Objective To observe the prokinetic effect of domperidone on esophagus and lower esophageal sphincter (LES), and compare its effect with that of mosapride and cisapride. Methods In vivo experiments: forty rats were divided into control, domperidone, mosapride, and eisapride groups. Strain gauges were planted in proximal esophagus, distal esophagus and LES to record the activities of esophagus and LES in conscious rat. In vitro experiments: in the thermostatic muscle bath, the prokinetic effect of domperidone, mosapride, and cisapride on the contractility of rat muscle strips from esophagus body and LES were recorded by tone-transducers. Results In vivo experiments, ① In the interdigestive period of resting conscious rats, only mild contraction activities were recoded in esophagus bodies. In LES, typical interdigestive migrating motor complex (MMC) with phase Ⅰ,Ⅱ,Ⅲ,and Ⅳ was recorded. The contraction amplitude of LES was much greater than esophagus body. ② Domperidone significantly enhanced the contraction of esophagus body and LES. The mean contraction amplitude of proximal esophagus, distal esophagus, and LES increased by 63.24%±7.17%, 75.54%±5.27%, and 85.81%±6.02%, respectively, compared with controls. The prokinetic effect showed a dose-effect relation. Mosapride at the same dosage increased the mean contraction amplitude of proximal esophagus, distal esophagus, and LES by 29. 71%±4.15%, 40.15%±3.30%, and 35.24%±5.36%, respectively, compared with controls. The prokinetic effects of mosapride on esophagus and LES were much less than domperidone. Cisapride at the same dosage increased the mean contraction amplitude of proximal esophagus, distal esophagus, and LES by 59.84%±6.55%, 70.11%±5.62%, and 75.13%± 5.10%, respectively, compared with controls. The prokinetic effects of cisapride were similar as domperidone. In vitro experiments. ① Domperidone perfusion could significantly increase the contraction of esophagus body and LES muscle strips by 87.74%±7.65% and 92.44±7.17%, respectively, compared with Krebs-Ringer (KR) solution perfuslon. Mosapride at the same dosage increased the mean contraction amplitude by 35.42%±5.02% and 31.12%±4.32%, respectively, compared with KR controls. The prokinetic effects of mosapride were much less than domperidone. Cisapride of the same dosage showed a similar prokinetic effect as domperidone. ② Atropine and tetrodotoxin could block the prokinetic effects of domperidone on esophagus and LES. Conclusions Domperidone can significantly enhance the esophagus body contraction and LES motility. The effects of domperidone are similar as cisapride and much greater than mosapride. The prokinetic effects of domperidone on esophagus and LES are not only through well-known dopaminergic receptor blockade, but also through the cholinergic nerves of the enteric nervous system.

Objective To investigate the cause,type,clinical manifestation,diagnosis and treatment of bile duct injury(BDI)during laparoscopic cholecystectomy(LC).Methods Data of 26 cases suffering from biliary injury during LC from 1997 to 2007 were retrospectively analyzed.Results Among 26 cases with BDI,5 cases suffered from type Ⅰ BDI,13 cases from typeⅡ,2 cases from typeⅢ,and 6 cases from type Ⅳ.Injuries were diagnosed as BDI intraoperatively in 3 cases,23 BDI cases were diagnosed postoperatively,including 13 cases diagnosed one week after LC,8 cases 20-60 days after LC,2 cases 2 years after LC.Twenty-four cases underwent interventional therapy,with 5 cases cured,19 cases were tideovered to operative treatment after cholangitis and jaundice were under control.Among all BDJ cases,20 cases underwent resection of impaired dile duct and hepatico-jejunostomy. Conclusion BDI is a serious complication of LC,temporary stent graft or bile dranage will help to put jaundice and cholangitis under control so as to buy a time for final definite surgical procedures.

Objective To evaluate the long-term efficacy of modified loop choledochojejunostomy (MLC). Methods The clinical data of 259 patients who had underwent choledochojejunostomy in First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2006 were retrospectively analyzed. Of all the patients, 130 underwent MLC (MLC group) and 129 underwent Roux-en-Y choledochojejunostemy (RYC, RYC group). The changes in incidence of cholangitis and liver function between the 2 groups were compared. All the data were analyzed by t test, chi-square test or Fisher exact probability. Results The levels of alaninetransa-minase and alkaline phosphomonoesterase were (63±42) U/L and (147±147) U/L in MLC group, and (84±52)U/L and (256±201)U/L in RYC group, with statistical difference between the 2 groups (t=1.634, 1.655, P>0.05). The level of gamma-glutamyl transferase in MLC group was (116±91)U/L, which was signifieandy lower than (169±96)U/L in RYC group (t=2.461, P<0.05). Three patients (2.3%) in MLC group and 9 (7.0%) in RYC group suffered from acute cholangitis after operation, with no statistical difference in the incidence between the 2 groups (P>0.05). Of the 12 patients with acute cholangids, 1 in MLC group and 7 in RYC group were hospitalized, with statistical difference between the 2 groups (P<0.05). Conclusions The incidence of acute cholangitis in patients who underwent MLC is comparable to that of RYC. However, the procedure of MLC is simpler than RYC, and patients have milder symptom and lesser frequency of reflux cholangitis onset after MLC.

Objective To analyze the factors influencing the prognosis of patients with pancreatic cancer.Methods The clinical data of 276 patients with pancreatic cancer who had been admitted to our department from September 1995 to August 2005 were retrospectively analyzed.Cox regression analysis was used to screen out independent risk factors influencing the prognosis of patients with pancreatic head cancer or pancreatic body and tail cancer,and Kaplan-Meier method to calculate the median survival time.The effects of tumor location on the prognosis were examined by Log-rank and Breslow test.Results Cox regression analysis showed that the diameter of tumor,invasion of the superior mesenteric vessel and treatment method were the independent risk factors influencing the prognosis of patients with pancreatic head cancer;while age,lymphadenectasis and treatment method were the independent risk factors influencing the prognosis of patients with pancreatic body and tail cancer.The median survival time of patients with pancreatic head cancer and pancreatic body and tail cancer after radical resection were 460 days and 480 days,which were significantly longer than 240 days and 200 days of patients who received palliative treatment or gave up treatment.The median survival time of patients with whole pancreatic cancer was 117 days,which was significantly shorter than 330 days of patients with pancreatic head cancer and 300 days of pancreatic body and tail cancer.Conclusions Radieal resection is currently the best choice for pancreatic cancer.The prognosis is poor for patients with pancreatic head cancer(diameter≥4 cm)and invasion of the superior mesenteric vessel.Patients with age≤60 and lymphadenectasis are the factors resulting in poor prognosis of pancreatic body and tail cancer.The prognosis of patients with pancreatic head cancer and pancreatic body and tail cancer are close.Patients with whole pancreatic cancer is in the terminal stage with the worst prognosis.

Objective To investigate the effect and mechanism of oetreotide (OCT) on DENA related hepatoeareinogenesis in rats. Methods Fresh diethylnitrosamine (DENA) solution was given to induce the model of rat hepatoeellular carcinoma. The rats were divided randomly into two groups: OCT treatment group and control group. The survival rate and hepatoeareinogenesis rate were observed. SSTR2 mRNA and protein expression were measured. Results The survival rote of OCT treatment group (70.0%, 7/10) was significantly higher than that of control group (30.0%, 6/20) (X2 = 4.344, P<0.05). 16 weeks after DENA treatment, the difference of bepatoearcinogenesis rate between the two groups was not remarkable though the value of OCT treatment group (0%, 0/10) was lower than that of control groups (30.0%, 6/20)(X2 = 3.750, P＞0.05). However, 22 weeks after DENA treatment, hepatoeareinogenesis in control group (83.3%, 10/12) was markedly higher than that in OCT treatment group (22.2% , 2/9)(X2 =7.843, P<0.01). With liver cirrhosis progressing, the expressions of SSTR2 mRNA and protein increased, and reached the peak 16 weeks after DENA treatment, then began to decrease. The expressions of SSTR2 mRNA and protein in hepatocellular carcinoma were significantly lower than those in the liver 22 weeks after DENA treatment (F = 35.010 and 13. 386, P<0.01). The expression levels in OCT treatment group were similar to those in control group 8 and 16 weeks after DENA treatment. But the expression levels in OCT group 22 weeks after DENA treatment didn't lower markedly, and were higher significantly than those in control group (t = 2.806 and 4.498, P<0.05). Conclusion OCT can inhibit efficiently hepatocareinogenesis and reduce the mortality of rots treated with DENA possibly by a mechanism maintaining the expression levels of SSTR2.