ObjectiveTo improve the diagnosis and treatment of duodenal carcinoma (DC).Methods A retrospective study was made on the diagnosis, treatment and prognosis of 45 duodenal carcinoma patients. Results The detection rate of DC by duodenoscopy was 95% (20/21), 96% (22/23) by hypotonic duodenography, 29% (13/45) by B ultrasound, 73% (19/26) by CT, and 80% (4/5) by MR. Forty four cases underwent surgery with resection rate of 53% (24/45), radical resection rate of 42% (19/45). The postoperative (radical resection) 1, 3, 5 year survival rate was 91%, 39%, and 26%, while the median survival time was 5 months in cases with unresectable tumor. Conclusions Duodenoscopy and hypotonic duodenography are ideal tools for the diagnosis of DC. For DC cases with obstructive jaundice, B ultrasound, CT and MR could show the obstructive portion and the metastasis.Radical resection is the mainstay for a long term survival.

Objective To investigate the clinical features,therapeutic approach and prognosis of focal nodular hyperplasia (FNH) of the liver. Methods Clinical data of 34 FNH patients confirmed by operation were analyzed retrospectively. Results Focal nodular hyperplasia of the liver was found mainly in males (67. 6% ) , Mean nodular size was significantly smaller in men than women. Most of the patients (64.7%) had no significant clinical symptoms. Tumor markers including CA19-9 and A-fetoprotein were within normal range. MRI is helpful to achieve a more accurate diagnosis of the disease, correct preoperative diagnosis rate was 54. 5%. All patients underwent liver resection with no recurrence within 17 - 134 months of follow up. Conclusions FHN of the liver is benign in entity. If a definite diagnosis can be obtained preoperatively, observation follow-up are recommended. Hepatectomy is indicated when there is a suspicion of malignancy.

Objective To investigate the clinical characteristics, diagnosis, treatment and prognosis of hepatic angiomyolipoma (HAML). Methods The clinical data of 14 patients with hepatic angiomyolipoma admitted in our hospital from 1989 to 2007 were analyzed retrospectively. Result There were 4 male patients and 10 female patients. Median age was 41 years old. The lesions located in right lobe in 8 patients, and in left lobe in 6 patients. B-US was taken in 12 patients before operation, and other examinations included CT in 8 patients, MRI in 7 patients and angiography in 2 patients. Five patients were diagnosed with HAML by imagine features. Fine needle biopsy was taken in 1 patient with no definite diagnosis. All patients underwent resection and got the histopathologic diagnosis with HAML. All specimens were HMB-45 positive. S-100 and SMA were tested in 7 and 6 patients respectively, and were positive in all those patients. All cases were followed up for 6 months to 18 years (median time was 3 years). 13 patients were still alive without recurrence and 1 patient died of postoperative DIC and heart failure. Conclusion There was marked female predominance in HAML. Imaging features are helpful for preoperative diagnosis of HAML, but correct diagnosis was achieved in only a fraction of patients. HMB-45 positive was definitive proof for histopathologic diagnosis of HAML. Hepatectomy was an effective treatment for HAML.

Objective To summarize the experience in the diagnosis and treatment for solidpseudopapillary tumors of the pancreas (SPTP). Method In this study, 27 cases of SPTP from September 2000 to June 2007 were retrospectively analyzed. Results The median age of these 27 cases was 26 years. There were 26 females and 1 male. Epigastric pain was complained in 16 cases, abdominal aponia mass in 11 cases. Tumour marker level was within normal range. Ultrasonic manifestation usually shows cystic and solid lesion without blood signal. Lesions were typical with high blood supply in enhanced CT scan, cystic and solid component confounding in it. MRI revealed low-middle signal in T1 and middle-high signal in T2. Pancreaticoduodenectomy was performed in 9 cases, pancreatic local excision and pancreaticojejunostomy were performed in 4 cases, pancreatic local excision was performed in 6 cases, Distal pancreatectomy and spleen resection were performed in 8 cases. Post-operative pathology shows local lesion in 12 cases, invading the pancreatic parenchyma in 14 cases and intravascular tumor thrombi and lymphnode metastasis in 1 case. All cases were followed up with an average period of 26.1 months. There was no recurrence nor metastasis. Conclusion Solid-pseudopapillary tumor of the pancreas has a low malignant potential, affecting primarily young women. It has no typical clinical appearance. Enhanced CT scanning has the relative characteristic imaging. Complete resection usually results in long-term survival.

Objective To investigate the clinical features and prognosis of hepatic angiomyolipoma(HAML). Methods Clinical data of 13 patients with operatively confirmed HAML treated in our hospital were retrospectively analyzed. Results HAML was usually asymptomatic and the imaging features varied. Only 1 case was correctly diagnosed before operation. HMB45 positive staining was the pathologic characteristic of HAML. Conclusion HAML can be easily misdiagnosed, should be properly treated by surgery and has a good prognosis.

Objective To investigate the possibility of perform depression screening with the patient health questionnaire (PHQ-9) in hepatocellular carcinoma patients,and to evaluate the prevalence of depression among these patients.Methods 186 hepatocellular carcinoma patients completed PHQ-9 and Hamilton depression scale (HAMD) from January 2015 to April 2015.60 patients randomly selected from these 186 patients received depression screening again with PHQ-9 in 7 to 14 days after the first survey.Results Cronbach's α coefficient of PHQ-9 was 0.869,the test-retest reliability 0.963,and the range of correlation coefficient of the nine items with the total score of the scale was 0.546-0.752 (P＜0.01).The sensitivity and specificity of PHQ-9 were 84.4％ and 95.7％ respectively.69(37.1％) cases of the 186 patients were detected with depression with PHQ-9,and mild,moderate and major depression were 41 (22.0％),21 (11.3％) and 7(3.8％) respectively.Conclusion PHQ-9 has been shown to have good reliability and validity for screening of depression in hepatocellular carcinoma patients.

Objective To investigate the effects on the condition of nutrition and immunologic function of gastric cancer treated with the insertion of jejunal nutrient canal after total gastrectomy.Methods In this study 113 gastric cancer patients were randomly divided into enteral nutrition group (the group of the fine-needle/catheter jejunostomy during operation,FCJ group) and parenteral nutrition group (PN group) after total gastrectomy.Evacuating time and postoperative complications were observed and relative laboratory parameters were measured prior to surgery (preoperative) and on days 3 and 7 postoperatively.Results The evacuating time in enteral nutrition group was shorter than that in parenteral nutrition group significantly[(4.1±2.2) d vs.(5.1 ±2.0) d,t =2.156,P =0.037];Serum level of prealbumin[( 18 ± 7 ) mg/dl vs.( 14 ± 7 ) mg/dl,t =2.370,P =0.022]and transferring[(205 ±45 ) mg/dl vs.( 186 ± 39 ) mg/dl,t =3.665,P =0.001]in enteral nutrition group on postoperative day 7 was higher than that in parenteral nutrition group;Serum IgA[( 2.3 ± 1.0 ) g/L vs.( 1.9 + 0.7 ) g/L,t =2.178,P=0.034],lgM[(1.4 ±0.4) g/L vs.(1.0 ±0.4) g/L,t=2.124,P=0.039]and IgG[(9.5 ±1.9) g/L vs.(9.0 ± 2.3 ) g/L,t =2.189,P =0.033]were higher in enteral nutrition group than that in parenteral nutrition group;The incidence of postoperative alimentary dysfunction in enteral nutrition group was lower than that in parenteral nutrition group( 3％ vs.13％,x2 =3.962,P =0.048).Conclusions It is safe and convenient to use early postoperative enteral nutrition support by fine-needle/catheter jejunostomy (FCJ) in gastric cancer patients immediately after total gastrectomy.

ObjectiveTo investigate the clinical features,therapeutic approach and prognosis of solitary necrotic nodule of the liver (SNN).MethodsClinical data of 10 SNN patients confirmed by operative pathology were analyzed retrospectively.ResultsSolitary necrotic nodule of the liver was found mainly in males (70.0％,7/10),with a median age of 47 years,most of the patients (80.0％,8/10) have no significant clinical symptoms,no underlying hepatitis.Tumor markers including CA19-9,a-fetoprotein and CEA were within normal range.Nine patients had solitary nodule and 1 patient had multiple nodules.Seven lesions located in left lobe and 4 lesions in right lobe.The diameter of the nodules was 2.9 cm ± 1.1 cm.The lesions were low or iso-intense in T1-weighted MR image,low or slight high intense in T2-weighted MR image.Contrast-enhanced MR imaging showed that internal part of lesions had no enhancement,while the capsule of the lesions demonstrated enhancement.MRI image had high diagnostic accuracy rate of 66.7％.A preoperative liver biopsy was difficult to achieve a definite diagnosis.On microscopic examination,all nodules had a central necrotic core,surrounded by fibrotic cells,inflammatory cells and multinucleated giant cells.Furthermore,among them 5 patients have fatty degeneration of the liver.All patients underwent liver resection with no recurrence within 6 - 67 months of follow up.ConclusionsThe etiology of solitary necrotic nodule is unclear.Misdiagnosis was common due to the low incidence and insufficient recognition among physicians,if a definite diagnosis can be obtained,clinical observation is recommended,and the prognosis is good.

Objective: To investigate the influence of early enteral nutrition (EEN) and PN in postoperative patients with liver tumour.Methods: 120 patients with liver tumour were randomized into 2 groups:EEN+PN group or TPN group. Results: The preoperative condition of two groups was not significantly different. ALB, PA, TBIL and PT were better in EEN+PN group than those in TPN group. The time of gut movement recovery in EEN+PN group was shorter than in TPN patients. Conclusion: Early enteral nutrition combined with PN can improve nutritional state and digestive function recovery in patients with hepatectomy.

ObjectiveTo sum up the experience in the treatment of huge primary retroperitoneal pelvic tumors (diameter≥10 cm), and analyze factors influencing the removal of the tumors during surgical procedures. MethodsA clinical retrospective review of 26 cases with huge primary retroperitoneal pelvic tumors undergoing surgical resection was made during a period of 1980～2000 in our hospital. The rate of tumors resected was compared between benign and malignant, male and female patients. Results The tumor resection rate in this group was 73%(19/26). There was no mortality within 30 days and no severe postoperative complication. Conclusion Resection should be attempted whenever possible for patients suffering from huge pelvic tumors. The resection rate was higher in female patients than that in male patients. Major blood vessels invasion is responsible for low radical resection rate.