Abstract:Abstract:Objective:To investigate the possibilities and advantages of laparoscopic left lateral hepatectomy combined with choledochoscopic exploration of common bile duct.
Methods :Laparoscopic left lateral hepatectomy combined with choledochoscopic exploration of common bile duct(n=10) and traditional open operations(n=10) were performed in patients who had gallstones in liver and biliary duct. The hospitalization time, operative complications and post-operative liver functions of the two groups were comparatively studied.
Results:The operation time and post-operative liver functions of the two groups had no significent differences, but the hospitalization costs and the operative complications of the laparoscopic liver resection and choledochoscopic bile duct exploration group were significantly lower than those of traditional open operation group.
Conclusions:Laparoscopic left lateral hepatectomy liver resections combined with choledochoscopic bile duct explorations had more advantages than traditional open operation for patients with gallstone in liver and biliary duct, because it could significantly shorten hospital time, and decrease hospital costs and postoperative complications, while it does not prolong operation time and has no adverse effect on liver function.

Abstract:Abstract:Objective:To summarze our experience and evaluate the therapeutic effect of hepatectomy for intrahepatic bile duct stones. Methods:The clinical data of 316 patients suffering from intrahepatic lithiasis who underwent hepatectomy from Feb. 1985 to Dec. 2004 were retrospectively analyzed. Stones distribution, operation modality, postoperative complications, and therapeutic effect were evaluated. Among the 316 patients, 192 cases(60.76%) were treated with left lateral hepatectomy, 58 cases（18.35%） with left hemihepatectomy, 12 cases（3.80%）with quadarate lobectomy, 54 cases（17.09%） with right hemihepatectomy or segmentectomy, and 14 cases（4.43%）with left and right segmentectomy. Additional biliary procedures including common bile duct exporation and cholangio-enterostomy were performed in 184 patients（58.23%）. Results:Postoperative complications occurred in 56（17.72%）cases, including biliary fistula, hemobilia, and subdiaphragmatic infections. Three patients（0.95%）died. The follow-up study conducted in 258 patients（81.65%）for an average of 10.3 years showed that excellent results were achieved in 90.31% of the patients. Conclusions:Regular hepatic lobectomy/segmentectomy is the most effective treatment for intrahepatic lithiasis.

Abstract:Abstract:Objective:To explore the method and effect of primary closure of choledochostomy with placement of a modified biliary stent after common bile duct exploration.
Methods :Open or laparoscopic common bile duct exploration was done in 39 patients with both gallbladder and common bile duct (CBD) stones. After extraction of stones, an 8F J-stent (pigtailed) was placed in the CBD and into the duodenum over a guide wire. The proximal end of the stent was secured to the CBD wall with rapidly absorbable suture. The CBD incision was primarily closed.
Results:The stent dislodged and was discharged with stool at the 13th (10-18) postoperative day . Three patients developed transient hyperamylasemia in the immediate postoperative period. None of the patients had complications of bile leak, stent occlusion, early stent dislodgement, or stent retraction into the CBD.
Conclusions:Placement of a self-release biliary J-stent in CBD and into the duodenum during common bile duct exploration is easier to manipulate with the help of choledochoscpe and guide wire. It is safe and cost-effective, therefore, it can expand the indications for primary closure of CBD incision, and reduce the complications related to T-tubes.

Abstract:Abstract: Objective:To investigate the causes of and prophylactic measure for complications of minilaparotomy cholecystectomy (MC).
Methods :The clinical data of 10 200 patients receiving MC from Apri1 1991 to March 2006 were analyzed.
Results:MC was successful in 9 835 cases（96.4%）, and in 365 cases（3.6%） the incision was lengthened. Serious complications were 12 cases（0.12%）of bi1e duct injury, 4 cases（0.04%）of colon injury, 8 cases（0.08%）of massive haemorrhage, and 25 cases （0.25%）of bile leakage. Four 4 cases（0.04%） died.
Conclusions:The key to prevention of complications is a strict selection of MC indications,careful identification of the anatomical structures of Calot's triangle,use of suture ligation of the mesentery of gallbladder triangle and the technique of deep knot-tying and the timely use of extension of the incision.

Abstract:Abstract:Objective:To study the effect of magnetic nanoparticles on human cholangiocarcinoma xenograft in nude mice, and compared with otherchemotherapy drugs
Methods:We established human cholangiocarcinoma xenograft in nude mice with QBC939 cell line.The nude mice were devided into 4 groups randomly.Saline,5-FU, Gemcitabine and magnetic nanoparticles were given to nude mice through tail vein on 20d after implanting QBC939 cell line. Calculations were done at different time after treatment in order to compare tumor volume,inhibition ratio of tumor and tumor growth curve of each group. The nude mice were killed on 35d after treatment to harvest tissue for electron microscopic examination to observe ultra-structural changes. Results:The tumor volume of control, 5-FU, magnetic nanoparticles and Gemcitabine groups was (2256.1±267.1) mm3, (2096.5±237.9)mm3,(1392.2±189)mm3, and (1534.9±115 )mm3 respectively.The last two groups have significant difference compared to the first two groups（P<0.05）. The ratio of inhibition of tumor and apotosis in the chemotherapy treated groups were 7.4%,39.6%, and 33.0% respectively. Conclusions:The effect of targeting drug magnetic nanoparticles was better than equivalent dosage of 5-FU, but as the same of Gemcitabine.

Abstract:Abstract:Objective:To investigate the effect of Bcl-2 ASODN on VP-16 induced growth inhibition and apoptosis in human bile duct carcinoma cell line QBC939.
Methods : Human cholangiocarcinoma cell line QBC939 was conventionally cultured. Specific target selective Bcl-2 ASODN，designed and artificially synthesized，was transfected to the cell line;MTT assay and flow cytometry (FCM) were used to study cell proliferation and apoptosis in cell line QBC939.
Results: MTT assay showed cell survival rate in ASODN group was significantly lower than that in NSODN group(P＜0.05).The survival rate in ASODN+VP-16 group was significantly lower than that in ASODN group and VP-16 group(P＜0.05). FCM analysis showed that apoptosis rates in ASODN group, VP-16 group and ASODN+VP-16 group were significantly higher than those in control groups(P＜0.05). The apoptosis rate in ASODN +VP-16 group was significantly higher than that in ASODN group and VP-16 group (P＜0.05).
Conclusions:Bcl-2 ASODN can enhance the effect of VP16-induced growth inhibition and apoptosis in QBC939 cell line.

Abstract:Abstract:Objective:To explore the relationship between survivin and chemoresistance of gallbladder cancer cell line (GBC-SD) cells after treatment with various concentrations of cisplatin. Methods:RT-PCR and Western blot were used to analyze the changes in expression levels of survivin mRNA and protein. GBC-SD cells were examined with MTT assay to determine drug sensitivity to 4 routine chemotherapeutic drugs. Results:In GBC-SD cells, the sensitivity sequence of those 4 drugs from high to low was DDP>ADM>5-FU>MMC. The level of survivin mRNA decreased in all the GBC-SD cells treated with three concentrations of cisplatin for one day. The survivin mRNA treated with 0.5μg/mL DDP decreased 10%, decreased 36% for 3μg/mL DDP，and decreased 28% for 6μg/mL DDP. In the third day, the survivin level treated with 0.5μg/mL DDP cells increased 22%, with 3μg/mL DDP increased 64%, but with 6μg/mL DDP decreased 34% compared with the first day. Similarly, survivin protein level increased 15% for those cells treated with 0.5μg/mL DDP after three days, increased 12% for 3μg/mL DDP, but decreased 80% for 6μg/mL DDP. Conclusions:A high expression of survivin was induced in GBC-SD by low concentration of cisplatin. Survivin may correlate with the chemoresistence of GBC-SD cells.

Abstract:Abstract:Objective:To explore an improved technique of mouse ventral heterotopic heart transplantation and construct an animal model for the study of transplantation immunity.Methods:The donor heart aorta and the recipient ventral aorta, the donor pulmonary artery and the recipient inferior caval vein, were anastomosed by using the end-to-side suture technique respectively. At the same time, important anatomical structures of transplantation-related sites were measured.Results:The diameter of recipient inferior caval vein and ventral aorta was (1.9±0.2)mm and (0.9±0.1)mm respectively. The average length of ventral blood vessels which can be used was (6.0±1.0)mm. The model construction success rate was 92%. The average time of donor operation and recipient operation was (8.0±1.0)min and (40.2±3.0)min respectively. The time of artery anastomosis and vena cava anastomosis was (9.3±1.2)min and (7.8±1.7)min respectively. Conclusions:The animal model is stable and can be used for the study of transplantation immunity.

Abstract:Abstract：Objective:To evaluate the effect of local co-application of basic fibroblast growth factor (bFGF) and mobilized bone marrow stem cells on angiogenesis in ischemic limbs of rabbits. Method:After ischemia models were induced by surgical section and ligation of left femoral artery and its branches in 40 rabbits, they were randomized to receive intramuscular injection of recombinant human granulocyte colony-stimulating factor (rhG-CSF) (n=10) in ischemic zone, hypodermic injection of recombinant human G-CSF (n=10) , co-application of bFGF and G-CSF (n=10), or normal saline (n=10). Four weeks later, angiogenesis of ischemia models was observed and evaluated by abdominal aortography, histopathologic analysis and immunohistochemical studies with the antibodies of VEGF. Results:The member of capillaries, the compensatory circulation blood vessel and the vascular endothelial cells that expressed VEGF protein in bFGF+G-CSF group was the most(P<0.05), that of bFGF group was more than that of G-CSF group(P<0.05), and that of saline group was the least (P<0.05). Conclusion:Both intramuscular injection of recombinant human bFGF and hypodermic injection of recombinant human G-CSF (mobilization of bone marrow stem cells) can stimulate angiogenesis of the ischemic limbs. But the effect will be better if co-application of them is used.

Abstract:Abstract:Objective: To construction of recombinant adenovirus containing KDR promoter-HSV-tk suicide gene by using a pAdeasy system and evaluate its specific killing effect on vascular endothelial cells. Methods: By using pAdeasy system, recombinant adenoviral plasmid containing KDR or cytomegalovirus (CMV) promoter-controlled HSV-tk gene (AdKDR-tk and AdCMV-tk) was constructed. After packaging and amplification in 293 cells, the virus was used to infect KDR-expressed human umbilical venous endothelial cells (HUVEC) and KDR-unexpressed HepG2. Following administration of ganciclovir(GCV), the survival rate of gene-transfected HUVEC and HepG2 was evaluated by using MTT method.
Results: The pAdeasy System produced a higher titer of the recombinant adenovirus (1×1010pfu/ml). Under infection index of 100, with increasing GCV concentration from 0 up to 50ug/ml, the survival rate of AdKDR-tk-transfected HUVEC and HepG2 decreased from 100% to (28.94±5.67)% and(75.45±2.91)%, respectively (P<0.01), while the survival rate of AdCMV-tk-transfected HUVEC and HepG2 declined from 100% to (17.56±2.48)% and (23.15±5.72)%, respectively (P>0.05). Conclusions: KDR promoter-HSV-tk gene possess a specific killing effect on vascular endothelial cells treated with GCV.

Abstract:Abstract: Objective:To investigate the preventive effect of octreotide combined with sodium hyaluronate on postoperative abdominal adhesions in rabbits.
Methods:The established postoperative abdominal adhesion models were divided into 4 groups:(1)without use of octreotide or sodium hyaluronate (model control group); (2)local application of sodium hyaluraronate(HA group) before closure of abdomen; (3)intraperitoneal injection of octreotide (OC group),(4)local application of sodium hyaluronate and peritoneal injection of octreotide 20ug/kg(OC+HA group). relaparotomy was done 14 days later, and the adhesion extent was judged.
Results:Incidence rates of abdominal adhesion on the day 14 after the operation betweent the 4 groups were not different(P>0.05). However,the incidence rates of severe abdominal adhesion were different(P<0.05). In OC+HA group was significantly lower than that in the model control group、 octreotide group and HA group （P<0.05）; and no significant difference between the octreofid group and sodium hyaluronate group (P>0.05).
Conclusions: Combination of octreotide and sodium hyaluronate have the synergetic preventive action on the degree and rate of formation of severe peritoneal adhesions after abdominal operation in rabbits

Abstract:Abstract:Objective:To study the causes of reoperation after biliary duct operation, in order to decreasing the rate of biliary tract reoperation. Methods:The clinical data of 828 patients who underwent reoperation of biliary duct diseases in Nankai hospital between 1990－1999 were evalated, and the causes of biliary duct reoperation were classified and analysed.Results:The most common cause for reoperation was recurrent or retained bile stone(65.10% ), bile stone companied by stenosis of the sphincter of oddi (33.82%), simple stenosis of sphincter of Oddi ( 9.54%), traumatic stricture of bile duct and stricture of bilioenteric anastomosis( 10.39%), bile duct obstruction due to tumor (6.52%), and other less important factors. Conclusions:Recurrent or retained bile duct stone was the main cause for biliary reoperation,and stenosis of the sphincter of Oddi was the next important factor for reoperations.Thoroughness of the initial operation and rationality of operative procedure are the chief factors to decrease bile duct reoperations.

Abstract:Abstract:Objective:To analyze the causes and prevention measures of missed diagnosis of internal biliary fistula. Methods :A retrospective analysis of the clinical data of 32 patients with missed diagnosis of internal biliary fistula was made. Their mean age was 52.1(range 25~72)years. Ultrasonography, T tube cholangiography, upper gastrointestinal endoscopy and bariums meal examination, choledochofiberscopy, ERCP, and PTC were taken in these patients. All of the patients were treated by open laparotomy. Results:Among 44 cases with internal biliary fistula ,the preoperative missed diagnosis rate was 72.73%(32/44cases), and all of the 32cases were correctly diagnosed during operation. Conclusions:The preoperative missed diagnosis rate of internal biliary fistula was high. Awareness of internal biliary fistula must be heightened. Clinical features, history and laboratory evidence characteristic of the disease must be sought preoperatively. When biliary pneumatosis is shown on ultrasonography, endoscopy and visualization must be done. These are reliable methods in preoperative diagnosis of internal biliary fistula.

Abstract:Abstract:Objective:To investigate the risk factors and methods for prevention and treatment of iatrogenic bile duct injury caused by cholecystectomy in patients with extrahepatic aberrance of right hepatic duct.
Methods :The clinical data of 25 patients with extrahepatic aberrance of right hepatic duct and iatrogenic bile duct injury during cholecystectomy treated in our hospital from Match, 1990 to June, 2005 were retrospectively analyzed.
Results:The bile duct of right posterior lobe was erroneously regarded as the cystic duct and resection was the major reason for its injury. The major injury type was class Ⅱ.
Conclusions:A heightened awareness of abnormal bile duct anatomy such as extrahepatic aberrance of right hepatic duct and following the principle of “identification-cut-identification” during cholecystectomy is important for prevention of iatrogenic bile duct injury. Important factors in improving the therapeutic outcome of bile duct injury are the time when diagnosis of the injury was made,the type of the injury and the correct selection of surgical procedure.

Abstract:Abstract:Objective:To evaluate the surgical therapy for patients with hilar cholangiocarcinoma. Methods:The clinical data, including clinical manifestation, clinical stage, operative approaches and results of the treatments, of 64 patients with hilar cholangiocarcinoma treated during 16 years were retrospectively analyzed. Of the 64 patients, 35cases underwent tumor resection (radical resection in 16cases, palliative resection in 19cases), and 29 patients underwent bile duct drainage operations (internal drainage in 16cases and external drainage in 13cases).
Results:In the radical resection group, the 1-, 2- and 3-year survival rate was 80.0%, 53.3% and 26.7%,respectively; in the palliative resection group, the 1-, 2- and 3-year survival rate was 50.0%, 16.7% and 0%, respectively. In the internal drainage group, the 1- and 2-year survival rate was 45.5% and 18.2%, respectively; in the external drainage group, the 1- and 2-year survival rate was 25.0% and 0%, respectively. Conclusions:Surgical resection, especially radical resection, can improve the therapeutic results and prolong the survival time of patients with hilar cholangiocarcinoma.