Objective To investigate the effect of the duct-to-mucosa anastomosis in invaginating end-to-side pancreaticojejunostomy. Methods A retrospective review was conducted for 200 patients treated with pancreaticoduod-enectomy （PD） between August 2005 and December 2012. Reconstruction of digestive tract in PD was done according to the method described by Child. The duct-to-mucosa anastomosis was applied in the invaginating end-to-side pancrea-ticojejunostomy. The outline of the anastomosis structures was as follows：anastomosis of pancreatic duct and jejunal mucosa， anastomosis of pancreatic and jejunal resection margin， and anastomosis of pancreas and jejunal seromuscular layer. A cilicone tube was put into the pancreatic duct and lead to the jejunum. The anastomotic stoma was covered with part of the omentum majus, and put a drainage tube under the anastomotic stoma. Results The operation went smoothly，and no deaths occurred during perioperative period. The surgical time was 280-420 min， the average time was （298±77） min. The pancreatic fistula were observed in 22 patients （11%）， including 17 patients in Grade A， 2 patients in Grade B， and 3 patients in Grade C. The other complications were observed in 19 patients， including 16 patients with addominal infection， 1 patient with bleeding from splenic vein， 1 patient with bleeding from ruptured of pseudoaneurysm at biliary intestinal anastomosis， 1 patient with abdominal abscess. Three patients with pancreatic fistula in Grade C were cured by reoperation, and the other patients with pancreatic fistula were cured by expectant treatment. Conclusions The duct-to-mucosa anastomosis in invaginating end-to-side pancreaticojejunostomy is a simple and safe procedure that has the advantage in reducing the incidence of the pancreatic fistula. Using omentum to cover the anastomotic could localize the diffusion of panreactic fistula， and reduce the incidence of serious complications caused by pancreatic fistula.
Objectives To evaluate the expression levels of serum microRNA-21 (miRNA-21) and microRNA-155 (miRNA-155) from patients and rats with pancreatic cancer, and to explore its value in the diagnosis of pancreatic cancer. Methods The clinical materials and the serum samples from 18 patients with pancreatic cancer (pancreatic cancer group) and 12 patients with benign pancreatic disease (benign pancreatic disease group) admitted to Fujian Medical University Union Hospital between January 2016 and December 2016 were collected prospectively. The real-time fluorescent quantitative PCR was performed to detect the levels of serum miRNA-21 and miRNA-155. 7, 12-dimethylbenz (a) anthracene (DMBA)-induced pancreatic cancer rat models (n=20) and the models of the blank control group (sham operation, n=10) were established and the serum samples from the pancreatic cancer group and the blank control group were measured by the real-time fluorescent quantitative PCR, to detect the levels of miRNA-21 and miRNA-155. Results The median expression levels of serum miRNA-21 and miRNA-155 were 1.99 (1.43–5.30) and 7.06 (4.98–21.48) in the pancreatic cancer group, as well as 1.28 (0.58–2.01) and 2.20 (1.76–3.02) in the benign pancreatic disease group. The expression levels of serum miRNA-21 and miRNA-155 were significantly higher in the pancreatic cancer group (Z=–2.621,P=0.009; Z=–3.430,P=0.001). In animal studies, the rat models of pancreatic cancer were successfully established and 11 rats with pancreatic cancer were acquired, as well as 9 rats in the blank control group were acquired. The median expression levels of serum miRNA-21 and miRNA-155 were 2.12 (1.33–2.72) and 16.45 (7.18–25.40) in the rat pancreatic cancer group, as well as 1.00 (0.45–1.60) and 1.49 (1.25–1.97) in the blank control group. The expression levels of serum miRNA-21 and miRNA-155 were significantly higher in the rat pancreatic cancer group (Z=–2.621,P=0.009; Z=–3.609,P<0.001). For distinguishing pancreatic cancer from benign diseases, the best cutoff value of serum miRNA-21 level was 4.21 and the sensitivity and specificity were 75.0% and 61.1% respectively; the best cutoff value of serum miRNA-155 level was 4.67 and the sensitivity and specificity both were 83.3%. Conclusions The serum miRNA-21and miRNA-155 levels are elevated both in patients and rats with pancreatic cancer. Detection of serum miRNA-155 will be helpful to some extent to distinguish pancreatic cancer from benign diseases.