Objective To evaluate endos copy combined with peritoneal lavage for the treatment of severe acute biliogen ic pancreatitis(SAP).Methods 62 cas es of SAP were randomized into endoscopic intervention group (32 cases) and con trol group (30 cases) treated conservatively. The endoscopic group were treated with ERCP and EST,and BUS guided abdominal paracentesis drainage and antibiotic lavage. Abdomi nal pain, amylase level in blood and urine, WBC counts, average hospital stay, t he operation rate within one month, complication, mortality and curative rate in patients of the two groups were recorded and compared.Results Results in endoscopic group were superior to contro l group (all P

Objective To assess the efficacy of endoscopic papillary balloon dilatation(EPBD)for bile duct stones.Methods Four hundred and six patients with bile duct stones who had been treated by ERCP from January 2000 to December 2000 were divided into EST group(n=205)and EPBD group(n=201)according to the admission time.The differences upon incidences of early and long-term complications,clearance rate of bile duct stones between the 2 groups were detected.Results There was no significant difierence upon the incidence of early complications.clearance rate of bile duct stones and incidence of pancreatitis between the 2 groups(χ2=0.540.0.058.0.010,P＞0.05).The incidence of eholecystitis and recurrence rate of bile duet stones in EST group were significantly higher than those in EPBD group(χ2=4.002,4.263,P＜0.05).Conclusions The incidence of cholecystitis and recurrence rate of bile duct stones after patients being treated by EPBD are significandy lower than EST.EPBD is superior to EST in protecting the sphincter of Oddi.

Secreted frizzled-related protein (SFRP) can inhibit the expression of Wnt signaling pathway through Frizzled protein.The silencing of SFRP gene promoter methylation is associated with the occurrence and metastasis of many cancers such as colorectal cancer,gastric cancer,liver carcinoma,lung cancer and ovarian cancer.Several studies have found that SFRP gene has latent clinical value,which is expected to become the novel target for the gene diagnosis and treatment of cancer.

Objective To determine the best endoscopic treatment for acute obstructive suppurative cholangitis (AOSC).Methods Data of 93 patients who were diagnosed as having AOSC in endoscopic center in the last three years were retrospectively analyzed.All patients were divided into three groups according to the different treatment methods:ENBD group,ENBD+ERBD group and double ERBD group.Postoperative temperature,bilirubin levels and mortality were compared.Results For patients with high level obstruction,incidence of fever in ENBD+ERBD group and double ERBD group were significantly higher than that of ENBD group (1/18 VS 4/10,P ＜ 0.05;0 VS 4/10,P ＜ 0.05).There were no significant differences in incidence of fever(1/18 VS 0) or bilirubin level decrease (17/18 VS 14/15) between ENBD+ERBD group and double ERBD group.For high level obstruction,if the patient had biliary imaging with contrast medium during operation,they would have higher incidence of high fever[(4/10 VS 3.45％ (1/28)] and mortality(3/11 VS 0),lower declining rate of bilirubin level [10/14 VS 96.55％(28/29)] than those without.Conclusion Both left and right hepatic ducts drainage should be recommended for high level biliary obstruction.During the operation,contrast medium should be limited to minimum dose,and should be avoided in high level obstruction cases.Air biliary imaging could be used when necessary.

Objective To investigate the expression and role of cyclooxygenase-2(COX-2)in the ischemia reperfusion in"ury in liver transplantation in rat.Methods Fifty-four male Wistar rats were divided into control group(n=6),liver transplantation group(n=24)and NS398 treated group(n=24)according to random number table.The expression of COX-2 mRNA was detected by RT-PCR,the distribution of COX-2 positive cells by immunohistochemistry.and the content of serum TNF-αand IL-10 by enzyme-linked immunosorbent assay.All the data were processed by one-way ANOVA.Results The serum indexes and changes of TNF-α.expression were in accordance with the histological injury of liver graft.The expression of COX-2 mRNA was essential to the ischemia reperfusion injury of the liver graft.Inhibition of the expression of COX-2 mRNA would aggravate the isehemia reperfusion injury of the liver graft.Conclusions COX-2 plays an important role in the ischemia reperfusion injury in liver transplantation.COX-2 may decrease the isehemia repertusion injury of liver graft.

Objective To investigate the frequency distribution of Val762Ala(T2444C)polymorphism among Han Chinese population in Gansu province,and to explore its relation to the suseeptibihty to gastric cancer. Methods A hospital-based,case-control study was performed involving 138 patients with gastric cancer and 110 healthy controls by PCR-RFLP method.Logistic regression and Chisquare analyses were used to assess OR and 95% CI. Results PARP-1762Ala allele was overexpressed in gastric cancer cases(11.5%)compared with controls(4.5%)(OR=3.012,95%CI 1.054-8.603,P=0.033).Statistic analysis showed increaged risk for gastric cancer patients with the 762Ala allele.Conclusion PARP-1 Val762Ala(T2444C)is related to the risk of gastric cancer,PARP-1762Ala allele could be used as a susceptibility marker for the development of gastric cancer.

Objective To study the expression of cyclooxygenase-2(COX-2)in hepatic inflammatory reaction and the effects of COX-2 on immunologic function of rats with sepsis.Methods Fifty-four Wistar rats were divided into sham group(n=6),sepsis group(n=24),and NS-398 intervention group(n=24).All rats were subjected to cecal ligation and puncture or sham operation.The expression of COX-2 mRNA in rat hepatic tissue was determined by RT-PCR,serum levels of IL-6,IL-10 and TNF-α were detected by ELISA,and percentage changes of CD4+,CD8+ cells by flow eytometry.The pathological changes of liver were observed at the same time.Results (1)Severe pathologic injuries of liver were observed in sepsis group,while not in NS-398 intervention group.(2)The expression of COX-2 mRNA was up-regulated in sepsis group and NS-398 intervention group,and the expression value was higher in sepsis group than that in NS-398 intervention group.The expression of COX-2 mRNA was the lowest in sham group.(3)The level of IL-6 was higher in sepsis group than that in sham group and NS-398 intervention group(F=125.582,134.712,54.760,121.441,P＜0.05).(4)The level of IL-10 was higher in NS-398 intervention group than that in sham group and sepsis group(F=39.064,34.382,51.115,8.174,P＜0.05).(5)The levels of TNF-α in sepsis group and NS-398 intervention group were increased,and the difference between the 2 groups had no statistical significance(x2=5.600,6.162,7.136,7.200,P＞0.05).(6)The ratio of CD4+to CD8+ was higher in NS-398 group than that in sepsis group(F=17.448,15.055,30.068,64.210,P＜0.05).Conclusions COX-2 plays an important role in the development of sepsis by changing the dynamic equilibrium between pro-inflammatory and anti-inflammatory cytokine and that between CD4+and CD8+.

Objective To investigate the efficacy of endoscopy for the treatment of benign biliary stricture after biliary surgery.Methods The clinical data of 127 patients with benign biliary stricture after biliary surgery at the First Hospital of Lanzhou University from January 2007 to December 2011 were retrospectively analyzed.According to the Bismuth classification,there were 60 patients with type Ⅰ,35 with type Ⅱ,21 with type Ⅲ and 11 with type Ⅳ.The efficacies of endoscopy for the treatment of biliary stricture with different Bismuth subtypes were analyzed.Results The location and severity of biliary stricture were confirmed by endoscopic retrograde cholangiopancreatography (ERCP) + cholangiography.Sixteen patients ( including 7 with type Ⅲ and 9 with type Ⅳ) were transferred to surgical treatment due to severe biliary stricture.A total of 111 patients underwent endoscopic treatment successfully,with the success rate of 87.4％ (111/127).The success rates of endoscopy for the treatment of patients with Bismuth Ⅰ,Ⅱ,Ⅲ and Ⅳ biliary strictures were 95％ (57/60),86％ (30/35),9/14and 1/2,respectively.Twenty-nine patients were implanted with retrievable metallic biliary stent,and 82 were implantated with plastic biliary stent.Of the 111 patients,only 6 patients were complicated by acute pancreatitis,and they were cured by conservative treatment.The alleviative rates of yellow skin and icteric sclera,tenderness and distending pain of right upper quadrant,fever were 73％ (81/111 ),83％ (74/89),90％ (73/81 ) and 89％(68/76) at 1 week after treatment,and they were 88％ (98/111),91％ (81/89),94％ (76/81) and 92％(70/76) at 8 weeks after treatment.The efficacy of endoscopy was good in 97 patients and poor in 14 patients,and the 14 patients were converted to open surgery.The symptoms including yellow skin and icteric sclera,tenderness and distending pain of right upper quadrant,fever were completely alleviated at postoperative month 6.Conclusion Endoscopic treatment for benign biliary stricture is safe and effective.

Objective To investigate the efficacy of combined application of laparoscope and multiple endoscopes for the treatment of extra-hepatic bile duct stones.Methods The clinical data of 3780 patients with extra-hepatic bile duct stones who were admitted to the First Hospital of Lanzhou University from March 1998 to June 2010 were retrospectively analyzed.According to the condition of bile duct stones,laparoscope,choledochoscope and duodenoscope were applied separately or combinately.All patients were divided into A,B and C groups.Patients in group A were treated by laparoseopy,choledochoscopy or duodenoscopy;patients in group B were treated by choledochoscopy+duodenoscopy.duodenoscopy+laparoscopy or laparoscopy+choledochoscopy;patients in group C were treated by laparoscopy+duodenoscopy+choledochoscopy.The efficacies of different treatment approaches were analyzed by comparing the results of imaging examination and follow-up.Results The curative rate and complication rate of the group A were 89.54%(1276/1425)and 6.73%(86/1276),respectively.Of the 149 patients in the group A who were failed in the treatment,83 patients were transferred to the group B,and 66 patients were transferred to the group C.The curative rate and complication rate of the group B(including 83 patients transferred from the group A)were 95.93%(1719/1792)and 4.07%(70/1719),respectively,and 73 patients who were failed in the treatment were transferred to the group C.The curative rate and complication rate of the group C(including 139 patients transferred from the group C)were 99.75%(783/785)and 0.26% (2/783),respectively,and 2 patients who were failed in the treatment received open surgery.Conclusion Combined application of laparoscope and endoscopes could raise the success rate of stone clearance and decrease the postoperative complications.

ObjectiveTo investigate the treatment of Mirizzi syndrome (MS) by ERCP、laparoscopy and choledochoscopy. MethodsIn this study 12 cases were confirmed intraoperatively as with MS from July 2005 to June 2009. Patients were treated by ERCP,laparoscopy and choledochoscopy according to the Csendes Classification. ResultThere were 7 MS patients complicating common bile duct stones among all 12 MS cases.There were 8 cases of Type Ⅰ Csendes MS,3 cases of Type Ⅱ and 1case of Type Ⅲ.11cases were treated by the ERCP、laparoscopy and choledochoscope.4 cases was treated by primary closure of common bile duct in laparoscopy,all the patients were cured.The case of type Ⅲ with T tube placed for stone caused bile duct injury had no stricture of the common bile duct as demonstrated by postoperative follow-up cholangiography.ConclusionsERCP,laparoscopy and choledochoscopy are effective for the treatment of Mirizzi syndrome.