Objective To study the clinical feature,diagnosis,treatment and prognosis of hepatocellular adenoma(HA).Methods The clinical data of 10 patients confirmed pathologically with HA,were retrospectively analyzed.Results There were four females and six males,aging from 25 to 71 years(mean:42.6 years).Among these 10 patients,6 cases were discovered to have no clinical symptom.Tumors were located in the right lobe of the liver in 4 cases,and in the left lobe in 6 cases.Uhrasonography was performed in all cases.Six cases underwent CT examination and three cases experienced MRI as well as angiography was conducted in one case.All cases were confirmed by complete excision and pathology.All of them were followed up for 5 months to 9 years without tumor recurrence.Conclusion The combination of imaging data is helpful in the diagnosis of HA.Surgery is the best treatment with satisfactory results,and its prognosis is fairly good.

Objective To study the diagnosis and treatment of pancreatic cystadenoma and cystadenocarcinoma.Methods The clinical data of 21 surgically treated patients of the cystic neoplasms of pancreas(CNP),confirmed by pathology,in recent 8 years were retrospectively analyzed.Results CNP was more frequently seen in young to middle-aged women.Upper abdominal mass and abdominal distention and pain were the main clinical presentations.The CNP resection rate was 95%(100%and 80%in benign and malignant CNP respectively).Of the 21cases,pancreaticoduodenectomy and distal pancreatectomy were performed in 2 and 16 respectively;and middle segment pancreatectomy in 2 patients.Postoperative pancreatic fistula was the leading complication.Conclusion CNP have no clinical characteristics.Ultrasonography and CT could be helpful to the diagnosis of CNP.The resection of the whole tumor with part paratumor pancreas tissue is advocated.

Objective:To study the effect of seeding cells of tissue-engineered skins,keratinocytes and fibroblasts,on the phenotypes of langerhans cells (LC).Methods:Peripheral blood mononuclear cells were induced by cytokines,granulocyte macrophage-colony stimulating factor (GM-CSF),interleukin 4 (IL-4),transforming growth factor β1 (TGF-β1) to generate LCs,which were subsequently cocultured with allogenic keratinocytes or fibroblasts.Then the phenotypes of langerhans cells was detected by flow cytometer (FCM),and the degree of proliferation of autogeneic lymphocytes was assessed after stimulation with LCs.Results:Cultured LCs had low level expression of HLA-DR,CD80,CD86 and no expression of CD83.Cocultured with allogenic keratinocytes or fibroblasts,phenotypes of LCs did not change significantly.Simultaneously,LCs could not stimulate autogeneic lymphocytes proliferation.Conclusion:These data indicate that LCs cocultured with seeding cells of tissue-engineered skins remain immature state.It is suggested that seeding cells of tissue-engineered skins have low immunogenicity and are unable to induce significant immunological rejection of host after transplantation.

Objective To evaluate the influence of rectal washout on the prognosis of rectal cancer after anterior resection.Methods Data of 144 patients with rectal cancer undergoing anterior resection at Chinese Academy of Medical Science Cancer Hospital between May 2006 and November 2007 were reviewed.69 patients received rectal washout and 75 patients did not.The incidences of recurrence and 5-year disease-free survival rates were compared.Data were analyzed by SPSS 13.0 software packet,using x2 and t inspection.Kaplan-Meier method was used to calculate postoperative survival rate.Results Washing sample was positive for malignant cells in 55 patients (79.7％).The incidences of recurrence were 4.6％ and 6.7％ in washout group and no-washout group respectively (x2 =0.368,P =0.721).The five-year disease-free survival rate was 79.7％ in washout group and 74.7％ in no-washout group(x2 =0.517,P =0.553).Conclusions Free malignant cells were ubiquitous in rectal lumen during anterior resection,and there was a high positive rate of cytological examine for washout sample.Rectal washout may reduce local recurrence and prolong patients' survival.

Objective To investigate the effectiveness of surgical resection for metastatic liver cancer in patients of gastric carcinoma, and evaluate the prognosis. Methods Clinical data of 24 gastric cancer cases undergoing hepatectomy for hepatic metastatic tumor were collected retrospectively. There were 18 cases of synchronous resection and 6 cases of heterochronous resection. The prognostic values of clinicopathological factors were assessed by univariate and multivariate analyses. Results Postoperatively all cases were followed up until the death of the patietns. Counting from the time of liver resection the 1-,3- and 5-year survival rate was 67%, 21% and 13% respectively. Univariate analysis showed lymph node involved, tumor size of hepatic metastases, vascular invasion and R0 margin as significant prognostic factors;Multivariate analysis indicated that tumor size of hepatic metastases and vascular invasion were independent prognostic factors influencing the survival. Conclusion These results suggest that for patients with liver metastasia from gastric cancer, better prognosis can be obtained by surgical treatment.

The clinical data of 147 patients with carcinoma of ampulla of Vatar at our hospital from January 1998 to December 2012 were retrospectively analyzed.The neutrophil-to-lymphocyte ratio ( NLR) was calculated from pre-operative complete blood count.They were divided into low NLR group (NLR<5,n=121) and high NLR group (NLR≥5,n=26).The 5-year survival rates of two groups were compared and the prognostic risk factors examined by univariate analysis and Cox model.The 5-year free survival rates of low and high NLR groups were 57.9%and 27.6%respectively ( P=0.005 ).Univariate analysis revealed that depth of invasion (P=0.006),pancreatic invasion (P=0.002),lymph nodal metastasis (P=0.008), poor differentiation ( P =0.008 ) , tumor stage ( P =0.003 ) and per-operative NLR ( P =0.005 ) were significant prognostic factors.Multivariate analysis showed that per-operative NLR significantly increased the risk of recurrence (P<0.05).Pre-operative NLR represents a significant independent prognostic indicator for patients with carcinoma of ampulla of Vatar.

Objective To discuss the cause and means of prevention of postoperative acute renal failure(ARF) in patients with malignant tumors.Methods Clinical data of 32 patients with malignant tumors who suffered postoperative ARF were retrospectively studied.Results 13 patients(40.6%)suffered ARF because of hemorrhea or hypovolemia shock in or after operation, 10 patients(31.3%)suffered ARF because of fistula or sepsis after operation, 2 patients(6.3%)because of chemotherapy and other 7 patients(21.9%)with no evident causes. Conclusions ARF is a severe postoperative complication with high mortality. Maintaining adequate circulating volume before operation, carefully operating to decrease complication, avoiding nephrotoxins are key strategies to prevent the patients from ARF and improve prognosis.

Objective To investigate the effects on the condition of nutrition and immunologic function of gastric cancer treated with the insertion of jejunal nutrient canal after total gastrectomy.Methods In this study 113 gastric cancer patients were randomly divided into enteral nutrition group (the group of the fine-needle/catheter jejunostomy during operation,FCJ group) and parenteral nutrition group (PN group) after total gastrectomy.Evacuating time and postoperative complications were observed and relative laboratory parameters were measured prior to surgery (preoperative) and on days 3 and 7 postoperatively.Results The evacuating time in enteral nutrition group was shorter than that in parenteral nutrition group significantly[(4.1±2.2) d vs.(5.1 ±2.0) d,t =2.156,P =0.037];Serum level of prealbumin[( 18 ± 7 ) mg/dl vs.( 14 ± 7 ) mg/dl,t =2.370,P =0.022]and transferring[(205 ±45 ) mg/dl vs.( 186 ± 39 ) mg/dl,t =3.665,P =0.001]in enteral nutrition group on postoperative day 7 was higher than that in parenteral nutrition group;Serum IgA[( 2.3 ± 1.0 ) g/L vs.( 1.9 + 0.7 ) g/L,t =2.178,P=0.034],lgM[(1.4 ±0.4) g/L vs.(1.0 ±0.4) g/L,t=2.124,P=0.039]and IgG[(9.5 ±1.9) g/L vs.(9.0 ± 2.3 ) g/L,t =2.189,P =0.033]were higher in enteral nutrition group than that in parenteral nutrition group;The incidence of postoperative alimentary dysfunction in enteral nutrition group was lower than that in parenteral nutrition group( 3％ vs.13％,x2 =3.962,P =0.048).Conclusions It is safe and convenient to use early postoperative enteral nutrition support by fine-needle/catheter jejunostomy (FCJ) in gastric cancer patients immediately after total gastrectomy.

Objective To compare the short-term results of laparoscopic-assisted with open surgery for primary rectal cancer in elderly patients. Methods The medical records of forty-nine elderly patients (≥70 years) with laparoscopic-assisted resection and fifty-five cases (≥70 years) with open surgery for rectal cancer were retrospectively reviewed. Results There were no thirty-day mortality in both groups. Operative procedure and operating time did not differ significantly in laparoscopic-assisted group (LAG) and open group (OG), and blood loss was significantly greater in OG (P =0.031). The rate of postoperative complications was lower (12.2 % vs 25.5 %) in LAG than that in OG, but the difference was not statistically significant (P = 0.088). The time to faltus (3.26 d vs. 4.49 d) and time to liquid diet (3.98 d vs.5.56 d) were significantly shorter in LAG than that in OG. Both the circumferential and distal margins were negative. The number of identified lymph nodes were similar for LAG and OG (mean 13.31 vs 13.13, P =0.886). Conclusion Laparoscopic-assisted rectal resection for elderly patients is safe and feasible, with less complications and blood loss, and rapid intestinal recovery compared with open surgery.

Objective To investigate the prognosis of local resection in patients with low rectal cancer, and assess surgical indications for this procedure. Methods One hundred and twenty-four patients with low rectal cancer from Jan 1975 to Dec 2006 were analyzed, the clinicopathologic features and surgical, outcome were examined as prognostic factors. Survival rate was estimated by Kaplan-Meier method and compared by Log-Rank test, prognostic factors were analyzed by multivariate COX proportional hazards model. Results The 5-year survival rate of 124 patients underwent local resection was 90.7 %(97/107), there were 4.8 %(6/124) patients with complications and 15.3 %(19/24) ones with local recurrence.The infiltration, vascular invasion, the size of tumor and the histological grade were significant prognostic factors of overall survival, but gender, age, the tumor site and the macroscopic type were not. Multivariate analysis indicated that the tumor infiltration were independent poor prognostic factor. Conclusion Local resection is suitable for Tis and T1 low rectal cancer, and those with high local recurrence factors should undergo radical resection. Strict follow-up and adjuvant therapy is necessary for local excision.