Objective To evaluate left liver anatomical resection via left vertical groove by laparoscope.Method Among 103 patients with left intrahepatic biliary calculi,39 cases underwent left lateral hepatectomy,20 cases did left liver anatomical resection via left vertical groove by laparoscope,29 cases underwent left lateral hepatectomy via left liver diaphragmatic surface,15 cases did left liver anatomical resection via the first porta.Result In the 103 cases of laparoscopic left liver anatomical resection,101 cases were successful and two cases were conversed to open surgery.In the success group,total laparoscopic anatomical left lateral lobectomy was performed (Ⅱ,Ⅲ section) in 68 cases.Compared with the approach via left liver falciform ligament diaphragmatic surface,the operatve time via left vertical groove was significantly shorter(t =-2.723,P =0.008,intraoperative blood loss was significantly smaller (t =-5.399,P =0.000),while the differences in postoperative hospital stay (t =-0.168,P =0.867) and postoperative complications (x2 =0.664,P =0.415) were of no statistical significance between the 2 groups.In the 33 cases of left hemihepatectomy (Ⅱ,Ⅲ,Ⅳ section),those performed via left vertical groove compared with through the first porta hepatic,used shorter operation time(t =-3.144,P =0.004),while blood loss was similar(t =-1.049,P =0.302),as well as the length of hospital stay(t =0.784,P =0.439).There was no postoperative bleeding and intractable bile leakage,nor postoperative air embolism.Flatus on an average of (2.5 ± 1.2) days.Patients were discharged from hospital 5-17 (9.98 ±2.98) days post-op.96 cases were followed up in the 101 cases undergoing successful total laparoscopic left hemihepatectomy.The followed-up time were 3-52 (32.6 ± 5.7) months.Postoperative review found no residue stone.One case in first porta hepatis group,caudate lobe atrophy was found by postoperative CT.Conclusions Left liver anatomical resection via left vertical groove by laparoscope is less traumatic,quick recovery with satisfactory clinical curative effect for the treatment of left hepatolithiasis.

Objective To explore the reasons and preventive measures for the postoperative complications of hilar cholangiocarcinoma.Methods The clinical features,diagnosis,surgical therapy,postoperative complications and follow-up result were retrospectively analyzed on 89 cases of hilar cholangiocarcinoma admitted into our hospital from January 2008 to September 2014.Surgical approach:47 cases of radical resection including hepatoduodenal ligament skeletonized resection in 18 cases; concurrent partial hepatectomy in 29 cases,palliative resection in 17 cases,biliary tract drainage in 25 cases.There were 6 cases receiving partial portal vein resection and reconstruction.Results Among 89 patients there were 93 postoperative complications.Biliary complications developed in 22 cases (24.7％,22/89) including bile leakage in 13 cases (14.6％),biliary tract infection in 7 cases,anastomotic stricture in 2 cases.Wound infection in 19 cases,lung infection in 4 cases,ascites in 31 cases,pleural effusion in 10 cases,liver abscess in 1 case,intraabdominal bleeding in 2 cases,postoperative gastrointestinal bleeding,intestinal fistula,liver failure and multiple organ failure (MODS) developed in one each cases.One case died of MODS with the mortality of 1.1％.Conclusions Postoperative complications were common in hilar cholangiocarcinoma combined liver resection and/or vascular resection and reconstruction.Bile leakage is the most frequently seen necessitating long term proper drainage.

Objective To increase curative rate of nonoperation treatment for adult blunt splenic trauma.Methods Data of 141 patients with blunt splenic trauma treated in our hospital from March 2010 to October 2014 were retrospectively analyzed in accordance with the spleen injury degree classification issued by the Spleen Surgery Group of Chinese Society of Surgery in 2000.According to the treatment within 6 hours of injury,these patients were divided into operative and nonoperative management groups.Results The proportion of non operation was 69.5％ (98/141) and the success rate was 89.8％ (88/98).43 cases were in operation group:34 cases in grade Ⅲ,9 cases with grade Ⅳ,3 cases died; 98 cases were in non operation group:including 32 cases of grade Ⅰ,50 cases of grade Ⅱ,15 cases of grade llⅢ,1 case with grade Ⅳ.10 cases failed non operation treatment including 1 case with grade Ⅰ complicated by pancreatic and intestinal injury causing peritonitis during the period of observation,1 case of grade Ⅱ complicated by contusion of the liver and secondary bleeding on day 3 after the trauma,7 cases of grade Ⅲ,were converted to surgery because of multiple organ injury and rebleeding secondary to pulmonary complications,and 1 case of grade Ⅳ with multiple organ injury and shock being immediately converted to surgery.In overall there were 2 deaths in nonsurgery group,1 case with grade Ⅲ and 1 case with grade Ⅳ.Condusions Nonoperative treatment of blunt splenic trauma is safe and feasible in grade up to]Ⅱ blund splenic trauma patients.

Objective To evaluate the safety and efficacy of one-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for the treatment of patients who have concurrent gallstones and CBD stones.Methods We conducted a prospective study from Mar 2008 to Nov 2011 in our department.A total of 63 consecutive patients of concurrent gallstones and CBD stones were included and divided into two groups:31 patients in test group first underwent ERCP and EST to remove CBD stones,and then during the same general anesthesia underwent laparoscopic cholecystectomy (LC) ; while 32 patients in control group first underwent ERCP and ES,and then LC 3-5 days later.Results The stone clearance rate in test group and control group were 96.9％ and 96.7％ (P ＞ 0.05),respectively.The postoperative lung infection rate in the test group and the control group were 7.1％ and 16.1％ (P ＜0.05),respectively.The length of hospital stay (LOS) of the two groups was (7.5 ± 1.7) days and (12.6 ±2.5) days,respectively (P ＜ 0.05).The total expense of hospitalization was (￥) (2 356 ± 126) and (￥) (37 056 ± 152),respectively (P ＜ 0.05).Conclusions One-stage laparoendoscopic management of patients with concurrent gallstones and CBD stones is safe,effective and more economic approach than two-stage treatment for patients suffering from concurrent gall stone and choledocholithiasis.

Objective To investigate the expression of transcription factor Oct 4 in gastric carcinoma and its effects on gastric cancer cell proliferation and apoptosis after Oct 4 gene interfered by lentivirus vector.Methods Real time PCR and Western blot were used to observe the expression of Oct 4 in different differentiated gastric cancer cell lines.Gastric cancer cell lines with high expression of Oct 4 was cultured and infected by siRNA-Oct 4-lentivirus vector.Cell proliferation and apoptosis were observed after Oct 4 gene was interfered.Results Oct 4 was highly expressed in poorly and moderately differentiated gastric cancer cells.Gene interfered with siRNA inhibits the expression of Oct 4 in gastric cancer cells and show significant effects on cell proliferation and mobility as well as apoptosis after down-regulation of Oct 4.Condusions Oct 4 expression is in close relationship with gastric cancer cell proliferation and invasive ability.

Objective To compare the complication and long-term efficacy of standard and extended pancreaticoduodenectomy for carcinoma of the head of pancreas by meta-analysis.Methods A literature search was performed of PubMed,Web of Science,Springer,WanFang,CNKI and CBMDisc databases from January 1990 to August 2014.Qualitative analysis of these literatures was conducted using Jadad evaluation.Patients with pancreatic head carcinoma undergoing extended radical resection and standard radical resection were divided into treatment group (extended pancreaticoduodenectomy group,EPD) and control group (standard pancreaticoduodenectomy group,SPD),respectively.Based on the heterogeneity test,meta-analysis of a fixed-or random-effect model were used.Results A total of 5 studies suitable for the selection criteria were chosen,involving 597 patients (299 in EPDs and 298 in SPDs).The results of meta-analysis showed that the EPDs have significantly longer operative time (MD =64.36,95％ CI =23.88-104.85,P =0.002) and more dissected lymph nodes (MD =16.45,95％ CI =9.61-23.29,P ＜ 0.000 01) than SPDs.There was no statistical difference (OR =1.76,95 ％ CI =0.66-4.65,P =0.26) in postoperative complications (46.3％ vs 36.0％) mortality (OR =1.31,95％ CI =0.47-3.69,P =0.61),1-year survival rate (OR =0.70,95 ％ CI =0.49-0.99,P =0.05),3-year survival rate (OR =0.79,95％ CI =0.55-1.15,P =0.22),and 5-year survival rate (OR =-0.02,95％ CI =-0.17-0.12,P =0.77).Conclusions Compared with standard radical resection,extended radical resection for pancreatic head carcinoma does not prolong the postoperative 1-,3-,and 5-year survival rates with comparable postoperative mortality and morbidity and prolonged operative time.

Objective To investigate the mechanism of recurrent laryngeal nerve injury during total thyroidectomy.Methods The clinical data of 36 patients suffering from recurrent laryngeal nerve injury in total thyroidectomy from 2003 to 2014 was analyzed retrospectively.Results 21 cases had temporary recurrent laryngeal nerve injury while 16 cases had permanent injury.The cases of injury included giant thyroid goitre,with variation of recurrent laryngeal nerve,undergoing secondary surgery,with tumor invasion and complicating thyroiditis.During the first surgery,the incidence of temporary recurrent laryngeal nerve injury was 0.43％,and the incidence of permanent damage was 0.27％.The temporary and permanent injury incidence of secondary surgery after initial subtotal thyroidectomy was 4.59％ and 4.59％,respectively.For patients with grade 3 thyroid gland,that was 1.81％ and 0.30％,respectively and 0.51％,0.72％ respectively in malignant cases.In cases complicating thyroiditis temporary recurrent laryngeal nerve injury occurred in 1.01％.Conclusions There is increased risk of recurrent laryngeal nerve injury in giant goiter cases undergoing secondary operations.Hence it is suggested that initial surgical procedure be hemithyroidectomy or total thyroidectomy

Objective To investigate the correlation between iodine intake,BRAF mutation in thyroid gland and clinical biologic characteristics in papillary thyroid carcinoma(PTC) cases.Methods A total of 159 PTC patients and 200 healthy controls were enrolled in this study.Urine iodine was tested,BRAFV600E mutation was detected by PCR.The correlation was analyzed between BRAF mutation and iodine intake,BRAF mutation and clinical biologic characteristics of PTC respectively.Results The median urinary iodine (MUI) of the patients and healthy controls was 336 μg/L and 196 μg/L respectively (P =0.004).The overall prevalence of the BRAFV600E mutation in this series of PTC was 63.5％,showing a clear correlation of BRAFV~E mutation with iodine intake (P =0.006).There was no correlation of BRAFV600E mutation with age,gender,tumor size,extrathyroid extension or nodulor goiter in PTC (P ＞ 0.05).But there was a significant association of BRAFV~E mutation with lymph node metastasis (P =0.008) and Hashimoto's thyroiditis (P =0.037).Conclusions High iodine intake may be a risk factor for PTC occurrence.In PTC cases,high iodine intake may be a risk factor of BRAFV600E mutation.BRAFV600E mutations increase both in PTC with cervical lymph node metastases and uncoexisting Hashimoto' s thyroiditis.

Objective To discuss the feasibility of endoscopic thyroidectomy via breast approach for papillary thyroid carcinoma.Methods From April 2009 to December 2013,clinical data of 90 papillary thyroid carcinoma cases undergoing endoscopic thyroidectomy was analyzed retrospectively.Results There was no conversion to open surgery,the mean operation time was 97 min,the mean intraoperative blood loss was 10 ml,the mean postoperative drainage volume was 65 ml,the mean hospital stay was 4.5 d,the mean lymph node number dissection of central compartment was 5.3.No obviously chest pain and numbness occurred.No skin flap ecchymosis,necrosis,effusion,and hematoma occurred.No hypocalcemia convulsions occurred.Transient hoarseness occurred in 3 cases which recovered within 1 to 2 months.Follow-up time ranged from 1 to 5 years,the median follow-up time was 41 months,with no tumor recurrence and lymph node enlargement.All patients were satisfied with the cosmetic results.Conclusions Endoscopic thyroidectomy via breast approach is a safe and feasible procedure in treating papillary thyroid carcinoma (cN0).

Objective To evaluate the feasibility of endovascular repair for retrograde type A aortic dissection.Method 35 patients of retrograde type A aortic dissection admitted to Peking University People's Hospital from December 2001 to March 2014 were treated with endovascular repair.There were 33 males and 2 females with mean age of 46 ± 9 years.29 were on acute stage,2 on subacute stage and 4 on chronic stage.The entry tear was in the descending thoracic aorta in 32 cases,between the left subclavian artery and the left common carotid artery in one,and between the left common carotid artery and the innominate artery in two.Results Entry closure was achieved in all patients with a covered stent.2 patients died in 30 days postoperatively (5.7％).1 patient with two chimney developed acute renal artery embolized which was infused by false lumin (2.9％).One patient developed transient paraparesis after graft deployment(2.9％).During the follow-up period,the aortic remodeling is perfect,no entry tear was noted in the ascending thoracic aorta.All the endografts for preserving supra-aortic branches were patent.Conclusions The endovascular repair for retrograde type A aortic dissection is feasible and effective.