Objectives To study the liver protective effect of L arginine for postoperative cirrhotic patients with primary liver cancer (PLC) receiving total parenteral nutrition (TPN). Methods Thirty preoperative cases were divided into two groups:Group A,TPN only( n =14);Group B,TPN+arginine( n =16). Liver function, serum lipid, immune function and serum nitric oxide were observed on preoperative phase, postoperative day 1 (POD 1) and day 7 (POD7) respectively. Liver biopsy was taken for histological study intraoperatively and on POD 7. Results Compared with group A on POD7,AST and TBIL level were near preoperative level, ALB level signiflcanly decreased, TG was lower than preoperative level, CD4 + and NO increased signiflcanly,and the degree of liver steatosis showed a signiflcant decrease in group B. Conclusions Supplement of appropriate amounts of L arginine increases hepatic NO level, reduces serverity of hepatic steatosis associated with TPN, promotes postoperative recovery of transaminase activity, ameliorates cell mediated immunity and anti infection capacity in postoperative PLC patients.

Objective To investigate the inhibitory effects and the mechanisms of octreotide(OCT) on the growth of hepatocellular carcinoma(HCC).Methods Bel7402 HCC cells were studied for proliferative ability by MTT assay,morphology by light microscopy,adhesive and invasive ability by cell adhesion and "wound strack" experiments.Immunofluorescence flow cytometry was used for study of cMet expression and cell cycle as well. Furthermore,the effects of OCT on tumor growth metastasis were investigated in nude mice with implanted HCC.The expression of cMet in implanted tumor cells was studied by immunohistochemistry.Results With OCT treatment,the proliferative ability of Bel7402 cells and cell morphology didn't change.The adhesive and invasive ability decreased compared with no OCT treatment cells(P

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 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 explore the long-term effect, prognosis and administration of corticosteroid treatment on autoimmune pancreatitis (AIP). Methods Clinical data were analyzed in 13 diagnosed and followed up AIP patients of Peking Union Medicine College Hospital during August 2004 to August 2008. Results Of 13 patients, 12 were males and 1 was female, with a mean age of 58.7 years old, and a mean follow-up of 30 months. Of 11 patients compliated with bile duct disease,biliary stents were placed in 9 patients and already taken out. Corticosteroid treatment was received by cured patients. The average corticosteroid therapeutic time was 9.2 months, 7.9 months in 6 biliary stent placed patients, 13.4 months in corticosteroid treated alone patients, the statistical difference was significant (P = 0. 023). Serum inflammatory parameters normalized range from 5. 3 to 8.8 weeks. After corticosteroid treatment, pancreas enlargement improved in all patients at the first imaging reexamination (1.0 to 11.3 weeks), pancreatic size normalized in 9 patients with an average of 16.6 weeks corticosteroid treatment. No relapsing sign was found with imaging examination during follow-up. Of 8 newly onset diabetes patients, glucose level normalized in 4 patients after corticosteroid treatment. Two patients complicated with autoimmune hepatitis developed early hepatic cirrhosis symptoms at the end of the follow-up. Swollen submandibular gland enlargement relapsed in one patient after corticosteroid withdrawn for six months. Conclsion AIP patients responsed well to corticosteroid treatment. Placement of biliary stent could shorten corticosteroid therapeutic time.Patients with bile duct complications and newly onset diabetes could partially relieve after the corticosteroid treatment, the prognosis of patients with autoimmune hepatitis complications was relatively poor.

Objective To evaluate the effects of branched-chain amino acids-enriched early parenteral and enteral nutrition on the liver function and serum aminograms in cirrhotic rats after partial hepatectomy. Methods In this prospective randomized controlled study, 24 cirrhotic rats, induced by thioacetamide, were randomized into three groups: enteral nutrition (EN) group, EN + branched-chain amino acid (BCAA) group, and parenteral nutrition (PN) + BCAA group. After receiving partial hepatectomy, rats in all three groups were nutritionally supported with equal amount of calorie and nitrogen contents from the 1st postoperative day ( PO day 1 ) to PO day 5. On PO day 6, parameters including body weight, liver functions, prealbumin, transferring, and serum aminograms were measured or determined, and the level of liver albumin mRNA was detected by reversal transcription-polymerase chain reaction and morphological examinations such as HE staining and immunohistochemical staining, which were assessed by index of Ki67 protein index. Results Body weight was significantly decreased in all three groups on PO day 6 (P ＜0.05 ). Compared with EN + BCAA group, serum aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase after partial hepatectomy were significantly higher in PN + BCAA group (P ＜0.05 ). Serum alkaline phosphatase level was significantly higher in PN + BCAA group than in EN group ( P ＜0. 05). The level of prealbumin was significantly lower in PN + BCAA group when compared with EN group or EN +BCAA group ( both P ＜ 0. 05 ), although no such significant difference was noted in terms of transferrin ( P ＞0. 05 ). The levels of leucine and isoleucine elevated while those of tyrosine, phenylalanine, arginine and tryptophan declined in PN + BCAA group or EN + BCAA group when compared with EN group ( P ＜ 0. 05 ). Aminograms were not significantly different between EN + BCAA group and PN + BCAA group ( P ＞ 0. 05 ). Levels of total amino acid and aromatic amino acid (AAA) were significantly lower while BCAA and ratio between BCAA and AAA (BCAA/AAA) were significantly higher in PN + BCAA group or EN + BCAA group than in EN group (P ＜ 0. 05 ).Significantly lower level of albumin mRNA and index of Ki67 were observed in PN + BCAA group than in EN group or EN + BCAA group (P ＜ 0.05 ) on PO day 6. Conclusions BCAA-enriched EN or PN reverses amino acid disequilibrium and restores BCAA/AAA in cirrhotic rats after partial hepatectomy. Compared with PN, EN is superior in improving postoperative liver function, promoting protein synthesis, and speed up tissue regeneration in the postoperative liver. However, it still can not restore serum albumin in a short term.

Objective To determine the clinical significance of hepatocyte growth factor receptor (Met) and epidermal growth factor receptor (EGFR) in the clinicopathology and prognosis of pancreatic cancer.Methods 70 patients admitted with pancreatic cancer from 1995 to 2005 were retrospectively analyzed with clinicopathological and follow-up data.Expression of Met and EGFR in cancer nest embedded with paraffin were detected by immunohislostaining (EnVision method) and correlation with clinicopathologic parameters and mutual correlation between these two receptors were further analyzed.Prognosis and related risk factors were analyzed by Kaplan-Meier survival analysis and Cox regression analysis,respectively.Results Both Met and EGFR significantly correlated with TNM staging,tumor size and superior mesenteric vessels invasion (P＜0.05).Expression level of Met positively correlated with that of EGFR (r9 =0.658,P＜0.05).Both Met and EGFR significantly correlated with patients' survival (P＜0.05) and Met was an independent prognostic risk factor for pancreatic cancer.Conclusions Both Met and EGFR significantly affect development and prognosis of pancreatic cancer and correlate with each other.Simultaneously targeting both Met and EGFR pathways may provide an advisable strategy of targeted therapy in pancreatic cancer.

Objective To investigate the complications and the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 339 patients who underwent pancreaticoduodenectomy at the First Affiliated Hospital of Sun Yat-Sen University from January 2000 to Decembcr 2009 were retrospectively analyzed.The risk factors of pancreatic fistula were analyzed.The incidences of complications accured from 2000 to 2004 and from 2005 to 2009 were compared.All data were analyzed by the t test,chi-square test,Fisher exact probability or Logistic regression model.Results The incidence of complications of all patients was 33.0％ ( 112/339),and the incidence of pancreatic fistula was 8.6％ (29/339).Of the 29 patients complicated with pancreatic fistula,6 patients were in grade A,8 in grade B and 15 in grade C.Soft texture of remnant pancreas and the diameter of pancreatic duct smaller than 3 mm were the independent risk factors of pancreatic fistula( OR =1.75,3.75,P ＜ 0.05 ).The number of hospital death was 12,including 1 patient died during the first period (2000-2004) and 11 patients died during the second period (2005-2009).Three patients died of pancreatic fistula and abdominal hemorrhage,3 died of postoperative upper gastrointesitnal bleeding,2 died of cardiac insufficiency,1 died of respiratory failure,1 died of pancreatic fistula,abdominal infection and necrotic pancreatitis,1 died of abdominal hemorrhage and hepatic and renal failure,1 died of bililary fistula,abdominal infection and multiple organ dysfunction syndrome.Conclusions Soft texture of remnant pancreas and the diameter of the pancreatic duct smaller than 3 mm are important risk factors of postoperative pancreatic fistula.Pancreatic fistula is the main factor causing death after pancreaticoduodenectomy.

Objective To evaluate the impact of early enteral nutrition (EEN) compared with parenteral nutrition (PN) on patients after hepatectomy. Methods Seventy-eight patients undergoing liver resection were randomized prospectively into two groups: EEN group receiving early enteral nutrition (n=35) and PN group receiving parenteral nutrition (n=43). The patients in both groups received isocaloric and isonitrogenous nutritional formulas 24 h after operation and the formulas were stopped on postoperative day 7. The general conditions, liver function tests, clinical complications,and clinical nutritional variables at three time points that included preoperative phase, postoperative day 1 (POD 1) and postoperative day 8 (POD 8) were observed. Results No significant differences were found in length of hospital stay, liver function and clinical nutritional variables between the 2 groups. In the EEN group, the serum prealbumin level almost returned to the preoperative level on POD 8. The nutritional complication rate of the EEN group was increased significantly but it was milder than that of the PN group. The time of gut function recovery in the EEN group was shorter than that of the PN group. The costs of nutritional drugs showed a significant decrease in the EEN group.Conclusion Early enteral nutrition is safe, rational and effective in patients who have undergone hepatectomy. Early enteral nutrition is better than parenteral nutrition in promoting liver function recovery, liver protein synthesis, postoperative recovery of gut function and decreasing costs of nutritional drugs.

Objective To investigate the effects of ω-3 fatty acids on inflammation and coagulation function in hepatocellular carcinoma (HCC) patients after partial hepatectomy.Methods In this prospective randomized controlled trial,80 HCC patients were randomly divided into two groups based on the parenteral nutrition (PN) scheme that was provided 5 days after partial hepatectomy:fish oil group:20％ fish oil and 80％ mediumlong fatty acid; and control group:100％ medium-long fatty acid.The inflammation,liver function,blood coagulation indicators,and prognosis were compared between two groups.Results After 3 days of hepatectomy,the serum C-reactive protein levels in the control and fish oil groups were (119.6 ± 57.3) mg/L and (97.1 ± 46.1) mg/L(P =0.016),respectively; and on day 6 after surgery,C-reactive protein levels of two groups were (54.9 ± 26.1)and (40.7 ±21.8) mg/L,respectively (P =0.018).The plasma fibrinogen level in the fish oil group was significantly lower than that in the control group 3 days [(3.4 ± 1.1) vs.(4.1 ± 1.3) g/L,P ＜ 0.001] and 6 days [(3.3 ± 0.9) vs.(3.8 ± 1.2) g/L,P ＜ 0.001] after surgery.The retention rate of indocyanine green at 15 minutes on the 7th postoperative day were 8.6％ ±4.9％ and 9.2％ ±7.3％ in the control and fish oil groups,respectively (P=0.179).The recurrent rate (40.63％ vs.44.12％,x2 =0.082,P =0.774) and survival rate in the fish oil and control groups (90.62％ vs.88.24％,x2 ＜0.001,P =1.000) also showed no significant difference after 6 months of follow-up.Conclusion ω-3 fish oil emulsion can reduce postoperative inflammatory response and prevent thrombosis.