Objective To investigate the causes and prevention of bile duct injury during laparoscopic cholecystectomy (LC). Methods Clinical data of 16 cases of bile duct injury during LC between January 2004 and November 2013 (9 cases from Songqiao Central Hospital and 7 cases from Northern Jiangsu People ’ s Hospital ) were analyzed retrospectively .The bile duct injury was found intraoperatively in 10 cases, 4 of which were given common bile duct repaired with T tube drainage , 1 of which was given common bile duct anastomosisd with T tube drainage , 1 of which was given Roux-en-Y anastomosis , and 4 of which were given suturing of leakage at the gallbladder bed .The bile duct injury was found postoperatively in 6 cases, 3 of which were given peritoneal drainage , 2 of which were given reoperation of bile duct repaire with T tube drainage , and 1 of which underwent percutaneous gallbladder drainage guided by B ultrasonography . Results The hospitalization stay was 12-23 days, with an average of 16.3 days.All the patients were cured after treatment .Among the 16 cases of bile duct injury , the T tube was removed 3 months later in 6 cases of common bile duct repaired with T tube drainage , and the T tube removed 6 months later in 1 case of common bile duct anastomosis with T tube drainage.No complications or dysfunctions occurred in postoperative follow-up ranging from 3 months to 8 years. Conclusions We should pay more attention to causes of bile duct injury in laparoscopic cholecystectomy , especially indications for emergency cases .The relationship among the common hepatic duct , common bile duct , and cystic duct should be carefully identified .A timely conversion to open surgery is needed if necessary .

Glutamine,a coding amino acid in the process of synthesis of protein,could be absorbed by endothelial cells of the small intestine in most cases,or converted from other amino acid and glucose in the assistance of concerned enzyme.This nonessential amino acid maintains homeostasis in rivo.In recent years,a large number of researches reveal that glutamine plays an extremely important role in the tumor metabolism and therefore influences the process and treatment of cancer.In the study,the netabolism of glutamine in normal cells and tumor cells and its effects on tumor therapy were reviewed.

Metabolic deregulation is a major essential feature in the development of cancer,wbich also correlates with invasion and metastasis of tumor.Metabolic characteristic of tumor cells which deviate significantly from those of normal cells.In this review,we summarize the research about the relationship between cellular metabolic abnormalities and capability of tumor's invasion and metastasis.

Objective To investigate the risk factors of portal venous thrombosis ( PVST) following laparoscopic splenectomy ( LS) in cirrhotic patients with hypersplenism .Methods The clinical data of 62 patients with secondary hypersplenism due to cirrhotic portal hypertension admitted to the Clinical Medical College of Yangzhou University were retrospectively analyzed .These patients underwent LS from January 2013 to April 2014.Based on whether the patients had PVST on postoperative day (POD) 7 or not, the pa-tients were categorized into the non-PVST and PVST groups .Fifteen perioperative variables were analyzed in these two groups .Results On univariate analysis , age and portal vein diameter in the PVST group were significantly higher and velocity of portal blood flow in the PVST group were significantly lower than those in the non-PVST group, (all P<0.05).Bivariate correlation analysis performed for the relationship between these variables and occurrence of PVST on POD 7 showed age >50 years, portal vein diameter >13 mm and velocity of portal blood flow >18 cm/s were significantly correlated .Multivariate logistic regression showed that age >50 years and portal vein diameter >13 mm were significantly independent risk factors of PVST, and velocity of portal blood flow >18 cm/s was an independent protective factor .Conclusion Age>50 years and portal vein diameter >13 mm were independent risk factors , while velocity of portal blood flow >18 cm/s was an independent protective factor of postoperative PVST .

Objective To evaluate postoperative complications of laparoscopy-assisted D2 radical total gastrectomy for gastric cancer as compared with open procedures. Methods In this study,358 patients of gastric cancer undergoing laparoscopy-assisted D2 total gastrectomy or open D2 total gastrectomy between January 2011 and December 2012 were retrospectively reviewed and analyzed.Patients were non-randomly divided into laparoscopic group ( LAP,n =165 ) and open surgery group ( OPEN,n =193 ).Operative time,intraoperative blood loss,postoperative hospital stay and complications were compared between the two groups. Results Operative time [ 225 ( 195 - 340 ) min vs.230 ( 195 - 300 ) min,P ＞0.05 ] and number of lymph nodes dissected [ (26 ± 4) vs.(27 ± 4 ),P ＞ 0.05] between the LAP group and the OPEN group were not significantly different.Compared with OPEN group,blood loss in the LAP group was less [ 160 ( 80 - 600 ) ml vs.270 ( 150 - 600) ml,P ＜ 0.01 ] and postoperative hospital stay was shorter [ ( 11.4 ± 2.6) d vs.( 13.7 ± 2.4) d,P ＜ 0.01 ].Postoperative complications developed in 18 patients in the LAP group and in 30 patients in the OPEN group,the difference was not statistically significant between the two groups. Conclusions In the hands of experienced surgeons laparoscopy-assisted D2 radical total gastrectomy for gastric cancer is safe,effective and miniinvasive.

ObjectiveTo investigate the clinical significance of admission hemoglobin (Hb) value for posttransplantation early respiratory complications in cirrhotic hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT).MethodsBetween April 2001 and February 2010,the medical record of 100 consecutive liver recipients at First Affiliated Hospital of Guangxi Medial University were retrospectively reviewed. Pulmonary complications developed in 45 patients after LT. Using bivariate correlation analysis between the admission Hb value and pulmonary complications screened for the threshold value of admission Hb value affecting early-phase pulmonary complications.According to the threshold value of admission Hb,LT recipients could be divided into two groups. Twenty-seven peri-operative clinical parameters were analyzed in the two groups.ResultsAdmission Hb ≤ 100 g/L was the threshold value affecting postoperative pulmonary complications.The duration of time to initial passage of flatus and the ICU length of stay were significantly prolonged in patients with admission Hb values ≤ 100 g/L,in which poorer arterial blood gas analyses were common. ConclusionsThe admission Hb value of patients with cirrhosisassociated hepatocellular carcinoma affects the early-phase prognosis after LT.

Objective To investigate the expression levels of hedgehog signaling pathway members (SMO,Gli1,ABCB1,ABCG2) in gemcitabine resistant pancreatic cancer cells and to study the effect of hedgehog signaling pathway inhibitor on acquired chemoresistance.Methods Human pancreatic gemcitabineresistant SW1990 cell line (SW1990/GZ) was established.Hedgehog inhibitor,cyclopamine,was used to treat resistant cells.Different expression levels of SMO,Gli1 and ABCB1,ABCG2 mRNA and proteins,and the percentage of CD44 + CD24 + and CD133 + cells were compared by quantitative RT-PCR and Western blot before and after cyclopamine treatment,respectively.Were treated with 100 μmol/L of gemcitabine SW1990/GZ cells after cyclopamine treatment,and cell apoptosis was determined by Annexin V/PI method.Results The percentage of CD44+ CD24+ and CD133+ cells in SW1990/GZ cells were increased from (29.45 ±1.99)％,(59.37 ± 1.69)％ in parental cells to (93.16 ±2.46)％,(95.88 ± 1.47)％ (P ＜0.05),respectively.The mRNA expression levels of ABCB1,ABCG2,and Gli1 were increased (274.90 ±31.44),(3.48 ±0.33),(4.15 ±0.42) folds,compared with that of parental cells.The mRNA expression of SMO was also detected in resistant cells.The results of protein expression were consisted with that of mRNA expression.After treatment of 2 μmol/L cyclopamine for 1 week,the percentage of CD44 + CD24 + and CD133 +in SW1990/GZ cells decreased to (36.68 ±2.44)％ and (62.76 ± 1.28)％ (P ＜0.05),respectively.After treatment with 2,5μmol/L of cyclopamine,SW1990/GZ cells were re-exposed to 100 μ mol/L of gemcitabine,and then the cell apoptosis and death rates were (53.68 ± 5.24 )％ and (69.99 ± 3.16 )％,which were significantly higher than those in control group ( 4.55 ± 0.87 ) ％ ( P ＜ 0.01 ).Conclusions G emcitabine-resistant pancreatic cancer SW1990 cells are enriched with cancer stem cells and highly express hedgehog member SMO and Glil.Inhibition of hedgehog signaling pathway by cyclopamine can reduce the proportion of cancer stem cell in gemcitabine-resistant cells,down-regulate SMO and Glil expression levels,partly restore the sensitivity to gemcitabine and reverts the acquired drug resistance.

Objective To explore the surgical skills and clinical efficacy of laparoscopic splenectomy (LS). Methods The operative duration, perioperative blood loss and postoperative complications were determined in 42 patients receiving LS in our hospital from October 2006 to May 2008 were retrospectively analyzed. Of the 42 patients, 12 suffered from splenomegaly due to blood disease, 1 from splenic tuberculosis, 1 from splenic cyst, 4 from traumatic splenic rupture,1 from malignant lymphoma and 23 from hypersplenism due to portal hypertension. Results LS was successfully performed in all the 42 patients. The mean perioperative blood loss was (300±110.60)ml, average operative duration (170±45.65) min (60-260 min) and mean postoperative inhospitalization duration (8.10±3.52)d. There was no severe complication after the operation. Conclusion For most types of splenic diseases, LS is safe and feasible. It is crucial to manage the splenic pedicle according to disease type, size, morphology and splenic hilus.

Objective To investigate the short-term therapeutic effect of warfarin in preventing portal vein thrombosis (PVT) after modified laparoscopic splenectomy combined with pericardial devascularization.Methods The retrospective cohort study was used to analyze the clinical data of 32 patients with cirrhotic portal hypertension who were admitted to the Clinical Medical College of Yangzhou University between January 2014 and August 2014.The characteristics of warfarin and aspirin regimens were introduced to the patients before operation for choosing postoperative therapeutic regimen.Based on the decisions, 17 and 15 patients receiving warfarin regimen and aspirin regimen were divided into the warfarin group and the aspirin group, respectively.All the patients underwent successful modified laparoscopic splenectomy and pericardial devascularization with intraoperative autologous blood salvage.The treatments were as follows : from postoperative day 3, patients in the warfarin group received 2.5 mg of oral warfarin once daily with titration of the dose to maintain a target international normalized ratio (INR) of 2.0-3.0 for 1 year;patients in the aspirin group received 100 mg aspirin enteric coated tablets for 1 year;and both groups received 50 mg of oral dipyridamole three times daily for 3 months and subcutaneous injection of 4 100 U of low-molecular-weight heparin (LMWH) once daily for 5 days.Blood cell analysis, liver function, coagulation function and Doppler ultrasound screening for the occurrence of PVT were performed at the first and third months.Postoperative electronic gastroscopy was performed at 3 months postoperatively for observing the change of the esophageal and gastric-fundus varices.The patients were followed up till February 2015.The incidences of PVT and the level of INR at the first week, the first month and the third month after operation were observed.Measurement data with normal distribution were presented as (x) ± s and analyzed by t test, and measurement data with skewed distribution were presented as M(range) and analyzed by the rank-sum test.Comparison of the mean INR at different time points between the 2 groups was analyzed by the repeated measures ANOVA.Comparison of count data was analyzed by the Fisher's Exact Probility.Results There were no gastrointestinal hemorrhage or perioperative death in the 2 groups.(1) The overall incidences of PVT at postoperative week 1 were 9/17 and 6/15 in the warfarin and the aspirin groups, respectively, with no significant difference (P ＞ 0.05).However, the overall incidences of PVT at postoperative month 1 and 3 were 7/17 and 3/17 in the warfarin group, which was significantly different from 12/15 and 12/15 in the aspirin group (P ＜ 0.05).(2)The incidences of main portal vein thrombosis (MPVT) at postoperative week 1 and postoperative month 1 were 5/17 and 6/17 in the warfarin group, 4/15 and 5/15 in the aspirin group, showing no significant difference (P ＞ 0.05).The incidence of MPVT at postoperative month 3 was 3/17 in the warfarin group, which was significantly different from 9/15 in the aspirin group (P ＜ 0.05).(3) The INR was changed from 1.30 ± 0.17 before operation to 1.55 ± 0.38 at postoperative month 3 in the warfarin group, and from 1.33 ±0.14 before operation to 1.21 ±0.11 at postoperative month 3 in the aspirin group, showing significant difference in the changing trend between the 2 groups (F =713.908, P ＜ 0.05).(4) All the 32 patients were followed up for a median time of 7 months (range, 3-11 months).The results of electronic gastroscopy at postoperative month 3 showed that the esophageal and gastric-fundus varices were obviously improved or disappeared.Conclusion Warfarin in preventing PVT after modified laparoscopic splenectomy combined with pericardial devascularization is safe and feasible, with a good short-term outcome.

Objective To investigate the safety and clinical efficacies of synchronous laparoscopic hepatectomy combined with splenectomy for the treatment of hepatocellular carcinoma (HCC) associated with cirrhotic portal hypertensive hypersplenism.Methods The clinical data of 5 patients with HCC associated with cirrhotic portal hypertensive hypersplenism who were admitted to the Clinical Medical College of Yangzhou University between January 2015 and April 2015 were retrospectively analyzed.Five patients underwent synchronous laparoscopic hepatectomy combined with splenectomy and intraoperative autologous blood transfusion.The operation time,volume of intraoperative blood loss,time for diet intake,postoperative drainage tube removal time,duration of hospital stay and occurrence of complications were observed.Patients were followed up by outpatient examination and telephone interview till June 2015.Measurement data with normal distribution were presented as x ± s.Results Of the 5 patients without conversion to open surgery,3 patients underwent synchronous laparoscopic hepatectomy combined with splenectomy,1 patient underwent laparoscopic hepatectomy + splenectomy + cholecystectomy and 1 patient underwent laparoscopic hepatectomy + splenectomy + devascularization.The operation time and volume of blood loss were (225 ± 41)minutes and (221 ± 81)mL.All the patients received intraoperative autologous blood transfusion without homologous blood transfusion.Two patients were complicated with abdominal effusion including 1 patient associated with pleural effusion,and symptoms of 2 patients disappeared after conservative treatment.All the patients took fluid diet at postoperative day 1 and out-of-bed activity at postoperative day 2,and drainage tubes were removed at postoperative day 3,with good recovery and without perioperative death.The duration of postoperative hospital stay was (7.8 ±0.8)days.All the 5 patients were followed up and survived well up to the end of follow-up.Conclusion Synchronous laparoscopic hepatectomy combined with splenectomy is safe and feasible for the treatment of HCC associated with cirrhotic portal hypertensive hypersplenism with an exact curative effect.