Objective To discuss the curative effect of Choledo-choledochostomy by observing different means of biliary duct reconstruction in the iatrogenic bile duct damage and the liver trans-plant. Method The clinical data of 19 patients who were found to have iatrogenic bile duct injury dur-ing operation and immediately repaired and 66 patients receiving liver transplantation in our hospital in the past 10 years were retrospectively analyzed. Meanwhile, the means for bile duct reconstruction were discussed. Results The rate of curative effect of the Choledo-choledochostomy was 86.6% for iatrogenie bile duct injury. However, whether to leave the T-tube or not was not a determinant factor for the procedure in liver transplantation (P>0. 05). Conclusion Choledo-choledochostomy has good curative effect for iatrogenic bile duct injury and liver transplantation. During the operation, the bile duct may not be excessively freed to guarantee blood supply in at the anastomosis site to further en-hance the curative effect.

Objective To analyze and compare thh effect of early surgical treatment and nonsurgical treatment for patients with traumatic severe acute pancreatitis.M~ethods The curative effect,surgical procedures and mortality data in 36 cases were retrospectively analyzed.ResUlts Compared with nonsurgieal treatment,early surgical treatment was associated with a significantly lower incidence of mortality,and with a highter cure rate (9.52% vs 33.33% ,P ＜ 0.05).Conclusion For traumatic severe acute pancreatitis,early operative management should be selected routinely as the first choice of treatment.

Objective To summaize the experience of application of direct digital radiography and electrohydraulic shockwave lithotripsy in treatment of residual bile duct stones.Methods A retrospective analysis of clinical records of 60 patients with residual bile duct stones treated in our hospital from 2003 to 2006 was made.Results In 59(95.9%) of 60 cases the stones were removed completely,including successful removal in one time of application of this method in 57 Patients(95.0 %),and 2 applications in 2 Patients ﹙3.3 %).One case with bile duct stone complicated with dile duct cancer was unsuccessful.The biggest stone was 3.5 cm?2.5 cm?2.0 cm.No serious complications occurred and changed to operation.The 59 cases were followed up for 6 mo to l yr,and all had a successful outcome.Conclusions The method of combination of direct digital radiography and electrohydraulic shockwave lithotripsy in treatment of postoperative residual bile duct stones after operation can facilitate removal of residual bile duct stones.The procedure is a safe way of treating residual stones.

Different degrees of HCV re-infection exist in patients with hepatitis C after liver transplantation. Its pathogenesis is different according to different phases of the disease. Factors affecting its recurrence include HCV gene type, viral load, HLA matching between donor and recipient, time of recurrence, donor's age and so on, in which the application of immunosuppressants is the most important influencing factor. The virological response can be used to evaluate the effects of treatment. Now, it is widely accepted that the best choice and therapeutic plan is Pegy interferon alfa-2a/2b combined with Ribavirin.

Objective HLA-G widely participates in immune tolerance by its combination with immunoglobulin-like tran-scripts IL-2 and IL-4 on the surface of dendritic cells (DCs).The aim of the article was to explore the effects of recombinant adnovirus-mediated HLA-G transfection in macaca mulatta immature dendritic cells on T cell proliferation . Methods Marrow blood was collected from macaca mulattas by the puncture needle after anesthesia .Density gradient centrifugation method was applied in separating mononuclear from the extracted blood on which CD 34+cells were collected and pu-rified by means of immunomagnetic separation .Small doses of cyto-kines were added to get the immature dendritic cells after induced dif-ferentiation of CD34+cells.After the recombinant adnovirus-mediated HLA-G transfection in macaca mulatta immature dendritic cells , observation was done on the viral infection efficiency and western blot was used in detecting the expression of HLA -G in immature den-dritic cells.Taking T cells in macaca mulatta as responders and DCs transfected by recombinant adnovirus -mediated HLA-G as stimu-lators, mixed lymphocyte test was conducted .T cells were divided into 5 groups: mDC group ( mature DCs ) , imDC group ( immature DCs), imDC(L) group(addition of 100 ng/mL lipopolysaccharide after getting imDC at 7th day) , imDC(V) group (imDCs infected by recombinant adnovirus-mediated HLA-G) , imDC( L+V) group ( imDCs infected by recombinant adnovirus-mediated HLA-G along with the addition of 100 ng/mL lipopolysaccharide in culture process ) . Results We obtained the immature dendritic cells and recom-binant adenovirus of HLA-G expressed in these cells .Flow cytometry showed DC purity was up to 92.3 %, imDC purity was up to 72.39%and positive percentage of CD 4+T was greater than 80%.In comparison with imDC group ,the proliferation of stimulated T cells in mDC and imDC(L) groups was obviously intensified (P<0.01).In comparison with imDC(V) group, the proliferation of stim-ulated T cells in imDC, mDC, imDC(L), and imDC(L+V) groups was obviously intensified (P <0.01).In comparison with imDC(L+V) group, the proliferation of stimulated T cells in mDC and imDC(L) groups was obviously intensified(P<0.01). Conclu sion Im-mature DCs infected by recombinant adnovirus can inhibit the proliferation of T cells effectively .

Objective To explore the rationality of pancreaticojejunostomy and double purse embedded pancreaticogastrostomy in pancreaticoduodenectomy through comparing the short-term effects between pancreaticojejunostomy and double purse embedded pancreaticogastrostomy in pancreaticoduodenectomy.Methods A retrospective review was performed for 38 patients who were underwent pancreaticoduodenectomy at the second affiliated hospital of Kunming Medical University from January 2010 to December 2012.Results All 38 pancreaticoduodenectomy were performed successfully.The pancreatic fistula (0％),operationtime [(327.50±32.56) min],postoperative hospital days [(10.31 ±2.44) d] were found to be significantly lower in double purse embedded pancreaticogastrostomy group than those of pancreaticojejunostomy group [3/12,(425.83 ± 33.77) min,(14.33 ± 4.14) d],which has statistical significance(P＜0.05).Although the incidence of bile leakage,postoperative abdominal bleeding,delayed gastric emptying,infection of incision,infection of lung,intraoperative amount of bleeding are also lower than that of pancreaticojejunostomy group,which has no statistical significance.Conclusions Double purse embedded pancreaticogastrostomy is a digestive tract reconstruction which is safer and more reasonable than pancreaticojejunostomy.The former one is operated simply and the operation time is shorter.There are great advantages in the prevention of complications such as pancreatic fistula after pancreaticoduodenectomy.

Objective To study the therapeutic effects of combined use of laparoscopic cholecystetomy and endoscopic sphincterotomy for cholecystolithiasis with secondary choledocholithiasis.Methods Thirty-five patients were diagnosed as cholecystolithiasis with secondary choledocholithiasis by B-ultrasonography and magnetic resonance cholangiopancreatography.Of them,in 28 cases,laparoscopic cholecystetomy was performed first,and ERCP and endoscopic sphincterotomy were done one week later;in 7 cases,endoscopic sphincterotomy were performed before laparoscopic cholecystectomy.Results The outcome of all the thirty-five cases was satisfactory without severe complications or conversion into open procedure.Conclusions The method of combined laparoscopic cholecystomy and endoscopic sphincterotomy,for cholecystolithiasis with secondy choledocholithiasis,especially for cases in whom the diameter of the common bile duct stone is ≤1cm,can give good therapeutic results and has advantages of minimal invasiveness,few complications and quick recovery.

Objective To evaluate the therapeutic effects of gemcitabine regional artery perfusion combined with systemic chemotherapy for late-stage cancer of pancreas.Methods Thirteen cases of late-stage cancer of pancreas proven by operation and pathology were treated with 5-FU+MMC as a combined system chemotherapy, and use of gemcitabine for regional artery perfusion chemotherapy.Results Among the 13 patients who could be evaluated for therapeutic effect, four cases had partial response (PR), six cases had (SD), three cases were PD, and the effective rate of the clinical benifical-reflected evaluation was 76.9%, pain releive rate 75.0% the median survival time was 6.3 months. None of the patients have had serious toxious side-effects.Conclusions The gemcitabine regional artery perfusion combined with systemic chemotherapy can relieve the cancer pain of patients with late-stage cancer of pancreas, improve their general condition, increase the survival quality of life, prolong the survival time. The drug tolerance of the patients is good.

Objective To evaluate the efficacy of X-ray guided choledochoscopy via T tube tunnel and interventional treatment of residual bile duct stones.Methods Cholangiography was performed in patients suspected of residual bile duct stone with choledochoscopy via the remaining T tube tunnel,and data of 45 patients who received endoscopically treatment for the residual bile duct stones and bile duct stricture were analyzed.Results Seven patients' with adhesive bile duct stenosis were resolved by repeat rinse and dilation,but the procedure failed in 2 cases of bile duct stricture caused by scar;seven cases of common bile duct stone combined with gradeHand Ⅲ multiple hepatic cholelith were removed within 1.5 h:six cases of hepatic bile duct narrowing with multiple cholelith were taken out in 1.0 hour;six cases of grade Ⅱ and Ⅲ multiple massive choledocholith were removed with lithotrity for over 2.0 h:six cases of grade Ⅱ-Ⅳ cholelith were eliminated within 1.5 h:six cases of hepatobiliary stone were removed successfully in 30 min.Stones in 3 cases of multiple stones with intrahepatie bile duct stenosis were not taken out due to bile duct stricture;stones in 2 cases of gradeⅡand Ⅲ multiple choledocholith were not removed for T tube tunnel bleeding.Conclusion X-ray guided choledochoscopy is convenient and effective to remove residue cholelith.

Objective:To assess the shielding requirements of low energy X-ray intraoperative radiotherapy room under the domestic and foreign standards and guidelines, to measure the sured transmission factors for a range of shielding materials, the ambient dose equivalent rate around concerned positions and the shielding effect of protective devices, so as to provide references for shielding design of such radiotherapy units and applications of radiological protection devices.Methods:The required shielding thicknesses for a treatment room with INTRABEAM intraoperative radiotherapy system were calculated under the Chinese national standard GBZ 121, IPEM report No. 75 and NCRP report No. 151, respectively. The transmission factors for a range of shielding materials including solid water slab, shielding sheet and shielding apron were measured. Moreover, the ambient dose equivalent rates were measured under the simulated working conditions and the shielding effectiveness of a lead screen was evaluated.Results:The required lead thicknesses calculated under different standards and guidelines were less than 0.6 mm for all the concerned points, with the differences at sub-millimeter level. The low energy X-rays generated by this equipment attenuated rapidly in the shielding materials. The measured transmission factors of 0.05 mm lead equivalent shielding sheet and 0.25 mm lead equivalent shielding apron were 0.068 and 0.003 8, respectively. When the radiation was delivered using spherical applicator without any attenuation, the ambient dose equivalent rates at 1 m and 2 m from the X-ray source were 10.7 and 2.6 mSv/h, respectively. The corresponding measurement values decreased to 3.8 and 0.9 μSv/h, respectively, when the spherical applicator was inserted into a small water tank. Meanwhile, the ambient dose equivalent rate at 2 m was reduced to the background level when using protective screen.Conclusions:The shielding requirements for a low energy X-ray intraoperative radiotherapy facility are minimal, with low effective energy of X-rays generated by this equipment, but the dose rate close to the unshielded radiation source is high. The shielding scheme of treatment room should be optimized in design and the protective device should be used in a reasonable way.