Pancreatic cancer is regarded as high malignant neoplasm and surgical resection is considered as the only efficient therapeutic method.Radical surgery includes not only removing the whole carcinoma,but also resecting lymph nodes efficiently.There exist controversies whether extended lymphadenectomy can improve the overall survival of patients currently.We have analyzed and reflected on the controversies on the basis of overseas and domestic research status and our experience.

Objective To evaluate techniques and indications of 2cm～3cm mini cholecystectomy. Methods After a 2cm～3cm incision was made below the right costal margin, cholecystectomy was carried out under direct vision in 465 cases. Results Mini operation was successfully completed in 435 patients (93.5%), while incision lengthening was required in 30 patients. One patient with postoperative bile leakage was cured after 3 weeks of drainage. There were no biliary duct injuries, postoperative bleeding, or deaths in the study. Conclusions Mini cholecystectomy with a 2cm～3cm incision is safe and effective provided patients are properly selected.

Objective To evaluate the clinical features of adenocarcinoma of the appendix.Methods The clinical data of 5 patients with adenocarcinoma of appendix hospitalized at our hospital from Sep 2005 to Dec 2010 were analyzed.Results Intraoperatively two cases were highly suspected of malignant tumor of the appendix,diagnosis of adenocarcinoma was confirmed by frozen pathology,and one stage right hemicolectomy was performed.One patient received simple appendectomy,but postoperative pathology showed adenocarcinoma of appendix and secondary right hemicolectomy was carried out two weeks later.One patient was preoperatively misdiagnosed as periappendiceal abscess and as a result fight hemicolectomy was performed because planned appendectomy was technically impossible.The postoperative pathology revealed adenocarcinoma of the appendix.In the last patient preoperative diagnosis was hypogastric space-occupying lesion with extensive intraabdominal metastasis.During exploration adenocarcinoma of the appendix with extensive metastasis was confirmed.Right hemicolectomy and carcinectomy was performed.Postoperatively all the 5 patients underwent regular chemotherapy.We followed them for 2 to 3 years and only the patient with intraabdominal metastasis at first laparotomy suffered from extensive recurrence 2 years after surgery.Conclusions The adenocarcinoma of appendix can be easily misdiagnosed as other diseases.Radiography,careful exploration during operation and frozen pathology help establish final diagnosis.Right hemicolectomy and postoperative chemotherapy are required in order to reduce tumor recurrence and prolong patients' survival.

Objective To evaluate the effect of mini-abdominal incision for choledochoscopy via cystic duct in exploration of the common bile duct(CBD).Methods The right subcostal incision was 4-6 cm in length.Choledochoscopy via cystic duct stump for exploration and extraction of CBD stones was done in 135 cases.Results The CBD stone was removed in 109 of 135 patients(80.7%).The CBD exploration was negative in 26 cases(19.3%)and retained CBD stones occurred in 4 cases(3.0%).One case(0.7%)had intraoperative injury of common bile duct,2 cases(1.5%)had tear of cystic duct stump,and 2 cases(1.5%)had biliary leakage,all the 5 cases were recovered after treatment.Conclusions The mini-abdominal incision with choledochoscopy via cystic duct for exploration of the CBD is safe and feasible.

Objective To investigate CT and MRI findings of giant cell tumors of the temporal bone(GCTTB).Methods CT and MRI features of 5 cases pathologically proven GCTTB were retrospectively reviewed.The lesion characteristics,including location, size,shape,margin,attenuation on CT scans,signal intensity on MR images,and enhancement pattern were documented and analyzed.Results In all 5 patients,the lesions were located adj acent to the mandibular fossa.These lesions were round or oval in shape,predominantly demonstrated as expansive lytic bone destruction containing hyperattenuating septa,calcifications,non-sclerotic borders,and discontinuous bony shells,with“boundary angle”sign.No soft tissue masses were found around the lesions.These lesions with different content demonstrated various MRI signal intensity,and the solid component enhanced intensely.Conclusion GCTTB is rare.Features such as expansive growing pattern,discontinuous bony shell,intralesional septa,calcification,and “boundary angle”sign are common,which may help in the radiographic diagnosis of giant cell tumor.

Objective To explore early endoscopic diagnosis and treatment of the clinical value of biliarypancreatitis. Methods From January 2007 to December 2009 completed 93 cases acute pancreatitis of endoscopic treatment,routining for endoscopic incision nipple,observed remission of symptoms and recurrence after treatment. Results In these cases acute biliarypancreatitis was 62.4% (58/93),occult biliarypancreatitis diagnosed by endoscopy was 27.6% (16/58),remission rate was 93.8% (15/16),no surgical operation and recurrence. Conclusion Occult biliarypancreatitis occupies a certain proportion of acute pancreatitis,also easily missed diagnosis and recurred,endoscopy is currently the most effective method.

Objective To determine the value of ERCP and EST after Billroth gastroenterostomy. Methods ERCP was used in 31 patients after Billroth- Ⅰ gastroenterostomy, 12 of whom received EST. It was in 137 patients after Billroth-Ⅱ gastroenterostomy, of the 34 received EST and 4 EPBD.Results Billroth- Ⅰ gastroenterostomy ERCP was successfully performed in 28 out of the 31 patients and EST in 11 out of the 12 patients. Billroth- Ⅱ gastroenterostomy ERCP was successfully performed in 109 out of the 137 patients and EST in 31 out of the 38 patients. There were no serious complications in patients receiving endoscopic treatments. Concluasion The success rates of ERCP and EST are high in patients with bile duct lithiasis after Billroth-gastroenterostomy. Endoscopic treatment or cholangioduodenostomy has good therapeutic effects.

ObjectiveTo investigate the safety and early clinical efficiency of dynamic cervical implant (DCI) internal fixation to treat cervical disc herniation.Methods From September 2009 to December 2010,31 patients with herniation of cervical disc underwent DCI implantation.The operation time and blood loss were recorded and analyzed.Neck disability index (NDI),Japanese Orthopaedic Association (JOA) score,and visual analogue scale(VAS) score were used to evaluate neurofunctional recovery pre- and post-operation.Routinely,the patients accepted X-ray examination preoperatively and postoperatively.We used White's measurement to measure the range of motion(ROM) and height ratio of implant segment and the superior vertebra pre- and post-operation.ResultsThe average operation time and amount of bleeding were 45 (30-60) min and (100±30) ml respectively.The average postoperative follow-up was 14 months (range,6-20).The average NDI (50.5±16.2 vs.19.6±4.3,P＜0.05),JOA score (12.3±1.6 vs.13.9±1.8,P＜0.05) and VAS score (6.3±2.6 vs.3.1±2.2,P＜0.05) changed significantly at the last follow-up compared with those pre-operation.There were no significant differences in the average ROM of implant segment (9.6°±4.2° vs.6.9°±5.3°,P＞0.05),the height ratio of implant segment and the superior vertebra(2.6±0.1 vs.2.5±0.1,P＞0.05) and the angle of functional spine unit(2.6°±5.2° vs.1.7°±2.9°,P＞0.05) at last follow-up compared with those preoperation.ConclusionUsing DCI to treat cervical disc herniation had shorter operation time and less bleeding advantages,and the early clinical effect was satisfactory.It may retain the cervical biomechanical movement in some degree,maintain the cervical stability.

Objective To study the feasibility and clinical effect of trans umbilical single incision laparoscopic right hemicolectomy for right hemicolon carcinoma.Methods The clinical data of 35 patients with right hemicolon carcinoma were retrospectively analyzed,the 15 cases were received the trans umbilical single incision laparoscopic right hemicolectomy (single incision group) and 20 cases were received laparotomy right hemicolectomy (laparotomy group).The clinical indexes were compared between the 2 groups.Results The length of incision,intraoperative bleeding volume,passage of gas by anus time,feeding time,hospitalized time in single incision group were significantly better than those in laparotomy group [(5.5 ± 0.6) cm vs.(17.6 ± 2.2) cm,(84.0 ± 31.1) ml vs.(155.5 ± 43.1) ml,(2.00 ± 0.76) d vs.(3.75 ± 0.63) d,(5.3 ± 0.6) d vs.(6.5 ± 0.6) d,(9.3 ± 1.4) d vs.(13.5 ± 1.5) d],the operation time in single incision group was significantly longer than that in laparotomy group [(238.4 ± 19.3) min vs.(165.3 ± 25.8) min],there were statistical differences (P ＜ 0.05).There was no statistical difference in number of incision lymph node between the 2 groups (P ＞ 0.05).Postoperative complication in single incision group occurred in 2 cases,postoperative complication in laparotomy group occurred in 3 cases,there was no statistical difference (P ＞0.05).The follow-up time was 1-55 months,the median follow-up time was 28 months,local recurrence and distant metastasis were found in 2 cases in single incision group,and 4 cases was found in laparotomy group,there was no statistical difference (P ＞ 0.05).Conclusions Single incision laparoscopic right hemicolectomy for right hemicolon carcinoma is safe and feasible,which has the advantages of minimal trauma,aesthetic outlook,less bleeding,quick recovery and short hospitalization time,etc.It can be developed in the hospital which has some basis of laparoscopic surgery.