Objective To study the etiology,diagnosis and treatment of xanthogranulomatous cholecystitis (XGC).Methods Clinical data of 78 cases with xanthogranulomatous cholecystitis (confirmed by postoperative pathology) from January 1985 to December 2012 were reviewed retrospectively.Results All 78 cases underwent ultrasonography,50 cases did CT scan.Preoperative diagnosis included chronic calculous cholecystitis in 60 cases,gallbladder carcinoma with cholelithiasis in 8 cases,gallbladder space-occupying lesions in 10 cases.Among those 68 cases of tentative gallstone disease,67 cases were with gallbladder neck incarcerated stones.Surgery were performed in all 78 cases including cholecystectomy in 48 cases,partial cholecystectomy or subtotal resection in 13 eases,cholecystectomy with partial hepatic wedge resection in 12 cases.Intraoperatively 5 cases were misdiagnosed as the carcinoma of the gallbladder and underwent partial liver resection along with cholecystectomy.17 cases underwent choledocholithotomy.2 cases suffered from hepatic duct injury and received Roux-en-Y hepatojejunal anastomosis.Conclusions XGC is a special type of chronic cholecystitis,and accompanied by yellow granuloma formation.Preoperative diagnosis of XGC is often difficult,the definite diagnosis depends on intraoperative fiozen and postoperative paraffin pathology.

Objective To evaluate the efficacy and safety of fluoroscopy guided frequency-doubled double-pulsed laser lithotripsy for removing difficult bile duct stones. Methods From March 2008 to December 2009, patients with difficult bile duct stones were divided into cholangioscopy guided group ( n = 21 )and fluoroscopy guided group ( n = 19) to receive corresponding treatments. The success rate of complete stone removal and the complication rate related to the procedure were compared between the two groups.Results There are no significant differences between 2 groups in regarding of either success rate of complete stone removal ( 19/21, 90. 5% in cholangioscopy guided group vs. 17/19, 89. 5% in fluoroscopy guided group, P ＞0. 05 ) or rate of procedure related complication (4/21, 19. 0% in cholangioscopy guided group vs. 3/19, 15. 8% in fluoroscopic guided group, P = 0. 559 ). Conclusion Frequency-doubled doublepulsed laser lithotripsy guided by cholangioscopy or fluoroscopy are both safe and effective.

Objectiye To evaluate the therapeutic efficacy and safety of (endoscopic sphincterotomy, EST) plus balloon dilation for difficult bile duct stones. Methods Patients with difficult common bile duct stones on endoscopic retrograde cholangiopancreatography (ERCP) from March 2008 to December 2009 were randomly divided into 2 groups to receive EST or EST plus balloon dilation ( EST + EPBD), respectively. The success rate of complete stone removal, number of endoscopic sessions, the rate of using mechanical lithotripsy and the complication rate related to the procedure were compared between the 2 groups. Results Compared with EST alone, EST plus balloon dilation resulted in similar outcomes in terms of overall successful stone removal rate (2/62 vs. 2/61 ) and early complication rate (4/62 vs. 6/61, P ＞0. 05). However,EST group needed more sessions ( EST 15/46 vs. EST + EPBD 5/57, P ＜0. 05) and use of mechanical lithotripsy to achieve complete removal of stones ( EST 12/61 vs. EST + EPBD 4/61, P ＜0. 05 ). Conclusion EST plus balloon dilation is as safe and effective as, but more convenient than EST, for endoscopic removal of common bile duct stones.

Objective To evaluate the efficacy and safety of Spyglass single-operator cholangioscopy-guided laser lithotripsy for removing difficult bile duct stones.Methods A total of 39 patients with difficult bile duct stones were divided into Spyglass single-operator cholangioscopy-guided group (n =20) and fluoroscopy guided group (n =19) to receive corresponding treatments.The success rates of complete stone removal and the complication rates related to the procedure were compared between the two groups.Results There was no significant difference in success rate of complete stone removal between Spyglass single-operator cholangioscopy-guided group(17/20, 85.0％) and the fluoroscopy guided group(16/19, 84.2％ ,P =0.661) or in rates of procedure related complication (acute pancreatitis P =0.695, infection of bile duct P =1.000).Conclusion Both Spyglass single-operator cholangioscopy-guided laser lithotripsy and fluoroscopy are safe and effective.

Objective To compare therapeutic efficacy and safety of covered and uncovered self-expandable metal stents for malignant biliary obstruction.Methods From October 2010 to August 2012,patients with unresectable malignant biliary obstruction were recruited and divided into 2 groups to receive covered metal stents (group A) or uncovered metal stents (group B).Efficacy and complication of the procedure were compared.Results A total of 81 patients were recruited,with 41 in group A and 40 in group B.Stents were placed successfully in all patients.The median patency time of stent in group A was 182.5 d,which was not significantly different from that of group B (195.0 d,P =0.616).Complications occurred in 3 patients of group A (7.3％) and 4 of group B (10％).Conclusion Covered and uncovered metal stents are both safe and effective for treatment of malignant biliary obstruction with same patency time.

ObjectiveTo explore the efficacy and safety of temporary placement of fully covered metal stent in the treatment of benign biliary strictures.MethodsFully covered metal stents were placed in 36 patients with benign biliary strictures.All patients were followed up every 1-2 months and the stents were removed when adequate biliary drainage was achieved.ResultsResolution of the benign biliary strictures was achieved in 28 of 36 patients (77.8％ ).All fully covered metal stents were removed successfully.Complications were observed in 3 patients (8.3％) after stent placement and in 1 (2.8％ ) after stent removal.ConclusionTemporary placement of fully covered metal stents for benign biliary strictures is safe and efficacious.Further investigation is required to longer follow-up.

Objective To explore the value of SpyGlass (direct visualization system) guided laser lithotripsy for large bile duct stones in ERCP.Methods Thirty-three patients with large bile duct stones were randomly assigned to two groups: SpyGlass guided laser lithotripsy group (n =16) and mechanical lithotripsy group (n =17).All patients underwent ERCP procedures for stones extraction.The success rate of complete stone removal, the early complication rate related to the procedure and procedure time were compared between the two groups.Results The success rate of complete stone removal in SpyGlass guided laser lithotripsy group was higher than that of the mechanical lithotripsy group [75.0％ (12/16) VS 41.2％ (7/17) ,P ＜ 0.05].There were no significant differences between two groups in either procedure time [(51.6 ± 18.6) min VS (60.4 ± 12.3) min, P ＞ 0.05] or the early complication rate related to the procedure (18.8％ VS 5.9％ ,P ＞ 0.05).Conclusion SpyGlass guided laser lithotripsy is safe and effective for large bile duct stones.

Objective To summarize surgical experience for the treatment of substernal goiter.Methods 102 cases of substernal goiter underwent surgical resection,in 74 by low collar incision,12 cases by larger low collar incision and pillowing the shoulder pad about 20 degrees for neck hyperextension,8 cases by unilateral or bilateral infrahyoid muscles transection,8 cases by low collar and up-mid-sternal incision plus horizontal sawing in 2 and 3 ribs.Results Resection was performed successfully in all cases.Hoarseness occurred in 7 cases,4 cases recovered after one month,3 cases did not improve because of tumor invasion of laryngeal recurrent nerve.Postoperative transient hypocalcemia in 9 cases recovered after 2 to 3 months.102 patients were followed up for 1 to 3 years without recurrence.Conclusions Substernal goiter can be resected successfully through a transcervical approach or mid-sternal incision.CT scanning and chest X radiograph are decisive for the surgical approach.

Objective To evaluate a method named “one-step procedure”,i.e.,combined duode-noscopy,laparoscopy and choledochoscopy for choledocholithiasis accompanied with cholecystolithiasis.Meth-ods Fifty-three cases with gallbladder stones combined with common bile duct stones diagnosed from February 2012 to February 2014 were assigned to two groups,29 cases in “one-step procedure”group,who underwent duodenoscopy,laparoscopy and choledochoscopy in one operation,and 24 cases in the control group,who first-ly underwent endoscopic sphincterotomy to remove common bile duct stones,and then LC was performed after several days.The rate of complications related to the procedure,success rate of complete stone removal,length of hospital stay and hospitalization expenses were compared between the two groups.Results All 53 patients underwent the surgery and ERCP procedure successfully.There were no significant differences between the“one-step procedure”group and the control group in complication rates[3.4%(1 /29)VS 12.5%(3 /24),P =0.21],complete stone removal rates[96.6%(28 /29)VS 100.0%(24/24),P =0.37].Differences were sig-nificant in length of hospital stay (6.7 ±1.3d VS 10.9 ±1.6d,P <0.01 )and hospitalization expenses (15 724 ±1 613 yuan VS 19 829 ±2 433 yuan,P <0.05)between the “one-step procedure”group and the control group.Conclusion The “one-step procedure”,the combined duodenoscopy,laparoscopy and chole-dochoscopy,is safe,effective,and has smaller length of hospital stay and lower hospitalization expenses.

Objective To explore the value of computer-animal-clinic sequential training model in colonoscopy training.Methods Sixty-five gastroenterologists without any experience in colonoscopy were randomly assigned to 2 groups to accept a two-week′endoscopy training with computer simulator or with com-puter-animal-clinic sequential training.Both groups underwent at least 10 hours of training with a computer-based simulator,and sequential training group also underwent animal simulator training for 2 days in first week,then both groups underwent clinical endoscopy training in the second week.Performance parameters including cecal intubation,procedure duration and degree of comfort were evaluated.Results The training group had higher cecal intubation rate (46.28% VS 35.79%;P <0.01 )and shorter procedure duration (9.05 ±2.12 min VS 11.15 ±3.12 min;P <0.05)and less degree of comfort (5.18 ±1.41 VS 6.78 ± 2.15;P <0.05).The sequential training group was much better in performance than the other group in colonoscopy training.Conclusion Computer-animal-clinic sequential training model is effective in providing trainees with colonoscopy skills in improving the success rate,shortening the teaching times and lessening the uncomfortable of patients.