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Objective To evaluate the clinical efficacy of modified Chen's biliojejunostomy technique in treating hilar cholangiocarcinoma.Methods The clinical data of the patients with hilar cholangiocarcinoma from January 2011 to June 2014 in the PLA general hospital and its first affiliated hospital were retrospective ly studied,and 17 of them underwent modified biliojejunostomy.There were 10 male and 7 female patients with a mean of 65 years old (range 34 ～82).Cases diagnosed as Bismuth-Corlette Type Ⅱ,Ⅲ a,Ⅲ b and Ⅳ were 2,6,4,and 5,respectively.Results Liver segment Ⅳ were resected from 2 patients,segment Ⅳ + Ⅴ from 7 patients and segment Ⅳ + Ⅴ + Ⅰ from 8 patients.No death was observed during the study period.One patient had mild bile leakage,2 patients had cholangititis,and another patient had biliary intestinal anastomotic bleeding.Three patients received resection and reconstruction of the portal vein.Three right hepatic arteries and 1 anterior branch of right hepatic artery were resected in combination with the tumor because of invasion.All the complications were alleviated under conservative treatment.Twelve cases had been followed up for a median time of 16 months (range 3 ～ 24).Two cases had cholangititis intermittently.One case underwent radiotherapy because of local recurrence in 2 years after the surgery.MRCP and relevant enzymes were within the normal range.Conclusion Modified Chen's biliojejunostomy is a simple,effective and safe method,which can be widely used when there are multiple biliary intestinal anastomoses.
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Objective To investigate the intra-and postoperative course of patients undergoing laparoscopic liver resections under intermittent total pedicle occlusion (IPO),hemihepatic vascular occlusion (HVO),and selective vascular occlusion(SVO).Methods Retrospective analysis the data of 41 cases of laparoscopic liver resection were conducted in three groups of patients under different occlusion methods,including 15 cases of intermittent total pedicle occlusion (IPO),12 cases of hemihepatic vascular occlusion (HVO) and 14 cases of selective vascular occlusion (SVO).Intraoperation blood loss,operation time,conversion to open operation,changes in postoperative liver function,hospital stays and complications were compared among the three methods.Results There was no operative death in any of the 41 patients.There was no conversion to open surgery.Generally,there was no significant difference among the three groups in blood loss,clamping time or operative time.Ten patients had postoperative complication and all were cured.The effect on liver function for Gro-HVO and Gro-SVO was significantly less severe than that for Gro-IPO (P ＜ 0.05) after operation.Conclusions Both HVO and SVO are feasible and safe in laparoscopic hepatectomy(LH),and have advantage in reducing liver remnant ischemia injury and modality rate over IPO.HVO is easy to do for left lateral lobe or resection of the left half of the liver.SVO is suitable for right lobe resection.
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The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome (MODS) were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups: control group (n=56) treated with conventional therapy, and intensive insulin therapy group (n=58) treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells (WBC) counts, prothrombin time (PT), serum creatinine (SCr), alanine aminotransferase (ALT), serum albumin and PaO(2) were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced (P<0.05), but the level of serum albumin was significantly increased (P<0.05) at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 (P<0.01) after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased (P<0.01). The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.
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Objective To study the effects of different nutritional support strategy on acute pancreatitis in rats induced by bile-pancreatic duct ligation. Methods Forty acute pancreatitic rats were divided into four groups and were given simple parenteral nutrition (PN, n=10), early enteral nutrition (EEN,n=10), mid term enteral nutrition(MEN, n=10), and late enteral nutrition (LEN, n=10) respectively. After seven-days of nutritional support, the weight changes and peritoneal dropsy were recorded, the zymologic index of serum biochemistry, pancreatic enzyme level, and malonaldehyde(MDA) concentration were detected, and the pancreatitic tissue were collected, stained with hematoxylin eosin, and histopathologically scored. Results Three rats died in EEN group, and one rat died in MEN group. The weight reduction and peritoneal dropsy in EEN and MEN groups were significantly larger compared with PN and LEN groups(P<0.05). The index of direct bilirubin in EEN rats was significantly higher than that in PN and LEN groups(P<0.05). The index of serum albumin of PN group was higher than those of the other three groups(P<0.05 ) ; the index of hemodiastase of PN group was lower than those of EEN and MEN groups(P<0.05 ) ; the index of hemolipase of PN group was lower than those of the other three groups(P< 0.05). The amount of pancreatic tissue amylase of PN and LEN groups was lower than those of EEN and MEN groups(P<0.05 ) ; the amount of pancreatic tissue lipase of EEN group was higher than those of PN and LEN groups (P<0.05). There was positive relationship between MDA concentration and histopathological score of pancreatic tissue(R=0.93, P<0.05) ; MDA concentration and histopathological score of EEN and MEN groups were significantly higher than those of PN and LEN groups (P<0.05).Conclusion Early enteral nutritional support exacerbates pathological changes of acute pancreatitic rats,which is unfavourable to the recovery of the pancreatitis.
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ObjectiveTo evaluate the value of tensionfree herniorrhaphy for inguinal hernia. Methods(1)Comparison was made in operating time, early postoperative response, hospitalization time, postoperative complications and recurrence rate between the two herniorrhaphy groups.In tensionfree herniorrhaphy group( n=137),hernias were repaired with polypropylene mesh plug or mesh patch.(2)In conventional herniorrhaphy group (n=98 ) ,hernias were repaired with Bassini operation. Mean Follow up time was 22 month in the 2 groups. Results The operating time, analgesic use, early response and hospitaliz ation time in tensionfree herniorrhaphy group were significantly lower than those in conventional herniorrhaphy group(P
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Objective To investigate the residual functions in the hepatic lobe with deprivation of bile duct by observation of histomorphological and functional changes in the hepatic cells in a rat model. Methods The right hepatic bile ducts of rats were obstructed with cyanoacrylate and then ligated two weeks after the left and caudate lobes were removed. The lobus quadratus hepatis served as self-control with or without portal vein ligation. The venous blood from individualized liver lobe was examined and histological observation was done to examine the histomorphological and functional changes in the hepatic cells. Results Compared to the controls of both sham operation and untreated lobe, the hepatic lobe with bile ducts deprived did not undergo atrophy significantly with few ultrastructural changes. The hepatocytes of the hepatic lobe with bile duct deprived contained plenty of mitochondria, ribosomes and rough endoplasmic reticulum when observed under transmission electron microscope (TEM). The results of periodic acid-Schiff staining revealed normal glycogen metabolism in the hepatic cells. No significant decrease was detected in the serum albumin and fibrinogen concentrations by examination of blood collected from vein of this liver lobe with deprivation of bile ducts. Conclusions The liver lobes with bile ducts deprived retain most of the liver functions such as protein synthesis and nutrition metabolism, and show no atrophy during the observation period. It is suggested that the hepatic lobes with bile duct deprived still possess the value of preservation. The present study has founded a theoretic basis for remaining the remaining liver lobes with bile duct deprived or ligated in some emergency and specific clinical situations.