Mechanical stapling devices have been widely applied in the gastrointestinal surgery since the 1950s because of its advantages of easy manipulation,less time consumption and low incidence of postoperative complications.With modification of these devices and technical proficiency,mechanical staplers have been introduced into several surgical procedures in hepatopancreatobiliary surgery including pancreatoduodenectomy,hepatectomy,cholecystojejunostomy,gastroenterostomy,cystogastrostomy and enteroenterostomy.Currently,there are no guidelines or consensus in China concerning the use of mechanical stapling devices. Current advances in mechanical stapling devices and complications in the clinical practice are discussed in this article.

To improve standardization and consensus regarding interpreting,and reporting CT and MRI scans of the liver in patients with high-risk HCC,Liver Imaging Reporting and Data System (LI-RADS) was launched in 2011 and subsequently modified in 2013 and 2014,respectively.Major diagnostic imaging features for HCC are hyper-enhancement in the arterial phase,rapid dissection in the portal vein phase and balance phase,capsule presence and appearance,interval threshold tumor growth and tumor diameter.LI-RADS categorizes nodules recognized at CT or MRI as LR-1 (definitively benign),LI-RADS is a system of standardized criteria for interpreting liver CT and MR images of patients at risk of hepatocellular carcinoma in higher interobserver reliability and faster categorization while maintaining diagnostic accuracy.LR-2 (probably benign),LR-3 (intermediate probability of being HCC),LR-4 (probably HCC) and LR-5 (definitively HCC).According to diagnostic classification,different options for treatment recommendations are adopted by surgeons including continue standard surveillance,regular follow-up,alternative imaging method,multidisciplinary discussion,liver resection or transplantation.LI-RADS is a system of standardized criteria for interpreting liver CT and MR images of patients at risk of hepatocellular carcinoma in higher interobserver reliability and faster categorization while maintaining diagnostic accuracy.

ObjectiveTo explore the efficacy of an antibiotic ertapenem for the treatment of bacterial liver abscess. MethodThe clinical data of 134 hospitalized bacterial liver abscess patients were retrospectively analyzed to evaluate the clinical and bacteriological efficacy of ertapenem from March 2009-2011in our hospital. ResultFever was present in 122 (91％)cases,abdominal pain was complained in 70 (52.2％ ) cases and rigor in 66 (49.3％ ) cases.In 92(68.7％ ) cases the abscess was located in the right lobe of the liver.Leukocytosis and liver dysfunction were found in 73 cases(54.8％ ) and 84 cases (62.7％ ),respectively.Ultrasonography was the most effective diagnostic means for liver abscess.Fortyone cases(30.6％ )were treated conservatively with ertapenem and 82(61.2％ )were treated with ertapenem associated with percutaneous liver puncture aspiration and 11cases (8.2％ )were treated with ertapenem associated with surgery.The clinical success rate was respectively 89％,87.8％,90.9％.The average duration of medication and length of stay were respectively ( 7.0 ± 2.4 ) d and 14.2 d.Ninety-seven pathogens were isolated from samples and predominant strains were Klebsiella species.Bacterial eradication rate was 92.8％.The sensitivities of isolated bacteria to ertapenem were 94.8％.ConclusionsErtapenem administration is effective therapy for bacterial liver abscess.

ObjectiveTo compare the efficacy of laparoscopic and open left lobectomy.MethodsThe clinical data of 92 patients who received left lobectomy at the First Affiliated Hospital of Harbin Medical University from May 2010 to June 2011 were retrospectively analyzed.Of the 92 patients,42 received laparoscopic left lobectomy (laparoscopic group ) and 50 received open left lobectomy (open group ). The advantages and disadvantages between laparoscopic and open left lobectomy were compared. All data were analyzed using the t test,chi-square test or by calculating the Fisher exact probability.ResultsTwenty-nine patients received left lateral lobectomy and 13 patients received left hemihepatectomy in the laparoscopic group. One patient was converted to the open group becaused of the injury of the middle hepatic vein.Thirty-three patients nnderwent left lateral lobectomy and 17 underwent left hemihepatectomy in the open group.The tumor-free resection margin of the laparoscopic group was ( 1.6 ± 0.6 ) cm,which was significantly longer than ( 1.2 ± 0.4 ) cm of the open group (t=3.81,P＜0.05).The volume of operative blood loss of the laparoscopic group was (158 ±89)ml,which was significantly smaller than (292 ± 172)ml of the open group (t =4.56,P ＜ 0.05 ).The time of postoperative pain control,time to bowel function recovery and duration of hospital stay were ( 1.2 ± 0.3 )days,(23 ± 4)hours,( 7.5 ± 2.8 ) days in the laparoscopic group,which were significantly shorter than ( 2.0 ± 1.1 ) days,(4.9 ± 7 ) hours,( 11.3 ± 4.2 ) days in the open group,respectively ( t =4.57,21.31,5.00,P ＜ 0.05 ).The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at postoperative day 1 were increased,while the increase of AST and ALT in the open group were greater than that in the laparoscopic group (t =6.73,5.03,P ＜0.05).The postoperative prothrombin time in the open group was significantly longer than that before operation (t =2.32,P ＜ 0.05 ).The incidence of postoperative complications and total hospital costs were 7％ (3/41) and (2.5 ±0.7) ×104 yuan in the laparoscopic group,which were lower than 8％ (4/50) and (2.6 ±0.6) × 104 yuan in the open group,but no significant difference was observed (t =0.74,P ＞0.05).One patient in the open group died of multi-organ dysfunction syndrome caused by acute hepatic failure.ConclusionLaparoscopic left lobectomy is safe and effective,and it has the advantages of small trauma,quick recovery of patients and significant overall efficacy when compared with open left lobectomy.

Objective To explore the hotspots and developing direction of splenic surgery in China.Methods The biliometric analysis was adopted.Database including Chinese Database of Literature on Biomedicine were searched with “脾,外科,移植”.The time for retrieving was from January 1984 to December 2013.Chinese articles on splenic surgery which were published by academic journals were retrieved,and data were analyzed and evaluated by 2 independent researchers,including published year,distribution of journals,key words,authors and publication type.The P-value was calculated according to P =2Ln(eE × Y),and Euler's number =0.577 2 and Y was maximum amount of published articles in each journal.Results (1) Published year:1 977 articles were retrieved.There were 168 articles from 1984 to 1993,and number of articles in every year was less than 30.There were 562 articles from 1994 to 2003 and increasing number of articles in every year,with a maximum number of 88.There were 1 247 articles from 2004 to 2013,and average number of articles in every year was 125,with a maximum number of 165 in 2009.(2) Distribution of journals:all the articles have been published in 489 journals,including 9 surgical journals in the core journal such as Chinese Journal of Hepatobiliary Surgery and 7 journals from Chinese Science Citation Database.The maximum number of published articles of each journal was 54,and literature number in the core journals P≈9.(3) Distribution of key words:occurrence frequencies of “脾破裂”and“脾切除术”were very high in 3 periods (from 1984 to 1993,from 1994 to 2003,from 2004 to 2013) and percentages of occurrence frequencies were respectively 9.524％,24.911％,51.163％ and 12.500％,19.217％,38.813％,showing an increasing trend.Occurrence frequencies of“回顾性研究”“手术后期间”“胰腺切除术”and“脾动脉”reached the top 20 of key words from 1994 to 2003 and then continued to increase from 2004 to 2013,and occurrence frequency of“回顾性研究”was significantly increased witha growth rate of 23.742％.The percentages of occurrence frequencies of“回顾性研究”“手术后期间”“胰腺切除术”and“脾动脉”were respectively 3.203％,8.185％,4.448％,3.559％ from 1994 to 2003 and 26.945％,16.279％,7.939％,6.496％ from 2004 to 2013.“创伤和损伤”and“腹腔镜”first appeared on the top 20 of key words from 2004 to 2013,with percentages of occurrence frequencies of 15.958％ and 11.307％.Occurrence frequencies of“胰腺”and“肝”were gradually increased in 3 periods,with the percentages of 2.976％,3.915％,10.906％ and l.786％,4.804％,6.496％.The percentage of occurrence frequency of“移植,自体”in 3 periods was respectively 15.476％,20.107％,8.821％.Conclusions The Chinese articles of splenic surgery are rising obviously in the past 30 years.The splenic injury and splenectomy have always been research hotspots in splenic surgery.The preservation of spleen function and minimal invasive surgery are the developing direction of splenic surgery.

The surgical treatment of hepatocellular carcinoma have advanced greatly in recent years: associating liver partition and portal vein ligation for staged hepatectomy can bring hope and relief to patients with advanced liver cancer and less future liver remnant; the application range of laparoscopic hepatectomy and robotic hepatectomy were amplified; hepatectomy following anatomic or non-anatomic direction should be decided by particular situations; the precise preoperative assessment of liver reserve function ensured the success of extended hepatectomy; the further discussion of United Network for Organ Sharing criteria for liver transplantation made the appearance of University of California at San Francisco, Up-to-seven and Hangzhou criteria; bridge therapy can decrease tumor progression and the dropout rate from the liver transplantation waiting list; downstaging treatment is used in selected patients with more advanced liver cancer who are beyond the accepted transplant criteria to acquire the chance of liver transplantation and increase survival rates.
Carcinoma, Hepatocellular ; surgery ; Hepatectomy ; Humans ; Ligation ; Liver Neoplasms ; surgery ; Liver Transplantation ; Portal Vein ; surgery ; Survival Rate ; Treatment Outcome

ObjectiveTo compare the efficacy and safety of sequential intravenous moxifloxacin treatment against cefoperazone/sulbactam in patients with acute biliary tract infection. MethodsA prospective, randomized, non-blind, multi-centric study was performed to compare the efficacy and safety of moxifloxacin 400 mg Ⅳ once daily to cefoperazone-sulbactam (2 g q12 hours) and metronidazole 250 ml once daily to treat patients, from March- December 2009 in 13 hospitals, with acute biliary tract infection.The primary efficacy variable was clinical cure rate after the end of a 5 - 14 day treatment period,bacteriologic outcomes and adverse reaction effects were also determined.ResultsA total of 319 subjects were enrolled, 282 of whom were eligible for protocol efficacy analyses ( 138 moxifloxacin, 144 comparator).Demographic and baseline medical characteristics were similar between the 2 groups. Clinical success rates were 86.2％ for moxifloxacin and 84. 7％ for the comparator(P =0. 7192). Pathogens (55 moxifloxacin, 61 comparator) were isolated from bile or blood cultures and the predominant strains were E. coli, Klebsiella species and Enterococcus species. Bacterial eradication rates were 85.4％ ( 37 of 55 ) with moxifloxacin versus 82. 0％ (50 of 61 ) in the comparator group ( x2 = 0. 2568, P = 0. 6123 ). Both treatments were safe and well tolerated. ConclusionsE. coli, Klebsiella species and Enterococcus species were the most common bacteria isolated from bile or blood from patients with acute biliary tract infection. Moxifloxacin monotherapy has high clinical and bacteriological efficacies and safety for the treatment of acute biliary tract infection.

Eukaryotes inhibit the translation of mRNA under stress conditions and form particles-stress granules (stress granules). At present, stress granules have been proved to be related to the occurrence and development of a variety of diseases, including tumors. The production of stress granules is promoted by microenvironment such as hypoxia and hyperactive oxygen in tumor cells, while stress granules-related proteins such as G3BP1, RACK1, YB-1 and mammalian target of rapamycin (mTOR) can promote the occurrence and metastasis of tumors, but the mechanism is not yet clear. In addition, studies have linked the formation of stress granules to the survival of tumor cells during chemotherapy, and believe that stress granules play a role in the treatment of tumors by different anti-tumor drugs. This review introduces the biological characteristics of stress granules and their relationship with tumors.

Adenocarcinoma ; Aged ; Antineoplastic Agents ; pharmacology ; Apoptosis ; drug effects ; Cell Line, Tumor ; Cisplatin ; pharmacology ; Dexamethasone ; pharmacology ; Female ; Humans ; Lung Neoplasms ; Male ; Middle Aged ; Tumor Cells, Cultured

Hepatic cellular carcinoma is the third most common cause of cancer deaths in China.Partial hepatectomy is still the most effective treatment for hepatic cellular carcinoma.The liver is an organ with strong regenerative ability,and its regenerative mechanism is very complex.Majority of patients with hepatic cellular carcinoma are accompanied by cirrhosis,and cirrhosis is an important factor affecting the regeneration of the remaining liver after surgery.Liver regeneration is obviously impaired under this condition.However,the anti-liver fibrosis mechanisms behind these processes have not been completely elucidated,the current treatment of fibrosis is merely supportive care,and thus further definition of the antiliver fibrosis related factors such as keratinocyte growth factor,hepatocyte growth factor,milk fat globule epidermal growth factor 8,collagen-binding vascular endothelial growth factor,ex vivo expansion of circulating CD34+ cells has far-reaching significance for improving their prognosis.This article mainly introduces some relevant factors associated with anti liver fibrosis,for later use of single factor or a combination of multifarious factors to resist liver fibrosis,to provide reference for improving the ability of remained liver regeneration after partial hepatectomy.