Abstract:ObjectiveTo investigate the clinical manifesfations and diagnostic and therapeutic features of cholangiocarcinoma associated with hepatolithiasis.Methods The clinical data, the diagnotic and therapeutic featares of 54 cases of cholangiocacinoma associated with hepatolithiasis were retrospectively analyzed.Results The occurrence rate of hepatolithiasis concomitant with hepatocholangiocarcinoma was 11.8%.Due to a lack of specific clinical manifestations, the preoperative diagnosis of this condition was difficult. In this series, the correct diagnotic rate of hepatocholangiocarcinoma before operation was only 11.1%. The radical resection rate was 51.8%. Radical resection of the tumor had a better prognosis than that of nonresection of tumor.ConclusionsPatients with longterm recurrent hepatolithiasis tended to have associated cholangiocarcinoma. Early diagnosis of the disease was difficult, and the treatment results and prognosis were poor. Therefore, patients with hepatolithiasis, espesially those with recurrent attacks, should undergo operation early. In cases diagnosed as hepatic cholangioearcinoma at operation, a radical resection should be performed, if possible, and a favorable outcome may be attained.

Abstract:ObjectiveTo explore the treatment of incidental gallbladder carcinoma（UGC）discovered during laparoscopic cholecystectomy（LC）. MethodsThe clinical data of 17 cases of incidental gallbladder carcinoma discovered during laparoscopic cholecystectomy were reviewed retrospectively. Results11cases with Nevin stage I or stage II were treated by LC and 1 case with Nevin stage III and 3 cases with Nevin stage V were treated by LC and radical local lymphadenectomy. 2 cases with Nevin stage IV were treated by cholecystectomy. UGC was incidently found in 0.6% of the cases. Cases with Nevin Stage I and II were observed for 5 years with no recurrence. A case with Nevin Stage III was found to have recurrence within one and a half years postoperatively and had a reoperation. The prognosis of patients with Nevin Stage IV and V was poor and they were dead within a year after operation. ConclusionsThe incidently found gallbladder carcinoma with Nevin Stage I and II disease can be radically resected with laparoscopic cholecystectomy. The incidently found gallbladder carcinoma with Nevin Stage III and IV disease needs to be radically resected, and if the resection margin is found to be free of tumour, the prognosis is enhanced. The ones with Nevin Stage V need to be treated by local lymphadenectomy and wedgeresection of liver.

Abstract:ObjectiveTo investigate the feasibility of cholangioenterostomy without stent tube drainage. MethodsIn this study 52 cases anastomosed without stent tube drainage (group A) and 56 cases with stent tube drainage (control,group B) were included. The patients′course of therapy and recovery, postoperative followup and reoperation were compared between group A and B. ResultsThe rate of bile leakage was 5.8% (3/52) in group A and 3.6%(2/56) in group B, respectively ,which was not significant（P﹥0.05）. In group A the length of time of fasting, use of drug therapy and hospital stay of patients was significantly shorter（P﹤0.01） and the postoperative complications were lower（P﹤0.05） than those in group B. On postoperative followup, the rates of biliary infection, recurrence of gallstone, adhesions and reoperation of group A and B were 4.4% and 20.4% （P﹤0.05）, 2.2% and 8.16% （P﹥0.05）, 4.4% and 20.4% （P﹤0.05）, 2.2% and 16.3% （P﹤0.05）, respectively. In group B there were 8 reoperated cases, of which 4 cases had recurrent gallstones, and 5 cases had inflammatory hyperplasia and sclerosis of the anastomosis. ConclusionsCholangioenterostomy without stent tube drainage, and with improvement in technique of anastomosis is safe and effective. This method has less postoperative complications, faster recovery and satisfactory longresults and is easily accepted by patients.

Abstract:ObjectiveTo survey the etiology of gallstone disease in Kelamay region of Xinjiang.MethodsA population of 8257 people based on local demographic data was chosen by means of PPS（Probability proportional to size）randomly. They were investigated by questionaire and physical examination, followed by ultrasound and analysis of fasting blood sugar and lipid profile. The data were analyzed by statistical software SPSS 11.0, and the main risk factors were identified by means of logistic regression. Results92.4% of the designed population went through all the processes of the study. The prevalence of gallstone in Kelamay region was 15.45%. Among a variety of risk factors, the predominant ones were sex, diameter of the common bile duct and difference in nationality (with OR=1.92,1.83,1.4 respectively). ConclusionsThe formation of gallstone is a result of the action of multiple factors, among which, sex, difference of nationality and internal diameter of common bile duct have influence on its formation.

Abstract:ObjectiveTo evaluate the dangerous and experience of cholecystectomy in patients with liver cirrhosis. MethodsThe clinical data of 40 patients with liver cirrhosis undergoing cholecystectomy were retrospectively analyzed. ResultsCholecystectomy was successfully performed in 38 patients. Intraoperative rupture of gallbladder bed with severe hemorrhage occurred in 4 cases, and extensive oozing of blood from gallbladder bed in 11 cases. In those 15 cases, the gallbladder bed was packed with omental pedicle, the bleeding was successfully controlled in all of the 15 cases, and with no rebleeding postoperatively. Intraoperative blood loss avcraged 400ml, but 1 case had the maximum blood loss which was>10 000ml. Six cases developed ascites postoperatively. There was no mortality or bile duct injury. The average hospital stay was 15d.ConclusionsIntraoperative bleeding and bile duct injuries are the major dangers of cholecystectomy in patients with liver cirrhosis, and packing of gallbladder bed with pedicle of greater omentum is a satisfactory method of hemostasis.

Abstract:ObjectiveTo study the diagnosis and treatment of acute gangrenous cholecystitis in senile patients, so as to decrease complications and lower the mortality rate. MethodsThe clinical data of 112 senile patients with acute gangrenous cholecystitis were retrospectived analysed.Results 19 cases(17.0%) of the 112 patients had hyperpyrexia, 8(7.1%) had icterus,11(17.0%) had a mass in the right upper abdomen, 26(23.2%) had symptoms of peritonitis; 11(9.8%) were complicated with acute edematous pancreatitis, 5(4.5%) had acute obstructive suppurative cholangitis, 6(5.4%) had septic shock. All of the 112 patients underwent surgery. At operation, 79 of 95 cases of acute calculous cholecystitis had gangrene of gallbladder,16(16.8%) had gangrene with perforation; in 17 cases with acute noncalculous cholecystitis had gangrene of gallbladder, 9(52.9%) had gangrene with perforation. Of the 112 patients, 86 underwent cholecystectomy, 18 underwent partial cholecystectomy, 5 underwent cholecystectomy with bile duct exploration and T tube drainage, and 3 underwent cholecystostomy 104 patients(92.9%) were cured, 8 patients(7.1%) died, and 9(8.7%) of the 104 cured patients had postoperative complications. ConclusionsAcute gangrenous cholecystitis in senile patients should be definitely diagnosed as soon as possible, coexistent diseases should be correctly treated, emergency operation should be performed with in 24 hours of onset of symptoms(or in the shortest time after admission), and a suitable operation should be selected.

Abstract:ObjectiveTo discuss the value of intraoperative cholangiography during laparoscopic cholecystectomy(LC). MethodsRetrospective analysis was made on the clinical data of 398 patients undergoing intraoperative cholangiography during LC from June 1996 to Dec 2004. ResultsForty cases of common bile duct stone, 3 cases of cystic duct stone, 53 cases of anomalous bile duct, and 6 cases of bile duct injury were detected. All patients were treated accordingly, and none died. ConlusionThe clinical use of cholangiography during LC can help to markedly reduce the incidence of residual bile stones and promptly detect bile duct injury and other serious complications.

Abstract:ObjectiveTo study the effect of BCL2 γradiation on BCL2 gene in dogs, and its relationship and signifcane on apoptosis of proliferated smooth muscle cells of bile duct wall. MethodsThe 103Pd radioactivity stent(experiment group) or ordinary stent(control group) was positioned into the target segment of bile duct. The injured bile duct segments were dissected free from the dogs, and BCL2 gene in the control and rradiationinduced apoptotic smooth mucle cells of bile duct wall was analysed by using immunohistochemical technique. The number of apoptotic cells was counted, and size of lumen of bile duct in both groups was measured by a computerized imaging system.ResultsBCL2 gene expression was weaker in the 103Pd radioactive stent group than in the ordinary stent group. The group of dogs with low expression of BCL2 genes showed marked apoptosis of proliferated smooth mucle cells of bile duct and there was no overt stenosis of extrahepatic bile ducts. The group that showed high expression of BCL2 gene did not show marked apoptosisi of proliferated smooth muscle cells of bile duct, and there was marked stenosis of extrahepatic bile duct.ConclusionsThe expression level of BCL2 in experimental dogs is related to the develoment of cellular apoptosis and to radiation sensitivity of the cells. 103Pd radioactive stent can reduce the expression of BCL2 gene, promote apoptosis of proliferated smooth muscle cells of bile duct, and suppress stricture formation of extrahepatic bile duct.

Abstract:ObjectiveTo investigate the effect of nerve growth factor(CNF) on the proliferative ability of human cholangiocarcinoma cell strain QBC939. MethodsAfter construction of a fulllength human βNGF expression vector, human cholangiocarcinoma cell QBC939 was transfected with pcDNA3.0NGF. Western blot assays were used to detect the expression of βNGF. Subsequently. In vitro proliferation before and after transfection of cells was analyzed by MTT assays. ResultsWestern blot assay indicated that βNGF could be stably expressed by transfected QBC939 cells, and compared with controls, the differences were significant (P<0.0001). MTT assays showed stable transfection of βNGF in QBC939 cells resulted in enhanced dosedependent proliferation of cancer cells, and the differences were significant （P<0.01）. ConclusionsNGF may enhance the proliferation of cholangiocarcinoma cells.

Abstract:ObjectiveTo study the clinical characteristics and the diagnosis and treatment of splenic tumors. MethodsThe clinical data of 56 cases of splenic tumors which diagnosis were confirmed by surgery and pathology were analyzed retrospectively. ResultsPrimary benign masses were found in 39 patients including splenic cyst in 25 patients, hemangioma in 9, hamartoma in 3, lymphangioma in 1, inflammatory pseudotumor in 1. Of the 39 patients with bengin tumors, 4 cases of splenic cyst, 1 hemangioma and 1 hamartoma underwent partial splenectomy; other underwent splenectomy; the results of the bengin tumors were successful except 5 cases were loss of follow up. Of 12 patients with primary malignant tumors including primary splenic lymphoma in 2, angiosarcoma in 2, reticulum cell sarcoma in 2, malignant fibrous histiocytoma in 2, leiomyosarcoma in 1, malignant neurinoma in 1, myofibroblastoma in 1, and unknown type in 1; of them, 1 underwent necrostic infective tissue debridement and drinage, 1 underwent splenectomy with partial pancreatectomy, other subjected to splenctomy with clearance of lymph nodes; among the followed up 8 cases, 3 survived for>5 years, 1 for 3 years, 4 for less than 1 year. In addition, metastatic tumors to the spleen were found in 5 patients, splenectomy with or without combined resection of other organs was performed in all 5 patients. Conclusions Imaging examination is the main method of diagnosis for splenic tumors. Partial splenectomy is recommended for benign tumors. For malignant splenic tumors, surgery, as the main aspect of combined therapy, is required.

Abstract:ObjectiveTo study the results of splenectomy for patients with idiopathic thrombocytopenic purpura(ITP), which refractory to medical therapy or with repeat recurrence of symptoms. Methods58 ITP patients who failed to respond to conservative management were treated with splenectomy and the clinical outcome was observed. Postoperatively, 52 cases were followed up for 6 months to 12 years, and in 48 of these cases the followup was more than 1 year. ResultsPlatelet count recovered to normal(≥100×109/L ) two weeks after operation in 47 cases(81.03%). The total effective rate was 79.31% when followedup for 2 months, 78.85% when followedup for 6 months and 11 cases had recurrence. ConclusionsSplenectomy is a safe and effective therapy for patients with ITP who failed to respond to conservative management or have relapse of ITP. Patients who showed temporary response to preoperative steroid therapy and those who had an early or a high amplitude of increase of platelet count after operation have better prognosis.

Abstract:ObjectiveTo explore the predisposing factors in the development of acute respiratory failure after abdominal surgery and the factors affecting the therapeutic effect of mechanical ventilation. MethodsA retrospective study was undertaken for acute respiratory failure after abdominal surgery in 91 patients. The underline diseases, introducing causes and efficacy of mechanical ventilation were retrospectively analysed. ResultsPostoperative pneumonia was the cause of acute respiratory failure in 53 cases and ARDS caused by severe abdominal infection and severe acute pancreatitis in 38 cases. Of the 91 cases, complicated with COPD in 38 cases, severe malnutrion 32 cases, and hypokalemia 14 cases. Respiratory failure occurred at（4.08±2.45）days after operation. The duration of mechanical ventilation was（21.66±21.42）days; 33 cases died, and 58 cases were successfully recovered with mechanical ventilation.ConclusionsThe management of acute respiratory failure after abdominal asurgery should be rational use of mechanical ventilation, adjustment of weaning strategy and avoidance of dependance on mechanical ventilation. Timely treatment of the primary disease, effective control of abdominal infection and aggressive symptomatic and supportive treatment are factors that affect the success or failure of mechanical ventilation.