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Objective: To study the surgical management of solid-pseudopapillary tumor of the pancreas (SPTP) and its characteristics of outcome., Methods: Fifty-eight patients with SPTP of the pancreas admitted from January 2001 to December 2010 were retrospectively analyzed. There were 7 male and 51 female patients, with an average age of 30 years (ranging 9 to 70 years). Most patients were symptomatic before admission; the most common symptom was abdominal pain. Of the 58 patients, 21 patients underwent pancreaticoduodenectomy, 30 patients underwent distal pancreatectomy, 6 patients underwent central pancreatectomy, 1 patient underwent simple tumor enucleation, and 1 patients underwent duodenum-preserving pancreatic head resection., Results: The average length of stay in hospital was 23.8 days (ranging 12 to 64 days). Thirteen patients (22.4%) developed postoperative complications, including grade A postoperative pancreatic fistula of 8 cases, gastrointestinal tract bleeding of 1 case, pleural effusion of 2 cases, wound infection and fat liquefaction of 2 cases. Two patients underwent reoperation due to gastrointestinal tract bleeding or wound infection. There was no hospital death. Forty-four patients were followed-up for 7 to 136 months with an average of 41 months. All the 44 patients were alive, while 8 patients developed dyspepsia and 4 patients developed diabetes mellitus. There were no tumor recurrences or metastasis., Conclusions: SPTP is found primarily in young women. Excellent prognosis would be achieved with surgical resection.

Objective: To study the influence of the depth of jaundice, the duration of jaundice and preoperative biliary drainage (PBD) on postoperative complications and mortality after pancreaticoduodenectomy (PD)., Methods: A retrospective review was performed of the medical records of 1025 patients who underwent PD between June 1986 and December 2010. The patients comprised 659 men and 366 women, ranging from 4 to 81 years old with a mean age of (54 ± 12) years. The indications for PD were malignant disease in 869 patients (84.78%) and benign or borderline tumors in 156 patients (15.22%). The operative procedures performed were pylorus-preserving modification in 279 patients and conventional PD, i.e. Whipple's operation in 746 patients. Complications after PD were compared among the different groups which was classified according to the depth of obstructive jaundice, the duration of obstructive jaundice and whether undergoing preoperative biliary drain or not, and the analysis was made by variance analysis and χ(2) test respectively., Results: The depth of jaundice did not significantly affect the incidence of complications after PD except for the hemorrhage complication (χ(2) = 11.06, P = 0.03). The duration of jaundice had no much influence on the postoperative complications and mortality. PBD could not reduce the postoperative complications and mortality, however, it would increase the incidence of postoperative incision infection (χ(2) = 9.84, P = 0.01). No significant relationship was observed between the duration of PBD and the postoperative complications and mortality., Conclusions: Either the depth or duration of obstructive jaundice has no relationship with the postoperative complications and mortality after PD but the postoperative hemorrhage. Patients undergoing PD can not be benefited from PBD. Consequently, PBD should not be performed routinely, but it can be used in some serious patients with severe depth of jaundice who can not received surgery at once.

Objective: To evaluate the early results of precise liver resection., Methods: Between May 2006 and June 2009, 65 patients with complicated liver space-occupying lesions were included in the study. Fifty-one patients underwent curative liver resection. Liver resections performed included 16 trisectionectomies, 11 hemihepatectomy, 5 meso hepatectomies, 3 combined segmentectomies, 5 caudate lobectomies and 11 irregular local resections., Results: Patients undergoing resection had no mortality with a major morbidity of 9.8%. Nineteen vascular repairs and reconstructions were patent at last follow-up. The postoperative 1-year survival rate was 100% in 10 patients with benign lesions and 92.7% in 41 patients with malignant tumors. The 1-year survival rate was zero in patients with malignant tumors, who underwent no liver resection., Conclusions: Precise liver resection, as an aggressive surgical approach, offers hope for these patients, who would otherwise have a dismal prognosis.

Objective: To summarize the methods, safety and efficiency of surgical resection for hilar cholangiocarcinoma., Methods: The clinical and follow-up data of 48 patients with hilar cholangiocarcinoma underwent surgical resection from January 2003 to December 2007 were analyzed retrospectively. There were 26 male and 22 female, aged from 38 to 72 years old with a mean of 63.6 years old., Results: Perioperative management including percutaneous transhepatic biliary drainage applied in 19 cases and portal vein embolization applied in 2 cases. Eight patients were treated with extrahepatic bile duct resection with or without parital hepatic segment II resection, 10 cases with perihilar hepatic resection (segment IVB, partial V, partial VIII, I), 28 cases with extended hemihepatectomy and 2 cases with central hepatic resection (segment IVB, V, VIII, I). R0 resection rate was 89.5% and the operative mortality was 2.1%. The 1-, 3- and 5-year survival rate were 93.5%, 51.8% and 36.5%, respectively. Patients undergoing extended hepatic resection survived significantly longer than those undergoing partial hepatic resection (P = 0.034)., Conclusions: Extended hepatic resection for hilar cholangiocarcinoma offers good outcomes with an acceptable mortality rate.

Objective: To analyze operative and perioperative factors associated with hepatectomy in hepatolithiasis., Methods: 245 consecutive hepatolithiasis patients undergoing hepatectomy from January 1986 to December 2005 at Chinese People's Liberation Army General Hospital were investigated retrospectively according to medical documentation., Results: Hepatolithiasis accounted for 29.6% (245/827) in all benign liver diseases treated with hepatectomy during this time period. There were 88 cases in male and 157 cases in female, the average age was (46.9 +/- 11.3) years. Cases of right liver resection and hepatic segments resection were much more than that in 1963 - 1985. Blood transfusion during operation was given in 45.3% of cases. Complication incidence was 16.3%, with infection 3.3% and bile leakage 2.4%. Length of stay after operation was (15.7 +/- 9.2) days. Perioperative mortality rate was 0.4% (1/245)., Conclusions: Individualized hepatectomy is the important surgical treatment of hepatolithiasis. Hepatectomy can be performed safely with low mortality and low complication incidence, provided that it is carried out with optimized perioperative management and innovative surgical technique.

Objective: To analyze operative and perioperative factors associated with hepatectomy., Methods: 2008 consecutive patients undergoing hepatectomy from January 1986 to December 2005 at Chinese People's Liberation Army General Hospital were investigated retrospectively according to their medical documentation. Diagnoses were made on basis of pathological results., Results: Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively. In the former, primary liver cancer accounted for 76.1% and hilar cholangiocarcinoma for 6.7%. Hemangioma (41.7%) and hepatolithiasis (29.6%) were listed in the first two in the latter group with relatively more patient ratios. Isolated caudate lobe resection was performed in 25 patients and micro-wave inline coagulation was induced in 236 cases of liver resection. In all cases, those with blood loss less than 200 ml accounted for 50.5% (1015/2008), whereas those with more than 400 ml accounted for 28.4% (570/2008). In patients performed micro-wave inline coagulation liver resection, those with blood loss less than 200 ml and more than 400 ml accounted for 60.6% (143/236) and 19.9% (47/236), respectively, which differed significantly from the average level (P < 0.05). The postoperative complication incidence was 14.44% for all cases, 12.54% for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. Complication incidence of primary liver cancer with tumor size smaller than 5 cm was 11.65% and that with tumor larger than 10 cm was 14.69%. There was no significant difference between the two groups. All-case hospital mortality was 0.55% and that for liver malignant disease was 0.60%, hilar cholangiocarcinoma 2.53%., Conclusion: Hepatectomy can be performed safely with low mortality and low complication incidence, provided that it is carried out with optimized perioperative management and innovative surgical technique.

Objective: To investigate the related factors of portal vein tumor thrombosis (PVTT) in patients with HCC., Methods: A total number of 234 patients with hepatocellular carcinoma (HCC) were included in this retrospective study. Uni-variate and multi-variate logistic regression analysis were employed to analyze the association between PVTT and 18 routine clinical parameters., Results: Among the 234 patients with HCC, 15% of patients (35/235) had PVTT. Univariate logistic regression analysis revealed significant association of age (P = 0.016), gamma glutamyl transferase (GGT, P = 0.003), number of segmental invasion (P = 0.007), microvascular invasion (P < 0.01), segment location of S2 (P = 0.001), S3 (P = 0.000), S4 (P = 0.004) and S6 (P = 0.016). Multivariate analysis shows potential significant predictors of PVTT in HCC were age (RR: 0.373; 95% CI: 0.146-0.954; P = 0.040), the tumor location of S3 (RR: 4.625; 95% CI: 1.916-11. 165;P = 0.001), GGT (RR: 4.091; 95% CI: 1.448-11.553; P = 0.008) and microvascular invasion (RR: 20.912; 95% CI: 4.745-92.172; P < 0.01)., Conclusions: PVTT occurred more commonly in the younger (< 50 years old), and those with high level of GGT, segment location of S3 and microvascular invasion.

Objective: To analyze clinical typing, pathologic characteristics of hilar cholangiocarcinoma (HCCA) and surgical strategies and their effects on HCCA, and to explore the factors that influence the surgical outcomes and long-term survival., Methods: The data of the 402 patients with HCCA admitted between January 1993 and December 2004 was investigated retrospectively. Primary outcomes examined included clinical typing, pathologic characteristics, surgical procedures and follow-up results. On the basis of Bismuth-Corlette typing, we defined the tumor originated from intrahepatic large bile duct (LBD) as type V (type Va and Vb)., Results: Among the 402 patients with HCCA, 198 cases accepted curative resection, 102 (51.5%) for radical resection and 96 (48.5%) for palliative resection. Of the rest patients, 8 received orthotopic liver transplantation (OLT), 161 received simple drainage and 35 were not operated on. The resection rates for type I, II, IIIa, IIIb, IV, Va and Vb were 69.4%, 55.5%, 57.4%, 71.7%, 19.6%, 100% and 34.6%, respectively. The one-year survival rates for radical resection, palliative resection, simple drainage and untreated were 80.3%, 53.2%, 26.7% and 9.8%, respectively. And the three-year and five-year survival rates in the four groups were 41.9% and 33.3%, 19.6% and 14.7%, 3.3% and 0, 0 and 0, respectively. Significant difference was found in survival rates between the radical and palliative resection. In the patients who received tumor resection, the ones without lymph nodes metastasis (LNM) survived much longer than those with LNM (P < 0.05). Complications were found in 36.1% of the patients and the mortality rate was 0.3%., Conclusions: HCCA type V originated from intrahepatic LBD has higher resection rate and better prognosis. The tumor differentiation is significantly correlated with the prognosis after operation. With HCCA, resection is still the major treatment selection. Curative resection carries the best effect. Extended radical resection of liver lobes, blood vessels, lymph nodes can prolong survive. The problem of high recurrence rate after OLT for HCCA has not been solved yet.

Objective: To inquiry into clinical-pathological factors influencing cytological accuracy of pancreatic head lesions., Methods: Cytology was retrospectively evaluated in 94 inpatients with a mass in head of pancreas existing with chronic pancreatitis in the past decade, the results of cytology were compared with clinical pathology or clinical follow-up to estimate the value and accuracy of cytology in detecting pancreatic cancer. Pancreatic clinical-pathology includes size of mass and component of mass which was composed of cancerous mode of development including shape of conglomeration, nest and pervasion, and pancreatic ductal epithelium inside the vicinity of 1 cm around the mass. Pancreatic ductal epithelium were divided into PanIN1, PanIN2 and PanIN3 three types according to classified criterion of pancreatic intraepithelial neoplasia (PanIN)., Result: Forty-six patients were pathologically diagnosed as pancreatic cancer and five patients as chronic pancreatitis, accordingly, 29 malignant, 5 suspicious, 10 atypical hyperplasia among of them 5 malignant, 3 hyperplastic ductal epithelium, 1 nondiagnostic results due to interfered by blood and 3 insufficient specimens. 43 patients were clinically diagnosed as chronic pancreatitis. Cytologic evaluation of pancreatic cancer has an 84.2% accuracy less than or equal to 2.5 cm and 71.9% larger than 2.5 cm. Shape of conglomeration, and nest have more accurate than pervasion in cytological diagnosis., Conclusions: Cancerous mode of development is a vital factor influencing accuracy of cytology, cytological estimation of atypical hyperplasia and is still waiting for further investigation.

Objective: To summarize the experience in diagnosis, prevention and treatment of carcinoma arising from congenital biliary duct cyst., Methods: The clinical and pathological data of 185 patients with congenital biliary duct cyst admitted to Chinese PLA General Hospital were analyzed retrospectively., Results: Among 185 patients, twenty-seven cases had carcinomas arising from congenital biliary duct cyst, and the frequency of malignant transformation was 14.6%, which closely related to the age (P < 0.001). The incidences of malignancy for different age groups were: 0 for 0-9 age group, 5.1% for 0-19, 9.1% for 20-29, 16.2% for 30-39, 26.7% for 40-49, 33.3% for 50-59, and 50% for over 60, respectively. Six patients had the history of cyst-enterostomy. Abdominal pain, fever, jaundice and weight loss were the main clinical manifestations. Abdominal ultrasonography, CT, MRI or magnetic resonance cholangiopancreatography, MRCP and endoscopic retrograde choledochopancreatography (ERCP) were the main diagnostic methods. For twenty patients (74.1%), a definite diagnosis was made preoperatively, but it's hard to make an early diagnosis. Nine patients (33.3%) underwent curative resection., Conclusions: Congenital biliary duct cyst is a premalignant lesion, and the incidence of carcinogenesis increases remarkably with age. The most effective method for prevention of carcinogenesis in choledochal cyst is complete excision of choledochal cyst during childhood, and the prognosis is poor for patients with biliary malignancy.

Objective: To investigate the potential causes and preventive measures for blood loss in laparoscopic liver resection., Methods: The candidates for laparoscopic liver resections were 21 patients with liver lesions, including 13 patients with primary liver cancer, 2 patients with liver abscess, 3 patients with liver hemangioma, 1 patient with hepatic cellular adenoma, 1 patient with hepatic focal nodular hyperplasia, and 1 patient with infected liver cyst. They were classified as Child A in 16 and B in 5 patients., Results: Twenty-one patients with liver lesions underwent 23 laparoscopic resections uneventfully. Operating procedures included partial liver resection in 12 patients, segment IV in 1 case and anatomical left liver resections in 8 patients. Operation duration was 80 - 320 (mean 193.8 +/- 78.3) minutes. The blood loss in operation was 100 - 1000 (mean 333.1 +/- 291.4) ml. The postoperative hospital stay averaged 6.3 +/- 1.5 days, which was markedly shortened in comparison to conventional laparotomy liver resections. In addition, there was no complication in this series., Conclusions: Based on these preliminary results, occlusion of hepatic vessels with clamp is very important for partial liver resection. The key technique is to control the blood loss in operation. We conclude that laparoscopic liver resection is a prospective minimally invasive technique. These experiences suggest that laparoscopic procedures could be employed both in the treatment of benign and malignant tumors in selected cases.

Objective: In order to study the diagnosis and treatment of HBV and HCV infection., Methods: We retrospectively analysed clinical data of 680 patients with cholangiocarcinoma from 1995 to 2001 and stated by SPSS software., Results: (1) The fastigium of cholangiocarcinoma was 60 - 65 years old. The incidence of cholangiocarcinoma was higher in aged males and the sex ratio (male:female) was 1.36:1. (2) The proximal cholangiocarcinoma was most (41.6%) and distant cholangiocarcinoma was secondly (28.7%). (3) Most patients of cholangiocarcinoma were late. The resection rate was low and the rate of radical operation was 21.6% (147/680). (4) The incidence of proximal cholangiocarcinoma was higher in the positive Serologic marks for HBV and HCV and course of diseases was short. Moreover, the pathology of. positive Serologic marks for HBV and HCV trended to low-differentiation and invasion, metastasis and the resection rate was lower., Conclusions: Cholangiocarcinoma is common in the aged males. The infection of HB(C)V and hilar cholangiocarcinoma are correlated and incline to the proximal bile duct. The hilar cholangiocarcinoma infected HB(C)V may have higher malignant degree in biological characteristics and more badly prognosis.