12 months in 36 patients),during the follow-up 2 patients died.Conclusions The DST is minimally invasive for the treatment of low rectal carcinoma with high rate of anus conservation,and can improve the life quality of the patients.

Pancreatic tuberculosis (PTB) is a rare,chronic,specific and infectious disease which is generally secondary to tuberculosis at the common sites of pancreas,and it has a high misdiagnosis rate due to the hidden onset and nonspecific symptoms of PTB.A patient with PTB was admitted to the First Affiliated Hospital of Zhengzhou University in June 2014.Before operation,the space-occupying lesions of the head of pancreas were detected by preoperative imaging examination,and the patient was regarded as with pancreatic cancer.Intraoperative exploration showed cystic duct involvement,and the granulomatous inflammation was detected by rapid pathological examination using frozen section technique,after that the patient received granuloma resection+cholecystectomy according to suspected PTB.The diagnosis of PTB was confirmed by postoperative pathological examination,and the patient received liver-protective and anti-tuberculosis treatments after discharge.

Objective To study the expression and the clinical significance of hypoxia-induced factor-1α (HIF-1α) in gallbladder cancer tissues,and the role and mechanism of HIF-1α in metformin-suppressed metastasis in gallbladder carcinoma GBC-SD cells.Methods 24 specimens of gallbladder cancer tissues and 5 specimens of chronic cholecystitis were collected from the First Affiliated Hospital of Zhengzhou University between June 2016 and February 2017.Immunohistochemistry and qPCR were used to detect the expression of HIF-1α in gallbladder cancer tissues,in adjacent non-cancer tissues and in chronic cholecystitis,and the clinical significance was analyzed.The model of metastasis was induced by hypoxia;the wound healing assay and the Transwell assay were used to detect the ability of cell metastasis;the expressions of HIF-1α and VEGF in gallbladder carcinoma GBC-SD cells were detected by western blotting assay and immunofiuorescence.Results The expression of HIF-1α in gallbladder cancer tissues was higher than the adjacent non-cancer tissues and in chronic cholecystitis.The expression of HIF-1α was correlated with lymph node metastasis and TNM staging in gallbladder cancer tissues (P ＜ 0.05).The wound healing rate after 48 h in the negative control group and in the treatment with hypoxia group (1％ O2) in GBC-SD cells were (46.5 ± 4.8) ％ and (67.3 ± 4.0) ％,respectively.The Transwell data showed that the numbers of metastasis after 24 h in the negative control group and in the treatment with hypoxia group GBC-SD cells were (147.4 ± 11.7) and (234.4 ± 17.7),respectively.When compared with the negative control group,treatment with hypoxia significantly increased the ability of metastasis and up-regulated the expression of HIF-1α and VEGF in GBC-SD cells (P ＜ 0.05).The wound healing rate after 48 h in the negative control group,the metformin group,the hypoxia group and the metformin and hypoxia group in GBC-SD cells were (40.6 ± 7.1) ％,(16.4 ± 9.4) ％,(69.5 ± 4.0) ％ and (22.4 ± 7.4) ％,respectively.The Transwell data showed that the numbers of metastasis after 24 h in the negative control group,the metformin group,the hypoxia group and the metformin and hypoxia group in GBC-SD cells were (148.4 ± 6.9),(90.0 ± 8.4),(185.8 ± 10.2) and (113.4± 8.6),respectively.When comparcd with the hypoxia group,treatment with metformin and hypoxia significantly decreased the ability of metastasis and down-regulated the expression of HIF-1α and VEGF in GBC-SD cells (P ＜ 0.05).The wound healing rate after 48 h in the negative control group,the 2MeoE2 group,the hypoxia group,the 2MeoE2 and hypoxia group in GBC-SD cells were (43.4 ±4.4)％,(25.9 ±9.0)％,(63.3 ±2.2)％,(46.2 ±4.5)％,respectively.The Transwell data showed that the numbers of metastasis after 24 h in the negative control group,the 2MeoE2 group,the hypoxia group,the 2MeoE2 and hypoxia group in GBC-SD cells were (144.2 ± 12.6),(80.2 ±7.7),(203.8 ±7.0),(124.0 ± 5.2),respectively.When compared with the hypoxia group,treatment with HIF-1α inhibitor 2MeoE2 and hypoxia significantly decreased the ability of metastasis and down-regulated the expression of HIF-1α and VEGF in GBC-SD cells (P ＜ 0.05).Conclusions The expression of HIF-1 α was correlated with lymph node metastasis and TNM staging in gallbladder cancer tissues.Treatment with hypoxia significantly increased the expression of HIF-1α and VEGF and promoted metastasis of GBC-SD cells,while treatment with metformin decreased the ability of metastasis induced by hypoxia via inhibiting the HIF-1o/VEGF pathway in GBC-SD cells.

Objective To study the effect of two different percutaneous transhepatic cholangiography and drainage (PTCD) procedures for malignant obstructive jaundice.Methods According to whether the tip of the catheter was carried across the ampulla and into the duodenum,patients were divided into external drainage group (54 cases) and both internal and external drainage group (57 cases).The effects of two surgical procedures on reducing jaundice,the postoperative complications,hospitalization days,and total hospitalization expenses were evaluated.Results Postoperative TBiL decreased significantly in both the two groups (t =2.338,P ＜ 0.05).The postoperative DBiL values went even lower in both external and internal group (t =2.201,P ＜ 0.05).There were 14 cases of biliary tract infection in the external drainage group,and 27 cases in two ways group (x2 =5.473,P ＜0.05).Total hospitalization expenses were statistically different between the two group (t =-2.200,P ＜ 0.05).Conclusion The internal and external drainage has a better drainage effect than the external drainage group,but more likely to cause infection of biliary tract,increase hospitalization expenses.

Objective To analyze the clinical characteristics,diagnosis,treatment and prognostic factors of primary hepatic neuroendocrine tumor (PHNET).Methods To analyze the clinical data of 21 patients with PHNET who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2019.There were 11 males and 10 females,with ages which ranged from 36 to 75 years.Log-rank test was used for single-factor analysis of the relationship between clinical and pathological indicators and prognosis.Cox proportional risk model was used for multi-factor analysis.Results Among the 21 PHNET patients,10 presented with central and upper abdominal pain,3 abdominal pain accompanied by nausea and vomiting,5 abdominal distension,and 3 were asymptomatic.Carbohydrate antigen (CA) 19-9 was elevated in 6 patients and CA125 in 7 patients.Abdominal enhanced CT showed solid liver space occupying lesions.Four patients had solitary and 17 had multiple lesions.The mean diameter was 58 mm.Fourteen patients had lymph node metastasis.Five patients underwent radical hepatectomy,2 transcatheter hepatic arterial chemoembolization + chemotherapy,12 chemotherapy,and 2 supportive treatment.Factors which were associated with prognosis of PHNET patients were surgery,tumor grading,cytokeratin positivity and lymph node metastasis.Multivariate Cox regression analysis showed that inoperability (HR =8.99,95％ CI:1.13-71.80) was an independent risk factor of prognosis of PHNET patients.The prognosis in patients who underwent surgical resection was better.Conclusion Patients with PHNET had no specific clinical manifestations.Surgical resection gave the best results in treatment.As surgical resection affected prognosis,it should be carried out if technically feasible.

Objective:To investigate the efficacy of two different percutaneous transhepatic biliary drainage (PTBD) procedures for malignant obstructive jaundice.Methods:The clinical data of 132 patients with malignant obstructive jaundice who underwent PTBD were retrospectively analyzed. According to whether the tip of the catheter was placed in the intestine, 132 patients were divided into the external drainage group and the internal-external drainage group. The effect on decrease in jaundice (total bilirubin, direct bilirubin levels), postoperative complications, and hospitalization costs of the two drainage methods were compared.Results:Of the 132 patients who were included in this study, there were 91 males and 41 females, aged 18 to 85 years. The external drainage group included 81 patients, and the internal and external drainage group included 51 patients. The total bilirubin [(190.2±41.8)μmol/L vs. (294.9±38.3) μmol/L] and direct bilirubin [(155.4±30.9)μmol/L vs. (242.1±39.6) μmol/L] levels in the external drainage group and the total bilirubin [(179.3±37.1)μmol/L vs. (288.1±35.4)μmol/L] and direct bilirubin [(147.7±32.5)μmol/L vs. (233.7±36.1)μmol/L] levels in the internal-external drainage group were significantly decreased after surgery (all P<0.05). The incidences of reoperation, re-intubation or bilateral catheterization [15.6%(8/51) vs. 3.7%(3/81)] and biliary tract infection [50.9%(26/51) vs. 27.1%(22/81)] in the internal-external drainage group was significantly higher than that in the external drainage group (all P<0.05). The mortality rate due to biliary tract infection in the internal-external drainage group was significantly higher than that of the external drainage group [7.8%(4/51) vs. 0, P<0.05]. Intestinal-derived bacteria such as Escherichia coli, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the main bacteria in the biliary tract infections of the two groups. The hospitalization cost of patients in the internal-external drainage group was significantly higher than that in the external drainage group [(34 928.0±3 693.0) yuan vs. (29 360.0±3 219.0) yuan, P<0.05]. Conclusion:Both PTBD external drainage and internal and external drainage could alleviate the symptoms of jaundice quickly and effectively.

Objective:To investigate the effect of local antibiotics irrigation on chronic proliferative cholangitis (CPC).Methods:CPC model of rabbits was established. Rabbits were divided into CPC group (without local antibiotics irrigation, n=20) and experimental group (with local antibiotics irrigation, n=20). Only the gallbladder was removed, and 20 rabbits with free bile duct (sham operation) were used as normal control. The inflammatory conditions, proliferation of cholangiocytes, biliary fibrosis and biliary stones formation ability were analyzed. Results:Compared with CPC group, the relative expression of inflammation index lipopolysaccharide and interleukin-6 [(1.21±0.13) vs. (3.24±0.21), (1.52±0.22) vs. (3.10±0.23)], biliary cell proliferation index cyclooxygenase-2 and vascular endothelial growth factor [(2.15±0.12) vs. (4.07±0.22), (2.44±0.14) vs. (3.22±0.21)], fibrosis index transforming growth factor-β and Collagen-I [(2.44±0.28) vs. (4.36±0.44), (1.54±0.13) vs. (2.22±0.18)] and biliary stones formation index β-glucuronidase and Mucin 5AC [(1.74±0.20) vs. (3.42±0.31), (1.47±0.15) vs. (2.81±0.22)] were significantly decreased in experimental group (all P<0.05). Conclusion:Local antibiotics irrigation could inhibit CPC by inhibiting the chronic inflammation of the biliary tract and excessive proliferation of cholangiocytes and biliary fibrosis, and reducing the probability of biliary stone formation.

Objective:To investigate the effect of expanded lymphadenectomy on the survival rate of the patients with hilar cholangiocarcinoma(HC).Methods:The clinical data of 129 patients undergoing radical resection of HC were retrospectively analyzed. According to the range of lymphadenectomy, they were divided into regional group(91 cases) and expanded group(38 cases). The clinical data, survival rate and postoperative complications in two groups were compared and analyzed.Results:The 3-year and 5-year survival rates of metastasis free(M0) patients in the regional group and expanded group were 44.1%, 24.8% and 47.0%, 33.6%, respectively; there were no statistically significant difference in survival rates between the two groups(χ 2=0.662, P=0.416). Compared with patients in the regional group, the average number of harvested lymph nodes in the expanded group was significantly increased and the difference was statistically significant( t=14.678, P=0.000), while the incidence of severe complications and mortality does not increase significantly. Conclusion:Expanded lymphadenectomy did not improve the survival rate of M0 HC patients, which while yielding more lymph nodes does not increase the incidence of postoperative complications and mortality in resectable HC patients.

Objective To investigate effects of complete resection of the cyst or incomplete resection with 3 ～ 5 mm remnant proximal cyst wall in treating adult type Ⅰ choledochal cyst (CC).Methods Medical records of 133 surgical patients with type Ⅰ CC from December 1995 to December 2017 in the First Affiliated Hospital of Zhengzhou University were reviewed retrospectively.According to whether to reserve the 3 ～ 5 mm cyst wall in proximal end of cyst,133 patients were divided into unreserved group (n =85) and reserved group (n=48),and the related indicators of the two groups were compared and analyzed.Results No significant difference was observed in age,sex ratio,clinical performance between the two groups(all P＞0.05).And there was no statistical difference in the operation time,intraoperative blood loss,and biliary-intestinal anastomosis diameter between the two groups(all P＞0.05).The main complications of the two groups were similar,including incision and abdominal infection,bile leakage,cholangitis,reflux cholangitis,bile duct stones and anastomotic stricture,and there was no statistical difference in the incidence of each complication.Biliary-intestinal anatomical site malignancy was observed in one patient with recurrent cholangitis in the reserved group in the 33th months.Conclusions There was no statistical difference in the incidence of early and late complications in two different methods of cyst management for treating adult type Ⅰ CC.Whether reserve the 3～5 mm cyst wall in proximal end of CC increases the risk of cancer still needs further studies.