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.

Objective To investigate the diagnosis and treatment of mutinous cystadenoma of the pancreas.Method The clinical data of 12 cases with pancreatic mutinous cystadenoma was confirmed by pathology from May 2000 to May 2009 was retrospectively analysed.Results The accuracy rates of ultrasound,CT and MRCP were 50.0%(5/10),66.7%(6/9)and 83.3%(5/6)respectively.Pancreaticoduodenectomy,duodenum-preserving pancreatic head resection,distal pancreatic resection,distal pancreaticresection and splenectomy,segment pancreatic resection were performed according to the site of tumors.Completed resectable rate was 91.7%(11/12),palliative resection in 1 case,postoperative pancreatic leakage in 3 cases.2 cases cured;1 case died of intra-abdominal infection caused by pancake fistula 1 month later;1 case died of tumor recurrence and metastasis 25 months later.Conclusions Pancreatic cystic neoplasms is lack of specific clinical manifestations.Combined with application of imaging methods,can improve the diagnosis rate.Operation is the most effective therapy.The feasible procedures for mucinous cystadenoma of the pancmas should be choiced according to the site of tumors.

The length of tracheal defect or stenosis exceeded 5 cm could not be treated by simple resection and end-to-end anastomosis of the remaining trachea. Various ways of tracheal replacement had appeared sequentially, such as radial forearm free flap with cartilage grafts, tracheal tissue-engineering and tracheal allotransplantation. Among these methods, tracheal allotransplantation displayed a better long-term result. In this review, we are focused on recent advances in tracheal allotransplantation, particularly on revascularization and reepithelialization of graft, as well as on the application of immunosuppressive agents.

OBJECTIVETo summarize the clinical features and diagnosis and treatment of uncinate process carcinoma of the pancreas.

METHODSFrom January 1998 to December 2000, 41 patients of pancreas uncinate process carcinoma were retrospectly analysed.

RESULTSUpper abdominal pain accompanied with back pain,weight loss and jaundice were the main symptoms. Thirty-six patients were subjected to regional pancreaticoduodenectomy (RP), 11 to SMV-PV or SMA lateral wall partial resection or partial vascular resection and reconstruction, of which PV reconstruction with PTEE grafts was performed in 2 patients. Two cholecystojejunostomy Roux-en-Y. Alcohol injection was made in the nerve plexus of the trunks of both celic axes and the superior mesenteric artery and regional chemotherapy via chemotherapy pump and liver biopsy in one case. Abdominal exploration was performed in 1 case and no-operation in another. None of the cases died perioperatively. Postoperation survival 2 - 44 months and was 1 the median survival was 11.2 months. Four patients are still alive, the longest surviving have been 44 months. The 1-year and 3-year survival rate was 37.0% and 3.7%.

CONCLUSIONSPancreas uncinate process carcinoma has a tendency to invade adjacent SMV/SMA-PV and is difficult to diagnose early. Since those are related to its location and not to its invading behaviors, the tumon is highly resecable (87.8%).

Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Pancreatic Neoplasms ; diagnosis ; surgery ; Pancreaticoduodenectomy

ObjectiveTo investigate the effect of Blumgart anastomosis (BA) on pancreatic fistula (PF) and other complications after pancreaticoduodenectomy. MethodsThe clinical data of 190 patients who underwent pancreaticoduodenectomy in our hospital from January 2005 to December 2011 were analyzed retrospectively. The patients were divided into three groups, with 55 patients in the BA group, 65 patients in the duct-to-mucosa anastomosis group, and 70 patients in the invaginated pancreaticojejunostomy group. The incidence rates of PF and other complications after different methods of anastomosis were compared. The chi-square test was applied for comparison of the incidence of complications between groups. ResultsNo deaths occurred during surgery. The incidence rate of postoperative complications was 48.4% (92/190), and that of PF was 20.5% (39/190), with 5.5% (3/55) in the BA group, 20% (13/65) in the duct-to-mucosa anastomosis group, and 32.9% (23/70) in the invaginated pancreaticojejunostomy group. In the pancreatic duct with a diameter of ＜3 mm, the incidence rate of PF showed a significant difference between the three groups (χ2=6.089, P＜0.05), while in the pancreatic duct with a diameter of ≥3 mm, there was no significant difference in PF between the three groups (χ2=5.436, P＜0.05). ConclusionBA is a safe, simple, and time-saving technique and can reduce the incidence of PF, which is worthy of clinical application.

Objective: To assess the outcomes of partial cricotracheal resection (CTR) and extended cricotracheal resection (ECTR) for severe laryngotracheal stenosis. Methods: From November 2009 to September 2017, 18 patients underwent CTR and ECTR at the Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Air Force Medical University for severe laryngotracheal stenosis were reviewed retrospectively. There were 12-male and 6-female patients, with the age ranged from 4 to 56 years (median 25 years). The causes were postintubation in 11 cases, cervical trauma in 4, idiopathic in 3. The stenosis located in subglottic and tracheal (n=12), glottic and subglottic and tracheal (n=3), subglottic (n=2), and glottic and subglottic (n=1). Two patients had concurrent unilateral vocal cord palsy.One patient had undergone previous endoscopic balloon dilation and 8 patients had previous laryngotracheal reconstruction. The stenosis was graded according to modified Myer-Cotton classification as follows: Ⅲb (n=1), Ⅲc(n=1), Ⅳa (n=2), Ⅳb (n=12), Ⅳc (n=2). The surgical outcomes and complications were recorded. Results: Among 18 patients,11 of the 12 patients undergoing CTR were decannulated. Five of the 6 patients undergoing ECTR were decannulated. Resected airway length ranged from 1.5 to 4.0 cm (median 2.8 cm). Surgical complications included infection of incision wound in 2 cases, anastomotic granulation in 2, cervical subcutaneous emphysema in 1, aspiration in 1, and unilateral arytenoid prolapse in 1. No recurrent laryngeal nerve injury or tracheoesophageal fistula occurred. The median follow up was 11 months. Conclusions CTR is efficient for severe subglottic and upper tracheal stenosis while ECTR is efficient for subglottic stenosis extended to the glottis. Both procedures also provide a salvage therapy for patients with previous failed treatments.

Malignant tumor is the common disease that threaten severely to people's health. Formulae of traditional Chinese medicine (FTCM), as the major component of traditional drugs, has played more important role on the prevention and cure to tumor. The Folkman's theory that tumorous growth depends on tumor neovascularization has been confirmed so many years, so to inhibit the tumor angiogenesis, is an important path to treat tumor. The research of FTCM to antagonizing tumor angiogenesis in our country has been started more lately. Since it has been reported some FTCMs can inhibit angiogenesis, and it also exists many problems. The article summarized the correlated research of FTCM to antagonize tumor angiogenesis for the past several years, and according this, analyzed, stated and commented to the problems, countermeasures, development and direction of PTCM to antagonize tumor angiogenesis.
Animals ; Chemistry, Pharmaceutical ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; Neoplasms ; drug therapy ; pathology ; prevention & control ; Neovascularization, Pathologic ; drug therapy ; prevention & control

non-myeloablative BuCy+fludarabine conditioning regimen,and another one was treated with TBI+VP-1 6 +CTX+CCNU conditioning regimen.Only one case received short-term MTX,cyclosporin A and ATG regimen for prevention of graft-versus-host disease (GVHD).The GVHD prevention regimens of the other patients were based on short-term MTX,cyclosporin A,ATG and mycophenolate mofetil regimen.The hematopoietic reconstitution, complications and prognosis were observed.Results One patient died of intracranial hemorrhage,and hematopoi-etic reconstitution was achieved in the other 20 patients.The median time for hematopoietic reconstitution shortened by one day in large-dose group compared with that in low-dose group.Adverse reactions included high fever, shivering,gastrointestinal tract adverse reaction,liver injury,oral mucositis and other rare side effects.GVHD occurred more frequently in patients with HLA mismatched transplantation.Nine patients with aGVHD and 9 patients with cGVHD recovered after effective treatment.Within 100 days after transplantation,18 patients had bacterial or fungal infection,mainly upper respiratory tract infection;7 patients had cytomegalovirus infection;2 had EB viremia,and one had urinary BK virus infection.Only one patient died of VOD.Hemorrhagic cystitis occurred in 5 patients and improved after treatment.The median survival time was 24 months (ranging from 136 days to 9 years).One-year and 3-year overall survival rates were 85.2% and 63.9%,the disease free survival rates were 81% and 23.8%,recurrence free survival rates were 71.4% and 14.3%,respectively.Conclusion URD-HSCT was an effective method to treat leukemia.Conditioning regimen of BuCy and modified BuCy2 were safe and effective,the adverse reactions were reversible and well tolerated.Hematopoietic reconstitution time shortened in large-dose MNC and CD34 + cell number groups compared with that in low-dose group.The occurrence rate of GVHD with HLA mismatched transplantation was more than that of HLA matched transplantation.Low-dose heparin,prostaglandin E1 and Danshen injection can effectively prevent VOD.