ObjectiveTo summarize the experience in diagnosis and treatment of malignant change in choledochal cyst patients in the past 20 years. MethodsThe clinical data of 16 patients admitted from 1980 to 2000 were analyzed retrospectively. Results9 patients had had a previous internal drainage procedure,12 patients had biliary tract infection, 4 cases presented with abdominal masses. All suffered body weight loss and general malaise. ERCP was performed in 5 cases with no previous operation, in which abnormal pancreatobiliary duct junction was found in 4 patients. Laparotomy plus metastatic lymph node biopsy was performed in 4 patients, choledochotomy with T-tube drainage for 4 patients, cyst excision and pancreatoduodenectomy for 3 cases, partial cyst excision with left lobectomy for 2 patients, cyst excision with Roux-en-Y hepaticojejunostomy for 3 patients. Pathology proved carcinoma was located in cyst wall in most cases.Postoperative survival time ranged from 4 to 31 months with a mean of 12.7 months. ConclusionsThe clinical symptoms of malignant change in congenital choledochal cyst were non-specific. The preoperative diagnosis for canceration was difficult, and the prognosis was poor.Total extrahepatic choledochocele resection should be adopted for the prevention of canceration.Intraoperative frozen section is helpful to confirm diagnosis. Cyst excision with pancreatoduodenectomy is the treatment of choice for carcinoma invading pancreatic head.

Objective To investigate the efficacy and safety of atorvastatin combined with clopidogrel in the treatment of elderly patients with angina pectoris.Methods 90 elderly patients with angina pectoris were randomly divided into the observation group and control group,45 cases in each group.All patients were given conventional treatment and atorvastatin,the observation group was given clopidogrel based on this.The TC,TG,HDL-C,LDL-C,angina attack frequency,duration and adverse reactions,adverse cardiac events of two groups before and after treatment were compared,and the clinical effect was evaluated.Results The total effective rate of the observation group was 9 3.3 ％ (42/45),whichwassignificantlyhigherthan75.6％ (34/45) inthecontrolgroup (x2 =5.67,P ＜ 0.05).After treatment,the TC,TG,HDL-C,LDL-C of two groups were significantly improved than before treatment (t =5.34,4.78,4.56,4.92,4.31,3.92,4.11,4.62,all P ＜ 0.05),the improvement in the observation group was significantly better than that in the control group (t =4.20,4.08,3.98,4.03,all P ＜ 0.05).After treatment,the angina attack frequency and duration of two groups were significantly decreased compared with before treatment (t =6.22,5.78,4.12,4.02,all P ＜ 0.05),and the observation group decreased significantly than the control group(t =4.23,3.99,all P ＜ 0.05).3 cases of adverse reactions and 1 case of adverse cardiac events occurred in observation group,2 cases of adverse reaction and 3 cases of adverse cardiac events occurred in control group.Conclusion Atorvastatin combined with clopidogrel in the treatment of elderly patients with angina pectoris can regulate blood lipid and improve the symptoms of angina pectoris.

Colorectal cancer is one of the most common malignant tumors of digestive system.There are significant differences between young patients and other ages in aspects of the disease features, biological characteristics, risk factors, clinical treatment and prognosis, etc.And the analysis of young colorectal cancer patients′ characteristics can provide new ideas for clinical treatment.

Objective: Gallbladder polyps are frequently discovered in the past decade. Ifthe polyps are oenign,without concomitant stone and the gallbladder has a good function, it is not an absolutely indication for cholecystectomy. For this reason percutaneous endoscopio polypectomy of the gallbladden polyps were developed and applied. Methods: Among those who underwent peroutaneous endosoopic polypectomy of the gallbladder, 85 patients with gallblaeder polyps were studied. Under the epidural anesthesia, cholecystoscope was introduced into the gallbladder. The polyps were coagulated by self-made miorowave ceagulator and then resected for histopathelogical evaluation. The preserved gallbladders were followed up to evaluate the effioacy of this minimally invasive therapy. Results: All precedures were eventful with mean operation time of 1h to 1. 5h. Sixty seven patients were followed-up for a mean of 5.5 yeah (2～9 years) and showed all patients to be symptom free and in 64 cases the gallbladder function was found to be well preserved without recurrence of polyps and occurrenca of gallstones on ultraSound. Conclusion: The procedure reposed is a reliable, simple,effective and minimally invasive technique to remove gallbledder polyps and to preserve gallbladder function for the patients who have the benign gallbladder polyps.