Objective To investigate the effects of IL-6/STAT3 activation on the proliferation of biliary epithelial cell following liver transplantation in rat.Methods Based on the classic "two-cuff" technique for orthotopic liver transplantation in rat,end-to-end anastomosis between the common hepatic arteries of donor and recipient by the modified "Gao stent" was performed to reconstruct hepatic artery blood flow.Wistar rats were then randomly divided into CP1h group and CP12h group(grafts were preserved in UW solution at 4℃ for 1h and 12h respectively),RPM group(CP12h group treated by rapamycin,RPM)and C group(control).At 1,3,7,14d after operation,liver IL-6 mRNA expression was analyzed by real-time RT-PCR.STAT3 activation was determined using laser confocal scan microscopy(LSM).BEC proliferation was detected by immunohistochemistry.Results In the CP1h group,expression of IL-6 mRNA was upregulated one day after operation(0.41?0.03),and then fell to the C group level subsequently(0.28?0.03,0.23?0.03 and 0.27?0.05 at 3,7 and 14d after operation).STAT3 activation in the BEC(94?8,61?6,39?4 and 34?3)and proliferation of the BEC following liver transplantation(2.1%?0.3%,5.9%?0.5%,2.6%?0.5% and 2.3%?0.5%)showed a similar trend.Compared with the CP1h and C group,the CP12h group demonstrated a significant and persistent up-regulation of IL-6 mRNA(0.60?0.03,0.73?0.02,0.38?0.02 and 0.30?0.04)and STAT3 activation(167?17,247?13,110?9 and 74?8).BEC proliferation in CP12h group were 7.0%?0.5%,27.8%?1.8%,23.1%?1.6% and 17.8%?1.2%,there was a direct correlation between IL-6 mRNA expression and STAT3 activation(r=0.95,P

Objective To explore the current management strategy and effect of damage control operation(DCO)for severe pancreatic trauma. Methods The clinical data of 19 cases with severe pancreatic trauma were selected as the object of this study.A retrospective analysis was done on preference of DCO moduses and perioperative therapies.Results Operations were performed in all 19 patients including six cases(32%) treated with rapid surgical haemorrhage control,wound excision and drainage,three(11%) with Cogbill operation and 10(53%) with Whipple operation without reconstituted digestive tract.Then,all cases were under reoperations after SICU resuscitation.Death was caused by associated organs injuries and secondary infection,with mortality rate of 11%.The pancreatic fistula occurred in two cases(11%) that were healed by conservative treatments.Conclusion For severe pancreatic trauma cases in accordance with DCO indications,active and reasonable operation should be done according to location and degree of pancreas injury.

Objective To explore the management strategy of damage control operation(DCO) for extrahepatic bile duct injury.Methods Clinical data of 15 cases with extrahepatic bile duct injury from June 2002 to September 2007 were selected as the object of this study.Results DCO was performed in all of 15 patients,then all cases were underwent reoperation after surgery intensive care unit resuscitation.All cases survived.Two cases(13.3%) occurred biliary fistula and 1 case(6.7%) occurred intestinal fistula of colon after reoperation,2 cases(13.3%)occurred infection and disruption of incisional wound,and 1 case(6.7%) occurred acute liver function failure.All complications were cured by drainage,symptomatic and supportive treatment.The cure rate of these 15 cases was 100%.There were no stricture of bile duct and correlative complications during 28 months of median follow-up.Conclusion To increase survival rate and reduce complications,severe trauma patients with extrahepatic bile duct injury should be made positively under DCO and choose eligible operations modus.

Objective To explore a new method of parapancreatic abscess treatment and establish an idea of minimally invasive technologies for parapancreatic abscess to improve the recovery rate of acute pancreatitis. Methods The patients had experienced percutaneous puncture and placed drainage tube under the ultrasound guidance first, then the sinus tract was expanded gradually to 24F perimeter by Cook's fascia expender. Finally, the necrotic tissue and pyogenic membrane was removed and repeatedly washed under guidance of choledochoscopy. Results The recovery rate was 91.1 %(33/36). The complication incidence was 10.7% (hemorrage:2 cases, external intestinal fistula:3 cases, and fatal MOF: 1 case). Conclusions The viewpoint which parapancreatic abscess only can be cured by drainage operation can be changed by associating debridement by choledochoscope with percutaneous puncture drainage under the ultrasound guidance. It is a simple, safe and effective method. It can be used to reduce the patients' damage, complication and mortality and accomplish the idea of damage control by minimally invasive technologies.

0.05). At time points of end of cold preservation, 10, 30 and 60 min of reperfusion, the activity of p38MAPK in control group was significantly higher than that at the time points of before resection and 120 min of reperfusion (P0.05). The expressions of TNF-? mRNA and ICAM1 mRNA at the time points of before resection, end of cold preservation, and 10 and 30 min of reperfusion were significantly lower than those in 60 and 120 min of reperfusion in both two groups (P

0.05).But there were significant difference in operation time,blood loss,time of resumption of food,time of intestinal function recovery,length of hospital stay and complications between OC group and LC group(P

Objective To expand the utilization of minimally invasive technologies for parapancreatic abscess,and summarize the application experience of choledochoscope for treatment of parapancreatic abscess.Methods The clinical data and treatment effectiveness of 36 patients with parapancreatic abscess from Dec.2000 to Dec.2008 were analyzed retrospectively.These patients had experienced percutaneous puncture and been placed drainage tube under the ultrasound guidance first,then expanded the sinus tract gradually,and performed debridement by choledochoscope.The flexibility of choledochoscope was used to remove the necrotic tissue and pyogenic membrane repeatedly by clamping,netting and vacuum aspiration in every domain.Results Thirty-six patients were performed percutaneous puncture and placed drainage tube,3 cases were given canalis singularis,7 cases were double tube,26 cases were over three tube.The debridement times were 3-14 by choledochoscope,average 5.6 times.There were 6 cases with improving systemic symptoms,blood routine and temperature recovering normal,and drink and food recovering,then discharged from hospital with tube after 1-2 times of debridement.Length of stay was 25-132 d,average 76 d.The curing rate was 91.7% (33/36).Two cases were turned into open surgery because of broad necrotic tissue range combined with many abdominal cavity abscess with good postoperative recovery and cured.One case was dead of severe multiple organ failure combination.There were 2 patients with hemorrhage,3 patients with external intestinal fistula.Conclusions The debridement of choledochoscope for parapancreatic abscess treatment is a simple,flexible and effective method.It changes the viewpoint that parapancreatic abscess can be cured only by operation drainage,decreases the patients’ trauma and accomplishes the idea of damage control by minimally invasive technologies.

Objective To summarize the experiences on the diagnosis of pancreatic trauma and to explore the strategy of its management.Methods The clinical data of 48 patients with pancreatic trauma,who were admitted and treated in the Center for General Surgery,General Hospital of Chengdu Command of PLA from June 1998 to June 2008,were retrospectively studied,and the diagnosis,surgical management,and the therapeutic effects were analyzed.Results Of the 48 patients,32 patients(66.7%) were diagnosed as pancreatic injury before operation,and in 16(33.3%) the final diagnosis was confirmed intraoperatively.For these 48 patients,the degree of pancreatic injury was graded according to AAST-OIS as follows:Grade Ⅰ 9 cases,Grade Ⅱ 28 cases,Grade Ⅲ 5 cases,Grade Ⅳ 4 cases and Grade Ⅴ 2 cases.Of the 48 patients,44(91.7%) recovered and 4(8.3%) died.Early complications occurred in 2 cases(4.2%),one with traumatic pancreatitis and another subphrenic Abscess.Late complication such as pancreatic secretion insufficiency occurred in 3 patients(6.3%) in whom resection of distal portion of pancreas was done.7 patients(14.6%) had postoperative complications,including 2 cases of pancreatic pseudocyst,4 cases of pancreatic fistula and 1 case of pancreatic fistula combined with intestinal fistula.Conclusions The early diagnosis of pancreatic trauma should be based on a comprehensive patient history and scrupulous physical examination,aided by auxiliary examinations including serum amylase level,ultrasound,CT scanning,endoscopic retrograde cholangio-pancreatography(ERCP) or magnetic resonance cholangio-pancreatography(MRCP),and laparotomy if necessary.Pancreatic fistula is the main complication following pancreatic trauma and often occurs in the patients with severe pancreatic injury.Aggressive operation on the pancreas is not recommended,while correct judgement of injury to the main duct,a good debridement,effective drainage and flawless pancreaticoenterostomy are the key factors to avoid postoperative fistula.

Objective To investigate the efficacy of holmium laser coagulation under choledochoscope for the treatment of intrahepatic hemobilia.Methods The clinical data of 55 patients with intrahepatic hemobilia who received holmium laser coagulation under choledochoscope at the General Hospital of Chengdu Military Area from June 2003 to August 2011 were retrospectively analyzed.After the hemobilia was confirmed with choledochoscopy,an optical fiber of holmium laser was inserted into the intrahepatic bile duct from the hole of choledochoscope.The top of the optical fiber was posed close to the bleeding region,and then the laser was stimulated for coagulation under direct vision.If the observation of the bleeding area was influenced by the bleeding,the porta hepatis was temporarily occluded with a rubber hose combined with pressurized liquid injection bag.For patients with distal bile duct stenosis and bleeding,the narrow area was first expanded by biliary balloon or laser,then hemostasis was completed after the flow of bile duct was restored.Results The hemorrhage of the 55 patients was controlled,with an average time of 5.5 minutes (range,2-15 minutes).Temporary hepatic portal clamping was applied for 16 patients (27 times),and the average blocking time was 2.2 minutes (range,1-4 minutes).Biliary rehaemorrahagia occurred after operation in 2 patients,and they were cured by non-surgical treatment.All patients were discharged after successful hemostasis.The time of follow-up was 35-49 days.The epithelium of the bile duct coagulated by intraoperative holmium laser restored flat in 41 patients,and new biliary stricture was not found in the other 14 patients.Conclusion Holmium laser coagulation under choledochoscope for intrahepatic hemobilia is simple and effective.

Objective To study the relationships between tissue damage and the ability of the pancreatic cells to regenerate ,and analyze the alteration of the pancreatic cells regeneration .Methods Sixty rats were divided into two groups :impact group(the pan‐creas was injured by a BIM‐Ⅲ biotical impact machine ,40 rats) and control group(sham operated ,20 rats) .All rats were sacrificed at 6 h ,24 h ,72 h ,7 d after operation .The level of AMS ,LPS in the serum were detected by spectrophotometry ,pancreatic cells re‐generation were examined and analyzed by TUNEL staining and flow cytomertry ,and the Bcl‐2 and Bax expression were measured by Western blot .Results In the impact groups ,LPS was activated later than AMS ,and lasted persistently .The results from TUNEL stain ,flow cytometry and Western blot indicated that pancreatic trauma induces cell death and the compensatory prolifera‐tion of pancreatic cells .The characteristics of pancreatic cells regeneration in the animal model of isolated pancreatic trauma indicate that the proper remedial time is in the first 24h after the pancreatic trauma .Conclusion Detecting AMS and LPS at the same time can help us to determine the exocrine function of pancrease .