Objective To evaluate surgical management of pancreatic duct stones.Methods From 1997 to 2007, 24 cases of pancreatic duct stones underwent surgical treatment, the clinical data were retrospectively analyzed. Results In this study, 17 cases underwent lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosis(side-to-side) of pancreatic duct to jejunum, extra drainageof the main pancreatic duct was done in two cases, hepaticojejunostomy in three cases, pancreaticcystojejunostomy in one case. One case suffered from postoperative bleeding at pancreatic ojejunostomy, one from stress ulcer, and both were cured by conservative treatment. Three cases underwent pancreaticeduodenectomy, anastomosis bleeding occurred in one patient, and was cured by conservative method. One case underwent duodenum-preserving resection of the head of the pancreas, 2 cases underwent distal pancreatectomy, one case underwent lithotomy by pancreatic duct incision and primary closure, no postoperative complications occurred among those patients. 21 cases were followed up, results were excellentin 17 patients. Conclusions Lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosisof pancreatic duct to jejunum is the main and effective surgical procedure, while duodenum preserving pancreatic head resection and lithotomy by pancreatic duct incision and primary closure are also rational for the treatment of pancreatic duct stones.

Objective To study the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) in the treatment of pancreatic benign and borderline tumors.Methods The clinical data of 15 patients with preoperative diagnoses of pancreatic benign or borderline tumors who underwent LSPDP in the Jinhua Hospital,Zhejiang University from March 2013 to March 2017 were retrospectively analyzed.The diameter of tumors ranged from 2.6 to 6.8 cm,with an average of 4.4 cm.Results 15 patients were successfully treated with LSPDP.Twelve patients underwent splenic vessels preservation and 3 without splenic vessels preservation.The average operation time was 215 min (160 ～ 270 min).The mean intraoperative blood loss was 340 ml (180 ～700 ml),and the average postoperative hospital stay was 10.5 days (7 ～ 16 days).There was no patient with postoperative abdominal hemorrhage.Three patients developed postoperative pancreatic fistula and they were treated successfully with conservative therapy.Two patients developed splenic infarction,and the splenic infarction improved markedly after two months on CT.The pathological diagnoses showed 9 patients with serous cystadenoma,4 patients with mucinous cystadenoma,1 patient with a pancreatic neuroendocrine tumor and 1 patient with a solid pseudopapillary tumor.There was no recurrence on follow-up which ranged from 6 to 24 months.Conclusions Laparoscopic spleen-preserving distal pancreatectomy was safe and feasible in the treatment of pancreatic benign or borderline tumors.The Kimura procedure should be performed in preference to the Warshaw procedure.

Objective To evaluate the safety and efficiency of combined finasteride and metformin on benign prostatic hyperplasia (BPH) with type 2 diabetes mellitus(T2DM).Methods Totally 106 patients with BPH plus T2DM received finasteride and metformin treatment for over 12months.Before and after treatment,the side effects and following parameters were measured:prostatic volume (PV),prostate-specific antigen(PSA),international prostate symptom score (IPSS),quality of life (QOL),the maximum flow rate of urinary (Qmax),residual urine(RU),body mass index (BMI),cholesterol (TG).Results There were obvious changes in the following:PV decreased from (56.40±18.75)ml to(42.40± 19.68) ml,PSA decreased from(3.65± 1.08) μg/L to (1.76±0.66)μg/L,IPSS decreased from(22.58±9.45)to(16.67±7.56),QOL decreased from(4.22± ±0.87) to (2.36 ± 0.74),Qmax increased from(8.32±2.42)ml/s to(15.48±3.61)ml/s,RU decreased form(68.36±19.25)ml to(36.42±13.91)ml,BMI decreased from(28.52±3.73)kg/m2 to (19.76± 1.88)kg/m2,TG decreased from (2.52 ± 0.43) mmol/L to (1.38 ± 0.52) mmol/L.The changes of PV,PSA,IPSS,QOL,Qmax,RU,BMI and TG were statistically significant (all P＜0.05).Conclusions Long term combined finasteride and metformin treatment for BPH plus T2DM is effective and safe.And the two drugs may be improve the efficacy each other.

ObjectiveTo investigate the feasibility and efficacy of using the hepatoduodenal ligament tension-reduced operation (tension-reduced operation in short) for iatrogenic bile duct injury where the bile duct was severely defective. MethodsBetween March 2006 and May 2009, the authors treated 6 patients with iatrogenic bile duct injury (Bismuth type Ⅱ : 5 patients and type Ⅲ : 1 patient). A no. 7 black silk thread was used to hold the hilar plate tissues and the seromuscular layer of the bulbous part of the duodenum closer together and knots were tied. This method brought the porta hepatis and the duodenal bulb closer together and the hepatoduodenal ligament was shortened. An end to end anastomosis could then be made between the two broken ends of the defective bile duct without tension. ResultsSix patients suffered from bile duct injury and they recovered fully after the tensionreduced operation. There was no complication on follow-up. ConclusionsThe tension-reduced operation was efficacious in the treatment of iatrogenic bile duct injury. This technique should be popularized and more widely used.

Objective:To explore the clinical value of three-dimensional visualization combined with 3D laparoscopy in the resection of middle segment pancreatectomy.Methods:The clinical data of 11 patients who underwent middle segment pancreatectomy by 3D laparoscopy admitted in the Department of General Surgery of Jinhua Hospital affiliated with Zhejiang University from December 2016 to March 2020 were retrospectively analyzed. The 3D visualization software was used to reconstruct the image data collected from 2D CT images of the patients before operation, showing the three-dimensional location of the tumor, the extent of pancreatic tumor involvement, the relationship between tumor and surrounding vessels and the status of peripheral enlarged lymph nodes; according to the reconstructed figure, the specific surgical approach and procedures were determined. All the middle segment pancreatectomy was performed under 3D laparoscopy.Results:Three-dimensional visualization clearly displayed the middle pancreatic tumor and the adjacent organs, especially showing the distinct relationship between the tumor and the artery, vein and common bile duct. All the surgery had been successfully completed because of the good depth of field and sterescopic image of 3D laparoscopy, and no patient was transferred to open surgery and Roux-Y pancreaticojejunostomy was performed in all the patients. The average operation time was (264±98)min, and the intraoperative blood loss was (105±82)ml. The average hospital stay ranged from 6 to 17 days after operation. There were 3 cases of grade B pancreatic fistula after operation, which were cured by active drainage and conservative treatment. All the patients recovered and discharged without death.Conclusions:Three-dimensional visualization can accurately evaluate the pancreatic tumor before operation, and it combined with 3D laparoscopic middle segment pancreatectomy was safe and feasible.

Objective:To study the feasibility, safety and efficacy using transperitoneal approach guided by puncture catheter on laparoscopic treatment of infectious necrotizing pancreatitis.Methods:The clinical data of 7 patients who underwent laparoscopic treatment of infectious necrotizing pancreatitis using the transperitoneal approach at Jin Hua Jinhua Hospital of Zhe Jiang Zhejiang University from June 2018 to March 2021 were retrospectively analyzed. There were 3 males and 4 females, with age of (49.6±9.4) years old (range 32-65 years old). The general data, operation time, intraoperative blood loss and other clinical data were collected. Hepatobiliary and pancreatic CT was reviewed 1 week after the operation to study the changes in size of lesion, double cannula position and effect of necrotic tissue removal.Results:All patients were treated with percutaneous puncture and drainage under ultrasonic guidance before surgery. The course of the disease before operation was 42-58 days. All patients successfully completed surgery, and 5 patients underwent cholecystectomy. No patients required conversion to open surgery. The operation time was 140-195 min, the intraoperative blood loss was 30-100 ml, the postoperative hospital stay was 28-42 days, the postoperative time to first passed flatus was 2-4 days. Routine hepatobiliary and pancreatic CT 1 week after the operation showed that the degrees of necrosis and infection of pancreas were significantly improved and the lesion cavity was reduced compared with those before the operation. One patient suffered from abdominal hemorrhage after operation. There were no other serious complications. All patients recovered well after 6 to 12 months follow-up.Conclusion:Laparoscopic treatment of infectious necrotizing pancreatitis by using the transperitoneal approach guided by puncture catheter was safe and feasible. The treatment had the advantages of less trauma and fast recovery, and it was especially suitable for patients with biliary pancreatitis.

To investigate the relationship of bcl-2, p53, proliferating cell nuclear antigen (PCNA) to cell proliferation, apoptosis and pathological parameters, the patterns of cell growth and turnover in renal cell carcinoma (RCC), formalin-fixed and paraffin-embedded tissue blocks from 34 patients with RCC were examined. Cell proliferation activity was detected by PCNA immunostaining and the proliferation index (PI) was expressed as a percentage of the PCNA-positive cells in the tumor cells. Apoptosis was detected by terminal deoxy- nucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL), and the apoptotic index (AI) was expressed as a percentage of the TUNEL-positive cells in the tumor cells. Expressions of bcl-2 and p53 were assessed immunohistochemically. Our results showed that the PI ranged from 6.0% to 24.0% (median 12.3%) and the AI from 2.0% to 8.0% (median 5.4%) in RCC. The expression of the bcl-2 protein was demonstrated in 15 cases (44.1%); the expression of the p53 protein, however, was seen in only 3 case. bcl-2 positivity was not associated with PI or AI or any pathological parameters. There were close associations between PI and tumor grade and stage, and a significant relationship between AI and the tumor grade of RCC, Our study suggests that bcl-2 positivity was not associated with PI or AI or any pathological parameters. There are close associations between PI and AI and tumor grade and stage of RCC. Active cell proliferation may be accompanied by frequent apoptosis in RCC.
Adult ; Aged ; Apoptosis ; physiology ; Carcinoma, Renal Cell ; metabolism ; pathology ; Cell Division ; Female ; Humans ; Kidney Neoplasms ; metabolism ; pathology ; Male ; Middle Aged ; Proliferating Cell Nuclear Antigen ; biosynthesis ; genetics ; Proto-Oncogene Proteins c-bcl-2 ; biosynthesis ; genetics ; Tumor Cells, Cultured ; Tumor Suppressor Protein p53 ; biosynthesis ; genetics

Objective:To study the feasibility and safety of combining liver suspension with 3D laparoscopy in resection of liver tumors in segments 7 and 8.Methods:The data of 26 patients who underwent liver tumor resection in segments 7 and 8 with 3D laparoscopy at Jinhua Hospital of Zhejiang University from January 2018 to December 2019 were retrospectively analyzed. There were 20 males and 6 females, with an average age of 58.7 years. All patients underwent liver tumor resection in segments 7 and 8 with liver suspension combining with 3D laparoscopy. The operative data was analysed.Results:For 25 patients underwent successful operations, and 1 patient was converted to open surgery. The mean operating time was 153 (65-350) min. The Pringle's maneuver was used in 15 patients. The mean blood loss was 155 (30-1 200) ml. Postoperative ascites developed in 4 patients (16.0%), and pleural effusion in 2 patients (8.0%). There was no bile leakage or incisional infection. The mean postoperative hospital stay was 6.2 (4-10) days.Conclusion:The liver suspension technique combing with 3D laparoscopy is safe and effective for resection of liver tumors in segments 7 and 8.

Objective: To study the feasibility of using a double purse-string bridging pancreaticojejunostomy in total laparoscopic pancreaticoduodenectomy (TLPD). Methods: A database of 35 patients who underwent TLPD using a double purse-string bridging pancreaticojejunostomy from January 2016 to January 2019 in Jinhua Hospital of Zhejiang University was retrospectively reviewed. The perioperative outcomes were analyzed. Results: All the 35 patients underwent TLPD successfully. The surgery time was (370.2±33.5) min, and the time of constructing the pancreaticojejunostomy was (28.4±12.6) min. The hospital stay after surgery was (14.2±6.9) days. Five patients developed postoperative complications, including pancreatic fistula in 3 patients, bile leakage in 1 patient, gastroparesis (complicated with abdominal infection) in 1 patient, and abdominal infection in 3 patients (2 patients with pancreatic fistula, and 1 patient with gastroparesis). All the patients with complications responded well to conservative treatment. Conclusions A double purse-string bridging pancreaticojejunostomy was simple and widely applicable. It is safe and feasible in total laparoscopic pancreaticoduodenectomy and should be promoted in clinical practice.

Objective:To compare the clinical outcomes of a double purse-string and bridging technique versus duct-to-mucosal pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy.Methods:The clinical data of patients who underwent laparoscopic pancreaticoduodenectomy using the double purse-string and bridging pancreaticojejunostomy technique versus those who underwent duct-to-mucosa pancreaticojejunostomy at the Affiliated Jinhua Hospital of Zhejiang University School of Medicine from January 2016 to August 2021 were retrospectively analyzed. Of the 93 patients who underwent laparoscopic pancreaticoduodenectomy, there were 48 males and 45 females, with age of (62±10) years old. These patients were divided into two groups: patients who underwent double purse-string and bridging pancreaticojejunostomy (the double purse-string group, n=51), and patients who underwent duct-to-mucosa pancreaticojejunostomy (the duct-to-mucosa group, n=42). The clinical data of the two groups were compared. Results:All the 93 patients underwent laparoscopic pancreaticoduodenectomy successfully, and there were no deaths within 3 months of operation. Compared with the duct-to-mucosa group, the double purse-string group had significantly shorter time of pancreaticojejunal anastomosis [(32.41±8.75) vs. (47.62±8.90) min] and time of operation [(365.75±43.74) vs. (389.07±45.31) min] (all P<0.05). The postoperative pancreatic fistula rates were 9.8% (5/51) in the double purse-string group and 7.1% (3/42) in the duct-to-mucosa group. There was no significant difference between the two groups ( P>0.05). In the double purse-string group, there were 18 patients with a pancreatic duct diameter >3 mm, and 3 of these patients developed grade B pancreatic fistula, giving a grade B pancreatic fistula rate of 16.6% (3/18). In the duct-to-mucosa group, there were 11 patients with a pancreatic duct diameter >3 mm, and no patients developed grade B pancreatic fistula, giving a pancreatic fistula rate of 0(0/11). Conclusion:Compared with the duct-to-mucosa anastomosis, the double purse string and bridging pancreaticojejunostomy was technically simpler. It shortened the time of pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy, especially for patients with a non-dilated pancreatic duct.