Objective To explore the causation as well as the prevention and treatment of unsuspected gallbladder carcinoma (UGC) during laparoscopic cholecystectomy (LC). Methods Clinical data of 16 cases of UGC encountered during 6 031 cases of LC (0.26%) in this hospital were retrospectively reviewed. Results Out of the 16 cases of UGC, 9 were diagnosed intraoperatively and the other 7 were identified by histopathologic examination after surgery. The median survival time was 20.3 months. Of the 15 cases with primary tumor over T 2 stage: open operation was performed in 10 cases and the other 5 cases didn’t undergo open surgery after the diagnosis was clarified, the postoperative survival time being (19.9?4.9) and (9.8?2.8) months, respectively; 9 cases underwent radical or aggressive radical cholecystectomy and 6 didn’t undergo redical resection, the postoperative survival time being (21.6?5.3) and (7.8?2.6) months, respectively. Conclusions Recognition and precautions about gallbladder carcinoma should be strengthened before LC. The resected gallbladder should be routinely examined and frozen-section examination should be applied promptly if there have any suspicions of malignancy. Once the UGC is diagnosed, radical or aggressive radical resection should be adopted as early as possible, and necessary measures should be taken to prevent implantation and metastasis of carcinoma.

Objective To investigate the endoscopic diagnosis and therapy for patient with relapsing pancreatitis after cholecystectomy. Methods The clinical data of 21 patients with relapsing pancreatitis after cholecystectomy underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) were analyzed. Results Nineteen out of 21 patients were diagnosed as sphincter of Oddi dysfunction (SOD), and remaining 2 patients as choledocholith iasis. The treatment outcome of EST for the 21 patients in short-term after EST was satisfactory, and there was no complication of EST. Conclusions ERCP has a great value in the diagnosis of the cause of relapsing pancreatitis after cholecystectomy.The treatment of EST for patients with relapsing pancreatitis after cholecystectomy is safe and effective.

ObjectiveTo evaluate the effect of regional radical pancraticoduodenectomy (PD) combined with resection and reconstruction of invaded blood vessel (Fortner type Ⅰ?Ⅱ procedure) for pancreatic cancer.MethodsResult of 5 Fortner Ⅰ cases undergoing PD and resection of superior mesenteric-portal vein (SMPV),and 1 FortnerⅡ case with resection of SMPV,superior mesenteric artery(SMA)and hepatic artery(HA) was reviewed. ResultThe case undergoing Fortner Ⅱ surgery survived for 13 months.The 5 Fortner Ⅰ cases were followed-up for 5～34 months,with patent graft as identified by CT and ultrasonography and with no recurrence. ConclusionRegional pancreatectomy combined with resection of invaded blood vessel can be carried out in carefully selected patients of pancreatic cancer with favourable long term-result.

Objective To explore the cause of and treatment for superior mesenteric artery syndrome (SMAS). Methods Clinical data of 21 patients from 1992 to 2002 with SMAS were analyzed retrospectively. Results Three cases of SMAS recovered with nonoperative treatments, eighteen recovered after surgical therapy including lysis and downward movement of the ligament of Treitz and extensive mobilization of the duodenum in 4 cases (Type Ⅰ), lysis and Roux-en-Y duodenojejunostomy in 9 cases (Type Ⅱ), side to side duodenojejunostomy in one (Type Ⅲ), and Billroth-Ⅱ gastrectomy in 2 cases (Type Ⅳ), and anterior side to side duodenojejunostomy or Roux-en-Y reconstruction in 2 cases (Type Ⅴ). Conclusion Correct diagnosis and appropriate surgery for SMAS lead to satisfactory outcomes.

Objective To evaluate the clinical significance of re operation for postoperative recurrent gastric carcinoma. Methods From 1986 to 2001, fifty one patients with postoperative local recurrence of gastric carcinoma were admitted into our hospital. The clinical data were analyzed retrospectively. Results Of 51 cases, there were 31 cases with recurrence within the stump stomach and 20 with local and metastatic recurrence. Twenty seven cases were treated by radical resection, 3 cases by palliative residual stomach resection, 15 cases by gastrojejunostomy or gastroenterostomy, 6 cases by simple exploration. Pathological examination of 30 cases revealed perianastomosis recurrence in 10 cases, stump stomach carcinoma in 20 cases. The 1,3,5 year survival rate of 27 cases after radical resection was 88%, 58%, 19% respectively. The survival time of palliative and comprehensive treatment group was 6 to 24 months and mean survival time was 16 months, while all patients undergoing simple exploration and abdominal cavity chemotherapy died after 2 to 7 months. Conclusion Most postoperative recurrent gastric carcinoma are within the residual stomach and hence could be treated by reoperative resection.

Objective To evaluate the advantage of transabdominal modified Sugiura procedure Methods We retrospectively analyzed 45 cases undergoing transabdominal modified Sugiura procedure from May 1997 to May 2003 The procedure included devascularization of near half gastric and inferior part of esophagus after splenotomy The left and right vagus nerves, the anterior and posterior Latarjet nerves and paraesophageal collateral veins were left intact The gastric submucous vasculature was sutured on the plane 3～5 cm distal to cardia (suture group); or the esophagus 3 cm above cardia was cut and reanastomosed with pipe anastomat Results There was no inhospital mortality Free portal veinous pressure and portal vein flow speed did not change significantly The flow volume of portal vein decreased ( P

OBJECTIVETo study the effect of angiogenesis inhibitor Rg3 on the growth and metastasis of gastric cancer in SCID mice.

METHODSMetastatic model simulating human gastric cancer was established by orthotopic implantation of histologically intact human tumor tissue into the gastric wall of SCID mice. Rg3 was administered by gastric perfusion at doses of 0, 2.5, 5.0, 10.0 mg/kg every day for 6 weeks 1 week after tumor implantation. One week after last administration, the mice were killed and their tumor weight was measured and the presence of metastasis recorded. Intratumoral microvessel density was examined by immunohistochemical staining with anti-CD31 monoclonal antibody.

RESULTSCompared to the untreated controls, the growth of the orthotopically implanted tumor was significantly reduced in weight in mice treated with Rg3 with an inhibition rate of 52.3%, 63.3% and 71.6% at doses of 2.5, 5.0, 10.0 mg/kg, respectively. Tumor metastasis to the liver and peritoneum was also significantly inhibited in a dose-dependent manner. Decreased intratumoral microvessel density was noted in the treated mice.

CONCLUSIONAngiogenesis inhibitor Rg3 has strong inhibitory effect on tumor growth and metastasis of human gastric cancer in SCID mice.

Angiogenesis Inhibitors ; therapeutic use ; Animals ; Antineoplastic Agents ; therapeutic use ; Female ; Ginsenosides ; therapeutic use ; Humans ; Mice ; Mice, SCID ; Neoplasm Metastasis ; Stomach Neoplasms ; blood supply ; drug therapy ; pathology

ObjectiveTo study the proper timing for radical hepatectomy after tumour-down-staging with transcatheter arterial chemoembolization for unresectable primary liver cancer.Method This is a retrospective study of 18 patients with unresectable primary liver cancer who received radical liver resection after tumour-downstaging with transcatheter arterial chemoembolization (TACE) from January 2005 to August 2010 at Zhejiang Province People's Hospital Hepatobiliary Surgery Department.The patients received TACE 1 to 3 times (once n=4,twice n=12,and thrice n=2).After tumour-downstaging,radical liver resection was carried out (right hepatectomy,n =10 ; resection of tumour in right liver + resection of right liver metastases,n=2; resection of tumnour in right liver +radiofrequency ablation of right liver metastasis,n=1; right hepatectomy + removal of portal vein tumour thrombus,n=1 ; left hepatectomy + radiofrequency ablation of right liver metastases,n=2 ;Mesohepatectomy,n=1; and left hepatectomy + excision of liver metastasis,n=1).ResultsAfter TACE,the diameter of the primary tumour reduced by over 30％ in 6 patients (6/18,33.3％);10％～30％ in 8 patients (8/18,44.4％),and 10％ in 4 patients (4/18,22.2％).Before TACE,the tumours were not encapsulated in 6 patients (33.3％).After TACE,only 1 patient (5.6％) had the tumour remained unencapsulated.After TACE in 6 patients,the primary tumour shrunk to be within a hemiliver,and ultrasound and CT showed the tumours to have defined borders and they were away from the porta hepatis and major blood vessels.In another 6 patients,there were metastases to the contralateral hemilivers but these tumours had all shrunk in size.Selective vascular inflow and outflow occlusion technique was routinely used for liver resection.ConclusionFor primary liver cancers which are not resectable,TACE should be used first.When the tumours shrink in size,radical resectional surgery should be performed as soon as possible.The surgical technique should follow the following principles:-preserve as much normal liver parenchyma as possible,use selective vascular inflow and outflow occlusion technique to avoid ischaemia/reperfusion injury to the remnant liver,and to reduce haemorrhage.The surgery should be carried out by experienced surgeon.