Abstract:Abstract:Objective：To evaluate the feasibility, safety and short-term outcome of laparoscopic-assisted surgery for colorectal cancer. Methods：From August 2001 to November 2004, laparoscopic resection of colorectal carcinoma were performed in 112 cases, including right hemicolectomy(n=23), left himicolectomy(n=7), radical resection of sigmoid cancer(n=15), Dixon procedure(n=49), and Miles procedure(n=18). Results：One hundred and five patients underwent laparoscopic resection successfully, 7 cases were converted to open surgery because of hemorrhage, obesity or adhesion with adjacent organ, 6 of which were left colon or rectal cancer. The mean operating time was (161.2±48.6)min, and the mean operative blood loss was 78.5 mL. There were 8 cases occurred postoperative complications, and no mortality during perioperative period. The length of upper and lower segment of resection for colonic cancer was (14.5±3.2)cm and (11.0±2.6)cm respectively. The length of upper and lower segment of resection for rectal cancer was (15.3±2.7)cm and (2.8±1.6)cm, respectively. The mean number of lymph nodes dissected was (8.2±4.6), and lymph node metastases were found in 49 cases. One hundred and seven cases(95.5%) were followed up for 8-44 months, of which, 7 cases had local recurrence and 6 cases had distant metastases. No case of trocar port tumor implantation was observed. Conclusions：Laparoscopic surgery for colorectal cancer is feasible and safe, can result in the same outcome as open radical surgery, and has the advantages of mini-invasive procedure.

Abstract:Abstract:Objective： To explore the feasibility and value of laparoscopic-assisted surgery(LAS) for colorectal cancer. Methods：The clinical data of 51 cases of LAS for colorectal cancer were reviewed retrospectively. Of them, 3 cases were converted to open operation, and in 48 cases LAS for colorectal cancer was completed. Among them,9 cases underwent right hemicolectomy,8 cases left hemicolectomy,14 cases sigmoid resection,9 cases rectal anterior resection, and 6 cases Miles operation. Results：No intra-operative deaths occurred. The average operation time was 195（150-320）min with 120（40-300）mL average blood loss.The average number of lymph nodes excised was 8（2-26）.The time of bowel function recovery was 20-72h after operation.The average hospital stay after operation was 8（7-10）d.No major intra-operative blood loss nor postoperative complications were observed.The follow-up time was from 3-54months for 45(88.2%) patients. Two cases with Ducke′s C rectal cancer died,one died of liver metastasis 17 months after operation, and the another died of diffuse peritoneal metastasis 19 months after operation. There was no trocar port tumor metastasis and no local tumor recurrence at the small abdominal incision. Conclusions：LAS of colorectal cancer is technically feasible and has advantages such as less surgical trauma,less bleeding and quick recovery. It is a mini-invasive, safe and efficient treatment for colorectal cancer.

Abstract:Abstract:Objective：To investigate the safety and efficacy of laparoscopic splenectomy(LS) in treatment of refractory idiopatic thrombocytopenic purpura(ITP). Methods：The clinical data of 18 patients with ITP underwent LS from 2002 to 2006 were analyzed retrospectively. Results：One case was converted to open surgery. Seventeen patients successfully underwent LS. The mean operation time was 92(52-172)minutes, and intraoperative mean blood loss was 102(30-500)mL. At operation an accessory spleen was found in 3 cases and it was excised. The platelet count was elevated rapidly in one week postoperatively, and peristalsis of alimentary tract recovered in 12 to 24 hours after operation in all cases. The mean hospitalization time was 8 days. Complication(puncture of abdominal wall caused bleeding) occurred in two cases. Seventeen patients were followed up for 2-37months, one patient relapsed. Conclusions：LS is a relatively safe and effective measure for treatment of ITP.

Abstract:Abstract:Objective：To compare the postoperative changes in immune function of patients undergoing robot-assisted laparoscopic cholecystectomy(RLC) and conventional laparoscopic cholecystectomy (CLC). Methods：The clinical data of 52 cases of gallbladder stones and gallbladder polyps treated with RLC(23 cases), and with LC(29 cases) was compared. Blood samples from both groups were taken to measure immune markers (T cells, IgA, IgM, IgG, C3, C4) before operation and in the first postoperative morning. Results：The postoperative levels of CD4/CD8 and IgM decreased from 1.56±0.67, 1.42 ±0.58 to 1.30±0.53, 1.26±0.46 respectively after RLC（all P<0.05）. C3 and C4 after CLC decreased from 1.48±0.34, 0.25±0.09 to 1.38±0.28, 0.22±0.07 respectively(all P<0.05). But the levels of immune markers before and after operation were not significantly different between RLC and CLC groups（P>0.05）. Conclusions：RLC and CLC showed no significant postoperative effect on cellular immune function, but both had some effect on humoral immune function.

Abstract:Abstract:Objective：To discuss the clinical value of combined antegrade and retrograde technique of laparoscopic cholecystectomy in prevention of bile duct injury. Methods：Clinical data of 613 patients who underwent laparoscopic cholecystectomy with combined antegrade and retrograde technique from March 1991 to June 2006 were analyzed retrospectively. Results：Cholecystolithiasis with atrophy of gallbladder was found in 121 cases, acute and subacute cholecystitis in 432 cases, cholecystolithiasis with chronic cholecystitis in 42 cases and polyps of cholecyst in 18 cases. Nine cases were converted to laparotomy(5 cases of cholecystolithiasis with atrophy of gallbladder and 4 cases of subacute cholecystitis). The average operation time was 43.5 minutes. Bile leakage occured in only 1 case after operation and fully recovered after 3 days of drainage, and all the other cases had smooth recovery with no bile duct injuries or serious complications such as haemorrhage, infection or death. The mean hospitalization time after operation was 5.5 days. Conclusions：The application of combined antegrade and retrograde technique can increase the success rate of laparoscopic cholecystectomy，and reduce the incidence of injuries of bile duct，especially in those patients with inadequate exposure or anatomical variation of Calot′s triangle.

Abstract:Abstract:Objective：To study the therapeutic effects of combined use of laparoscopic cholecystetomy and endoscopic sphincterotomy for cholecystolithiasis with secondary choledocholithiasis. Methods：Thirty-five patients were diagnosed as cholecystolithiasis with secondary choledocholithiasis by B-ultrasonography and magnetic resonance cholangiopancreatography. Of them, in 28 cases, laparoscopic cholecystetomy was performed first, and ERCP and endoscopic sphincterotomy were done one week later; in 7 cases, endoscopic sphincterotomy were performed before laparoscopic cholecystectomy. Results：The outcome of all the thirty-five cases was satisfactory without severe complications or conversion into open procedure. Conclusions：The method of combined laparoscopic cholecystomy and endoscopic sphincterotomy, for cholecystolithiasis with secondy choledocholithiasis, especially for cases in whom the diameter of the common bile duct stone is ≤1cm, can give good therapeutic results and has advantages of minimal invasiveness, few complications and quick recovery.

Abstract:Abstract:Objective：To study the BC047440 mRNA expression in human hepatocellular carcinoma tissues, and the role of BC047440 gene in the carcinogenesis and development of human hepatocellular carcinoma. Methods：Specimens from 36 cases of hepatocellular carcinoma and their corresponding adjacent non-cancerous tissues were examined for BC047440 mRNA expression by polymerase chain reaction after reverse transcription(RT-PCR). Results：（1）the BC047440 mRNA expression in specimens of 36 cases of hepatocellular carcinoma was higher than that in their adjacent non-cancerous tissues(0.2594±0.0928 and 0.0942±0.0443, respectively, P<0.01). （2）In BC047440 mRNA over expression group, the tumor was bigger, and invasion of portal was more severe than those in BC047440 mRNA high expression group(all P<0.05). Conclusions：The expression of BC047440 gene may be related to the cancinogenesis, the growth, infiltration and metastasis of human hepatocellular carcinoma.

Abstract:Abstract:Objective：To evaluate the relationship between the expression of survivin,caspase-3 and Cox-2 and clinicopathological characteristics in gallbladder carcinoma(GBC). Methods：Immunohistochemistry was used to detect the expression of survivin,caspase-3 and Cox-2 in 49 specimens of GBCs,9 cases of gallbladder adenoma and 10 cases of chronic cholecystitis. Results：Positive cytoplasmic immunoreactivity was detected in a proportion of 65.3% for survivin, 44.9% for caspase-3, and 75.5% for Cox-2 in GBCs, respectively, and those were significantly higer in malignant lesions than in benign diseases. There was no significant relation between the expression of survivin or Caspase-3 and patients′ clinicopathological features, except the expression of caspase-3 was related to the tumor differentiation. There was a relationship between Cox-2 expression and the depth of invasion, lymph node metastases and Nevin′s staging of the tumor. Furthermore, the expression of survivin correlated positively with Cox-2 expression(r=0.404,P=0.004) and inversely with caspase-3(r=－0.373,P=0.008),but no significant correlation was found between the expression of caspase-3 and Cox-2 (r=-0.156,P=0.284).Conclusions：The over-expression of survivin and Cox-2 and descended expression of caspase-3 play an important role in the carcinogenesis and progression of GBC. Survivin and Cox-2 may be identified as targets for target therapy of gallbladder carcinoma.

Abstract:Abstract:Objective：To explore the effects of administration of chondritin-sulfate(CS) on acute necrotizing pancreatitis(ANP) and its associated tissue oxidation stress injury.Methods：Male Wistar rats(n=90) were divided randomly into three groups：group A, ANP group; group B, ANP rats received chondroitin-sulfate therapy; group C, control group．Rats in three groups were killed at 30min,1h,3h,6h,and 12h after operation, respectively．The levels of pancreatic indexes (pancreatic wet/body weight),malonyl dialdehyde (MAD)、total superoxide dismutase (SOD),glutathione (GSH)、ATP and serum amylase (SAM) were measured．Changes of adhesion junctions were examined by using a electron microscopy．The cellular distribution and changes of localizetion of E-cadherin was observed by confocal fluorescence microscopy; an adhesion junction protein expression was studied by western-blot method．Results：Compared with group B, Levels of GSH、SOD and ATP in group A decreased markely （P<0.01）,however MDA increased significantly (P<0.01).In group A，compared with B and C group, it demostrated a rapid and sustained increase in levels of pancreatic indexes(P<0.01); damages of adhesion junctions E-cadherin was localized at the cytoplasm, the level of E-cadherin protein was markedly decreased(P<0.01)．Conclusions：In the early stage of experimental ANP, in pancreat tissue, the CSH, SOD and ATP decredsed significantly,resulting in severe damage of adhesion junction，which was responsible for the formation of pancreatic edema．Treatment with CS can protect adhesion junction by increasing E-cadherin protein concentration, and thus relieve pancreatic edema．

Abstract:Abstract:Objective：To summarize the clinical technique and experience of one stage combination of renopancreatic transplantation(SKPT) with portal venous drinage of pancreatic endocrine and enteric drainage of exocrine(PE). Methods：Five patients with insulin-dependent diabetes mellitus and end-stage renal disease underwent SKPT with PE drainage. The clinical data, operative techbuque, and the prevention of non-technical complications were summarized. Results：This procedure was successfully applied in the 5 patients. Three patients recovered excellently; but 2 died perioperatively, one died of sepsis due to pancreatic leakage, and one of FK506 toxicity. On postoperative day 3, in the 3 survivors, blood creatinine and urea nitrogen levels returned to normal; insulin administration was discontinued on 7d postoperatively, and the endogenous and exogenous secretory functions of the graft were normal.Conclusions：SKPT with PE is a resonable procedure, because of its potential physiologic,metabolic,and immunologic advantages. PE drainage may become the prefer technique of pancreas transplantation. Intensive perioperative managements are effective methods to prevent complications and to improve the therapeutic effects.

Abstract:Abstract:Objective：To explore the feasibilty of emergency hepatectomy in the treatment of hepatolithiasis. Methods：The clinical data of 24 patients with hepatolithiasis who underwent emergency hepatectomy and of 24 patients with hepatolithiasis who underwent secondary elective hepatectomy in our hospital from June 1992 to June 1999(emergency hepatectomy group) were retrospectively analyzed. Operative complications, mortality, efficacy of treatment, residual stone rate, days of hospitalization and medical expenses were compared between the two groups. Results：There were no significant differences in the rate of operative complications, operative mortality, excellent treatment result rate and residual stone rate between the two groups(all P>0.05). The days of hospitalization and medical expenses were markedly decreased(P<0.01) in the emergency hepatectomy group than those in the control group. Conclusions：For some strictly selected hepatolithiasis patients with severe complications, such as acute cholangitis, severe acute cholangitis, biliary hepatic abscess, obstructive jaundice and severe hemobilia, emergency hepatectomy may be considered to avoid reoperation.

Abstract:Abstract:Objective：To investigate the diagnosis and the relationship between its clinicopathological characteristics, treatment and the prognosis of primary colorectal lymphoma. Methods：The clinical data of 20 primary colorectal lymphoma patients who received operative treatment in the past 34 years in our hospital were retrospectively summarized, and the influence of treatment and each clinicopathological factor on prognosis was assessed. Results：Tumor size, lymph node metastasis, invasion of neighboring organs and distant metastasis, and type of operative treatment were significantly related to the survival(P<0.01). Age, sex, single or multiple tumors, degree of cell malignancy in lymphoma tissues and depth of tumor invasion were not independent factors of prognosis(P>0.05).Conclusions：Diagnosis of primary colorectal lymphoma before operation is difficult, and misdiagnosis is common. Operative treatment is the main therapeutic means for colorectal lymphoma. Radical operation combined with chemotherapy can gain a good prognosis.

Abstract:Abstract:Objective：To discuss methods of diagnosis and treatment of abdominal visceral injury.Methods：The clinical data of 210 patients with abdominal visceral injury admitted to our hospital during recent 15 years were analyzed retrospectively.Results：The positive rate of abdominal paracentesis was 88.6%. Preoperative correct diagnosis was in 125 cases(59.5%). All of the 210 cases received operative treatment, of which, 190 cases(90.5%) were cured and 20 cases died(9.5%).Conclusions：Abdominal visceral injury is common. Abdominal paracentesis is a reliable diagnostic tool. In patients with indications for exploratory laparotomy, aggressive operation should be performed. The abdominal exploration must be systematic to avoid overlooking an injury, but, at the same time, unnecessary exploration must be avoided.

Abstract:Abstract:Objective：To analyze the characteristics of sliding hernia and evaluate the therapeutic effects of traditional herniorrhaphy and mesh plug tension-free herniorrhaphy for sliding hernia. Methods：The clinical data of twenty three cases with sliding hernia, among 426 cases of inguinal hernia, treated in our hospital over a period of 14 years, were analyzed retrospectively. Traditional herniorrhaphy was performed in 10 cases and mesh plug herniorrhaphy in 13 cases. All of the patients were followed up for 1 to 3 years. The operative time, length of hospital stay, postoperative analgesic use, complications, and discomfort and recurrence rate were analyzed and compared in the 2 group. Results：There was no significant difference in the operative time and length of hospital stay between the 2 group. The use of postoperative analgesic, postoperative complications, postoperative discomfort and recurrent rate in traditional and mesh plsg tension-free herniorrhaphy was 60%(6/10) and 7.6%(1/13), 30.0%(3/10) and 7.6%(1/13) and 50%(5/10) and 7.6%(1/13), respectively; while postoperative time for return to work was 54d and 32d, respectively, and the recurrence rate was 40%(4/10) and 0%, respectively, (P<0.05). Conclusions：Compared with traditional herniorrhaphy, mesh plug tension-free herniorrhaphy for sliding hernia has advantages, such as simple, less trauma, less postoperative discomfort, and lower recurrence rate, so, it is suitable for treatment of patient with sliding hernia.

Abstract:Abstract:Objective：To evaluate the clinical effects of tension-free herniorrhaphy in treatment of incarcerated inguinal hernia(IIH) in adults. Methods：A retrospective study was made on analysing the clinical data of 12 cases of IIH treated by Lichtenstein hernioplasty, 31 cases of IIH by mesh-plug hernia repair and 2 cases by Kugal herniorrhaphy. Results：There was no infection of incisional wound, rejection of foreign materials, and no operative mortality. All the patients were followed-up for three months, no hernia recurrence was observed. Conclusions：Tension-free herniorrhaphy in treatment of incarcerated inguinal hernia in adults is a effective method with very satisfactory results.