The incidence of pancreatic cancer is on the rise in China, with a 5-year post-operative mortality being over 95%. Difficulties in early diagnosis, post-operative relapse, liver metastasis and a lack of effective adjuvant therapies are the major causes for poor long-term post-operative survival. To improve the survival rate, efforts should be made to strengthen screening for pancreatic carcinoma in high-risk populations at an early stage and to select patients for radical operation with specialized and standardized surgical procedures.

Objective To summarize the clinical features of intraductal papillary mucinous tumors (IPMT) of the pancreas to improve the diagnosis and treatment of IPMT.Methods The clinical features,imaging features and clinicopatholagic characteristics of 49 IPMT patients,who underwent operations in our department from March 1996 to September 2008,were retrospectively analyzed.The clinical features of benign,borderline and malignant IPMT were compared.Results Among the 49 patients,there were 27 males and 22 females;the average age was 58±11 years.There were 18 benign cases,9 borderline cases and 22 malignant ones.The difference in sex ratio,age of disease onset,smoking and drinking habit,history of pancreatitis and diabetes,presence of abdominal pain,radiation pain,abdominal bloating and weight loss symptoms,serum levels of CEA,AST,ALT,tumor location and type were not significantly different between the 3 groups.However,there were significant difference in term of jaundice,serum carbohydrate antigen 19-9(CA19-9)and alkaline phosphatase (AKP) levels,size of tumor,diameter of main pancreatic duct,presence of septum in cystic tumor,mural modules in the tumor.Among the malignant IPMT patients,one patient died 5 years after operation,one patient had malignancy recurrence;among the benign and borderline IPMT patients,1 patient had malignancy recurrence and 1 patient died due to other disease.Conclusions Different types of IPMT had different clinical features and comprehensive judgment were needed to differentiate.

Two stage polymerase chain reaction(restricted fragment length polymorphism was used to study K ras mutations and chemiluminescence immunoassay was used to detect CA19 9 in plasma from patients with pancreatic adenocarcinoma, some samples were analyzed by direct seqencing. The results showed 18 (60%) of 30 patients with pancreatic adenocarcinoma had K ras mutations in plasma, and 25 (83 3%) of 30 had elevated CA19 9 in plasma. The former was less sensitive than the latter, but the diagnostic rate of combined analysis was 100%. It is concluded that combined analysis of molecular tumor markers and protein tumor marker is more sensitive than protein tumor markers alone, it might overcome Lewis blood type limitation to protein markers.

Objective To summarize the experience of the diagnosis and treatment of mass-type chronic pancreatitis(MTCP) to improve the knowledge about MTCP. Methods The clinical data of tweent-five patients with MTCP undergoing operation in recent 8 years were analyzed retrospectively. The positive discovery rates with computed tomography(CT),ultrasonography(US),endoscopic retrograde cholangiopancreatography(ERCP),and endoscopic ultrasonography(EUS) were 95.7%,85.7%,83.3%,and 100%,respectively. All patients received operation,including pancreatoduodenectomy(15 cases),pancreatoduodenectomy with reservation of pylorus(2 cases),Beger′s procedure(1 case),Frey′s procedure(3 cases),and resection of pancreatic body and tail(4 cases). Results Upper quadrant abdominal pain is the main symptom of MTCP. Pancreatic masses were located in the head of pancreas in 21 cases(84.0%),in the body or tail in four cases(16.0%). 16 patients were diagnosed as MTCP and 9 diagnosed as pancreatic adenocarcinoma before operation. 22 patients were diagnosed as MTCP and 3 were diagnosed as chronic pancreatitis complicated with adenocarcinoma by pathology after operation.Preoperative misdiagnosis rate was 24.0%. Pain relieved immediately after operation in 92.0% of patients. One patients developed pancreatic leakage and two had anastomotic hemorrhage postoperatively,morbidity rate was 12.0%. 23 patients were followed-up for 1-5 years (mean 3.4 years). The therapeutic outcome was satisfactory in 82.6% of patients. Conclusions Operation should be performed as early as possible when the MTCP is diagnosed. It is effective to delay the progress of the disease.

ObjectiveTo study the diagnosis and treatment of pancreatic cystadenoma and cystadenocarcinoma.MethodsClinical data of 27 cases of pancreatic cystadenoma and 20 cases of cystadenocarcinoma were retrospectively analyzed.ResultsAdenomas were successfully resected in 22 out of 27 cases, while adenocarcinomas were resected in 9 out of 20 cases, with a total resection rate of 67%. The preoperative misdiagnosis rate was 26%. There was no recurrence after a complete resection of pancreatic cystadenoma. The postresection 5 years′ survival rate was 42% in pancreatic cystadenocarcinoma. Conclusions It is suggested that cystic neoplasms of the pancreas is uncommon and grows slowly. In order to promote the diagnosis and treatment of pancreatic cystadenoma and cystadenocarcinoma, surgeons must be familiar with the clinical features and pathologic appearance. The long-term survival of the patients with resected adenocarcinoma is favourable.

Objective To study the effect of oral chemotherapy on patients of pancreatic carcinoma undergoing Whipple′s procedure. Methods48 cases undergoing radical pancreaticoduodenectomy with regional lymphadenectomy were divided into two groups. 24 cases received oral chemotherapy consisted of 5′ DFUR and calcium folinate for a course of 6 months. ResultsThe clinicopathological features were similar between the two groups. During the period of follow up,5 cases in chemotherapy group died including motality caused by liver metastasis in 2 cases whereas 7 cases died of liver metastasis in the control group( P

Perineural invasion(PNl) is regarded as a factor associated with local recurrence and an important prognostic factor in pancreatic cancer.Little is known about the mechanism of PNI in Pancreatic cancer.This review summarizes the role of innervation, clinicopathologic factors, lymhatic vessels, vascularity, cytokines, adhesion molecules, some immunoglobulin superfamily members and mucin in PNI.Because PNI is often followed by poor survival.An ear-lier diagnosis can improve pancreatic cancer prognosis.IPEUS,CT scan and immunostaining CK-19, K-ras gene a-nalysis can be used to diagnose perineural invasion pre-, in-tra-or postoperatively.A wide surgical exeresis with an enough lymph nodes clearance together with surrounding connective and nervous tissue can get a better long term survival rate.

Objective: To analyze the experience in the treatment of intraductal papillary Mucinous tumors(IPMT) of the pancreas.Methods: We retrospectively analyzed the clinical and imageological features of 30 IPMT patients,17 males and 13 females,who underwent operations in our department from May 2003 to December 2005.The patients with intraductal papillary mucinous adenoma(IPMA) were included in the benign group,and those with intraductal papillary mucinous borderline tumor(IPMB) and intraductal papillary mucinous carcinoma(IPMC) in the malignant group.Results: There were more males than females in the malignant group(76.5% vs 30.8%,P40 mm,which were considered to be the predictors of malignancy.Conclusion: Clinical and imageological features differ signifcantly between different pathological types of IPMT.The presence or absence of mural nodules,the diameter of the main pancreatic duct and the size of the tumor may help differentiate the malignancy from benignancy of IPMT.

Objective To explore the clinical characteristics of periampullary carcinoma in the prejaundice stage and improve early diagnosis rate and operative effects.Methods Clinical data of 27 cases with periampullary carcinoma in the prejaundice stage in our institute during the period of Jan 1998 to Dec 2005were analyzed retrospectively.Results The clinical symptom was mostly nonspecific, mainly included abdominal discomfort ( 92.6% ), abdominal pain ( 55.6% ), and irregular fever ( 29.6% ).The positive diagnosis rate with US, CT, MRCP, ERCP and EUS was 75.6%, 85.2%, 83.3%, 84.6%, and 88.9%,respectively, and they were helpful for early diagnosis.Among these 27 patients, 19 cases received regional pancreaticoduodenectomy, and 5 cases received pancreaticoduodenectomy in combination with vessel resection,3 cases received bile duct or gallbladder jejunal Roux-en-Y anastomosis, the overall resection rate was 88.9% with no operative mortality, and the post-operation complication rate was 7.4%.The 1,3, and 5 year survival rates were 100%, 70.8% and 41.7%, respectively.Conclusions The periampullary carcinoma in the prejaundice stage has its own clinical characteristics and abnormal image changes.If the diagnosis can be confirmed in the prejaundice stage, it is still an important method to improve the resection rate and prognosis.

0.05). Low shear stress and high shear stress of BRV in GC control group were (20.32?5.42)mPa?s and(7.96?3.16)mPa?s, respectively;those in GC LMWH group were (11.42?5.03)mPa?s and (3.96?3.07)mPa?s,respectively after operatin. Low shear stress and high shear stress of BRV were (21.82?6.17)mPa?s and ( 8.62 ?3.48) mPa?s,respectively in PC control group;those in PC LMWH group were (13.11?5.17)mPa?s and (4.96?3.61)mPa?s. After operation,there were no hemorrhagic complications in GC and PC LMWH groups. Conclusions Low shear stress and high shear stress of BRV rise generally seeing in GC and PC patients after operation,and in PC patients are higer than those in GC patients. The use of Low molecular weight heparin could reduce the occurrence of thrmbosis.