Abstract:

Objective：To evaluate the short-term clinical outcome of precise hepatectomy for liver neoplasms.
Methods：A prospective, non-randomized controlled study was conducted on 143 selected patients with liver neoplasms admitted to our Hospital  in recent two years. Of the patients, 84 cases undergoing precise hepatectomy were designated as observation group and 59 cases undergoing conventional hepatectomy were used as control group. The indexes of the perioperative conditions between the two groups were compared. Hepatic lobectomy or segmentectomy was performed in the patients of precise hepatectomy with hemihepatic vascular occlusion or without vascular occlusion. Conventional hepatectomy was performed using clamp-crushing method under total vascular occlusion.
Results：The mean operative time of the observation group was significantly prolonged compared with the control group ［(134±86) min vs. (71±52) min, (P＜0.01)］. No difference was noted between the two groups (P=0.055) in the mean intraoperative bleeding volume, which was (274±186) mL in the observation group and (340±220) mL in the control group (P>0.05). The mean drainage volume of the first postoperative day was (175±86) mL in obsevation group and (311±98) mL in the control group, and the difference between both groups was highly significant (P＜0.01). The peak levels of serum ALT, AST, total bilirubin and C-reactive protein at 3 days after operation between the two groups were all significantly different (P＜0.01), which were (283.9±218.4) U/L, (215.5±171.3) U/L, (27.7±15.9) μmol/L and (35.4±17.3) mg/L in the observation group, and were (754.5±273.0) U/L, (692.1±216.7) U/L, (46.3±20.1) μmol/L and (79.5±31.8) mg/L in the control group, respectively. The incidence of postoperative complications was 10.7% and 23.7% in obserxation and control group respectively, and that was significantly different (P=0.037). No perioperative mortality occurred in the 2 groups.
Conclusions：Precise hepatectomy is a safe, effective and minimally invasive procedure for liver resection, and it can obtain a better clinical outcome.

Abstract:

Objective：To investigate the clinical value of laparoscopic hepatectomy (LH) and the effect on immunological system.
Methods：Forty-five patients who met the inclusion criteria to undego hepatectomy were randomly divided into LH group and open hepatectomy (OH) group. The parameters including length of incision,  duration of operation, intraoperative blood loss, postoperative time to oral intake, dosages of analgesics, postoperative hospital stay, complication rate, perioperative body temperature and hemogram between the two groups were compared.
Results：The parameters of length of incision, blood loss, dosages of analgesics, time to food intake, postoperative hospital stay and body temperature of LH group were all significantly less than those of OH group (all P＜0.05). No difference was noted in duration of operation between the two groups (P＜0.05).
Conclusions：LH is a safe, feasible and effective procedure for liver resection as long as the patient is properly selected, and it has little effect on the immunological system and better short-term outcome than open surgery.

Abstract:

Objective：To study the safety, feasibility and minimal invasiveness of laparoscopic hepatectomy for primary liver cancer.
Methods：The clinical data of 32 patients with primary liver cancer undergoing laparoscopic hepatectomy from October 2008 to February 2011 were retrospectively analyzed.
Results：Laparoscopic hepatectomies were successfully performed in all patients without convertion to an open surgery. The lesions were located in Couinaud hepatic segment II (n=3), segment III (n=8), segments II and III (n=10), segment IV (n=2), segment V (n=4) and segment VI (n=5), respectively. All patients had a single lesion combined with liver cirrhosis and the lesion size ranged from 1.8 to 9.2 cm. The grades of liver function before operation was Child′s grade A (n=27) and Child′s grade B (n=5), respectively. The operative procedures consisted of left hemihepatectomy (n=2), left lateral lobectomy (n=15) and local resection (n=15), respectively. The liver parenchyma was transected by combining Laparoscopic ultrosonic scalpel with LigaSure or Endo-GIA. Two patients underwent hepatic inflow occlusion for 15 and 22 min, respectively, and 3 patients received 2 units of RBC transfusion. No postoperative complications such as bleeding, biliary leakage or liver failure occurred. All cases recovered and discharged. Three cases had local tumor relapse and no death occurred in the 32 patients during the follow-up period of 5-26 months.
Conclusions：Laparoscopic hepatectomy for primary liver cancer is safe and feasible. Indications of laparoscopic hepatectomy for primary liver cancer should be strictly defined because the procedure has high technical difficulty. The size and location of the hepatic lesions are the major selective indicators. The combination of ultrosonic scalpel and LigaSure for liver transection has the advantages of good hemostatic effect and clear anatomy.

Abstract:

Objective：To investigate the treatment of recurrent small hepatocellular carcinoma (HCC).
Methods：The clinical data of 47 patients with recurrent small HCC after initial operation and treated in our haspital from January 2003 to December 2008 were retrospectively analyzed. The patients were divided into reoperation group and radiofrequency ablation group, and the 3-year survival and recurrences between the two groups were compared.
Results：Twenty-four patients in the reoperation group underwent local resection and chemoembolization with an implanted chemotherapy pump via hepatic artery. Twenty-three patients in the radiofrequency ablation group underwent local radiofrequency ablation and chemoembolization with a catheter introduced into the hepatic artery via femoral artery. The 3-year tumor-free survival rate of the reoperation group was higher than that of the radiofrequency ablation group ［66.7% (16/24) vs. 47.8% (11/23), P＜0.05］, and the local recurrence in reoperation group was lower than that of the radiofrequency ablation group ［25.0% (6/24) vs. 34.8% (8/23), P＜0.05］. However, the 3-year survival and recurrence rate showed no statistical difference between the treatment of reoperation and radiofrequency ablation among the patients with recurrent tumor size less than 3 cm (P＞0.05), but the treatment by reoperation had a high 3-year survival rate and a low recurrence rate compared with treatment of radiofrequency ablation among the patients with the recurrent tumor size between 3 to 5 cm (both P＜0.05).
Conclusions：For small (<3 cm) recurrent HCC, surgeons should give full consideration to the wishes of the patients as well as the specific condition of the patients in selection of reoperation or rediofrequency ablation. However, reoperation is the preferential treatment for patients whose recurrent tumor sizes are between 3 to 5 cm.

Abstract:

Objective： To investigate the perioperative management of liver cancer patients with concomitant hyperglycemia undergoing hepatectomy.
Methods：The clinical data of 98 liver cancer patients with concomitant hyperglycemia were analyzed retrospetively.
Results：Of the 98 patients, the fasting blood glucose (BG) was controlled within 6.1-11.1 μmol/L, and ketonuria was negative before operation; intraoperation, the BG was controlled within 6.8-11.2 μmol/L; and the BG was controlled by insulin postoperatively. The 98 patients underwent operation uneventfully and all recovered. After operation,  surgical incision infection occurred in 7 cases (7.14%); pulmonary infection occurred in 3 cases (3.06%), among them 1 combined with ketoacidosis (1.02%);  urinary system infection occurred in 3 cases (3.06%) and abdominal abscess occurred in 1 case (1.02%).
Conclusions： Hepatic dysfunction of liver cancer patients may cause hyperglycemia or aggravate diabetes. For those with concomitant hyperglycemia, the perioperative management including tight blood glucose control, nutritional support enhancement, and aggressive treatment of complications such as infection and ketoacidosis is the important basis for successful surgical treament.

Abstract:

Objective：To investigate the safety and effectiveness of using fast track surgery (FTS) in perioperative period of patients with primary hepatic cancer undergoing liver resection.
Methods： Forty patients were randomly designated into observation group (using FTS in perioperative period) and control group (using traditional protocol in perioperative period). The parameters including C-reactive protein (CRP) levels at 1st and 5th day after operation, time of the first passing of flatus and defecation after operation, length of hospital stay, hospitalization expenses between the two groups were compared. The postoperative adverse events and complications of the two groups were also recorded.
Results：Compared with the control group, FTS management decreased the postoperative stress, accelerated recovery of bowel movement and reduced hospital stay and cost (P＜0.05), while the postoperative adverse events and complications of the two groups showed no difference (P＞0.05).
Conclusions：Application of FTS in perioperative management of patients with primary hepatic cancer is safe and effective, and can accelerate the recovery of patients undergoing hepatectomy.

Abstract:

Objective：To investigate the predictive factors of blood transfusion in liver resection for hepatocellular carcinoma (HCC).
Methods：The clinical data of 222 HCC patients undergoing liver resection were retrospectively analyzed to identify the clinicopathological factors that predict the probability of blood transfusion in liver resection for HCC.
Results：Following univariate logistic regression analyses, multivariate analyses were performed to identify the independent predictors of blood transfusion. The results revealed that eight variables could be as independent predictors of blood transfusion including cirrhosis, tumour size, main vessel invasion, resection extent, serum levels of aspartate aminotransferase, direct bilirubin and indirect bilirubin, and preoperative hemoglobin concentration. From these variables, a logistic regression equation was derived to predict the probability of blood transfusion.
Conclusions：Analysis of the preoperative factors of blood transfusion in HCC patients to predict the likelihood of transfusion can be used to identify patients who are at high risk for blood transfusion and therefore to employ autologous blood transfusion, which may decrease the disadvantages of allogeneic blood transfusion.

Abstract:

Objective：To evaluate the clinical importance of P-POSSUM scoring system in predicting the risks of hepatectomy for liver cancer in patients over 60 years of age.
Methods：The clinical data of 382 patients over the age of 60 undergoing hepatectomy from January 2006 to December 2009 in our hospital were retrospectively analyzed. The predictive postoperative complication incidence and death were calculated with modified POSSUM (P-POSSUM) scoring system and the results were compared with those of the patients under 60 years of age operated at the same period.
Results：Of the patients over 60 years of age, the predictive complication incidence and death estimated by P-POSSUM scoring system was 43.71% (167/382) and 7.59% (29/382), and the actual complication incidence and death was 38.22% (146/382) and 4.97% (19/382), respectively (P＞0.05). In contrast, the predictive complication incidence and death were both higher than those of actual data (P＜0.05) in patients under 60 years of age.
Conclusions： P-POSSUM scoring system is valid for prediction of the postoperative complication incidence and mortality in the elderly patients undergiong hepatectomy, and this system can be used to guide perioperative management of patients over the age of 60.

Abstract:

Objective：To study the imaging and clinicopathological features, treatment, and prognosis of hepatic angiomyolipoma (HAML).
Methods：The clinicopathological data of 5 patients with HAML treated in our haspital from 2007 to 2009 were retrospectively analyzed. All patients underwent excision of hepatic mass or partial liver resection for hepatic parenchymal disease as suggested by B ultrasound, CT or MRI examination.
Results：The imageological examination showed that the masses exhibited regular shapes and clear margins. Microscopically, the tumors were composed of a mixture of blood vessels, smooth muscle and fat tissues in different proportions. Immunohistochemical staining showed that the tumors were positive for HMB45 and SMA. These tumors were finally comfirmed to be HAML by routine pathological and immunohistochemical diagnosis. No recurrence or death occurred during the half to 1 year periods of postoperative follow-up.
Conclusions：HAML is a rare tumor of liver and its biological behavior is generally benign. HAML is likely to be misdiagnosed as malignant tumor due to the diverse morphological traits. Pathologists must be aware of the histological findings of HAML to avoid misdiagnosis in their pathological evaluation.

Abstract:

Objective：To study the displaying features and clinical significance of multi-detector spiral CT angiography (MDCTA) for demonstrating the hepatic arterial and portal venous systems in patients with neoplastic hepatic lesions.
Methods：One hundred and nineteen patients with neoplastic liver disease whose clinical data were complete were selected to perform MDCTA. All patients underwent 64-detector spiral CT scanning of hepatic arterial and portal venous phase, and images were reconstructed by maximum intensity projection (MIP), shaded-surface display (SSD) and volume rendering (VR) technique, respectively. The imaging findings of hepatic arterial and portal venous system from MDCTA with different reconstruction methods were compared, and the risk of bleeding in surgery was also assessed.
Results：The display for the VI level of hepatic artery in MIP and VR showed no difference (P＞0.05) but both displayed better than SSD (P＜0.05). The 3 reconstruction methods all clearly displayed the I, II and III levels of portal vein and the display rates were all above 98.1% (P＞0.05). The coincidence rate of CTA estimation of low bleeding risk in surgery was 96.7%, high bleeding risk in surgery was 90.5%, and the results were statistically significant (P＜0.05).
Conclusions：MDCTA can satisfy the clinical requirements in liver surgery. The combined use of MIP and VR can  optimally displaly the hepatic artery and portal vein, and SSD also has helpful effects. CTA can be used for prelimmary estimation of the risk of intraoperative bleeding.

Abstract:

Objective：To investigate the gene expression and significances of PTCH and SMO in diethylnitrosamin (DEN)-induced primary hepatocellular carcinoma (HCC) in rats.
Methods：Rat HCC models were established by DEN-induction method. The gene expressions of PTCH and SMO in rat HCC tissues along with their adjacent benign tissues were determined by real time PCR.
Results： Of the 13 rats, the expression level of PTCH mRNA in HCC tissues and their benign adjacent tissues was 6.33±0.62 and 7.18±0.99 (P＜0.05), respectively. The expression level of SMO mRNA was 7.93±1.00 and 8.76±0.83 (P＜0.05), respectively.
Conclusions：PTCH and SMO are important regulation factors of the Sonic Hedgehog (SHH) signaling pathway. Thus, the SHH signaling pathway is probably involved in the tumorigenesis of HCC.

Abstract:

Objective：To investigate the relation between clinicopathology and expression level of vascular endothelial growth factor A (VEGF-A), VEGF-C and placenta growth factor (PIGF) in liver cancer, and evaluate the influence of PIGF expression on recurrence of liver cancer after hepatectomy.
Methods：Tumor specimens of 63 patients with liver cancer who underwent hepatectomy from May 2006 to August 2008 were randomly collected. The expression level of VEGF-A, VEGF-C and PIGF genes in the tumor tissues were detected by real time PCR and the concentrations of PIGF protein in the tumor tissues were determined by ELISA method. The microvessel densities (MVD) of the tumor tissues were assessed by CD34 immunohistochemical staining. The correlations between these angiogenic factors and the clinicopathology of liver cancer as well as early recurrence after hepatectomy were analyzed. The relation between PIGF content and MVD of liver cancer was also observed.
Results：The proportions of high expression of VEGF-A, VEGF-C and PIGF in the HCC patients with early metastasis were 62.5% (10/16), 68.75% (11/16) and 87.5% (14/16), respectively; and the ratio of high expression of PIGF was higher than that of the other two angiogenic factors in the  HCC patients with early metastasis (P＜0.05). The expression levels of VEGF-C and PIGF were associated with AFP level,  proportions of high expression of VEGF-C and PIGF significantly increased when APF level was higher than 245 ng/dL (P＜0.05). The higher the PIGF protein content, the more likely to have an early recurrence in patients at stage II or III (P＜0.05). MVD in patients of stage II and III was higher than that in patients of stage I (P＜0.05), and MVD was positively correlated with the PIGF content (r=0.58, P=0.025) in patients with tumor larger than 5 cm in diameter.
Conclusions：PIGF content of liver cancer patients is closely associated with early recurrence after hepatectomy, especially in the stage II and III  patients. PIGF can be used as an independent predictive factor for early recurrence in advanced liver cancer after hepatectomy.

Abstract:

Objective：To investigate the abnormal expression of β-catenin and its role in the development and differentiation of primary hepatocellular carcinoma.
Methods：Four types of cell lines (L-02, WB, HepG2 and SMCC-7721) were attachment cultured and subcultured. The expression characteristics of β-catenin in those cells were detected by immunocytochemical staining.
Results：Of the L-02 cells, the β-catenin proteins were expressed totally on the cell membrane and none of them were expressed in the cytoplasm and nucleus. Of the WB cells, the β-catenin proteins were expressed mainly on the cell membrane and slightly expressed in the cytoplasm and nucleus. However, the β-catenin proteins were strongly and totally expressed in the cytoplasm and nucleus of HepG2 and SMCC-7721 cells, and the β-catenin expressions in SMCC-7721 cells were higher than those of the HepG2 cells.
Conclusions：The translocated expression of β-catenin from the cell membrane to cytoplasm and nucleus may play an important role in the development and differentiation of primary hepatocellular carcinoma.

Abstract:

Objective：To investigate a simple procedure to establish an ideal animal model of hepatocellular carcinoma (HCC) featuring low mortality, high success rate, short period for tumor induction and tumorigenesis profile similar to human  HCC.
Methods：Forty Wistar rats, aged 2 months, were used. Firstly, all rats underwent subcutaneous hind-limb injection with 50% CCl4 oil solution at a dose of 0.3 mL/100 g twice a week for 2 weeks,  then injection was discontinued for 2 weeks. After that, the rats were fed with diethylnitrosamin (DEN, 95 μg/mL in drinking water) for 12 consecutive weeks.
Results：No death of rats occurred during the course of the study. The body weight of rats increased and the general state of rats was normal. HCC was successfully induced in all rats at the 16 weeks of the study.
Conclusions：A rat HCC model of low mortality and high success rate can be easily and stably induced  by DEN feeding with sensitivity enhancement by CCl4.

Abstract:

Objective：To investigate the protective effect of fasudil, a Rho-kinase inhibitor, on ischemia/reperfusion (I/R) injury after partial liver resection in rats and its mechanisms.
Methods：Fifty-four Wistar rats were randomly divided into group A (sham operation, control group), group B (I/R group) and group C (fasudil pretreatment + I/R group). I/R models were induced by blocking the blood supply of hepatic left lateral and median lobes (70% blood supply of liver) with an atraumatic microvascular clip for 45 min. After ischemia, the rats were reperfused and the non-ischemic hepatic lobes (30%) were resected at the same time. The serum transaminase, NO and malondialdehyde (MDA) levels, the activity of eNOS and superoxide dismutase (SOD) in liver tissues were determined at 1, 3 and 6 h after reperfusion to evaluate the hepatoprotective effects of fasudil.
Results：The liver function was improved, the SOD activity and NO level was increased, the MDA level was decreased, SOD/MDA ratio was increased and the hepatocytes impairment was alleviated significantly in group C after fasudi pretreatment. RhoA protein showed a basal expressionly in group A. RhoA protein expression significant increased in group B compared with group A, and the elevation was inhibited in group C.
Conclusions： RhoA/Rho kinase signaling pathway plays an important role in liver ischemia/reperfusion injury. Fasudil inhibits the expression of RhoA protein, regulates NO release, reduces lipid peroxidation in liver tissue and promotes clearance of free radicals. Thus, it protects the liver against 1/R injury.

Abstract:

Objective：To investigate the inhibitory effect of (-)-Epigallocatechin-3-gallate (EGCG) on angiogenesis of gastric cancer induced by IL-6 and its molecular mechanism.
Methods：AGS gastric cancer cells were cultured with  IL-6 (50 ng/mL) or with a series of concentrations of EGCC. Protein levels of vascular endothelial growth factor (VEGF) in tumor cells were examined by Western blot, the VEGF release in tumor culture medium was determined by ELISA, and VEGF mRNA expression in tumor cells by RT-PCR. The conditioned media from gastric cancer cells were prepared for culturing human umbilical vein endothelial cells (HUVEC).Vascular endothelial cell proliferation was measured with MTT assay, in vitro angiogenesis was determined with endothelial cell tube formation assay in Matrigel, and angiogenesis in vivo was measured with Matrigel plug assay.
Results：The VEGF protein level, release and mRNA expression were increased in the IL-6 induced AGS cells by 2.4, 2.8 and 3.1 folds, respectively. EGCG treatment significantly inhibited the IL-6 induced increase in level and release of VEGF protein and in mRNA expression in a dose-dependent manner. The proliferation and tube formation of vascular endothelial cells induced by IL-6 in vitro were markedly inhibited by VEGF neutralizing antibody and EGCG. The angiogenesis in vivo induced by IL-6 was also markedly inhibited by VEGF neutralizing antibody and EGCG.
Conclusions：EGCG reduces expression of VEGF induced by IL-6 in gastric cancer cells, and thereby inhibits tumor angiogenesis.

Abstract:

Objective：To investigate the effects of small interfering RNA targeting human growth hormone receptor (hGHR) combined with 5-fluorouracil (5-FU) on liver metastasis of colon cancer.
Methods：Animal model of liver metastases with human colon cancer cell SW480 was established on BALB/c mouse and siRNA interfering plasmid targeting hGHR gene was constructed. The tumor-bearing mice were randomly divided into 6 groups that included saline control group, plasmid group, growth hormone (GH) group, 5-FU group, 5-FU+plasmid group and 5-FU+plasmid+GH group. The liver metastasis in each group was observed.
Results：Liver metastases were found in all the mice. siRNA interfering plasmid treatment significantly reduced the incidence of liver metastases compared with saline or GH group (2.67±1.37 vs. 10.17±1.94, 10.50±1.38, P＜0.05). The combined treatment of interfering plasmid and 5-FU slightly decreased the incidence of liver metastases compared with plasmid alone or 5-FU alone treatment (2.33±1.03 vs. 3.17±0.98, 2.67±1.37, P＞0.05),  but had no statistical significance. On the basis of the combination of interfering plasmid and 5-FU, the additional GH did not increase the incidence of liver metastases (P＞0.05), but improved the weight loss of the mice (P＜0.05) induced by inhibition of GHR and toxicity of 5-FU.
Conclusions：siRNA targeting hGHR can reduce the incidence of liver metastases of human colon cancer cell SW480 in mice. GHR may play an important role in tumor metastasis.

Abstract:

Objective：To investigate the influence of different methods of nutritional support on infection rate during the early postoperative period of liver transplantation (LTx).
Methods：Forty-five LTx recipients, who were to be given nutritional support in the early postoperative stage (1-7 days after operation), were randomly assigned into parental nutrition (PN) group, enteral nutrition (EN) group and metabolic intervention (MI) group (EN+glutamine+arginine) with 15 cases in each group. Each group of nutritional support received equal amounts of nitrogen and calories. The infection rate of each group in 2 weeks post-LTx was observed.
Results：The infection rate within 2 weeks post-LTx between the EN and MI group showed no difference, but both was significantly lower than that of the PN group (P＜0.05).
Conclusions：EN and MI supports are more effective than PN support in reducing the risk of infection during the early postoperative period of LTx.

Abstract:

Objective： To evaluate the efficacy of nonsurgical management for blunt hepatic injury  in adult patients.
Methods：The clinical records of 96 adult patients with blunt hepatic injury undergoing nonsurgical treatment at our hospital during the past 6 years were retrospectively analyzed. Of the patients, the  hepatic injury grade was 51 (53.1%) in grade I, 30 (31.3%) grade II, 12 (12.5%) grade Ⅲ and 3 (3.1%) grade Ⅳ. Diagnosis was based on the history, ultrasonic examination, abdominal paracentesis and CT scan. All patients had monitoring of vital signs and were given symptomatic relief and supportive treatment.
Results：Nonsurgical management was successful in 87 patients (90.6%) and 9 patients were converted to operation.  Complications occurred in 15 cases, which included 12 right pleural effusions and 3 perihepatic abscesses. All these complications resolved with non-surgical symptomatic treatment.
Conclusions：Nonsurgical management is feasible for adult patients with blunt hepatic injury. However,  strictly defined indications and precise hemodynamic monitoring along with ultrasonic and CT examination are all critical factors for improving the success rate.

Abstract:

Objective：To explore the diagnosis and treatment of hepatolithiasis complicated by both liver abscess and cholangiocarcinoma.
Methods：Fourteen patients with hepatolithiass complicated by both liver abscess and cholangiocarcinoma admitted from July 2004 to September 2009 were retrospectively analyzed.
Results：The cases complicated by both liver abscess and cholangiocarcinoma accounted for 0.58% (14/2432) of the hepatolithiasis patients admitted during the same period.  Five cases were diagnosed before operation (5/14, 35.7%), 7 cases were detected by intraoperative  pathological examination and 2 cases were identified by the postoperative final pathological diagnosis. The tumor resection rate was 50.0% (7/14). At follow-up period, all the 5 patients who underwent tumor resection survived more than 1 year and 1 patient survived for 5 years and 3 months after operation; but 4 patients who underwent non-resective palliative surgery survived for 1 month, 6, 7 and 13 months, respectively.
Conclusions：Cholangiocarcinoma should be considered in patients who have a history of hepatolithiasis for many years and complicated by liver abscess. Early diagnosis and aggressive surgical resection are crucial for improving the outcomes in these patients.

Abstract:

Objective：To investigate the procedure and efficacy of hepatic lobectomy in treating intrahepatic bile duct stones.
Methods：The clinical data of 83 patients with intrahepatic bile duct stones undergoing hepatic lobectomy from January 2003 to June 2010 were retrospectively analyzed. The stones were distributed on the left side of liver in 42 (50.6%) cases, on the right side of liver in 18 (21.7%) cases, and on both sides of liver in 23 (27.3%) cases. Twenty-eight (33.7%) patients had concomitant common bile duct stones, 15 (18.0%) patients also had stenosis of bile duct, and 2 (2.4%) patients were found to have intrahepatic cholangiocarcinoma of left liver. Of the patients on admission, the liver function of Child grade A, B and C accounted for 46 cases (55.4%), 30 cases (36.1%) and 7 cases (8.5%), respectively. The options of surgical procedure, postoperative complications and outcomes of the patients were statistically analyzed. 
Results： Postoperative complications occurred in 10 (12.0%) cases and 1 case (1.2%) died. Of the 83 patients, 71 (85.5%) cases showed no residual stone. Of the 12 (6.0%) cases who had residual stone fragments, the retained stones were removed completely in 7 (58.3%) cases and incompletely in 5 (41.7%) cases with cholangioscope. Of the 5 patients with incomplete stone removal, 3 cases refused further treatment and were lost of follow-up, and 2 cases underwent reoperation for residual stones due to the onset of symptoms 1 year later (the reoperation rate was 2.4%). The other 80 patients were followed up for 2 months to 3 years and no recurrence was found.
Conclusions：Hepatic lobectomy is an effective method in treating intrahepatic bile duct stones and has high complete stone removal rate and low mortality. It carries low reoperation rate when combined with use of cholangioscopy.

Abstract:

Objective：To investigate the effects of splenectomy and azygoportal disconnection on the glycometabolism of patients with cirrhosis and portal hypertension and their possible potential mechanisms.
Methods：Forty hospitalized non-diabetic patients with portal hypertension due to hepatitis B cirrhosis were selected. The parameters that included fasting serum insulin, insulin sensitivity index (ISI), homeostasis model assessment-insulin resistance (HOMA-IR), leptin and tumor necrosis factor-α (TNF-α) level were analyzed before and 2 weeks after splenectomy and azygoportal disconnection.
Results：The insulin level of fasting serum was decreased from (13.55±4.55) mU/L (before surgery) to (9.85±1.35) mU/L (2 weeks after surgery) (P＜0.01). The ISI was increased from -4.1±0.2 (before surgery) to -3.6±0.4 (after surgery) and the HOMA-IR was deceased from 5.5±2.1 (before surgery) to 3.3±0.6 (after surgery) (both P＜0.01). The serum level of leptin and TNF-α decreased from (14.0±9.88) μg/L and (381.6±69.5) ng/L (before surgery) to (10.68±6.04) μg/L and (325.3±48.7) ng/L (after surgery) (both P＜0.05), respectively.
Conclusions：Splenectomy and azygoportal disconnection may relieve insulin resistance and improve disorders of glucose metabolism in patients with portal hypertension due to hepatitis B cirrhosis.

Abstract:

Objective：To investigate the preoperative management and principles of therapeutic of inguinal hernia in patients with liver cirrhosis.
Methods：The clinical data of 30 patients with inguinal hernia and liver cirrhosis were analyzed retrospectively. Five cases had emergency operation and 25 had elective operation; 9 cases were treated by conventional inguinal hernia repair and 21 cases were treated by tension-free inguinal herniorrhaphy.
Results：The data included 28 male patients and 2 female patients with median age of 48 years (31-79 years).Of the patients, 24 cases were unilateral indirect hernias, 4 cases were unilateral direct hernias and 2 cases were bilateral indirect hernias. The Child-Pugh grades of liver function were grade A (9 cases), grade B (19 cases), and grade C (2 cases). The operation was performed successfully in all patients. Postoperative wound infection occurred in 2 patients, scrotal hydrocele occurred in 2 patients, incision pain and〖JP+2〗 foreign-body sensation occurred in 2 patients. Of the 2 patients in Child-Pugh grade C, 1 developed mild hepatic encephalopathy and 1 died of liver failure. During the period of 6 to 36 months of follow-up, 1 case lost contact and 2 cases experienced recurrence.
Conclusions：Inguinal hernia in patients with liver cirrhosis should be treated as soon as possible and surgical treatment can improve the patients′ life qualities. Proper preoperative management is crucial to the patients with poor liver function.

Abstract:

Objective：To evaluate the applicability of curved cutter stapler in the ultra-low anterior resection with sphincter-preserving surgery for low rectal cancer.
Methods：A prospective study was carried out on 63 patients with low rectal cancer who underwent radical resection by the same surgical team from January 2006 to December 2010. Following total mesorectal excision (TME) and lateral lymph node dissection (LLND), the patients were randomly assigned either to use curved cutter stapler (the ContourTM, observation group) or to use linear cutter stapler (control group) during the distal rectum (anus) transection and closure. Finally, the ultra-low colo-rectal (anal) anastomosis was performed by a 32 mm curved intraluminal stapler. The advantages and disadvantages of the two methods were compared.
Results：The rectal (anal) remnant and colorectal (anal) closure were conducted perfectly in the 32 cases with curved cutter stapler during operation. No postoperative anastomotic fistula occurred. Compared with the control group, the operation time was shorter ［(117.3±37.5)min vs. (149.3±42.4)min, P＜0.05)］ and complication rate was lower in the observation group (9.4% vs. 19.4%, P＜0.05). The rate of sphincter-preservation in the observation group was also higher than that of the control group ［100% (32/32) vs. 90.3% (28/31), P＜0.05］. 
Conclusions：Curved cutter stapler has the advantage of complete cutting and closure, shorter operation time, low related complication incidence and low convertion to Miles method in the ultra-low anterior resection for low rectal cancer. It has great application prospects.

Abstract:

Objective：To explore the diagnosis and optimal surgical treatment of traumatic colon injury.
Methods：The clinical data of 33 patients admitted with traumatic colon injuries from May 2000 to December 2010 were retrospectively studied.
Results：Of the patients, 7 cases were diagnosed before surgery and 26 cases were diagnosed during surgery. The 32 patients who underwent modified colostomy achieved primary wound healing and the tube was removed 3 months later. Among them, 1 patient with several colonic ruptures underwent conventional colostomy and had a second operation 3 months later to close the colostomy. All cases were cured and no severe complications occurred.
Conclusions：The modified colostomy is safe and reliable for treatment of the majority of colon injuries, and its application is worth promoting.