Medicine is a practical science which needs comprehensive analysis.The old fashion of disease treatment model divided by different professions or departments was gradually unable to meet the needs of the clinical diagnosis and treatment,and the corresponding medical education pattern was very limited.As the development of multi disciplinary treatment (MDT) focused on a certain disease or organ,medical teaching mode also changed.Since our hospital used MDT as the treatment of severe acute pancreatitis (SAP),teaching model has been reformed by launching the joint multidisciplinary teaching.After that,the graduate students and advanced students from relevant departments have greatly improved their diagnosis and treatment skills.

Objective To explore a new way to drain a postoperative abdominal abscess. Method Drainage catheter and sinography were employed to locate the site of the abscess, and a 10.2F~16F catheter with single or double lumen was inserted into the abscess by interventional technique. Result A 100% success was obtained for the 15 patients with 18 abscesses by inserting the drainage catheters, and all the abscesses were cured 7~65 days after drainage. Conclusions Compared with the surgical or percutaneous drainage, the present method is less traumatic, safer, more economical and effective, and it could be applies to all kinds of postoperative intraperitoneal abscesses which could not been drained adequately or with formation of sinus because of displacement of drainage tube.

To study the clinical and pathological features of hepatocellular adenomas.History and comprehensive imaging features in 6 patients with confirmed hepatocellular adenomas were reviewed retrospectively and correlated with pathological findings.The results showed that all six patients had solitary adenomas. Of the 6 patients, 4 were men and 2 were women. The diameter of tumors ranged from 4 to 11 centimeters, with an average of 8.5 centimeters. All the adenomas were hypervascular, and were nearly isoattenuating to normal liver on nonenhanced, portal vein period and delayed images except for areas of necrosis, hemorrhage, or focal fatty degeneration. Six lesions showed heterogeneously high signal intensity on T1 weighted images of MRI. All tumors were resected completely, and there were no serious complications and death. It suggested that these tumors may have some common features on CT and MRI images that should allow us to improve our diagnostic ability, if we could contrast imaging features with pathological characters. The surgical operation is effective.

Objective To investigate the clinical value of lasting methylene blue staining in precise hepatectomy.Methods The clinical data of 21 patients with liver cancer who received precise hepatectomy after methylene blue staining at General Hospital of PLA from February to August in 2009 were retrospectively analyzed.After the hepatic pedicle Was dissected,methylene blue WaS injected into the portal vein,and then the hepatic pedicle was ligated.Parenchymal division is initiated along the line of devascularization demarcated on Glisson capsule.Results The success rate of methylene blue staining Was 100%.Methylene blue retained in the parenchyma for(80±23)minutes.Right hepatectomy was performed on 2 patients,left hepatectomy on 1,right posterior lobectomy on 2,right anterior lobectomy on 3,left lateral lobectomy on 1,segmentectomy of segment Ⅷon 2,segmentectomy of segment Ⅶ on 3,segmentectomy of segment Ⅵ on 1,segmentectomy of segment Ⅳ on 2 and combined segmentectomy on 4.The mean volume of blood loss,incidence of postoperative complications and postoperative hospital stay were(236±6)ml,14%(3/21)and(12±3)days.Conclusions Ligation of hepatic pedicle after methylene blue injection has the advantages of high success rate and lasting staining of parenchyma of liver.Especially,this staining method contributes to improve the precision of hepatectomy by guiding the segment selection during parenchyma transection.

Objective To investigate the effects of hepatic pedicle exclusion and low central venous pressure (LCVP) on blood loss in right lobe tumor resection and evaluate its influence on hepatic and renal function. Methods Forty-eight patients with right lobe tumor admitted from December 2006 to June 2008 were randomly allocated to the LCVP group (23 cases) and routine hepatectomy, (control group 25 cases). During the parenchymal transection phase of surgery, CVP < 5 mm Hg ( 1 mm Hg = 0.133 kPa) and SBP ≥90 mm Hg were maintained in the LCVP group by drugs. However, no special management of CVP and SBP was done in control group. The parenchymal transection blood loss, postoperative hospital stay, postoperative hepatic and renal function changes between two groups were compared, and the incidence of comphcation was also observed. Results There were no significant difference in type of hepatectomy, time of vascular clamping, period of operation, postoperative complication rate, postoperative hepatic and renal functions between two groups. Parenchymal transection blood loss in the LCVP group was significantly lower than that in the control group (326.67 ± 109.13 ) ml vs (538.33 ± 177.07 ) ml, (P < 0.01 ). Postoperative hospital stay in the LCVP group was significantly shorter than that in the control group (8.52 ± 1.78) d vs (9.40±1.68) d, (P < 0.05). Conclusions Hepatic pedicle exclusion and LCVP during hepatectomy is safe. It can reduced blood loss during parenchymal transection and decrease postoperative hospital stay. It is no detrimental effect to hepatic or renal function.

In 1989, Fitz defined and classified severe acute pancreatitis (SAP) and he thought that surgical treatment of SAP is feasible. Since then, the strategy of treating SAP was a controversial issue over past decades. Currently, relevant literatures reported that medical or minimally invasive treatments are superior to surgical treatment, while it is too early to make the final conclusion because of the complexity of SAP. From 1989 to 2008, 1852 patients with acute pancreatitis were treated at the General Hospital of PLA, and the clinical data of 18 patients who died of SAP were retrospectively analyzed. Based on the analysis, we concluded that medical conservative therapy and surgical operative therapy should not be opposed to each other. Selecting ideal timing and appropriate operation on the basis of pathological changes of retroperitoneum and pancreatitis should be considered seriously, and the new concept of "miniaturization of trauma" should also be introduced in treating SAP.

Objective To evaluate the clinical efficacy of modified Chen's biliojejunostomy technique in treating hilar cholangiocarcinoma.Methods The clinical data of the patients with hilar cholangiocarcinoma from January 2011 to June 2014 in the PLA general hospital and its first affiliated hospital were retrospective ly studied,and 17 of them underwent modified biliojejunostomy.There were 10 male and 7 female patients with a mean of 65 years old (range 34 ～82).Cases diagnosed as Bismuth-Corlette Type Ⅱ,Ⅲ a,Ⅲ b and Ⅳ were 2,6,4,and 5,respectively.Results Liver segment Ⅳ were resected from 2 patients,segment Ⅳ + Ⅴ from 7 patients and segment Ⅳ + Ⅴ + Ⅰ from 8 patients.No death was observed during the study period.One patient had mild bile leakage,2 patients had cholangititis,and another patient had biliary intestinal anastomotic bleeding.Three patients received resection and reconstruction of the portal vein.Three right hepatic arteries and 1 anterior branch of right hepatic artery were resected in combination with the tumor because of invasion.All the complications were alleviated under conservative treatment.Twelve cases had been followed up for a median time of 16 months (range 3 ～ 24).Two cases had cholangititis intermittently.One case underwent radiotherapy because of local recurrence in 2 years after the surgery.MRCP and relevant enzymes were within the normal range.Conclusion Modified Chen's biliojejunostomy is a simple,effective and safe method,which can be widely used when there are multiple biliary intestinal anastomoses.

Objective To investigate the effects of structured triglyceride (STG) and physical mixed medium chain/long chain triglycerides (MCT/LCT) on hepatic and renal function and lipometabolism of patients with acute necrotizing pancreatitis (ANP).Methods The clinical data of 30 patients with ANP who were admitted to the PLA General Hospital between January 2012 and June 2014 were prospectively analyzed.A double-blind,randomized,controlled study was performed in 30 patients who were allocated into the experimental group (15 patients received STG) and the control group (15 patients received physical mixed MCT/LCT).All the patients received isometrical nitrogen and isocaloric parenteral nutrition more than 5 days.The levels of alanine transaminase (ALT),aspartate transaminase (AST),glutamyl-transpeptidase (GGT),alkaline phosphatase (ALP),creatinine (Cr),blood urea nitrogen (BUN),triglyceride (TG) and total cholesterol (TC) were assayed before nutritional support treatment and at day 1,3 and 5 after nutritional support therapy.The measurement data with normal distribution was presented as (x) ± s.The skew distribution data were described as M (range).The comparison between groups were evaluated with an independent sample t test or one-way ANOVA.The count data were analyzed using the chi-square test.Results A total of 30 patients were screened for eligibility.The levels of ALT,AST,GGT,ALP,Cr,BUN,TG and TC were changed within a certain range at day 1,3 and 5 after nutritional support treatment.The levels of ALT,AST,GGT,ALP,Cr,BUN and TC before treatment and at day 5after treatment were changed from 29.0 U/L,25.4 U/L,83.2 U/L,(193 ± 115) U/L,(124 ± 97) μmol/L,(8±6)mmol/L and (2.4±1.1)mmol/L to 29.4 U/L,33.0 U/L,77.7 U/L,(172±74)U/L,(117 ±103)μmol/L,(8 ± 5) mmol/L and (2.3 ± 1.0) mmol/L in the experimental group,and from 23.8 U/L,22.9 U/L,96.2 U/L,(148 ± 108) U/L,(82 ± 57) μmol/L,(9 ± 7) mmol/L and (2.5 ± 0.7) mmol/L to 21.3 U/L,24.5 U/L,127.4 U/L,(179 ± 126) U/L,(80 ± 54) μmol/L,(10 ± 6) mmol/L and (2.4 ±0.8) mmol/L in the control group,respectively.There were no significant differences in the changing trends of the levels of ALT,AST,GGT,ALP,Cr,BUN and TC between the 2 groups (F =0.647,1.186,0.282,0.553,0.862,0.182,0.369,P＞0.05).The level of TG in the experimental group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (1.5 ± 0.7) mmol/L,with increasing trend from pre-treatment to day 1 after treatment and reaching the normal level at day 3 and 5 after treatment.The level of TG in the control group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (2.4 ± 0.6) mmol/L,with increasing trend from pre-treatment to day 1,3 and 5 after treatments.There were significant differences in the changing trends of TG before and after nutritional support therapy between the 2 groups (F =7.940,P ＜ 0.05).Conclusion STG and physical mixed MCT/LCT don't influence the hepatic and renal function of patients with ANP undergoing parenteral nutritional support therapy,while STG has a better effect of lipometabolism compared with physical mixed MCT/LCT.Registry This study was registered with the UMIN Clinical Trial Registry with the registry number of UMIN000016958

Objective:To study the use of left renal vein as a graft vessel in reconstruction after portal vein/superior mesenteric vein (PV-SMV) resection in pancreaticoduodenectomy.Methods:A retrospective study was conducted on 5 of these patients who underwent surgery from July 2008 to December 2017 at Chinese PLA General Hospital. The operative, complication and follow-up data were analysed.Results:There were 4 males and 1 female, with an average age of 57 (33-72) years. The mean operative time was 6.8 (5.4-9.1) h and the mean tumor size was 3.8 (2.8-4.8) cm. The average length of the PV-SMV defect left after resection was 3.8 (3.2-4.6) cm. The average length of the left renal vein used was 3.4 (3.0-4.1) cm. The operations were carried out in 3 patients with pancreatic cancer and in 2 patients with colon cancer pancreatic metastasis. The average postoperative hospital stay was 12 (10-25) days. Perioperative complications included 1 patient each with ascites, diarrhea and delayed gastric emptying. The creatinine levels ranged from 70-98 μmol/L preoperatively, with a transient creatinine rise to 80-156 μmol/L after operation and became 62-107 μmol/L upon discharge from hospital. The follow-up time was 4.3-17.8 months. Two patients died of recurrence/metastasis at 14.2 and 17.8 months after surgery.Conclusions:The left renal vein has the appropriate diameter and rich collateral branches. It has a sufficient length and it is conveniently located in the surgical field. This study showed that there was a minimal effect on renal function after its excision, and it can be used as a graft vessel for reconstruction in pancreaticoduodenectomy after PV-SMV resection.

Objective To study the risk factors of delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).Methods Between Ja(n)uary 1st 2013 and December 31st 2013,data from 196 consecutive patients who underwent PD at the Chinese PLA General Hospital were studied retrospectively.17 factors were examined.Univariate analysis and multivariate logistic regression analysis were used to determine the relative risks.Results DGE occurred in 71 patients (36.2％).The incidences of grade A,grade B and grade C DGE were 22.4％ (44/196),6.1％ (12/196) and 7.7％ (15/196) respectively.There were three postoperative deaths.The overall mortality rate was 1.5％.BMI,Braun anastomosis,clinically relevant postoperative pancreatic fistula (CR-POPF) and intra-abdominal collection were significantly correlated with DGE on univariate analyses.BMI ≥25 kg/m2,CR-POPF,and intra-abdominal collection were independent risk factors on univariate and multivariate regression analyses.Conclusions Post-operative complications were associated with DGE.Early diagnosis and timely treatment for pancreatic fistula and abdominal collection were helpful to decrease morbidity and to promote recovery of DGE.