This study was to evaluate the feasibility of hepatectomy for primary liver cancer (PLC) without hepatic blood flow occlusion. Methods 194 PLC patients admitted between 1988～1998 underwent hepatectomy without hepatic blood flow occlusion including nonanatomical hepatectomy (100 cases),hepatolobectomy (41 cases), combined adjacent organ resection (30 cases), hepatic segmentectomy (22 cases) and left hemihepatectomy (3 cases). Results Operative time was 2 4 hr, intraoperative blood transfusion averaged at 649 ml. Operative complication rate was 18 0%, and there was no mortality. Conclusion Hepatectomy without hepatic blood flow occlusion for PLC patients can be performed safely, so it is a useful technique for hepatectomy.

Objective To prospectively evaluate the value of US,MSCT,EUS and MRI in the quantitative evaluation of the extent of pancreaticobiliary duct obstruction in pancreatic cancer.Methods Consecutive 68 patients with pancreatic carcinoma underwent US,MSCT,EUS and MRI before surgery.The diameter of extrahepatic bile duct and pancreatic duet were measured,and correlation analysis was performed with surgical specimens.Results Diameters of extrahepatic bile duct scaled by US.MSCT,EUS and MRI were(16.60±6.33)mm,(18.90±6.74)mm,(18.80±5.88)nun and(17.26±4.83)mm,and diameter measured from surgical specimens was(18.39±6.05)mm;the correlation among the four imaging examinations and the surgical evaluation were r=0.3839,P=0.1055;r=0.7113,P=0.0011; r=0.3759,P=0.0465;r=0.3376,P=0.2872,respectively. Kappa Values were 0.6285,0.7115,0.6661 and 0.7490,respectively.The diameter of pancreatic duct was(15.90±3.41)mm,(6.83 4-3.70)mm,(6.77±3.22)mm and(5.58±2.65)mm,and diameter measured from surgical specimens was(5.97±2.60)mm,the correlation among the four imaging examinations and the surgical evaluation were r=0.3584,P=0.2895;r=0.6148,P＜0.0001; r=0.7373,P＜0.0001;r=1.0746,P＜0.0001.Kappa values were 4.159,9.094,9.001 and 4.050.All of these parameters were in coherence with surgical findings.Condusions US could be used as the initial method in the assessment of extrahepatic and pancreatic duct obstruction.MRI and MSCT,combined with EUS if necessary,could be used to quantitatively evaluate the extent of pancreaticobiliary obstruction.

Objective To explore the diagnosis and treatment of intrahepatic biliary cystadenoma and cystadenocarcinoma. Methods Eight patients with intrahepatic biliary cystadenoma and cystadenocarcinoma treated in our hospital were studied retrospectively. The clinical and pathological data were reviewed. Results Most of the patients had nonspecific symptoms and serum AFP level was normal. Uhrasonography and CT diagnosed correctly in 75% and 87.5% of all patients, respectively. All the 8 patients underwent resection and had no recurrence after operation except that 1 case of cystadenocarcinoma died of recurrence 3 years later. Conclusion The diagnosis of intrahepatic biliary cystadenoma and cystadenocarcinoma depends on radiography and pathological examination. Surgery is recommended to get satisfactory results.

Objective To explore the clinicopathological features, diagnosis and therapy for pancreatic mutinous noncystic adenocareinoma(MNAC). Methods Eleven MNAC cases treated in our hospital were studied retrospectively. The clinical and pathologic data were reviewed. Results Of the 11 patients, 6 were male and 5 were female. The age ranged from 47 to 76 years with average of 60. 5 years.The main complains included upper abdominal discomfort in 8 cases, abdominal mass in 1 case and jaundice in 2 cases. CA199 serum test was positive in all patients and 5-fold high above normal value in 6 cases. The preoperative radiography of MNAC was usually not specific. Tumors located in the head in 5 cases and in the body and tail of the pancreas in 6 cases. The diameter of the tumor was 4 - 11 cm with average of 6. 5 cm.All cases underwent operation, with radical resection in 2 cases. Liver or abdominal metastasis was found in 5 cases. Postoperative immunohistochemistry showed that MUC-1 was negative in all patients. MUC-2,PCNA and Ki-67 were positive in all patients. All 9 cases that were followed-up died within 5 -22 months,with an average survival time of 10 months. Conclusions The diagnosis of MNAC depends on pathology. Its prognosis is poor.

Objective To explore the clinical diagnosis and management of hepatecellular adenoma(HA). Methods Seventeen HA cases treated in our hospital from Janurary 1986 to June 2007 were studied retrospectively.The clinical and pathologic data were reviewed. Results Of 17 patients,9 were male and 8 were female with median age of 46 years.None of the female patients had a history of oral contraceptives.Most patients were agymptomatic.Preoperative liver function test and AFP serum test were normal.Preoperative imaging study yielded deftnite diagnosis in only a fraction of patients.All 17 cases underwent surgical resection and the postoperative course is uneventful.All cases were followed up ranging from 6 to 252 months.Recurrence was not found.Pathology reported atypical hyperplagia in 2 cases and with malignant transformation in 1 case. Conclusions The diagnosis of HA is exclusive and dependent on clinical data,laboratory test and radiography.HA has a tendency to malignancy.Surgery is recommended in all cases.

Objective To explore the clinicopathological characteristics as prognostic factors in patients with colorectal signet-ring cell carcinoma. Methods Clinical data of 62 patients of colorectal signet-ring cell carcinoma and 281 patients of colorectal low-differentiated adenocarcinoma were retrospectively analyzed. COX Proportional Hazards Model was used in multivariate analysis. Results Colorectal signet-ring cell carcinoma occurred more frequently in young patients and most of them located in the rectum. Gender, preoperative CEA, pathological type and liver metastasis were not statistically different from low-differentiated adenocarcinoma (X2=0.07,0.04,0.06,1.79,P>0.05).Bowel obstruction, operative modalities, tumor embolism, infiltration depth, lymph node metastasis were statistically different from low-differentiated adenocarcinoma (X2=8.96,75.1,18.5,72.0,7.44,P<0.05). Median survival time was 28 months in patients of colorectal signet-ring cell carcinoma and 49 months in patients of colorectal low-differentiated adenocarcinoma. The difference was statistically significant (X2=12.51,P<0.05). Infiltration depth, lymph node metastasis, operative modalities and postoperative adjunctive therapy were independent prognostic factors based on a multivariate analysis of the COX Proportional Hazards Model. Conclusions The biological malignancy of colorectal signet-ring cell carcinoma is higher than that of low-differentiated adenocarcinoma in colorectal carcinoma. Radical resection and postoperative adjunctive therapy were effective treatment methods.

Objective To evaluate the clinical presentation,pathologic features,diagnosis and treatment of hepatic angiomyohponm(HAML).Methods Retrospective analysis was made on 22 HAML cases in terms of clinical finding,images,pathologic examination and surgical treatment.Results Of the 22 patients,6 were male and 16 were female.The average age was 48.2 years.Seventeen patients had no clinical symptoms.None had the history of hepatitis virus infection.None of them was complicated with renal AML.None had tlle history of taking oral contraceptives in the sixteen female patients.Serum AFP、CEA、CA19-9、CA242 levels were all within normal limits.The correct diagnostic rate of BUS.CT and MRI was 2l%(4/19)、23.5%(4/17)and 25%(2/8),respectively.All tumorts were single nodule with a diameter of 4～17 cm,without complete capsula.All these 22 patients underwent tumor resection,including partial liver resection in 17 patients,left hemihepatectomy in 5.One patient died of postoperative complication,one patient suffered from temporary bile leak.The HMB45 positive rate by immunohistochemical method was 100%.Extramedullary hemopoiesis was found in 4 patients.Follow up of 6 months to 17 years in 91%(20/22)patients found no tumor recurrence. Conclusions HAML had no specifiC symptoms.The preoperative imaging diagnosis is difficult.Surgical resection is the therapy of choice for HAML.

Objective To explore clinieopathologieal features and prognosis in a high grade malignancy group of colorectal mueinous carcinoma, signet-ring cell carcinoma and low-differentiated carcinoma. Methods Retrospective analysis and follow-up were made on 148 patients with colorectal mucinous carcinoma, 55 patients with signet-ring cell carcinoma and 281 low- differentiated carcinoma treated in our hospital from 1988 to 2006. Obtained data were analyzed by SPSS13.0. Related factors underwent x2 analysis, survival analysis were estimated using Kaplan-Meier method and compared using the Log-rank test. Results Coloreetal signet-ring cell carcinoma were significantly different from mucinous carcinoma and low- differentiated carcinoma in gender, age, tumor location, bowel obstruction, operative modus, tumor embolism, tumor infiltration and lymph node metastasis(x2 = 7, 67,38.4,86.0,14.5,93.7,17.3,62. 1,24. 4,56.17 ,P <0.05). Median survival time was 24 months in signet-ring cell carcinoma, 47 months in mueinous carcinoma and 49 months in low- differentiated carcinoma. The difference is of significance(x2 = 21.3, P < 0.05). Conclusions Clinicopathological characteristics and prognosis of colorectal signet-ring cell carcinoma, mueinous carcinoma and low- differentiated carcinoma is of significant difference(P < 0.05). Malignancy of signet-ring cell carcinoma is higher with worse prognosis.

Objective To investigate the relationship between clinicopathological characteristics and lymph node metastasis for carcinoma of the ampulla and papilla of Vater. Methods In this study, 152 patients with carcinoma of the ampulla and papilla of Vater underwent radical duodenopancreatectomy. Lymph node metastasis was correlated with clinicopathological factors. Results The rate of lymph node metastasis was 31%, that for T1,T2 ,T3, and T4 was 0, 20% (11/54) , 26% (19/72) , and 94% (16/17) , respectively, x2 analysis revealed that lymph node metastasis was associated with tumor size (

Objective To discuss the diagnosis and treatment of splenic harmatoma(SH). Methods The clincial data of three cases of SH treated in our hospital from January 1997 to December 2007 were collected,and the other 17 cases which were published from January 1997 to December 2007 in the Chinese biological and medical lit-erature database were reviewed. The clinical manifestation,pathological findings,diagnosis and treatment of these 20 patients were analyzed. Results The main symptoms were abdominal pain or discomfort and abdominal mass in 13 cases(13/20). All 20 patients underwent surgical treatment with good recovery without severe complications and re-currence. Conclusions The definite diagnosis of SH depends on postoperative pathological findings. Complete surgi-cal resection is the best treatment for SH with favourable prognosis.