Objective:To evaluate the inflammatory factors effects of early endoscopic therapy for elderly patients with acute biliary pancreatitis (ABP) and its clinical efficacys.Methods:206 elderly patients with ABP admitted from Jan. 2010 to Dec. 2019 were divided into observation group (102 cases) and the control group (104 cases) according to treatment method. The observation group received endoscopic retrograde cholangiopancreatography (ERCP) , endoscopic sphincterotomy (EST) and endoscopic naso-biliary drainage (ENBD) , while the control group received conventional treatment. Clinical symptoms, changes of inflammatory factors, complications and prognosis were observed in each group.Results:CRP, SAA, IL-6, IL-8 and TNF-a after treatment were significantly lowered than those before treatment ( P<0.05) . In addition, the levels of CRP, SAA, IL-6, IL-8 and TNF-a in the observation group were significantly lower than those in the control group ( P<0.05) . The time to abdominal pain extinction, time to fever cessation, hospital stay in observation group were (3.92±1.54) , (3.63±1.41) , and (14.35±2.46) d, significantly less than those in the control group [ (5.81±1.72) , (5.45±2.13) , (19.37±3.12) d, P<0.05]. APACHE Ⅱ score of the observation group was (10.02±2.67) point after treatment, significantly lower than that in the control group [ (12.35±3.62) point, t=4.42, P<0.05]. The incidence of complications in the observation group was 10.78% after treatment, significantly lower than that in the control group [ (24.03%) , χ2=6.27, P< 0.05]. The mortality in the observation group was 1.96%, lower than 4.81% in the control group, with no statistical significance. Conclusion:Early endoscopic therapy is safe and highly effective for elderly patients with ABP, with the advantages of shorter hospital stay, quicker subsided inflammation, and lower incidence of complications.

Objective:To investigate the diagnosis, classification and treatment of pancreatic duct stones (PDS) .Methods:Clinical data and prognosis of 32 patients with PDS treated in our hospital from Jan. 2010 to Dec. 2019 were retrospectively analyzed. The treatment methods were summarized.Results:All 32 cases were diagnosed with PDS by imaging examinations such as B ultrasonography, CT, endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) . The diagnosis accuracy was 81.3% (26/32) for B-ultrasound, 86.2% (25/29) for CT, 90.4% (19/21) for MRCP, and 100% (8/8) for ERCP. According to the location of stones and intraoperative exploration, the 32 patients were divided into 3 groups: Type I, 17 patients, the stones were located in the main pancreatic duct; TypeⅡ, 11 patients, the stones were located in both main and branch pancreatic duct; Type Ⅲ, 4 patients, the stones were located in the branch pancreatic duct. Different treatment methods were employed according to the different types. No patient died in the perioperative period. 11 (34.3%) patients had postoperative complications. 3 (9.3%) patients had postoperative residual stones. 32 cases were followed up for a period of 6 to 60 months. The abdominal pain and steatorrhea disappeared or significantly improved postoperatively. 2 patients complicated with pancreatic cancer died 12 to 35 months after operation.Conclusions:The treatment and diagnosis of the PDS still remains complicated. Imaging examinations are the main methods for diagnosis of PDS. The accurate classification and individual treatment are important. Surgery is the most commonly used method for PDS.

Objective To investigate the clinical significance of serum miR-187 and miR-143 in the development and diagnosis of gallbladder cancer.Methods 75 serum samples in patients with gallbladder cancer were selected as gallbladder cancer group.75 serum samples in patients with gallbladder benign disease and 45 serum samples in healthy physical examinations at same period were selected as the benign gallbladder disease group and healthy control group.Quantitative RT-PCR was used to detect the serum miR-187 and miR-143 expression in each group,and the expression of those related with the clinicopathological factors,the proliferation and migration of gallbladder cancer cells,and the efficacy in diagnosis of gallbladder cancer was observed.Results The serum miR-187 expression in gallbladder cancer group was significantly higher than that in benign gallbladder disease and healthy control;the serum expression of that in benign gallbladder disease was significantly higher than that in healthy control;after surgery,the expression of that was significantly lower than that before treatment (all P ＜ 0.05).The serum expression of miR-143 in gallbladder cancer group was significantly lower than that in benign gallbladder disease and healthy control;the serum expression of that in benign gallbladder disease was significantly lower than that in healthy control;after surgery the serum expression of that was significantly higher than that before surgery (all P ＜0.05).The serum expression levels of miR-187 and miR-143 in gallbladder cancer were not correlated with gender and age (both P ＞ 0.05),and were significantly correlated with Nevin stage,TNM stage,differentiation and lymphatic metastasis (all P ＜ 0.05).Furthermore,it was confirmed that miR-187 promoted the proliferation and migration of gallbladder cancer cells in vitro,while miR-143 inhibited the proliferation and migration.In the diagnosis of gallbladder,the diagnostic efficacy of miR-187 and miR-143 was significantly better than that of CA199 and CA242 (both P ＜ 0.05).Combined detection could further improve the efficacy in diagnosis of gallbladder cancer.Conclusions miR-187 and miR-143 are involved in the development of gallbladder cancer.Combined detection of serum miR-187 and miR-143 in gallbladder cancer has a high diagnostic efficiency in the diagnosis of gallbladder cancer.

Objective To investigate the relationship between the expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells,to observe the inhibitory effect of 5-Aza-CdR on the growth of gastric cancer cells,to observe the effect of demethylation on the expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells,and to explore the molecular mechanism of gastric cancer.Methods Real-time PCR was used to detect the expression of ASPP2 mRNA in two gastric cancer cells and normal gastric epithelial cells.BSP was used to detect the methylation of ASPP2 gene in two gastric cancer cells and normal gastric epithelial cells.CCK-8 was used to detect the growth inhibition rate of gastric cancer cells treated with 5-Aza-CdR of different concentrations,then they were used to detect expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells again after the demethylation.Results ① The expression of ASPP2 mRNA in MKN-45 cells was significantly lower than that in GES-1 cells(P＜0.01).The expression of ASPP2 mRNA in MGC-803 cells was significantly lower than that in GES-1 cells (P＜0.01).There was no significant difference in MGC-803 cells and MKN-45 cells(P＞0.05).② The methylation rate of ASPP2 in MKN-45 cells was significantly higher than that in GES-1 cells (P＜0.01).The methylation rate of ASPP2 in MGC-803 cells was not significantly different from that in GES-1 cells (P＞0.05).The methylation rate of ASPP2 in MKN-45 cells was significantly higher than that in MGC-803 cells (P＜0.01).③ At the same time,the growth inhibition rate of each 5-Aza-CdR concentration group increased as the drug concentration depended.4.The expression of ASPP2 mRNA in MKN-45 cells was significantly higher than that before treatment (P＜0.01),the expression of ASPP2 mRNA in MGC-803 cells was not significantly different from that before treatment(P＞0.05).The methylation rate of ASPP2 in MKN-45 cells was significantly lower than that before treatment (P＜0.01).The methylation rate of ASPP2 in MGC-803 cells was not significantly different from that before treatment (P＞0.05).Conclusion ① Abnormal hypermethylation of ASPP2 gene in MKN-45 cells may be a molecular mechanism of decreased ASPP2 mRNA expression.② 5-Aza-CdR can inhibit the growth of MKN-45 and MGC-803 cells,and it can enhance the expression of ASPP2 mRNA in MKN-45 cells.Reversal of methylation in the promoter region of ASPP2 gene is the possible mechanism.③ Abnormal hypermethylation of the promoter region of ASPP2 gene may lead to silencing of mRNA expression that may be associated with gastric cancer.

Objective To investigate the methods for prevention and treatment of unexpected hemorrhage during operation of biliary tract.Methods The clinical data of 28 patients with intraoptrative hemorrhage from Jan.2006 to Dec.2016 in our hospital were retrospectively analyzed.Results The cause of introoperative hemorrhage included:iatrogenic biliary injuries in 14 cases (50％),cholelithasis complicated biliary infection in 9 cases (32.1％),bleeding in gall bladder bed in 3 patients (10.7％),and other causes in 2 cases (7.1％).The intraoperative blood loss was 600 to 3000 ml.According to the specific location of bleeding,the amount of blood loss,the cause of bleeding and other conditions,the individual treatment was given.26 were cured and 2 died of hemorrhagic shock and MODS.Conclusions The major causes of hemorrhage during operation of biliary tract comprise iatrogenic biliary injuries,biliary infection,and biliary lithiasis.The reasonable treatment of intraoperative hemorrhage should be based on the concrete bleeding etiologies.

Objective To investigate the clinical characteristics and perioperative management of 1aparoscopic cholecystectomy(LC) in the elderly with gallbladder diseases. Methods From January 2006 to December 2016,the clinical data of two hundred and sixteen elderly patients with LC in the Sixth Affiliated People's Hospital of Jinshan Branch were analysed retrospectively. Results The operations of LC were successfully done in 206 patients ( 95. 8%) and 9 cases ( 4. 2%, 9/216 ) underwent conversion to open cholecystectomy for various reasons. Postoperative complications occurred in 22 cases (10. 2%,22/216). 2 cases died within 1 weeks after the operation,and the remaining patients recovered from the hospital. Conclusion Adequate perioperative management,strict surgical indications and operative skills are the necessary conditions for the successful implementation of LC in the elderly.

Objective To observe the efficacy of endoscopic retrograde cholangiopancreatography (ER-CP) and laparotomy in treatment of acute gallstone cholangitis and their impact on the levels of serum amyloid A (SAA),C-reactive protein (CRP) and endothelin-1 (ET-1).Methods 80 patients with acute gallstone cholangitis,from Jan.2013 to Dec.2016,were divided into observation group(35 cases) and the control group (45 cases)according to the surgical procedure.The observation group received ERCP,and the control group were performed with open cholecystectomy,common bile duct extraction and T-tube placement.The operation time,blood loss,gastrointestinal function recovery time,hospital stay,and the success rate of stone removal,and the levels of SAA,and changes in CRP and ET-1 before and after treatment were observed in each group.Results Compared with the control group,the observation group had shorter operative time [(76.43±9.82)min vs (69.28±7.53) min,P=0.000],less blood loss[(1 1.73±2.83)ml vs (78.41±3.28) ml,P=0.000],shorter gastrointestinal function recovery time [(29.53±3.27) h vs (78.33±8.43) h,P=0.000],and shorter hospital stay [(5.73±1.32)d vs (8.54±1.62) d,P=0.000],while the success rate of stone removal was not significantly different between the two groups (97.14％ vs 95.56％,P＞0.01).Before treatment,the levels of SAA,CRP and ET-1 had no significant difference between the two groups(P＞0.05).The levels of SAA,CRP and ET-1 in the two groups after treatment were significantly lower than those before treatment (P＜0.01),while the levels decreased more in the observation group compared with that in the control group (P＜0.01).Conclusions The endoscopic therapy and laparotomy in treatment of acute cholangitis stones have both achieved good efficacy.Compared ith laparotomy,ERCP has faster recovery,shorter hospital stay,and quicker subsided inflammation.

Objective To explore the etiological factors,clinical characteristic and diagnosis of nonacute biliary pancreatitis (NABP) and acute biliary pancreatitis (ABP).Methods The Clinical data of 152 patients with NABP and 206 patients with ABP from January 2004 to December 2014 in the Hepatobiliary Surgery Department of Jinshan Branch of the Sixth People's Hospital of Shanghai were analyzed retrospectively.Results There were no statistically significant differences in terms of the Ranson score,blood amylase and C reactive protein (CRP) between two groups (P ＞ 0.05).The incidences rate of hepatic insufficiency,renal insufficiency and encephalopathy were 35.5％ (54/152),25.6％ (39/152) and 8.5％ (13/152) in the NABP group,and 25.7％(53/206),12.1％(25/206) and 3.3％(7/206) in the ABP group,with significant difference between the two groups (x2 =4.01,10.89,4.41;P ＜ 0.05).Conclusion The key to reduce the complications and improve the cure rate is to make clear the etiology of NABP and ABP and to take active and effective treatment for the cause of the disease.

Objective To summary clinical experience of laparoscopic treatment of cholecystitis with cholecystolithiasis complicated,in order to provide reference for clinical difficult laparosco-pic resection of gallbladder.Methods Reviewing the operation treatment of laparoscopic cholecystectomy on 94 complex cases of resection during January 2008 to December 2014.Results The 94 patients included 17 cases with severe adhesion around gallbladder,9 cases with gallbladder atrophy,39 cases with gallbladder ampulla and cystic duct stone incarceration,11 cases with acute gangrenous cholecystitis with gallbladder stones,14 cases with gallbladder triangle anatomy is not clearing and 19 cases with gallbladder stones with schistosomial cirrhosis or liver volume variation.Some cases were with the two or more kinds gallbladder stone.There were 91 cases with successful implementation of the laparoscopic cholecystectomy,4 of 91 cases were treated with subtotal cholecystectomy,and 3 cases were converted to open cholecystectomy.There were no cases with serious complications or even deaths.Conclusion Regarding of the complex gallbladder stones appear different situation in operation,we can complete the operation by using different operation method and treatment method in laparoscopic.