Objective To study variant artery and treatment under video laparoscopic cholecystectomy(LC). Methods 521 patients who received selective cholecystectomy(male 159 patients and female 362 patients, aged 11 to 76 years),were operated on with video laparoscopy. Cystic artery was anatomized under general anesthesia and carbon dioxide pneumoperitoneum. Results Variant Cystic artery presented in 140 patients(26 .9% ). Cystic artery of 60 patients originated from anterior or posterior common bile duct, single cystic artery was in 3 patients, double cys- tic artery in 51 patients, cystic artery arose from celiac artery was in 6 patients, cystic body artery existed in 17 pa- tients and cystic artery originated from variant right hepatic artery in 3 patients. Conclusion Variant cystic artery is very common. Correct recognition, dissection and safe treatment are an important to prevent hemorrhage and bile duct injuries during laparoscopic cholcystectomy.

Hemodynamic changes and regulations of indomethacin have been studied in 64 patients with obstructive jaundice and 39 patients with simple gallstones (group C) Obstructive jaundice patients were divided into non indomethacin group (group A) and indomethacin group (group B) The results showed that stroke volum,cardiac output and cardiac index were significantly higher in group A than those in group C( P

With the developments of digital medicine, Gd-EOB-DTPA enhanced magnetic resonance imaging, molecular imaging and optical/acoustic multi-modality imaging, the hepatopancreatobiliary surgery have entered the era of precise diagnosis and treatment.Bidimensional pattern of disease diagnosis and treatment is developing toward three-dimensional pattern, which make the diagnosis and treatment more comprehensive and clear.Morphological imaging is gradually developing towards molecular imaging.Ultimately, the goal of truly precise diagnosis and accurate treatment will be achieved.

Objective To study the expression of proliferating cell nuclear antigen (PCNA) in the occurrence and development of hepatocellular carcinoma. Methods Sixty SD rats were randomly divided into control group and experimental group. 3′-Me-DAB was administrated into rats to establish the experimental model of hepatocarcinoma. The expressions of PCNA of different phases were detected by immunohistochemistry and the liver pathologic changes were observed by optical microscope. Results The process of canceration was divided into three stages: inflammation, proliferative fibrosis and hepatic carcinoma. The expression of PCNA firstly presented in the oval cells that located in the portal area at the stage of inflammation, and a part of PCNA were hyper-expressed in the portal area. The expression rate of PCNA in the middle phase of inflammatory stage was higher than that of any other phases but declined later. Yet, when it came to the stage of hepatic carcinoma, the rate increased again. Conclusion Under the experimental circumstance when liver cancer is caused by the carcinogenic agent, PCNA may be firstly expressed in the oval cells, and the dynamic expression of PCNA may be an indicator for the early diagnosis of hepatocarcinogenesis.

Hepatolithiasis is a common disease in China with a high rate of residual stones up to 30％-90％ after surgery.Patients often require re-operation because the high rate of residual stones and stone recurrence.Because the calculi are deeply distributed in the liver,and the condition is often accompanied by anatomical variations,distortion and biliary strictures,traditional preoperative imaging examinations do not easily locate the lesioos precisely,making diaguosis and treatment difficult.In recent years,three-dimensional computed imaging and visual simulation have provided a novel preoperative diagnostie method for hepatolithiasis,and have offered a clearer radiologic basis for surgical planning.The value of digital medical technology in the diagnosis and treatment of hepatolithiasis is discussed in this article.

In this study,changes in immunity were observed in 120 patients undergoing laparoscopiccholecystectomy. It was found that postoperative levels of IgG,IgM,CD3+,CD4+,and CD8+ were significantly higher than that of preoperative and postpneumoperitoneal with CO2 (P

Objective To investigate the myocardial injury induced by bile duct obstruction and the protective effects ulinastatin(UTI). Methods Dynamic observation of of the levels of malondialdyhyde(MDA) and superoxide dismutase(SOD) of myocardial tissues, and the levels of serum TBil, alkaline phosphatase(ALP), MB isoenzyme of creatine kinase(CK MB), endotoxin (ET), and tumor necrosis factor(TNF ?) in bile duct obstruction(BLD) rats and UIT treatment rats. The left ventricles of the rats were obtained for light and electronic microscopic observation . Immunohistochemical staining method of ABC used was to locate the expression and distribution of TNF ? in myocardial tissues. Results After ligation of the common bile duct, serum TBIL, ALP, CK MB, ET, TNF ? levels and myocardium MDA gradully increased, while SOD levels gradually decreased, and the expression of TNF ? in myocardium increased. As compared with BDL group at the same phase, in UIT group, serum TBIL, ALP, CK MB, ET, TNF? levels and myocardium MDA in UTI treated groups decreased, while myocardium SOD increased, and the expression of TNF ? in myocardium decreased.Myocardial injuries of bile duct obstruction were aggravated as time progressed, and there were less myocardial injuries in UTI treated groups than in BDL groups at the same stage as shown with light and electronic microscopic observation.Conclusions UTI can effectively protect the myocardium from ET,TNF ? and free radical injury in bile duct obstucion rats.

Objective To explore the distribution and migration of oval cells in progressive hepatic injury.Methods Sixty SD rats were divided into the control group ( n =20) and experimental group ( n =40). After the establishment of hepatic carcinoma models, C kit was continuously detected by immunohistochemistry and the liver pathologic changes were regularly observed by optical microscopy. Results The hepatic surface was smooth with eumorphism in histology in the control group. The C kit positive cells were occasionally found. In the experimental group, the oval cells with C kit positive were initially discovered in the portal regions in the second week, and these cells proliferated along the bile duct epithelia. With the hepatic injury becoming more serious, the oval cells extended into the hepatic lobular regions from the portal regions. When hepatocellular carcinoma occurred,the majority were mixed carcinomas, and the oval cells were found inside and outside the carcinoma nodes. In this period, the most of C kit positive cells still located in the portal regions. Conclusion ①The oval cells are the most sensitive cells for the hepatic injury. ②The oval cells which migrate unruly participate in the formation of hepatic pseudolobules. ③The oval cells play an important role in hepatocarcinogenesis.

The development of science and technology not only promotes the development of the society,but also has a great influence on the progress of medicine.The three dimensional (3D) printing technology together with other digital production modes will promote the realization of the third industrial revolution.New 3D equipments and concepts brought a huge leap of surgery,and pancreatic surgery is also benefited from this.The author has committed himself to the scientific research of 3D pancreatic surgery for decades,and applying 3D visualization technology of the diagnosis and treatment of pancreatic cancer,3D visualization of peri-pancreatic vessels,resectability evaluation of the pancreatic cancer and prevention of pancreatic fistula.This article presents a new idea on the development of pancreatic surgery and introduces not only the progress in the diagnosis and treatment of pancreatic diseases in the era of digital medicine,but also the relative advantages brough about by the new equipments (such as da Vinci robotic surgical system,3D laparoscope).

Digital medical technology pioneered the three dimensional (3D) era of the surgery.The 3D reconstruction and visualization technology made a breakthrough of the bottleneck of clinical diagnosis and therapy of the biliary surgery,and are widely used for the treatment of biliary disease such as hepatolithiasis and hilar cholangiocarcinoma,and achieved digital anatomy,procedural diagnosis and visualized surgery,just as provide a 3D Ⅹ-ray vision to surgeons.With the development of the digital medical technology and the wide application of 3D laparoscopy and robotic system,biliary tract surgery access to a 3D era.