Objective To evaluate the therapeutic effects of endoscopic biliary double stents for advanced malignant hilar biliary obstruction.Methods From January 2007 to December 2010,double stents was attempted in 28 patients (15 men and 13 women,median age 66.4 years (44-88 years),including 9 with Bismuth Ⅱ,8 with type Ⅲa,5 with type Ⅲb and 6 with type Ⅳ.A total of 23 consecutive patients ( 11 men and 12 women,median age 65.8 years (42-83 years) with malignant hilar obstruction undergoing a therapy with single stent were recruited as the control group,including 7 with Bismuth Ⅱ,5 with Ⅲa,6 with Ⅲlb and 5 with Ⅳ.The rates of successful drainage,complications,mean survival time of patients and the average duration of biliary stent patency were compared between the two groups.Results Successful rate of cannulation was both 100％ in the two groups.Successful rate of drainage and complications of double stent group were 96.4％ (27/28) and 17.9％ (5/28),and these two variables of single stent group were 87.0％ (20/23) and 13.0％ (3/23),which were not significantly different (P ＞0.05).23 patients (82.1％ ) in double stent and 19 ( 82.6％ ) in single stent group were followed up.The average duration of stent patency and mean survival time of double stent group were ( 129 ±48.5) d and ( 187 ±94.5) d,which were superior to those of the single stent group,i.e.( 102 ±37.8) d and ( 103 ±98.5) d.Conclusion Double stenting is an effective therapy for malignant hilar obstruction of Bismuth Ⅱ and above.It is superior to single stent method in the mean duration of patency and mean survival time.

ObjectiveTo explore diagnosis and surgical treatment of pancreatic duct stone.MethodsClinical data of 21 patients with pancreatic duct stone was analyzed retrospectively. All patients were diagnosed definitely by B-ultrasonography,CT and MRI, the positive rates were 90.5％( 19/21 ),66.7％(14/21) and 55.6％ (5/9) respectively, 15 cases did transpancreatic duct lithotomy and pancreatico-intestinal anastomosis, 1 case excised the tail of pancreas simultaneously, 1 case did pancreaticoduodenectomy, 4 cases treated by endoscopy. ResultsAll operations succeeded, 1 case occurred with pancreatic leakage after a small amount of discharge tube, 1 case appeared acute pancreatitis after endoscopic treatment,who was discharged after conservative treatment. Following up 19 cases from 4 to 72 months, the symptom was released, no stone relapsed,6 cases with mild catarrhal dysentry. ConclusionB-ultrasonography, CT can basically make definite diagnosis for pancreatic duct stone, and B-ultrasonography has higher rate of diagnosis, transpancreatic duct lithotomy and pancreatico-intestinal anastomosis are the main surgical treatments, endoscopy is the method to treat pancreatic duct stone.

Objective To observe the pathological changes of tissues of the injured bile duct, and to provide theoretical basis for bile duct repair. Methods Dog models of obstructive biliary injury were established.Sixty dogs were equally divided into five groups according to the duration of biliary obstruction: biliary obstruction for 5 days (BDL5 group), 10 days (BDL10 group), 15 days (BDL15 group), 20 days (BDL20 group) and 30 days (BDL30 group). The morphological and pathological changes of bile duct and local tissues were observed, and biliary-enteric Roux-en-Y anastomosis was applied to repair the injured bile duct and postoperative complications were observed. All data were analyzed by LSD test, independent sample t test, one-way analysis of variance and chi-square test. Results Proximal bile duct rapidly expanded as the pressure increased in the early stage, and the bile duct expanded to ( 15.6 ± 1.8)mm in the BDL10 group. The expansion rate decreased in the later stage,and the bile duct expanded to (18.9 ± 1.9)mm in the B DL15 group. Acute inflammation was observed in injured local tissues. The acute inflammation was severe in the BDL5 group with white blood cell count of 54 ± 6, and the acute inflammation was relatively mild in the BDL15 group with white blood cell count of 42 ± 7. There was a significant difference between the BDL5 group and BDL15 group in the degree of acute inflammation (t =4. 688,P ＜ 0. 05). The content of the collagen was increased in the injured bile duct as time passed by. Bile duct repair was successfully performed on 57 dogs. Ten dogs ( three in the BDL5 group, four in the BDL10 group, one in the BDL15 group, one in the BDL20 group and one in the BDL30 group) died of bile leakage after the operation. The incidences of bile leakage was 30% (7/23) within 10 days and 9% (3/34) beyond 10 days, with a significant difference between the two groups (x2 =4.429, P＜0.05). Conclusion Ten days after obstructive biliary injury,an obvious reduction of bile duct expansion and edema of the bile duct is observed, the difficulty of the operation is reduced and the incidence of bile leakage is low, so 10 days after the incidence of obstructive biliary injury is the proper timing for the surgical repair.

Objective:To investigate the clinical feature, diagnosis and treatment of autoimmune pancreatitis(AIP).Methods:Clinical data of 20 AIP patients admitted to the First Affiliated Hospital of University of Science and Technology of China from Jan 2014 to Dec 2019 were retrospectively analyzed.Results:Nineteen patients were diagnosed with type 1 AIP and 1 patient was with type 2 AIP. Fifteen patients were diagnosed by imaging, serology and other organ involvement, and 5 patients were confirmed by postoperative histopathology. Thirteen patients received glucocorticoid therapy. Five patients have not received glucocorticoid therapy after surgery.One patient refused treatment, and 1 patient is currently under clinical observation. Seventeen of the 20 patients were followed up, 11 patients were on glucocorticoid therapy with related clinical symptoms being gradually improved, serum IgG4 decreased and imaging findings improved. Five patients did not relapse after drug withdrawal. Three patients had recurrence of jaundice after drug withdrawal. One patient had recurrence of pancreatic lesions after drug withdrawal. Two patients had recurrence of high serum IgG4 after tapering the doses, these 6 patients were treated with steroid maintenance therapy. One patient died of repeated gastrointestinal bleeding 2 months later, and another 4 surgical patients and 1 patient under clinical observation are in good condition.Conclusions:AIP should be diagnosed in combination with clinical manifestations, serological examination, imaging examination and histopathology, especially focal lesions should be differentiated from pancreatic cancer, so as to avoid missed diagnosis and unnecessary surgical intervention.

Objective To investigate the effect of diabetes on hyperlipidemic acute panereatitis. Methods The clinical data of 96 patients with hyperlipidemic acute pancreatitis from Jun 1996 to Jun 2006 were retrospectively reviewed. Results Of all 96 patients, 21.9% (21/96) suffered from severe acute pancreatitis ( SAP ), 78. 1% ( 75/96 ) suffered from mild acute pancreatitis ( MAP ), respectively. Twenty-four patients (25%) were diabetics. Triglyceride level, obesity rate, SAP cases and APACHE Ⅱ scores in patients with diabetes were significantly higher than those of no-diabetes patients( P < 0. 05 ). The glucose level, diabetes of history length, triglyceride level and fat were the independent factors for prognosis of acute pancreatitis with hyperlipidemia by the Cox model analysis. With the increasing of APACHE Ⅱ score, the blood glucose level of patients increased. Blood glucose level in a short period of time does not correlate with lipid levels. Conclusions The level of blood glucose is related with hyperlipidemic acute pancreatitis, the history of the diabetes to a certain extent influences the development of hyperlipidemic acute pancreatitis.

Objective To investigate the effects of Ulinastatin (UTI) on the expression of NF-κB and ET-1 in rats with acute necrotizing pancreatitis (ANP)-associated lung injury and morphology of lung tissue.Methods 60 Sprague-Dawley rats were randomly divided into 3 groups with 20 rats in each group,including sham operation (SO) group,ANP group and UTI group.ANP was induced by injection of 5% sodium taurocholate (1 ml/kg) into pancreatic duct;normal saline was injected for SO group with same amount.UTI was injected for UTI group with the amount of 10 000 U/L via tail vein after ANP induction.The rats were sacrificed 24 h later.The contents of serum amylase,TNF-α and wet/dry weight ratio of the lung were measured.The expression of NF-κB and ET-I protein were detected by immunohistochemical method.The level of apoptosis was detected by TUNEL Results The contents of serum amylase,TNF-α,and wet/dry weight ratio of the lungin in UTI group at 24 hours were (5 648±378)IU/L,( 89.19±3.54) ng/L and 4.55 ±0.07,respectively;which were significantly lower than the corresponding (6 799±437 )IU/L,(183.30±8.18) ng/L and 4.89±0.20 in ANP group (P＜0.05 ).There was no NF-κB and ET-1 expression,and no apoptosis was present in SO group.The positive rates of NF-κB and ET-1 in UTI group were (19±3 ) % and(8±1) %,respectively,the corresponding values in ANP group were (25±2) % and (13±1 ) %,respectively (P ＜ 0.05 ).The level of apoptotie index in UTI group was 13.75±1.25,which was higher than that (6.90±0,85) in ANP group ( P ＜ 0.05 ).Conclusions The high expression of NF-κB and ET-1 in lung tissue may cause lung injury.UTI could ameliorate the microcirculation and lung injury caused by inflammation.

Objective To evaluate the treatment of gastroentero-pancreatic neuroendcorine neoplasms with liver metastasis.Methods Two gastroentero-pancreatic neuroendcorine neoplasms with liver metastases treated at Anhui Provincial Hospital Affliated of Anhui Medical University were analyzed retrospectively.Results In first patient liver metastases from duodenal papilla neuroendocrine neoplasm was treated by four courses of TACE until the liver metastases completely disappeared.The patient then underwent pancreaticoduodenectomy to eradicate the primary tumor.The patient was followed up for 2 years and was doing well.In second patient, liver metastasis, noted four years after distal pancreatectomy for a neuroendocrine tumor, was initially managed by high dosage of octreotide and sunitinib.After these attempts failed, the patient received a liver transplantation four years ago and was followed up until March 1, 2015 without tumor recurrence.Conclusion Liver metastasis of gastroenteropancreatic neuroendcorine neoplasms responds positively to liver transplant with pretty good prognosis.

Objective To explore the value of diffusion tensor imaging (DTI) and diffusion tensor tracography (DTT) in assessment of Corticospinal tract (CST) and medial lemniscus (ML) in tumors involving brainstem.Methods A total of 35 cases with pathologically confirmed tumors involving brainstem were collected,and 35 volunteers matched with genders and ages were recruited as the normal group.DTI scanning was performed on all the patients and controls.The damage degrees of CST and ML were evaluated and graded by DTT,and the dysfunction degrees were evaluated for the patients.Spearman correlation was used to statistically analyze the relationships of limb movement,sensory dysfunction and CST and ML damage.Results According to the rating results,normal findings,shifting,edema or infiltration and damage of CST was found in 9,9,11,and 6 cases respectively.They were 8,9,15,3 cases for ML.Motor function was normal in 20 cases,slightly defective in 11 cases,and moderate defective in 4 cases.Sensory function was normal in 21 cases,slightly defective in 6 cases,and moderate defective in 8 cases.The patients' dyskinesia and CST damage degree,sensory dysfunction and ML damage degree were positively correlated (r was 0.786 and 0.686 respectively,P ＜ 0.01).The position relationship among tumor and CST and ML could be well displayed on images.None of the patients showed new symptoms of dysneuria after surgery.Conclusions DTI and DTT technology can be used to evaluate CST and ML damage degree in tumors involving brainstem.They can display the position relationship between tumor and the brainstem CST and ML,which is important in protecting the brainstem fiber tract during operation and evaluating the recovery after the operation.

Objective To explore the effects and safety of endoscopic parallel placement of double metal stents on unresectable hilar malignant obstruction.Methods The clinical data of 11 patients with malignant hilar obstructive jaundice due to advanced carcinoma who were treated with parallel placement of double biliary stents from January 2011 to September 2012 were retrospectively analyzed.Results Out of 11 patients,10(90.9％) were successfully embedded with double biliary stents and 4 were dead during the follow-up.There was no sign of stent occlusion during the follow-up period.The survival time ranges from 128 to 185 days.One case was lost during the follow-up and 5 others are still alive.Conclusion The endoscopic parallel placement of double biliary stents is effective and safe for patients with unresectable malignant hilar obstruction.

ObjectiveTo explore the histopathological changes of bile duct,liver and local tissue for injurious biliary stricture(IBS). MethodTo observe the morphological and pathological changes of bile duct, local tissue and liver in different periods with dogs as the established animal model for IBS. ResultBile duct obstruction due to injury can expand the proximal bile duct up to 18.91 ±1.85 mm as the pressure goes up. Damage to local tissue triggers acute inflammation. In early injury phase (within 10 d), inflammatory cell infiltration and proliferation appears on the wall of the duct with increased mucosal edema as well as thickening of the biliary ductile wall. In the late injury phase (15 d), the degree of infiltration of inflammatory cells, edema and mucosal thickness were reduced whereas fibroblast and collagen tissue were proliferated extensively. The wall of biliary duct also becomes fibrotic and thickens. Quantitative analysis of the inflammatory edema shows the most severe outcome on the 5th day (HE staining WBC count of 54.2±5.8 unit) and its severity progressively subsides on the 15th day. (HE staining WBC count of 41.7±7.2 vs 54.2±5.8 a, P＜0.0,5). In the early obstruction (5 d and 10 d), the liver cells showed mild to moderate swelling and its degeneration is often associated with steatosis and sinusoidal expansion and congestion. As the obstruction time increases in the 20 d and 30 d group, liver cells starts to show extensive vacuolation and sinusoidal occlusion. ConclusionsEarly phase (5 days) of acute bile duct obstruction due to injury shows rapid expansion of the bile duct, edema in the bile duct itself as well as its surrounding tissue and liver damage. After 15 days, the local inflammatory edema is greatly reduced and is replaced by hyperplasia of fibers and collagen. Liver damage appears to be irreversible after 20 days. Considering local environmental and systemic conditions, the optimal time frame to repair obstruction of bile duct surgically is between 10-20 days.