Objective To explore the feasibility of laparoscopic subtotal cholecystectomy without using titanium clips.Methods Laparoscopic subtotal cholecystectomy was performed without using titanium clips on 48 patients,who had serious adhesions at the Calot's triangle.The cystic duct was ligated by silk.Results The operations were completed uneventfully in all the cases without converting to open surgery.No massive hemorrhage or biliary leakage occurred during the operation.The patients were followed up for 3 months to 3 years(mean,18 months),during which no one developed abdominal pain,fever,or jaundice.Conclusions Laparoscopic subtotal cholecystectomy without using titanium clips is a safe and simple method for patients with serious adhesions at the Calot's triangle.The rate of postoperative complications is low.

Objective:To investigate the oncological efficacy and functional evaluation of total elbow arthroplasty (TEA) for the reconstruction of tumor around elbow joint.Methods:A retrospective case series study was made on the clinical data of 26 patients who underwent total elbow joint replacement after tumor resection in Beijing Jishuitan Hospital from June 1988 to June 2019. According to the inclusion and exclusion criteria, 23 patients were enrolled in the final study, there were 14 males and 9 females, the mean and median age was 37.6±19.9 and 35.0 years respectively. 23 patients included 3 cases of giant cell tumor, 4 cases of metastatic cancer, 4 cases of Ewing's sarcoma, 2 cases of osteosarcoma, 2 cases of aneurysmal bone cyst, 1 angiosarcoma, 1 primary malignacy in giant cell tumor, 1 low-grade central osteosarcoma, 1 parosteosarcoma, 1 synovial sarcoma, 1 plasma cell myeloma, 1 tendon sheath giant cell tumor and 1 case of mixed tumor. There were 6 cases of benign tumor, 4 cases of low grade sarcoma and 13 cases of high grade malignancy. With 19 cases of distal humerus, 3 cases of proximal ulna and 1 case of elbow. Each patient underwent tumor resection followed by restrictive tumor prosthesis and semi-restrictive of coonrad-morrey prosthesis were used for reconstruction.The duration of the operation, the amount of blood loss, epidemiological data, reconstruction length, oncology parameter, complications and functional evaluation were enrolled and statistical analyzed.Results:The mean length of the osteotomy followed by reconstruction was 12.5±3.9 cm, the mean operative time was 154.1±50.1 minutes, and the mean bleeding was 262.2±100.9 ml. Thirteen patients were treated with customized tumor limited prosthesis while 10 patients with Coonrad-Morrey semi-limited prosthesis. The 5-year survival rates of 23 patients was 64.3%, benign tumors, low-grade and high-grade malignancies were 100%, 100% and 39.7%, respectively. Three cases of lung cancer and three cases of Ewing's sarcoma died during the follow-up period (6/23, 26.1%), one case of giant cell tumor and one case of synovial sarcoma developed local recurrence (2/23, 8.7%). The median range of motion for the elbow increased from 35 to 85 degrees ( t=-13.787, P<0.05), the median NRS score decreased from 5.0 to 0.5 ( t=14.391, P<0.05). Postoperative complications occurred in 9 cases (9/23, 39.1%), the recent complications were nerve injury in 4 cases and infection in 1 case, late complications were prosthesis loosening and failure in 4 cases, the 5 year survival rate of prosthesis was 82.0%. The mean and median MSTS 93 score was 84.5%±11.0% and 88.3% respectively. Conclusion:The local control around the elbow is satisfactory after tumor resection. Total elbow arthroplasty can relieve pain and significantly improve function.