0.05).As for patients' age the old age group had the statistical significance vs the non-old age group(P

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.

Objective To investigate the change and effect of SSeCKS(src suppressed c kinase substrates)in the activation of hepatic stellate cells(HSCs).Methods HSCs were isolated from normal rats,the change of SSeCKS mRNA expression on HSCs culture in vitro was determined using real.time PCR.protein level was determined by Western blot and immunofluorescence methods.A rat model of liver fibrosis was established.The expression and location of SSeCKS and α-SMA(α-smooth muscle actin)in liver tissues were detected by immunofluorescence methods.Results SSeCKS mRNA expression WaS loW in freshly isolated HSCs cell and the expression increased in activated HSCs in vitro.In liver fibrosis tissue,the number of SSeCKS-positive cells was increased and these cells were distributed along the sinusoids which also contained α-SMA positive cells.Conclusion The expression of SSeCKS was increased in activated HSCs in vitro.Therefore.SSeCKS may be involved in the liver inflammation and fibrosis.

Objective To investigate effects of preoperative application of parecoxib on postoperative analgesia and coagulation function in neurosurgical patients.Methods A total of 90 patients (38 males and 52 females,ASA physical status Ⅰ or Ⅱ) undergoing crainotomy were randomly divided into two groups(n=45): parecoxib group (group P) and control group (group C).At 30 min before operation,group P received intravenous injection of parecoxib 40 mg (5 ml),group C intravenous injection of saline 5 ml.Postoperative patient-controlled intravenous analgesia (PCIA) was performed in all patients.PCIA formula of sufentanil 2 μg/kg+tropisetron 0.2 mg/kg,were diluted with normal saline to 120 ml.The visual analogue scale (VAS),the total and effective PCIA pump compressions,Ramsay sedation scale of 2,4,16,24,48 h after operation were recorded.Coagulation function was measured before and 2 h,48 h after parecoxib administration.Meanwhile,adverse reactions were recorded.Results Comparion of VAS between the two groups was made within 48 h after surgery,the total and effective PCIA pump compressions,were much more in group C than in group P (P<0.05).Ramsay sedation scale of group C was higher than that in group P at 2 h after operation.There were no significant differences in coagulation function.And the percentage of patients′ adverse effects in group P was lower than that in group C (P<0.05).Conclusion Parecoxib,as an analgesic,can enhance analgesic effect of sufentanil PCIA.Not only does it reduce the amount of sufentanil and incidence of adverse reactions,but also it has no significant effect on blood coagulation function.

Objective:To study the results of surgical treatment on post-pancreaticoduodenectomy hemorrhage (PPH).Methods:The clinical data of 47 patients who developed PPH after pancreaticduodenectomy treated with surgery at the First Affiliated Hospital of University of Science and Technology of China from January 2012 to December 2020 were retrospectively analyzed. The operative indications, bleeding site, intraoperative treatment and prognosis were analyzed.Results:There were 33 males and 14 females, aged 42 to 81 (mean 60) years. Early hemorrhage occurred in 17 patients and delayed hemorrhage in 30 patients. A total of 35 patients developed intraperitoneal hemorrhage, 7 gastrointestinal hemorrhage and 5 intraperitoneal combined with gastrointestinal hemorrhage. The indications for surgery were hemodynamic instability ( n=31) and other treatment failure ( n=10). In 17 patients (36.2%), hemorrhage was associated with blood vessels. In 14 patients (29.8%), hemorrhage was associated with anastomotic stoma, while in 6 patients (12.8%) with gastrointestinal hemorrhage, the bleeding was non-anastomotic related. Early hemorrhage was mainly vascular related, and the surgical treatment mainly consisted of suture hemostasis at the bleeding site combined with abdominal irrigation and drainage. Delayed hemorrhage was most commonly anastomotic associated, and its management should consider avoiding anastomotic fistula formation after treatment. The operation time of early hemorrhage was significantly shorter than that of delayed hemorrhage [(136.0±37.5) min vs. (191.1±73.8)min, t=-3.289, P<0.05]. The incidence of re-hemorrhage was 23.4% (11 patients) and 9 patients died with a mortality rate of 19.1%. The re-hemorrhage and mortality rates of early-stage bleeding were significantly lower than those of delayed bleeding [5.9%(1/17) vs. 33.3%(10/30), 0 vs. 30.0%(9/30), P<0.05]. Conclusions:Surgical treatment of early hemorrhage had better results than that of delayed bleeding. Patients with anastomotic related hemorrhage were at high-risks of postoperative death after surgery. Recurrent bleeding was the main cause of death.