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    25 November 2020, Volume 25 Issue 06 Previous Issue    Next Issue
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    Editorial
    Pancreaticobiliary junction: another evolutionary defect in human
    TIAN Fuzhou
    2020, 25 (06):  453-455.  DOI: 10.16139/j.1007-9610.2020.06.001
    Abstract ( 138 )   HTML ( 2 )   PDF (392KB) ( 150 )  
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    Experts forum
    Long-term complications after endoscopic sphinctectomy: sphincter Oddi dysfunction and treatment
    ZHANG Cheng, YANG Yulong
    2020, 25 (06):  460-463.  DOI: 10.16139/j.1007-9610.2020.06.003
    Abstract ( 133 )   HTML ( 11 )   PDF (388KB) ( 85 )  
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    Original article
    Endoscopic retrograde cholangiopancreatography in diagnosis and treatment of pediatric pancreaticobiliary maljunction:a report of 74 cases
    WENG Mingzhe, WENG Hao, TAO Yijing, GU Jun, ZHANG Wenjie, WANG Xuefeng
    2020, 25 (06):  468-472.  DOI: 10.16139/j.1007-9610.2020.06.005
    Abstract ( 201 )   HTML ( 2 )   PDF (505KB) ( 56 )  

    Objective To investigate the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of pediatric pancreaticobiliary maljunction(PBM). Methods A total of 74 children with PBM diagnosed by ERCP were enrolled. The clinical data with postoperative follow-up were analyzed. Results There were 32 cases with type A, 16 cases with type B, 23 cases with type C and 3 cases with type D based on the classification of PBM proposed by Japanese Study Group on PBM. The positive diagnostic rate of PBM was only 8% using MRCP. All children underwent endoscopic sphincteropapillotomy with endoscopic nasobiliary drain of which 69 cases(93.4%) were preceded with extraction of pancreatic protease emboli or stones. Pancreatic stent was followed in 2 cases. Seven cases (9.5%) had mild pancreatits after ERCP. No bleeding or cardiac laceration and perforations were found. The children had resection of extrahepatic bile duct combined with hepatic duct jejunum Roux-en-Y anastomotisis except for 7(9.5%) cases without biliary dilatation. Conclusions ERCP could be performed safely with effective diagnosis and treatment in pediatric PBM, and is an important procedure for children with PBM during early stage.

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    Analysis of effect of storage time and centrifugation speed on activity of biliary α-amylase
    LI Guangming, LIU Jiayue, ZHANG Guixin, LI Shijie, SHANG Dong, CHEN Hailong, YANG Yulong
    2020, 25 (06):  473-476.  DOI: 10.16139/j.1007-9610.2020.06.006
    Abstract ( 211 )   HTML ( 1 )   PDF (448KB) ( 72 )  

    Objective To study the effect of storage time and centrifugation speed on the activity of biliary α-amylase and the factors which affect the activity of α-amylase. Methods A total of 18 cases were randomly selected from 27 cases with endoscopic retrograde cholangiopancreatography in our hospital. The activity of biliary α-amylase was measured by iodine-starch colorimetry after bile samples were stored at 4℃ for 30 min, 3 h, 12 h, 24 h, 72 h and 30 d respectively, which was to study storage time in 6 groups each 18 cases. The bile samples in other 9 cases were used to study centrifugation speed including one group without sample centrifugation and the other two groups with sample centrifugation at 3 000 r/min or 8 000 r/min respectively. Results The activity of α- amylase decreased 0.73%, 2.11% and 3.94% in the bile stored at 4℃ for 3 h, 12~72 h or stored to 30 d respectively when compared with that stored 30 min (P>0.05), which indicated that the activity of biliary α-amylase did not change significantly for a period of storage 30 d at 4℃. The activity of biliary α- amylase decreased 0.16% after the centrifugation of 3 000 r/min compared with that without centrifugation, and increased 4.74% after the centrifugation of 8 000 r/min. The increase of 4.91% in the activity of biliary α-amylase was found at 8 000 r/min compared with that at 3 000 r/min(P>0.05), which indicated that the activity of biliary α-AMY had no obvious change when the centrifugal speed did not exceed 8 000 r/min. Conclusions The activity of biliary α-amylase would be relatively stable when bile is stored at 4℃ for 30 d and the centrifugal speed is 8 000 r/min or less.

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    Analysis of duodenal papilla diseases associated with recurrent choledocholithiasis
    BIAN Dapeng, FENG Qiushi
    2020, 25 (06):  477-480.  DOI: 10.16139/j.1007-9610.2020.06.007
    Abstract ( 148 )   HTML ( 1 )   PDF (353KB) ( 133 )  

    Objective To observe and analyze the duodenal papilla diseases associated with recurrent choledocholithiasis. Methods A total of 614 patients with choledocholithiasis who had been treated with endoscopic retrograde cholangiopancreatography and without endoscopy or surgery of duodenal papilla were analyzed retrospectively from January 1, 2018 to June 30, 2020 in our hospital. Results Twenty patients with common bile duct stone extraction were studied as recurrent choledocholithiasis group, and 20 patients without biliary surgery or intervention were as initial choledocholithiasis group matched according to the age and gender. The number of patients with each duodenal papilla diseases in recurrent group were more than those in initial group. Parapapillary diverticulum was 9 vs. 5, long nipple 10 vs. 4, duodenal papillitis 2 vs. 0, atrophic papillitis 4 vs. 1 in both groups without statistically significant differences. There were more patients with duodenal papilla diseases in recurrent group than those in initial group. Normal nipple was 3 cases in recurrent group and 12 cases in initial group (P=0.008) with statistically significant difference. Conclusions More patients with recurrent choledocholithiasis had duodenal papilla disease and further studies are required for the mechanism of duoneal papilla disease associated with choledocholithiasis.

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    Endoscopic retrograde cholangiopancreatography combined with SpyGlass digital system choledochoscope in treatment of gallbladder neck stones and acute cholecystitis
    WANG Hongguang, TAO Liying, GUO Qingmei
    2020, 25 (06):  481-485.  DOI: 10.16139/j.1007-9610.2020.06.008
    Abstract ( 244 )   HTML ( 3 )   PDF (830KB) ( 89 )  

    Objective To investigate the safety and feasibility of endoscopic retrograde cholangiopancreatography (ERCP) combined with SpyGlass digital system (DS) choledochoscope in the treatment of gallbladder neck stones and acute cholecystitis. Methods The clinical data of 11 patients with gallbladder neck stone and acute cholecystitis were retrospectively analyzed for the treatment using ERCP combined with SpyGlass DS choledochoscope in the Department of Gastroenterology our hospital from September 2017 to May 2020. Results There were 11 patients including 6 cases with gallbladder neck stones and acute cholecystitis, 4 cases with choledocholithiasis and gallbladder neck stones and suppurative cholecystitis, and 1 case with Mirrizi syndrome and suppurative cholecystitis. All the removal of gallbladder neck stones for 11 cases was successful by endoscopy. ERCP time was (30.0±19.9) (24-71) min with SpyGlass DS time (13.0±6.4) (5-25) min, postoperative feeding time (2.8±1.0) (2-5) d and hospital stay (6.3±1.6) (5-10) d. Postoperative symptoms and complication were mild. Conclusions ERCP combined with SpyGlass DS choledochoscope in treatment of gallbladder neck stone and acute cholecystitis would be safe and feasible.

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    Forkhead box D1 promotes invasion and metastasis of pancreatic cancer via extracellular signal-regulated kinase pathway
    DING Fangmi, LIU Zhendong
    2020, 25 (06):  486-492.  DOI: 10.16139/j.1007-9610.2020.06.009
    Abstract ( 191 )   HTML ( 2 )   PDF (1030KB) ( 70 )  

    Objective To study on the expression of forkhead box D1 (FOXD1) in pancreatic cancer and the mechanism of invasion and metastasis of pancreatic cancer through FOXD1 via the extracellular signal-regulated kinase (ERK) pathway. Methods We searched the database of expression of FOXD1 in both pancreatic cancer and normal pancreatic tissue from the Cancer Genome Atlas and analyzed the difference in expression of FOXD1. Expression of FOXD1 mRNA in pancreatic tissue of 15 cases with pancreatic cancer was detected using polymerase chain reaction. Expression of FOXD1 in pancreatic cancer cell lines was analyzed using Western Blot. The effect of FOXD1 knockdown on the expression of proteins associated with epithelial mesenchymal transition(EMT) was investigated using Western Blot. The effect of FOXD1 knockdown on the proliferation and invasion of pancreatic cancer cell lines were tested by cell counting kit-8 assay and Transwell assay. Results FOXD1 was highly expressed in pancreatic cancer tissues and cell lines. Knockdown of FOXD1 attenuated the proliferation and invasion of pancreatic cancer cell lines and enhanced expression of EMT associa-ted proteins including epithelial cadherin and ERK while attenuated expression of neuronal cadherin and phosphorylated ERK. Conclusions FOXD1 would be the oncogene of pancreatic cancer by promoting invasion and metastasis of pancrea-tic cancer via ERK pathway.

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    Relationship between metabolic risk factors and serum markers of bone metabolism in patients with metabolic and bariatric surgery
    ZHANG Guixiang, CHEN Gang, LI Zhengzheng, CHEN Yi, DU Xiao, CHENG Zhong
    2020, 25 (06):  493-497.  DOI: 10.16139/j.1007-9610.2020.06.010
    Abstract ( 149 )   HTML ( 1 )   PDF (462KB) ( 56 )  

    Objective To investigate the influence of metabolic risk factors on serum markers of bone metabolism and their relationship. Methods The data of patients with metabolic and bariatric surgery including blood glucose, triglyceride (TG), high density lipoprotein (HDL), bone specific alkaline phosphatase (B-ALP) and carboxy terminal peptide of type I collagen (CTX) were collected from department of gastrointestinal surgery in our hospital from January 2015 to April 2020. The patients were divided into two groups according to the median of B-ALP (≤14.24 μg/L, >14.24 μg/L) and CTX (≤0.36 μg/L, >0.36 μg/L). The clinical data and metabolic risk factors were compared between two groups and the clinical and metabolic factors correlated with parameters including B-ALP and CTX were analyzed. Results A total of 205 patients were included in this study with 81 males and 124 females There were significant differences in the parameters including systolic blood pressure, diastolic blood pressure, TG, HDL and the cases with lower HDL between B-ALP≤14.24 μg/L group and B-ALP>14.24 μg/L group (P<0.05). Between CTX ≤0.36 μg/L group and CTX >0.36 μg/L group, there were significant differences in gender, subcutaneous fat area and fasting blood glucose (P<0.05). B-ALP correlated with age and HDL negatively, and with systolic blood pressure, diastolic blood pressure and TG positively. CTX correlated with age and fasting blood glucose negatively. Logistic regression analysis showed that the risk of abnormal B-ALP increased significantly in patients with higher HDL (OR=2.931, 95% CI:1.585-5.421, P=0.001). Patients with larger area of subcutaneous fat decreased risk of abnormal CTX significantly (OR=0.381, 95% CI:0.194-0.748, P=0.005), while those with higher HDL had higher risk of abnormal CTX significantly (OR=2.067, 95% CI:1.118-3.824, P=0.021). Conclusions It was shown that lower HDL, higher fasting hyperglycemia and hypertension have influence on bone metabolism indexes of patients with metabolic and bariatric surgery.

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    Analysis of risk factors for positive circumferential resection margin in rectal cancer
    ZHU Congcong, ZHENG Hongtu, XU Ye
    2020, 25 (06):  498-502.  DOI: 10.16139/j.1007-9610.2020.06.011
    Abstract ( 287 )   HTML ( 1 )   PDF (427KB) ( 111 )  

    Objective To explore the higher risk factors for positive circumferential resection margin (CRM) in rectal cancer. Methods The patients with rectal cancer undergoing surgery in Fudan University Shanghai Cancer Center between January 2006 to April 2018 were collected, and 71 patients with positive CRM were included in positive group in this study. One hundred forty-two patients with negative CRM as negative group were matched by random number method with a ratio of 2∶1. Clinicopathologic analysis was done for positive group compared with negative group. Uni and multifactorial analysis assessed the risk factors for positive CRM. Results It was shown by univariate analysis of two groups that significantly different factors were distance of tumor to the anal verge (P<0.001), surgery type (P<0.001), differentiation extent (P<0.001), lymphovascular invasion P=0.001), perineural invasion (P<0.001), T stage (P<0.001), N stage (P=0.001), TNM stage (P<0.001), and neoadjuvant chemoradiotherapy (P=0.049). Patients in CRM positive group had higher locoregional recurrence rate(P=0.001), higher distant metastases rate (P<0.001) and less overall survival (P<0.001) compared with those in negative group. Multifactorial analysis demonstrated that poor differentiation (OR=4.415; 95% CI: 1.906-10.224; P=0.001), perineural invasion (OR=3.344; 95% CI: 1.431-7.817; P=0.005) and T3-T4 in pathological stage (OR=3.225; 95% CI: 1.026-10.142; P=0.045) were independent higher risk factors for positive CRM. Conclusions Positive CRM predicted a worse clinical outcome. Poor differentiation, perineural invasion and T3-T4 of pathological stage were higher risk factors for positive CRM in rectal cancer patients after curative surgery.

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    Analysis of feasibiliaty of robotic assisted male thyroidectomy
    GAO Haoji, SUN Hanxing, HUANG Haiyan, YING Xiayang, LIU Zhuoran, LI Rui, KUANG Jie, YAN Jiqi
    2020, 25 (06):  503-506.  DOI: 10.16139/j.1007-9610.2020.06.012
    Abstract ( 144 )   HTML ( 1 )   PDF (483KB) ( 61 )  

    Objective To explore the feasibility of robotic assisted male thyroidectomy. Methods The data of 228 patients with robotic assisted thyroidectomy in our hospital from May 2015 to September 2017 were analyzed retrospectively. The data of tumor size, operative time, blood loss, amount of lymph node dissection, postoperative complications, hospital stay and tumor recurrence were compared between male group and female group. Results There was no significant diffe-rence in operative time, size of tumor resected, blood loss, hospital stay, postoperative complication and tumor recurrence between male group and female group. It was shown that no significant difficulty was present during robotic assisted thyroid surgery in men when compared with that in women. Conclusions Robotic assisted male thyroidectomy could be safe and effective, which is feasible with profit greatly from the robotic assisted surgical system.

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    Analysis of risk factors for hypoparathyroidism in patients after thyroidectomy
    GUO Ying, XU Huijie, ZHENG Lei, ZHANG Shiyu, LEI Ming, YAN Jiqi, CHEN Xi, YANG Weiping
    2020, 25 (06):  507-511.  DOI: 10.16139/j.1007-9610.2020.06.013
    Abstract ( 186 )   HTML ( 2 )   PDF (518KB) ( 90 )  

    Objective To analyze the risk factors associated with hypoparathyroidism (HP) after thyroidectomy. Methods The clinical data of 118 patients with thyroidectomy were reviewed in Ruijin Hospital including parathyroid hormone (PTH) in serum before and after surgery from May 2018 to July 2018. Risk factors associated with postoperative HP were analyzed by multivariate Logistic regression models. Results The incidence of postoperative HP in this study was 17.80% including 2 cases with permanent HP. PTH in serum of 2 cases with permanent HP was 0.049 6 pg/L, 0.008 2 pg/L, 0.013 8 pg/L and those of 19 cases with temporary HP was 0.047 9 pg/L, 0.021 7 pg/L, 0.033 2 pg/L preoperative, postoperative 1 d and 180 d later respectively. Univariate analysis showed that HP was related with tumor N1 stage, Hashimoto thyroiditis, lymph node dissection, parathyroidectomy, without use of nano-carbon tracer and tumor diameter (P<0.05). However, HP was not related with gender, age, body mass index, hypertension, smoking, drinking, and pathological type (P>0.05). It was shown by multivariate analysis that Hashimoto thyroiditis, tumor N1 stage, tumor diameter 4 cm and more, lymph node dissection, parathyroidectomy, without use of nano-carbon tracer were independent risk factors for HP. Conclusions The patients with HP after total thyroidectomy were associated with tumor N1 stage, Hashimoto thyroiditis, tumor diameter 4 cm and more, lymphatic dissection, parathyroidectomy, and without use of nano-carbon tracer which would be the risk factors of HP.

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    Lecture
    Endoscopic treatment strategies for unresectable malignant hilar bile duct stricture
    XIA Mingxing, HU Bing
    2020, 25 (06):  512-514.  DOI: 10.16139/j.1007-9610.2020.06.014
    Abstract ( 109 )   HTML ( 2 )   PDF (309KB) ( 62 )  
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    Clinical research
    Analysis of endoscopic ultrasonography-guided transgastric drainage of pancreatic pseudocyst: a report of 21 cases
    PANG Yong, ZHANG Hui, GAO Qian, TANG Shanhong, WANG Tao
    2020, 25 (06):  515-516.  DOI: 10.16139/j.1007-9610.2020.06.015
    Abstract ( 144 )   HTML ( 3 )   PDF (338KB) ( 73 )  
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    Retrospective analysis of clinical results of laparoscopic and open Dixon surgery
    MENG Jianqing, JIANG Jianlong, GU Jianfeng, GU Xiuwen, TAO Danhao
    2020, 25 (06):  517-519.  DOI: 10.16139/j.1007-9610.2020.06.016
    Abstract ( 135 )   HTML ( 1 )   PDF (360KB) ( 44 )  
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    Case report
    Gallbladder carcinoma with umbilical metastasis: a case report
    CAI Yebing, CHEN Yongjun
    2020, 25 (06):  520-522.  DOI: 10.16139/j.1007-9610.2020.06.017
    Abstract ( 152 )   HTML ( 1 )   PDF (510KB) ( 130 )  
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    Review
    Progress in diagnosis and treatment of pancreaticobiliary maljunction
    LIU Luhong, DENG Gang, CHEN Junzong, TANG Di
    2020, 25 (06):  523-528.  DOI: 10.16139/j.1007-9610.2020.06.018
    Abstract ( 242 )   HTML ( 5 )   PDF (724KB) ( 146 )  
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    Changes in function of gallbladder mucosal epithelium and formation of cholesterol stones
    SHEN Weiyi, HU Hai, JIANG Zhaoyan
    2020, 25 (06):  533-536.  DOI: 10.16139/j.1007-9610.2020.06.020
    Abstract ( 111 )   HTML ( 1 )   PDF (393KB) ( 59 )  
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