Objective To analyze the clinical characteristics and therapeutic effects of cutaneous metastasis from cholangiocarcinoma. Methods From 2006 to 2009, clinical data of 6 patients found with cutaneous metastasis from cholangiocarcinoma were reported. Perineural and vascular invasion were all found in the primary cholangiocarcinoma in these 6 cases with cutaneous metastasis and results were compared with 60 cases of cholangiocarcinoma without cutaneous metastasis. Follow-up to the 6 patients with cutaneous metastases was conducted at an interval of three months. Results One patient with mixed hepatocellular and cholangiocellular carcinoma developed cutaneous metastatic tumor and the pathological diagnosis was cholangiocellular carcinoma. Three patients with hilar cholangiocarcinoma and two patients with distal cholangiocarcinoma presented cutaneous metastases. All six cases of the primary cancers and cutaneous metastases were diagnosed as moderately- poorly differentiated adenocarcinoma. And there was perineural and vascular invasion in the primary tumors. Perineural and vascular invasion of primary cancer was found in 17of 60 patients with cholangiocarcinoma and without cutaneous metastasis. The cutaneous metastasis was positively correlated to the perineural and vascular invasion in the primary tumor (χ2 = 12. 7288, P ＜0. 001 ). Two of 6 cases presenting solitary nodular cutaneous metastasis received skin tumor excision. These two patients survived 8 and 10 months respectively. Among four patients with multiple cutaneous metastases,two cases received chemotherapy and survived 3 and 6 months respectively, the other two cases refusing treatment survived 3 and 4 months respectively. Conclusions Cutaneous metastasis usually occurred at cholangiocarcinoma with lower differentation and perineural and vascular invasion in the primary tumor.Solitary nodular cutaneous metastasis could be excised, multiple cutaneous metastases had poor prognosis.

Objective To investigate the mechanism of PBEF in pulmonary vascular endothelial permeability increasing after car-diopulmonory bypass ,in order to provide the basis for a better lung protective measures during cardiopulmonary bypass .Methods Animal models were established ,group A :the rats were transfected with the lentiviral AD-PBEFshRNA ;group B :the rats were took 30 min deep hypothermic circulatory arrest ;group C :the rats were took 30 min deep hypothermic circulatory arrest ,then trans-fected with the lentiviral AD-PBEFshRNA ;control group :the rats were anesthetized and established CPB tube ,without CPB by-pass .Lung tissue was detected with Western blotting and ELISA .Results PBEF ,phosphorylation of P38MAPK ,ERK ,MLC ,VE-cadherin ,FAK in group C had significant difference with group A ,B and the control group(P<0 .05) .VEGF ,MMP2 ,MMP9 ,W/D in group C had significant difference with group A ,B and the control group(P<0 .05) .The pathological results showed that rat lung tissue of the control group was normal ,while in group C ,it had severe pathological damage ,the pathological damage degree in group A ,B reduced compared to group C .Conclusion PBEF can through MAPK/PI3K-Akt/VEGF signaling pathway ,increase pulmonary vascular endothelial permeability .

ObjectiveTo evaluate the various methods of choledochoplasty in the repair of major bile duct defects in Mirizzi syndrome.MethodsThis is a retrospective study on 3 patient with Mirizzi syndrome with a large bile duct defect.These defects were repaired by using a vascular gastric pedicle patch in our department from July 2008 to November 2011.The authors searched the domestic medical literature on surgical repair for Mirizzi syndrome in the past ten years.The patients were treated by various surgical methods,and they were analyzed according to the Csendes Classification.ResultsThere were no surgical complications in our three patients.There was one patient with a Csendes type Ⅲ,while the remaining 2 patients were with Csendes type Ⅳ.At a median follow- up of 2.5 years,no patient developed signs of chronic cholangitis.In the medical literature,there were 93 patients who were with Csendes type Ⅰ ; and 58 patients were treated by cholecystectomy only,while 35 patients were treated by partial cholecystectomy plus mucosal ablation.Of the 40 patients with type Ⅱ,29 patients were treated by direct fistula repair,9 patients by pedicle gallbladder flap and 2 patients by pedicle round ligament.Of the 20 patients with type Ⅲ,9 patients were treated by pedicle gallbladder flap.1 patient by pedicle round ligament,3 patients by pedicle gastric flap and 7 patients by Rouxen- Y hepaticojejunostomy.For the 5 patients with type Ⅳ,they were treated by Roux-en- Y hepaticojejunostomy.Of these 159 patients,postoperative complications included biliary fistula (n=1 ),upper gastrointestinal bleeding (n=1),and biliary stricture (n=1).All the remaining patients were cured.ConclusionIn patients with Mirizzi Syndrome,the choice of treatment depends on the size of the fistula.For patient with a major tissue defect in the common hepatic duct,a pedicle vascular gastric flap is a good treatment.

Objective To study the diagnosis and treatment of hepatocellular adenoma(HCA).Methods The preoperative imaging findings,pathologic specimens and surgical treatment of 18 patients with HCA who were admitted in our hospital from January 1990 to April 2007 were retrospectively analyzed.Results Most patients were male(male-to-female:11/7)and only 1 female patient had oral contraceptive history.Six patients presented with pain in the right upper quadrant.Contrast-enhanced CT and contrast-enhanced MRI both displayed that most lesions were characterized by homogeneous enhancement on arterial phase,except the lesions affected by irregular hemorrhage or fatty degeneration,and by washout on portal venous phase and delayed phase.All patients received resection.Hemorrhage in the lession was found in 10 patients and precancerous lesion in 2after operation.All patients were alive and well with no recurrence till December 2007.Conclusion The enhanced CT or MRI scanning for HCA has special features.Complete resection is the first choice for HCA.

Among 2625 patients with type 2 diabetes,body mass index,systolic blood pressure,HbA1C,triglyceride,ApoB,serum uric acid,highly-sensitive C reactive protein,tumor necrosis factor α levels,and common carotid artery intima-media thickness in hypertriglyceridemic-waist ( HTWC ) phenotype group were higher than those in non-HTWC group,while high-density lipoprotein cholesterol and ApoA1 levels were lower( all P＜0.05 ).HTWC phenotype was an independent risk factor for atherosclerosis of carotid artery in patients with type 2 diabetes mellitus (OR 1.45,95％CI 1.07-1.96).

OBJECTIVE: To explore the correlation between the width of lingual varix and changes of hemodynamics of portal system in patients with primary liver cancer so as to supply the data for the forecast of portal hypertension by observing lingual varix. METHODS: The diameter of lingual vein (Dlv) was measured by vernier caliper as dependent variable, and the diameters and indexes of hemodynamics of portal vessels were measured by Doppler as independent variables, then a multipe stepwise analysis was performed. RESULTS: The diameters of portal vein (Dpv) and splenic vein (Dsv) entered the formula Dlv (mm) = 0.185 + 0.311 Dsv (mm) + 0.236 Dpv (mm) when the entry and removal values were alpha(in)=0.10 and alpha(out)=0.15, respectively. CONCLUSION: The width of lingual vein is closely correlated with the diameters of portal vein and splenic vein in patients with primary liver cancer.

Objective To evaluate dynamic graciloplasty (DGP) for canine in situ anal reconstruction. Methods Seventeen dogs were randomly divided into experimental group and control group. In control group, on the stage 1, the gracilis muscle were dissected in situ, manometry performed intraoperatively; In experimental group, the gracilis muscle were dissected in situ and stimulated chronically starting 7 days postoperatively. On stage 2, abdominoperineal resection of anus and graciloplasty for anal reconstruction were performed in two groups. After 2 weeks recovery, manometry and muscular fatigue-resistant curve (MFRC) were observed while myostimulator is switched off and on. The muscle of neosphincter was biopsied. Results After chronic low frequency electrical stimulation (CLFS), the percentage of type Ⅰ fibers in the stimulation group was higher than the control group (P0.05), but functioning neosphincter pressure is different significantly (P

Benign biliary stricture is a challenging problem in hepatobiliary surgery. Benign biliary stricture is associated with major portal vein variation, which is not be found in literatures. A male patient with benign biliary stricture was admitted to the Chinese PLA General Hospital in March, 2010.The stricture was located in the hilar confluence with intrahepatic biliary dilation and hepatolithiasis. The result of computed tomography showed that the hilar biliary confluence was compressed by the left portal vein and right anterior portal vein. The patient was cured after receiving gallbladder interposition, choledocholithotomy and T tube drainage. We suggested that the benign hilar biliary stricture due to portal vein variation may be named as biliary nut-craker syndrome.

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.

Objective To summarize experiences associated with hepatectomy of huge liver neoplasm.Methods Two hundred and sixty six consecutive cases of huge liver neoplasm undergoing hepatectomy from January 1987 to December 2005 at Chinese PLA General Hospital were analized retrospectively based on the clinical data.Results There were 174 males and 92 females with the average age of(44.8 ± 12.2)years(range 7-76 yrs).Among them,93 cases were with benign neoplasms.The maximum diameter of tumors was 30 cm and hemangioma accounted for 86.0%(80 cases).The other 173 cases were huge liver malignant neoplasms with the maximum diameter of 33 cm,hepatocellular carcinoma accounted for 73.4%(127 cases).The average diameter of all tumors was(14.7 ±4.0)cm(range 10.2-33.0 cm).HBsAg(+)was found in 40.49% of cases.Numbers of resected segments averaged(3.3 ±1.2)in benign cases and(3.1 ±1.2)in malignant ones without significant difference between the two groups(t=1.710,P=0.310).Postoperative complications occurred in 17.29% of cases and the hospital mortality was 0.75%.The postoperative 1-,3-and 5-year survival rates in patients with malignant liver tumors were 58.3%,39.7% and 27.5%,respectively.Conclusions Hepatectomy of huge liver benign and malignant neoplasms can be performed safely with low morbidity and mortality,provided that it is carried out with skillful surgical expertise and optimized perioperative management.