crushing technique was used for liver parenchymal transection.In group B (n =39) the Aquamantys(R) system was used.The intraoperative and postoperative complication rates were compared.Results The operation time in group B was significantly longer than group A (216.4 min vs.253.5 min,P ＜ 0.05).The intraoperaitve blood loss in group B was significantly less than group A (381.1 ml vs.257.2 ml,P ＜ 0.05),and less blood transfusion was required (211.3 ml vs.90.9 ml,P ＜ 0.05).The volume of abdominal drainage fluid in group B in the first and the 5th day was significantly less than group A (242.6 ml vs.199.2 ml,P＜0.05;84.3 ml vs.70.4 ml,P＜0.05,respectively).The drainage tube in group B was taken off earlier than in group A (8.1 d vs.7.0 d,P ＜ 0.05).The average hospitalization stay after surgery in group B was also significantly shorter (13.4 d vs.11.6 d,P ＜ 0.05).There was no significant difference in the overall postoperative complication rate (P ＞ 0.05) between the 2 groups,and no death was observed.Conclusion The use of a saline-coupled bipolar sealer (Aquamantys(R)) in liver resection for hepatocellular carcinoma was associated with less intraoperative blood loss and was better for the patients' postoperative recovery.

OBJECTIVE ToobservetheprotectiveeffectandmechanismofCompoundGinkgo biloba(CGB)againstalcohol-inducedliverinjury.METHODS MiceweregivenCGB0.125,0.25and 0.75 g·kg -1 ,Ginkgo biloba extract (GBE)0.1 25 g·kg -1 and bifendate(Bif)0.1 5 g·kg -1 for 8 weeks, respectively.At the end of 4th week the mice were given wine by gavage (56% V/V,0.01 L·kg -1 ), and (56% V/V,0.016 L·kg -1 )at the end of the 8th week.The serum was obtained to measure alanine transaminase (GPT),aspartate aminotransaminase (GOT),mitochondrial aspartate aminotransferase (mGOT)and tumor necrosis factor-α(TNF-α).Liver histopathology was revealed by HE staining.The protein expression of cytochrome P450 (CYP)2E1 ,NF-E2-related factor 2 (Nrf2)and TNF-αin the liverwasanalyzedbyWesternblotting.RESULTS Comparedwithnormalcontrolgroup,theactivitiesof GOT and mGOT were increased in model group (P<0.01 ).Compared with model group,CGB 0.25 and 0.75 g·kg -1 groups and Bif 0.1 5 g·kg -1 group significantly decreased the activity of GOT and mGOT in serum (P<0.05,P<0.01 ),while there was no significant difference between these groups in serum GPT activity (P>0.05).Fatty degeneration and neutrophil infiltration were significantly ameliora-ted in CGB 0.25 and 0.75 g·kg -1 groups.Preliminary mechanism research showed CGB not only increased the protein expression of Nrf2 with a positive dose-effect relationship (r=0.942,P<0.01 ), but reduced the protein expression of hepatic CYP2 E1 and the level of TNF-αin hepatic tissue with a negative dose-effect relationship (r=-0.987,P<0.05;r=-0.940,P<0.05).In addition.The level ofTNF-αwasalsosignificantlydecreasedintheserum(P<0.05,P<0.01).CONCLUSION CGB may protect the liver fro m acute alcoholic injury and the mechanis m may be that it increases the protein expression of Nrf2,restrains the protein expression of hepatic CYP2E1 and TNF-αand reduces the TNF-αlevel in the serum.

Objective To study the pathogenesis,diagnosis and treatment of pancreatic portal hypertension (PPH).Methods The clinical data of 37 patients with PPH treated in Henan Province People's Hospital from January 2008 to January 2016 were retrospectively analyzed.Result Nine patients underwent conservative treatment and 28 patients underwent surgical treatment.No deaths were observed in the perioperative and follow-up periods.One patient underwent a second operation becausc of gastrointestinal bleeding.The clinical symptoms of the remaining patients were significantly relieved after surgery.Conclusions Treatment should be individualized and directed at the underlying cause.The anatomy of the coronary vein and the location of obstruction of the splenic vein determined the degree of the variceal veins and the surgical methods.Splenectomy was the basic treatment for PPH.Subcapsular splenectomy was effective in some challenging cases.

Objective To investigate the clinical features and the prognosis after surgical treatment for hilar cholangiocarcinoma (HCC).Methods The surgical therapy and follow-up result were retrospectively analyzed on 98 cases of hilar cholangiocarcinoma admitted into our hospital from January 1995 to January 2005.Differences between groups were evaluated using Chi-square analysis or Student t-test according to the data type.Survival rate was calculated with Kaplan-Meier method,and using the log-rank test.Results Among 98 patients,83 patients underwent surgical treatment (radical resection in 33,palliative resection in 16,and nonresectional internal or external bile duct drainage in 34),15 patients underwent conservative therapy.The 1-,3-,5-year survival rates were 79％,42％,and 17％ in the resection group and 88％,54％,and 24％ in the radical resection group,respectively.The 1-,3-year survival rates were 55％,and 9％ in palliative resection group,respectively,and none of the patient survived for over 5 years.There were significant differences in the survival rate among the radical resection group and the palliative resection group (log-rank test,P ＜ 0.001).Conclusions Radical resection improves the prognosis of hilar cholangiocarcinoma.

Objective:To summarize our experience in diagnosis and treatment of Budd-Chiari syndrome(BCS) accompanied with hepatic nodules.Methods:The clinical data of 33 patients with BCS accompanied with hepatic nodules who were treated at Henan Provincial People's Hospital from January 2012 to December 2018 were retrospectively analysed. A total of 33 patients were enrolled, including 17 males and 16 females, with an average age of 51 years. Analyze the treatment and prognosis of different types of nodules.Results:Of 33 patients, 27 were diagnosed to have hepatocellular carcinoma and 6 benign proliferative nodules. Treatment of patients with hepatocellular carcinoma included, transcatheter arterial chemoembolization ( n=1) and hepatectomy ( n=26). The survival time of these patients with hepatocellular carcinoma ranged from 10.0 to 78.0 months (mean 37.8 months). For the remaining 6 patients with benign nodules, the nodules were multiple and no malignant changes were observed on follow-up. Conclusion:For patients with BCS associated with benign nodules, no specific treatment was required. Hepatocellular carcinoma assocated with BCS had good prognosis. An aggressive surgical resectional approach is recommended to treat and to relieve the hepatic outflow obstruction.

Objective To study the combined use of ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) with hepatic artery reconstruction in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.Methods The clinical data of 7 patients with hilar cholangiocarcinoma who underwent ALPPS combined with hepatic arterial resection and reconstruction were analyzed retrospectively.The technical points and the perioperative management were analyzed.Methods At the first stage,the relationship between the tumor and the vessels were explored,the portal vein of the part of the liver to be resected was ligated and the liver was transected with a CUSA (Cavitron Ultrasound Surgical Aspirator).Then the bile duct was cut and a hepaticojejunostomy was completed.Finally,under ultrasound guidance,a bile duct drainage tube was inserted transhepatically into the part of the liver which was to be resected.Two to three weeks later,and after enough hypertrophy of the liver remnant size was confirmed,tumor resection was completed with reconstruction of the hepatic artery.Results Seven patients underwent the second stage operation,with no perioperative death.Six patients developed pulmonary infection and were treated successfully with conservative treatment.Two patients developed postoperative bile leak with secondary abdominal infection.One patient developed postoperative hepatic artery thrombosis secondary to biliary tract infection.Conclusion ALPPS combined with hepatic artery reconstruction was safe and feasible in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.