Objective To summarize the experiences in learning laparoscopic cholecystectomy （LC） and discuss young surgeons how to learn LC scientifically. Method The clinical data of 198 patients received LC by myself since I got the qualification of LC were analyzed retrospectively. Results LC was performed successfully in 187 patients with an average operation time of 68 min. Eleven patients were converted to laparotomy. In these 11 patients， 10 patients because of unclear anatomy in Calot triangle and 1 patient because of uncontrollable bleeding due to pathologic anatomy in Calot triangle caused by gallstone. All 198 patients did not suffer from complications such as severe hemorrhage or injury of biliary duct. Liquid therapy and antibiotics therapy were applied in patients with cholecystitis after LC. Food intake and ambulation were recovered at 12-24h after operation. All the patients were discharged from hospital with anaverage of 2.8d after LC. There was no complications related bile duct injury in all of the patients. Conclusion Managed by hierarchical operations management system， mastering regional physiological and variant anatomy， making use of other open cholecystectomy and laparoscopic simulative learning system well， complying with the learning curve， controlling the indications， contraindications and timing of conversion to laparotomy， young surgeons are able to master LC scientifically， safely， and solidly.
目的 总结胰腺瘘管空肠Roux-en-Y吻合术治疗胰管离断综合征的治疗效果。方法 回顾性分析2002年3月至2010年7月期间我院行胰腺瘘管空肠Roux-en-Y吻合术治疗的5例胰管离断综合征患者的临床资料，分析其治疗效果及手术并发症。结果 5例患者均为急性出血坏死性胰腺炎手术治疗后，经MRCP确诊为胰管离断综合征，手术方式为瘘管空肠Roux-en-Y吻合术，中位手术时间为178min（120～360min），中位术中失血量为300ml（150～600ml），术后中位进食时间为5d（3～8d）。随访中位时间为390d（120～712d），5例患者恢复顺利。2例患者切口感染，经切口换药治愈；1例患者出现短暂的胰肠吻合口漏，经保守治疗治愈。结论 从本组有限的病例资料看，胰腺瘘管空肠Roux-en-Y吻合术是胰管离断综合征较安全的治疗方式。
ObjectiveTo investigate the effect and prognosis of emergency hepatectomy and second stage hepatectomy after transcatheter arterial chemoembolization (TACE) in spontaneous rupture and bleeding of resectable primary liver cancer.MethodsA total of 42 patients with spontaneous rupture and bleeding of resectable primary liver cancer in this hospital from January 2010 to January 2016 were retrospectively reviewed. Among them 24 cases had accepted the emergency hepatectomy in 24 h–48 h after admission (emergency hepatectomy group, n=24), 18 cases had accepted the second stage hepatectomy in 1 week–2 weeks after the TACE (second stage hepatectomy group, n=18), the intraoperative blood loss and intraoperative blood transfusion volume, perioperative mortality, postoperative incidence of hepatic insufficiency, recurrence rate and abdominal metastasis rate within 1 year after the operation, 1- and 3-year survival rates were compared between the emergency hepatectomy group and the second stage hepatectomy group.ResultsThere was no significant difference in the preoperative general data between these two groups (P>0.050). The intraoperative blood loss and transfusion volume of the emergency hepatectomy group were significantly more than those of the second stage hepatectomy group (P=0.028, P=0.017). There were no significant differences in the perioperative mortality (P=0.489), incidence of hepatic insufficiency (P=1.000), 1- and 3-year survival rates (P=0.650, P=0.463) and 1-year recurrence rate (P=0.601) between these two groups. No intraperitoneal implantation metastasis was found in these two groups.ConclusionBoth emergency hepatectomy and second stage hepatectomy after TACE are safe and effective in treatment of spontaneous rupture and bleeding of resectable primary liver cancer, appropriate treatment should be selected according to the specific conditions of patients.
ObjectiveTo detect the expression of Prox1 (prospero-related homeobox 1) gene in primary hepatocellular carcinoma (HCC), and to analyze the correlation of Prox1 gene expression with pathological grade and clinical stage of HCC. MethodsThe expressions of Prox1 gene in carcinoma tissues and adjacent cancerous tissues in HCC as well as normal liver tissues were detected by semi-quantitative RT-PCR, then the correlation of Prox1 gene expression with HCC pathological grade and clinical stage were analyzed. ResultsThe expression of Prox1 gene in carcinoma tissues (0.243±0.102) and adjacent cancerous liver tissues (0.537±0.235) was significantly lower than that in normal liver tissue (0.812±0.372), respectively （ Plt;0.01 or Plt;0.05）. Furthermore, the expression of Prox1 gene in carcinoma tissues was significantly lower than that adjacent cancerous liver tissues (Plt;0.05). The expressions of Prox1 gene in different pathological grade (F=97.950, Plt;0.001) and clinical stage were significantly different (F=228.300, Plt;0.001), and when compared with each other, the differences of pathological grade and clinical stage were also significant (Plt;0.001 or Plt;0.01). The expressions of Prox1 gene in HCC carcinoma tissue were negatively correlated with pathological grade (r=-0.930, Plt;0.01) and clinical stage (r=-0.980, Plt;0.01) of HCC. ConclusionsExpression of Prox1 gene may be related to the initiation and development of HCC, however, that whether Prox1 gene functions as tumor suppressor in HCC needs further investigation.
Objective To summarize the experiences of “three holes and one hook in the end (TOE)” laparoscopic cholecystectomy (LC) in 1 260 cases and to investigate the operation procedures, technical points and the prevention of complications. Methods The data of 1 260 patients suffering from chronic calculous cholecystitis, acute calculous cholecystitis, atrophic cholecystitis, gallbladder polyps etc., who were admitted to this hospital and treated by TOE from March 1999 to March 2008 were included and analysed retrospectively in this study. Results One thousand two hundred and sixty of cases were cured, including 1 252 cases of succeeding LC (99.37%), conversions to open in 8 cases, no death, no bile duct injury, with intraoperative hemorrhage in 3 cases, umbilicus infection in 2 cases, gallbladder fossa hydrops in 3 cases, with operation time for 8-60 min (mean 38.5 min) and hospitalization for 3-7 d (mean 5 d ) after surgery. During the follow up of 1 002 cases for 1 to 7 years (mean 3.5 years), there were no complications such as bile fistula, bile duct stricture, residual stones of biliary duct, etc.. Conclusion TOE is worthy of application and promotion for the excellent effectiveness, few complications, rapid recovery and safety.
ObjectiveTo observe the impact of antiviral therapy on prognosis in patients after curative resection for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). MethodsThe data of 50 patients who had undergone liver resection for HBV-related HCC in our department from August 2008 to June 2012 were retrospectively analyzed. The patients were divided into two groups:21 patients who had not antiviral therapy (untreated group) and 29 patients who received antiviral therapy using nucleotide analogues (antiviral therapy group). ResultsAfter radical resection of HCC, the disease-free survival rate of 1-year, 3-year, and 5-year were 72.4%, 58.6%, and 31.0% in antiviral therapy group and 61.9%, 38.1%, and 14.3% in untreated group, respectively. The overall survival rate of 1-year, 3-year, and 5-year were 86.2%, 68.9%, and 55.2% in antiviral therapy group and 71.4%, 47.6%, and 28.6% in untreated group, respectively. The cumulative disease-free survival rate and overall survival rate of antiviral therapy group were significantly higher than those in the untreated group (P < 0.05). Univariate analysis revealed that the number of tumor, antiviral therapy, and TNM staging were risk factor for tumor-free survival rate, The tumor size, the number of tumor, antiviral therapy, and TNM staging were risk factor for overall survival rate. Multivariate analysis revealed that the number of tumor and TNM staging were independent risk factor for tumor-free survival rate (OR:2.95, 95% CI:1.502-6.114, P < 0.05; OR:4.12, 95% CI:1.972-8.960, P < 0.05), the antiviral therapy and TNM staging were independent risk factor for overall survival rate (OR:3.86, 95% CI:1.745-7.028, P < 0.05; OR:5.17, 95% CI:2.356-11.479, P < 0.05). ConclusionUsing nucleotide analogs antiviral therapy may improve the prognosis after resection of patients with HBV-related HCC.