Objective To investigate the value of preoperative risk assessments and countermeasures on ultrasound-guided radiofrequency ablation for benign thyroid nodules.Methods The preoperative risk assessments of 311 benign solid thyroid nodules in 274 patients were divided into level 0-Ⅳ,among which 38 nodules on level 0,69 nodules on level Ⅰ,36 nodules on level Ⅱ,59 nodules on level Ⅲ,109 nodules on level Ⅳ.Treatments were performed by moving shot technique or multiplanar shot technique,using Leverage Displacement or Hydrodissection to prevent the adjacent vital structures from thermal injuries.Results 311 thyroid nodules were completely ablated.In ablating the 59 nodules on risk level Ⅲ,thermal injuries were effectively avoided in 30 cases by using Leverage Displacement,while recurrent laryngeal nerve injuries happened in 2 cases using Hydrodissection for 29 nodules.The difference between these two methods on risk level Ⅲ had no statistical significance(P =0.237).To avoid thermal injuries during ablation for 109 nodules on risk level Ⅳ,using Leverage Displacement for 102 nodules,recurrent laryngeal nerve injuries happened in 1 case,while using Hydrodissection for 7 nodules,recurrent laryngeal nerve injuries happened in 2 cases.The difference between the two methods on risk level Ⅳ had statistical significance(P =0.010).No thermal injury happened during ablation for 143 nodules on risk level 0-Ⅱ.Conclusions Preoperative risk assessment on thyroid nodules is helpful in preventing potentially avoidable complications.Proper use of Leverage Displacement can protect adjacent vital structures from thermal injuries during ablation for nodules,which is easy and simple to handle and has a certain practical application value.

Objective To analyze the clinicopathological characteristics and the related factors influencing the prognosis of pancreatic neuroendocrine carcinoma.Methods The clinicpathological and follow-up data of 21 patients with pancreatic neuroendocrine carcinoma admitted between April 2000 and August 2013 in Zhongshan Hospital of Fudan University were analyzed retrospectively.The influence facts on patients' prognosis were analyzed statistically.Results Univariate analysis showed that age,stage,tumor size,degree of tumor differentiation and lymph node metastasis were factors separately influenced patients' survival.Multivariate analysis (Cox regression) revealed that age (P =0.019) was the only independent factor affecting the prognosis.Conclusions Patients with pancreatic neuroendocrine carcinoma were mostly non-functional and presented no specific clinical features.Tumors tended to metastasize and the prognosis was poor.Age was the independent factor affecting the prognosis.

Objectives: To investigate the role of glutamine on splanchnic blood flow in SAP rats and underling mechanism. Methods: 32 rats were randomized divided into 2 groups:glutamine group(Gln group, n =16) and SAP group ( n =16).Jejunotomy was performed. Gln group received glutamine.SAP group received saline.All groups were subdivided into 2 groups.8 normal rats were used as the controls.At 12,24hours after the induction of SAP,8 rats in each group were sacrificed.Plasma glutamine concentrations were measured by HPLC.The regional pancreatic microvascular blood flow was measured by Dopplar ultrasound,the blood flow of portal vein,spleen artery and superior mesenteric artery was also measured. Results: Enterally administered Gln was well tolerated by the rats.There was an increase in plasma Gln levels after Gln supplementation on Gln group.The regional pancreatic microvascular blood flow decreased significantly in SAP group( P

Objective To analyze the relationship between age and the prognosis of patients with pancreatic neuroendocrine tumors (pNETs).Methods The clinical data of 102 patients with pNETs who were admitted to the Zhongshan Hospital of Fudan University from January 1999 to December 2010 were retrospectively analyzed.The properties of the tumors were determined by morphology and immunohistochemical staining of chromogranin A,synaptophysin and neuron-specific enolase.Preoperative grading of the tumors was done by mitotic count and Ki67 proliferation index,and the staging of the tumors was done by ENETS TNM system.All patients were divided into younger group (age≤60 years,77 patients) and older group (age ＞ 60 years,25 patients).The survival of the patients was estimated using the life table,and the survival curve was drawn by the Kaplan-Meier method.The survival of the 2 groups was compared using the Log-rank test.Multivariate analysis was performed with the COX proportional hazards model.Results The median survival time was 139.8 months.The overall 1-,2-,5-,and 10-year survival rates were 96％,93％,90％ and 80％,respectively.The postoperative survival time of patients in the younger group was significantly longer than that in the older group (x2 =4.717,P ＜ 0.05 ).The prognosis of patients with higher tumor grades ( G2,G3) and higher TNM stages ( Ⅲ,Ⅳ ) in the older group was significantly poorer than those in the younger group ( x2 =11.158,5.375,P ＜ 0.05 ).The results of multivariate analysis showed that age and major vascular invasion were the independent predictors for survival (RR =8.626,12.795,P ＜0.05 ).Conclusions Age above 60 years is an important independent factor influencing the prognosis of pNETs patients.Tumor grading and TNM staging are highly correlated with the prognosis of the pNETs patients.

Objective To analyze the surgical treatment strategy and prognostic factors of pancreatic neuroendocrine tumor. Methods The clinical data of 30 patients who underwent pancreatic surgery in our department from April, 1999 to May, 2007 were retrospectively reviewed. According to the new WHO classification system, factors possibly influence the long term survival, such as tumor size, operation types, pathological types, were analyzed. Results There were 18 males and 12 females, with a mean age of 54 years old (28 ～ 78 years old). Five patients were lost in follow up. Among 25 patients who were completely followed, 20 cases were benign and other 5 were malignant, the median survival time of benign and malignant group was 74.8 months and 33.8 months, respectively (X2 = 8.90, P = 0.003). Overall 1, 2, 3, 4, 5-year survival rates were 100%, 100%, 82. 0%, 82. 0%, 65. 6%, respectively. Conclusions Pancreatic neuroendocrine tumor was a rare type of tumor of the pancreas with a good prognosis if surgically resected. The new classification method was effective in predicting the prognosis.

Objective To investigate the clinical features,diagnosis and prognosis of solid pseudopapillary tumor of the pancreas(SPTP). Method The clinical data of SPTP cases that underwent surgical resection with a definitive histological diagnosis in Zhong Shan Hospital from 1999 to 2007 were retrospectively analyzed.Result There were 42 SPTP cases undergoing surgery in this period,including 37 females and 5 males:mean age was 37.6 years.Tumors located in the pancreatic head in 18 cases and in the body or tail in 24 cases.The most common symptom was abdominal discomfort(n=20),palpable mass (n=8).Preoperative diagnostic accuracy of MRI and CT were 93%and 31.8%,respectively.Ten cases underwent pancreaticoduodenectomy,20 cases received distal pancreatectomy,3 cases did spleen-preserving distal pancreatectomy.Tumors were simply enucleated in 8 cases.Average diameter of the tumors was 6.1 cm,34 lesions were solid,6 were solid-cystic,2 were cystic.The overall perioperative morbidity was 38.1%,10 cases developed postoperative pancreatic fistula.The mean follow-up time was 38.6 months.Except three cases that were lost to follow-up,all the other cases were alive.Four cases(2 cases had had tumor enucleation,2 had had distal pancreatectomy)developed hepatic metastases on 70、110、41、3 months after first surgery,respectively.A transarterial chemoembolization was employed in three cases,while right hemihepatectomy was performed in one case. Conclusion SPTP is an indolent tumor with low-grade biological aggressiveness.Patients had a favorable outcome after surgical treatment,but enucleation should be avoided.Patients with liver metastasis may benefit from chemoembolization and liver resection.

Objective To investigate the histological features,biological features,clinical treatment and prognosis of pancreatic acinar cell carcinoma.Methods A retrospective review of 10 patients with pancreatic acinar cell carcinoma treated in our hospital from 1999 to 2008 was conducted and the clinical features,imaging changes,pathologic feature,treatment course and follow-up data were collected.Results There were 9 men and 1 woman with a mean age of (62±8) years old.Tumors were located in the uncinate process in 1 patient,head of pancreas in 7,body and tail in 2.The median size of these tumors was 4.5 cm×4.7 cm;common bile duct and intrahepatic bile duct,pancreatic duct dilation was detected in 7 cases,and superior mesenteric vein was invaded in 2 cases.Of the 10 patients,8 received pancreaticoduodenectomy,among these 8 patients,3 had extended lymph node dissection,2 had portal vein resection and replacement;2received resection of pancreatic body and tail as well as splenectomy.Histologically,the size of these tumors were 4.0 cm×3.3 cm×3.4 cm.Macrescopically,duodenum was invaded in 5 patients,superior mesenteric vein was invaded in 2 patients and neural invasion was present in 7 cases.Lymph node metastasis was noted in 6 cases.Follow-up data was available in 9 patients and 1 patient was lost in follow-up.The survival ranged from 3 to 51 months with a median survival 18 months,and 9 patients died of tumor recurrence and metastasis after operation.Conclusions Pancreatic acinar cell carcinoma should be recognized as a distinct tumor entity and it may not be sensitive to radiotherapy or chemotherapy.The biological features of pancreatic acinar cell carcinoma should be investigated further.

Objective To evaluate the early postoperative complications of pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG) following pylorus preserving pancreaticoduodenectomy (PPPD).Methods Clinical data of 97 patients undergoing PPPD,in Zhongshan Hospital,Fudan University from June 2011 to October 2012,were retrospectively analyed.Digestive tract continuity was established respectively by PG(n-45) or PJ(n =52) after PPPD.Results The demographic characteristics of both group were not significantly different.In the two groups,there were not statistically significant difference in those postoperative complications such as biliary fistula,introabdominal infection,bleeding,and the rc-admission rate.The rate of pancreatic fistula in PJ group was significantly higher than that in the PG group (28.85％ vs.6.67％,P =0.033).However,in PG group the incidence of delayed gastric emptying was significantly higher than that in the PJ group (22.22％ vs.5.77％,P =0.018),and the average length of stay was significantly longer than that in PJ group (19.28 ± 11.04 vs.15.09 ± 6.21 ; P =0.034).In PJ group,one patient died of pancreatic fistula and ensuing surgical site infection and intra-abdominal hemorrhage,there was no mortality in PG group.Conclusions After PPPD,PG and PJ are both safe ways of digestive tract reconstruction.But compared to PJ,PG can decreas the rate of pancreatic fistula but may increase the risk of postoperative delayed gastric emptying,and prolong postoperative hospital stay.

Objective To investigate the biological features and treatment of pancreatic adenosquamous carcinoma. Methods A retrospective clinical analysis was conducted in 6 cases of pancreatic adenosquamous carcinoma treated in our hospital from 1995 to 2005. The clinical features, imaging findings, therapy and pathology were analyzed. Results Pancreatic adenosquamous carcinoma was found in 3 men and 3 women with a mean age of 51. 8?10. 8 years. Tumor was located in the head of the pancreas in 4 patients, body in 1 and tail in 1. Three cases received pancreaticoduodenectomy, two did distal pancreatectomy and splenectomy, one underwent palliative operation. The mean size of the tumor was 5. 2 cm ? 4. 1 cm ? 3. 0 cm, pathologically primary tumor and the liver metastasis were mixture of adenocarcinoma and squamous cell carcinoma. Tumor invaded the duodenal wall and common bile duct in 3 cases, portal vein was invaded in 1 case. Neural invasion was present in 4 cases. Lymphatic invasion was found in 3 cases. Postoperative mean survival time was 6. 7 months after the operation with patients finally dying of tumor recurrence and liver metastasis. Conclusions Pancreatic adenosquamous carcinoma is characterized by the mixture of adenomatous and squamous cell element with aggressive biological behavior. The prognosis of this tumor is poor demanding early diagnosis and proper surgical treatment.

Objective To investigate the clinical characteristics and surgical outcomes of pancreatic acinar cell carcinoma (PACC).Methods The clinical and follow up data of PACC patients treated with surgery in Zhongshan Hospital of Fudan University between 1999 and 2012 were analyzed retrospectively.Results A total of 16 PACC were identified including 13 male and 3 female patients.The age of the patients ranged from 38 to 71 with an average of 57 years old.Six patients presented as abdominal pain,while low back pain in 3 patients,abdominal distention in 2 patients,emaciation in 2 patients,jaundice in 2 patients and melena in 1 patient.Elevated CA19-9 level was observed in 8 patients and 2 patients had elevated serum CEA.The tumors were located in the uncinate process in 1 patient,head in 9,body and tail in 6.The superior mesenteric vein was invaded in 2 cases and 1 patient had hepatic artery invasion.The tumor invaded both the celiac trunk and splenic artery in 1 patient.One patient had just undergone intra-operative needle aspiration biopsy due to unresectable tumor.All the other 15 patients underwent surgical excision with R0 resection.Among the 10 patients received pancreaticoduodenectomy,2 had superior mesenteric vein resection and replacement and 1 had hepatic artery resection.Five patients underwent distal pancreatectomy without spleen preservation.The mean size of these tumors was 5.7 cm × 4.6 cm,12 cases had a surrounding envelope,while lymphatic metastasis was observed in 8 cases.The follow up data of 15 patients were collected and the median postoperative survival was 21 months,and the survival rate of 1,3,5 year was 71.4％,28.6％,7.1％.Conclusions Pre-operative diagnosis of PACC is extremely difficult due to lack of specific clinical features and lab tests.Surgery is the first line treatment for PACC,and the prognosis of PACC is better than that of pancreatic ductal adenocarcinoma.