Objective To evaluate the clinical significance of measuring angel of lesser pancreas(ALP) by ultrasound in diagnosis of neoplasm in the head of pancreas.Methods ALP was measured by ultrasound in 41 cases of pancreatic neoplasm,and in 52 normal cases as contrast.All of the cases were divided into three groups: group A,32 cases which were proven having mass in the head of pancreas by ultrasound; group B,9 cases which were discovered mass in the head of pancreas by CT or MRI,but not diagnosed by ultrasound; group C,52 cases as contract without presence of any mass in the head of pancreas.Results The mean value of ALP in group A,group B and group C was 83??9?,78??9?,and 43??5?, respectively.The angel in group A and group B was significantly wider than that in group C (P60?.Conclusions The widing of ALP by ultrasound is a sensitive sign for mass in the head of pancreas.

Objective:To evaluate the value of gastrointestinal endoscopy in patients with hepatic cell cancer.Methods:A retrospective analysis was made on 316 patients with hepatic cell cancer undergoing gastrointestinal endoscopy preoperatively from 1992 to 1998.Results:2 cases were accompanied with gastric cancer,62 cases with esophagogastric varices,58 cases with gastric or duodenal ulcer,218 cases with gastritis,Of them 30 cases with portal hypertension gastropathy,24 cases were normal.Conclusion:Hepatic cell cancer is usually accompanied with upper gastrointestinal lesions,It should be paied attention to treat perioperatively.

Objective To study the anatomy of pelvic autonomic nerves, to avoid autonomic nerves damage during rectal cancer surgery. MethodsAnatomical dissections were carried out on 7 adult cadavers, and clinically autonomic nerve-preserving rectal cancer resection was performed. Results The superior hypogastric plexus lies just posterior to the inferior mesenteric vessels. There were no obvious autonomic nerve trunks in the loose areolar tissue plane between the parietal fascia and the visceral fascia right posterior to the rectum. There were no obvious autonomic nerve trunks between the rectum and the seminal vesicles or the prostate. The inferior hypogastric plexus was a rhomboid shaped plaque of nervous tissue. The main components of the lateral ligament were autonomic nerves passing from the pelvic plexus to the rectum within a condensation of connective tissue. WT5”HZConclusionsThe inferior mesenteric vessels can be used a landmark intraoperatively to identify the superior hypogastric plexus. In order to preserve the inferior hypogastric plexus while dissecting the lateral of rectum, we should dissect along the medial surface of the inferior hypogastric plexus, and along its curvature. JP2

Objective To decrease tumor local recurrence after abdominoperineal resection (APR)for low rectal cancer using cylindrical abdominoperineal resection. Methods From February 2009 to February 2010 cylindrical APR was performed in 15 patients of advanced ultralow rectal cancer at the Department of General Surgery, Qilu Hospital of Shandong University, according to the standard protocol as described by Holm. The procedure involves careful mobilization of the mesorectum as far down as the origins of the levator muscle. Ater stoma formation, the abdomen is closed, the patient is rotated into the prone position, and an extended perineal dissection is performed. This includes the sphincter complex and the inferior surface of the levators to a point laterally where they originate on the pelvic sidewall. This point should be just inferior to the level where the abdominal procedure was terminated. The coccyx is often removed in continuity with the main specimen to improve direct visualization of the dissection.Results The cylindrical technique removed more tissue in the distal rectum. There was no bowel perforation, perineal wounds were primary healing. One patient developed perineal seroma. One patient developed peritoneocele hernia of pelvic floor. Conclusions Cylindrical APR performed in the prone position for low rectal cancer removes more tissue around the tumor that leads to a reduction in intraoperative perforations, which should reduce local disease recurrence.