Objective To discuss the feasibility of stone removal in laparoscopic choledocholithotomy by routine laparotomic instruments. Methods A total of 73 patients with common bile duct stones were divided randomly into 2 groups: the Experimental Group received laparoscopic stone removal by routine laparotomic instruments; the Control Group received stone removal by choledochoscopic net-basket. The stone-free rate, operative time, total hospitalization costs and postoperative complications between the two groups were compared. Results There were no statistical significances in stone-free rate between the Experimental Group ( 94.4% , 34/36) and the Control Group (94.6%, 35/37) ( ? 2=0.000, P =1.000). The operative time in the Experimental Group (150.9 min?26.8 min) was shorter than that in the Control Group (172.3 min?28.6 min) ( t=3.297, P =0.002), whereas the total hospitalization costs in the Experimental Group (4400 yuan?1100 yuan) was lower than that in the Control Group (5000 yuan?1300 yuan) ( t=2.126, P= 0.037). No severe operation-related complications were observed in both of the groups. Conclusions Laparoscopic choledocholithotomy by either routine laparotomic instruments or choledochoscopy is safe and effective. Stone removal by routine laparotomic instruments has the advantages of low costs and short operative time.

Objective To discuss the effective surgical treatment of intrahepatic lithiasis combined with high hepa-t ic duct strictures. Methods Two hundreds and sixteen cases of intra hepatic lithiasis and high hepatic duct strictures treated in this hospital fr om January 1993 to October 2002 were analysed retrospectively.Results One hundred and eighty- three cases underwent different selective operation by selected time; 33 case s complicated with acute obstructive suppurative cholangitis underwent emergency were performed single biliary drainage, in which 30 cases were re-operated. Th e operative procedure were: hepatic lobectomy,high cholangiotomy and plastic repair,exposure of hepatic duct of the 2nd and the 3rd order,and plastic re pair with own patch and choledochojejunostomy.Two hundreds and six cases w ere cured,the curative rate was 95.4%; 8 cases improved (3.7 %), and 2 cases died (0.9%).Conclusion The best effective surgical treat ment of intrahpatic lithiasis is hepatic lobectomy. Exposure of hepatic duct of the 2nd and the 3rd order is a satisfactory to release the hepatic duct str ictures and to clear the intrahepatic lithiasis. For patients with normal extr ahepatic bile duct and Oddi's function, plastic repair of bile duct with own patch is possible to keep the normal form and function. Cholang ioscopy may play an important role in the treatment of intrahepatic tr act lithiasis during operation.

Objective To investigate the effect of lineal polypeptide injection on immune function of severe sepsis patients in ICU.Methods 40 severe sepsis patients in ICU were randomly divided into two groups after signed the consent form:the treatment group (20 cases)and the control group (20 cases).On the 1st day of antibiotic therapy, the patients in the treatment group were simultaneously treated with lineal polypeptide intravenous injection,while the patients in the control group received the same routine treatment,but without lineal polypeptide injection,all with a 10 days treatment course.Blood bacteria culture and drug sensitivity test were completed after entering the hospital. The scores of Sequential Organ Failure Assessment(SOFA)before treatment and at day 3,7 and 10 of therapy were evaluated.The peripheral blood of patients was taken and send to the clinical laboratory.The WBC,NEU%,PCT, hs -CRP,IL -6,total T lymphocytes (CD +3 )and T lymphocyte subgroup (CD +4 ,CD +8 ,CD +4 /CD +8 )were detected in both the treatment group and the control group.Adverse drug events were also detected in the process of therapy. Results Compared with before treatment[(5.56 ±2.03)points],after 7 days of lineal polypeptide therapy,the SOFA score of the treatment group[(3.48 ±1.83)points]decreased significantly(t =2.793,P <0.05),and after 10 days therapy,the descending degree in the treatment group was more significantly and declined earlier than the control group (t =4.401,P <0.01 ).In the aspect of improving the inflammatory markers,two groups were all improved after therapy,but the degree of improvement in the treatment group was better than the control group.After 7 days therapy,IL -6 level was (37.61 ±7.51)mg/L in the treatment group,while (50.49 ±7.68)mg/L in the control group (t =1.969,P <0.01),and the improvement of NEU% was not found in control group.In the aspect of improving the immune function,the CD +3 ,CD +4 ,CD +4 /CD +8 ratios were increased significantly [before therapy:(41.27 ±6.91)%,(19.65 ±5.29)% and (0.96 ±0.42);after 3 days therapy:(46.57 ±7.11 )%,(24.99 ± 7.70)%,(1.27 ±0.39)],and CD +8 [before therapy:(25.62 ±5.18)%,after 3 days therapy:(23.51 ±3.19)%] was decreased dramatically after 3 days of lineal polypeptide injection treatment,there was significant improvement in time and degree in the treatment group compared with the control group (t =1.390,t =1.407,t =3.974,t =2.081, all P <0.05).No severe adverse drug events were found.Conclusion As an immune modulator,lineal polypeptide injection could effectively improve the immune function of severe sepsis patients in ICU.