Objective To study the mechanisms involved in the regulation of endogenous β-glucuronidase expression and to explore the more effective methods to prevent recurrence of hepatolithiasis formation.Methods The expression levels of c-myc and endogenous β-glucuronidase in the liver specimens of hepatolithiasis were examined by immunohistochemical staining.The expressions of c-myc and endogenous β-glucuronidase in the human intrahepatic biliary epithelial cell line (HiBEpiC),and normal liver cell line (L02) treated with different concentrations of lipopolysaccharide (LPS) were studied using western blot.The c-myc siRNA transfection was utilized to detect the role of c-myc in the regulation of the expression of endogenous β-glucuronidase.Results Compared with normal liver samples,the expressions of endogenous β-glucuronidase and c-myc in the liver specimens of hepatolithiasis were significantly increased,and they were positively correlated with each other.LPS induced increased expressions of endogenous β-glucuronidase and c-myc in a dose-dependent manner.C-myc siRNA transfection effectively inhibited the increased expression of endogenous β-glucuronidase as induced by LPS.Conclusion LPS played a crucial role in the formation of hepatolithiasis by stimulating the endogenous expression of β-glucuronidase in liver and biliary epithelial cells via c-myc.

Objective To investigate the clinical efficacy of transumbilical single-incision retrograde laparoscopic cholecystectomy.Me,otis The clinical data of 979 patients with gallbladder diseases who were admitted to the Shengjing Hospital of China Medical University from May 2009 to December 2012 were retrospectively analyzed.The numbers of patients who were admitted in the year of 2009,2010,2011 and 2012 were 51,265,374,289,respectively.The preoperative preparation of transumbilical single-incision retrograde laparoscopic cholecystectomy was similar to that of traditional multi-portal laparoscopic surgery.During the operation,the umbilical incision was selected.After the body and bottom of the gallbladder was dissociated,the cystic duct of gallbladder was dissociated and straightened,which was vertical to the common bile duct.After clipping the proximal part of the cystic duct of gallbladder with 2 hem-o-lock clips,the cystic duct was cut off with the ultrasonic knife,and then the gallbladder was removed.Postoperative nursing was also similar to that of traditional laparoscopic cholecystectomy.Patients were followed up via phone call or out-patient examination till March 2013.The wound infection,incisional hernia,incisional pain,cosmetic benefits were observed.Results No patient was converted to open surgery.Twenty patients were converted to multi-portal laparoscopic cholecystectomy because of severe inflammation (3 patients in 2009,5 in 2010,5 in 2011 and 7 in 2012).The mean operation time and volume of blood loss of the 959 patients were 48.5 minutes and (27 ± 25) mL.The operation time in 2009,2010,2011 and 2012 were 51.8 minutes,49.2 minutes,48.9 minutes and 46.7 minutes.The volumes of blood loss in 2009,2010,2011 and 2012 were 35.0 mL,32.1 mL,33.8 mL and 22.9 mL,respectively.The postoperative pain was slight.Forty-seven patients were administered antalgesics (5 in 2009,12 in 2010,18 in 2011 and 12 in 2012).In the 959 patients,umbilical swelling occurred in 4 patients,and was cured by disinfection treatment.Bile duct injury occurred in 3 patients from 2010 to 2011,timely repair wad done in 2 patients,and 1 was cured by drainage.The mean time of postoperative exhuast time and duration of hospital stay were 2.2 days and 4.2 days.A total of 924 patients were followed up for 1-3 months.The scar was hidden in the navel,and no incisional hernia occurred.Conclusion Transumbilical single-incision retrograde laparoscopic cholecystectomy is safe and effective with cosmetic benefits.

Objective To investigate application value of cutter stapler in transumbilical single port laparoscopic left lateral lobectomy.Methods The retrospective cohort study was adopted.The clinical data of 26 patients who underwent transumbilical single port laparoscopic left lateral lobectomy at the Shengjing Hospital of China Medical University from January 2010 to February 2016 were collected.Nine patients who received liver parenchyma using ultrasonic knife were allocated into the ultrasonic knife group,17 patients who received liver parenchyma using cutter stapler were allocated into the cutter stapler group.Observation indicators included (1) operation situations:operation time,volume of intraoperative blood loss,postoperative complications,time of postoperative bowel function recovery,time of abdominal cavity drainage tube removal,duration of postoperative hospital stay.(2) Postoperative reexamination and follow-up:ultrasound or computed tomography (CT) examination was performed when necessary for detecting local exudation or encapsulated effusion.The patients were followed up at postoperative 1 to 3 months with telephone interview for whether with abdominal distension or abdominal pain till March 2016.Measurement data with normal distribution were presented as (x) ± s and analyzed by using t test.Measurement data with skewed distribution were presented as M (range) and analyzed by ranksum text.Comparison of count data was analyzed by the Fisher' s exact probility.Results (1) Operation situations:all the 26 patients received transumbilical single port laparoscopic left lateral lobectomy with no conversion to porous laparoscopic surgery or open surgery.The operation time was (114 ± 54) minutes,the volume of intraoperative blood loss was 100 mL (range,20-800 mL),and no intraoperative blood transfusion was adopted.The operation time and volume of intraoperative blood loss were (135 ±43)minutes and 200 mL (range,20-800 mL) in the ultrasonic knife group,(103 ±57)minutes and 100 mL (range,20-300 mL) in the cutter stapler group,respectively,showing no statistically significant difference between the 2 groups (t =1.500,Z =-0.961,P ＞ 0.05).All the 26 patients recovered well after surgery,with no postoperative complications as postoperative hemorrhage,bile leakage,incision infection or death.The time of postoperative bowel function recovery,time of abdominal cavity drainage tube removal and duration of postoperative hospital stay was (1.5 ±0.4) days,(5.8 ± 2.0) days and (7.0 2.0) days in the ultrasonic knife group,(1.1 ± 0.3) days,(4.1 ±1.1) days and (4.9 ± 1.4) days in the cutter stapler group,respectively,showing statistically significant differences between the 2 groups (t =2.599,2.875,3.036,P ＜ 0.05).(2) Postoperative reexamination and follow-up:of 26 patients,11 patients received ultrasound or CT examination after surgery and detected no obvious local exudation or encapsulated effusion,with no special treatment.The other 15 patients didn't receive ultrasound or CT examination.All the 26 patients were followed up for 1-3 months,with no occurrence of upper abdominal distension or abdominal pain.Conclusion Transumbilical single port laparoscopic left lateral lobectomy is safe and feasible,the application of cutter stapler is helpful to safety and success of the operation,further accelerating the postoperative recovery of patients.

Objective To study the application of the cold cutting technique in transumbilical sin gle-incision laparoscopic liver resection (TUSI-LLR),and to evaluate its feasibility and treatment results.Methods The clinical data of 35 patients with liver lesions treated by transumbilical single-incision laparoscopic liver resection from 2013 to 2017 were retrospectively analyzed in Shengjing Hospital of China Medical University.In all these patients,the liver parenchyma was transected with the cold cutting technique.The operation time,intraoperative blood loss,postoperative complications,time to remove abdominal drain,and total hospital stay in the patients were analyzed.Results 11 of the 35 patients were male.The average age was (49.9 ± 10.8) years.The average body weight was (63.2 ± 11.1) kg.The diagnoses were hemangiomas in 18 patients,hepatolithiasis in 5 patients,malignant hepatocellular tumors in 5 patients,focal nodular hyperplasia in 3 patients,and others in 4 patients.There were 22 left lateral sectionectomies,2 left hemihepatectomies,11 wedge resections (8 in the left and 3 in the right).The operations were all successfully performed,with no conversion to conventional laparoscopic hepatectomy or open surgery.The average operation time was (112.2 ±51.0) minutes,and the intraoperative blood loss was (105.4 ±70.1) ml.No patients required intraoperative blood transfusion.The average surgery cost was (36 336.7 ± 5 938.2) yuan.All patients recovered well,with no postoperative hemorrhage,bile leakage,or incisional wound infection.The average time periods for removal of the abdominal drain,and hospital stay were (4.5 ± 1.2) days and (5.2 ± 1.4) days,respectively.All the 35 patients were followed up (1 ～ 3 months),with no patients complaining of abdominal distension or abdominal pain.Conclusions The cold cutting technique in transumbilical single-incision laparoscopic liver resection was safe and feasible.Its benefits included the operative speed,the small amount of intraoperative blood loss and the rapid postoperative recovery of the patients.

Objective To investigate the application value of the adhesive suspension of left lateral lobe of liver in transumbilical single-port laparoscopic left upper abdominal surgery.Methods The retrospective crosssectional study was conducted.The clinical data of 112 patients who underwent single-port laparoscopic left upper abdominal surgery in the Shengjing Hospital of China Medical University between January 2010 and October 2016 were collected.Patients underwent single-port laparoscopic left upper abdominal surgery,and intraoperative surgical fields were exposed through adhesive suspension of left lateral lobe of liver.Observation indicators:(1)intraoperative situations:surgical completion,surgical procedures,time of liver adhesive suspension,total operation time and intraoperative liver adhesive suspension-related complications;(2) postoperative situations:pre-and post-operative alanine transaminase (ALT) and aspartate transaminase (AST) levels,hospital expenses and duration of hospital stay;(3) follow-up:number of patients with follow-up,follow-up time,complications during follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to June 2017.Measurement data with normal distribution were represented as (x)+s.Repeated measurement data were analyzed using the repeated measures ANOVA.Results (1) Intraoperative situations:112 patients underwent successfully single-port laparoscopic left upper abdominal surgery,without conversion to multi-port surgery or open surgery.Of 112 patients,30,23,13,11,11,10,3,3,3,3,1 and 1 underwent radical resection of gastric cancer,partial gastrectomy,esophageal Heller myotomy + Dor fundoplication,subtotal gastrectomy,resection of body and tail of pancreas,paraoesophageal hiatal hernia repair + fundoplication,total gastrectomy,splenectomy,splenectomy + devascularization,pancreatic tail resection,simple fundoplication and splenic artery aneurysm resection,respectively.Time of liver adhesive suspension and total operation time in 112 patients were respectively (1.4±0.4)minutes and (192.0±91.3) minutes.There was no hepatic laceration,hepatic subcapsular hematoma and other complications.(2) Postoperative situations:of 112 patients,preoperative ALT and AST levels of 6 patients were mildly elevated,postoperative ALT and AST levels in 2 of 6 patients returned to normal,that in 1 of 6 patients were elevated at day 1 postoperatively and returned to normal at day 3 postoperatively,and that in 2 of 6 patients remained mildly elevated at week 1 postoperatively;preoperative ALT and AST levels of 106 patients were normal,ALT and AST levels in 31 of 106 patients were elevated at day 1 postoperatively (that in 28 patients returned to normal within week 1 postoperatively,and that in 3 patients remained mildly elevated),and that in 75 of 106 patients returned to normal.ALT and AST levels of 112 patients were (16± 11) U/L,(18±7) U/L before operation and (31 ±21) U/L,(34±26) U/L at day 1 postoperatively and (19 ± 17) U/L,(19 ± 12) U/L at week 1 postoperatively,respectively,with statistically significant differences in ALT and AST levels before operation and at day 1 postoperatively (F=36.353,29.792,P＜ 0.05),and no statistically significant difference in ALT and AST levels before operation and at week 1 postoperatively (F=2.905,1.284,P＞0.05).Hospital expenses,surgery-related expenses and duration of hospital stay were (45 231±20 440)yuan,(23 511±9 609)yuan and (6.0±l.9)days,respectively.(3) Follow-up:112 patients were followed up for 1.0-3.0 months,with a median time of 1.6 months.During the follow-up,there were no obvious complications.Conclusion Adhesive suspension of left lateral lobe of liver is simple and safe,with satisfactory exposure effects,and it is suitable for the better operative field exposure in single-port laparoscopic left upper abdominal surgery.