Pancreaticoduodenal anastomotic dehiscence complicated with peritoneal hemorrhage following pancreaticoduodenectomy is a serious complication which threatens patients'life.Prevention and mangement of pancreaticoduodenal anastomotic dehiscence and peritoneal hemorrhage is the focus in the surgical treatment.Operation is the most reliable treatment for bleeding.While reoperation is difficult for most surgeons and the risk of fistula and rebleeding after reoperation exist.Some procedures will affect the endocrine and exocrine function of pancreas.We applied pancreaticojejunal bridge drainage for most patients with hemorrhage after pancreaticoduodenectomy.This procedure is easy,safe,and can protect the pancreatic function.

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 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 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.

Objective:To compare the efficacy of computed tomography(CT)and comventional X-ray plain film in assessing hip joint trauma.Methods:76 patients with hip joint trauma were studied by CT and X-ray plain film.The efficacy of CT and X-ray plain film in assessing the acetabular fracture,femoral head and neck fracture,intra-articular loose bone fragment,dislocation of hip joint,and para-articular soft tissue injuries was evaluated and compared.Results:CT was superior to X-ray plain film in demonstrating acetabular fracture,femoral head fracture and intraarticular loose bone fragment.CT was also effectively in revealing of intra-articular effusion and hemorrhage,paraarticular soft swelling.Conclusion:CT was a necessary way to evaluated hip joint trauma,and was more effective than X-ray plain film in diagnosis of hip joint trauma.

Purpose To investigate the expression of CD147,MMP-9 and VEGF and their relationships in lung adenocarcinoma.Methods The expression of CD147,MMP-9 and VEGF proteins was examined in 90 lung adenocarcinoma tissues by SP immunohistochemical method.The positive unit (PU) of CD147,MMP-9 and VEGF was assessed quantitatively using Imagepro Plus image analysis software.Results Positive intensity of CD147,MMP-9 and VEGF in lung adenocarcinoma was significantly higher than that in non-neoplastic internal controls and benign control tissues (P ＜ 0.001).The positive rates of CD147,MMP-9 and VEGF were 88.89％ (80/90),84.44％ (76/90),and 80％ (72/90),respectively.The expression of CD147,MMP-9 and VEGF was positively correlated with the degree of histologic differentiation,lymph node metastasis status and TNM stage (P ＜ 0.001).CD147 was correlated positively with MMP-9 and VEGF expression (rp =0.992,rp =0.984,P ＜ 0.001).Conclusion CD147,MMP-9 and VEGF may play an important role in the pathogenesis and progression of lung adenocarcinoma;CD147 may induce tumor invasion and metastasis by stimulating production of MMP-9 and VEGF,which is expected to be a potential promising target for immunotherapy.

OBJECTIVE To realize the situation of nosocomial infection and usage of antibiotic in order to prevent and control nosocomial infection effectively. METHODS According to the request of countrywide nosocomial infection net,using the method of clinic investigation and case history investigation,we have investigated the infection complexion about all patients in 19 May 2006 and 24 May 2007,including the duration,transferring department and dead case.Then to analyze the comparison between two results. RESULTS 3489 cases were investigated,including 186 infection cases.The prevalence rate of nosocomial infection was 5.33%.Five departments had the high prevalence rate of nosocomial infection.They were hematology department,ICU,pediatrics department,neonatal unit and cadre ward.The highest rate was 31.30%.The lowest was 0.The infection site focused on lower respiratory tract.The antibiotic utilizing rate was high. CONCLUSIONS Enhanceing the management of nosocomial infection in key departments,regulating the antibiotic utilizing,to reduce the prevalence rate of nosocomial infection.

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.

Objective To investigate the expression of NF-κB and CD147 in lung adenocarcinoma.Methods The expressions of NF-κB and CD147 protein were detected on 80 lung adenocarcinoma tissue by S-P immunohistochemical method.The positive units(PUs) of NF-κB and CD147 were assessed quantitatively using Imagepro Plus image analysis softwore.Results NF-κB and CD147 protein positive intensity in lung adenocarcinoma was significantly higher than that in the non lung carcinoma (P =0.000,respectively).The positive rates of NF-κB and CD147 were 68.75％ (55/80) and 81.25％ (65/80) respectively.The expressions of NF-κB and CD147 were positively correlated with the degree of histologic differentiation,lymph node metastasis status and TNM stage (P =0.000,respectively).Both of them were not associated with sex,age,patients with history smoking,and tumor located in the central (P ＞ 0.05,respectively).NF-κB was correlated positively with CD147 expression (rp =0.498,P =0.000).Conclusions The high expression of NF-κB in lung adenocarcinoma may promote the high expression of CD147,and promote the tumor invasion and metastasis.

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