Objective To improve the resection rate of central type hepatoma. Method Under selective exclusion of hepatic blood flow and the use of caritational ultrasonic surgical aspiration (CUSA), hepatectomy of central hepatic segments was performed for liver tumors. Result There were 46 cases in this group. Preoperative hepatic function was Child A in 43 cases and Child B in 3 cases. Regional entire bloodstream was excluded ranging from 8 to 33 minutes in 39 cases, Intraoperative blood loss was 100 to 2400 ml,the average was 490 ml. Postoperative hepatic function recovery to Child A grade in 43 cases within one week, postoperative aacites developed in 3 cases, jaundice in 1 case, biliary fistula in 1 case, gastroplegia in 1 case. One patient died of myocardial infarction 3 days postoperatively. Thirty-five malignant cases were followed-up with a mean period of 9 months, one died of intraabdominal metastasis 10 months postoperatively, the other 34 cases was alive without recurrence. Conclusion Hepatic regional entire bloodstream exclusion is effective in the control of intraoperative blood loss ; Hypersound-emulsifying- attractor separates blood vessels and bile ducts in hepatic hilar region. The combination of these two techniques helps in the resection of central hepatic tumors.

Hepatic failure following partial liver resection is a major complication and a cause of perioperative mortality for patients with primary liver cancer. Today, many different tests have been established for liver function evaluation. These tests contain conventional tests and quantitative tests.Furthermore, we should combine them to precisely evaluate hepatic functional reserve.

At present,hepatectomy are recognized as the firsttreatment option for hepatocellular carcinoma (HCC).However,the patients have high frequency of recurrence after operation.In China,Most of the patients with HCC are related to chronic hepatitis B infection.The hepatitis B virus(HBV) factors such as:genotype,status of hepatitis B e antigen,HBV DNA level in serum and HBV DNA level in liver tissue influence the recurrence of tumors.Antiviral therapy,especially interferon therapy may be the effective method to prevent recurrence.HBV status also can influence the recurrence rate after transplant.

Extracellular signal-regulated kinase/mitogen-activated protein kinase(ERK/MAPK) signaling pathway plays an important role in gastrointestinal tumorigenesis and development.ERK/MAPK signal transduction pathway has three important molecular targets: the small G protein Ras,Raf kinase and MEK1/2 and ERK1/2.At present,there are three kinds of approach which can inhibit ERK / MAPK signal transduction pathway:⑴ destroying the structure and(or) function of the target protein,⑵adopting the deficit strategy,⑶damaging the interaction between proteins.These approaches can provide new ideas for the treatment of gastrointestinal cancer.

Acute cholecystitis and acute cholangitis are common acute abdomen in biliary surgery. The morbidity of acute cholecystitis is high, and abdominal ultrasound has become the first choice for imaging examination. Disease assessment and severity grading are used to guide the formulation of treatment plan. Early laparoscopic cholecystectomy is the first choice for mild acute cholecystitis. Supportive treatment should be used in patients with severe acute cholecystitis to improve symptoms for elective cholecystectomy. For patients with severe cholecystitis who can not tolerate the risk of surgery and have no effect on conservative treatment, gallbladder drainage should be performed in time. Acute cholangitis is an acute disease with high mortality. Magnetic resonance cholangiopancreatography is an important imaging examination. The treatment principle of acute cholangitis is early biliary decompression, antibiotic application and general supportive treatment. The common methods of biliary decompression include percutaneous transhepatic cholangiography drainage, endoscopic duodenal papillary bile duct drainage, endoscopic ultrasound-guided biliary drainage, and surgical placement of T-tube drainage.

ObjectiveTo improve the diagnosis and treatment of duodenal carcinoma (DC).Methods A retrospective study was made on the diagnosis, treatment and prognosis of 45 duodenal carcinoma patients. Results The detection rate of DC by duodenoscopy was 95% (20/21), 96% (22/23) by hypotonic duodenography, 29% (13/45) by B ultrasound, 73% (19/26) by CT, and 80% (4/5) by MR. Forty four cases underwent surgery with resection rate of 53% (24/45), radical resection rate of 42% (19/45). The postoperative (radical resection) 1, 3, 5 year survival rate was 91%, 39%, and 26%, while the median survival time was 5 months in cases with unresectable tumor. Conclusions Duodenoscopy and hypotonic duodenography are ideal tools for the diagnosis of DC. For DC cases with obstructive jaundice, B ultrasound, CT and MR could show the obstructive portion and the metastasis.Radical resection is the mainstay for a long term survival.

Objective To evaluate the value of vascular intervention in the diagnosis and management of hemobilia. Methods With Seldinger's technique ,digital subtraction angiography of superior mesenteric artery and hepatic arteriography were performed on 3 patients with hemobilia, two of whom manifested hemobilia after the operation of liver trauma and one of whom did after the operation of command bile duct stones . Arteriography showed the bleeding vascular branch, the false aneurysm and the arteriovenous fistula. And then a small catheter was put into the bleeding focus. The bleeding branch arteries were selectively embolized with embolus of n-butyl cyanoacrylate (NBCA),PVA granule,spring wire loop and gelatin sponge. Results Two cases showed diffuse bleeding focus and another showed a local bleeding focus. Two cases had expression of false aneurysm and one showed expression of ateriovenous fistula. The artery branches of the bleeding focus were successfully embolizated and the hemobilia stopped immediately. Conclusions Vascular intervention is an effective method for the diagnosis and management of hemobilia.

Objective To investigate the effects and mechanisms of extracellular-signal regulated protein kinase-motogenactived protein kinase(ERK-MAPK)signaling pathway in gastrin-induced cell proliferation and apoptosis of colorectal cancer cells.Methods HT-29 cells were incubated in different media,and then were divided into the control group,gastrin group,proglumide group and gastrin + proglumide group.No reagent was added in the control group,and other groups were dealed with reagent in different concentrations.The changes of proliferation of the HT-29 cells were detected by MTT assay,and the optimal concentration of gastrin and proglumide were determined.The changes of proliferation index and apoptotic rates of HT-29 cells were detected by cell cytometry.The mRNA expressions of gastrin receptor/cholecystokinin-B receptor(CCK-BR),ERK1/2 and K-ras were detected by RT-PCR.The protein of ERK1/2,K-ras protein and phosphorylation levels were detected by Western blot.All data were analyzed by analysis of variance and SNK-q test.Results The proliferation of HT-29 was stimulated by gastrin when the concentration of the gastrin was 6.25-100.00 mg/L,and the optimal concentration of gastrin was 25.00 mg/L(F =31.36,P ＜ 0.05).Proglumide had no obvious effects on the proliferation of HT-29 cells,while it significantly inhibited the proliferation of HT-29 cells stimulated by gastrin when the concentration of proglumide was 8.00-128.00 mg/L,and the optimal concentration was 32.00 mg/L(F =24.31,P ＜ 0.05).The proliferation index of the gastrin(25.00 mg/L)group was 37.5 ％ ± 5.2％,which was significantly higher than 27.7％ ± 5.0％ of the control group and 27.3％ ± 5.8％ of the gastrin(25.00 mg/L)+ proglumide(32.00 mg/L)group(q =4.56,4.75,P ＜ 0.05).The apoptotic index of the gastrin(25.00 mg/L)group was 1.9％ ± 0.4％,which was significantly lower than 2.5％ ± 0.4％ of the control group and 2.4％ ± 0.3％ of the gastrin(25.00 mg/L)+ proglumide(32.00 mg/L)group(q =4.23,4.06,P＜0.05).The mRNA expression of CCK-BR was detected in the HT-29 cells.The levels of phosphorylated ERK1/2 protein and phosphorylated K-ras protein were 0.43％ ± 0.04％ and 0.45％ ± 0.06％,which were significantly higher than 0.32％ ± 0.02％ and 0.31％ ± 0.05 ％ of the control group(q =7.78,4.95,P ＜ 0.05),and they were also higher than 0.36％ ± 0.01％ and 0.35 ％ ± 0.04％ of the gastrin(25.00 mg/L)+ proglumide(32.00 mg/L)group(q =5.72,4.08,P ＜0.05).There were no significant differences in the mRNA and protein expressions of ERK1/2 and K-ras among the control group,gastrin(25.00 mg/L)group,proglumide(32.00 mg/L)group and gastrin (25.00 mg/L)+ proglumide(32.00 mg/L)group(F =0.52,0.72,0.78,0.28,P ＞0.05).Conclusion Gastrin could stimulate the proliferation of HT-29 cells and inhibit their apoptosis by upregulate the phosphorylation levels of ERK and K-ras through the Ras→Raf→ MEK1/2→ ERK1/2 pathway,while the effect can be restrained by gastrin receptor antagonist proglumide.

Objective To investigate optimum dose of anesthesia in pediatric axillary brachial plexus branch block under ultrasound-guided. Methods Forty-eight children from May 2012 to May 2013 in hand surgery of our hospital,whose age was from 6 to 12 years,were randomly divided into four groups, each group has 12 cases. The doses of Ropivacaine were different in different groups. Group A was 0. 25 mL/kg,group B was 0. 2 mL/kg,group C was 0. 15 mL/kg,group D was 0. 10 mL/kg. And Ketamine was added to the treatment ac-cording to the incidence of anesthesia intraoperative. Evaluating the effect of anesthesia according to the situation of nerve block,observing an-esthesia duration time,dosage of anesthesia and rates of complications. Results The blocking effect of group A,B and C in each nerve area was correspond after 30 min,and anesthesia efficiency was higher than group D,but additional rate was lower than group D,the differences were statistically significant (P<0. 05). The block time in group D was shorter than the other groups,and the dose of Ketamine was most, and the block onset,perfect time were longer than the other groups (P<0. 05). But the differences between group A,B,C were not signifi-cant. Two cases in group D converted to general anesthesia. Four groups did not occur complication related narcotic drug. Conclusion In pediatric brachial plexus block used Ropivacaine under ultrasound-guided would get complete branch block,the exact effect of anesthesia, smaller dosage of local anesthesia. When the dosage of Ropivacaine was 0. 15 mL/kg could achieve a better anesthesia effect.

Objective To explore the diagnosis and treatment of cancerization relative to breast intraductal papilloma. Methods Clinical and pathological data of 52 patients with cancerous change of intraductal papilloma were studied retrospectively from January 1998 to December 2008. Results 39 of the 52 cases were diagnosed as malignance or suspected malignance by at least one of the preoperative imaging examinations such as ultrasonography, breast mammography or ductography. Cancer cells were found in 13 of the 46 patients who received fine needle aspiration. Frozen section established the malignance in 18 of the 39 cases. In a postoperative pathological report, 32 cases were cancerization of intraductal papilloma (carcinoma in situ) and 16 were cancerous change with microinvasion, only 4 patients with invasive carcinoma. All the patients received surgical management, 26 of the 52 cases were treated with modified radical mastectomy, 8 of them were performed with breast-conserving surgery (segmental resection plus axillary lymph node resection),7 cases underwent total mastectomy and 11 were just conducted with segmental resection. Only one people was found with axillary node metastasis among the 34 patients who received axillary lymph node dissection.Conclusion The correct preoperative diagnosis of the carcinomatous change of breast intraductal papilloma are always difficult and inconclusive, the frozen section may be helpful and the final diagnosis relied on the fully drawing materials of pathology after the operation. Treatment should be varied based on different pathological findings.