Application of endoscopic retrograde cholangiopancreatography to common bile duct stones with periampullary diverticulum / 中华消化内镜杂志

Objective@#To explore the safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for bile duct stones with periampullary diverticula (PAD).@*Methods@#Data of 2, 103 patients with common bile duct stones(CBD stones), who underwent therapeutic ERCP for the first time from April 2013 to March 2016, were prospectively analyzed. Patients were divided into two groups according to presence or absence of PAD (PAD group and non-PAD group). Success rate of ERCP, complete clearance rate of the CBD stones after the first attempt and difficult cannulation rate were compared between the two groups.@*Results@#The difficult CBD cannulation rate was 14.87%(117/787) in PAD group and 9.93% (123/1 239) in non-PAD group with significant difference (P=0.001). Successful CBD cannulation was achieved in 96.92% (787/812) patients in PAD group and 95.97% (1 239/1 291) in non-PAD group (P=0.156). The complete clearance rate of CBD stones after the first attempt was 85.39% (672/787) in PAD group and 87.09% (1 079/1 239)in non-PAD group (P=0.154). There was no significant difference between the two groups in the complication rate[26/812(3.20%) VS 33/1 291(2.56%), P=0.833].@*Conclusion@#Although PAD increases the difficulty of ERCP, ERCP is an effective and safe method for patients of CBD stones with PAD.

A clinical controlled study of mesh and non-mesh technique in laparoscopic repair of large hiatal hernias / 中华消化内镜杂志

Objective To investigate the safety and effectiveness of mesh and non-mesh techniques in laparoscopic repair of large hiatal hernias (LRLHH).Methods A retrospective clinical controlled study of mesh and non-mesh techniques in LRLHH form January 2006 to August 2014 was performed.Results A total of 83 and 36 patients were recruited to mesh and non-mesh group respectively.There were no significant differences in operation time,operation bleeding volume,hospitalization time or complications between the two groups.Main symptoms were significantly improved during the postoperative long-term follow-up in both groups.The improvement of dysphagia in mesh group showed no significant difference [22.9％ (19/83) VS 12.0％ (10/83),P=0.066],however,non-mesh group showed significant difference [30.6％ (11/36) VS 5.6％ (2/36),P=0.006].Rate of dysphagia alleviation in non-mesh group was significantly higher than that in mesh group [25.0％ (9/36) VS 10.8％ (9/83),P =0.048].Mesh-related complications of esophageal erosions occurred in 5 patients (6.0％) in mesh group,including esophageal stenosis in 3 patients,esophageal-cardiac stricture in 1 patient.Recurrent hernia occurred in 1 patient (1.2％) in mesh group and 3 patients (8.3％) in non-mesh group (P =0.082).Conclusion LRLHH with mesh should be individualized.The use of mesh in LRLHH reduces the recurrence rate,but may lead to some complications.

Technical modification for laparoscopic giant hiatal hernias repair / 中华消化内镜杂志

Objective To investigate the safety and efficacy of technical modification for laparoscopic repair of giant hiatal hernias.Methods A total of 49 patients with giant hiatal hernia underwent modified laparoscopic repair by dissecting sac, closing hiatal, mesh placement and fundoplication from June 2010 to May 2014.The operation time, hospitalization time, postoperative complications, upper gastrointestinal imaging and improvement of postoperative symptoms were observed.Results The average operation time was (103.6 ±31.7) min(88-173min).The average length of post operation hospitalization was (4.2 ± 1.8) d (range,3-12d).Postoperative complication occurred in 4 patients,including pleural effusion (1 patient),respiratory failure (1 patient), difficulty in swallowing (2 patients)with complication occurrence rate being 8.2％ (4/49).No conversion or death occurred.The average time of follow-up was (28.3 ± 12.7) months (6-50 months) in 49 cases.During the follow-up, main symptoms were relieved and no recurrence was found by barium swallow.Conclusion Technical modification for laparoscopic repair of giant hiatal hernias is safe and effective.

Long-term follow-up for laparoscopic anterior 180° partial fundoplication for gastroesophageal refulx disease / 中华消化内镜杂志

Objective To evaluate long-term follow-up for laparoscopic anterior 180° partial fundoplication for gastroesophageal refulx disease (GERD).Methods A total of 48 patients had undergone a laparoscopic anterior 180° partial fundoplication from July 2004 to October 2007.Patients were followed up at 3 months,12 months,3 years,5 years by using a structured questionnaire via phone or e-mail which evaluated symptoms of reflux,dysphagia,side-effects,and overall satisfaction with the clinical outcome.Results Follow-up data were collected from 43 patients,ranging from 60 to 98 months.Postoperative heartburn significantly improved in 37 patients.Normal belching was preserved in 40 patients,and 38 patients were able to eat normally.Thirty nine (90.7％) patients reported a good or excellent result (minimal or no symptoms) at the late follow-up.Two patients underwent laparoscopic anterior 180° partial fundoplication again due to acid reflux at the 12th and 38th month respectively.Conclusion At minimum 5 years followup,laparoscopic anterior 180° partial fundoplication for GERD is effective and lasting,and most patients are satisfied with the outcome.

Management of complications after laparoscopic adjustable gastric banding / 中华消化外科杂志

Objective To investigate the management of complications after laparoscopic adjustable gastric banding (LAGB).Methods The clinical data of 83 obese patients who were treated by LAGB at the Nankai Hospital from September 2005 to June 2011 were retrospectively analyzed.The complications after LAGB were analyzed.The adjustable gastric band was installed under laparoscope so as to form a small gastric pouch with a volume ranged between 20-30 ml.The water pump was fixed in the rectus abdominis anterior sheath under the appendix ensiformis.The gastric band was adjusted according to the changes of the body weight,symptoms after diet and results of imaging examination of upper gastrointestinal tract.Patients were followed up via out-patient examination and phone call till July 2013.Results The incidence of complications of the 83 patients was 44.6％ (37/83).Six patients had short-term complications and 31 patients had long-term complications.The short-term complication mainly presented as post-prandial vomiting.The symptoms of 5 patients were relieved by changing of eating habit.The condition of 1 patient was severe,and the symptom was relieved 5 days later after fasting and nutritional support.For the 31 patients with long-term complications,25 were complicated with band erosion into gastric lumen via gastric wall (6 patients were complicated with infection of the water pump site),and they were cured by removal of band laparoscopicly.Ten patients were complicated with water pump-related complications,including 6 with infection of the water pump site and 4 with pump migration.The water pumps of the 4 patients with pump migration were surgically removed.Two patients had band slipping to the stomach.The band was restored to the original place after removing the liquid from the band and reducing the food intake,and then the position of the band in 1 patient was restored to normal,and no change was observed in another patient,and the band was removed laparoscopicly.Conclusions The incidence of complications after LAGB is high,and it increases as the time passes by.Most of the long-term complications after LAGB need to be treated by reoperation.

Laparoscopic fundoplication in the treatment of gastroesophageal reflux disease: analysis of 372 cases / 中华胸心血管外科杂志

Objective To investigate the feasibility and clinical value of laparoscopic surgery in treating patients with gastroesophageal reflux disease. Methods From September 2001 to August 2009, 372 patients with gastroesophageal reflux disease undertwent laparoscopic fundoplication, including 146 cases of Nissen fundoplication, 79 Toupet fundoplication, and 147 anterior 180 degrees partial fundoplication. Para-operative clinical parameters were recorded. All patients were routinely followed up. Clinical outcomes were collected and analyzed. Results Laparoscopic surgery was successfully performed in all patients, and no conversions were required. The operating time was 50 -210 minutes (mean, 85 minutes), the operative blood loss was 40 - 150 ml( mean, 86 ml) ,the postoperative hospital stay was 3 - 21 days( mean, 4.3 days ). The symptoms in most cases were adequately relieved after operation. There were no severe postoperative morbidity and mortality. Endoscopy, radiology, esophageal manometry and 24-hour pH monitoring were repeated 3 months after surgery. After the follow-up period of 3 -63 months ( mean, 27.3 months), the satisfaction rate of operation was 92.57%. 19 cases had mild dysphagia when eating solid food. Symptoms recurrence of acid reflux occurred in 6 cases, which were controlled by antacid medications. Hiatal hernia recurrence occurred in 1 case. Conclusions Laparoscopic operation should be the method of choice to treat the moderate to severe gastroesophageal reflux disease, with the advantages of minimized trauma,quick recovery, safety,feasibility and reliable effect. According to individual condition of patients, appropriate fundoplication procedure should be employed carefully to ensure results of operations, reduce operating difficulties and the rate of postoperative complications.

Laparoscopic repair of giant hiatal hernia: analysis of 25 cases / 中华胸心血管外科杂志

Objective To investigate the clinical characteristics and feasibility of laparoscopic repair of giant hiatal hernia. Methods From January 2008 to August 2010, 25 consecutive patients with giant hiatal hernia underwent laparoscopic repair. Crural closure was performed by means of two or three interrupted nonabsorbable sutures plus a tailored PTFE/ePTFE composite mesh. It was patched across the defect and secured to each crura with staples. Laparoscopic fundoplication was performed concomitantly in 16 cases according to the specific conditions of patients. Para-operative clinical parameters were recorded. All patients were routinely followed up. Clinical outcomes were collected and analyzed. Results All laparoscopic surgeries were accomplished successfully. The operating time was 85 -210 minutes (mean, 106 minutes) ,the operative blood loss was 55 - 150 ml( mean, 94 ml) ,the postoperative hospital stay was 4 -21 days( mean, 6.8 days). The symptoms in most cases were adequately relieved after operation. There was no severe postoperative morbidity. After the follow-up period of 3 - 35months ( mean, 13.6 months), the satisfaction rate of surgery was 88%. 4 cases had mild symptom recurrence of acid reflux.Hiatal hernia recurrence occurred in 1 case. Conclusions Laparoscopic repair of giant hiatal hernia is a safe and effective minimally invasive procedure, with the advantages of minimized trauma, quick recovery and reliable effect. The use of a tailored PTFE/ePTFE composite mesh ( Bard CruraSoft Mesh)for giant hiatal hernia proved to be effective in reducing the operation time and technique demands, and the rate of postoperative hernia recurrence, with a very low incidence of mesh-related complications.

Pancreatic duct stenting for acute biliary pancreatitis with difficult endoscopic cannulatio / 中华消化内镜杂志

Objective To evaluate pancreatic duct stenting for acute biliary pancreatitis with difficult endoscopic cannulation. Methods From January 2005 to December 2009, in patients with acute biliary pancreatitis who needed intervention of emergency ERCP, a total of 81 cases were found to be with difficult cannulation and were randomly divided into either treatment group (n = 35 ) to receive pancreatic duct stenting, or control group (n =46) to receive the procedure without pancreatic duct stenting. All patients were treated with same medication, and the pancreatic stents were removed after stabilization at a mean time of 11days after ERCP. All patients were followed up for 3 months after discharging from the hospital. Results There was no significant difference between two groups in regarding of mean age, the time from onset to endoscopy, Glasgow scores and relevant biochemical parameters, but the occurrence of postoperative complications was significantly higher in control group than that of the treatment group ( 17. 39% vs. 5. 71%*, P ＜0. 01 ). Conclusion Pancreatic duct stenting is a safe and bridging procedure for patients with acute billiary pancreatitis, which can also reduce complications.

Evaluation of the treatment effect of laparoscopic surgery on benign diseases of gastroesophageal junction / 中华消化外科杂志

Benign diseases of gastroesophageal junction include gastroesophageal reflux disease,hiatal hernia and achalasia of the cardia.Surgical intervention is superior in the treatment of moderate to severe cases.With the rapid development of laparoseopic technology,minimally invasive surgical procedures,such as laparoscopic fundoplication,laparoscopic rear of hiatal hernia and laparoscopic cardiamyotomy are widely applied with excellent efficacy.According to our experience and clinical study,laparoscopic surgery,with advantages of minimal trauma,rapid recovery,safety and reliable efficacy,could be the first-line treatment for benign diseases of gastroesophageal junction.

A control study of laparoscopic versus open hepatectomy: the stress reaction of patients / 中华肝胆外科杂志

Objective:To investigate the influence of laparoscopic versus open hepatectomy on the stress reaction of patients.MethodsRetrospectively 30 cases who received operation of laparoscopic and open left lateral lobectomy of liver for stones in bile ducts within left lobes of lives were selected form May 2006 to September 2010.The serum level of neutrocytes (N),adrenaline (AD),cortisol (Cor),blood glucose (BG),white blood cell (WBC),Natural killer cell ( NK cell),interleukin-6 (IL-6),C-reactive protein (CRP) were detected preoperatively as well as 24 h,28 h,72 h postoperatively.ResultsAD,Cor reached their peaks after operation,and N,BG,IL-6,CRP reached their peaks in 24 h postoperatively.There were significant difference between O and L groups (P＜0.05).NK cell sank to its lowest level in 24 h postoperatively,and there were no significant difference between the two groups (P＜0.05).ConclusionLaparoscopic and open left lateral lobectomy of liver are two methods curing stones in bile ducts within left lobes of lives,the former process can result in less stress reaction of patients than the latter.

Laparoscopic mesh for massive esophageal hiatal hernia / 中华消化内镜杂志

Objective To assess the clinical outcome of massive hiatal hernia repair by mesh via laparoscopic approach. Methods A total of 31 patients with massive hiatal hernia who underwent laparoscopic repair from March 2005 to January 2009 were enrolled in the study, among which mesh was used in 20 patients. The clinical outcomes of these patients were compared with other 11 patients without mesh repair procedures. Results Surgical repair, combined with Dor fundoplication, was successful in all 31 cases.Five patients in the mesh group developed post-operative recurrent symptoms, 2 ( 10% ) of whom were confirmed by imaging study. Six patients in non-mesh group had recurrent symptoms after operation and 4 (36. 4% ) were confirmed. Conclusion Laparoscopic repair of massive hiatal hernia is technially demanding with a high post-operative recurrent rate. Administration of intro-operative mesh can reduce the difficulty of the procedure and recurrence as well.

A study of mechanism of modulation of NF-κB activity of HepG2 cells by BC047440 genes / 中华肝胆外科杂志

Objective To investigate the mechanism that BC047440 gene regulates nuclear fac-tor κB sigal passway and analyze the differential expression gene between HepG2 cells and HepG2 cells BC047440 gene silenced by RNAi using 35K Human Genome Array. Methods The differential expres-sion gene between HepG2 cells and HepG2 cells with BC047440 gene silenced was analyzed by 35K Human Genome Array, and the data were submitted to the database and MAS system of Capitalbio Corporation.Then TRAF6 was confirmed by RT-PCR test. Results Among the total 35000 probe sets, the expression of 59 genes was down-regulated for more than 50% and 130 genes were up-regulated more than 2 fold in the silencing group when compared with normal controls. TRAF6 mRNA was decreased for 29.5% in silicening HepG2 compared with that of wild HepG2 by RT-PCR, which is similar to human genome array(23.06%).Conclusion The high throughput and effective oligomicroarray can analyze the differential expression gene and BC047440 gene might regulate NF-κB signal pathway inderectly by TRAF6.

Combination of endoscopy and laparoscopic hepatectomy in the treatment of intra-and extrahepatic bile duct stones / 中华消化外科杂志

Objective To study the approach of the combination of endoscopy and laparoscopic hepatectomy in the treatment of intra-and extrahepatic bile duct stones.Methods Eighty-one patients with intra-and extrahepatic bile duct stones who had been admitted to Nankai Hospital from July 2004 to March 2008 were divided by random number table into 2 groups.Twenty patients in group A underwent open hepatectomy+biliary exploration.Sixty-one patients in group B received duodenoscopy first,and patients with successful clearance of stones in the extrahepatic bile duct underwent total laparoscopic hepatectomy or hand-assisted laparoscopic hepateetomy according to the location of the stones in the liver;patients with residual stones in the extrahepatic bile duct underwent hand-assisted laparoscopie hepateetomy+biliary exploration.The changes of the indexes during perioperative period of the 2 groups were analyzed by t test.Results Minimally invasive surgeries were successfully carried out in group B.Satisfactory outcomes were obtained,and no severe complication was observed.The gastrointestinal function recovery time of patients who underwent hand-assisted laparoscopic hepatectomy+biliary exploration in group B was significantly shorter than in group A(t:3.062,P＜0.05),but there was no significant difference in operation time and perioperative blood loss between the 2 groups(t=0.953,0.911,P＞0.05).Compared with patients who underwent hand-assisted laparoscopic hepateetomy,the operation time was significantly longer,hut the gastrointestinal function recovery time was significantly shorter in patients who underwent total laparoscopic hepatectomy(t:2.046,2.316,P＜0.05),there was no significant difference in operation time between the 2 groups(t=0.874,P＞0.05).Conclusion Endoscopy+laparoscopic hepatectomy is safe and effective,and can decrease the trauma to the minimum for patients with intra-and extrahepatic bile duct stones.

Double-frequency laser lithotripsy under endoscope for refractory biliary stones: Report of 23 cases / 中国微创外科杂志

Objective To evaluate the efficacy and safety of double-frequency laser lithotripsy under endoscope in the treatment of refractory biliary stones. Methods A total of 23 patients with refractory biliary stones underwent double-frequency Nd:YAG laser lithotripsy from January 2002 to June 2004. The authors performed the laser lithotripsy during laparoscopic common bile duct exploration in 14 patients and during postoperative choledochoscopy in 9 patients. Results Biliary stones were completely removed in 19 patients, the stone free rate for refractory biliary stones being 82.6% (19/23). No bile duct or T-tube tract injuries occurred. Conclusions Double-frequency laser lithotripsy has the advantages of mini invasion, high efficiency, and low postoperative complication rate. It is an effective alternative for patients with refractory biliary stones during endocopic surgery.

Function of osteopontin and its clinical relation with tumor / 医学研究生学报

Osteopontin (OPN), a phosphorylated and glycosylated protein, is a prominent matricellular component of the extracellular matrix of mineralized tissues of bones and teeth, in which they can regulate the formation and growth of hydroxyapatite crystals and influence a variety of cell activities. Recent studies have reported that the expression of OPN is not only correlated with bone formation and bone resorption but also with tumor aggression and metastasis in several types of human cancer, and OPN is even considered to be an index for the diagnosis and prognosis of tumor. The roles of OPN in angiogenesis were also reviewed.

Role of RhoC-siRNA expression vector on growth velocity and invasiveness of hepatoma carcinoma cells / 第三军医大学学报

Objective To construct a RhoC-siRNA expression vector, and study its role on the biological behaviors of hepatoma carcinoma cells. Methods RhoC-siRNA gene was synthesized and cloned into the expression vector pSilencer2.1. The constructed RhoC-siRNA expression vector was stably transfected into hepatoma carcinoma cell line SK-Hep1. The inhibitory effect of RhoC-siRNA on the expression of RhoC in transfected cells was detected by Western blotting. The morphous, growth velocity and the ability of cell adhesion, cell migration, cell invasion before and after transfection was observed. Results Enzyme digestion and DNA sequencing confirmed that the RhoC specific siRNA expression vector was constructed successfully. After transfection, RhoC expression was inhibited by 60%, and no marked difference was observed in cellular morphous and growth curve, while the ability of cell adhesion, cell migration, and cell invasion were markedly decreased. Conclusion The RhoC-siRNA expression vector can effectively suppress RhoC expression in transfected hepatoma carcinoma cells. Although having no effect on the morphous and growth velocity of hepatoma carcinoma cells, it decreases the potentiality of cell invasion and cell metastasis, which may provide a novel applicable strategy for gene therapy on hepatocellular carcinoma.

Expression of BC047440 gene in human hepatocellular carcinoma tissues and its significance / 中国普通外科杂志

Objective To study the BC047440 mRNA expression in human hepatocellular carcinoma tissues, and the role of BC047440 gene in the carcinogenesis and development of human hepatocellular carcinoma.Methods Specimens from 36 cases of hepatocellular carcinoma and their corresponding adjacent non-cancerous tissues were examined for BC047440 mRNA expression by polymerase chain reaction after reverse transcription(RT-PCR).Results(1)the BC047440 mRNA expression in specimens of 36 cases of hepatocellular carcinoma was higher than that in their adjacent non-cancerous tissues(0.2594?0.0928 and 0.0942?0.0443,respectively,P

Combination use of endoscopy and laparoscopy in the treatment of intra-and extra-hepatic bile duct stones / 中国微创外科杂志

Objective To study the most appropriate approach of combination use of endoscopy and laparoscopy in the treatment of intra and extra-hepatic bile duct stones.Methods A total of 1 669 patients with intra-and extra-hepatic bile duct stones were treated from October 2000 to December 2005 in this hospital.According to patient's individual conditions,different surgical schemes were employed,including duodenoscopy only,combination of laparoscopy and duodenoscopy(or choledochoscopy),combination of duodenoscopy,laparoscopy,and choledochoscopy,and hand-assisted laparoscopic hepatectomy.The success rate and post-operative results were observed and analyzed.Results The combination use of endoscopy and laparoscopy was successfully carried out in 1 636 patients,the total success rate being 98.0%(1636/1669).There were no serious post-operative complications.Conclusions Combination use of endoscopy and laparoscopy can be employed for various conditions of patients with intra-and extra-hepatic bile duct stones.The technique integrates advantages of both digestive endoscopy and laparoscopy,broadens indications of minimally invasive treatment,and improves the success rate.