ObjectiveTo discuss the diagnosis and therapy of primary presacral tumor. Methods23 patients with primary presacral tumors underwent surgical treatment from 1983～1999 were studied retrospectively. ResultsIn respect to pathological type, congenital tumor was the most frequent one in 23 patients. Digital examination together with B ultrasound and CT examination were quite important in determining the extent and degree of tumor invasion. As for operative ways, transacral and transperineal approach were the most common choices to detect the tumor. Conclusion Complete and enbloc resection is the principal method in treating presacral tumor, whether the lesions are beign or malignant. Choices of operative way should be made accordial to tumor condition. Keep nerves and blood vessels from being injuried during operation.

ObjectiveTo investigate the inhibition of telomerase activity of colorectal cancer by chemotherapeutic drugs.MethodsBy using telomerase repeat amplification protocol (TRAP) combined with PAGE silver staining, we detected the telomerase activity of human colorectal cancer cell line HT-29 under the effect of cisplatin, doxorubicin, pirarubicin, mitomycin C, and 5-FU.ResultsIn high doses,no inhibition of tolemerase activity was found when cells were collected after only 4 hours of drug treatment, but the telomerase activity was completely inhibited by cisplatin when the drug was removed and cells were reculured for 20 hours. However, doxorubicin, pirarubicin, mitomycin C, 5-FU had no such effect. ConclusionCisplatin inhibits telomerase activity of human colon cancer cell HT-29, while other drugs had no such effect.

Objective To investigate the correlation of tissue factor (TF) and p53 protein expression in colorectal carcinoma. Methods The expression of TF and p53 protein was studied by immunohistochemistry in 43 cases of primary colorectal carcinoma. Results TF expression was positive in 44.2% (19/43) of cases, and p53 protein expression was positive in 48.8% (21/43) of cases. The lymph node metastatic rate was 78.9% (15/19) in patients with positive expression of TF, and 85.7% (18/21) in patients with positive p53 protein expression. Both TF and p53 protein expressions showed significant correlation with lymph node metastasis (?~2=8.96 and 14.88, P

ObjectiveTo explore the clinical characteristics and diagnosis of primary small intestinal tumor (PSIT). MethodsRetrospective analysis of the clinical and pathological data of the 112 PSIT cases was made. ResultsDuodenum was the most common site for PSIT (62 5%). Leiomyomas were most common benign tumors which were most likely found in ileum and jejunum. Adenocarcinoma was the most frequently seen malignant PSIT followed by lymphoma and leiomyosacroma. The chief method of diagnosis is barium meal X ray examination especially with the hypotonic contrast X ray examination. Endoscopy can increase the diagnostic rate. Superior mesenteric arteriography sometimes helps in determing the site of gastrointestinal haemorrhage. CT scan can be helpful in establishing diagnosis, preoperative classification and postoperative recurrences. Conclusion Duodenal adenocarcinoma is most common PSIT, followed by malignant lymphoma, liomyoma and leiomyosarcoma. Hypotonic contrast X ray examination is most effective in diagnosis, and locating of small bowel tumors. Superior mesenteric artery angiography and CT scanning are also helpful.

Objective To study the causes of pancreatic fistula following pancreatioduodenectomy, and evaluate the effect of total pancreatic uncinate process resection on the prevention of pancreatic fistula by analyzing the potential aetiology of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 68 patients, who were admitted into the No. 1 ward of Surgical Department of Peking University First Hospital during the period from Jan. 2004 to Jun. 2009, were retrospectively analyzed. The day-average level of amylase higher than 3 times of normal value, as measured from the drainage of peritoneal cavity, serves as the diagnostic criterion of the postoperative pancreatic fistula.Factors relevant to fistula, which result in the abnormal increase of the amylase in the drain, such as the extent of resection of pancreatic uncinate process, the anastomotic manners of pancreas and digestive tract, and the pancreatic fibrosis were statistically analyzed. Results The incidence of pancreatic fistula was 33. 8% according to the diagnostic criterion mentioned above; Single factor analysis showed that the resection extent of uncinate process (P = 0. 000) and the level of serum glucose ( P = 0. 045 ) were correlated with the occurrence of pancreatic fistula. Multivariate analysis identified that the independent risk factor for pancreatic fistula was the resection extent of uncinate process(P =0. 000). Pancreatic fibrosis, the manners of the anastomosis of pancreas and digestive tract were not independent risk factors. Conclusion Total resection of uncinate process could prevent pancreatic fistula from residual pancreatic uncinate process, hence reduce the incidence of pancreatic fistula following pancreaticoduedenectomy.

Objective To evaluate the diagnostic effect of intro-operative tissue puncture biopsy and find its influential factors.Methods The clinical data of 94 patients with pancreatic mass treated in our hospital from July 1994 to December 2007 and undergoing intro-operative tissue puncture biopsy were retrospectively analyzed.Results The sensitivity,the specificity,the positive predictive value and the negative predictive value were 74.6%,93.8%,98.0%and 46.9%,respectively.The single factor analysis showed that the size of pancreatic mass,the number of puncture and complicating with pancreatic fibrosis or not were related to the diagnosis of tissue puncture.The multiple factor analysis showed that the size of pancreatic mass(P=0.014)and the number of puncture(P=0.020)were crucial to the diagnosis of puncture.The sensitivity and specificity of intro-operative tissue puncture biopsy for the pancreatic mass less than 25 mm were lower than that for the mass larger than 25 mm (P=0.000).The sensitivity and specificity would be increased as the number of puncture increased (P=0.000).For the mass less than 25 mm,increasing the humber of puncture would improve the sensitivity(P=0.002).Conclusion Intro-operative tissue puncture biopsy is a simple and accurate procedure for differentiating the pancreatic mass.The sensitivity and specificity could be improved by increasing the number of puncture,especially for the patients with pancreatic mass less than 25 mm.

Objective To determine the value of preoperative clinical, biochemical, cross-sec-tional imaging features and results of fine-needle aspiration for predicting malignancy in cystic neo-plasms of the pancreas (CNP). Methods The medical records of 69 patients receiving operations for CNP between 1994 and 2008 in our hospital were reviewed retrospectively. The predictive effect of va-rious preoperative factors such as sex, location, clinical manifestation, maximum diameters, tumor marker, pancreatic duct obstruction and calcification on the malignant potential of CNP was evaluated by Single and multi-factor analysis, fine needle aspiration (FNA) and intraoperative frozen-section ex-amination of the pancreatic transection margin was investigated. Results All the 69 patients were con-firmed pathologically. Of the 69 patients, 13 suffered from serous cystic neoplasms, 30 from mucinous cystic neoplasms,7 from intraductal papillary mucinous neoplasms,12 from solid pseudopapillary neo-plasms and 7 from cystic neoplasms. Forty-four lesions were diagnosed as malignant or borderline.Univariate analysis should that jaundice, raised CEA and/or CA19-9, maximum diameters and solid component of cystic neoplasmshad were of statistical significance for the risk of malignancy in CNP.The sensitivity was 34.1% (15/44), 47.7 % (21/44), 88.6%(39/44),72.7%(32/44) and specificity 96% (24/25), 84% (23/25), 68% (17/25),72% (18/25), respectively. The last three were identified as independent predictive factors for malignancy by multivariate analysis. Three cases were accurately diagnosed out of the 9 undergoing FNA preoperatively. One of 7 patients with intraductal papillary mucinous neoplasms (IPMN) undenwent total pancreatetomy for transection margin positivity.Conclusion Most malignant CNP can be accurately diagnosed preoperatively from a typical clinical,biochemical and cross-sectional imaging picture. FNA is only used in the patients who are potential candidates for nonoperative management. Margin analysis is necessary for pancreatic resection.

Objective To evaluate the clinical features of and appropriate surgical modality for congenital choledochal cyst(CCC). Methods Retrospective study on the clinical data of 85 surgically treated CCC cases was made. Results Among the 85 cases 12 were found malignant in character(14%). Out of the 29 cases in which the junction of pancreaticobiliary ductal system was showed by image, junction anomaly was identified in 26 cases. Surgical correction was applied to 83 cases with cyst excision and Roux-en-Y hepaticojejunostomy as the main procedure. External drainage of the CCC was adopted first in 4 cases to tide the patients over serious infection, before second stage definite radical resection was carried out. Excellent and good result were achieved on follow-up in 47 out of 60 CCC cases undergoing CCC resection and Roux-en-Y reconstruction, while only one out of 6 undergoing CCC internal drainage enjoyed fair result. Conclusions External drainage is mandatory for CCC patients with severe infection. The total choledochal cyst excision, with Roux-en-Y hepaticojejunstomy is effective in the treatment of CCC.

Objective To explore the association between perioperative glycemic control and the post-operative complications of patients undergoing pancreatic surgery. Method The clinical data of 412 patients who underwent pancreatoduodenectomy between January 1995 and April 2010 were retrospectively analyzed. Results The average fasting glycemic level was significantly higher than normal postoperatively, and the post-operative application of insulin effectively controlled glycemic levels. The rates of postoperative mortality, pancreatic fistula,hemorrhage, and infections among patients with glucose level > 8. 3 mmol/L (7.0% , 23.7% , 9.7% , and 15. 1 % ) were significantly higher than those with glucose level ≤8. 3 mmol/L (2. 7% , 11. 9% , 4. 0% , and 6.6%) (P=0.037, P=0.002, P = 0.020, and P=0.005). On the contrary, the rates of postoperative mortality and hemorrhage among patients with glucose level≤6. 1 mmol/L (6. 2% and 8. 6% ) were significantly higher than those with glucose level between 6. 1 and 8. 3 mmol/L (0. 7% and 1.4% ) (P = 0. 023 and P = 0. 011).The rate of hypoglycemia was significantly higher in patients with glucose level ≤6. 1 mmol/L (7. 4% vs. 0. 7% ,P = 0. 009). Conclusions Postoperative glucose level can be stably controlled by continuous intravenous glucose infusion plus regular insulin therapy. A target perioperative glucose level between 6. 1 and 8. 3 mmol/L can effectively and safely reduce postoperative mortality and complications.

Objective To investigate factors affecting the metastasis of lymph nodes around the root of inferior mesenteric artery(IMA) in rectal cancer,and the significance of root lymph nodes dissection of IMA in radical surgery for rectal cancer.Methods Clinicopathological data of 105 rectal cancer patients undergoing root lymph node dissection of IMA during radical resection in Peking University First Hospital from January 2005 to December 2008 were analyzed retrospectively.Rectal cancer patients without root lymph node dissection of IMA during the same period served as control.Results were compared between these two groups for survival and local recurrence rates.Results The rate of lymph node metastasis around the origin of IMA was 9.5％ (10/105).The five-year survival rate in patients with IMA root nodal dissection was 71.3％,and that without was 70.6％ (P =0.995),while the local recurrence was respectively 1.9％ and 7.4％ (P ＜ 0.05).In multivariate analyses,IMA root nodal metastasis occurred more frequently in patients with pT3 and pT4 tumor(Wald =5.764,P ＜ 0.05) and poorly differentiated tumor(Wald =7.818,P ＜ 0.05).Conclusions Root lymph nodes dissection of IMA could not increase five-year survival rate,but it could reduce local recurrence rate in patients with rectal cancer.In radical surgery of rectal cancer,lymphadenectomy of IMA root should be performed in patients with T3 and T4 tumor with poorly differentiated tumor,so as to reduce local recurrence rate.