Objective To investigate the effect of postoperative anti-viral therapy using adefovir dipivoxil in recurrence of hepatocellular carcinoma HCC with HBV infection. Methods Sixty HCC patients with HBV infection were randomized into two groups:Group A (n=23) received hepatectomy only, and Group B (n=37) received hepatectomy and postoperative therapy using adefovir dipivoxil. The changes in liver func-tion, the suppression of HBV-DNA, HBeAg seroconversion rate, tumor recurrence rate and median survival in the two groups were observed and compared. Results In Group B, serum albumin, total bilirubin, AST and ALT were significantly improved compared with Group A (P < 0.05). Furthermore, the rate of 6-month and 1-year HBV-DNA suppression, the rate of 6-month and 1-year HBeAg seroconversion were significantly improved compared with Group A (P < 0.05). In Group A and Group B the tumor recurrence rate was 82. 6% (19/23) vs 78.4% (29/37) (P > 0.05), the recurrence time was 7.3 vs9.6 months (P > 0.05) and the median survival time was 17.4 vs 24.9 months (P < 0.01). Conclusion The results suggest that an-ti-viral therapy using adefovir dipivoxil postoperatively may improve the remnant liver function, suppress the HBV reaction, prolong the survival for patients with HCC with HBV infection.

Objective To investigate the effect of standardization regional lymphadenectomy in radical resection of ductal adenocareinoma in the pancreatic head.Methods On the basis of routine panereaticoduodenectomy(whipple proceduce),we performed the standardization regional lymphadenectomy,the emphasis of the procedure was the resection of wide nodes,particularly the mesenteric root lymph nodes(14abcd),the paraaortic lymph nodes(16a2b1),the hepatoduodenal ligament lymph nodes(12abpeh),hepatic artery(Group 8)and coeliacus lymph nodes(Group 9). Results Eleven patients underwent this procedure,there was no operative mortality,1 case occurred pancreatic fistula,the lymph nodes metastasis occurred in 7(63.6%)patients,the posterior pancreaticoduodenal lymph nodes(Groupl3)and superior mensenteric artery(Groupl4)was the predominant metastatic site of the tumor,the rate of the second site metastasis to lymph nodes was 57.1%.of the 11 cases follow-up 1 died. Conclusion The radical pancreaticoduodenectomy combined with wide resection of standardization regional lymph nodes is a safe and effective procedure of the treatment of adenocarcinoma of the head of the pancreas.but the long-term survivalrate must be valued objectively with many cases.

Familial adenomatous polyposis is characterized by the multiple and adenomatous polyps in the colorectum combined with polyps in the stomach and duodenum, while it is rarely seen in the common bile duct (CBD).In July 2013, 1patient with FAP combined with adenomas in the CBD was admitted to the Fujian Provincial Hospital.The patient underwent laparoscopic CBD exploration and resection of masses due to acute pancreatitis 11 months ago, and was confirmed as with adenoma in the distal CBD by postoperative pathological examination.Multiple polyps were found in the stomach, duodenum,CBD, colorectum after admission to hospital, biopsy confirmed that polyps were tubular adenoma.The patient received pancreaticduodenectomy and was diagnosed as with duodenum-CBD tubular adenoma in postoperative pathological examination.The patient was followed up by telephone interview and outpatient examination and had a full recovery, in addition to the increasing of stools frequency and occasioned hematochezia, and then was treated by total colectomy at postoperative month 7.The tubular adenoma was confirmed by postoperative pathological examination.

Objective To explore clinical characteristics and surgical treatment of pancreatic duct stone.Methods Clinical data of 25 cases pancreatic duct stone undergoing operation from 1990 to 2008 were retrospectively analyzed. Results All of the 25 cases suffered upper abdominal pain, among whom 8 cases were concomitant with type 2 diabetes mellitus, 5 with steatorrhea, 2 with obstructive jaundice, 1 with pancreatic head cancer and 6 with acute pancreatitis recurrence history. All cases were confirmed by imaging diagnosis, such as ultrasonography, abdominal X-ray film, CT, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography. 20 cases underwent pancreolithotomy with Roux-en-Y side-to-side pancreaticojejunostomy. 4 cases underwent body-tail pancreatectomy with pancreatojejunostomy and 1 case underwent pancreatoduodenectomy. No complication was found. 25 cases were followed for 2 months to 4 years after operation. Among all 25 cases with upper abdominal pain, 20 cases got rid of the symptoms and 5 cases were relieved postoperatively.Among 8 cases with diabetes mellitus, 4 cases resumed normal blood glucose postoperatively. Among 5 cases with steatorrhea, steatorrhea disappeared in 2 cases and 1 case were alleviated postoperatively. Conclusions Imaging examinations are the main diagnostic methods for pancreatic duct stone. Pancreolithotomy and Roux-en-Y side-toside pancreaticojejunostomy are effective operative techniques.

Objective To investigate the diagnosis and treatment of mucin-producing intrahepatic biliary tumor (MPIBT).Methods We retrospectively analyzed the clinical,radiologic,surgical and pathologic findings of 16 MPIBT cases from January 2004 to December 2011.Results There were six men and ten women,age ranged from 44 to 69 years (mean 60 years).Clinical presentation included jaundice with abdominal dull pain in 5 patients,acute cholangitis in 4 patients,painless jaundice in 2 patients,upper abdominal dull pain in 3 patients,no obvious symptoms in 1 patient,body weight loss more than 5 kg within 3 months in 5 patients.The most characteristic appearance of MPIBT on magnetic resonance cholangiopancreatography were asymmetry of intrahepatic bile duct dilatation and the dilatation in both extraand intrahepatic bile duct distal to the hepatic mass and not sudden interruption in extrahepatic bile duct.The primary tumor located in the left hepatic bile duct in 15 cases,in the right hepatic bile duct in one.13 MPIBT cases received hemihepatectomy and extrahepatic bile duct resection and Roux-en-Y anastomosis was done in 8 cases,3 received palliative biliary drainage.Pathologically 13 was papillary adenocarcinoma and 3 was papillary adenoma.The 1-,2-,3-year survival rates for the 16 MPIBT patients were 81％,66％,56％,respectively.Conclusions MPIBT had no specific clinical manifestations,MRCP might be an effective means for the diagnositic strategy and assessment of tumor extension before surgery,radical resection was the first choice of treatment,palliative biliary drainage could prolong the survival time.

Objective To investigate kupffer cells (KCs) expressing indoleamine 2,3-dioxygenase(IDO)in the inhibition of allogeneic T-cell proliferation in vitro. Methods Real-time PCR was used to investigate the expression of IDO mRNA and FasL mRNA in KCs pretreated with or without IFNγ. High performance liquid chromatography was used to analyze the catabolism of tryptophan by IDO from KCs. Allogeneic T-cell response was used to confirm the inhibition of KCs in vitro. The proliferation of lymphocytes was detected using [3 H] thymidine incorporation. Cell cycle and lymphocyte apoptosis were evaluated by flow cytometric assay. Results Real-time PCR revealed IDO mRNA and FasL mRNA expression in KCs pretreated with IFN-γ. IDO catabolic effect was confirmed by a decrease in tryptophan and increase in kynurenine concentration. KCs expressing IDO and FasL from BABL/c mice acquire the ability to suppress the proliferation of T-cells from C57BL/6, which could be blocked by the addition of 1-methyl-tryptophan and anti-FasL antibody. The co-cultured T-cells with KCs expressing IDO and FasL could induce allogeneic T-cell apoptosis and exhibited cell-cycle arrest in G1. Conclusion In addition to the Fas/FasL pathway, IDO may also play an important role in KCs to inhibit allogeneic T-cell proliferation in vitro.

Objective To investigate the technical and therapeutic effects of laparoscopic surgery for adult patients with Dong Type C bile duct dilatation.Methods A retrospective cohort study approach was used.The clinical data of 47 patients with Dong Type C adult biliary dilatation who underwent surgery in Fujian Provincial Hospital from January 2014 to December 2017 were collected.There were 12 males and 35 females.The age ranged from 16 to 68 years,with a median age of 30 years.According to different surgical methods,the patients were divided into the laparoscopic group (treated with laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy,n =21) and the open group (treated with traditional open operation,n =26).The intraoperative blood loss,complication rate,operation time,postoperative intestinal function recovery time and postoperative hospital stay were observed.Measurement data with normal distribution were expressed as mean ± standard deviation (Mean ±SD) and analyzed by t test.Comparison of count data was done by the chi-square test.Results There was no perioperative deaths in either group.There was no significant difference in intraoperative blood loss and complication rate between the two groups (P ＞ 0.05).The operation time of the laparoscopic group was significantly longer than that of the open group[(333.7 ±61.1) min vs (235.9 ±64.3) min],with statistically significant difference between graps (P =0.000).The recovery time for the intestinal function of the laparoscopic group was significantly shorter than that of the open group [(2.2 ± 0.5) d vs (2.9 ± 0.6) d],with statistically significant difference between groups (P =0.000).The postoperative hospital stay in the laparoscopic group was significantly shorter than the open group [(7.1 ± 1.8) d vs (12.0 ± 5.9) d],with statistically significant difference between groups (P =0.001).Conclusion For adult biliary dilatation patiens with Dong Type C,laparoscopic surgery is safe and feasible with the advantages of mini-invasive and quick recovery.

ObjectiveTo investigate the expression and clinical significance of serum exosomal microRNA(miRNA)-221-3p in hepatocellular carcinoma (HCC). MethodsA total of 66 patients who underwent surgery in Nanjing Drum Tower Hospital, Nanjing University Medical School, from February 2010 to December 2014 and were diagnosed with HCC were enrolled as HCC group, and 25 individuals who underwent physical examination in our hospital during the same period of time were enrolled as control group. The exosome extraction kit was used to isolate the exosomes in serum; Western blotting was used to measure the expression of exosome markers; a transmission electron microscope was used to observe the morphology of serum exosomes; quantitative real-time PCR was used to measure the expression of serum exosomal miRNA-221-3p. The Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method and the log-rank test were used to analyze the association of the expression of serum exosomal miRNA-221-3p with prognosis, and the Cox proportional hazards regression model was used to analyze the influencing factors for prognosis. ResultsSerum exosomes were small membranous vesicles with a diameter of about 40-100 nm, and HSP70, Alix, and CD63 were expressed in the exosomes. The HCC group had significantly higher expression of serum exosomal miRNA-221-3p than the control group (U=354.00, P＜0.001). In the patients with HCC, the high expression of serum exosomal miRNA-221-3p was associated with tumor size (χ2=6.016, P=0.014), capsular invasion (χ2=7.580, P=0.006), and TNM stage (χ2=6.340, P=0012). In addition, the HCC patients with high expression of serum exosomal miRNA-221-3p had a significantly lower overall survival rate than those with low expression (χ2=17.105, P＜0.001). The multivariate analysis showed that the expression of serum exosomal miRNA-221-3p (hazard ratio ［HR］=2.434, 95% confidence interval ［CI］: 1.178-5.027, P=0.016) and tumor stage (HR=2.653, 95% CI: 1.222-5.760, P=0.014) were independent risk factors for the prognosis of patients with HCC. ConclusionThere is a significant increase in the expression of serum exosomal miRNA-221-3p in HCC patients, which provides a reference for the diagnosis and prognostic evaluation of HCC.