Objective To study the treatment of hepatocellular carcinoma(HCC) complicated with bile duct thrombus.Methods Restrospective study was performed on the treatment of 34 cases of HCC complicated with bile duct tumor thrombus from January 1995 to December 2002 admitted to our hospital.Results Among the 34 cases, one patient had no treatment,6 cases received PTCD and 27 cases received operation.In surgical treatment patients,the postoperative 30 days mortality was 22.2%(6/27),the morbidity was 55.6%(15/27).In 16 patients who received hepatectomy with thrombectomy and biliary duct drainage, the survival time was 1～27 months with a median survival time of 16.5 months.Conclusion The prognosis of HCC complicated with bile duct tumor thrombus is poor. Early diagnosis and aggressive operative are the key points to improving the survival time of patients.

AIM: To observe the ability of dendritic cells (DC) vaccine transfected with human hepatocellular carcinoma (HCC) total RNA induce specific cytotoxic T lymphocyte(CTL) response in vitro. METHODS: DCs generated from HCC patient's peripheral blood mononuclear cells (PBMC) were incubated with recombinant human granulocyte macrophage colony-stimulationg factor (GM-CSF) and human interleukin (IL-4). Tumor total RNA was isolated from Hep G-2 cells and HCC cells. DCs transfected with tumor total RNA were used to induce specific CTL proliferation. Specific cytotoxicity was measured using MTT method. RESULTS: DC transfected with HepG-2 cell RNA and HCC RNA exhibited increased expression of CD83, CD86 and HLA-DR. The CTL from DCs transfected with HepG-2 cell RNA killed 5.84%, 14.26%, 25.19%, or 35.78% of HepG-2 cells, and 5.26%, 11.67%, 14.68%, or 23.24% of HCC cells, respectively, at an E/T ratio of 2.5, 5, 10, or 20. The CTL from DCs transfected with HCC cells RNA killed 4.65%, 12.23%, 15.61%, or 19.15% of HepG-2 cells, and 7.20%, 12.83%, 27.21%, or 31.15% of HCC cells,respectively, at an E/T ratio of 2.5, 5, 10, and 20. These CTL did not kill allogeneic malignant cells as human gastric carcinoma cells SGC-7901. CONCLUSION: DC transfected with tumor-derived total RNA could induce specific antitumor immune CTL response. These results suggest that CTL generation is applicable to adoptive immunotherapy of HCC.

AIM: To investigate the effects of ErbB2 overexpression on growth and invasiveness in cultured MCF-7 cell line. METHODS: Retrovirus containing ErbB2 gene was transfected into MCF-7 cells and ErbB2 expression was detected by Western blotting. Proliferation and invasive assays were carried out. Cells overexpressed ErbB2 and its control, AP2, were used in the experiment. RESULTS: ErbB2 was overexpressed in MCF-7 cells after transfection. In vitro, cells overexpressed ErbB2 showed highly proliferated and highly invasive characteristics compared to the control cells. CONCLUSION: Overexpression of ErbB2 promotes cell proliferation and enhances invasiveness in MCF-7 cells. Inhibition of signaling induced by ErbB2 might be a novel strategy for the therapeutics of cancer with ErbB2 overexpression.

Objective To evaluate the application of 64-slice computed tomography (CT) and software-assisted image analysis in preoperative evaluation and surgical planning of hilar cholangiocarcinoma. Methods The clinical data of six patients with hilar cholangiocarcinoma who were admitted to The First Affiliated Hospital of Sun Yat-sen University from June to December, 2009 were retrospectively analyzed. All six patients underwent 64-slice CT scanning before the operation, and then three-dimensional (3D) reconstruction of the liver, tumor, blood vessels and bile ducts was achieved with the assistance of Myrian (R) XP-Hepatic software. The relationships of the tumor, blood vessels and bile ducts were illustrated in the 3D model. Virtual liver resection was carried out for surgical planning. Results The 3D models of the liver, tumor, blood vessels and bile ducts were successfully constructed . The 3D models were able to be rotated and magnified as necessary. Preoperative evaluation and surgical planning were in accordance with actual surgery. The relative accuracy of the software-assisted image analysis system for calculating the hepatic volume to be resected was 5%. Patients recovered well without occurrence of hepatic failure. Conclusion Sixty-four-slice CT scanning and software-assisted image analysis are important for preoperative evaluation and surgical planning of hilar cholangiocarcinoma.

Objective To investigate the value of interventional therapy in bile duct injury (BDI) due to laparoscopie cholecystectomy (LC). Methods Data of 24 BDI patients, who received interventional treatment after LC from June 1997 to May 2007, were retrospectively analyzed. Results According to Liu Yunyi criteria of BDI classification, there were 5 cases of type Ⅰ , 11 cases type Ⅱ , 2 type Ⅲ and 6 type Ⅳ. BDI was found during LC in 2 patients and the operation was switched to open cholecysteetomy, but bile duct infection was experienced 10 months and 2 years after the operation, respectively. BDI was diagnosed postoperatively in 22 patients, in which 13 eases occurred 3-12 days after LC, 7 cases 20-60 days after LC, and 2 cases 2 years after LC. Complete remission was achieved by interventional therapy in 5 patients, the other 19 patients received curative operation after control of cholangitis and jaundice. Among 13 patients who were diagnosed BDI 3-12 days after LC, 6 underwent emergency operation and failed. Of the 7 other patients who received interventional therapy, 3 were cured and the others underwent curative operation after cholangi-tis and jaundice were controlled. Conclusion Application of interventional therapy in BDI after LC can a-chieve successful bile duct support and drainage, and can obtain complete image of bile duct system, which is effective not only in control of cholangitis and jaundice for the safety of the following surgery, but also in cure of BDI.

Objective To analyze the factors influencing the prognosis of patients with pancreatic cancer.Methods The clinical data of 276 patients with pancreatic cancer who had been admitted to our department from September 1995 to August 2005 were retrospectively analyzed.Cox regression analysis was used to screen out independent risk factors influencing the prognosis of patients with pancreatic head cancer or pancreatic body and tail cancer,and Kaplan-Meier method to calculate the median survival time.The effects of tumor location on the prognosis were examined by Log-rank and Breslow test.Results Cox regression analysis showed that the diameter of tumor,invasion of the superior mesenteric vessel and treatment method were the independent risk factors influencing the prognosis of patients with pancreatic head cancer;while age,lymphadenectasis and treatment method were the independent risk factors influencing the prognosis of patients with pancreatic body and tail cancer.The median survival time of patients with pancreatic head cancer and pancreatic body and tail cancer after radical resection were 460 days and 480 days,which were significantly longer than 240 days and 200 days of patients who received palliative treatment or gave up treatment.The median survival time of patients with whole pancreatic cancer was 117 days,which was significantly shorter than 330 days of patients with pancreatic head cancer and 300 days of pancreatic body and tail cancer.Conclusions Radieal resection is currently the best choice for pancreatic cancer.The prognosis is poor for patients with pancreatic head cancer(diameter≥4 cm)and invasion of the superior mesenteric vessel.Patients with age≤60 and lymphadenectasis are the factors resulting in poor prognosis of pancreatic body and tail cancer.The prognosis of patients with pancreatic head cancer and pancreatic body and tail cancer are close.Patients with whole pancreatic cancer is in the terminal stage with the worst prognosis.

Objective To investigate the effect on and mechansm by which prostaglandin E_1(PGE_1)protects liver functions after hepatectomy.Methods In this study,82 cases undergoing hepatectomy were divided randomly into control group with conventional therapy(41 cases),and PGE_1 treatment group(41 cases)treated with liposomal prostaglandin E_1 in addition to conventional therapy.Postoperative hospital days,urinary volume and abdominal drainage volume were observed.Pre-and postoperative liver functions were measured.Results Postoperative hospital days(median time 22 days)in PGE_1 treatment group were significantly shorter than those(median time 26 days)in control group.The postoperative levels of alanine transaminase,aspartic transaminase,total bilirubin and albumen in PGE_1 treatment group recovered to preoperative levels more quickly,than control group.Postoperative urinary volume in patients of PGE_1 treatment group was significantly more than that in control group,while abdominal drainage volume was markedly less,although there was no significant difference in prothrombin time between the two groups.Conclusion In patients undergoing hepatectomy,PGE_1 is very useful and safe to protect and improve hepatic function,decreasing the level of bilirubin,preventing ascites,formation shortening hospital days,without causing prolongation of prothrombin time remarkably.

Objective To investigate the cause,type,clinical manifestation,diagnosis and treatment of bile duct injury(BDI)during laparoscopic cholecystectomy(LC).Methods Data of 26 cases suffering from biliary injury during LC from 1997 to 2007 were retrospectively analyzed.Results Among 26 cases with BDI,5 cases suffered from type Ⅰ BDI,13 cases from typeⅡ,2 cases from typeⅢ,and 6 cases from type Ⅳ.Injuries were diagnosed as BDI intraoperatively in 3 cases,23 BDI cases were diagnosed postoperatively,including 13 cases diagnosed one week after LC,8 cases 20-60 days after LC,2 cases 2 years after LC.Twenty-four cases underwent interventional therapy,with 5 cases cured,19 cases were tideovered to operative treatment after cholangitis and jaundice were under control.Among all BDJ cases,20 cases underwent resection of impaired dile duct and hepatico-jejunostomy. Conclusion BDI is a serious complication of LC,temporary stent graft or bile dranage will help to put jaundice and cholangitis under control so as to buy a time for final definite surgical procedures.

Objective To evaluate the long-term efficacy of modified loop choledochojejunostomy (MLC). Methods The clinical data of 259 patients who had underwent choledochojejunostomy in First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2006 were retrospectively analyzed. Of all the patients, 130 underwent MLC (MLC group) and 129 underwent Roux-en-Y choledochojejunostemy (RYC, RYC group). The changes in incidence of cholangitis and liver function between the 2 groups were compared. All the data were analyzed by t test, chi-square test or Fisher exact probability. Results The levels of alaninetransa-minase and alkaline phosphomonoesterase were (63±42) U/L and (147±147) U/L in MLC group, and (84±52)U/L and (256±201)U/L in RYC group, with statistical difference between the 2 groups (t=1.634, 1.655, P>0.05). The level of gamma-glutamyl transferase in MLC group was (116±91)U/L, which was signifieandy lower than (169±96)U/L in RYC group (t=2.461, P<0.05). Three patients (2.3%) in MLC group and 9 (7.0%) in RYC group suffered from acute cholangitis after operation, with no statistical difference in the incidence between the 2 groups (P>0.05). Of the 12 patients with acute cholangids, 1 in MLC group and 7 in RYC group were hospitalized, with statistical difference between the 2 groups (P<0.05). Conclusions The incidence of acute cholangitis in patients who underwent MLC is comparable to that of RYC. However, the procedure of MLC is simpler than RYC, and patients have milder symptom and lesser frequency of reflux cholangitis onset after MLC.

Objective To evaluate risk factors of hepatectomy for patients with large hepatocellular carcinoma (HCC). Methods Clinical data of 310 large HCC cases receiving hepatctomy were analyzed retrospectively. Results Hepatitis B infection rate was 60.7% in this group with cirrhosis rate of 66.8%. Tumor size averaged at (9.4?3.8) cm in diameter. Child A grade was found in 51.0% of cases, Child B in 36.8% and Child C in 12.3%. Pringle′s procedure, semi-liver blood occlusion and modified Heaney procedure were used in 31.6%, 11.0% and 2.3% of cases respectively, with occlusion time of ( 17?8) min, (25?9) min and (20?10) min, respectively. Left lateral lobectomy, left hemihepatectomy, right hemihepatectomy and segmentectomy were performed in 17.1%, 11.6%, 9.0%, and 62.3% cases, respectively. Blood loss, blood transfusion and operation duration were (820?1 151) ml, (966?945) ml and (182?74) min, respectively. The overall morbidity and liver failure were 22.3%, and 5.8%, respectively, with an operative mortality of 2.6%. The univariate analysis for liver failure revealed its risk factors being preoperative AST value(P