Pancreatoduodenectomy was performed in 131 cases for peri-ampullar carcinoma between 1957~1993. Early operative complications occurred in 61 cases, the incidence was 46.5%. 13 cases died with a mortality of 9.9%. This article discussed the prevention of three major complications namely pancreatic fistula, biliary fistula and massive bleeding.The key means in the prevention of pancreatic fistula included isolating the stump completely, minimizing the tension of anastomtic sterna,accurate suturing of the layers of anastomosis, inserting drainage in the pancreatic duct routinely and placing the anastomotic sites of choledochojejunostomy and pancreatoje-junostomy in a distance of 10 centimeters. In case pancreatic fistula occurred, drainage is very important and TPN could improve its cure rate. To prevent bile leakage, tube strut and drainage should always be used.In choledochojejunostomy, to prevent massive bleeding and shock, careful hemostasis in operation and reduction in the quantity of bank blood transfusion are important measures. Child's reconstruction of the alimentary tract is the procedure of choice.

Callstone section is a very important method in histochemical study of gallstones. The way of Fourier Transform Infrared Spectroscopy (FT-IR) on the polyvinyl alchol-paraffin embedded a series gallstone section can be used to identify the variation of compositions in different sections of gallstones,and provides a new simple method to study directly the mechanism of the gallstone formation.

We randomly selected gallstone samples from 100 cases treated in our hospital, and observed the centers of the gallstones using the method of dissolving the centers of gallstone and staining ther smears. We found that 20 per cent of the gallstones in which the centers contain the ascarid ova(including one ease of larva); among the positive results the gallstones of gallbladder were 20.31% percent (13/64), of the common bile duct 19.44% percent (7/36).

Objective　To evaluate the effect of vascular endothelial growth factor (VEGF) on tumor angiogenesis, and its usage in tumor therapy. Methods　The recent literatures about VEGF and angiogenesis were reviewed and analyzed. The advances of VEGF study were summarized. The effects of anti-angiogenesis in tumor biological therapy were introduced.Results　Angiogenesis had been identified as an important factor for promoting tumor growth. VEGF was a basic and pivotal factor in tumor angiogenesis. The anti-angiogenesis treatments aimed at VEGF, including the applications of VEGF inhibitor and gene therapy of adenovirus medium, had got great progress. Conclusion　 VEGF is a leading factor of tumor angiogenesis, the anti-angiogenesis therapy aimed at VEGF has probably provided a new chance to malignant tumor treatment.

Primary carcinoma of the gallbladder(PCG) is the most common malignant tumor in biliary system and its morbility has been rising year by year in our country.Because there is no specific clinical manifestation,patients diagnosed finally as PCG have mostly been in intermediate or advanced stage,thus losing the chance of radical resection of gallbladder carcinoma and having a poor prognosis.In this article we analyze the high risk factors,diagnosis of imageology,study of molecular biology,therapeutic progression and existent problems about PCG,by reviewing the related literature about diagnosis and treatment of PCG and the clinical data of 945 patients with PCG who were treated in our hospital in recent fifty years.We realize that early diagnosis of PCG is still difficult nowadays,it is very significant for secondary prevention of PCG to continue to carry out the foundamental and clinical study of PCG.Combined therapy that mainly includes surgical operation remains cardinal therapeutic management,and gene therapy has gradually developed to become a new therapy and displays favourable prospect of application.

Sphincter of Oddi dysfunction(SOD) is grouped under the functional gastrointestinal diseases.Due to lack of typical symptoms and signs,the diagnosis of SOD is difficult.The proposal to classify SOD significantly improves diagnosis and has important clinical significance in selecting treatment.This paper reviews the researches on classification,recent progress in diagnosis and treatment of SOD.

Gastrointestinal cancer is the most prevalent cancer among malignant tumors,with a upward trend in incidence.Since there is absence of specific clinical manifestation as well as low diagnostic rate,patients diagnosed with cancer of digestive tract are mostly in intermediate or advanced stages.Therefore,they lose the best chance of surgery and have a poor prognosis. Metabonomics,a kind of high sensitivity research technology,shows great potential in the exploration of occurrence and development of malignant tumor.The aim of this study was to review the progress of application in gastrointestinal cancer by metabonomics.

Objective To promote the level of early diagnosis and strengthen the understanding of pathogenesis, pathological staging and prognosis of primary gallbladder carcinoma (PGC). Methods The data of 679 patients with PGC treated in our hospital from 1956 to 1998 were retrospectively analyzed. Results The incidence of PGC has been increasing in recent years while the surgical management for the disease was not satisfactory. Upon diagnosis, most patients were with PGC in advanced stage. PGC was usually found among the aged woman patients. The female/male ratio was 3∶1. There was a close relationship between gallstone and PGC, for the gallstone was found in 60% of the patients with PGC. The diagnostic accordance rate before and after operations was low. Most cases of PGC were found unexpectedly during operation due to gallstone or acute cholecystitis. It was even worse that many patients with PGC missed the opportunity of diagnosis and treatment because doctors noticed the gallstone only. Pathological classification revealed that most cases of PGC were of adenocarcinoma. Development in imaging medicine might help a lot in finding early-stage cases and improving prognosis. Conclusions Strengthening the understanding of pathogenesis, pathological staging and prognosis of the disease and proper use of various examinations are the basic means of obtaining early diagnosis and improving the prognosis.

Objective To summarize the experience in diagnosis and treatment of primary splenic neoplasm (PSN). Methods The clinical data of 31 patients with PSN treated in our hospital were retrospectively analyzed. Results Amongst the patients, 25 were diagnosed as PSN postoperatively. Fifteen out of the 19 patients with benignancy were treated with splenectomy, and the others underwent partial splenectomy or tumor excision. Eleven out of the 12 patients with malignancy received splenectomy (including two by excision of pancreatic body and tail), and the other one underwent biopsy alone. The pathological types were as follows: varieties of cyst in 11, angiocavemoma in 4, inflammatory pseudotumor in 2, cavernous lymphangioma in 1, cystic degeratin of liomyoma in 1, malignant lymphoma and lymphsarcoma in 6, hemangiosarcoma in 3, fibrosarcoma in 1, liomyosarcoma in 1 and malignant fibrous histiocytoma in 1. Three patients with malignancy survived for 5 years. The reason was that they received radical splenectomy in combination with chemotherapy or radiotherapy and immunotherapy. Conclusions PSN should be diagnosed mainly according to clinical manifestations and image examination. The differentiation between benignancy and malignancy depends on CT, hemangiography and determination of seros AKP and ? GT levels. Early diagnosis, radical operation and comprehensive treatment are important for improving the prognosis of PSN.

ObjectiveTo improve the diagnosis and treatment of primary duodenal carcinoma.MethodThe clinical data of 45 patients with primary carcinoma of the duodenum from 1987 to 2000 were analyzed retrospectively.ResultAccording to the site of cancer, tumors around, below and above the duodenal papilla accounted for 64%, 22% and 13% of all cases. The diagnosis rate of duodenoscopy was 71%(15/21). Pancreatoduodenectomy was performed in 22 cases, segmental duodenectomy in 2 cases, simple tumor resection in 3 cases, gastroenterostomy or choledochojejunostomy in 12 cases and simple laparotomy in 4 cases. In patients of curative resection, the postoperative 3 and 5 years′ survival rate was 41 4% and 23 6%. In those with gastroenterostomy or choledochojejunostomy, the average survival time was 6～15 months. All cases undergoing biopsy only died within six months.ConclusionPrimary duodenal carcinoma mainly occurs around duodenal papilla. The long time survival of Whipple′s procedure is favourable.