Objective To investigate the diagnosis and treatment of upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension.Methods The clinical diagnosis and follow-up data of 13 patients with upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension from Jan 2010 to Dec 2017 were retrospectively analyzed.Results Of the 13 patients,5 had pancreatic pseudocysts and 8 had chronic pancreatitis.All of them had a history of hematemesis or (and) tarry feces,and 2 of them had a history of hemorrhagic shock.13 patients had isolated gastric varices,and 5 of them had varicose veins in the lower esophagus.13 patients had splenomegaly and hypersplenism,and all patients underwent splenectomy.All patients were followed up,and the varicose veins were significantly improved or disappeared.During 1 year to 8 years of follow-up,there was no rebleeding.Conclusion Splenectomy cures upper gastrointestinal hemorrhage caused by rupture of the varicose veins in patients of pancreatic segmental portal hypertension.Preoperative interventional spleen artery embolization can reduce the difficulty of spleen resection.

Objective To analyze the complicationsin patients surviving over ten years after liver transplantation.MethodsTotal 397 patients underwent liver transplantation from May 2000 to May 2008 at Department of Hepatobiliary Surgery,Peking University People's Hospital,among whom 217 patients survived for ≥10years;after 12 cases with incomplete data were excluded,205 cases were enrolled in the study.The complications of patients after liver transplantation were analyzed.Results The survival rate of patients over 10 years after liver transplantation was 51.6％ (205/397).In 205 patients surviving ≥10years after liver transplantation,the incidence of de novo neoplasms was 3.9％ (n=8);the prevalence of hyperuricemia,obesity,hyperlipidemia,metabolic syndrome,hypertension,and diabetes was 54.1％ (n=111),52.2％ (n=107),48.3％ (n=99),46.8％ (n=96),42.9％ (n=88),and 18.5％ (n=38),respectively.The recurrence rate of hepatitis B and the incidence of newly infected hepatitis B were 2.0％ (n=4) and 1.0％ (n=2),respectively.The incidence of cardiovascular and cerebrovascular events,renal insufficiency and biliary complications were 2.0％ (n=4),4.9％ (n=10) and 12.2％ (n=25),respectively.Fourteen patients dies 10 years after liver transplantation,the causes of death were cancer (n=4),biliary complications (n=4),recurrence of hepatitis B (n=2),cardio-cerebrovascular disease (n=2),renal insufficiency (n=1),and secondary liver transplantation (n=1).Conclusion Liver transplantation may prolong survival of patients with terminal liver diseases.The neoplasms,metabolic diseases,cardiovascular and cerebrovascular diseases,hepatitis B recurrence and chronic renal damage would affect the long-term survival of patients after liver transplantation.

Objective To evaluate the therapeutic effect or safety of selective paraesophagogastric devascularization with or without splenectomy for treatment of esophagogastric variceal hemorrhage.Methods The clinical data of 70 patients with a history of esophagogastric variceal hemorrhage from 2009 to 2015 were analyzed.29 cases received spleen preserving paraesophagogastric devascularization and 41 were given portoazygous devascularization plus splenectomy.Results Postoperative portal pressure in spleenpreserving group decreased 14％,that in splenectomy group decreased 23％ (t =2.87,P =0.01).The average blood loss in without splenectomy group was (829 ± 720) ml in contrast to (1 400 ± 1 329) ml in splenectomy group (t =2.311,P =0.024).Postoperative WBC and platelet count in without splenectomy group were lower (t =-5.379,t =-4.924,all P ＜0.01).The postoperative complication rate (24％ vs.39％),and portal venous thrombosis (10％ vs.31％) were all in favour of splenectomy free group (x2 =0.036,P ＜0.05).The 1-and 3-year's recurrent bleeding rate were 4％ and 8％ compared with 4％ and 8％ (all P ＞ 0.05).Conclusion Paraesophagogastric devascularization without splenectomy has less blood loss during the surgery,lower rate of PVT and comparable effect against post-op recurrent bleeding in contrast to devascularization plus splenectomy.

Objective To investigate the complication and risk factors in elderly patients undergoing pancreaticoduodenectomy (PD).Methods From Jan 2005 to Dec 2016,358 consecutive patients undergoing PD were divided into ≥ 70 years group (98 cases) and ＜ 70 years group (260patients).Perioperative complications were compared and risk factors explored between the two groups.Results There were differences in coronary heart disease between the two groups in the preoperative medical comorbidities (P =0.008),and that of albumin,alanine aminotransferase,alkaline phosphatase and creatinine (all P ＜ 0.05).Perioperative mortality was higher in the elderly group than in the younger group (P =0.038),probably related to higher systemic complications (P =0.001).The independent risk factors influencing the postoperative medical complications were preoperative total bilirubin ≥ 171 μmol/L and intraoperative blood loss ≥ 1 000 ml.Conclusions Patients over 70 years old have a comparatively higher perioperative mortality rate after pancreaticoduodenectomy,which were probably derived from a higher postoperative vital organ dysfunction.

Objective To explore the expression of ANLN in HCC and study the clinical value of ANLN expression for HCC patients after liver transplantation.Methods The protein and mRNA expression of ANLN was detected by immunohistochemistry and RNA-seq from TCGA respectively.Chi-square test and t test were used for correlation analysis between ANLN expression and clinicopathological characteristics.The predictive value of ANLN expression for HCC patients after liver transplantation was estimated by log-rank test and cox proportional hazards regression model.Results The positive protein expression rate of ANLN in HCC detected by immunohistochemistry was 37.0％ (34/92),significantly higher than 6.5 ％ (6/92) in para-carcinoma non-tumor tissue (P＜0.001,x2 =25.044).Upregulation of ANLN mRNA expression in HCC was also detected by the analysis of RNA-seq from the TCGA (P ＜ 0.000 1).The positive ANLN protein expression was positively correlated with AFP＞400 ng/L (P＜0.001,x2 =11.952) and tumor size ＞8 cm (P =0.034,x2 =4.506).The independent risk factors for poorer 5-year survival of patients after liver transplantation were confirmed,including positive ANLN protein expression (P =0.031,OR =1.965,95 ％CI =1.064-3.630),tumor size ＞8 em (P =0.003,OR =2.841,95 ％CI =1.437-5.617),worse differentiation degree (P =0.001,OR =3.613,95％ CI =1.646-7.928),peritumor intravascular cancer emboli (P =0.041,OR =1.896,95％CI =1.028-3.498) and tumor necrosis or hemorrhage (P=0.010,OR=2.195,95 ％CI=1.211-3.979).Conclusion The expression of ANLN in HCC is upregulated and the positive protein expression indicates the poor prognosis for long-term survival of patients after liver transplantation.

Objective To investigate the differential diagnosis and management of IgG4 associated biliary pancreatic diseases.Methods A total of 18 patients with jaundice and abdominal pain were retrospectively studied.The final diagnosis was 7 cases of type Ⅰ autoimmune pancreatitis (Ⅰ-ALP),4 cases of IgG4-associated sclerosing cholangitis (IgG4-SC),and 7 cases of I-AIP combined IgG4-SC.Results (1)Imaging features:I-AIP patients showed pancreatic head mass,with relatively poor blood supply when under dynamic contrast-enhanced scan,in delay image,enhanced amplitude more than the normal pancreas.IgG4-SC can be seen in patients with symmetrical bile duct wall stenosis and (or) soft tissue mass,the thickened bile duct wall and intraluminal soft tissue mass can be enhanced with bile duct wall thickening.(2) Serological characteristics:Serum IgG4 fluctuated between 59.3 and 1 120.0 mg/dl,CA19-9 fluctuated between 12.2 and 230.8 U/ml.(3) Histopathology:Plasma cells lymphocyte infiltration and fibrosis,immunohistochemical staining showed IgG4 positive cells ＞ 10/hpf,and obliterative phlebitis.(4) Combined with other organ lesions in 6 cases including renal injury,retroperitoneal fibrosis,mesenteric inflammatory nodules,omental inflammatory nodules,submandibular gland enlargementin,and pituitary inflammation.(5)Response to hormone therapy:4 out of 6 operated patients were none resected and we re given hormonotherapy.In twelve non-surgical patients,2 cases abandoned therapy,10 cases were treated with hormone therapy,and improved.Conclusion IgG4 associated biliary pancreatic disease characterized by localized pancreatic or bile duct disease,can be distinguished from malignancy by special imaging,IgG4 elevation,histopathology and positive response to experimental hormonotherapy.

Objective To investigate the significance of tumor markers CEA and CA19-9 in predicting the clinicopathologic characteristics and prognosis of primary duodenal carcinoma.Methods A retrospective analysis of 110 cases with primary duodenal carcinoma treated in our hospital from January 1999 to December 2016 was conducted.ROC analysis,univariate and multivariate analysiswere performed to investigate the relationship between CEA,CA19-9 and the clinicopathologic characteristics of primary duodenal carcinoma.Kaplain-Meier method was used to analyze the relationship between CEA and CA19-9 and the prognosis of primary duodenal carcinoma.Results CEA level was of value for predicting the depth of infiltration,lymphatic involvement,metastasis and TNM stage.The receiver operating characteristic was 0.629,0.672,0.749,0.692 respectively.Univariate analysis showed serum CA19-9 lever was related to the depth of infiltration and serum CEA lever were related to tumor differentiation,lymphatic invasion,metastasis and TNM stage.Logistic analysis showed that CEA value was only associated with metastasis (OR:9.853,P ＜ 0.01).Patients with elevated serum CEA level had a significant worse prognosis than patients with normal serum CEA level (P ＜ 0.05).Conclusion Serum CEA level was closely associated with the clinicopathologic characteristics and prognosis of primary duodenal carcinoma.

Objective To investigate the effect of a new type of retrograde reperfusion on the intraoperative internal environment and hemodynamics during classic orthotopic liver transplantation (OLT).Methods 20 patients underwent classic OLT using a new type of retrograde reperfusion in our center.Blood sampling was done at different parts or time points including:before blood venting via the portal vein (PV) of the donor liver,5 ml of blood was collected from the superior vena cava (PSVC),inferior vena cava (PIVC) and portal vein (PPV).During retrograde reperfusion through the inferior vena cava (IVC),5 mL of blood was collected when the volume of blood venting reached 5 ml (T1),100 ml (T2),and 200 ml (T3),respectively.The differences of data were compared after the blood samples were analyzed.In addition,the number instances of postreperfusion syndrome (PRS) were recorded.Results All operations were completed successfully,in which PRS occurred in 4 patients (20％).The most notable findings are the significant changes of nearly all data at T1,T2 and T3,including pH value,PvO2,SvO2,BEecf,HCO3-,Lac,K +,and Ca2 +,compared with PIVC (P ＜ 0.05) and a trend toward recovery in all the data.Yet their levels at T3 did not come back to the levels at PIVC (P ＜ 0.05).Besides,for pH value,Lac,K +,HCO3-and BEecf,there were no significant differences between PSVC,PIVC and PPV (P ＞ 0.05).Conclusions During classic OLT,the main factors leading to a disordered internal environment after recirculation stem from venous retum within the donor liver.This new type of retrograde perfusion can eliminate some of the harmful metabolites inside the donor liver in time and to some extent reduce internal environment disorders as well as drastic hemodynamic fluctuations after recirculation.

Objective To discuss the clinical presentation and management of pancreatic arteriovenous malformation.Methods The data pool for the analysis was collected from pancreatic arteriovenous malformation cases encountered by our hospital and sporadic case reports in the literature.Results A total of 95 cases were collected,including 83 males (87.37％) and 12 females (12.63％).The most common presenting symptom was epigastric pain (45.26％),followed by melena (17.89％),epigastric pain accompanied melena (14.74％) and haematemesis (8.42％).The most commonly associated complications were gastrointestinal bleeding (48.42％),pancreatitis (23.16％),duodenal ulcer (16.84％),portal hypertension (11.58％),pseudocyst (4.21％) and hemobilia (3.16％).Most cases were of singular lesion,located in the pancreatic head (61.05 ％) in 58 cases and in the pancreatic body-tail (20％) in 19 cases.Surgery (51.58％) was the most common treatment for pancreatic arteriovenous malformation cases,followed by transarterial embolization (17.89％),a combination of surgery and transarterial embolization (7.37％) and radiotherapy (4.21％).Watchful conservation was adopted in 20％ cases.Conclusions Pancreatic arteriovenous malformation occurs most commonly in males.Epigastric pain and gastrointestinal bleeding are the main clinical presentations.Surgical resection is indicated in symptomatic patients.

Objective To evaluate the diagnostic procedures and treatment choice of primary malignant tumor of the duodenum.Methods The clinical data of 170 cases with primary malignant tumor of the duodenum at Peking University People's Hospital from 1996 to 2015 were analyzed retrospectively.Results Tumors located in the first,second,third and fourth parts in 14 cases (8.2％),144 cases (84.7％),9 cases (5.3％),and 3 cases (1.8％) respectively,and among them,tumors within papillary area accounted for 62.4％ (106 cases).The main clinical presentations included jaundice,upper abdominal pain,abdominal distention,nausea and vomiting.Among the 170 cases,125 cases obtained accurate tumor stages,with 34 cases on stage Ⅰ (27.2％),45 cases on stage Ⅱ (36.0％),30 cases on stage Ⅲ (24.0％),16 cases on stage Ⅳ (12.8％).The accuracy rate of ultrasound and CT in preoperative diagnosis was 27.6％,and 72.3％ respectively.The pathological type of 144 cases (84.7％) was adenocarcinoma.The postoperative 1-,3-and 5-year survival rate was 69.1％,48.6％ and 33.9％.Conclusions Most primary malignant duodenal tumors are located in papillary region,necessitating radical pancreaticoduodenecomy,early diagnosis remains the key for longterm survival.