Digestive tract reconstruction is one of the important steps following pancreatoduodenectomy.Traditional methods of digestive tract reconstruction,such as Whipple,Child and Cattel method,had disadvantages of bringing damage to the normal physiological structure and raising the incidence of complications.In this review,the improvements of the digestive tract reconstruction in recent years were introduced,and their benefits and shortcomings were also analyzed.

There is a common consensus amongst pathologists as to how to determine and examine the pancreatic,biliary tract and gastrointestinal surgical margins for specimens after pancreaticoduodenectomy (PD).However,for the retroperitoneal surgical margin which is one of the most important surgical margins in PD has not been well studied,and its determination remains unclear.In the present study,the definition,evaluation criteria and clinical significance of retroperitoneal surgical margin in PD were analysed.The relationship between R0,R1 resection rates and survival rates were compared.We presented a new technique to obtain a negative surgical margin in the uncinate process of the pancreas.

Objective To investigate the effect of cyclooxygenase-2 inhibitor Celebrex on the growth of(gallbladder) carcinoma GBC-SD cell line.Methods Cell growth suppression was counted by MTT method.Apoptotic index(AI) was evaluated by TUNEL staining.The apoptotic rate was counted by flow cytometry(FCM),fluorescence microscopy(FM) and transmission electron microscopy(TEM).Results Celebrex(inhibiting) the growth of GBC-SD cell line was dose-depend.The growth inhibition rate with 40?mol/L,80?mol/L,120?mol/L and 160?mol/L was 18.77%,25.32%,46.58% and 52.19%(respectively),(P

Radical pancreaticoduodenectomy is the most effective method for the treatment of malignant tumor of pancreatic head.Safe and complete resection of the uncinate process of the pancreas is the most difficult and important part in radical pancreaticoduodenectomy.For the past years,we put forward the new idea of prior selective arteriovenous treatment in radical pancreaticoduodenectomy according to whether the portal vein and superior mesenteric vein was invaded by the tumor.Thin slice scan and vessel reconstruction using multidetector spiral CT can accurately evaluate the condition of the blood vessels near the pancreatic tumor and judge whether the tumor was resectable.By exchanging superior mesenteric artery,controlling blood stream of pancreatic uncinate process and using 3 or 4 vascular blocking bands and the integrated radical resection of uncinate process for those patients can be successfully completed.It can reduce the operating bleeding,operating time and the miscut of superior mesenteric vein and (or) superior mesenteric artery,and also avoid postoperative pancreas necrosis,infection and hemorrhage caused by the pancreas uncinate process residues,and theoretically reduces the chance of tumor cells spread.

Objective To investigate the application value of three-dimensional (3D) laparoscopic pancreaticoduodenectomy (LPD) and compare the clinical outcomes between 3D-LPD and open pancreaticoduodenectomy (OPD).Methods The retrospective cohort study was adopted.The clinicopathological data of 349 patients who underwent pancreaticoduodenectomy at the Affiliated Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology between July 2014 and March 2016 were collected.Of 349 patients,146 undergoing 3D-LPD were allocated into the 3D group and 203 undergoing OPD were allocated into the OPD group.Observation indicators:(1) surgical situations:operation time,volume of intraoperative blood loss,cases of blood transfusion,number of lymph node dissected,resection margin and vascular resection and reconstruction,(2) postoperative situations:time of gastric tube removal,duration of intensive care unit (ICU) stay,duration of hospital stay,(3) complications:pancreatic fistula,delayed gastric emptying,intra-abdominal infection or abscess,bile leakage,hemorrhage,pulmonary infection or wound infection,(4) follow-up.All the patients were followed up by telephone interview to detect the tumor-free survival rate up to June 2016.Measurement data with normal distribution were presented as (x) ± s and comparison between groups was analyzed using the t test.Count data were analyzed using the chi-square test.Results (1) Surgical situations:all the patients underwent successful pancreaticoduodenectomy.Operation time,volume of intraoperative blood loss,cases of blood transfusion,number of lymph node dissected and positive resection margin were (334 ± 175)minutes,(254 ± 107)mL,29,13 ±8,1 in the 3D group and(320 ±91)minutes,(290 ± 101) mL,35,14 ±9,5 in the OPD group,respectively,with no statistically significant difference between the 2 groups (t =0.975,1.383,x2=0.390,t =12.155,x2=1.589,P ＞ 0.05).Vascular resection and reconstruction were respectively applied to 0 patient in the 3D group and 14 patients in the OPD group,with a statistically significant difference between the 2 groups (x2 =10.490,P ＜ 0.05).(2) Postoperative situations:time of gastric tube removal,duration of ICU stay and duration of hospital stay were (2.9 ± 1.9) days,(6.9 ± 2.1) days,(12.9 ± 7.2) days in the 3D group and (5.1 ± 1.7) days,(7.4 ± 1.2) days,(19.8 ± 7.1) days in the OPD group,respectively,with statistically significant differences between the 2 groups (t =11.350,2.814,8.903,P ＜ 0.05).(3) Complications:of 146 patients in the 3D group,40 had postoperative complications with incidence of complications of 27.40％ (40/146).Twenty-nine patients with pancreatic fistula (20 in grade A,9 in grade B and C) were improved by conservative treatment.Thirteen patients with delayed gastric emptying were cured by gastrointestinal decompression and enhancing gastric motility.Of 5 patients with postoperative hemorrhage,3 were improved by conservative treatment,and 2 were improved by small vein hemostasis behind the head of pancreas.One patient died of systemic inflammatory response syndrome.Partial patients were combined with multiple complications.Of 203 patients in the OPD group,60 had postoperative complications with incidence of complications of 29.56％ (60/203),including 39 patients with pancreatic fistula (31 in grade A,8 in grade B and C),25 with delayed gastric emptying,15 with intra-abdominal infection and 13 with systemic inflammatory response syndrome,and they were improved by conservative treatment.Of 8 patients with postoperative hemorrhage,4 were improved by conservative treatment,and 4 were cured by hemostatic therapy after ineffectual blood transfusion and interventional treatment.Two patients died of cardiopulmonary complication.Partial patients were combined with multiple complications.There was no statistically significant difference in the incidence of postoperative complication between the 2 groups (x2 =10.490,P ＞ 0.05).(4) Follow-up:all the patients were followed up at postoperative month 6.Tumor-free survival rate was 90.41％ (132/146) in the 3D group and 85.22％ (173/203) in the OPD group,with no statistically significant difference between the 2 groups (x2 =2.076,P ＞ 0.05).Conclusion Compared with OPD,3D-LPD can provide the more realistic visual effects and refinement of surgical procedures,with a good short-term outcome.

Objective To investigate the effects of urinastatin on the production of inflammatory mediators and cytokines of acute pancreatitis(AP), and the effect of treating AP with urinastatin. Methods Serum levels of tumor necrotic factor ?(TNF ?), nitrogen oxide(NO), oxygen free radicals and amylase were determined in AP rats and patients with AP respectively. Effects of urinastatin treatment on the alleration of symptoms, signs and of pancreas in patients with AP were also examined. Results Urinastatin could apparently decrease the serum levels of TNF-?, oxygen free radicals and amylase in AP rats and the patients with AP, also alleviate the symptoms and signs of the patients with AP, and the effective rate of treating AP with urinastatin reached 90 percent. Conclusions Urinastatin, which can inhibit the production of inflammatory mediators and cytokines in AP, is an effective and cheap drug for AP.

Objective To investigate the anti-migratory and anti-invasive effect of somatostatin receptor type 2(SSTR2) gene transfection mediated by adenovirus in human pancreatic carcinoma cell and the mechanisms involved in this effect.Methods The full length human SSTR2 cDNA was introduced into pancreatic cancer cell line BXPC-3 by adenovirus-mediated transfection,and stable expression of RNA and protein of SSTR2 were detected by RT-PCR and Westen-blot.The Matrigel coated Transwell was used to detect the migratory and invasive ability of SSTR2expressing cells,Adv-GFP control cells and mock control cells.Furthermore,the expressions of matrix metalloproteinase-2(MMP-2) and tissue inhibitor of metalloproteinase-2(TIMP-2) were detected by RT-PCR method in these cells.Results The stable expression of SSTR2 was detected in BXPC-3 cells transfected by Adv-GFP-SSTR2.A dramatic decrease of BXPC-3 expressing SSTR2 cell(migrated) through a Matrigel-coated filter was observed,as compared with Adv-GFP control cells and mock control cells(P

Objective To explore the expression and clinical significance of EphA2 and E-cadherin in (pancreatic) cancer tissue and cells.Methods The expression of EphA2 and E-cadherin in 56 pancreatic(carcinomas) and 23 adjacent noncancer tissues were studied by immunohistochemistry,and their relationship to clinicopathological characteristics were analyzed.RT-PCR was performed to explore the expression of EphA2,BXPC-3,PC-3 and PANC-1 in pancreatic carcinoma cell lines.Results In pancreatic carcinomas tissuse showed increased EphA2 expression and reduced E-cad expression which compared with adjacent noncancer tissues.The expression level of EphA2 had a significant positive relationship with tumor differentiation degree,lymphatic metastasis and clinical stage.However,the expression level of E-cadherin had negative relationship with both the tumor clinical stage and lymphatic invasion.Furthermore,a significant negative relationship(between) the expression of EphA2 and E-cadherin was observed.The expressions of EphA2 were higher in high-invasive cell lines PXPC-3 and Panc-1 than in low-invasive cell line PC-3.Conclusions The(expression) and/or abnormal function of EphA2 and E-cadherin may together be involved in the development and progression of pancreatic cancer;the combined measurement of these two proteins may be useful for(determination) of metastatic potency of pancreatic carcinoma.

Objective To determine the methods and effects of common bile duct(CBD) exploration and primary suture by laparoscopic procedure after laparoscopic cholecystectomy (LC) . Methods After LC, 35 patients' CBD were explored.After hte CBD stone was removed by choledochofiberscopy completely and CBD stenosis was excluded, the CBD was sutured primarily. Results 32 cases of CBD gallstone were removed ,and 3 exploration were negative.All the 35 CBD were sutured primarily . Two patients occurred bile leakage 1～3 day after the operation ,which were cured by conservative therapy.29 patients were followed-up for 3～24 months,no residual stone or bile duct stricture was found. Conclusions Primary suture CBD is safe and effective in laparoscopic CBD exploration,if the patient selected correctly.

Objective To observe the effect of antisense hypoxia inducible factor-1?(HIF-1?) on (chemosensitivity) of human pancreatic cancer cell line BxPC-3 under hypoxia. Methods BxPC-3 cells were divided into 3 groups:(1)BxPC-3 cells were non-transfected with antisense HIF-1? plasmid and exposed to 0.5% O_2 for 4hr(hypoxia control);(2)normoxic BxPC-3 cells were non-transfected with antisense(HIF-1?) plasmid(normoxia control);(3)BxPC-3 cells were transfected with antisense HIF-1? plasmid and exposed to 0.5% O_2 for 4hr(experimental group).Expression of HIF-1? and survivin was detected by RT-PCR and Western Blot.Growth inhibition rates and apoptosis rates of BxPC-3 cells under different(dosages) of chemotherapeutic agents(5-fluorouracil,doxorubicin and gemcitabine) were measured by MTT(colorimetric) assay and flow cytometry (FCM).Results Expression of HIF-1? was obviously down-regulated and at the same time susvivin expression was markedly down-regulated in experimental group(P