Objective To review the experience in perioperalive management of 324 consecutive cases of pancreatico-duodenectomy(PD).Methods The clinical data of 324 cases of PD were analyzed retrospectively.All underwent PD successfully,275 cases received the standard PD,while,49 cases had pylorus preserving PD.Digestive tract reconstruction was done by Child method.Pancreatointestinal anastomosis was performed by pancreas stump intussussception in 303 cases,and end-to-side anastomosis in 21 cases.Results The 30 day mortality rate was 0.3%(1/324).Complicalion rate was 8.0%,included one case of liver dysfunction,7 cases with pancreatic fistula and intraabdomind bleeding,1 case of stenosis of pancreaticoenteral anastomosis,3 cases with pancreatic dysfunction,4 cases with gastroenteral anastomosis ulcer,6 cases with delayed gastric emptying,1 with reflux of bile and 3 with lymphatic fistula.Conclusions Perioperative managemen for pancreaticoduodenectomy is crucial for patient prognosis.Carful perioperative management can decrease postoperative complications and ensure smooth recover of these patients.

Objective To summarize the experiences of middle pancreatectomy. Methods Eleven female and 4 male with a mean age of 49.4 years (23.8-73.1 years) who underwent middle pancreatectomy from January 2001 to October 2005 were collected. Eight patients with neuroendocrine tumor (non-function of 5 cases), 5 with serous cystadenomas and 2 with mucinous cystadenomas were included. The proximal apical end of pancreas was sutured, while distal end of pancreas was anastomosed to a Roux-en-Y jejunal loop. Results Mean operative time was 275 min (179-370 min), mean length of resected pancreas was 45 mm (30-60 mm) and max diameter of tumor was 23 mm (15-40 mm). Complication after operation was pancreatic fistula 4 cases (26.7%), in which 3 cases (20.0%) had intraabdominal blood. The mean time of follow-up was 23 months (3 months-5 years). one patient was died of multiple organs failure for pulmonary infections in month 3 after operation, and the others were alive without novo-diabetes. Conclusion Middle pancreatectomy is an effective operation for benign and borderline tumors of neck and body of pancreas without a significant increase of postoperative morbidity.

Objective To explore the therapeutic modalities and clinical characters of acute pancreatitis (AP) in the middle or late stage of pregnancy.Methods There were 26 cases of AP in the middle or late stage of pregnancy, among which 18 cases (69.2 %) received conservative therapy, and 8 cases (30.8 %) underwent operation for removal of necrotic tissue and termination of pregnancy.Results Two cases of both fetus and mother death occurred, whereas 24 mothers were cured. 15 (57.7 %) fetuses were healthy but 11(42.3 %) died.Conclusions The women in middle and late stage of pregnancy are inclined to pancreatitis because of hormonal changes, especially in those with history of cholecystitis and cholelithiasis. The main method of management is active non-operative therapy and surgical intervention when necessary, so as to decrease the tragedy of both maternal and fetal death.

BACKGROUND:Destroying posterior stable structure of cervical vertebra may facilitate the ligamentum flavum regeneration. Whether anterior cervical instability can induce the regeneration in posterior and adjacent ligamentum flavum remains unclear.
OBJECTIVE:To observe the changes of transforming growth factor-β1 expression and histopathology in the ligamentum flavum of cervical instability animal models.
METHODS:Thirty-six New Zealand white rabbits were randomly divided into control group and experimental group, with 18 rabbits in each group. In the experimental group, cervical instability animal models were established made through destroying annulus fibrosus by anterior puncture and absorbing nucleus pulposus in C4/5 . And no intervention was given to the control group.
RESULTS AND CONCLUSION:Compared with the control group, fibers in the C 3/4, 4/5, 5/6 ligamentum flavum arranged disorderly and the glass like degeneration was found in the experimental group. The expression of transforming growth factor-β1 in ligamentum flavum was increased, especial y in C 4/5 , in the experimental group. At 4, 8, 12 weeks, transforming growth factor-β1 expression in the C 3/4, 4/5, 5/6 ligamentum flavum segments was similar between the two groups. Experimental findings indicate that, anterior cervical instability can induce the regeneration in posterior ligamentum flavum, especial y in the injured segment.

Objective The purpose of this study was to discuss the therapies for hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.Methods After three cases of pancreatoduodenectomy,the disruptions of pancreatojejunal stoma resulted in serious pancreatic leakage and the hemorrage in abdominal cavity.During all the second operations,the drainage-tube insertions into the main pancreatic ducts were used to lead the pancreatic juice into the neighboring loop of jejunum.Results Afer the operations,the supportive treatment,continuous irrigation of peritoneal cavity and pancreatic enzyme inhabition were given to the patients of these cases and all of the patients were successfully cured.Conclusions The bridge-crossing internal drainage which inserts drainage-tube into the main pancreatic duct was a convenient and effective therapy and method to rescue the hemorrage caused by the fissuration of pancreatojejunal stoma and pancreatic leakage after pancreatoduodenectomy.While the patients' lives were saved,their functions of pancreas were preserved and the qualities of life were improved after the operations.

BACKGROUND:Healthy human umbilical cord jel y is a mucous connective tissue without vessels and has been used in eye plastic operation because of its elasticity and toughness. It contains lysozyme, placental globulin, hyaluronic acid enzyme, AMP antibody and complement, and also contains a lot of mesenchymal stem cells, so it is not prone to infection and rejection. OBJECTIVE:To observe the histocompatibility and histopathological changes of human umbilical cord jel y as a tarsal substitute transplanted for eyelid reconstruction in guinea pigs. METHODS:The mucous connective tissue of healthy neonate umbilical cord jel y was made into tissue blocks at even thickness. Models of tarsal defects were established in guinea pigs, and then the mucous connective tissue of healthy neonate umbilical cord jel y was implanted. Samples of implanted materials were col ected for histological examination at 1, 2, 3 weeks postoperation under light microscope. RESULTS AND CONCLUSION:There were no obvious rejection, infection and eyelid deformation observed, the corneas of al the animals were clear, corneal epithelial shedding did not occur, and the eyelid could move normal y. One week after implantation, there was no infection and rejection on the conjunctiva and the incision of the eyelid, the eyelid could move normal y, and partial inflammatory cells were observed between the human umbilical cord jel y and the muscle of the eyelid with microscopy. Two weeks after implantation, there was no infection and rejection on the conjunctiva and the incision of the eyelid, the cornea was clear, the eyelid and eye could move normal y, and no symblepharon occurred;umbilical cord jel y showed the tendency of absorption, and the inflammatory cells were reduced at 2 weeks after implantation. Three weeks after implantation, the incision of the conjunctiva healed wel , the cornea was clear;there was no difference in the eyelid form and movement between the two eyes;the umbilical cord jel y was absorbed partial y, normal fibrous tissues formed and there were no inflammatory cells. With low immunogenicity, human umbilical cord jel y can guide the growth of new col agen and serve as an ideal tarsal substitute.

AIM:To determine the methylation and expression of Wnt antagonist secreted Frizzled-related protein-2(SFRP2) in gastric cancer and to explore the role of SFRP2 in gastric carcinogenesis.METHODS:Methylation status of SFRP2 was detected by methylation-specific PCR(MSP).Real-time PCR was used to determine the expression of SFRP2 in gastric cancers and matched cancer adjacent normal tissues.SFRP2 expression in gastric cancer cell lines was determined by reverse-transcriptional PCR(RT-PCR) and Western blotting.RESULTS:SFRP2 methylation was found in 26(65%) gastric cancers and in 3(7.5%) matched cancer adjacent normal tissues.The frequency of methylation for SFRP2 was significantly higher in gastric cancers than that in matched normal tissues(x2=28.614,P

Objective:To invest the risk factors associated with delayed hemorrhage after pancreaticoduodenectomy occurred.Methods:A retrospective analysis was performed from January 2012 to June 2015 Shengjing hospital 511 cases of patients who accepted pancreaticoduodenectomy.Results:The incidence of PD postoperative delayed hemorrhage was 8.81％ (45/511).Univariate analysis shows:Preoperative bilirubin levels,pancreatic fistula,biliary fistula,postoperative abdominal infection are all the meaningful related factors(P＜0.05).With the application of multivariate logistic regression analysis,pancreatic fistula (OR=2.158) and abdominal infection (OR=3.051) were independent risk factors for postoperative delayed hemorrhages (P＜0.05).Conclusion:Dealing with the postoperative complications of PD like pancreatic fistula,abdominal infection and others,early detection and rapid diagnosis and correct treatment can effectively reduce the incidence of delayed hemorrhage.

Objective The purpose of this study was to determine how to preserve the remaining pancreatic body and tail in the pancreatectomy. Methods In seven cases of pancreatectomy, three of them were the rupture of pancreatojejunal anastomosis, and four of them were the pancreatectomy for tumor in the pancreatic neck or body. During operations, a bridge internal drainages was used to drain the pancreatic juice into the adjacent jejunum. After the operations, the supportive treatment, continuous irrigation of peritoneal cavity and pancreatic enzyme inhibition were used. Results In all seven patients, the remaining pancreatic body and tail were successfully preserved. The endocrine functions of these patients recovered to nearly normal level and patients were discharged. Conclusions In preserving the remaining pancreatic body or tail, the bridge internal drainage has its advantage of convenience. It effectively preserves the exocrine of pancreas as well as its endocrine

Delayed gastric emptying(DGE)is a common complication after pancreatoduodenectomy. Due to its complex causes and difficul-ties in treatment,it has been a difficult problem in general surgery. By analyzing the improvement in the surgical procedure of pancreaticodu-odenectomy in recent years and the influence of the establishment of predictive scoring model on DGE,this article puts forward new direc-tions for the prevention and treatment of DGE. It is pointed out that effective preoperative assessment and reasonable selection of surgical pro-cedures may help to reduce the incidence rate of DGE after surgery.