Objective: To summarize the experience of human orthotopic liver transplantation (OLTx) in treatment of patients with end-stage hepatic disease and their perioperative management.
Methods: A retrospective analysis was made on OLTx performed in 77 patients from April 1993 to September 2001 in our department included combined liver-Kidney transplantation (6 patients) and living related liver transplantation (2). Among them, 76 were adults and 1 was infant (67 males and 10 females). The donors included 75 non-heart beating donors and 2 living related donors. Veno-venous bypass was used only in 45 cases during the operation. immunosuppressive agents consisted of cyclosporine, cellcept, ALG corticosteroids and FK506.
Results: The one-year survival rates of grafts and recipients with benign hepatic disease were 75%. The recipients this year are surviving with good function of grafts.
Conclusion: liver transplantation is the best therapeutic method for a large number of patients with end-stage hepatic disease in China.

The shortage of cadaveric livers has sparked an interest in adult live donor liver transplantation. Right lobe donor hepatectomy is frequently required to obtain a graft of adequate size for adult recipients. This procedure requires not only a precise understanding of liver anatomy and anatomic anomaly, but also the means of assessing them. This review focuses on the key points in adult live donor liver transplantation using the right lobe combined with our own experience in 81 cases including graft size, related anatomical anomaly and imaging evaluation of donor.

Bioartificial liver assist devices (BALs) offer an opportunity for critical care physicians and transplant surgeons to stabilize patients prior to orthotopic liver transplantation. Such devices may also act as a bridge to transplant, providing liver support to patients awaiting transplant, or as support for patients post living-related donor transplant. Four BAL devices that rely on hepatocytes cultured in hollow fiber membrane cartridges (Circe Biomedical HepatAssist(r), Vitagen ELADTM, Gerlach BELS, and Excorp Medical BLSS) are currently in various stages of clinical evaluation. Comparison of the four devices shows that several unique approaches based upon the same overall system architecture are possible. Preliminary results of the Excorp Medical BLSS Phase I safety evaluation at the University of Pittsburgh, after treating four patients (F, 41, acetominophen-induced, two support periods; M, 50, Wilson’s disease, one support period; F, 53, acute alcoholic hepatitis, two support periods; F, 24, chemotherapy-induced, one support period, are presented. All patients presented with hypoglycemia and transient hypotension at the start of extracorporeal perfusion. Hypoglycemia was treated by IV dextrose and the transient hypotension responded positively to IV fluid bolus. Heparin anticoagulation was used only in the second patient. No serious or adverse events were noted in the four patients. Moderate Biochemical response to support was noted in all patients. More complete characterization of the safety of the BLSS requires completion of the Phase I safety evaluation.

Objective: To investigate human cytomegalovirus infection and genetic variations in glycoprotein B (gB) in liver transplant recipients in south-east China.
Methods: EDTA-blood samples were obtained from 21 liver transplant recipients. The semi-nested PCR was used to amplify a region of high sequence variability in the gB gene of human cytomegalovirus (HCMV) followed by direct sequence analysis.
Results: Out of the 21 liver transplant recipients, 5 were proved HCMV Positive 62 to 180 days after transplantation. The nucleotide and encoded amino acid sequences were compared with published sequences of AD169 and Towne laboratory strains. Within the region sequenced, 2 out of 5 strains possessed a peptide configuration similar to that of strain AD169, while another 2 strains displayed a peptide configuration similar to that of strain Towne. One strain had amino acid substitution, which was different from those of both AD169 and Towne in the cleavage site.
Conclusion: Our results provide molecular epidemiological data for HCMV strains circulating among transplant recipients in south-east China.

Objective: To explore cytomegalovirus (CMV) infection in recipients of liver transplantation (LT).
Methods: 30 recipients of LT were screened for the appearance of CMV infection by using ELISA to test anti-CMV-Ab from serum samples and using immunohistochemistry method to test CMV antigen expression and nested-PCR to amplify CMV-DNA from blood samples.
Results: Four of 243 samples taken from 30 recipients came out positive of anti-CMV IgG and anti-CMV IgM with a positive rate of 100% and 1.6% respectively. 85 samples resulted in CMV antigen expression (35.0%) with the average antigen index being 4.2±3.1/5×10⁴ WBC. Besides, 99 samples were found to be positive by nested-PCR with a positive rate of 40.7%. 61 samples were found to be simultaneously positive in test of CMV antigen and DNA, with a rate of 25.1%.
Conclusions: Infection of CMV is common in recipients of LT. Simultaneous screening of anti-CMV-Ab, CMV-Ag and CMV-DNA after liver transplantation is very important for early diagnosis of CMV infection.

Objective: To explore the pathological features and the differential diagnosis of recurrent HBV after liver transplantation.
Methods: One case of liver transplantation for HBV cirrhosis was subjected to liver biopsises on time postoperatively.
Results: 25 days after liver transplantation, serologic HBsAg, HBeAg and HBV-DNA of the patient became negative, but HBsAg was positive again on day 58 after liver transplantation. Histopathological examination showed balloon-Like changes of hepatocytes with fragmental necrosis, fibrosis in the portal areas and around the portal veins, cholestasis in some hepatocytes and canaliculi, and positive HBsAg and HBcAg with immunohistochemical staining. clinically hepatic enzyme levels progressively increased, maintained for some Time, and decreased rapidly at last. Stubborn hypoproteinemia was associated with the aggregation of general condition of the patient.
Conclusions: Fibrosing cholestatic hepatitis (FCH) is a special type in recurrent infection of HBV after liver transplantation. It has a serious clinical process and specific pathological changes different from those of the usual HBV.

Background: Recurrence after resection of hepatocellular carcinoma (HCC) is a major obstacle to improve prognosis. Therefore, further improvement of long-term survival may depend on prevention and treatment of the recurrent tumor.
Objective: To evaluate the progress of surgery for HCC, the risk factors for recurrence, and clinical and basic studies on the prevention and management of recurrence and metastasis after resection of HCC.
Data sources: A review of currently available data in the mentioned areas.
Data synthesis: Encouraging changes in the prognostic pattern were observed when the primary liver cancer (PLC) data of 1958-1967 (n=118), 1968-1977 (n=356), 1978-1987 (n=715) and 1988-1997 (n=2038) were compared. The 5-year survival was 2.8%, 7.3%, 27.1% and 52.5%, respectively, and the 10-year survival 2.8%, 4.3%, 19.8% and 39.9%, respectively. Risk factors for recurrence included symptomatic patient, high γ-glutamyl-peptidase (γ-PGT), large tumor size, portal vein embolus, advanced tumor stage, etc. Active hepatitis activity in the nontumorous liver and perioperative transfusion enhanced the recurrence. Molecular research into the invasiveness of HCC identified some factors positively related to invasiveness, P16 and P53 mutation, H-ras, c-cerbB2, mdm2, transforming growth factor (TGF), epidermal growth factor receptor (EGF-R), matrix metalloproteinase-2 (MMP-2), urokinasetype plasminogen activator (uPA), its receptor (uPA-R) and inhibitor (PAI-1), intercellular adhesion molecule-1 (ICAM-1), vascular endothelial growth factor (VEGF), platelet-derived endothelial cell growth factor (PD-ECGF), and basic fibroblast growth factor (bFGF). In contrast, some factors were negatively related to HCC invasiveness: nm23-H1, Kai-1, tissue inhibitor of metalloproteinase-2 (TIMP-2), integrin 5, and E-cadherin. Re-resection of subclinical recurrence yielded a 5-year survival of 56.0% calculated from the first resection (n=202). Postoperative transarterial chemoembolization (TACE, n=103), hepatic artery cannulation during operation (n=105), postoperative biotherapy (n=49), and cryohepatectomy (cryosurgery followed by immediate resection of the frozen tumor, n=84) might decrease the recurrence rate, and the 3-year recurrence rate was 7.6%, 18.0%, 11.1%, and 30.1%, respectively. Minimal intraoperative blood loss and transfusion could reduce postoperative recurrence, although the exact mechanism remains to be elucidated.
Conlusions: HCC invasiveness is the major topic to be studied, particularly in the molecular level. Anti-angiogenesis, biotherapy, novel approach based on molecular findings, and multidisciplinary interventions might also be important for HCC.

Objective: To study the indications for resection of very big primary liver cancer and the operative results.
Methods: From January 1985 to June 1996, 86 patients with very big primary liver cancer (≥15 cm in diameter) underwent hepatectomy in our hospital. The volume of bleeding and blood transfusion was recorded during the operation. After the operation, the draining quantity from their abdominal cavities, and the days of transfusion and hospitalization were recorded. The occurrence of complications and survival time of the patient were followed up.
Results: The postoperative mortality was 3.48% and the occurrence rate of complications was 31.40%, which was significantly correlated with preoperative lower level of serum albumin or the elevated γ-globulin level and the amount of resected liver tissue. But their liver function before operation was fairly good, the 1-, 3-and 5-year survival rates after hepatectomy were 58.2%, 35.7% and 17.64%.
Conclusions: patients with very big primary liver cancer, should be subjected to hepatectomy if their liver function before operation are normal and the margins are distinct between the tumor and liver tissues. After the operation, other treatments are suitable for good effects.

Objective: To discussthe safety and feasibility of hepatectomy for huge primary liver cancer (PLC).
Methods: The effect of resection of huge PLC was examined retrospectively. Some problems in resection of huge PLC were discussed.
Results: Of 375 patients with huge PLC undergoing hepatectomy, 11 (2.9%) died in one month after operation. The 1-, 2-, 3-, 5-and 10-year survival rates of the patients were 63.3%, 45.6%, 34.7%, 16.5% and 1.8%, respectively. The effect of prolonging survival time was significant.
Conclusion: Hepatectomy for huge PLC is safe, feasible, and effective.

Objective: To investigate the experience and some related problems of non-bleeding technique in partial hepatectomy.
Methods: 49 cases of hepatic tumors were reviewed, including 41cases of hepatic carcinoma, 3 cases of secondary hepatic carcinoma, 4 cases of haemangioma, and 1 case of hepatic adenoma. Three kinds of bleeding control technique including normothermic complete hepatic vascular exclusion (47/49), complete vascular isolation with hypothermic perfusion (1/49), and partial extracorporeal hepatectomy (1/49) were employed.
Results: The intraoperative volume of blood loss was 1560±1252 ml, and operative duration was 4.7±0.8 h. One case died perioperatively because of severe bleeding. 31 cases of primary hepatic carcinoma were followed up, the 0.5-, 1-, and 5-year survival rates were 77% (24/31), 55% (17/31), and 36% (11/31) respectively.
Conclusions: in liver surgery concerning hepatoma in the segment of Couinaud I, IV, V or VIII, Pringle’s procedure is still the major method for bleeding control. When the vena cava or/and venae hepaticae was/were implicated, normothermic complete hepatic vascular exclusion is helpful. The partial extracorporeal technique can provide a good exposure to the cava inferior, and is an alternative to the complete extracorporeal method. Intraoperative B ultrasound detection plays an important role in choosing bleeding control technique.

Objective: To evaluate the tolerance limit of rats to normothermic hepatic inflow occlusion under portal blood bypass.
Methods: A new rat model of normothermic hepatic inflow occlusion under portal blood bypass was established by clamping temporarily the pedicles of all liver lobes while the caudal lobe was kept as a passage of the portal blood flow. After hepatic blood flow restored, the caudal lobe was cut off. On the 7th postoperative day, survival rate, hepatic morphological changes, and the severity and reversibility of the injured energy metabolism of the liver were investigated.
Results: All rats that had been subjected to 30, 60 and 90 minutes of hepatic inflow occlusion under portal blood bypass survived on the 7th postoperative day. ischemia-reperfusion injury of the liver was reversible and compensatory in rats with hepatic inflow occlusion within 90 minutes. However, the survival rates of rats with 100, 110 and 120 minutes of hepatic inflow occlusion were 50%, 30% and 20% respectively. Liver injury of rats with 120 minutes of hepatic inflow occlusion was severe and Irreversible.
Conclusions: The tolerance limit of rats to normothermic hepatic inflow occlusion is enhanced significantly under portal blood bypass and the upper limit is 90 minutes.

Objective: To clarify the association of hepatitis B virus mutants in precore and core promoter regions in patients with hepatic failure and HBeAg state.
Methods: precore and core promoter regions of 25 HBV isolates from the patients with hepatic failure were analyzed by polymerase chain reaction (PCR) direct sequencing approach.
Results: precore G-to-A¹⁸⁹⁶ mutants were iden tified in 16 (64%) of the 25 isolates. The “hot spot” mutations at A-to-T¹⁷⁶² and G-to-A¹⁷⁶⁴ were present together in 19 (76%) of the 25 isolates, while C-to-T¹⁶⁵³ and T-to-C¹⁷⁵³ eXisted in a mutually exclusive manner and more frequently in hepatic failure with liver cirrhosis group than in hepatic failure with chronic hepatitis group (100% vs 50%). Both A¹⁸⁹⁶ and T1762-A¹⁷⁶⁴ could be found frequently in HBeAg-positive subjects (77.8% and 88.9%), whereas T¹⁶⁵³/C¹⁷⁵³ was more prevalent in anti-HBe-positive subjects than in HBeAg-positive subjects (93.8% vs 33.3%).
Conclusions: The whole frequency of mutations in precore and core promoter gene will become more frequent as HBV infection is to be persistent. Mutation to T¹⁶⁵³/C¹⁷⁵³ may be useful as a marker for hepatic failure. It requires further study whether the mixed infection of mutants and wilds will develop and affect the condition of HBeAg in serum along the progression of liver disease.

Objectives: To evaluate the value of the arterial Phase (AP) of biphase enhanced spiral CT (SCT) in the diagnosis of small HCC and to investigate the criteria, initial time, ending time and duration of AP.
Methods: From May 1995 to March 1999, patients with small HCC proved surgically and pathologically including 49 patients (n=53) in group A, 148 (n=186) in group B and 52 (n=52) in group C were collected. Biphase dynamic enhanced SCT scans were performed in all patients of the three groups and additional single-level dynamic scans only done in the group C. The detectability, diagnostic accuracy of lesions and enhancement of the lesions in AP were analyzed statistically. In addition, the initial time, ending time and duration of AP were measured.
Results: The results of the group A showed the detectability of small HCC was 88.68% in AP and 90.57% in both Phases, higher than those by ultrasound. Markedly enhanced lesions in AP accounted for 76% and 78% in the groups B and C respectively. The initial time, ending time and duration of AP measured on single-level dynamic scans were 16.9 s, 39.6 s and 22.7 s on average respectively.
Conclusions: The biphase dynamic SCT especially its arterial phase appears to be very valuable in diagnosing small HCCs. In light of short duration of AP, understanding and strict control of AP is obviously imperative.

Objective: To detect circulating hepatocellular carcinoma by demonstrating hepatocellular carcinoma cells or hepatocyte-associated mRNA in the nuclear cell component of peripheral blood (PBL).
Methods: Peripheral blood (5 ml samples were obtained from 93 patients with hepatocellular carcinoma (HCC) and from 33 control subjects (9 with liver cirrhosis after hepatitis B, 14 with chronic hepatitis B, 10 with normal liver function). To identify HCC cells in Peripheral blood, liver-specific human alpha-fetoprotein (AFP) mRNA was amplified from total RNA extracted from whole blood by reverse transcription-polymerase chain reaction.
Results: AFPmRNA was detected in 50 blood samples from the HCC patients (50/93, 53.8%). In contrast, there were no clinical control patients whose samples showed detectable AFPmRNA in PBL. The presence of AFPmRNA in blood seemed to be correlated with the stage (by TNM classification) of HCC, the serum AFP value, and the presence of intrahepatic metastasis, portal vein thrombosis, tumor diameter and/or distant metastasis. In addition, AFPmRNA was detected in the blood of 21 patients with metastasis at extrahepatic organs (100%) in contrast to 29 (40.3%) of 72 patients without metastasis.
Conclusion: The presence of AFPmRNA in peripheral blood may be an indicator of malignant hepatocytes, which might predict hematogenous spreading metastasis of tumor cells in patients with HCC.

Objective: To find out an optimal condition for isolation and primary culture of hepatocytes.
Method: Rat hepatocytes were isolated by a two-step collagenase perfusion, and cultured in hepatozyme-SFM. The reduction of MTT to formazan salt was examined. Supernatant medium was collected for analysis of alanine amino transferase (ALT) and ureagenesis.
Results: The two-step collagenase perfusion yielded 39±12×10⁶ cells/g liver tissue with a viability of 88%±2%. Fine morphology and stable urea synthesis for one week could be achieved when hepatocytes were cultured in hepatozyme-SFM.
Conclusion: High yield of hepatocytes can be isolated with two-step collagenese perfusion. Hepatozyme-SFM is suitable for sustained growth of hepatocytes.

Objective: To study the significance of E-selectin and its ligand-sLeX in the metastasis of hepatocellular carcinoma (HCC).
Methods: Flow cytometry and immunohistochemistry were used to detect the expression of E-selectin and its ligand-sLeX in both HCC cell lines and human HCC tissues.
Results: The positive rate of E-selectin in vascular endothelial cells adjacent to cancer was 67.9% (19/28). The expression of E-selectin in tumors accompanied with emboli or satellite foci was significantly higher than that in tumors without emboli or satellite foci (P<0.05), and it was not related to tumor size, tumor capsule, AFP content, and the degree of differentiation. The positive expression of sLeX in SMMU-7721, PLF/PRF/5 and HepGII cell lines was 7.03%, 63.35% and 97.29% respectively. The positive cells of sLeX mainly distributed in the margin of  tumor tissues. The positive expression of sLeX in HCC cells in emboli or invasive tumor tissues was much higher than in Primary foci.
Conclusion: E-selectin and its ligand-sLeX are closely correlated with the metastasis of HCC.

Objective: To investigate the age range, liver function damage and prognosis of patients with sporadic acute hepatitis A and E in Beijing.
Methods: Enzyme immunoassay (EIA) was used to detect anti-HAV and anti-HEV immunoglobulin M (IgM). Serum samples were collected from the patients with sporadic acute viral hepatitis in Beijing from January 1995 to June 2000.
Results: The total Positive rate for anti-HAV and anti-HEV IgM was 55.2% (112) in 203 patients with acute hepatitis, of whom 22.2% (45 patients) and 33.0% (67) were positive for anti-HAV and anti-HEV respectively. The duration of anti-HEV IgM was 45-60 days and that of anti-HAV IgM was at least 2-3 months. The patients with acute hepatitis A and hepatitis E all experienced jaundice and a rising of liver enzyme, but did not develop chronic hepatitis or died.
Conclusion: Acute hepatitis A as well as acute hepatitis E plays an important role in sporadic enterically transmitted hepatitis in Beijing.

Objective: To study the function of augmenter of liver regeneration (ALR) as a regulatory factor that specifically stimulates hepatic cell regeneration, we constructed yeast expressive vector of ALR and expressed it in yeast cells.
Methods: Total RNA was extracted from HepG2 cells, and reverse transcription polymerase chain reaction (RT-PCR) was performed to amplify the coding region of ALR. The products were cloned into PGEM-T vector and sequenced, then cloned into PGBK T7 vector. The recombinant plasmid PGBK T7-ALR was transformed into yeast AH109. The yeast protein was extracted and analyzed by SDS-polyacrylamide gel electrophoresis (SDS-PAGE) and Western blotting hybridization technique.
Results: DNA sequencing results confirmed that the coding region of ALR was correctly inserted into the yeast expression vector, and Western blotting assay showed that recombinant ALR was successfully expressed in yeast. Its molecular weightwas identical to the theore tical value of 15 000 Da; the pro tein was found inside the yeast cells.
Conclusion: The successful expression of ALR in yeast cells makes it possible to study further on its Biological function.

Objective: To explore the operative procedure for patients with Primary liver cancer associated with portal hyper tension (PLCPH).
Methods: We analyzed retrospectively the effect of operative procedure for 9 patients with PLCPH complicated by severe esophageal varicosity and hypersplenism.
Results: All patients underwent liver resection and pericardiac devascularization with splenectomy. Of the 9 patients, 2 died from liver cancer recurrence separately 13 and 16 months after operation, and 1 died from massive duodenal ulcer bleeding and multiple organs failure. Six patients survived 3, 4, 8, 10, 12 and 25 months after operation.
Conclusions: The patients with PLCPH undergoing simultaneous operation could acquire curative effect as compared with those who underwent liver resection. This operation is beneficial to the patients with poor liver function.

Objective: To study the significance of detecting autoantibodies in primary hepatocarcinoma (PHC) patients.
Methods: Autoantibodies were detected by indirect immunofluorescence assay. Antigens and antibodies of HBV were determined by enzyme immune assay. Antibody to HCV IgG was detected by enzyme-linked immunoabsorbent assay.
Results: The positive rate of autoantibody was 27.3% (38/139) in 139 PHC patients. The main type of autoantibodies in PHC was anti-nuclear antibody (36/38, 94.7%), others included anti-smooth muscle antibody(2/38, 5.3%), anti-mitochondria antibody (1/38, 2.6%), anti-midbody antibody (1/38, 2.6%, and anti-liver cell membrane antibody (2/38, 5.3%).
Conclusions: Detecting autoantibodies in PHC patients is of significance in studying the mechanism of autoimmune reaction and etiology in PHC. The diversity of autoantibodies might result from a wide variety of etiological factors involved in PHC development, and from a wide variety of overexpressed or mutated proteins involved in repeated cycles of necrosis and regeneration in hepatocarcinoma development.

Objective: To observe the effects of S-adenosylmethionine (SAMe) in the treatment of cholestasis after total parenteral nutrition (TPN).
Methods: Thirty SD rats were randomly divided into control group, hypercalorie group, hypercalorie+SAMe group, sepsis group and sepsis+SAMe group to compare their states of cholestasis. Six teen patients received SAMe because of cholestasis after prolonged TPN, and the therapeutic efficacy was observed.
Results: Bile flow was obviously decreased and the serum levels of total bile acid and gamma-glutamyl transpeptidase (γ-G T) were markedly increased in the hypercalorie and sepsis groups. Meanwhile, hepatocyte fatty degeneration, dilatation of cholangioles, and bile sludge could be seen microscopically. SAMe administration in the hypercalorie+SAMe and sepsis+ SAMe groups could increase the bile flow, decrease the serum levels of total bile acid and γ-G T, reduce the pathological damage to the liver, and clear the bile sludge in the cholangioles. Cholestasis and abnormal liver function were the main manifestations of the 16 patients before SAMe administration. After SAMe treatment for 3 weeks, serum levels of total bilirubin, alkaline phosphatase (AKP), γ-G T, alanine amino transferase (ALT), and aspartate amino transferase (AST) were obviously decreased, and normalized in the 4th week.
Conclusion: SAMe could prevent and treat cholestasis without discontinuation of TPN.

Objective: To assess the safety and effect of endoscopic sphincterotomy (EST) and endoscopic Papillary balloon dilatation (EPBD) for choledocholithiasis.
Methods: 328 patients with choledocholithiasis were subjected to EST or EPBD; they included 174 patients with single stone, 112 patients with two stones and 42 patients with three stones (one patient with 20 stones). Patients with stones less than 10 mm in diameter underwent EPBD and those with stones larger than 11 mm in diameter underwent EST.
Results: EST and EPBD succeeded in 323 patients (98.5%), and failed in 5. Stones in 98 patients were excluded spontaneously after endoscopic therapy. 207 patients were subjected to basket or balloon stone extraction. Stones in 14 patients were discharged by basket lithotripsy. Four patients were given wave lithotripsy. Stones in 22 of the 323 patients were extracted thoroughly after 2-3  Times attempts. Total complications were noted in 2.5% of the patients. Hemorrhage from the gastrointestinal tract was seen in one patient, cholangitis in 4 patients, and pancreatitis in 3 patients. In92 patients receiving digestive tract barium X-ray examination, 86 developed no barium reflux to the baliary tract, 2 pneumobilia, 4 barium reflux to the biliary tract.
Conclusion: EST and EPBD are relatively safe and effective in treatment of choledocholithiasis, and have few complications.

Objective: To evaluate the role of simple non-image technique in intraoperative diagnosis of bile duct injury (BDI).
Methods: BDI was highly suspected at the original laparoscopic cholecystectomy (LC) when the following 3 abnormal findings were noted: the “cystic duct” stump (the common bile duct stump actually) markedly retracted down to the duodenum; bile leakage from the porta hepatis; abnormal mucosal Patch attached to the “cystic duct” stump of the removed gallbladder. All cases of suspected BDI were converted to have laparotomy. image techniques such as intraoperative cholangiography or ultrasonography were not utilized for recognition of BDI in all 9 patients.
Results: BDI in 4 of the 9 patients was suspected according to 1-3 abnormal intraoperative findings described above. The four patients were subjected immediately to converted laparotomy. Abnormal findings were not observed or misinterpreted in the other 5 misdiagnosed patients.
Conclusions: Timely recognizing whether BDI occurs should be considered as a routine procedure of LC. Negligence of operators to the abnormalities of the original LC, is the main cause of misdiagnosis for BDI. Simple non-Image approaches such as close observation of these abnormalities can make timely diagnosis for most BDIs during the original LC.

Objective: To determine the causes of choledochal dilatation in patients with obstructive jaundice.
Methods: One hundred and sixty-four patients with obstructive jaundice were investigated by endoscopic retrograde cholangiopancreatography(ERCP), and patients with choledochal dilatation (group I, n=110) were compared with those without choledochal dilatation (group II, n=54).
Results: The causes of common bile duct dilatation were choledocholith, juxtapapillary duodenal diverticula and congenital dilatation of the common bile duct. The distal common bile duct and its surroundings were abnormal in 104 (94.55%) of the 110 patients and in 13 (24.08%) of the 54 patients (P<0.01). Juxtapapillary duodenal diverticulum accounted for 24.55% in group I, and only in 9.26% in group II (P<0.05). Post-cholecystectomy patients were 13.64% in group I, and only 5.56% in group II.
Conclusions: The abnormalities of the distal common bile duct and its surroundings can usually be detected as underlying causes of common bile duct dilatation. ERCP is necessary Before cholecystectomy, since it is considered the “gold standard” for the diagnosis of distal common bile duct abnormalities.

Objective: To explore the indications and the value of endoscopic retrograde cholangiopancreatography (ERCP) in perioperative phase of laparoscopic cholecystectomy.
Methods: From January 1998 to April 1999, a total of 1500 consecutive laparoscopic cholecystectomies were analyzed. The indications for preoperative group (n=33) included elevated bilirubin level and alkaline phosphatase level, jaundice, pancreatitis, abnormal liver function, dilated bile duct and/or stones on ultrasound or CT. The indications for postoperative group (n=20) included clinical signs or symptoms as well as common bile duct stones demonstrated by intraoperative cholangiography.
Results: preoperative ERCP for 32 patients (2.1%) showed abnormalities in 12 (37%). Postoperative ERCP for 20 patients (1.3%) demonstrated abnormalities in 14 (70%). Super-selected criteria for preoperative ERCP would predict more than 66% ductal stones. Endoscopic sphincterectomy and duct stones clearance were performed in all 16 patients with documented common bile duct stones. The morbidity was confined in 2 patients with self-limited pancreatitis (3%).
Conclusions: Using super-selected creteria to select patients for preoperative ERCP can avoid unnecessary ERCP. As soon as postoperative patients have clinical signs or symptoms, endoscopic treatment should be performed.

Objective: To overview the different surgical approaches for the resection of pancreatic cancer and our experience with these techniques.
Methods: Surgical procedures including the Whipple resection, Pylorus-preserving resection, total and subtotal panreatectomies, regional pancreatectomy and the extended lymph node resection were discussed.
Results: Studies have shown that no operation seems to produce significantly improved results in terms of survival, mortality and resection rates compared to the standard Whipple resection and pylorus-preserving duodenopancreatectomy.
Conclusion: Despite the progress in the surgical treatment of pancreatic cancer, the overall prognosis after resection remains unsatisfied. Surgery is likely to be optional for the treatment of pancreatic cancer.

Objective: To evaluate retrospectively the relationship between the types of operation, characteristics of tumor, and survival rate after radical pancreatoduodenectomy for patients with carcinoma of the pancreatic head performed in recent 30 years.
Methods: Of 377 patients with carcinoma of the pancreastreated during 1970-1999, 75 were subjected to Whipple procedure or pancreatectomy with dissection of regional lymph nodes 910 patients receiving intervention therapy). The latter is beneficial to patients with carcinoma of the pancreatic head. The operation may be extended by resection of a segment of superior mensenteric-portal vein confluence if involved.
Results: The resection rate was increased from 9% in the 1970s to 28.2% in the 1990s. The 1-, 3-, 5-year-survival rates were 50%, 25%, 0 in the 1970s; 57.1%, 28.5%, 9% in the 1980s; and 61.1%, 27%, 11.1% in the 1990s, respectively.
Conclusion: Despite its retrospective in nature, the present study suggests that in patients with pancreatic cancer without visceral or distant metastasis, resection should always be at tempted when there is no high operative risk factor and the operation is  technically feasible.

Objective: to investigate the operative timing and indications for severe acute pancreatitis SAP.
Methods: Data collected from 172 patients with SAP treated in our hospital since 1980 were analyzed retrospectively.
Results: In the 94 patients who had undergone early operation before June 1992, 57 (62.8%) healed 35 (37.2%) died and 16 (17.0%) had no postoperative complications. In the 78 patients who had been treated after July 1992 according to the principle of “individualization” 66 (84.6%) healed 12 (15.4%) died and 37 (47.4%) had no postoperative complications. In the 78 patients 32 received non-operative treatment but 30 (93.8%) cured 12 early operation but 7(58.3%) cured 18 late operation but 13 (72.2%) cured and 16 selected time operation but all cured.
Conclusions: IT is concluded that individualized therapy is effective and reasonable for treating SAP. The indications for early late and selected time operation should be emphasized.

Objective: To investigate the procedure choice of palliative operation for carcinoma of the head of the pancreas (CHP).
Methods: The clinical data from 187 patients with CHP treated in the last 20 years were analyzed retrospectively.
Results: The operation mortality rate was 8.6%, the mortality of hepatic duct-jejunostomy (HDJS) was not higher than that of cholecystojejunostomy (CJS) (P>0.05). The postoperative relapse of jaundice and cholangitis was significantly lower than that of CJS (P<0.025), while the survival was apparently higher than that of CJS (P<0.01). The mortality of HJDS or CJS with gastrojejunostomy (GJS) was not significantly higher than that of the simple procedure without GJS (P>0.05), whereas the survival was significantly higher than that of the simple procedure without GJS (P<0.01). The occurrence of duodenal obstruction after HDJS or CJS was 29.3%.
Conclusion: As a palliative operation, Roux-en-Y choledochojejunostomy especially in combination with preventive gastrojejunostomy is strongly recommended.

Objective: To study the methods for diagnosis and treatment of insulinoma.
Methods: clinical data from 105 patients with insulinoma who had been admitted to our hospital from July 1966 to December 1999 were retrospectively reviewed.
Results: Fasting blood glucose values were less than 2.75 mmol/L in all the patients. Fasting serum insulin values in 60 patients were higher than 25 mU/L, average 65 mU/L. Before operation, carcinoma was detected in 2 of 45 patients by ultrasound scan, and in 10 of 35 by CT. Enucleation of insulinoma was performed in 60 patients. Operations included insulinoma resection (35 patients), distal resection of the pancreas (8), and biopsy (2).
Conclusion: Whipple’s triad and the index of insulin release >0.3 are the major variables for diagnosis. Intraoperative exploration and ultrasound scan are the methods for the localization of insulinoma. Enucleation of benign insulinoma is preferred, but proximal or distal resections of the pancreas are required only for large, deep or multiple tumors.

Objective: To explore the changes of plasma endothelin (ET) and nitric oxide (NO) levels in patients with acute pancreatitis.
Methods: The level of plasma ET was measured by radioactive-immunoassay, and NO by spectrophotometry.
Results: The levels of ET, NO and the ET/NO ratio in patients with severe acute pancreatitis (SAP) within 24 hours in hospital were all significantly higher than those in other groups of patients [(176±8) pg/ml, (97±11) μmol/L, and 1.83±0.12, P<0.01] . Compared to healthy controls (N), the levels of ET and NO in patients without pancreatitis acute abdomen (NAP) and patients with mild acute pancreatitis (MAP) increased significantly (P<0.01). After appropriate treatment, the levels of ET and NO in the MAP group were lower (P<0.01). Compared with those Before treatment, the levels of ET and NO in the SAP group on the 3rd and 7th day in hospital dropped significantly (P<0.01). The ET/NO ratio on the 7th day was also lower than that on admission (P<0.01).
Conclusions: The malfunction of endothelial cells and the increased ET/NO ratio may be related to the mechanism of pancreatic microcirculatory disturbance in patients with SAP; early dynamic determination of these parameters may help predict the prognosis of SAP.

Objective: To retrospectively analyze 85 hospitalized nonoperative patients with severe acute pancreatitis (SAP) and to find out the stages of the disease.
Methods: We statistically calculated the time of onset of complications in these patients from 1987 to 1999.
Results: The 95% confidence interval of total average for the complications of acute respiratory distress syndrome (ARDS), shock and kidney failure was between 2 to 4 days, and for encephalopathy, hemorrhage of the digestive tract, bacterial infection, fungous infection and abscess between 3 to 6 days, 3 to 5 days, 13 to 16 days, 13 to 16 days, and 14 to 23 days respectively. The 95% confidence interval of total average in 18 deaths (21%) was between 5 to 6 days. ARDS, kidney failure, and shock occurred within 4 days, encephalopathy within 6 days (average 4.8±0.9 days), abscesses after 14 days, systemic bacterial infection and fungous infection within half a month (average 14.6±1.1 days, 14.8±0.9 days respectively), and death within 6 days.
Conclusion: According to the time of the occurrence of complications, we divide the courses of the disease into three stages: early phase (first 4 days) with ARDS, kidney failure, shock, encephalopathy and hemorrhage of the digestive tract; middle phase (5-15 days) with bacterial infection and fungous infection; late phase (15 days after the onset) with abscess.

Objective: To observe the role and the timing of EN in the treatment of patients with severe acute pancreatitis (SAP).
Methods: Eleven patients with severe acute pancreatitis underwent systemic nutrition support were studied. EN was given through jejunostomy tube (or Bengmark tube) after a period of PN maintenance. EN started when serum and urine amylase activity returned to normal with regular peristaltic sound, defecation or break wind. The sequence of preparation was as follows: saline glucose→chemically defined diet→polymeric diet→normal diet.
Results: In all the patients, none died. The rate of late complications was lower, and the levels of serum albumin and transferritin significantly increased in the post-EN Period as compared with the pre-EN period, although the count of lymphocytes was less changed.
Conclusions: Nutritional support should be transformed from PN to EN as early as possible during the treatment of patients with severe acute pancreatitis. EN could not only continue sufficient nutritional support, but also avoid the unfavorable effects of long-time PN, thus reducing complications as well as mortality.

Objective: To evaluate the effect of early intrajejunal nutrition in attenuating bacterial and/or endotoxin translocation and improving gut barrier function of severe acute pancreatitis (SAP) in dogs.
Methods: 15 dogs were divided into parenteral nutrition (PN) group (7 dogs) and early intrajejunal nutrition (EIN) group (8). EIN was delivered nutrients via a needle jejunostomy catheter feeding at 48 h after operation. SAP model was induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and 8000-10 000 BAEE units trypsin/ml into the pancreas via the pancreatic duct. Systemic blood samples were obtained Before and 1, 3, 5, 7 d following SAP, and cultured by aerobic as well as anaerobic bacterial growth. Systemic plasma and portal vein endotoxin levels were quantified by the chromogenic limulus amebocyte lysate (LAL) technique. Portal vein blood and specimens of tissue from the mesenteriolum and mesocolon lymph nodes, lung, pulmonary portal lymph nodes, pancreatitistissue and periopancreas tissue were adopted Before the experiment was finished. Aliquots of the homogenata were cultured as blood mentioned above to determine the magnitude of the bacteria. DNA, protein and the villi, the thickness of mucosa, and the whole bowel wall of the ileum and transverse colon were measured.
Results: The study showed that the levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and systemic blood and distant organ were reduced significantly in the EIN group as compared with the TPN group. The contents of Protein and DNA, the height of villi, the thickness of mucosa and whole bowel wall of the ileum and transverse colon in the EIN group were higher than those in the PN group.
Conclusion: Our results suggested that EIN is safe and effective to be adopted by intrajejunal delivery of nutrients in SAP, decreases the occurrence of gut bacterial translocation, and improves the gut barrier function.

Objectives: To clarify the inhibition of pancreatic cancer cells by interference with the hTR component of the telomerase reverse transcriptase enzymatic complex and evaluate susceptibility of antisense hTR pancreatic cancer cellsto chemotherapeutic reagents.
Methods: A 593 bp of full length hTR cDNA was subcloned into a mammalian expression vector pcDNA3.1(-) in antisense orientation to construct an antisense hTR expression plasmid. The plasmids were introduced into Pancl cells, a human pancreatic carcinoma cell line, by lipofectin, and G418-resistant stable transformants were expanded. Resulting stable clones were screened for the presence of hTR insert by PCR with T7 and BGH reverse primers located on the flanks of the multiclonal site of pcDNA3.1 vector. Cell growth rate, hTR expression, telomerase activity, and anchorage-independent growth property were analyzed. Finally, susceptibility of antisense hTR cellsto chemotherapeutic reagents was evaluated.
Results: Significant downregulation of endogenous hTR was evident in the antisense-hTR transformed cells, and telomerase activity was markedly decreased compared to control cells in standard TRAP assays. Furthermore, the proliferation and the anchorage-independent growth ability in antisense-hTR expressing cells were significantly decreased compared with the control parental cells. However, no crisis or senescence phenomena was observed. Antisense hTR appearsto increase Pancl cell’s susceptibility to chemotherapeutic reagent cDDP, but not to differentiation reagent DMSO, COX2 inhibitor sulinbac, NS-398, curcumin, and chemotherapeutic reagent adriamycin (ADM).
Conclusions: These data indicate that hTR is probably a critical component of human telomerase activity and that downregulation of the RNA component of human telomerase is an effective target for anticancer strategy and antisense hTR can increase Pancl cell’s susceptibility to cDDP.