Gastric cancer is one of the high incidence of malignant tumors in China,the incidence of which is in the second among the world and is only inferior to Japan.But the mortality of gastric cancer in China is 2 times of world's average level,which is often associated with low early diagnostic rate,big regional differentials in the surgical quantity of gastric cancer (especially D2 radical gastrectomy) and prognosis of patients influenced by surgical quantity.Therefore,a standardized treatment of gastric cancer is the current development trend and hotspot.The correct and programmed staging,evaluation,operation methods,approaches,lymph node dissection and digestive tract reconstruction are selected,thus improving the long-term survival of patients with advanced gastric cancer and reducing mortality in China.

Objective To study the methods and outcome of surgical treatment of distal bile duct carcinoma.Methods The clinical data of 51 cases of distal bile duct carcinoma who underwent surgery were analyzed retrospectively.Of them,28 cases received radical pancreaticoduodenectomy,and 23 cases had internal bile duct drainage procedures.Results The total average survival time was 20 months.The mean survival time of radical and drainage operation was 32 months and 8 months respectively.Postoperative 5-year survival rate in radical pancreaticoduodenectomy group was 17.8%,and in drainage group was 0.The outcome of radical pancreaticoduodenectomy group was significantly better than that of internal bile duct drainage procedures group(P

Objective To explore the the application of sternocleidomastoid lateral path for thyroid cancer surgery lateral neck lymph node cleaning.Methods 40 patients with thyroid carcinoma were detected in the lateral neck lymph node cleaning using sternocleidomastoid lateral path(experimental group)and 40 cases of patients with thyroid cancer in the lateral neck lymph node cleaning cleaning scope with traditional operation method(control group),comparing with success rates,operation time,quality of life and incidence of complications.Results Experimental group can achieve the purpose of curing in the operation,operation field showed more clearly,the lymph node zone Ⅱ,Ⅲ,Ⅳ,Ⅴ number (32,58,50,35)were higher than traditional surgery group(17,35,33,20).Experimental group can significantly shorten the operation time[(30.0±1.20)min vs(45.0±3.10)min].The difference of incidence of near and forward future overall complications was statistically significant between the two group(P<0.05).Conclusion Sternocleidomastoid lateral path in thyroid carcinoma in the lateral neck lymph node cleaning can achieve the purpose of curing,significantly improve the lymph node zone Ⅱ,Ⅲ,Ⅳ,Ⅴ,shorten the operation time,reduce the recent and long-term complications and improve patient's quality of life.

Objective To evaluate the feasibility and safety of portal-superior mesenteric vein resection and end-to-end anastomosis in cases of colonic carcinoma invading portal vein undergoing combined right hemicolectomy (RH) and pancreaticoduodenectomy (PD) without the need of graft interposition.Methods From 2004 to 2011,5 patients underwent resection of right-sided colon and pancreaticoduodenectomy combined mesentericoportal vein resection at a length from 3 to 4 cm and end-toend anastmoses without graft.Results Surgery was successful in all 5 patients,with complete resection,no severe complications occurred,and all 5 patients were cured.Conclusions Cancers in hepatic flexure of the colon frequently infiltrates the head of the pancreas and duodenum,involving the portal vein.Conservative radical right hemicolectomy and pancreaticoduodenectomy combined long mesentericoportal vein resection and end-to-end anastmoses without graft is a reasonable and safe procedure.

Objective To investigate the correlation between the expressions of tumour suppressor gene PTEN and oncogene C-myc in colorectal carcinoma.Methods The expressions of PTEN and C-myc protein in normal colorectal mucosa(n=8), adjacent non-cancerous tissues(n=10) and primary colorectal carcinoma tissues(n=60) were observed by S-P immunohistochemical assay.Results Of 60 colorectal carcinoma tissues,C-myc protein was detected in 46 cases.The expression rate of C-myc in the primary colorectal carcinoma tissues(76.70%) was significantly higher than that in the normal(0) and adjacent non-cancerous tissues(10%)(P0.05).The positive expression rate of PTEN protein in the primary colorectal carcinoma tissues(25.00%,15/60) was significantly lower than that in the normal(100%) and adjacent non-cancerous tissues(90%)(P

Objective To compare the clinical effect of three-dimensional(3D)and two-dimensional(2D)imaging systems in laparoscopic radical resection of rectal cancer.Methods The retrospective cohort study was adopted.The clinical data of the 97 patients who underwent laparoscopic radical resection of rectal cancer at the Xinmin Branch of the China-Japan Union Hospital of Jilin University between May 2012 and December 2014 were collected.Of 97 patients,47 undergoing 3D laparoscopic radical resection of rectal cancer were allocated into the 3D group and 50 undergoing 2D laparoscopic radical resection of rectal cancer were allocated into the 2D group.The operation followed strictly tumor-free and total mesorectal excision principles.Observation indicators included:(1)surgical situations:operation time,time of deep lymph nodes dissected,volume of intraoperative blood loss,bleeding volume of obturator lymph nodes dissected,number of lymph nodes dissected,postoperative complications and duration of hospital stay.(2)Follow-up situations:follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015.Measurement data with normal distribution were presented as-x±s and comparison between groups was analyzed using the t test.Count data were analyzed using the chi-square test.Results(1)Surgical situations:all the patients underwent successful laparoscopic radical resection of rectal cancer,without conversion to open surgery.Operation time,time of deep lymph nodes dissected,volume of intraoperative blood loss,bleeding volume of obturator lymph nodes dissected,number of lymph nodes dissected and duration of postoperative hospital stay were(134.6±18.5)minutes,(21.2±2.7)minutes,(65±20)mL,(16±3)mL,23.6±3.5,(8.2±2.3)days in the 3D group and(157.4±17.8)minutes,(25.2±2.5)minutes,(89±27)mL,(23±5)mL,20.5±2.8,(9.4±2.1)days in the 2D group,respectively,with statistically significant differencesbetween the 2 groups(t=2.999,3.739,2.327,4.221,2.337,1.274,P＜0.05).The postoperative complications were detected in 7 patients in the 3D group and 9 patients in the 2D group,with no statisfically significant difference between the 2 groups(x2=0.170,P＞0.05).(2)Follow-up situations:75 of 97 patients were followed up for 12-36 months with a median time of 24 months,including 35 in the 3D group and 40 in the 2D group,and they were tumor-free survival.Conclusion Compared with 2D laparoscopic radical resection of rectal cancer,3D laparoscopic radical resection of rectal cancer can shorten the operation time and reduce tissue damage and intraoperative blood loss,and it is beneficial to deep lymph node dissection.

Objective To compare the incidence of pancreatic fistula after hand and stapler suture in preventing pancreatic fistula after distal pancreatectomy.Methods The literatures published before December 2011 were retrieved from SinoMed and electronic database.Prospective controlled trials and retrospective reports were screened out for Meta analysis.The diagnostic criteria of pancreatic fistula were based on the criteria formulated by the International Study group of Pancreatic Fistula.The heterogeneity of the studies was analyzed using the Ⅰ2 test.The data were integrated using the fixed or random effect model.The results of the Meta analysis were presented with odds ratio (OR) and 95％ confidence interval (95％ CI).Results According to the selection criteria,lO literatures were selected which included 1 prospective randomized controlled study,3 prospective nonrandomized controlled studies and 6 retrospective studies.There were 1 441 cases in the hand suture group and 612 cases in the stapler suture group.There was no significant difference in the incidences of the pancreatic fistula between the hand suture group and the stapler suture group (OR =1.10,95％ CI:0.86-1.40,P ＞0.05).Six studies compared the incidences of severe pancreatic fistula (grade B or C) between the hand suture group and the stapler suture group.There were 1 182 cases in the hand suture group and 383 cases in the stapler suture group.There was no significant difference in the incidence of severe pancreatic fistula between the hand suture group and the stapler suture group (OR=1.33,95％CI:0.94-1.88,P＞0.05).Conclusion The efficacies of hand suture and stapler suture in preventing pancreatic fistula after distal pancreatectomy are comparable.Stapler suture provides an another option in distal pancreatectomy.

Objective To study the outcome of surgical therapy of perforation of gastric cancer. Methods The clinical data of 37 cases with perforation of gastric carcinoma which underwent different surgical procedures were analyzed retrospectively. Among them,24 cases underwent partial gastrectomy,8 cases underwent radical mastectomy,4 cases had repair of perforation. 1 case received non-operative therapy. Results The preoperative diagnotic rate was 24.3%,and misdiagonsis rate was 75.7%. The perioperative mortality rate was 5.4%,including 1 case that underwent repair of perforation. The post-operative complication rate of patients undergoing palliative gastrectomy,radical gastric cancer operation and repair of perforation was 41.7%,25.0% and 75.0%,respectively,and the mean survival time was 25 months,29 months and 3.0 months,respectively.The partial gastrectomy and radical mastectomy patients had significantly better outcomes than those who underwent repair of perforation or received non-operative therapy.Conclusions For patients with perforation of gastric cancer with resectable lesions and who are in good general coaditon,a one-stage radical gastric resection or palliative subtotal gastrectomy can be performed.

Objective To research the special manifestations of magnetic resonance cholangiopancreatography(MRCP) in carcinoma of pancreatic head.Methods MRCP in 22 cases with pancreatic head carcinoma confirmed by operation and pathology (including SE sequences with T1WI and fat saturation,FSE with T2WI and fat saturation and MRCP in coronal sectior) were performed before operations.Additional CE MRA on abdominal vessels including abdominal ateries, portal veins and superior mesenteric arteries and their veins in 16 cases also examined before operations. Results Carcinomas of the pancreatic head were diagnosed correctly by MRCP in 21 cases, and 1 case was misdiagnosed as chronic pancreatitis. MRCP all demonstrated abrupt interruption at pancreatic head segments of dilated left common bile duct and main pancreatic duct at the pancreatic head ones, their left segments were dilate with higher signal and both didn't cross each other, because they were destroyed by carcinomas of pancreatic head. Destruction and no cross each other of pancreatic head segments of choledochus and main pancreas duct,it was called "no cross sign". CE MRA demonstrated destruction of abdominal ateries in 3 cases, portal vein in 3 cases and superior mesenteric vein in 4 cases and not being resected.Conclusion "No cross sign"on MRCP examination is of important value in diagnosis of carcinoma of the pancreatic head.

OBJECTIVE:To prepare Baicalin proliposomes (PBA) containing sodium deoxycholate (SD) with optimized for-mulation,and to study pharmacokinetics of it in rats in vivo. METHODS:PBA were prepared by spray drying method. Response surface method based on Box-behnken design was adopted to optimize the formulation of PBA with the amount of HSPC,cholester-ol and SD as factors using entrapment efficiency of PBA as index. The particle size,morphology,leakage rate and stability of the optimal PBA were evaluated along with the pharmacokinetics of it(compared to raw materials)in rats after ig administration of 15 mg/kg. RESULTS:The optimal formulation of PBA was that the amounts of baicalin,HSPC,cholesterol and SD were 100,214, 68 and 53 mg,respectively;the predicted and practical values of entrapment efficiency were 86.42% and 84.32%,respectively, and particle size of the optimal PBA was 358.4 nm. The leakage rate of reconstituted liposomes was low and the stability of PBA was good. Compared with baicalin raw material,t1/2,tmax,MRT,cmax and AUC0-t of PBA were all increased significantly(P<0.05 or P<0.01 or P<0.001). CONCLUSIONS:PBA were prepared successfully using the spray drying method. This method is simple and easy,and the optimized formulation is feasible and can improve the oral bioavailability of baicalin.