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Objective To evaluate the safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma(HCC). Methods From January 2002 through December 2007,86 HCC cases were divided into laparoscopic hepatectomy group and open hepatectomy group.Clinical data were analyzed. Results There were 36 cases in LH group,and 50 cases in OH group.Significant differences were noticed in the length of incision,operative blood loss,food-taking time,postoperative hospital stays,and analgesic usage between the two groups (respectively t =-37.608、-2.396、-13.073、-4.283 、x2 = 35.765,all P＜0.05),in which LH group was superior to OH group.Differences appeared in ALT,AST,ALP,r-GT and LDH on post-op day 1,and 3.APTT,ALB response on the fifth day after operation were different in the two groups (separately t =-3.465,-3.236,-3.470,-6.812,-4.837 and-3.998,-2.894,-4.286,-7.887,-5.388,6.131,7.292; all P ＜0.05);ALT,AST,ALP,r-GT value on the fifth day post-operation,and T-BIL on the day 1,5 post-operation were different in two groups (separately t =-4.795,-2.155,-3.442,-4.194,-2.712,-1.600,all P ＜0.05),Meanwhile,as the results all showed that,injuries were all less severe in LH than OH group.There were no significant differences between the two groups in operative time,resection method,overall complications,1-year,3-year survival rate,disease free survival (t =-0.893,separately x2 =0.066,0.026,0.468,0.156,0.106,2.732,all P ＞0.05) while 3-year survival rate in LH group and OH group were 50.0%,25% respectively (x2=2.732,P = 0.098). Conclusion Laparoscopic hepatectomy was safe and feasible for treatment of HCC,and its short-term efficacy was better than open hepatectomy.Furthermore,laparoscopic hepatectomy had promising long-term effectiveness.
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Objective To investigate management strategy of minimally invasive surgery for common bile duct stones. Methods Three hundred and four cases of common bile duct stones were divided into 3 groups receiving respectively endoscopic papillary balloon delation plus laparoscopic cholecystectomy ( EPBD group, 35 cases ), endoscopic sphincterotomy plus LC ( EST group, 138 cases), and Laparoscopic common bile duct exploration plus LC (LCBDE group, 131 cases). Results There was no significant difference in treatment success rate, short-term complications and bile duct retained stones among these three group ( x2 = 1. 930, 0. 038, and 0. 427 respectively, P > 0. 05 ). There was significant difference among these three groups in operation time ( F = 17.941, P = 0. 000 ), and the operation time in LCBDE group was shorter than that in other two groups( EPBD-EST: P = 0. 122, EST-LCBDE:P = 0. 000, EPBD-LCBDE:P = 0. 020 ). There was significant difference among these three groups in postoperative hospital stay (F =24. 016,P =0. 000) ,and the postoperative hospital stay in EPBD group was shorter than that in other two groups ( EPBD-EST: P = 0. 000, EST-LCBDE : P = 0. 198, EPBD-LCBDE : P = 0. 000 ). In EPBD group,bile duct recurrent stones was found in 2 cases(6. 7% ) and cholangitis in 1 case(33% ) and no duodenal papilla stenosis was encountered; In LCBDE group, bile duct recurrent stones were found in 7 cases (6. 0% ), cholangitis in 3 cases ( 2. 6% ), and there was no duodenal papilla stenosis; In EST group, bile duct recurrent stones were complicated in 18 cases ( 15.8% ), duodenal papilla stenosis in 9 cases (7.9%), and cholangitis in 14 cases( 12. 3% ). There were significant differences among these three groups for these three complications( x2 = 6. 482, 9. 160, and 12. 020 respectively,P < 0. 05 ), and the rate of complications in EST group was higher than that in other two groups. Conclusion For common bile duct stones, EPBD is the first choice followed by LCBDE while EST is only indicated for very few cases.
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0.05).The number of cases with disappearance of esophagcal varices was significantly higher in MSO group than in the simple venous disconnection group(P
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Objective To investigate the clinical significance of the treatment of intrahepatic bile duct stones with fiber choledochoscope combined with intraoperative ultrasound.Methods The clinical data of 185 cases with intrahepatic bile duct stone were analysed retrospectively,included 96 cases with stone removal by fiber choledochoscope intra-and post-operatively(choledochoscope group),and 89 cases with stone removal by fiber choledochoscope combined with intraoperative ultrasound(combined group).Results The rateo of bile duct retained stones in choledochoscope group(9.38%) was higher than that in combined group(2.08%)(P=0.041),and the rate of bile duct recurrent stones in choledochoscope group(12.34%) was higher than that in combined group(3.61%)(P=0.036).There was no significant differences between the two groups in the occarrence of cholangitis(P=0.087),but 3 cases of severe cholangitis required re-operation in choledochoscope group.Conclusions Fiber choledochoscope combined with intraoperative ultrasound can decrease the rate of bile duct retained stones and bile duct recurrent stones,and can improve the therapeutic effect.
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The arteries of the M. latissimus dorsi, gracilis, tensor fasciae latae, gastrocncmius and soleus were studied on 100 Chinese cadavers (40 fetus and babies, 60 adults) by dissection and arteriography. The origin, number, diameter and distribution of these arteries were observed, and were investigated quantitatively by means of MAGISCAN-Ⅰ Image Analyser.Based on the studies of the vascular anatomy of muscles. We classified the arterial distribution into three patterns: Type Ⅰ: The muscle of this group was supplied by one or two main arteries which coursed the entire muscle belly, as in: M. tensor fasciae latae, gastrocnemius, soleus. Type Ⅱ: The muscle of this group had a segmental supply of several arteries, which is distributed partially in muscle belly, as in: M. gracilis, soleus. Type Ⅲ: The musele of this group had a combination of both patterns of vascular arrangement, as in: M. latissimus dorsi, soleus.The muscles of Type Ⅰ and Type Ⅱ could often be divided into several regions which were based on the distribution of each branch of the artery.