Objective To summarize the experiences of a single treatment group in surgical treatment of hilar cholangiocarcinoma during the past 10 years. Methods From January 2000 to December 2009, 1572 patients with hilar cholangiocarcinoma were admitted to the Eastern Hepatobiliary Surgery Hospital, and the clini-cal data of 462 patients in our treatment group were retrospectively analyzed. Among the patients, 314 received surgical treatment, and the remaining 148 received conservative interventions or refused any therapy. Factors that may have influenced the prognosis were analyzed by the Kaplan-Meier method, Log-rank test and Cox proportional hazards model. The correlation of different factors was analyzed by the chi-square test. Results A total of 314 patients underwent surgical treatment and tumor resection was performed in 237 patients, including 174 with R0 resection, 17 with R1 resection, and 46 with R2 resection. There were 91 patients with postoperative complications and 10 in-hospital deaths. A total of 260 patients had been followed up for 5-113 months, and the overall 1-, 3-, and 5-year survival rates were 71.7% , 32.6% and 10.9% , respectively; the 1-, 3-, and 5-year survival rates of patients with R0 resection were 76. 9% , 48. 6% and 32. 7% , respectively, with a median survival time of 35 months. R0 resection, TNM staging, regional lymph node involvement and tumor differentiation were the independent prognostic factors (RR = 2. 1, 1.9,2.2, 1.7, P<0.05). Conclusions Curative resection is the treatment of choice for hilar cholangiocarcinoma. Preoperative systematic evaluation and preparation can improve the radical resection rate and reduce postoperative morbidity.

Objective To detect the changes of hemodynamics in patients with portal vein embolization (PVE) before surgery for hilar cholangiocarcinoma, and analyze the relationship between hemodynamics and liver hypertrophy. Methods The clinical data of 21 patients with hilar cholangiocarcinoma who were admitted to the Eastern Hepatobiliary Surgery Hospital from April 2008 to December 2009 were retrospectively analyzed.Relevant hemodynamic variables were detected and analyzed before and 3, 7, 14 days after PVE. Data were processed using Student t test or linear correlation analysis. Results The main portal vein pressure after PVE was (25.9 ± 4.1 ) cm H2O ( 1 cm H2O = 0.098 kPa), which was ( 3.5 ± 2.5 ) cm H2O higher than that before PVE [( 22.4 ± 4.1 ) cm H2O] ( t = - 6. 504, P ＜ 0.05 ). The blood flow velocity in the non-embolized branch of portal vein increased after PVE, and reached peak [(26 ±9)cm/s] at the seventh day after PVE. A positive correlation was found between the hypertrophic rate of the non-embolized lobes and the ratio of embolized lobes to total liver volume ( r = 0. 593, P ＜ 0. 05 ). Conclusion Greater scope of the embolized vascular bed of portal vein induces higher hypertrophic rate of non-embolized liver.

Objective To summarize experience of diagnosis and treatment of the mucin-producing bile duct tumors(MPBTs). Methods Clinicopathological features of 7 patients with MPBT undergoing surgery from Nov 2002 to May 2005,were retrospectively reviewed.The clinical radiography characteristics and the resection type were summarized respectively. Results Fluctuant iaundice was the most common manifestation of MPBTs,with different characteristics of magnetic resonance cholangiopancreatography when compared with gallbladder carcinoma,hilar cholangiocarcinoma and distal bile duct cancer.All the 7 patients with MPBT underwent successful surgical resection and were cured. Conclusion Appropriate diagnosis and treatment of MPBTs made it possible to achieve long-term survival of these patients.

Objective To analyze factors influcing the surgical curative effect of hilar cholangiocarcinoma. Methods A retrospective clinical analysis was made on 198 patients with hilar cholangiocarcinoma, who were surgically treated in our hospital from 1997 to 2002. Jaundice (94.5%, 187 cases), pruritus (56.6%, 112 cases) and abdominal pain (33.8%, 67 cases) were the main symptoms. According to Bismuth-Corlette classification, there were 14 type Ⅰ cases, 19 type Ⅱ cases, 12 type Ⅲa caese, 15 type Ⅲb cases, 112 type Ⅳ cases and 26 unclassifiable cases. 144 patients received laparotomy, and tumor resection was performed in 120 cases, including radical resection in 59 caese (41.0%) and palliative resection in 61 cases. 54 cases were treated by endoscopic therapy or PTCD. 16 cases received postoperative adjuvant radiation. Results Occupation, preoperative maximum tatal serum bilirubin level, operative procedure and postoperative adjuvant radiation affected postoperative survival. The postoperative survival of ENBD group, ERBD or EMBE group, biliary exploration & drainage group, palliative resection group and radical resction group differed statistically as a whole (?2= 87.048?9, P

Objective To investigate the risk factors of early postoperative complications in patients undergoing pancreaticoduodenectomy. MethodsClinical data of 200 patients undergoing pancreaticoduodenectomy in our hospital from December 1999 to September 2002 were collected and analyzed retrospectively. Nine clinical factors were recruited for the study in relation to surgical complications. ResultsThe overall early postoperative complication rate was 21% (42/200). Logistic regression analysis revealed that no T tube drainage(OR=10.015), preoperative total serum bilirubin level over 171.1?mol/L(OR=7.756), preoperative diabetes (OR=4.086), end-to-end pancreaticojejunostomy (OR=2.616), intraoperative blood transfusion over 1000 ml (OR=2.410), over 65 years old (OR=2.162) were important factors for early complications. ConclusionsT tube drainage, end-to-side mucosa-to-mucosa pancreaticojejunostomy and good surgical expertise can decrease early morbidity rate.

Objective To analyze the characteristics and prognostic factors of gallbladder carcinoma and investigate the measures of various modus operandi. Methods The clinicopathological data of 181 patients with advanced gallbladder carcinoma treated in our hospital from June 2002 to June 2008 were retrospectively analyzed. SPSS16. 0 software package was used for statistical analysis.Results The overall median survival rate of the 181 patients with gallbladder carcinoma was 6 months. The median survival rate after radical resection for gallbladder carcinoma was 19.5 months,which was remarkably higher than other R1 resection, R2 resection and palliative operation groups (P ＜0. 01) The RO resection rates were 95.5%, 62. 2%, 14.1% and 4.7%, respectively based on different pathological stages of Nevin( Ⅱ , Ⅲ, Ⅳ, and Ⅴ ). There were significant differences among all groups (P＜0.01). The Cox multivariate analysis revealed that pathological stages of Nevin, total bilirubin, CA-199 and therapeutic method had significantly higher risk ratios for gallbladder carcinoma.Conclusion Radical resection may help to improve the survival rate and prognosis of advanced gallbladder carcinoma.

Gallbladder carcinoma (GC) is the most common malignant tumor in bile duct system.Xanthogranulomatous cholecystitis (XGC) is a benign inflammatory gallbladder disease.It is often misdiagnosed between them.This paper,through reviewing the literature and summarizing our own clinical experience,will give a better understanding on the two diseases,which was summarized as follows:inflammation is important both in the pathogenesis of GC and XGC,and we can make the correct diagnosis and choose an appropriate treatment by analy zing the feature of disease history,image data and rapid intraoperative pathological diagnosis.Radical resection remains the first choice in the treatment of GC,but the extent of resection is controversial.Normally,cholecystectomy is sufficient for curing XGC,but different surgeries are needed according to the specific disease conditions.

Objective To discuss the clinical feasibility and safety of modified invaginated pencreaticojejunostomy approach (Jiang's anastomosis) which was developed by the team of biliary surgery department from Shanghai Eastern Hepatobiliary Surgery Hospital.Methods Clinical data of 289 patients receiving modified invaginated pencreaticojejunostomy approach in pancreaticoduodenectomy were retrospectively studied.Wilcoxon signed-rank test,Chi-square and logistic regression tests were comprehensively used to evaluate the postoperative complications and the association with POPF.Results One hundred and sixtythree of 289 patients (54.6％) experienced postoperative complications after pancreaticoduodenectomy procedure.There were 45 onsets of severe complications,accounted for 17.6％ (45/255).Perioperative mortality was 3.1％ (9/289).The most common complications included celiac effusion and infection (26.6％),delayed gastric emptying (17.6％),gastroenterological tract fistula (12.4％),gastroenterological tract hemorrhage (9.7％).Additionally,the incidence of POPF was 9.3％,which all conformed as biochemical fistula (6.9％) and grade-B fistula (2.4％).Conclusions As a risk factor,POPF may play crucial role in celiac hemorrhage and infection associated with pancreaticoduodenectomy.Modified invaginated pencreaticojejunostomy approach (Jiang's anastomosis) with easy manipulation,wide indication,safe and effective performance,could be recommended to reduce POPF incidence.

Objective:To explore the expression of Aurora Kinase A (AURKA) in hepatocellular carcinoma (HCC) and its prognostic value.Methods:mRNA expression profiles and clinical data of HCC patients were downloaded from the Cancer Genome Atlas (TCGA) database. Expression of AURKA mRNA in HCC patients of TCGA database from normal liver tissue and all tumor tissues, normal tissues adjacent to cancer and matched tumor tissues were analyzed, and then expression of AURKA to was investigated in HCC tissues and normal liver tissues in the Human Protein Atlas (HPA) database. According to the TNM stage information of HCC patients in TCGA database, expression of AURKA in different stages was analyzed. Kaplan-Meier method was used to analyze whether the high and low expression of AURKA in HCC patients of TCGA database (with the median as the cut-off value) was significantly related to the length of survival. The RNA-seq expression profile data of HCC patients in the public resource platform of the Kaplan-Meier Plotter website was used for external verification. Cox univariate and multivariate analysis were performed on the age, sex, degree of differentiation, TNM stage, and AURKA mRNA expression of TCGA database patients.Results:374 cases of HCC tumor tissues and 50 cases of adjacent normal liver tissues in the TCGA database were included. All HCC tumor tissues in the TCGA database compared with the paired adjacent tissues mRNA level of AURKA was significantly increased, and the protein level was also increased, the difference was statistically significant ( P<0.05); With the tumor TNM stage increase of AURKA mRNA expression showed a gradual upward trend, and the difference was statistically significant ( P<0.05); in the TCGA database HCC cohort, high expression of AURKA mRNA was associated with poor HCC prognosis, and was obtained in Kaplan Meier Plotter database. The difference was statistically significant ( P<0.05); Cox multivariate regression analysis showed that TNM stage ( HR=1.69, 95% CI: 1.37-2.10) and AURKA mRNA expression level ( HR=1.03, 95% CI: 1.01-1.10) are the independent prognostic factors of HCC patients. Conclusions:AURKA is highly expressed in HCC, which is associated with the poor prognosis of HCC. AURKA is an independent prognostic factor of HCC.

Objective To retrospectively study the clinical value and the advantages in " planned hepatectomy" for the "central type" intrahepatic and extrahepatic choledochal cysts.Methods The clinical data of 7 patients with the "central type" of intrahepatic and extrahepatic choledochal cysts which were treated with "planned hepatectomy" from January 2014 through April 2017 at the Department of Biliary Tract Surgery of the Eastern Hepatobiliary Surgery Hospital,Second Military Medical University were retrospectively analyzed.Results All the patients completed radical resection of the intrahepatic and extrahepatic choledochal cysts in accordance with the " planned hepatectomy".The operations included 6 patients who were treated with percutaneous transhepatic cholangial drainage (PTCD) and 5 patients with portal vein embolization (PVE) prior to the surgical excision.Combined right liver resection was performed in 6 patients,and combined left liver resection in one patient.All the 7 patients had a history of chronic cholangitis.Liver volume tests demonstrated that the hemiliver volume to be removed (the embolized hemiliver) significantly decreased after PVE,whereas the hemilivers to be persevered were remarkably enlarged.No complication associated with PTCD and PVE occurred.The mean postoperative hospitalization was 12 days.Liver function tests suggested all the patients recovered well.No postoperative complication of bleeding,infection or liver function failure was observed,except in one patient who experienced pleural and abdominal effusion.Conclusions Combined subtotal hepatectomy may increase the risk of complications associated with the "central type" intrahepatic and extrahepatic choledochal cysts.The surgical strategy in planned hepatectomy can be used effectively to treat the "central type" of intrahepatic and extrahepatic choledochal cysts,with improved surgical safety,decrease in incidences of postoperative liver function failure and residual choledochal cysts.