Abstract:Abstract:Objective：To discuss the resection technique for pancreatic carcinoma in patients with tumour invasion to the portal and/or superior mesentery vein, and the clinical significance of palliative resection of pancreatic carcinoma. Methods：The clinical data of 71 cases of pancreatic carcinoma operated on within a period of 3 years were retrospectively reviewed. In patients with tumour invasion to the portal vein, a method of direc transection of pancreas was used in resection of the tumor, and was combined with local radiotherapy and chemotherapy. Results：The resection rate was 57.75%.The complication rate was 22.54%.One patient died of multiple organ failure resulting from pneumonia. The survival rate at 6m,1- and 2-years was 100%,81.69％, and 40.85% respectively. Conclusions：The direct transection method of pancreas resection is a simple and safe method to increase resection rate and prolong survival time for patients with advanced pancreatic carcinoma.

Abstract:Abstract:Objective：To study a rational method of pancreaticojejunostomy after pancreatoduodenectomy. Methods：Retrospective analysis was made on the clinical material of 108 cases of bundle-invagination pancreaticojejunostomy after pancreatoduodenectomy performed from Jan 1996 to Dec 2003 in our department. Results：The operative time was 3.5~4.5 hours. No perioperative death nor pancreatic fistula occurred. One diabetic patient developed biliary fistula on the 8th post-operative day and it healed spontaneously after drainage. Two cases had wound dehiscence that healed after tension relaxation suture. Two cases of postoperative gastroparesis recovered after conservative treatment.Conclusions：The bundle-invagination pancreaticojejunostomy can more effectively prevent pancreatic fistula and have less operation time.

Abstract:Abstract:Objective：To explore the etiology, mechanism and treatment of diarrhea after pancreatoduodenectomy. Methods：Based on the clinical data of 159 cases of pancreatoduodenectomy performed in the recent one and half years, the pathogenesis of post-pancreatoduodenectomy diarrhea was analyzed and the effect of different treatments was observed. Results：Seventy-one cases had diarrhea, with an incidence of 44.7%. Tweenty-two cases had bacterial infection of the intestinal tract and 4 cases had fungus infection. The incidence of infection was 36.6%. In 64 cases diarrhea was relieved with effective treatment, accounting for 90.1% of all cases. Seven cases with chronic diarrhea had additional treatment with oral pancreatic enzyme and symptoms were relieved 2 weeks after treatment. Conclusions：Diarrhea is frequently observed in patients after pancreatoduodenectomy, and the majority of them can be cured with treatment selected according to the pathogenesis.

Abstract:Abstract:Objective：To investigate the timing of operation and the selection of surgical procedure for acute biliary pancreatitis. Methods：The clinical data of 247 cases of acute biliary pancreatitis were retrospectively analysed. Results：Among 10 non-operation patients, 4 died; 12 patients underwent emergency operation, 5 had postoperative complications and 2 patients died after operation. 169 patients underwent delayed operation after effective conservative therapy and 1 patient had postoperative complication; 56 patients underwent selective operation without any postoperative complication or death. Conclusions：Early emergency operation should be performed for relief of biliary obstruction in acute biliary obstructive pancreatitis. The patients with acute non-obstructive biliary pancreatitis should undergo conservative therapy at first and then, after pancreatitis has been controlled, delayed operation or selective operation to treat the biliary pathologic condition should be performed.

Abstract:Abstract:Objective：To discuss the therapeutic effects of rhubarb and natrii sulfas for severe acute pancreatitis(SAP). Methods：Eighty-three patietns with SAP were randomly divided into treatment group(group A, n=45) and control group(group B, n=38). The 2 groups received the same therapy except that group A received rhubarb and natrii sulfas through nasogastric tube. Results： In treatment group compared to control group, the clinical symptoms such as abdominal pain and distention were more quickly relieved, with early return to oral food intake, lesser complications and shorter hospital stay(all with P<0.05).Conclusions：Combined use of rhubarb natrii sulfas for treatment of SAP has a significant therapentic effect.

Abstract:Abstract:Objective：To investigate the effect and mechanism of cyclopamine，the inhibitor of Sonic hedgehog signaling pathway, on the proliferation and apoptosis of pancreatic cancer cell line SUIT-2. Methods：The SUIT-2 cells used in the experiment were cultured in vitro，and the MTT assay was used to examine the antiproliferative effect of cyclopamine. Flow cytometry(FCM) was used to examine the effects of cyclopamine on the proliferation index(PI) and apoptosis index(AI) of SUIT-2 cells. Nude mice tumor graft model was used to determine the effect of cyclopamine on growth inhibition of tumor graft.Results：Cyclopamine produced time and concentration dependent antiproliferative effects on SUIT-2 cells. Cyclopamine could induce apoptosis and block cell cycle at G0／G1 phase. In cyclopamin treated SUIT-2 cells, the apoptosis index(AI) was 14.3±0.35, and proliferation index(PI) was 36.1±0.44; and in control group, the AI was 1.3±0.24, the PI was 52.3±0.28(all P<0.05）．In the nude mice model, cyclopamine produced apparent antiproliferative effect in concurrent treatment group, but had weaker effect in delayed treatment group. Conclusions：shh signaling pathway is essential for the maintaining of pancreatic cancer cell proliferation. Blocking shh pathway can inhibit the growth of pancreatic cancer cell and induce apoptosis.

Abstract:Abstract:Objective：To investigate the expression of 5-LOX in pancreatic cancer tissue and the relationship between expression of 5-LOX and COX-2. Methods：The expression of 5-LOXmRNA and COX-2mRNA in 35 fresh pancreatic cancer tissue samples were detected by semi-quantitive reverse transcriptase-polymerase chain reaction method. Results：Expression of 5-LOX mRNA and COX-2mRNA in pancreatic cancer tissue was 74.3%, 80%, respectively. Expressions of 5-LOX mRNA and COX-2 mRNA were not coordinated(P>0.05). There was correlation between the expression of 5-LOX and TNM stages. The expression of 5-LOX in stages III~IV of pancreatic cancer was markedly higher than that in stages I~II of pancreatic cancer（P<0.05）. Conclusions：Expression of 5-LOX and COX-2 in pancreatic cancer tissue was markedly elevated, and correlated with clinical stage. Expressions of 5-LOX and COX-2 in pancreatic cancer were not coordinated.

Abstract:Abstract:Objective：To observe the effect of antisense hypoxia inducible factor-1α(HIF-1α) on chemosensitivity of human pancreatic cancer cell line BxPC-3 under hypoxia. Methods：BxPC-3 cells were divided into 3 groups:(1)BxPC-3 cells were non-transfected with antisense HIF-1α plasmid and exposed to 0.5% O2 for 4hr (hypoxia control); (2)normoxic BxPC-3 cells were non-transfected with antisense HIF-1α plasmid (normoxia control); (3)BxPC-3 cells were transfected with antisense HIF-1α plasmid and exposed to 0.5% O2 for 4hr (experimental group). Expression of HIF-1α and survivin was detected by RT-PCR and Western Blot. Growth inhibition rates and apoptosis rates of BxPC-3 cells under different dosages of chemotherapeutic agents (5-fluorouracil, doxorubicin and gemcitabine) were measured by MTT colorimetric assay and flow cytometry (FCM). Results：Expression of HIF-1α was obviously down-regulated and at the same time survivin expression was markedly down-regulated in experimental group (P<0.05). Higher dosages (100 mg/L, 200 mg/L and 400 mg/L of 5-fluorouracil, 0.05 mg/L, 0.075 mg/L and 0.1 mg/L of doxorubicin, 10-9 mol/L, 10-8 mol/L and 10-7 mol/L of gemcitabine) caused a greater increase of inhibition in experimental group than in hypoxia control (P<0.05). Conclusions：The results demonstrate that antisense HIF-1α inhibits expression of survivin and enhances chemosensitivity of human pancreatic cancer cell BxPC-3. Blocking HIF-1α in pancreatic cancer cells may offer an avenue for gene therapy.

Abstract:Abstract:Objective：To study the relationship of expression of nuclear factor kappab gene and MMP-2mRNA and with lymph node metastasis of pancreatic cancer. Methods：The expression of NF-κB was investigated by Western blot in normal pancreatic(NP) samples of 9 cases and pancreatic cancer(PC) samples of 45 cases(lymph node metastasis 30 cases, non-lymph node metastasis 15 cases). The expression of MMP-2mRNA was detected through semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR). Results：Of 45 PC cases, the positive expression rate of p65 and MMP-2mRNA was 66.7%（30/45） and 57.7%（26/45），respectively. Of 30 cases of lymph node metastasis, the positive expression rate of p65 and MMP-2mRNA was 83.3%（25/30）and 73.3 %(22/30)， respectively. Of 15 cases of non- lymph node metastasis, the positive expression rate of p65 and MMP-2mRNA is 33.3%（5/15） and 26.7%（4/15）, respectively, and the expression of p65 gene was positively correlated with MMP-2mRNA expression（r=0.743,P<0.05）. Conclusions：The abnormal expression of NF-κB is closely associated with lymph node metastasis of PC. NF-κB is closely related to MMP-2，which indicated that NF-κB is involved in the lymph node metastasis of PC by mediating downstream gene expression.

Abstract:Abstract:Objective： To explore the effect and mechanism of kansui root on microcirculation of pancreatic tissues in severe acute pancreatitis(SAP) rats. Methods：SD rats were randomly divided into sham group (S group), SAP group and kansui root therapy group (K group). 40 rats in each group. Serum amylase, and thromboxame-B2(TXB2) ,6-Keto-F1α(6-Keto PGF1α)levels and expressions of cyclooxygenase-2(COX-2)mRNA and protein in pancreatic tissue, microscopy and election microscopy of pancreas,mortality within 72 hour after operation in each group were tested at 2h,6h,12h,and 24h after operation. Results：(1)The TXB2,6-keto PGF1α levels and the ratio of TXB2/6-Keto-PGF1α(T/P) in SAP group were all obviously higher than those in S group (P<0.01); the TXB2 levels and the ratios of T/P in K group at 6h,12h,and 24h were significantly lower than those in SAP group(P<0.01),but were significantly higher than that in S group (P<0.01).(2)Expression of COX-2 mRNA and protein were rare in S group, but expression in SAP group was significant. In K group expression of COX-2 mRNA at 6h and 12h and expression of COX-2 protein at 6h,12h,and 24h were significantly lower than those in SAP group(P<0.01 or P<0.05). (3)Correlation analysis :the ratio of T/P was significantly correlated to COX-2 protein expression in pancreatic tissue(P<0.01).(4)Microscopy and electron microscopy of pancreas: histologic structures of pancreas were normal in S group;hemorrhage, necrosis and abundant thrombosis in microvessels were observed in pancreatic tissue in SAP group; in K group the pancreatic injury was milder, and thrombosis in microvessels was decreased than that in SAP group.(5)Mortality within 72 hours in S group was 0%,in K group was 12.5%,both were significantly lower than that in SAP group (62.5%)(P<0.05). Conclusions：There was high expression of COX-2 and imbalance between TXA2 and PGI2 in SAP rats. Kansui root may reduce the expression of COX-2 and by correction of the imbalance between TXA2 and PGI2 which can improve the microcirculation of pancreas. This may be one of the mechanisms of the effect of kansui root in treating SAP in rats.

Abstract:Abstract:Objective：To investigate the changes of Toll-like receptor 2 and 4 gene expression in acute injury liver tissue of acute hemorrhagic necrotizing pancreatitis (AHNP) rats and the efficacy of intervention with chloroquine(CQ). Methods：Seventy SD male rats were randomly divided into Sham-operated group (n=10), AHNP group (n=30) and Chloroquine-treated group (n=30). Levels of serum amylase, ALT, AST, NO and TNF-α were detected. TLR2/4mRNA expression in the livers were measured by RT-PCR. Results： Comparing to sham-operated group, TLR2/4mRNA was markedly increased at 3 hours in liver tissues in AHNP group, peaking at 6～12 hours (P<0.05 ). As liver injuries were aggravated, the levels of serum amylase, ALT, AST and TNF-α were increased and the level of NO in livers was decreased (P<0.05 ). Treatment with CQ could effectively inhibit TLR2/4mRNA expression (P<0.05), and the degree of liver injuries was decreased, and the levels of serum amylase, ALT, AST and TNF-α were decreased and the levels of NO were also markedly increased (P<0.05 ). Conclusions：The expression of TLR2/4mRNA is increased in livers in AHNP. Up-regulation of TLR2/4mRNA expression in livers may be importantly involved in the pathogenesis and development of acute liver injury in AHNP rats. CQ may have protective effect against liver injuries induced by AHNP.

Abstract:Abstract:Objective：To study the effect of hyperbaric oxygen(HBO) treatment on plasma endotoxin, sCD14 and plasma endotoxin inactivation capacity(EIC) in acute necrotizing pancreatitis(ANP) in rats and its possible mechanism. Methods：SD rats were randomly divided into control group, sham operation group, ANP group and ANP+HBO group. Rat ANP models were made by retrograde injection of 3.5% sodium taurocholate(2.5mL/kg ) into the pancreatic duct. Thirty minues after models had been made, ANP+HBO group was treated by hyperbaric oxygen for 2h. At 3h, 6h, and 10h after establishment of rat models, the plasma endotoxin, sCD14, EIC, TXB2 and 6-K-PGF1a leves were determined in each group. Results：At 3h and 6 h after rat models were established, the levels of endotoxin, sCD14, and TXB2 in ANP+HBO group were significantly lower than those in ANP group （P< 0.05）;EIC level in ANP+HBO group was significantly higher than that in ANP group（P< 0.05）. Conclusions：Through improvement of microcirculation, HBO could increase the level of EIC and decrease the level of endotoxin and sCD14 in ANP rats.

Abstract:Abstract:Objective：To investigate the protective effect of losartan on acute ischemia-reperfusion(I/R) injury of pancreas in rats. Methods：Seventy-two Wister rats were randomly divided into 3 groups:（1）Control group;（2）Ischemia-reperfusion group:the anterior mesenteric artery and the celiac artery were occluded for 15 min,30min and 60min followed by 6 hours reperfusion;（3）Losartan group:losartan（40mg／kg）were administered by gavage at 12h and 1h before arterial occlusion. The pathologic changes of pancreatic tissue were observed under light microscopy; TUNEL was used to detect apoptosic of pancreatic cells;Bcl-2 expression in the pancreatic cells of rats was analyzed by immunohistochemistry technique. Results：Losartan treatment reversed the histological abnormalities including infiltration of inflammatory cells and atrophy of acinar cells.Compared with losartan group,pancreatic tissue of I/R group exhibited increased MDA［（20.1±1.2）nmol/g and （34.9±2.6） vs（17.9±2.1）nmol/g and （25.2±3.3）nmol/g,P<0.05］ and apoptosis［（10.2±3.2）％ and （18.4±3.1）％ vs. （6.5±2.9）％ and （10.5±4.3）％,P<0.05］.The administration of losartan increased expression of Bcl-2（11.3±2.2）％ and （16.2±2.7）％ vs （6.1±1.7）％、（10.3±2.1）％，P<0.05）.Conclusions：Losartan can decrease the pathologic changes and suppress cell apoptosis in pancreas of rats with I/R.

Abstract:Abstract:Objective：To investigate the effect of radiofrequency ablation (RFA) in the treatment of small liver cancer. Methods：In recent 6 years, 130 patients with primary or secondary liver cancer (≤5cm in diameter)were treated by RFA, among which 86 cases were primary, and 44 cases were secondary liver cancer. Among the 130 cases, 18 received RFA plus TAEC, and 20 had RFA combined with PEI. Results：Overall 1- and 3-year survival rate was 91.3% and 77.7% respectively. Complications occurred in 7 cases, including biliary fistula, intestinal fistula, and slight burn of skin. There was no death in this series. Conclusions：RFA is an effective and safe therapeutic approach for small liver cancer ≤5cm in diameter. Its effect may be similar to that of surgical resection.

Abstract:Abstract:Objective：To assess the application of the biofragmentable anastomosis ring（BAR） in intestinal anastomosis. Methods：One hundred and eighty-six patients who undergoing intestinal anastomosis were randomly allocated to biofragmentable anastomosis ring group (BAR group, n=92) and manual suture group (control group n=94). The restoration time of bowel fanctions, and the post-operative complications related to anastomotic site were recorded in each group. One hundred tweenty-seven patients with colonic carcinoma(62 patients in BAR group and 65 patients in manual group) were followed up post-operatively, and the incidence of inflammatory reactions at the anastomotic site was registered. Results：In 2 patients(2.17%) it was difficult to use the BAR procedure. One mortality was recorded in each group, but were not related to anastomotic procedure. In BAR group and manual group, post-operative bowel restoration time was 61.4±8.6h and 68.3±9.7h respectively(P>0.05). In BAR group and manual group, anastomotic leaks, anastomotic bleeding and obstruction occurred in 1, 2; 2,1 and 0,0 patients respectively(all P>0.05). Anastomotic inflammatory reaction occurred in 2 patients(3.2%) in BAR group and 13 patients(20.0%) in manual group. The difference was statistically significant(P<0.01). Conclusions：BAR is a safe and effective device for intestinal anastomsis.

Abstract:Abstract:Objective：To analyze and compare the effect of early surgical treatment and nonsurgical treatment for patients with severe acute pancreatitis. Methods：Acccording to the including criteria, five randomized controlled trials of this topic were enrolled into the analysis. The detail about the trial design, characters of the subjects, results of the studies were reviewed and analysed by using Revman 4.2 software. Results：Compared with nonsurgical treatment, early surgical treatment was associated with a significantly higher incidence of mortality (RR 3.42, 95% CI 1.81～6.47, P=0.0002) and complications (RR 3.16, 95% CI 2.15～4.64, P<0.00001), and with a lower cure rate (RR 0.83, 95% CI 0.75～0.92, P=0.0005). Conclusions：The findings suggest that for early severe acute pancreatitis, non-operative management should be selected routinely as the first choice of treatment and do not support operative treatment.