Objective To investigate the reasons of complications after ultrasound-guided PTBD and explore measures for their management. Methods The clinical data of 753 patients with obstructive jaundice treated with ultrasound-guided PTBD in our hospital from January 2001 to June 2008were retrospectively analyzed. Results The 753 patients received a total of 791 treatments of PTBD.The occurring rates of severe, common, and long-term complications were 1.14 % (9/791), 11.88 %(94/791 ) and 4.3% (9/791), respectively. Only 1 patient died of manipulation-related complications.Conclusion Ultrasound-guided PTBD is an effective method for treatment of obstructive jaundice.

Objective To analyze the relevant factors of portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis. Methods The clinical data of 226 patients with hypertension due to cirrhosis resulting from hepatitis receiving simple splenectomy or splenectomy and portal-azygous devascularization in our hospital from August 2000 to June 2007 were retrospectively analyzed. Effective results were found in 154 of the patients. The 154 cases were divided into the thrombosis group and non-thrombosis group. The relation of portal vein thrombosis to the descendent level of portal vein pressure after operation,the prothrombin ratio (PTR) and fibrinogen(FIB) before operation, platelet count before and 1, 7, 14 days after operation, diameter of main portal vein and bilirubin level before operation and blood loss in operation were determined by logistic regression analysis. Results Portal vein thrombosis occurred in 31 patients. Regression univariate analysis showed that portal vein thrombosis was related to the descendent level of portal vein pressure after operation but not to the PTR and FIB, platelet count, diameter of main portal vein, bilirubin level and blood loss. Multivariate analysis demonstrated the same results. Conclusion The descended level of portal vein pressure is an important factor in portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis.

Objective To study clinical value of percutaneous intrabiliary expandable metallic biliary stenting (EMBS) for treatment of malignant obstructive jaundice. Methods One hundred and sixty patients with malignant obstructive jaundice were treated with EMBS ( EMBS group) . Thirty patients underwent only external drainage by PTCD were recruited as control. The patency rate of stent,decline of bilirubin and the complication were analyzed retrospectively. Both groups were followed up for three months. The Kaplan-Meier method (log-rank test) was used to compare the survival period between the two groups. Results Anorexia,skin pruritus and color of urine alleviated at a certain degree in both groups.In the EMBS group,plasma total bilirubin was(218. 78 ±2. 29) μmol/L pre-stent,and decreased to (134. 90 ±2. 34), (83. 18 ±2.40) , (40. 74 ±2. 29) μmol/L at the 7,14,21 days after the stenting, respectively; direct bilirubin was (128.82 ±2.40) μmol/L pre-stent, and decreased to (81.28 ± 2. 34), (51. 29 ±2. 45) and (25. 70 ±2.40)μmol/L at the 7,14,21 days after the stenting ( P =0. 000). In the PTCD group,plasma total bilirubin was (223. 57 ± 2. 58) μmol/L pe-stent, and decreased to ( 145. 68 ± 2. 57 ) ,(87.57 ±2.58) ,(38.65 ±2. 20) μmol/L at the 7,14,21 days after the stenting,respectively;direct bilirubin was (127. 6 ±2. 59)μmol/L pre-stent,and decreased to (79. 78 ±2. 70) ,(58. 36 ±2. 46) and (29.46 ±2. 20)μmol/L at the 7,14,21 days after the stenting,respectively ( P <0.001 ). No significant difference was found between the two groups at any time point ( P > 0. 05). Complications occurred in 34 patients in the EMBS group and the incidence rate was 20. 62% . Two or more complications occurred in 9 patients. In the PTCD group, complications occurred in 60.00% of the patients. In the EMBS group, 14 patients were failed to follow up, and 136 died. The median length was 214 days. In the PTCD group,all patients were followed up and all died,with a median length of survival of 75. 5 days. The survival analysis showed that the EMBS group survived longer than the PTCD group (P =0. 000). Conclusions EMBS placement showed better effect than PTCD. Compared to PTCD, internal drainage of metallic stents lead few complications and faster recover, and can improve the life quality and prolong survival time of patient with malignant obstructive jaundice. The placement of metallic stents is recommended as a preference for palliative therapy of malignant biliary obstruction.

Peliosis hepatis is a rare benign hepatic vascular disease.There is the lack of specific clinical features and preoperative diagnosis.A patient with intermittent liver area pain was admitted to the Third Central Hospital of Tianjin in April 2014.The patient with space-occupying lessions of the right lobe of liver was preliminarily diagnosed as with hepatocellular tumor or vasogenic tumor by computed tomography and B ultrasound examinations and then received liver resection combined with cholecystectomy.The result of postoperative pathological examination confirmed peliosis hepatis with adenomatous hyperplasia of liver cells.The patient was followed up till October 20,2014 without recurrence.

Objective To analyze relevant factors causing pancreatic fistula post pancreaticoduodenectomy with ex-ternal drainage of pancreatic duct. Methods Altogether 133 patients who underwent pancreaticoduodenectomy with exter-nal drainage of pancreatic duct in our hospital from 1999 to 2011 were retrospectively analyzed. Logistic regression analysis was used to analyze the relevance of pancreatic fistula with age, gender, combined diseases, pancreatic duct diameter, patho-logical types, preoperative total bilirubin (TBIL), albumin (ALB) levels, drainage of the bile duct before operation, obstruc-tion of the pancreatic duct drainage and postoperative application of growth somatostatin. Then we also analyzed the relation-ship between those risk factors and the severity of pancreatic fistula. Results Postoperative pancreatic fistula occurred in 24 cases (3 cases were of grade A,13 cases were of grade B and 8 cases were of grade C) among the 133 patients. Logistic re-gression analysis showed that obstruction of the pancreatic duct drainage is a major risk factor of pancreatic fistula in these patients(OR=4.529,P=0.005). The patients whose pancreatic duct drainage was obstructed had a significantly higher pan-creatic fistula rate than the patients whose drainage was not obstructed (30.8%vs 12.8%, P＜0.05). The occurrence of pan-creatic fistula has no significant correlation with age, gender, combined diseases, pancreatic duct diameter, pathological types, preoperative TBIL, ALB level, preoperative bile duct drainage and postoperative application of somatostatin. What’s more, in those pancreatic fistula patients, the pancreatic fistulas were more severe in the obstructed ones than those in the un-obstructed ones. Conclusion The obstruction of the pancreatic duct drainage is a major risk factor of pancreatic fistula post pancreaticoduodenectomy with external drainage of pancreatic duct. If adequate preventive measures were employed during operation , the incidence of pancreatic fistula and pancreatic fistula severity will be significantly reduced.

Objective To investigate the effect of Treg cells and Th17 cells on the pathogenesis of SLE in patients with SLE,by detecting levels of serum IL-10 and IL-17 in patients with systemic lupus erythematosus (SLE).Methods Selected 54 patients with SLE diagnosed in Suzhou Municipal Hospital Affiliated to Nanjing Medical University from July 2013 to July 2015 as subjects,and 19 healthy persons were selected as control group.Using double antibody sandwich method (ELISA) to detect the levels of IL-10 and IL-17 in two groups.Using indirect immunofluorescence and western blot method to detect ANA,dsDNA,RNP,Sm,SSA and SSB in patients with SLE.Then compared and correlation analysed the level of IL-10 and IL-17,the levels of IL-10 and IL-17 in ANA,RNP,Sm,SSA and dsDNA groups were analyzed simultaneously.Results The level of IL-10 and IL-17 in SLE were 63.7±89.0 pg/ml and 87.7±123.0 pg/ml,and control group were 20.8±8.9 pg/ml and 18.5 ± 111.6 pg/ml,with the statistically significant difference (trL10 =3.484,tIL-17 =4.076,P＜0.01).The level of positive group in SLE were 176.5±93.2 pg/ml and 237.2±107.5 pg/ml,and negative group were 16.2±5.7 pg/ml and 12.9 ±8.3 pg/ml,with the statistically significant difference (tIL-10 =6.875,tIL-17 =8.843,P＜0.01).The level of IL-10 was positively correlated with IL-17 level in SLE (r=0.96,P＜0.05).The level of IL-10 and IL-17 in ANA high titer group were 91.8±100.8 pg/ml and 135.5±140.9 pg/ml,ANA low titer group were 44.5±76.7 pg/ml and 54.4±98.5 pg/ml,with the statistically significant difference (tIL10 =2.215,tIL-17 =2.345,P＜0.05).The level of IL-10 and IL-17 in anti ds-DNA antibody positive group were 87.1 ± 101.1 pg/ml and 122.4 ± 137.1 pg/ml,negative group were 27.4± 50.1 pg/ml and 28.6 ± 61.6 pg/ml,with the statistically significant difference (tIL-10 =2.904,tIL-17 =3.443,P＜0.05).Conclusion The levels of IL-10 and IL-17 were significantly increased and there was positive correlation.It was explained that the anti-inflammatory and pro-inflammatory response existing at the same time in SLE patients and Treg cell and Th17 cell may also play an important role in the occurrence and development in SLE.

Objective:To establish a determination of acteoside isomer in Total Cistanchis Glycosides Capsules by HPLC.Methods: HPLC analysis was carried out on C 18 ODS column with acetonitrile——1.5% acetic acid as the mobile phase. The linear gradient of acetonitrile was from 11.5% to 20%(0-25min). The detection wavelength was 335nm. Results: The method was linear in the range of 0.2～1.0?g, r =0.9996. The average recovery was 98.85%, RSD was 1.51%( n =9). Conclusion:This method is simple, accurate, highly sensitive and reproducible. It may be used for the determination of acteoside isomer in Total Cistanchis Glycosides Capsules.

Objective To observe the influence of peripheral serum came from patients with hepatectomy at different time points on hepatocyte proliferation in vitro. Methods According to the different types of cultured serum, cultured HL-7702 cells were divided into fetal bovine serum (FBS) group, preoperative serum group, 0.5 h, 3 h, 24 h and 72 h post operative serum groups. All groups of cells were cultured for 72 hours in the Cell-IQ unmarked living cell image analysis system, and the amplification curves of each group were mapped by continuous counting of cells. The cell amplification multiple was compared between all groups after culturing for 72 hours. BrdU immunofluorescence staining was performed and BrdU positive rate was calculated for comparing the cell proliferation of all groups. Results Amplification curves showed that HL-7702 cell proliferation rates of all human serum groups except for 72 h post operative group were higher than those of FBS group. Human serum 0.5 h and 3 h postoperative groups were more obvious. The amplification multiples of human serum groups, except for 72 h post operative group were all significantly higher than those of FBS group (P<0.01), and 0.5 h and 3 h post operative groups were both significantly higher than those of preoperative group (P < 0.05). BrdU positive rates of all human serum groups were significantly higher than those of FBS group (P < 0.01), which were significantly higher in 0.5 h and 3 h post operative groups than those of preoperative group (P < 0.05), but there were no statistical differences between 24 h and 72 h post operative groups and the preoperative group. Conclusion Human serum can promote the proliferation of hepatocytes compared with that of FBS. The influence of serum acquired post hepatectomy is closely associated with the post operative time.

ObjectiveTo evaluate the effect of preoperative percutaneous transhepatic biliary drainage (PTBD) on postoperative outcomes after pancreaticoduodenectomy.MethodsThe clinical data of 115 patients undergoing pancreatoduodenectomy between 2001 and 2009 were retrospectively analyzed.The diagnosis of periampullary cancer or cancer of the pancreatic head was confirmed histologically.The preoperative total bilirubin level was more than 100 μmol/L and there was no concomitant cholangitis.Forty-two patients underwent PTBD (PTBD group),and 73 were not drained (early operation group).The following parameters were analyzed:wound infection,intra-abdominal abscess,intra-abdominal or gastrointestinal bleeding,biliary or pancreatic leakage,gastroparesis,morbidity and mortality.The length of hospital stay and cost were also assessed.ResultsThe perioperative mortality and morbidity were 2.38％/54.76％ in the PTBD group and 2.74％/50.68％ in the early operative group,respectively.There were no significantly differences between these two groups.Similar results were obtained in biliary leak,pancreatic leak,intra-abdominal infection,wound infection and gastroparesis.The length of hospital stay and cost were significantly less in the early operation group than the PTBD group.ConclusionsPTBD had no beneficial effects on postoperative outcomes following pancreaticoduodenectomy.For distal biliary obstruction,PTBD should not be carried out routinely.

Objective To study the value of transcatheter arterial chemoembolization (TACE)in combination with portal vein chemotherapy (PVC) after resection of hepatocellular carcinoma to prolong survival. Methods From January 2000 to July 2007, 168 patients with hepatocellular carcinoma (HCC) underwent tumor resection in our hospital. After operation, TACE in combination with PVC was performed in 48 patients (combined group), TACE alone in 26 (TACE group), PVC alone in 50 (PVC group) and none of the above in 44 (control group). All the patients were followed up for 17-96 months. The 1-, 3-and 5-year survival rates were compared among the 4 groups. Results Accumulative 1-, 3-and 5-year survival rates were higher in the combined and TACE groups than in PVC and control groups. Conclusion After resection of HCC, combined use of TACE and PVC is the same as TACE in prolonging patient survival. However, it is better than PVC alone and non-surgical procedure.