Objective To analyze the effect of inner diameter of pancreatic duct following pancreaticoduodenectomy on pancreatic fistula.Methods From January 1995 to December 2008,256 patients underwent pancreaticoduodenectomy were divided into four groups based on the types of pancreaticojejunostomy: end-to-side "mucosa-to-mucosa" anastomosis group(n=115),end-to-end "mucosa-to-mucosa" anastomosis group(n=71),end-to-end invaginated pancreaticojejunostomy group(n=43) and pancreaticogastrostomy group(n=27).Alternatively,238 patients were divided into two groups according to drainage ways: stenting tube for internal drainage group(n=132) and stenting tube for external drainage group(n=106).Furthermore,233 cases were divided into three groups on the basis of inner diameter of pancreatic duct: ≤0.2 cm group(n=54),0.2-0.4 cm group(n=93) and ≥0.4 cm group(n=76).Then,the incidence rate of pancreatic fistula of each group was compared.Results The incidence of pancreatic fistula was 8.20%(21/256).The incidence of pancreatic fistula for different types of pancreaticojejunostomy was as follow: end-to-side "mucosa-to-mucosa" anastomosis group(7.83%,9/115),end-to-end "mucosa-to-mucosa" anastomosis group(7.04%,5/71),end-to-end pancreaticogastrostomy invaginated group(13.95%,6/43) and pancreaticogastrostomy group(3.70%,1/27),in which there wasn't significant difference in 4 groups(?2=2.763,P=0.430).There was no significant difference of the incidence of pancreatic fistula between stenting tube for internal drainage group(9.10%,12/132) and stenting tube for external drainage group(8.49%,9/106),?2=0.126,P=0.722.The incidence of pancreatic fistula in ≥0.4 cm group,0.2-0.4 cm group and ≤0.2 cm group was respectively 0,15.05%(14/93) and 11.11%(6/54),and the difference was significant(?2=12.009,P=0.002).No correlation was found between the incidence of pancreatic fistula of different inner diameter of pancreatic duct and the types of pancreaticojejunostomy (?2=1.878,P=0.598).Conclusion The inner diameter of pancreatic duct is an important factor for postoperative pancreatic fistula. No relationship is found between the types of pancreaticojejunostomy and pancreatic fistula in this study.

Objective To investigate the safety and feasibility of pancreatoduodenostomy com-bined with resection of PV/SMV for carcinoma of the head of pancreas.Methods The clinical data of 12 cases of carcinoma of the haed of pancreas underwent pancreatoduodenostomy in combination with resection of PV/SMV were retrospectively analyzed.Their data were compared with those of 40 cases of carcinoma of the haed of pancreas underoing pancreatoduodenostomy in the same period of time.Results Of the 12 cases, 3 underwent PV resection and reconstruction with ePTEE grafts, 3 PV re-section and reconstruction with end-end anastomosis, 6 PV lateral wall partial resection and recon-struction.There were no significantly differences in age, sex, time of operation, operative bleeding, complication, mortality rate, site of tumor,t umor differentiation, lymphtie metastasis, margin posi-tive resection and survival between the two groups.Conclusion Pancreatoduodenostomy combined with resection of PV/SMV is safe for carcinoma of the head of pancreas.

Objective To summarize the experience in performance of hepatopancreatoduodenostomy for hilar cholangiocarcinoma. Methods The clinical data of 11 cases of hilar cholangiocarcinoma receiving hepatopancreatoduodenostomy in our hospital from June 2000 to January 2008 were retrospectively analyzed. Results For Bismush-corlitte classification, 8 cases were grade Ⅲ the others Ⅳ.Quadrate lobectomy plus pancreaticoduodenectomy was performed in 2 patients, caudate lobectomy plus pancreaticoduodenostomy in 5, hepatectomy in right half plus caudate lobectomy, pancreaticoduodenostomy and PV lateral wall partial resection and reconstruction in 1, hepatectomy in left half and pancreaticoduodenostomy in 3. There were no death. Three patients had the complication of biliary fistula,1 pancreatic fistula, 2 pulmonary infection and 1 liver functional failure. The follow-up in 8 patients showed that the longest survival was 63 months. Conclusion HPD is safe and feasible for treatment of hilar cholangiocarcinoma invading the region of pancreaticoduodensum and it can promote the life quality of patients.

Objectives: To explore the role of liver in the process of severe acute pancreatitis. Methods:Comparing the survival time, the endotoxin level of plasma and ascites , the IL-6 level of serum and ascites, the platelet granule membrane protein-140 (GMP-140) level of plasma and the histology change of lung between control group, portocaval shunting group(PC), acute necrotic pancreatitis (ANP) group and acute necrotic pancreatitis immediately after portocaval shunt(PC+ANP) group of rats. Measuring the serum IL-6 of control group, portocaval shunt control group (injecting normal saline through caval vein, PCJ), ascites injecting group (AJ) and ascites injecting portocaval shunt group (PC+AJ). Results: The survival time of PC+ANP group was much shorter than those of the other groups, and its plasma endotoxin , serum IL-6 and plasma GMP-140 levels were higher than those of the other groups (P

ObjectiveEvidence-based medicine was used to make an individualized treatment plan for rare solitary splenic metastasis of an ovarian carcinoma in a female patient. MethodsAfter clinical problems were discovered, evidence was collected from the Cochrane Library, PubMed, EMBASE, ScienceDirect, CNKI and Wanfang databases according to our predefined search strategy. The search was done until October, 2009. The validity of the evidence was assessed. The evidence, combined with the doctor experience and the patient value, was applied to the patient. ResultsA total of 15 English literature and 11 Chinese literature were identified. A rational treatment plan was made upon a critical evaluation of the data. There were 5 review articles in PubMed, EMBASE and ScienceDirect databases and no RCT in the Cochrane Library. And there was one retrospective cohort study inCNKI and Wanfang databases. The others were all case reports. After 20 month follow-up, the treatment protocol was proven correct. Conclusion The patient has rare disease, and the evidence intension for the evidence-based medicine was low. It can not present the efficacy of the evidence-based medicine treatment sufficiently, though it could provide some suggestion for rare disease which was lack of large RCT for evidence-based Methods .