Abstract:

ObjectiveTo explore the appropriate operative methods for the treatment of CBD(common bile duct) stone in endoscopic era.
MethodsWe retrospectively analyzed the diagnosed and treated data of 309 patients with suspected CBD stones with ERCP, LC+ERCP and LECBD(laparoscopic exploration of the common bile duct) from January 2004 to July 2008 in our hospital.
ResultsA total of 216 patients received ERCP, among them 97(44.9%) cases had CBD stone, and there was the trend that the number of patients who received ERCP reduced yearly. Among the 93 patients who received LECBD, 71 cases were successful and 22 cases were converted to open operation. Of the 71 cases, transcystic duct CBD exploration was done in 11 cases, direct CBD exploration in 60 cases,and 6 cases had primary closure of CBD. The number of cases that received LECBD grew steadily with time. There was no difference in successful operative rate, intraoperative bleeding and residual calculi rate between ERCP+LC and LECBD group.The operative time, postoperative complications and length of hospital stay in LECBD. group were significantly lower than those in LC+ERCP group.
ConclusionsLECBD is better than LC+ERCP in the treatment of CBD stones, but in the endoscopic era, the selection of an individualized treatment approach is the best operative method for the management of CBD stone.

Abstract:

ObjectiveTo summarize our experience of choledochoscopy combined with shockwave lithotomy in the treatment of postoperative retained calculi in biliary tract.
MethodsCholedochoscopy via T-tube fistula and calculus-removing baskets combined with shockwave lithotomy was applied to treat 1 573 patients with postoperative retained calculi in the biliary tract, and the clinical data were analyzed retrospectively.
ResultsOf 1 573 patients,1 511 were cured(96.1%).The calculus-removal sessions varied from 1 to 9 times (average 3.31 times).Complications during treatment included hemobilia in 3 cases, fever in 17 cases and diarrhea in 22 cases rapy.
ConclusionsOwing to its advantages such as safety, effectiveness，mini-trauma and few complications，the choledochoscopic calculus-removing technique combined with shockwave lithotomy is currently an effective approach for treatment of postoperative retained calculi in the biliary tracts.

Abstract:

ObjectiveTo explore the factors related with difficulty of laparoscopic cholecystectomy (LC) for acute calculus cholecystitis.
MethodsA total of 245 patients were retrospectively divided into two groups: easy group（123patients）and difficult group(122patients, including 32patients of conversion to OC )based on surgery time and LC or OC.
ResultsThere were statistical differences between the groups in regards to preoperative body temperature, white blood cell count, surgical timing, the thickness of gallbladder wall, gallbladder volume, and diameter of common bile duct (all P<0.05); and there were obvious statistical differences between the 2 groups in thickness of gallbladder wall, gallbladder volume, diameter of common bile duct, stone impaction in the neck of gallbladder,and the condition of Calot′s triangle during operation (all P<0.01).
ConclusionsFactors related to difficulty of LC in acute calculus cholecystitis include elevated body temperature,increased white blood cell count,thickened gallbladder wall,increased gallbladder volume,common bile duct diameter more than 8 mm,stone impaction in neck of gallbladder and unclear anatomy of Calot′s triangle.

Abstract:

ObjectiveTo investigate the risk factors for conversion from laparoscopic (LC) to open cholecystectomy (OC).
MethodsThe clinical data of 2 850 cases of LC were retrospectively analyzed.
ResultsThe occurrence rate of conversion was 4.03%. The risk factors for LC conversion to open procedure comprised:two or more attacks of acute cholecystitis in recent 6 months;history of cholecysfifis>2 years; appeared righ quadrent abdominal signs, thickness of gallbladder wall≥3 mm;and hydrops of gallbladder.

ConclusionsThe risk factors for conversion of LC to OC were attacks of acute cholecystitis, the length of disease, tenderness of upper abdomen, thickening of gallbladder wall and hydrops of gallbladder. A detailed history, clinical examination with suitable imaging test,proper selection of patients and improving the skill of operators, may decrease the occurrence of the LC conversion rate and the complication after operation.OC should be selected for the patients with the above risk factors.

Abstract:

ObjectiveTo discuss the feasibility and superiority of EST combined with LC in treating cholecystolithiasis with common bile duct stones.
MethodsPatients underwent LC (laparoscopic cholecystectomy) preceded by EST（endoscopic sphincterotomy） and removal of common bile duct stones. ENBD(Endoscopic nasal biliary drainage tube)was placed if EST failure and then the patient underwent LC+laparoscopic biliary duct exploration(LCBDE),or open operative bile duct exploration.
ResultsIn 91 of the 99 cases,LC preceded by EST and stone removal was successful,while EST following LC was successful in 3 cases, and stone removal by EST was unsuccessful in 3 cases.Two cases less than 15 years of age underwent LC+LCBDE through the cystic duct and did not undergo EST.Three cases, who had EST failure, underwent LC+LCBDE with primary suture of the common bile duct or LCBDE with T-tube drainage of common bile duct,or open bile duct exploration with primary suture of the common bile duct(ENBD was in place). All patients were discharged from hospital without serious complications.
ConclusionsEST combined with LC in treating cholecystolithiasis with common bile duct stones is a safe and effective method. Combination of endoscopic and laparoscopic procedures fully reflects the advantage of minimally invasive therapy.

Abstract:

ObjectiveTo evaluate the impact of laparoscopic cholecystectomy (LC) on the prognosis of unsuspected gallbladder cancer(GC).
Methods A retrospective clinicopathologic study was performed on 21 patients with unsuapective GC,but diagnosed gallbladder cancer postoperatively by pathology. Of which, 11patients underwent LC and 10 patients underwent open cholecystectomy (OC), The correlation was evaluated between cumulative survival rates and the following 5 prognostic factors: histopathological grade, pathologic stage, occurrence of bile spillage, type of cholecystectomy (LC or OC), and additional surgical treatments.
ResultsEight patients (73%) after LC and 7 patients (70%) after OC had cancer recurrence,and the difference was of no statistical significance (P=0.86). There were no recurrences of cancer in the abdominal wall after either LC or OC. Survival rate was statistically correlated to tumor stage (P=0.006),and to the occurrence of bile spillage (P=0.003). Survival rate did not differ according to whether the operation was carried out using LC or OC (P=0.74).
Conclusions LC does not worsen the prognosis of unsuspected gallbladder cancer.

Abstract:

ObjectiveTo investigate the indications, and experience of laparoscopic cholecystectomy (LC).
MethodsThe clinical data of 3002 cases of LC,from Jan. 2006 to Dec. 2008, were reviewed.
ResultsThe total rate of convertion to open surgery was 3.63%, biliary tract injury 0.27%, bowel injury 0.07%, and postoperative bleeding of cystic artery 0.07%. In patients with acute cholecystitis or with a past history of upper abdominal operation, the convertion rate was 7.17% and 13.2% respectively, which was significantly higher than the total convertion rate (P<0.01), but no biliary tract injury occurred in any of the cases.
ConclusionsAcute cholecystitis or history of upper abdominal operation should not be as contraindication for LC. High attention to dissection of Calot′s triangle and appropriate timing of conversion to open surgery are the key elements to decrease complications.The prompt discovery and appropriate treatment of intraoperative bowel and bile duct injury and bleeding of cystic artery are important facts for decreasing postoerative complications.

Abstract:

ObjectiveTo evaluate the effect and safety of suture needle puncture and discission of bile duct in laparoscopic common duct exploration(LCDE).
MethodsThe clinical data of 75 cases who underwent LCDE with suture needle puncture and discission of bile duct in our department during the past 2 years were analyzed retrospectively.
ResultsLCDE was successfully performed in all the 75 cases. No patient had complications, such as injury to adjacent organs, bile leakage or postoperative bleeding,and there were no death. Two cases were converted to open surgery because of internal duodenal and common bile duct fistula in one case, and in another, because of cast-like stone impaction that could not be removed by choledoscope.There was no bile duct stenosis during follow-up of 4 months to 2 years.
ConclusionsThe technique of suture needle puncture and discission of bile duct is a simple,effective and safe method for laparoscopic common duct exploration.

Abstract:

ObjectiveTo study the feasibility and safety of transumbilical single port laparoscopic cholecystectomy (LC).
MethodsWe analyzed the clinical data of 52 cases of transumbilical single port LC done in our hospital from March 2009 to July 2009.
ResultsThree cases were operated by usual LC because of stone embedded in gallbladder neck and exposure was difficult. In the other 49 cases (94.2%), transumbilical single port LC was successfully performed.Operating time was 39 to 108 min［mean (48±23 min)］.There were no intraoperative complications. The patients were discharged from hospital in one to three days after operation, and resumed normal work in one week.
ConclusionsCompared with the routine LC, transumbilical single port LC is more feasible, has more micro-invasive advantages and with no visible abdominal scar.

Abstract:

ObjectiveTo investigate the effect of octreotide on inhibition of growth of subcutaneously implanted tumor with human gall bladder cancer cells in nude mice, and to explore the mechanisms.
MethodsWe established subcutaneous implanted tumor model in nude mice by using human gallbladder carcinoma cell line GBC-SD. A total of 18 male nude mice bearing xenografts of the cell line were randomly divided into therapy and control groups, with 9 in each group. Octreotide was administered intraperitoneally at a dose of 100 μg/(kg·d) to the therapy group and isovolumic normal saline was administered to the control group for 6 weeks. All mice were put to death, and the weight and volume of the tumors were assayed. Flow cytometry was used to examine apoptosis of tumor cells. Immunohistochemical staining was used to examin the expression of p53, bcl-2, and Ki-67.
ResultsThe weight of implanted tumors in nude mice in the therapy group［(0.99±0.54)g］ was lower than that in control group ［(1.58±0.51)g, P<0.05］. Tumor inhibitory rate was 37.3% in therapy group.The apoptotic rate of implanted tumor cells in the therapy group was significantly higher than that in the control group ［(7.76±2.62)% vs. (4.27±1.50)%, P<0.01］. In the therapy group, the percentage of p53, bcl-2, and Ki-67 positive cells was (79.48±5.22)%, (46.72±6.40)%,and (37.56±6.67)% respectively, while in the control group the percentage of p53, bcl-2, and Ki-67 positive cells was (87.13±8.26)%,(53.85±7.72)%,( 45.45±8.73)% respectively. There was a significant difference between the two groups (P<0.05).
ConclusionsOctreotide can inhibit the growth of human gallbladder carcinoma cells implanted tumor in the nude mice model. The mechanisms may involve inhibition of proliferation and induction of apoptosis.

Abstract:

ObjectiveTo establish an optimal co-cultivation of porcine hepatocytes with bone marrow mesenchymal stem cells (MSCS) in vitro for finding the ideal cell source of bioartificial liver.
MethodsMononuclear cells were isolated from bone marrow,which aspirated from the anterior superior iliac spine of swines (n=3) and isolated by density gradient centrifugation. A randomly distributed co-culture system composed of porcine hepatocytes harvested by a two-step in situ collagenase perfusion technique and MSCS of passage 3 generated. The morphological and functional character of varying group of co-cultured hepatocytes were observed.
ResultsThe purity of primary hepatocytes was more than 99%. Hepatocyte viability was greater than 95%. A rapid attachment and self-organization of three-dimensional hepatocyte spheroids were encouraged in co-culture. Heterotypic junctions remained similar to that of hepatocytes in vivo. The maximal induction of albumin production, urea synthesis, and cytochrome P4503A1 activities was achieved at seeding ratio of 2∶1 (P<0.05). The best hepatic function levels were achieved on day 2 and moderately decreased in the following co-culture days (P<0.05).
ConclusionsCo-cultivation of porcine hepatocytes and MSCS at a seeding ratio of 2∶1 can preserve hepatocyte morphology and functions, and could contribute highly potent cells to the functional bioartificial liver.

Abstract:

ObjectiveTo study the effects of different CO2 pressures on adhesive and invasive alility of MKN-28 gastric carcinoma cells.
MethodsWith an artificial pneumoperitoneum model in vitro, MKN-28 human gastric carcinoma cells were exposure to CO2 in 3 different pressure groups: 9mmHg, 15mmHg and control group. The adhesive ability of MKN-28 cells before and after exposed to CO2 was detected by CytoMatrixTM kit. The percentage of cells expressing E-cadherin and ICAM-1 among MKN-28 cells were counted by flowcytometry in vitro. All the MKN-28 gastric carcinoma cells were injected into abdominal cavity of nude mice(2×106cells/mouse) respectively. Five mice of each group were sacrificed 4 weeks later to record the number of tumor nodules in abdominal cavity.The remaining mice were kept to observe the survival time.
ResultsIn the 3 groups,all of the adhesive ability of MKN-28 cells (cd/m2). the percentage of cells expressing E-cadherin,and ICAM-1; the number of intra-abdominal tumor metastases. the survival time and the tumor metastasis in abdominal cavity of nude mice were no sigmificant difference call (P＞0.05).
ConclusionsWhen the pressure is below is below 15 mmHg and for less thqn 4 h, different CO2 pressures and different time intervals do not affect the adhesive and invasive ability of MKN-28 cells in the abdominal cavity,and not increase the chancws of tumonr metastasis.

Abstract:

ObjectiveTo investigate the effect of ursodeoxycholic acid（UDCA） on prevention of retrograde biliary tract infection after cholangioenterostomy.
MethodsFifty patients undergoing cholecystojejunostomy,cholangio-jejunostomy, pancreaticoduodenectomy and choledochoduodenostomy treated in our hospital, during a 2-year period, were randomly divided into control group and observation group, respectively. In addition to conventional postoperative care, control group received vitamin C, while UDCA was given to observation group. The incidence of postoperative retrograde infection of biliary tract in the two groups was compared. The duration of follow-up varied from 6 months to 2 years.
ResultsCompared with control group, The incidence of postoperative retrograde biliary tract infection in therapy group was significantly lower than that in comtrol group (4.0%vs.32.0%)(P＜0.05).
ConclusionsAdministration of UDCA following cholangioenterostomy is safe, and it can significantly reduce the occurrence rate of retrograde biliary tract infection.

Abstract:

ObjectiveTo analyze the causes of preoperative misdiagnosis of primary gallbladder carcinoma, and the effective measures of prevention of the misdiagnosis.
MethodsWe retrospectively analyzed the clinical records of 52 cases with primary gallbladder carcinoma that had been treated in our hospital in 10 years,and analyzed the causes of misdiagnosis.
ResultsNineteen cases were diagnosed preoperatively(36.5%), while 33 cases were misdiagnosed before operation(63.5%), including misdiagnsed as cholecystolithiasis in 13 cases, gallbladder polyps in 8cases, atrophic cholecystitis in 4cases, hepatic hilar cholangiocarcinoma in 3 cases, tumor of liver in 4 cases,and Mirizzi syndrome in 1 case.There were 29 cases diagnosed during operation(55.8%),and 4 cases misdiagnosed intratoperatively（7.7%）. Misdiagnosis was due to several reasons:complicated with other gallbladder disease, lack of distinctive clinical features of gallbladder carcinoma, over dependence on imaging methods,and not doing fast frozen section during operation in dubious cases.
ConclusionsIn suspected cases with high risk of gallbladder cancer,imaging studies should be performed,and, if necessary, invasive studies and even exploratory laparotomy should be done. Also,intraoperative rapid frozen section can result in early discovery and treatment,and is conducive to improvement of prognosis of gallbladder carcinoma.

Abstract:

ObjectiveTo improve the recognition of intrahepatic biliary cystadenoma.
MethodsThe clinical manifestations,radiologic features,diagnosis and surgical treatment of 18 patients with intrahepatic biliary cystadenoma admitted in our hospital during the recent 8 years were retrospectively analyzed.
ResultsFour cases were discovered by general medical examination, while the other 14 patients had varying symptoms that included right upper abdominal discomfort or pain in 11 cases, abdominal mass in 3 cases,and jaundice accompanied by fever in 2 cases. B ultrasound and CT scan showed intrahepatic cystic occupying lesions consisting of multilocular or single cyst,and usually with papillary structures in the cyst wall. All of 18 cases received surgical resection. The patholgic dingnosis was intrahepatic biliary cystadenoma in all the 18 cases, and 6 of them showed malignant change.The average survival time of maligmant patients was 35(27-58)months.
ConclusionsPreoperative diagnosis of intrahepatic biliary cystadenoma is difficult.Intrahepatic biliary cystadenoma is easy to develop into cystadenocarcinoma. Early surgical resection is necessary, and can effectively prevent recurrence or malignant transformation.

Abstract:

ObjectiveTo explore the feasibility and safety of hand-assisted laparoscopic surgery (HALS) in complicated liver and spleen surgery.
MethodsHALS was used in 202 cases including 94 cases of hepatectomy，29 cases of splenectomy, 28 cases of modified Sugiura procedure, 4 cases of combined hepatectomy and splenectomy, 41 cases of combined hepatectomy and choledocholithotomy, one case of combined hepatectomy and total hysterectomy and 5 cases of combined splenectomy with choledocholithotomy.
ResultsHALS was successful in all of the 202 cases. Mean surgical time was (138±12) minutes. Mean blood loss was (179±34) mL. No serious postoperative complications occurred. The mean postoperative hospital stay was (9.2±1.1) days.
ConclusionsHALS is feasible and safe in complicatedliver and spleen surgery for strictly selected patients. It offers to patients significant benefits such as decreased operative difficulty and trauma to the abdominal wall, shortened operative time,and effective control of hemorrhage.

Abstract:

ObjectiveTo explore the effect of damage control resuscitation in the treatment of severe liver injury.
MethodsWe retrospectively analysed the clinical data of 86 cases of severe liver injury who had damage control resuscitation during a period of 10 years.
ResultsIn 86 cases of severe liver injury, 10 patients died with mortality rate of 11.6%, and 76 patients were cured with cure rate of 88.4%.
ConclusionsDamage control resuscitation should be instituted throughout the whole perioperative process of severe liver injury,and early successful resuscitation is the key to improve the cure rate and reduce mortality.

Abstract:

ObjectiveTo recognize the features of the ligamentum teres hepatic (LTH) in multi-slice spiral CT, and to preliminarily explore its clinical value.
MethodsA total of 130 patients without liver disease underwent abdominal scanning with a 16-slice spiral CT scanner. LTHs, as focused points, were observed by using postprocessing techniques such as multi-planar reformation (MPR), slab maximum intensity projection (slab-MIP) and slab volume rendering (slab-VR).
ResultsThe LTH was detected by multi-slice spiral CT in 90.8%(118/130). On these oblique-sagittal MPR, slab-MIP and slab-VR images, LTH presented as slightly high density smooth cord-like structure in accordance with its anatomical morphology and position. The mean diameter of fissure portion of normal LTH was (5.44±0.96) mm (range 3.2-7.2 mm) measured at its middle region, and that of free portion of normal LTH was (3.43±0.91) mm (range 1.6-6.0 mm).
ConclusionsMulti-slice spiral CT demonstrates the LTH clearly, and has a potential to evaluate the LTH before abdominal operation in which the LTH is to be used as an autogenous repair material.

Abstract:

ObjectiveTo investigate the clinical features, diagnosis and treatment of nonfunctioning islet cell tumors (NFIT).
MethodsThe clinical data of 23 patients with NFIT, who were admitted to our hospital from Jan. 2002 to Dec. 2008, were retrospectively studied.
ResultsThe main clinical manifestations of NFIT included abdominal mass, abdominal pain and distension and obstructive jaundice.The diagnoses of pancreatic tumors were confirmed by imaging studies including ultrasonography, CT and MRI. The average diameter of the tumors was 9.5cm. Pancreaticoduodenectomy was performed in 47.8%(11/23), resection of pancreatic body and tail together with spleen was performed in 21.7%(5/23), and other procedures were performed in 31.5% (7/23) of patients. Tumors were malignant in 13.0%(3/23) and benign in 87.0% (20/23) according to postoperative pathology. The major postoperative complication was pancreatic fistula (13.0%), and it healed by nonoperative therapies in all of the cases.One of 3 patients with malignant NFIT died within 1 year after operation, while the other 2 had survived, without tumor recurrence, for 29 months and 8 months respectively on follow-up. Seventeen patients with benign NFIT had survived for 1 to 7 years on follow-up.
ConclusionsThe diagnosis of NFIT should be based on clinical manifestations, lab data, imaging study findings, intraoperative exploration and postoperative pathology. The prognosis of surgical treatment is good.

Abstract:

ObjectiveTo explore the feasibility of laparoscopy-assisted total mesorectal excision (TME) for anterior resection of rectal cancer.
MethodsThe clinical records of 42 patients with rectal cancer who underwent laparoscopic TME from April 2006 to July 2008 were analyzed retrospectively.
ResultsAll the laparoscopic TME with anal sphincter preservation operations were successful; no case was converted to open procedure. The distal end of rectum was anastomosed by a reusable linear stapler. The average operative time was 195 min (170-230 min) and the operative blood loss 15 mL (10-30 mL). The time for bowel function recovery was 32 hours. One patient had postoperative dysuria, and one had intraoperative subcutaneous emphysema. No anastomotic leakage or infection of incisional wound occurred.
ConclusionsLaparoscopy-assisted anterior resection for rectal cancer is safe and feasible.

Abstract:

ObjectiveTo explore the clinicopathologic characteristics, diagnosis and therapy of differentiated thyroid cancer in children and adolescents.
MethodsThe files of 68 children with differentiated thyroid cancer in our hospital from 1989-2002 were retrospectively reviewed.
ResultsAll patients received operation and postoperative thyroxin therapy. Seventeen patients underwent near-total or total thyroidectomy and 51 patients underwent ipsilateral subtotal thyroidectomy. Central compartment, unilateral and bilateral cervical lymphadenectomy was performed in 24,36, and 8 patients respectively. The patients in this group were all alive during one year to three years follow up (4 patients were lost to followup contact after three years).
ConclusionsThe optimal treatment of differentiated thyroid cancer in pediatric patients continues to be debated. The leading treatment is surgical. Selection of proper surgical procedure and comprehensive postoperative therapy are important for good outcome.Endocrine therapy was given to all of the patients postoperatively.