The traditional distal pancreatosplenectomy (DPS) has been the standard surgical procedure for the treatment of resectable pancreatic carcinoma of body and tail.With the development of medical technology,however,the results including the rate of R0 resection,number of lymph nodes dissected and postoperative 5-year survival rate were not significantly improved after DPS.According to pancreatic anatomy and phylembryogenesis,combined with renewed tumor treatment concept,the radical antegrade modular pancreatosplenectomy (RAMPS) was put forward after continuous exploration of pancreatic surgeons to improve prognosis of patients with pancreatic carcinoma of body and tail.Compared with DPS,RAMPS has advantages of R0 resection rate and regional lymphadenectomy and might become the standard surgical procedure.

As long non-coding RNA (LncRNA) research boom,Maternally Expressed Gene 3(MEG3) as LncRNA family is also a widespread concern.MEG3 not been studied in benign disease,and malignant disease more and more in-depth research.MEG3 because of the uniqueness of the tumor suppressor much attention in cancer research,but its specific mechanism of action of tumor suppressor and associated pathways have not been yet entirely clear,remains to be further research and clarify.This article will be now anticancer activity MEG3 and related Pathway summarized.

Objective To review the advances in techniques of hepatic blood occlusion in hepatectomy.Methods The related literatures were reviewed and analysed.Results There were many techniques of hepatic blood occlusion.The most frequently used and studied techniques were hemihepatic vascular occlusion and intermittent hepatic inflow occlusion.Hepatic vascular exclusion was employed when hepatic veins and/or vena cava would be damaged.Total vascular exclusion and other techniques were rarely used.Conclusion To reduce blood loss in hepatectomy and make patient safe,based on the situation of the patient,the technique should be ingeniously selected.

Objective To study the advances in use of imaging in the evaluation of living donor liver.Methods The literatures in recent years on the use of imaging in evaluation of living donor liver were reviewed.Results Preoperative computed tomography(CT) and magnetic resonance imaging(MRI) in the donor allowed accurate determination of liver volume and rough determination of macrovesicular hepatic steatosis of the liver.CT angiography could assess the anatomy of hepatic artery,portal vein and hepatic veins.Intraoperative cholangiography allowed detection of the anatomy of the biliary tree.Conclusion Imaging techniques are widely used in the evaluation of liver volume,vasculature and biliary system in the living donor liver.

Objective To summarize the study on the feasibility of celiac axis ligation. Methods Literatures about celiac axis ligation were reviewed retrospectively. Results Celiac axis branches included common hepatic artery, splenic artery, left gastric artery which had many variation and collateral flow between celiac and mesenteric vessels by gastroduodenal artery and pancreaticoduodenal artery. Celiac axis could be possibly ligated without obvious complications in patients who had celiac axis injuries, celiac artery aneurysms, upper gastrointestinal haemorrhage, excision of carcinoma around the celiac axis and portal hypertension. However, gallbladder necrosis or perforation, focal infarction of the liver even higher mortality had also been reported. Conclusion Celiac axis ligation should not be performed routinely, but it is surgically possible and may be a life saving approach in certain circumstances.

Objective To investigate the indications, maternal and fetal/neonatal risks and treatments of pregnancy after liver transplantation. Methods The related published literatures were summarized and reviewed.Results Most females can recover a regular menstrual cycle. Hypertension, preeclampsia, bacterial and viral infection resulted from immuno-suppression therapy and increasing rate of caesarian section are the major risks for the mother. Abortion and pre-term delivery, premature rupture of fetal membrane, hypoadrenalism, abnormality, immune deficiency, hepatitis virus B and cytomegalovirus and bacterial infection are the major risks for the fetus/neonate.Conclusion Satisfactory results can be obtained in most pregnancies after liver transplantation. Evaluation before gestation and surveillance during gestation by the related departments are mandatory. A guideline based on large cases is necessary for pregnancy after liver transplantation.

Objective To investigate the clinical choice on graft size and the type of donor's hepatectomy in adult living related partial liver transplantation. Methods The literatures in recent years on the donor's evaluation, the size of liver grafts, the types of donor hepatectomy and safety of donor in adult living related partial liver transplantation were reviewed.Results The size of liver graft is a crucial factor related to the safety of donor and the prognosis of the recipient. GW/ESLW≥30%, GW/BW≥0.8% may be the lowest limits. Left lobe contained middle hepatic vein, extended left lobe with left-side caudle lobe, right lobe or extended right lobe contained middle hepatic vein may be the practical choice.Conclusion It is important to make a reasonable choice of liver graft according to the estimation of GW/ESLW or GW/BW, and the anatomy of liver in adult living related partial liver transplantation.

Objective To investigate the technique of b iliary reconstruction and treatment of biliary complications in orthotopic liver transplantation (OLT). Methods From Feb. 1999 to Jan. 2003, OLT was performed in 103 patients with end-stage l iver disease. OLT was performed with standard techniques with or without a veno -venous bypass. Reconstructions of biliary tract were performed using choledoc hocholedochostomy (CDC) or Roux-en-Y choledochoje- junostomy (RCDJ). CDC was carried out in 94 cases, with T tube (CDCT) in 62 cases and without T tube (CDCO ) in 32 cases respectively. Among the 32 cases without T tube, 11 had a small tu be placed in the common bile duct through the recipient cystic duct. RCDJ was pe rformed in 9 cases without internal stent. Diagnosis of the biliary complication s after OLT was based on the clinical manifestations, ultrasound findings, MRCP and ERCP. All the patients were followed up regularly after discharge for 12 to 48 months. Results The overall incidence of biliary complications in 103 patients after OLT was 7 .8% (8/103). Of the 62 cases of CDCT posttransplant, biliary complications occ urred in 6 cases ( 9.6% ), including 4 cases of bile leaks following OLT and 2 cases of bile leaks following T-tube removed. Of the 32 patients subject to CD CO, 1 ( 3.1% ) had stricture of anastomosis. Of the 9 cases subject to RCDJ, one patient was complicated with bile leaks at the anasto mosis. Two cases of the bile leaks were drained reoperatively, and others were k ept adequate drained. The patient with stricture of CDCO was cured by balloon di latation and stent placed endoscopically. No death associated with biliary compl ications occurred. Conclusions Bile leaks and stricture of anatomosis are the common biliary complications afte r OLT. Good blood supply to biliary tract and surgical technique are the keys to prevent biliary complications after OLT. The timely endoscopical and radiologic al technique is a valuable nonoperative precedure for diagnosis and treatment of biliary complicat ions.

Objective To investigate the feasibility of a new clinical staging of primary liver cancer (PLC). Methods 1*!038 PLC cases were surgically treated in our hospital from January 1990 to December 1998. Of those, 504 patients receiving liver resection were classified with the TNM staging and new clinical staging. Both staging systems were correlated with survival rates. Results In TNM staging, 24 cases (4 8%) were in stage Ⅰ, 66 cases (13 1%) in Ⅱ, 385 cases (76 4%) in Ⅲ, and 29 cases (5 8%) in Ⅳa. The 5 year survival rates were 79 2%, 62 1%, 32 2% and 0, respectively. As with the new clinical staging, 27 cases (5 4%) were in stage Ⅰa, 81 cases (16 1%) in Ⅰb, 224 cases (44 4%) in Ⅱa, 141 cases (27 9%) in Ⅱb, and 31 cases (6 2%) in Ⅲa. The 5 year survival rates were 70 3%,53 1%,40 2%, 22 7% and 0 respectively. Conclusion While both the TNM staging and new clinical staging have significant correlation with the selection of treatment and evaluation of prognosis, the new staging is more useful in clinical practice.

Objective To summarize the experience in hepatic artery reconstruction in adult-to-adult living donor liver transplantation(ALDLT).Methods Fifty patients underwent ALDLT in our hospital from January 2002 to July 2006.All the hepatic a~ery reconstructions were done under surgical microscope.ResultsTwo patients(4%)presented with hepatic artery thrombosis.All the patients were followed up for 2 to 52 months (median,9 months),and no hepatic artery stenosis nor hepatic artery pseudoaneurysm occurred.The 1-year survival rate was 92%(46/50).Conclusions Systematic evaluation of hepatic artery reconstruction and use of microsurgical technique are key to the reduction of complications of hepatic artery reconstruction in ALDLT.