Regional anatomy of inguinal hernia is one of the teaching difficulties.The students always feel confused due to deficiency of visual and vivid teaching materials.The thesis analyzed the efficacy of using high-definition video of laparoscopic inguinal hernia repair (LIHR) in the clinical teaching of inguinal region anatomy aiming to deepen the understanding,inspire the enthusiasm and initiative of students and improve the quality of teaching.

Natural orifice tranluminal endoscopic surgery,NOTES is a noval surgical method whose major ad vantage is the diminishing of surgieal scar,thus is benefical to a subgroup of special patients.The key issues related to the development of NOTES are the invention of instrument satisfing the clinical demand,the setting up of safe method of closing the transluminal acce88 and the training of doctors.

Objective To evaluate the repot of common hepatic duct defect caused by Type Ⅱ or Type Ⅲ Mirizzi syndrome laparoscopically.Methods Eight cases of Type Ⅱ or Type Ⅲ Mirizzi syndrome treated under laparoscopy were analyzed retrospectively.Among them six cases were identified as Mirizzi Ⅱ and a defect on the lateral wall of common hepatic duct was found and repmred by suturing the stubble of cystic duct.The two Mirizzi Ⅲ cases had a defect on front and lateral wall or back and lateral wall of common hepatic duct respectively.Both defects were repaired by a patch from the infundibulum of galllbladder. Results All the 8 cases underwent laparoscopic subtotal cholecystectomy followed by repair of common hepatic duct defect.The operation lasted for 80～150 min(mean 110 min).There was no recurrence of the symptoms after 6～24 months follow up.Conclusion The familiarity of the anatomical characters of Mirizzi syndrome and the skillful suture technique under laparoscopy are both necessary.

By adopting the combination of dividing stages with differentiation of syndromes for the treatment of 235 cases of the disease.40. 85% were basically curedwith a total effective rate of 94.89%.Such method oftreatment increases the efficacy and lowers the mortali-ty and rate of disability.

Objective:To study the anti-proliferation effects of a heat shock protein 90(Hsp90) inhibitor,17-allylamino-17-demethoxygeldanamycin(17-AAG),on a human breast cancer cell line,SKBr3,and related mechanism.Methods:MTT assay was used to detect the growth inhibition of SKBr3 cells.Cell cycle and apoptosis were analyzed by flow cytometry.Alteration of human epidermal growth factor receptor 2(HER2) in SKBr3 cells being treated with 17-AAG were measured by immunohistochemistry.Results:17-AAG significantly inhibited growth of SKBr3 cells in vitro in a dose-dependent manner with an IC_(50) value at 3.09 ?g/ml.Under concentrations of 0,0.625,1.250,2.500,5.000 and 10.000(?g/ml,)the percentages of cell apoptosis were(1.03?0.08)%,(3.68?0.67)%,(7.06?1.12)%,(11.23?1.36)%,(20.32?1.98)%,and(31.65?2.96)%;the percentages of cells at G_(0)/G_(l) phase were 58.61%,54.34%,49.55%,43.73%,35.52%,and 27.46%;the percentages of cells at S phase were 29.57%,25.21%,19.65%,22.98%,19.71%,and 15.46%;the percentages of cells at G_(2) /M phase were 11.82%,20.45%,30.18%,33.29%,44.77%,and 57.08%,respectively.The level of HER2 expression in SKBr3 cells being treated with 17-AAG,compared to that in control cells,was reduced significantly.Conclusion:17-AAG can inhibit the growth of human breast cancer cell and enhance its apoptosis.It may be a promising anti-tumor drug.

Objective To investigate and confirm the value of minimal invasion of separation between specific subcutancous layers of rats.Methods Thirty-two male SD rats were randomized into four groups,group 1:normal incision plus separation beneath superficial fascia; group 2:normal incision plus subdermal separation; group 3:normal incision plus extended separation beneath superficial fascia ; group 4:extended incision plus separation beneath superficial fascia.Blood sampling was taken preopeatively,2 h,12 h,24 h and 48 h postoperatively.The increase of serum IL-6 and neutrophil elastase levels were compared between different groups.Results Compared with each other,the increase of serum IL-6 and NE levels in group 1 vs 3 and group 2 vs 4 was not different significantly (P value was 0.074,0.096 and 0.747,0.897,respectively).However,the increase of serum levels in group 1 vs 2,1 vs 4,3 vs 2 and 3 vs 4 was different significantly (P ＜ 0.01).Conclusion Operation of separating beneath superficial fascia plus small skin incision in rats conduces to relatively minimal invasion.

To improve the teaching quality of advanced students on minimally invasive surgery is important for the generalization of new techniques on this subject.The teaching plan should be made according to the academic level of these students.Both theory learning and clinical practice should be emphasized.Multimedia tools should be adopted and English teaching should not be neglected.All these means help to better the teaching quality of advanced students on minimally invasive surgery.

Objective To compare the effects of fundus-first laparoscopic cholecystectomy and laparoscopic subtotal cholecystectomy in complicated cholecystolithiasis cases. Methods The effects of fundus-first laparoscopic cholecystectomy (n = 21) and laparoscopic subtotal cholecystectomy (a = 18) in the 39 cases of complicated chole-cystolithiasis from our hospital within 2 years were analyzed retrospectively. Results The operation time in subtotal laparoscopic cholecystectomy group was shorter than in fundus-first laparoscopic cholecystectomy group (88.89±18.11) min vs. (109.52±21.79) min, P < 0.05). Less blood lose (82.78±44.96) ml and fluid replacement (847.22±169.32)ml during the operation were observed in the former group than those in the later group (116.67±53.23) ml and (964.29±147.60) ml, respectively, P < 0.05). However, the patients' postoperative recovery time and the duration of postoperative hospital staying were similar in the two groups(5.56±1.20) days vs. (5.29±1.38) days, P > 0.05). Conclusions Proper use of subtotal laparoscopic cholecystectomy in complicated cholecystolithiasis cases can simplify the operation and obligate the operation time, which will increase the safety of the operation with the outcome similar to fundus-first laparoscopic cholecystectomy.

ObjectiveTo evaluate the advantages and disadvantages of endoscopic thyroidectomy by the breast approach. MethodsFrom August 2002 to April 2003, sixty single thyroid nodule patients were divided into 2 groups randomly. Group 1 (30 patients) received endoscopic thyroidectomy(ET) by the breast approach. The other 30 patients underwent conventional thyroidectomy(CT). Preoperative diagnosis,operative time,operative cost,postoperative pain,complications,and cosmetic result between the 2 groups were compared. ResultsOperative time was 118.0?34.3 minutes for ET group and 80.0?23.5 minutes for CT group( P