Radical pancreaticoduodenectomy is the most effective method for the treatment of malignant tumor of pancreatic head.Safe and complete resection of the uncinate process of the pancreas is the most difficult and important part in radical pancreaticoduodenectomy.For the past years,we put forward the new idea of prior selective arteriovenous treatment in radical pancreaticoduodenectomy according to whether the portal vein and superior mesenteric vein was invaded by the tumor.Thin slice scan and vessel reconstruction using multidetector spiral CT can accurately evaluate the condition of the blood vessels near the pancreatic tumor and judge whether the tumor was resectable.By exchanging superior mesenteric artery,controlling blood stream of pancreatic uncinate process and using 3 or 4 vascular blocking bands and the integrated radical resection of uncinate process for those patients can be successfully completed.It can reduce the operating bleeding,operating time and the miscut of superior mesenteric vein and (or) superior mesenteric artery,and also avoid postoperative pancreas necrosis,infection and hemorrhage caused by the pancreas uncinate process residues,and theoretically reduces the chance of tumor cells spread.

Pancreaticoduodenectomy is the main treatment method for pancreatic head carcinoma and periampullary cancer,and is also the only possible cure way.With the development of minimally invasive surgery,laparoscopic pancreaticoduodenectomy has been widely carried out,it even has been the routine operation in some pancreatic surgery center.The traditional approach is still the main approach for laparoscopic pancreaticoduodenectomy.In recent years,the procedure of the artery approach with its advantages has been put forward and gradually developed in laparoscopic pancreaticoduodenectomy through the continuous study and exploration.On the basis of the early arterial approach,authors' center established an artery preferential disconnection procedure in laparoscopic pancreaticoduodenectomy,which has been named arterial first approach.In the clinical practices and studies,this procedure also represents its unique advantages.

Adult ; Empyema, Pleural ; complications ; etiology ; Humans ; Male ; Neck Injuries ; complications ; Tracheoesophageal Fistula ; complications ; etiology

Objective To observe the curative effect of condyloma acuminatum patients treated with differences of bacilli phlei injection after fulfufized and the effect of immunity function. Methods We compared curative effect and peripheral blood T lymphocyte subpopulation in the treatment group( 55 cases, 8 weeks, prior and posttreatment with differences of bacilli phlei only) and the control group (50 cases, 8 weeks, prior and post-treatment with recombinant human interferon α-2b only). Results Compared with the control group (24.0 %/41.7 % ), the treatment group(47.3 %/11.5 % ) had advantage in the terms of cure rate and relapse rate( P＜0.05 ). CD+3, CD+4 ,CD4+/CD+8 increased and CD+8 decreased in two groups after treatment. CD+3 , CD+4, CD+4/CDs+ were significantly increased in treatment group compared with the control group after treatment(P＜0.05), but CD+8 had no obvious difference in two groups(P＞0.05). Conclusion Differences of bacilli phlei injection can prevent relapse of condyloma acuminatum and increase immunity function of patients.

Objective To investigate the methods and techniques of simplified binding pancreaticojejunostomy for patients with periampullary malignant tumor after radical pancreatoduodenectomy (RPD). Methods From March 2005 to May 2010, 323 patients with periampullary malignant tumor received RPD at the Tongji Hospital of Huazhong University of Science and Technology, and their clinical data were retrospectively analyzed.Simplified binding pancreaticojejunostomy was applied after RPD: the distal end of pancreas was freed for 3-4 cm;a No. 6 or No. 8 silicone urinary catheter was inserted into the pancreatic duct for 4-5 cm, and the remaining urinary catheter (6-8 cm) out of the pancreatic duct was sutured to the pancreatic stump with absorbable sutures.The cutting end of the jejunum (2-3 cm) was everted, and the everted mucosa of the jejunum ( 1 cm) was injured by electrocautery, then the everted jejunum was reverted to its normal position. The cutting end of the mesentery of jejunum and its opposite side, as well as the mid-point of these two parts were sutured symmetrically with the lower and upper edges of the pancreas, and with the capsule of pancreas between them. The everted jejunum was wrapped over the pancreatic stump and sutured it to the pancreas for fixation. The cutting end of the jejunum was bound to the pancreatic stump with 1-0 absorbable suture after confirming the jejunum was completely invaginated into the pancreas. The alimentary tract was reconstructed by using Child's method. Results Simplified binding pancreaticojejunostomy was successfully completed in all patients, Pancreatic fistula was detected in one patient who was complicated with anastomotic bleeding on the third day after secondary laparotomy. The patient was discharged with catheter and spontaneously recovered one month later. Pancreatic fistula was also detected in two patients with distal bile duct carcinoma and two patients with carcinoma in the uncinate process of pancreas at postoperative day 3, 6, 8 and 11, and they were cured by expectant treatment. The incidence of pancreatic fistula was 1.5% (5/323). Conclusion Simplified binding pancreaticojejunostomy is simple, safe and feasible, and it can significantly reduce the incidence of pancreatic fistula.

Objective To assess the effect of L-carnitine(L-CN)on left ventricular hypertrophy(LVH)in patients undergoing maintenance hemodialysis. Methods Thirty-one patients undergoing hemodialysis were randomly divided into the L-CN group(n =20)and the control group(n = 11). Patients in the L-CN group received additional intravenous injection of 1.0 g L-CN immediately after hemodialysis for a 6-month period. Patients in the control group received isovolumic saline. Using echocardiography,left ventricular mass (LVM),left ventricular mass index(LVMI)and the ejection fraction(EF)were measured before and after the treatment. Plasma calculus,plasma phosphorus and hemoglobin levels were measured. Results The LVM decreased significantly from(252. 03 ±32. 29)g to(204. 47 ± 37.33)g in patients in L-CN group(P ＜ 0. 05),the LVMI decreased significantly from (155.83 ± 23.42)g/m2 to(129. 21 ± 17.46)g/m2 in patients in the L-CN group. However,LVM and LVMI remained unchanged in the control group. Conclusions Supplementation with L-CN induced hypertrophy of LVH in patients on maintenance hemodialysis.

Objective To measure the expression of Caspase-3 and P-gp in hepatocellular carcinoma (HCC) and adjacent tissues, and to examine these two proteins' relationships with HCC clinical and pathological characteristics and the associations between the two proteins. Methods The expression of Caspase-3 and P-gp were measured in 50 HCC tissues and adjacent tissues by EnvisionTM immunohistochemistry. HCC clinic and pathological characteristics and follow-up data were also collected and analyzed. Results The expression of Caspase-3 in HCC tissues was significantly lower than that in adjacent tissues(P <0.05). The expression of Caspase-3 in HCC tissues was significantly associated with HCC's Edmonson grade and the presence of hepatitis envelope(P <0.05). On the other hand, the expression of P-gp in HCC tissues was significantly higher than that in adjacent tissues( P <0.05 ). P-gp expression in HCC tissues was significantly correlated with HCC's Edmonson grade and the presence of cirrhosis(P < 0.05 ). The expression of Caspase-3 and P-gp was negatively correlated ( r = - 0. 600,P = 0.000). A better prognosis was observed among HCC patients with either positive Caspase-3 expression or negative P-gp expression(P < 0.05). Conclusion Caspase-3 may promote apoptosis and inhibit the development of HCC, while P-gp may have an anti-apoptosis function and play a role in HCC's drug resistance. P-gp can inhibit the function of Caspase-3 and an absence or low expression of Caspase-3 may be related to apoptosis resistance and multidrug resistance.

Objective:To explore the clinical regularities in acupuncture-moxibustion treatment of cancer pain by reviewing the relevant studies published between 1985 and 2017.Methods:Based on the Chinese Medicine Acupuncture-moxibustion Information Database,quantitative analysis,correlation analysis and Chi-square test were applied to analyze the commonly used acupoints,meridian affiliations and body region distributions,commonly used methods and acupoint correlations,treatment method correlations,the efficacy of acupuncture-moxibustion plus the three-step analgesic ladder for cancer pain,and indicators.Results:Zusanli (ST 36),Ashi point and Sanyinjiao (SP 6) ranked the top on the list of frequency;points from Bladder Meridian of Foot Taiyang and Stomach Meridian of Foot Yangming were often used;points from the lower limbs and back had high frequencies.The most commonly used treatment method was acupuncture-moxibustion plus medication.Acupuncture-moxibustion plus the three-step analgesic ladder showed certain advantage compared with the two methods used separately,and among the integrated methods,acupoint application plus the three-step analgesic ladder produced the most significant efficacy.It took (44.77±55.54) min for the analgesic effect to act and the effect lasted for (12.81±14.59) h.Numerical rating scale (NRS),visual analog scale (VAS) and Karnofsky performance status (KPS) scores all showed significant changes after interventions (all P＜0.01);there was no significant change in the score of quality of life (QOL) after interventions (P＞0.05).Conclusion:Zusanli (ST 36),Ashi point and Sanyinjiao (SP 6) are commonly selected in acupuncture-moxibustion treatment of cancer pain;acupuncture and acupoint application are often used;acupuncture-moxibustion plus the three-step analgesic ladder can boost the treatment efficacy.

Objective To investigate the diagnosis,preoperative examination and surgical treatment of carotid body tumor(CBT).Methods From December 2008 to December 2012 80 patients of carotid body tumor were treated in our center.The average age was(43:±:12)years,33 cases were male,47 cases were female.The lesions were unilateral in 68 cases and bilateral in 12.All tumors were surgically resected.In 26 of Shamblin Ⅰ,32 of Shamblin Ⅱ and 19 of Shamblin Ⅲ tumors were simply resected.One Shamblin Ⅱ and 2 Shamblin Ⅲ cases underwent tumor resection combined with external carotid embolization.3 Shamblin Ⅱ and 8 Shamblin Ⅲ cases were treated by tumor resection combined with internal carotid reconstruction,1 Shamblin Ⅲ was done with tumor resection combined internal carotid repair.Results All of 80 patients with 92 tumors were successfully resected.There was no death case during peroperative period,while one case developed hemiplegia and 14 cases suffered cranial nerve injuries.68 cases (85％) were followed-up from 1 year to 6 years.Thera were 14 patients with cranial nerve injuries,2 of them were lost to follow-up,11 with complete or partial recovery and 1 was still doing poorly.Conclusions Tumor size and its relation to the carotid artery form the basis upon which appropriate operation is adopted.

Objective:To investigate the metabolic response of different load of nutrition and recombinant human growth hormone(rhGH)after major abdominal surgery. Methods:32 patients were randomly divided into three groups as fellows:Group A : low calorie load,83.68 kJ/(kg?d);Group B: low calorie load combined with rhGH,83.68 kJ/(kg?d) and rhGH 4 U/d from d1-7 after operation;Group C :high calorie load combined with rhGH,125.52 kJ/(kg?d) and rhGH 4 U/d from d1-7 after operation.The levels of serum albumin and prealbumin and the excretion of urea nitrogen in urine were measured.after operation. Results:On day 8 after operation,the level of prealbumin in group B and C were higher than in group A(P