Application of membrane anatomy in hepatopancreatobiliary and splenic surgery / 中华外科杂志

Understanding of a variety of membranous structures throughout the body,such as the fascia,the serous membrane,is of great importance to surgeons. This is especially valuable in abdominal surgery. With the rise of membrane theory in recent years,membrane anatomy has been widely recognized in the treatment of abdominal tumors,especially of gastrointestinal tumors. In clinical practice. The appropriate choice of intramembranous or extramembranous anatomy is appropriate to achieve precision surgery. Based on the current research results,this article described the application of membrane anatomy in the field of hepatobiliary surgery,pancreatic surgery,and splenic surgery,with the aim of blazed the path from modest beginnings.

The optimal treatment for recurrent hepatocellular carcinoma / 中国实用外科杂志

High recurrence rate and metastasis rate after primary surgery for hepatocellular carcinoma have been restricting the long-term survival of patients. For the treatment of recurrent hepatocellular carcinoma, comprehensive treatment based on surgery is the main strategy. For patients who are unsuitable for surgery,local ablation,TACE,radiotherapy, systemic chemotherapy, targeted therapy,immunotherapy,traditional Chinese medicine and optimal supportive therapy are effective measures,which can delay disease progression and improve patient survival. According to the patient's characteristics and individual differences,the multidisciplinary treatment model should be adopted to optimize the treatment effect and reduce side effects,which will benefit the patients with better medical experience and longer overall survival rate.

GSK923295 as a potential antihepatocellular carcinoma agent causing delay on liver regeneration after partial hepatectomy / 中华医学杂志(英文版)

BACKGROUND@#The clinical trials emerged centromere protein E inhibitor GSK923295 as a promising anticancer drug, but its function in hepatocellular carcinoma (HCC) remain needs to be fully elucidated, especially as chemotherapy after hepatectomy for liver tumors. We aimed to describe anti-HCC activities of GSK923295 and compare its antiproliferative effects on liver regeneration after partial hepatectomy (PH).@*METHODS@#All subjects were randomized to treatment with either vehicle or GSK923295. Antitumor activity of GSK923295 was assessed by xenograft growth assays. The C57BL/6 mice were subjected to 70% PH and the proliferation was calculated by liver coefficient, further confirmed by immunohistochemistry. The proliferation and cell cycle analysis of liver cell AML12 and HCC cells LM3, HUH7, and HepG2 were investigated using the cell counting kit-8 assay and Flow Cytometry. The chromosome misalignment and segregation in AML12 cells were visualized by immunofluorescence.@*RESULTS@#Treatment with GSK923295 induced antiproliferation in HCC cell lines. It also caused delay on HCC tumor growth instead of regression both in a HCC cell line xenograft model and patient-derived tumor xenograft model. With microarray analysis, CENtromere Protein E was gradually increased in mouse liver after PH. Exposure of liver cells to GSK923295 resulted in delay on a cell cycle in mitosis with a phenotype of misaligned chromosomes and chromosomes clustered. In 70% PH mouse model, GSK923295 treatment also remarkably reduced liver regeneration in later stage, in parallel with the mitotic marker phospho-histone H3 elevation.@*CONCLUSION@#The anticancer drug GSK923295 causes a significant delay on HCC tumor growth and liver regeneration after PH in later stage.

Comparison of Intracorporeal and Extracorporeal Esophagojejunostomy after Laparoscopic Total Gastrectomy for Gastric Cancer: A Meta-Analysis Based on Short-Term Outcomes / 中华医学杂志(英文版)

<p><b>Background:</b>Laparoscopic total gastrectomy (LTG) is increasingly performed in patients with gastric cancer. However, the usage of intracorporeal esophagojejunostomy (IEJ) following LTG is limited, as the safety and efficacy remain unclear. The present meta-analysis aimed to evaluate the feasibility and safety of IEJ following LTG.</p><p><b>Methods:</b>Studies published from January 1994 to January 2017 comparing the outcomes of IEJ and extracorporeal esophagojejunostomy (EEJ) following LTG were reviewed and collected from the PubMed, EBSCO, Cochrane Library, Embase, and China National Knowledge Internet (CNKI). Operative results, postoperative recovery, and postoperative complications were compared and analyzed. The weighted mean difference (WMD) and odds ratio (OR) with a 95% confidence interval (CI) were calculated using the Review Manager 5.3.</p><p><b>Results:</b>Seven nonrandomized studies with 785 patients were included. Compared with EEJ, IEJ has less blood loss (WMD: -13.52 ml; 95% CI: -24.82--2.22; P = 0.02), earlier time to first oral intake (WMD: -0.49 day; 95% CI: -0.83--0.14; P < 0.01), and shorter length of hospitalization (WMD: -0.62 day; 95% CI: -1.08--0.16; P < 0.01). There was no significant difference between IEJ and EEJ regarding the operation time, anastomotic time, number of retrieved lymph nodes, time to first flatus, anastomosis leakage rate, anastomosis stenosis rate, and proximal resections (all P > 0.05).</p><p><b>Conclusions</b>Compared with EEJ, IEJ has better cosmesis, milder surgical trauma, and a faster postoperative recovery. IEJ can be performed as safely as EEJ. IEJ should be encouraged to surgeons with sufficient expertise.</p>

Laparoscopic Versus Open Resection of Small Bowel Gastrointestinal Stromal Tumors: Systematic Review and Meta-Analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoscopic resection (LAP) for small bowel gastrointestinal stromal tumors (GISTs) is not as common as for stomach. This study aimed to evaluate the safety and efficacy of LAP for small bowel GISTs with systematic review and meta-analysis.</p><p><b>METHODS</b>The Web of Science, Cochrane Library, Embase, and PubMed databases before December 2016 were comprehensively searched to retrieve comparative trials of LAP and conventional open resection (OPEN) for GISTs of small bowel with a relevance of review object. These researches reported intraoperative and postoperative clinical course (operation time, blood loss, time to first flatus and oral intake, hospital stay, morbidity, and mortality), oncologic outcomes, and long-term survival status.</p><p><b>RESULTS</b>Six studies involving 391 patients were identified. Compared to OPEN, LAP had associated with a shorter operation time (weighted mean difference [WMD] = -27.97 min, 95% confidence interval [CI]: -49.40--6.54, P < 0.01); less intraoperative blood loss (WMD = -0.72 ml; 95% CI: -1.30--0.13, P = 0.02); earlier time to flatus (WMD = -0.83 day; 95% CI: -1.44--0.22, P < 0.01); earlier time to restart oral intake (WMD = -1.95 days; 95% CI: -3.31--0.60, P < 0.01); shorter hospital stay (WMD = -3.00 days; 95% CI: -4.87--1.13, P < 0.01); and a decrease in overall complications (risk ratio = 0.56, 95% CI: 0.33-0.97, P = 0.04). In addition, the tumor recurrence and long-term survival rate showed that there was no significant difference between the two groups of patients.</p><p><b>CONCLUSIONS</b>LAP for small bowel GISTs is a safe and feasible procedure with shorter operation time, less blood loss, less overall complications, and quicker recovery. Besides, tumor recurrence and the long-term survival rate are similar to open approach. Because of the limitations of this study, methodologically high-quality studies are needed for certain appraisal.</p>

Autophagy in 5-Fluorouracil Therapy in Gastrointestinal Cancer: Trends and Challenges / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>5-Fluorouracil (5-FU)-based combination therapies are standard treatments for gastrointestinal cancer, where the modulation of autophagy is becoming increasingly important in offering effective treatment for patients in clinical practice. This review focuses on the role of autophagy in 5-FU-induced tumor suppression and cancer therapy in the digestive system.</p><p><b>DATA SOURCES</b>All articles published in English from 1996 to date those assess the synergistic effect of autophagy and 5-FU in gastrointestinal cancer therapy were identified through a systematic online search by use of PubMed. The search terms were "autophagy" and "5-FU" and ("colorectal cancer" or "hepatocellular carcinoma" or "pancreatic adenocarcinoma" or "esophageal cancer" or "gallbladder carcinoma" or "gastric cancer").</p><p><b>STUDY SELECTION</b>Critical reviews on relevant aspects and original articles reporting in vitro and/or in vivo results regarding the efficiency of autophagy and 5-FU in gastrointestinal cancer therapy were reviewed, analyzed, and summarized. The exclusion criteria for the articles were as follows: (1) new materials (e.g., nanomaterial)-induced autophagy; (2) clinical and experimental studies on diagnostic and/or prognostic biomarkers in digestive system cancers; and (3) immunogenic cell death for anticancer chemotherapy.</p><p><b>RESULTS</b>Most cell and animal experiments showed inhibition of autophagy by either pharmacological approaches or via genetic silencing of autophagy regulatory gene, resulting in a promotion of 5-FU-induced cancer cells death. Meanwhile, autophagy also plays a pro-death role and may mediate cell death in certain cancer cells where apoptosis is defective or difficult to induce. The dual role of autophagy complicates the use of autophagy inhibitor or inducer in cancer chemotherapy and generates inconsistency to an extent in clinic trials.</p><p><b>CONCLUSION</b>Autophagy might be a therapeutic target that sensitizes the 5-FU treatment in gastrointestinal cancer.</p>

Is Laparoscopic Hepatectomy a Safe, Feasible Procedure in Patients with a Previous Upper Abdominal Surgery? / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoscopic liver resection has become an accepted treatment for liver tumors or intrahepatic bile duct stones, but its application in patients with previous upper abdominal surgery is controversial. The aim of this study was to evaluate the feasibility and safety of laparoscopic hepatectomy in these patients.</p><p><b>METHODS</b>Three hundred and thirty-six patients who underwent laparoscopic hepatectomy at our hospital from March 2012 to June 2015 were enrolled in the retrospective study. They were divided into two groups: Those with previous upper abdominal surgery (PS group, n = 42) and a control group with no previous upper abdominal surgery (NS group, n = 294). Short-term outcomes including operating time, blood loss, hospital stay, morbidity, and mortality were compared among the groups.</p><p><b>RESULTS</b>There was no significant difference in median operative duration between the PS group and the NS group (180 min vs. 160 min, P = 0.869). Median intraoperative blood loss was same between the PS group and the control group (200 ml vs. 200 ml, P = 0.907). The overall complication rate was significantly lower in the NS group than in the PS group (17.0% vs. 31.0%, P = 0.030). Mortality and other short-term outcomes did not differ significantly between groups.</p><p><b>CONCLUSIONS</b>Our study showed no significant difference between the PS group and NS group in term of short-term outcomes. Laparoscopic hepatectomy is a feasible and safe procedure for patients with previous upper abdominal surgery.</p>

Blunt Dissection: A Solution to Prevent Bile Duct Injury in Laparoscopic Cholecystectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoscopic cholecystectomy (LC) has been a standard operation and replaced the open cholecystectomy (OC) rapidly because the technique resulted in less pain, smaller incision, and faster recovery. This study was to evaluate the value of blunt dissection in preventing bile duct injury (BDI) in laparoscopic cholecystectomy (LC).</p><p><b>METHODS</b>From 2003 to 2015, LC was performed on 21,497 patients, 7470 males and 14,027 females, age 50.3 years (14-84 years). The Calot's triangle was bluntly dissected and each duct in Calot's triangle was identified before transecting the cystic duct.</p><p><b>RESULTS</b>Two hundred and thirty-nine patients (1.1%) were converted to open procedures. The postoperative hospital stay was 2.1 (0-158) days, and cases (46%) had hospitalization days of 1 day or less, and 92.8% had hospitalization days of 3 days or less; BDI was occurred in 20 cases (0.09%) including 6 cases of common BDI, 2 cases of common hepatic duct injury, 1 case of right hepatic duct injury, 1 case of accessory right hepatic duct, 1 case of aberrant BDI 1 case of biliary stricture, 1 case of biliary duct perforation, 3 cases of hemobilia, and 4 cases of bile leakage.</p><p><b>CONCLUSION</b>Exposing Calot's triangle by blunt dissection in laparoscopic cholecystectomy could prevent intraoperative BDI.</p>

Progress of laparoscopic technique in treatment of gallbladder cancer / 浙江大学学报·医学版

Gallbladder cancer is a common malignant tumor in the bile duct system with high malignant degree and poor prognosis. Although it is still controversial, important progress has been made in clinical application of laparoscopic technique for diagnosis and staging of gallbladder cancer, treatment of early stage and laparoscopic unexpected gallbladder cancer in recent years. In this article we review the current status of application of laparoscopic technique and its value in diagnosis and treatment of gallbladder cancer.

The current status and prospect of laparoscopic hepatectomy / 浙江大学学报·医学版

Since the first laparoscopic hepatectomy has been reported in 1991, significant improvement has been made in this procedure. Laparoscopic hepatectomy has been applied as an importent procedure for treatment of hepatic diseases. In the paper, we give a review for present advances in the area of laparoscopic hepatectomy based on literature and our own experience, especially in the aspects of indications, surgical technique and the apparatus for hepatectomy.

Study on the effectiveness of continuous local infiltration analgesia and related short-term prognosis after laparotomy / 中华流行病学杂志

Objective To evaluate the effectiveness of incisional infusion through local anesthetics under a continuous-infusion elastomeric pump for the management of postoperative pain after laparotomy,on reducing the amount of opioids being used after surgery.Methods We performed a retrospective comparative analysis on 285 patients who had undergone laparotomies between January 2012 and September 2012.Among those patients,144 took a continuous-infusion elastomeric pump to receive local anesthetic (LA) at the incisional area for postoperative pain management while another 141 patients took ‘patient-controlled' intravenous analgesia (PCA).Data were reviewed on items as:visual analog pain scores (VAS) during both resting and active situation,mean opioid use,bowel function,condition of incision and complications etc.Results Both groups showed similar VAS scores for the first 48 hours post-operation.However,in the LA group,VAS scores appeared significantly higher within the first 72 hours (P＜0.001),with less opioid use (P＜ 0.01),less symptoms as postoperative nausea or vomiting (P＜ 0.001),with earlier recovery of bowel function (P＜0.01) etc.when compared to the PCA group.No significant difference found on the incidence rates of wound infection other than,a higher rate of incisional drainage (P＜0.001) was seen in the LA group.Conclusion Continuous infusion of local anesthetic under an elastomeric infusion pump post the laparotomy,a similar analgesic effect could be seen on those patient-controlled intravenous analgesia within the first 48 hours,it could also reduce opioid consumption and postoperative symptoms as nausea or vomiting,which all appeared to be associated with the earlier recovery of bowel function.

Tumor biomarkers: help or mislead in the diagnosis of xanthogranulomatous cholecystitis?-analysis of serum CA 19-9, carcinoembryonic antigen, and CA 12-5 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Xanthogranulomatous cholecystitis (XGC) is a rare type of gallbladder inflammation. Unlike other cholecystitis, it can be easily misdiagnosed as gallbladder cancer based on radiological images. In response to misdiagnosis, extended surgical treatments are inappropriately given to patients, which is not beneficial to their health and/or recovery. In this study, we set out to determine whether tumor biomarkers can help to avoid misdiagnosis in patients with XGC.</p><p><b>METHODS</b>Between January 2005 and January 2012, a total of 37 preoperative patients at Sir Run Run Shaw Hospital were suspicious of having gallbladder cancer and was pathologically confirmed to be XGC after surgical operations. Before operations, all patients received a tumor biomarker test to verify diagnosis, which included serum CA 19-9, carcinoembryonic antigen (CEA), and CA 12-5.</p><p><b>RESULTS</b>A measured amount (54.05%) of cases (20 in 37) had at least one elevation over the thresholds of CA 19-9 (37 IU/L), CEA (5 ng/ml), and CA 12-5 (35 IU/L), which increased the suspicion of malignancy and consequently enhanced the difficulty to make right diagnosis of XGC as benign. 45.95% of cases (17 in 37) had an elevation in CA 19-9. 2.70% of cases (one in 37) had an elevation in CEA and 24.32% of cases (nine in 37) had an elevation in CA 12-5. Analysis with Fisher's exact test discovered that the presence of common bile duct stone was a contributor to elevations of CA19-9 in patients with XGC. However, even in cases without common bile duct stones, 42.86% of patients (nine in 21) had elevations of at least one tumor biomarker. Among them, 26.09% of patients (six in 21) had elevations of CA 19-9, with the maximum of 536.29 IU/L.</p><p><b>CONCLUSIONS</b>The elevations of tumor biomarkers in XGC were frequent, suggesting their inabilities to clarify the disease's nature, especially when there was a suspicion of gallbladder cancer. Intraoperative frozen pathology of gallbladder might be a possible solution. However, it is against the en bloc surgical principle and has the potential to cause tumor cell spreading. More research should be conducted, such as the discovery of a novel biomarker, so that XGC can less likely be misdiagnosed as malignancy until the final pathological judgment.</p>

Experimental research of stent anastomosis of gastrojejunostomy in a porcine model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gastrojejunostomy is one of the most frequently used procedures for general surgeons. The creation of anastomosis between various parts of the gastrointestinal tract is a basic technical component and major task in the daily practice of almost all gastrointestinal procedures. This research evaluated a new procedure of making gastrointestinal anastomosis with stent.</p><p><b>METHODS</b>Twenty experimental mini-pigs were randomized into two groups. In stent anastomosis group (SA), the anastomoses were constructed with a poly-levolactic acid stent. In hand-sewn group (HA), the anastomoses were performed with a single-layer continuous suture. Abdominal X-ray with intraluminal contrast was performed on the 10th postoperative day. Five pigs of each group were sacrificed on the postoperative days 3 and 14 to determine anastomotic bursting pressure in situ, hydroxyproline concentration, and histopathological evaluation of the anastomotic sites.</p><p><b>RESULTS</b>There was no intraoperative morbidity or mortality. The median time needed for the sutured anastomosis was (21.7 ± 2.3) minutes and for the stent anastomosis was (11.9 ± 1.9) minutes (P < 0.001). Abdominal X-ray with intraluminal contrast demonstrated normal gas distribution and showed no evidence of leakage or obstruction. Macroscopic appearance at the longitudinal opening of anastomosis was always good in both groups. The median anastomotic bursting pressure was (18.2 ± 1.6) kPa in SA group on postoperative day 3, compared with (11.7 ± 3.2) kPa in HA group (P = 0.003). The anastomotic bursting pressure on day 14 was not significantly different between SA group ((27.1 ± 2.6) kPa) and HA group ((28.3 ± 1.7) kPa) (P = 0.388). The hydroxyproline concentrations were not significantly different.</p><p><b>CONCLUSIONS</b>The stent anastomosis was not considered to be more difficult than a sutured anastomosis. This method is proved to be safe and feasible compared with the traditional hand-sewn method in the porcine model. The method increases early anastomotic strength in this study.</p>

Sutureless choledochoduodenostomy with an intraluminal degradable stent in dog model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is difficult and time-consuming for carrying out conventional hand-sewn bilioenteric anastomosis, especially for small bile duct anastomosis and laparoscopic procedure. In order to simplify it, we have developed a novel procedure of sutureless bilioenteric anastomosis with an intraluminal degradable stent. This study aimed to evaluate the feasibility and safety of this technique with cholangioduodenostomy in dog model.</p><p><b>METHODS</b>A patent intraluminal degradable stent tube for sutureless choledochoduodenostomy in dog model was made with polylactic acid in diameter of 3 mm or 4 mm. Thirty-eight dogs were randomly divided into to a stent group (SG, n = 20) and a control group (CG, n = 18). Dogs in the SG underwent sutureless choledochoduodenostomy with intraluminal stent, while the CG underwent conventional choledochoduodenostomy (single layer discontinuous anastomosis with absorbable suture). Dogs of each group were divided into 4 subgroups according to time of death (1, 3, 6, and 12 months postoperatively) to evaluate the healing of anastomosis. Operation time, intraoperative tolerance pressure of anastomosis, rate of postoperative bile leakage, bursting pressure of anastomosis were compared between the two groups. Anastomosis tissue was observed afterwards by pathology evaluation, hydroxyproline content, serum bilirubin, liver enzyme level and magnetic resonance cholangio-pancreatography (MRCP) to assess the stricture.</p><p><b>RESULTS</b>All procedures were completed successfully. The surgical time of the SG was significantly less than the CG (SG: (19.2 ± 4.3) minutes, vs. CG: (29.2 ± 7.1) minutes, P = 0.000). One bile leakage was occurred in either group. No significant difference of intraoperative tolerance pressure of anastomosis, rate of bile leakage and postoperative bursting pressure of anastomosis, anastomotic stricture, hydroxyproline content, serum bilirubin and liver enzyme level was found between the two groups. MRCP showed no anastomosis stricture and obstruction during months of follow-up.</p><p><b>CONCLUSION</b>The technique of sutureless choledochoduodenostomy with a degradable intraluminal stent is feasible and a safe procedure in this dog model.</p>

Multivariable analysis of factors associated with hospital readmission following pancreaticoduodenectomy for malignant diseases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Readmission rates after pancreaticoduodenectomy (PD) for malignant diseases have a significant impact on survival rate. Identification of risk factors for readmission may improve discharge plans and postoperative care. Data exist on the morbidity and mortality of patients undergoing PD, but there are few reports about hospital readmissions after this procedure. Our aims were to evaluate the proportion and reasons for readmissions after PD for malignant diseases, the factors influencing readmissions, and to analyze the relationship between readmission rate and survival rate.</p><p><b>METHODS</b>Four hundred and thirty-six patients, who had undergone PD for malignant diseases in our centre from October 1999 to October 2009, a 10-year period, excluding perioperative (30-day) mortality, were identified. All readmissions within 1 year following PD were analyzed with respect to timing, location, reasons for readmission and outcome. We reviewed the hospitalization and readmissions for patients undergoing PD, and compared patients requiring readmission to patients that did not require readmission.</p><p><b>RESULTS</b>One hundred and forty-five patients (33.26%) were readmitted within 1 year following PD, for further treatment or complications. In those cases, diagnoses associated with high rates of readmission included radiation and/or chemotherapy (48.96%), progression of disease (11.72%), infection (11.72%), gastrointestinal dysfunction/obstruction (6.20%), surgery-related complications (2.76%) and pain (4.14%). The proportion of T4 in readmission group was lower than no readmission group (P < 0.05). The proportion of node positive cases in readmission group was much higher than no readmission group (P < 0.01). The number of readmission for complications reduced gradually in the first three months, and reached a second peak in the sixth and seventh month. Median survival was lower for the readmission group compared with the no readmission group (21 versus 46 months, P = 0.024).</p><p><b>CONCLUSION</b>These results may assist in both anticipating and facilitating postoperative care as well as managing patient expectations.</p>

Laparoscopic splenectomy by secondary pedicle division strategy: a highly cost-effective method / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoscopic splenectomy (LS) shows many advantages compared with open surgery except for the high cost. This study was aimed to recommend secondary pedicle division strategy as a method with high cost-effectiveness.</p><p><b>METHODS</b>From January 2003 to June 2005, 14 consecutive patients underwent laparoscopic splenectomy. The splenic pedicle was controlled by secondary pedicle division strategy in 8 cases and by Endo-GIA in the other 6 cases. A retrospective study was carried out to evaluate the operative time, blood loss, time to diet, operative morbidity, postoperative stay, and operative cost.</p><p><b>RESULTS</b>LS was performed successfully in a total of 14 cases. There was no significant difference between the two strategies in operative time, blood loss, time to diet, operative morbidity and postoperative stay. The operative cost of secondary pedicle division strategy group (RMB 8354.38 +/- 752.10) was significantly lower than that of Endo-GIA group (RMB 11053.33 +/- 602.27) (P < 0.01).</p><p><b>CONCLUSIONS</b>Laparoscopic splenectomy by secondary pedicle division strategy is a safe, effective and economical procedure with the value of popularization in developing countries.</p>

Hypertonic saline resuscitation reduces apoptosis of intestinal mucosa in a rat model of hemorrhagic shock / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>To investigate the early effects of hypertonic and isotonic saline solutions on apoptosis of intestinal mucosa in rats with hemorrhagic shock.</p><p><b>METHODS</b>A model of rat with severe hemorrhagic shock was established in 21 Sprague-Dawley (SD) rats. The rats were randomly divided into the sham group, normal saline resuscitation (NS) group, and hypertonic saline resuscitation (HTS) group, with 7 in each group. We detected and compared the apoptosis in small intestinal mucosa of rats after hemorrhagic shock and resuscitation by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), FITC (fluorescein-iso-thiocyanate)-Annexin V/PI (propidium iodide) double staining method, and flow cytometry.</p><p><b>RESULTS</b>In the early stage of hemorrhagic shock and resuscitation, marked apoptosis of small intestinal mucosa in the rats of both NS and HTS groups was observed. The numbers of apoptotic cells in these two groups were significantly greater than that in the sham group (P<0.01). In the HTS group, the apoptic cells significantly decreased, compared with the NS group (P<0.01).</p><p><b>CONCLUSION</b>In this rat model of severe hemorrhagic shock, the HTS resuscitation of small volume is more effective than the NS resuscitation in reducing apoptosis of intestinal mucosa in rats, which may improve the prognosis of trauma.</p>

The strategy of isolated complete resection of the caudate lobe of the liver through the anterior liver-splitting approach: a report of 19 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the strategy of isolated complete resection of the caudate lobe of the liver through the anterior liver-splitting approach.</p><p><b>METHODS</b>From January 1995 to June 2006, isolated complete caudate resection of the caudate lobe of the liver through the anterior liver-splitting approach in which accessed the caudate lobe by separation the liver parenchyma along the interlobar plane, was performed on 19 patients with tumors originated in caudate lobe. They were included hepatocellular carcinoma in 13 cases, cholangiocarcinoma in 4 cases and hemangioma in 2 cases, the tumor size range from 4 - 12 cm. The approach to hepatic resection involved routine use of Peng's multifunctional operative dissector, inflow and outflow of hepatic vascular control before hepatic parenchyma transection, low central venous pressure and selective use of liver hanging maneuver, as well as retrograde caudate lobectomy.</p><p><b>RESULTS</b>The operations were successful in 19 patients. Operating time averaged at (296 +/- 55) min. The average amount of blood loss were 1200 ml (ranged from 500 - 3000 ml). Postoperative complications included ascites in 2 cases, pleural effusion in 5 cases and bile leakage in 2 cases. They were cured by drainage. No mortality occurred in the perioperative period.</p><p><b>CONCLUSIONS</b>The application of anterior approach for isolated caudate lobectomy can converse certain kind of caudate lobe tumor from non-resectable to respectable resulting in widening the indication. The intraoperative routine use of Peng's multifunctional operative dissector, application of inflow and outflow of hepatic vascular control, low central venous pressure and selective use of liver hanging maneuver, as well as retrograde caudate lobectomy make the anterior liver-splitting approach for isolated complete caudate lobectomy safer and easier.</p>

Role of pancreatic hilar vascular occlusion in sophisticated pancreaticoduodenectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the value of a simple occlusive technique of the triple vessels, ie, portal vein, superior mesenteric vessels and splenic vein, in complicated pancreaticoduodenectomy.</p><p><b>METHODS</b>The technique was fulfilled with a No.8 urethral catheter to encycle the portal vein, superior mesenteric vessels and its near tissue plus pancreatic tail and splenic vein than the neck of pancreas was transected and well exposure superior mesenteric vein and complete transaction of uncinate. From November 2005 to November 2006 the technique was applied to 12 cases of pancreatic malignancy which presented very infiltrated and adhesive to the hilar vascular structure.</p><p><b>RESULTS</b>The 12 cases were accomplished according with this technique. The operating time was (292.4 +/- 36.3) min (270 - 390 min) and the intraoperative blood loss was (833.3 +/- 618.4) ml (300 - 2500 ml). The postoperative complication included one case of lymphatic leakage, two cases of pneumonia, one case of abdominal infection and two cases of wound infection. There was no perioperative mortality. The postoperative hospital stay was 17 d (11 - 29 d).</p><p><b>CONCLUSIONS</b>Use this triple vessels occlusive technique can improve the safety and feasibility in complicated cases of pancreaticoduodenectomy.</p>

Laparoscopic hepatectomy by curettage and aspiration: a new technique / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few institutions worldwide. Lack of efficient and safe techniques for liver transaction is the major obstacle preventing from its further development. We developed a new technique for laparoscopic hepatectomy by curettage and aspiration in 1998. In this paper we analyze the clinical outcomes of this technique after 7 years of practice.</p><p><b>METHODS</b>Altogether 59 consecutive patients underwent laparoscopic hepatectomy by curettage and aspiration from August 1998 to January 2005 at our institution. These patients included 33 males and 26 females, with a mean age of 47 years. For liver transection laparoscopic Peng's multifunctional operative dissector (LPMOD) was used. Lesions included malignant liver tumors in 19 patients, benign liver tumors in 17, intrahepatic calculus in 18, and other liver lesions in 5. Procedures included local resections in 30 patients, left lateral segmentectomy in 28, and right hemihepatectomy in 1.</p><p><b>RESULTS</b>Laparoscopic operation was completed in 57 patients. Two patients (3.4%) had the operation converted to laparotomy. The mean operating time was 143 minutes and the mean intraoperative blood loss was 456 ml. The mean length of postoperative hospital stay was 7 days. Complications occurred in 2 patients (3.4%), and there was no perioperative death.</p><p><b>CONCLUSION</b>Laparoscopic hepatectomy by curettage and aspiration is efficient and safe for liver resection.</p>