As a classic therapy for periampullary carcinoma,pancreaticoduodenectomy (PD) is still high-risk and technique demanding in abdominal surgery.Recently,the chance of performing PD for non-pancreatic surgeons is decreased because of specifying studies in abdominal surgery.While in clinical practice,some abdominal surgeons usually meet nonpancreatic diseases which PD is necessary,so the basic skills of PD is also very important for non-pancreatic abdominal surgeons.In this review,the skills of disclosing portal vein and superior mesenteric vein,prevention of abdominal bleeding and iatrogenic injury,treatment of postoperative pancreatic fistula,management of portal vein invasion,and the techniques of pancreatic uncinate process carcinoma resection were introduced.

Ampullary cancer is a relatively uncommon cancer,which is often considered to have a best prognosis among periampullary cancers.Preoperative endoscopic uhrasonography and transpapillary intraductal ultrasonography Call provide useful information not only for tumor staging but also for making therapeutic decisions,especially in patients who are appropriate for endoscopic papillectomy.Whipple resection and pylrus preserring panereaticoduodenectomy are considered to be the standard treatment for ampullary cancer.Although transduedenal ampullectomy is regarded as a less-invasive treatment compared with Whipple resection,it has a high morbidity and hish rate of cancer-cell remnant at the resected margin.Endoscopic papiilectomy may be the treatment of choice for selected cases of ampullary cancer. As to unresectable ampullary cancer,the performance of a biliary-enteric bypass is considered routine to solve obstructive ianndice.The decision as to whether to perform gastrojejunostomy in patients without obvious gastroduodenal obstruction secondary to the tumor remains controversial.We believe that prophylactic gastrojejunostomy should be performed routinely when a patient is undergoing surgical palliation for unresectable ampullary cancer.

Objective To evaluate the effect of simple closure operation followed by anti-Helicobacter pylori(Hp)therapy for perforated peptic ulcer. Methods 168 cases of perforated peptic ulcer treated by simple closure operation with or without postoperative medication therapy were followed-up and analyzed. Results 1 year after operation, the recurrence rate of peptic ulcer was 3.8% in the group of standard anti-Hp therapy(S group), and that of gastric and duodenal ulcer in S group was 8.3% and 3.6%,respectively; while it was 62.9%, 66.7% and 58.8% in the group of non-standard Hp therapy (N-S group), and 88.9%, 100% and 80.0% in the group without Hp therapy (NT group).The diffcrence of reccurrence rate of peptic ulcer between S group with N-S group?NT group was significant(P

Objective To explore the feasibility of local enucleation of pancreatic cystadenoma. Methods From Jan 2001 to Dec 2007, 11 patients with pancreatic cystadenoma underwent operation in Department of General Surgery, first affiliated hospital of China Medical University were enrolled and the clinical features, complications and prognosis were analyzed retrospectively. Results Of the 11 cases, the average age was 47 years old with 2 males and 9 females, the average size of the neoplasm was 4.8cm and 1 located in the pancreatic head, 10 in the body or the tail. Among which 3 cases were serous cystadenoma and 8 were mucinous cystadenoma confirmed by pathological evidence. Three patients developed temporary hyperglycemia and returned to normal after 1~2 weeks; one patient developed incisional infection; two cases developed pancreatic fistula postoperatively. All cases were followed up between 28 and 67 months. No neoplasm re-occurrence or diabetes mellitus occurrence were observed. Conclusions It was safe and feasible to perform enucleation for pancreatic cystadenoma with tumor size less than 6 cm.

Objective To describe the diagnosis and treatment of metastatic pancreatic cancer. Methods The clinical data of 10 cases of metastatic pancreatic tumor in the first affiliated hospital of China Medical University from July 1997 to July 2007 were analyzed retrospectively. Results The etiologies of primary tumors were lung cancer(n=3), colonic carcinoma(n=2), stomach cancer(n=2), renal cell carcinoma(n=2), nasopharyngeal carcinoma(n=1). The median interval between the diagnosis of primary tumor and pancreatic metastases was 40 months (range:0~192 months). All the metastases were located in the pancreatic heed and neck, and solitary metastasis was detected in one ease, while other 9 cases were multiple metastases. The mean maximum tumor size was 3.03 cm. The main clinical manifestations were abdominal pain, bloating, anorexia and jaundice. 2 cases underwent pancreaticoduodeneetomy, 1 case underwent arterial pancreatic perfusion chemotherapy, 1 case underwent percutaneous biliary stenting and 2 cases received systematic chemotherapy, 1 case received radiotherapy, 3 patients did not accept any therapy. 7 patients were followed-up, the median survival was 10.6 months (range:2~44 months). Conclusions Metastatic pancreatic cancer was rare and the clinical manifestation was non-specific, lndividuaized treatment should be selected on a case-by-case basis. Aggressive surgical resection should be offered to some selected patients.

Objective To investigate the experiences in the diagnosis and treatment of space-occupying lesions of the head of pancreas.Methods The clinical data of 247 patients with space-occupying lesions of the head of pancreas who were admitted to the First Affiliated Hospital of Chinese Medical University from January 2011 to April 2014 were retrospectively analyzed.All the patients received enhanced computed tomnography and (or) magnetic resonance imaging of the pancreas.The levels of alpha-fetal protein (AFP),CA19-9,CA125 and carcinoembryonic antigen (CEA) were detected,and the serum level of IgG4 was detected in patients who were suspected of autoimmune pancreatitis.Intraoperative pathological examination was applied to patients who were diagnosed as with cancer of the head of pancreas.Pancreaticoduodenectomy,extended pancreaticoduodenectomy or bilio-jejunostomy or (and) gastrointestinal anastomosis were applied to patients according to the stage and infiltration of the tumor.Duodenum-preserving pancreatic head resection or pancreaticoduodenectomy could be selected after informed consent.The adjacent tissues and organs should be preserved on the premise of complete tumor resection for patients with benign and low-grade malignancy.Results A total of 194 patients had solid spaceoccupying lesions of the head of pancreas,including 125 with pancreatic head cancer,45 with mnass in the head of pancreas,9 with chronic pancreatitis with mass in the head of pancreas,11 with autoimmune pancreatitis,4 with insulinoma.Fifty-three patients were with cystic space-occupying lesions,including 12 with mucinous cystadenoma,8 with serous cystadenoma,17 with pancreatic cyst,12 with solid-pseudopapillary tumor of pancreas and 4 with intraductal papillary mucinous neoplasm.The positive rates of AFP,CA19-9,CA125 and CEA of the 71 patients who were confirmed as with pancreatic cancer by pathological examination were 7.0％ (5/71),94.4％ (67/71),42.3％ (30/71) and 0,respectively.The positive rates of AFP,CA19-9,CA125 and CEA of the 12 patients with chronic pancreatitis with mass in the head of pancreas were 1/12,4/12,1/12 and 0,respectively.Seventynine patients with pancreatic head cancer,mass in the head of pancreas and chronic pancreatitis with mass in the head of pancreas received intraoperative pathological examination.A total of 119 patients received operation,including 71 with pancreatic head cancer,7 with chronic pancreatitis with mass in the head of pancreas,4 with insulinoma,1 with pancreatic tuberculosis,8 with mucinous cystadenoma,4 with serous cystadenoma,6 with pancreatic pseudocyst,1 with huge lymphangioma,1 with lymphoepithelial cyst,12 with solid-pseudopapillary tumor of pancreas and 4 with intraductal papillary mucinous neoplasm.Of the 247 patients with space-occupying lesions of the head of pancreas,61 received pancreaticoduodenectomy,4 received duodenum-preserving pancreatic head resection,4 received pancreatic head and neck resection,2 received partial resection of the uncinate process of the pancreas,9 received enucleation of the tumor,38 received bilio-jejunostomy or (and) gastrointestinal anastomosis,22 received endoscopic retrograde cholangio-pancreatography + stent installation,18 received percutaneous transhepatic cholangial drainage + stent installation,1 received exploratory lapartomy and the other 88 patients were untreated.Conclusions The diagnosis and differential diagnosis of the space-occupying lesions of the head of pancreas depend on the clinical presentation,medical history,laboratory examination,sonography,computed tomography or magnetic resonance imaging.Individualized treatment plan based on the feature of the tumor and kinds of the lesions combined with intraoperative pathological examination is helpful for selecting the surgical procedures.

Objective To detect the expression of MSI2 protein and mRNA in pancreatic ductal adenocarcinoma (PDAC) tissue,and investigate the correlation between the expression of MSI2 protein and the clinicopathological parameters.Methods The expression of MSI2 protein in 61 PDAC specimens and paired adjacent non-cancerous pancreatic tissues were detected by immunohistochemistry.Western blot and quantitative real-time PCR (QRT-PCR) were used to examine the expression of MSI2 protein and mRNA level in 10 PDAC specimens and adjacent non-cancerous pancreatic tissues.Then the relationship between MSI2 expression in cancerous tissues and clinicopathological parameters was analyzed.Results In 61 patients with PDAC,the expression rate of MSI2 protein was higher in cancerous tissues (63.9％) compared with that in paired non-cancerous pancreatic tissues (41.0％),and the difference between the two groups was statistically significant (t =2.809,P =0.007).The expression levels of MSI2 protein in 10 fresh PDAC specimens and adjacent non-cancerous pancreatic tissues were 0.748 ± 0.195 and 0.420 ± 0.171,and the expression level of MSI2 mRNA in PDAC specimens was as 2.507 ± 2.981 times as much of adjacent non-cancerous pancreatic tissues,and the difference between the two groups was statistically significant (t =3.689,P=0.005;t =2.660,P =0.026).The expression of MSI2 in cancerous tissues was only positively associated with the size of the tumor (x2 =5.096,P =0.024),but it was not associated with other parameters.The median survival of patients with high MSI2 expression was 321 d,and it was 730 d for patients with low MSI2 expression,and the median survival of patients with high MSI2 expression was significantly shorter than that of low MSI2 expression (x2 =6.706,P =0.010).Conclusions The expression MSI2 is up-regulated in PDAC and related to the tumor size.The patients with high expression of MSI2 protein have poor prognosis.

ObjectiveTo study the anti-proliferative effect and the mechanism of arotinoid Ro40-8757 on human pancreatic carcinoma cell line JF-305.MethodsMTT assay was used to evaluate the growth inhibition effect of Ro40-8757 on human pancreatic carcinoma cell line JF-305. The expression of p27 protein was measured by Western blotting, and flow cytometry for cell cycle analysis.ResultsRo40-8757 significantly inhibited the growth of JF-305 cells with a dose-, time-dependent manner. After 72 hours treatment with 10 -5mol/L Ro40-8757, the proportion of cells in G 1 phase increased from 56% to 76% while the cells in S phase decreased from 25% to 7%. Western blot analysis showed that the expression of p27 protein in cells treated with Ro40-8757 increased markedly.Conclusion Ro40-8757 inhibits the growth of pancreatic carcinoma cell line JF-305 possibly by up-regulating p27 protein expression and arresting cell cycle.

Objective: Our aim was to examine the correlation infection of HBV and the formation of cholelithiasis. Methods： Gallbladder bile samples of 38 HBV-infection patients and 35 non-HBV-infection patients were determined. Results： Elevated levels of unconjugated bilirubin(UCB)(P<0.01)and Ga2+(P<0.05),decreased levels of total bile acid (TBA)(P<0.01)and cholesterol (TC)(P<0.01)were found. Conclusio： The changes of bile elements of HBV-infection and cholelithiasis are correlated.

Objective To evaluate the clinical classification and timing of surgery in the treatment of gallstone acute pancreatitis(GAP). Method The clinical data of 109 patients with GAP admitted to the Department of General Surgery of our hospital were retrospectively analysed. Result and Conclusion Based on the analysis of the treatment methods and its outcome, GAP should be divided into four types according to ampullary obstruction and severity of acute pancreatitis. (1)Non-obstructive mild type GAP was treated mainly in conservative way.(2)Obstructive mild type GAP could be treated conservatively for 36 hours after onset. If the obstruction did not resolve, surgery should be done. (3)Obstructive severe type GAP was treated mainly in conservative way, and the timing of surgery depends on whether necrosis complicated with infection. (4)Obstructive severe type GAP: EST should be done first. If EST is not convenient to be done, an early surgery should be done after short period of supportive therapy. Special attention should be paid to, if suppurative cholecystitis or cholangitis presented, an emergency surgery should be done. Finally, for all the GAP treated by conservative treatment, an elective surgery should be performed to resolve the biliary disease.