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 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 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 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

Organ-specific tumor cell adhesion to extracellular matrix (ECM) components and cell migration into host organs often involve integrin-mediated cellular processes. Direct integrin-mediated cell adhesion to ECM components in the space of Disse appears to be required for the successful liver metastatic formation of colon cancer. In the present study, human colon cancer HT-29 cells were transfected by liposome with integrin-beta(1) antisense oligodeoxynucleotide (ASODN). The integrin-beta(1) gene expression in HT-29 cells was significantly down-regulated. The migration of HT-29 cells was assayed using transwell cell culture chambers in vitro. The number of migrating HT-29 cells in experimental group was far less than that in control group (P<0.05). The models of hepatic metastasis in nude mice were established by the intrasplenic injection of transfected HT-29 cells. Thirty days later, the nude mice were killed and the average number of hepatic metastases (4.00+/-0.93 per mouse), average volume (10.10+/-6.50 mm(3) per mouse), average weight (0.0440+/-0.0008 g per mouse) in experimental group were remarkably reduced as compared with those in control group (P<0.05). Integrin-beta(1) expression in the hepatic metastasis was studied by immunohistochemistry (SP). Positive cell percentage of hepatic metastases in experimental group was markedly decreased as compared with that in control group (P<0.05). It was concluded that integrin-beta(1) may take part in hepatic metastasis, and down-regulation of integrin-beta(1) expression may play a key role in decreasing migration and hepatic metastasis of human colon carcinoma cells (HT-29).

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

Objective To investigate the antitumor effect of tumor necrosis factor-related apoptosis-inducing ligand(TRAIL) gene transfection mediated by adenovirus into human pancreatic carcinoma cell line Panc-1,and the mechanisms involved in this effect.Methods TRAIL gene was transfected into pancreatic cancer cell line Panc-1 by an adenovirus vector(Ad-TRAIL).Level of TRAIL mRNA expression was determined using RT-PCR,and TRAIL protein synthesis was evaluated with Western blot.Cell-growth activities were determined by MTT assay.The bystander effect was observed by co-culturing the Panc-1 cells with and without the transfected TRAIL gene at different ratios.Apoptosis in pancreatic cancer cells was detected by flow cytometry.Proaspase-8 and procaspase-3 proteins were determined by Western blot.Results The stable overexpression of TRAIL was detected in Panc-1 cells transfected by Ad-TRAIL.Ad-TRAIL significantly inhibited cell viability of Panc-1 cells.Furthermore,co-culture of cancer cells transfected with TRAIL resulted in the nontransfected cell inhibition by bystander effect.Moreover,the percentage of apoptotic cells was significantly higher in the Ad-TRAIL-treatment group compared to the control groups(P