Objective:To evaluate the short-term and long-term efficacy of Heidelberg triangle dissection in surgical treatment for pancreatic head cancer.Methods:The clinicopathological data of 97 patients with pancreatic head cancer who underwent pancreaticoduodenectomy at Cangzhou Central Hospital from Jan 2017 to Jan 2020 were retrospectively analyzed. After propensity score matching, 33 patients were included into the Heidelberg group and 36 patients in the control group.Results:There were no significant difference between Heidelberg group and control group in preoperative general conditions and postoperative major complications, while there were more cases with safe surgical margin > 1 mm (81.8% vs. 58.3%, P=0.034) and a significantly higher total number of lymph node dissection (11.24±2.35 vs. 9.50±2.76, P=0.006). In the survival analysis, the cumulative recurrence rate at 12 months (0.182±0.067 vs. 0.444±0.083, P=0.023) and 18 months (0.424±0.086 vs. 0.667±0.079, P=0.024) were better off in the Heidelberg group, and the local recurrence rate in the Heidelberg group was significantly lower than that in the control group (15.3 % vs. 36.1 %, P=0.037). However, there was no statistical difference in the overall survival time between the two groups. Conclusion:Dissection of Heidelberg triangle in radical resection of pancreatic head cancer reduces tumor local recurrence ,while fails to provide survival benefit.

Objective:To analyze the common complications of laparoscopic duodenum- preserving pancreatic head resection(LDPPHR).Methods:The clinical data of 32 patients undergoing LDPPHR from Jun 2018 to Jun 2021 in Cangzhou Central Hospital were analyzed retrospectively.Results:LDPPHR was successfully performed in all 32 patients without conversion to open surgery. The incidence of postoperative complications was 21.9% (7/32), 3 cases suffering from sever complications (1 case of long-term postoperative pancreatic fistula, 1 case of obstructive jaundice caused by duodenal papilla stenosis, 1 case of postoperative abdominal bleeding) were cured by laparotomy; 4 cases of minor complications were simple pancreatic fistula, which were cured by prolonging dranage.Conclusions:LDPPHR is technically feasible for isolated noncancerous lesions within pancreatic head and uncinate process,the complications were manageable.Its suggested benefits remain to be established by long term follow-up.

Objective:To investigate the characteristics and risk factors of local recurrence in resected pancreatic cancer.Methods:The clinicopathological data of 190 patients in whom recurrent sites can be identified after radical resection of pancreatic cancer from Sep 2013 to Aug 2020 at the Cangzhou Central Hospital were retrospectively analyzed. The survival time and clinicopathological characteristics of local recurrence were compared with those of other recurrence types. Cox risk regression model was used to analyze the risk factors of local recurrence.Results:The recurrence sites were local (49 cases, 25.8%), liver (53 cases, 27.9%), lung (35 cases, 18.4%), peritoneal (25 cases, 13.2%) and multiple sites (28 cases, 14.7%). Patients mRFS and mOS were 17.8 months and 30.9 months respectively. The clinicopathological features of patients with local recurrence were compared with those of other recurrence types [tumor diameter ( P=0.023), preoperative CA199 level ( P=0.021), peripancreatic nerve plexus invasion ( P=0.031), lymphovascular invasion ( P=0.004), surgical margin state ( P<0.001) and postoperative adjuvant chemotherapy ( P=0.038)]. Tumor diameter ( P=0.018), peripancreatic nerve plexus invasion ( P=0.002) and postoperative adjuvant chemotherapy ( P=0.004) were independent factors for local recurrence in resected pancreatic cancer, and only peripancreatic nerve plexus invasion was not associated with other recurrence types. Conclusions:Local recurrence in resected pancreatic cancer has important impact on the prognosis of patients. Peripancreatic nerve plexus invasion is an independent factor affecting local recurrence.

Objective:To investigate the short-term outcome of Heidelberg triangle dissection in laparoscopic pancreaticoduodenectomy (LPD) for pancreatic cancer.Methods:The clinical data of 84 patients with pancreatic head cancer who underwent LPD from July 2015 to September 2020 in the Department of Hepatobiliary and Pancreatic Surgery of the Cangzhou Central Hospital were retrospectively analyzed. According to the scope of surgical dissection, the patients were divided into the control group ( n=45) and the Heidelberg group ( n=39). In the control group, routine lymph node dissection was performed, and in the Heidelberg group, all blood vessels, lymphatic tissue and nerve tissue in the Heidelberg triangle area were dissected on the basis of routine lymph node dissection. Operation-related indicators (operation duration, intraoperative blood loss, cases of patients with intraoperative blood transfusion, fasting time and hospitalization duration after operation), postoperative complications (pancreatic fistula, biliary fistula, lymphatic fistula, bleeding and delayed gastric emptying) and postoperative pathological parameters (surgical margin, degree of differentiation, tumor size, cases of nerve invasion, number of dissected lymph nodes, lymph node metastasis and TNM stage) were compared between the two groups. Results:Compared with the control group, the operation time of the Heidelberg group was longer [ (334.85±24.95)min vs (305.09±24.54)min], theincidence of lymphatic fistula was higher (15.4% vs 2.2%), the rate of >1 mm at surgical margin was higher (76.9% vs 53.3%), and the total number of lymph nodes dissection was more [ (11.31±2.46) vs (9.49±2.28)]. All the differences between the two groups were statistically significant ( P<0.05). However, there were no significant differences on the intraoperative blood loss, cases of patients with intraoperative blood transfusion, postoperative hospital stay and fasting time, incidence of pancreatic fistula and biliary fistula, bleeding, delayed gastric emptying, degree of differentiation, tumor size, cases of nerve invasion, lymph node metastasis and TNM stage between the two groups. Conclusions:LPD combined with Heidelberg triangle dissection for pancreatic cancer was feasible and safe, which can increase the R 0 resection rate, remove more lymph nodes, reduce the local recurrence of pancreatic cancer and improve the prognosis of patients.

Objective To investigate the choice of surgical methods and short-term therapeutic efficacy of laparoscopic pancreaticoduodenectomy.Methods A retrospective analysis was performed on the clinical data of 188 cases who underwent laparoscopic pancreaticoduodenectomy (LPD) from December 2015 to December 2017 in Cangzhou Central Hospital.Total laparoscopic pancreaticoduodenectomy (TLPD) was performed in 102 patients whose diameter of pancreatic duct was greater than or equal to 3 mm,and end-to-side anastomosis of pancreatic duct and jejunum was used to reconstruct the digestive tract (TLPD group).Laparoscopic assisted pancreaticoduodenectomy (LAPD) was performed in 86 patients with pancreatic duct diameter less than 3 mm,and the digestive tract was reconstructed by end-to-side pancreaticoduodenectomy with pocket-insertion (LAPD group).The clinical data of the two groups were analyzed and compared.Results There were no significant differences on sex,age,ASA grade,preoperative total bilirubin,alanine aminotransferase and serum albumin levels between the two groups(P ＞0.05),which was comparable.The total incision length and hospitalization time in TLPD group were significantly shorter than those in LAPD group [(8.2± 1.4)cm vs (12.9±2.6) cm];[(10.9±5.9)d vs (14.3±6.5) d],while the time of pancreaticojejunostomy was significantly longer than that in LAPD group [(36.1 ± 14.7) min vs (14.0 ± 4.2) min].The incidence of pancreatic fistula after operation was significantly higher than that in LAPD group (30.4％ vs 10.5％).The difference was statistically significant (all P＜0.05).There were no significant differences on mean operation time,intraoperative bleeding volume,number of lymph node dissection,R0 resection rate,ICU admission time,eating time,total complication rate and 6-month disease-free survival rate between the two groups.Conclusions TLPD has the advantages of less trauma and quicker recovery.But for pancreatic duct diameter less than 3 mm,the choice of LAPD can increase the safety of operation and reduce the incidence of postoperative pancreatic fistula.

Objective To explore the safety and feasibility of laparoscopic radical resection of Bismuth-type Ⅲb hilar cholangiocarcinoma.Methods The clinical data of 109 patients with Bismuth-type Ⅲ b hilar cholangiocarcinoma in the Department of General Surgery of Cangzhou Central Hospital from Jan 2015 to Feb 2018 were retrospectively analyzed.Among those 17 patients undergoing total laparoscopic surgery were compared with 17 open cases.Results There were significant differences between the laparoscopic group and the control group in operation time [(420.8 ± 136.5) min vs (292.3 ± 65.6) min],total length of incision [(8.2 ± 4.7) cm vs (20.4 ± 5.8) cm],incidence of postoperative complications [29.4％ (5/17) vs 52.9％ (9/17)],postoperative feeding time,postoperative ICU stay and postoperative hospital stay (P ＜ 0.05).There were no significant difference in the amount of bleeding[(325.2 ± 98.7)ml vs(367.4 ±72.9)ml],pathological results,number of lymph node dissection,R0 resection rate and tumor recurrence rate (P ＞ 0.05).Conclusion Total laparoscopic radical resection of Bismuth-type Ⅲ b hilar cholangiocarcinoma is safe,feasible,and has the advantages of minimal invasion and rapid recovery.

Objective to investigate the feasibility of laparoscopic radical resection for hilar cholangiocarcinoma.Methods From June 2016 to June 2018,30 patients with hilar cholangiocarcinoma (HCC) underwent total laparoscopic radical resection.Results Surgery was successfully performed in all cases without conversion,15 cases underwent hilar bile duct resection,and hilar lymph node dissection,14 cases underwent left hemi-hepatectomy and caudate lobectomy,and 1 case underwent extrahepatic bile duct resection.The operation time was 258-336 min,(286.8 ± 18) min,intraoperative bleeding was 60-210 ml (139.7 ±38.0) ml.Postoperative bile fistula occurred in 5 cases,healed conservatively after 5 days,stress ulcer in 1 case,and intestinal anastomotic bleeding in 1 case,were all cured by themselves.Postoperative hospitalization was 7-12 days (mean 8.9 d).After 6-12 months follow-up,3 cases died of recurrent and metastatic cancer after 6 months of operation,27 cases were alive.Conclusion Total laparoscopic radical resection of hilar cholangiocarcinoma is safe and feasible.

Objective To investigate the clinical features of Menetrier disease and the related treatment progresses.Methods The clinical data of 7 patients with Menetrier disease who were admitted to Cangzhou Central Hospital from Jan 1997 to Mar 2018 were retrospectively analyzed.Results There were 3 males and 4 females.The main clinical manifestations were abdominal pain (n =5),loss of appetite (n =4),nausea and vomiting (n =2),weight loss (n =4),edema (n =3),hypoalbuminemia (n =6) and anemia (n =6).All patients had typical imaging findings.Two of the patients underwent non-surgical treatmen with temporary symptom reliefs.Finally,6 patients received surgical treatment including Subtotal gastrectomy in 1 patient,total gastrectomy in 5 patients.All the 6 cases underwent surgery successfully with no serious complications.5 cases were followed-up data until April 2018.All were in good condition,Hemoglobin and albumin levels were within the normal range.Conclusion According to the clinical manifestations and the related auxiliary examinations,this disease is easy to diagnose.Surgical treatment is the only way to cure Menetrier disease.

Objective: To investigate the effect of end-to-side pancreaticojejunostomy with pocket-insertion on the incidence of pancreatic fistula after pancreaticoduodenectomy. Methods: The clinical data of 581 patients undergoing pancreaticoduodenectomy from Dec. 2012 to Sep. 2018 in Cangzhou Central Hospital were retrospectively analyzed, including 327 cases of open pancreaticoduodenectomy (OPD) , 175 cases of laparoscopic assisted pancreaticoduodenectomy (LAPD) , and 79 cases of total laparoscopic pancreaticoduodenectomy. End-to-side pancreaticojejunostomy with pocket-insertion was used in all cases. The incidence of pancreatic fistula after operation was analyzed. Results: The overall incidence of grade B or C pancreatic fistula was 3.10% (18/581) after end-to-side pancreaticojejunostomy with purse-pocket insertion. The incidence of grade B or C pancreatic fistula in OPD group was 2.75% (9/327) . The incidence of grade B or C pancreatic fistula in LAPD group was 2.29% (4/175) . The incidence of grade B or C pancreatic fistula in TLPD group was 6.33% (5/79) . The three groups were divided into two subgroups according to the pancreatic texture. There was significant difference in pancreatic duct diameter between subgroups (P<0.05) , but there was no significant difference in the time of pancreaticojejunostomy and the incidence of pancreatic fistula after operation (P>0.05) . Conclusion End-to-side pancreaticojejunostomy with pocket insertion has the advantages of simple operation, strong adaptability, safety and high efficiency, and can control the incidence of pancreatic fistula after pancreaticoduodenectomy at an ideal level.

Objective To study and prepare the monoclonal antibody library against human FXYD6 functional region,to screen the hybridoma cell lines secreting the monoclonal antibodies against intracellular or extracellular region of human FXYD6,and to identify the biological function of monoclonal antibody against extracellular domain.Methods FXYD6 functional region recombinant protein which did not contain the transmembrane region was prokaryotically expressed,purified,and FXYD6 recombinant protein was used to immunize BALB/c mice.Then splenocytes after immunization were fused with myeloma cells SP2/0.After several rounds of screening and cloning,the hybridomas which secreted the antibodies against the extracellular domain or the intracellular domain of human FXYD6 were established.The antibody specificity and subtype were identified with indirect ELISA,western blot and immunohistochemistry.The monoclonal antibodies against the extracellular domain which recognized the native conformation were screened with flow cytometry.The antibody against extracellular region was prepared with the ascites revulsion method and purified.The affinity constants were measured with indirect ELISA.The function of extracellular monoclonal antibody was detected by HepG2 cell line with high expression of FXYD6.Results The hybridoma cell library which secreted the monoclonal antibody against extracellular domain or the intracellular domain of human FXYD6 was successfully obtained,and extracellular region monoclonal antibodies with the functional blocking were prepared.Conclusion The prepared anti-human FXYD6 extracellular monoclonal antibodies could inhibit HepG2 cell proliferation.