Objective To investigate the operative skills of laparoscopic hysterectomy of large uterus.Methods A retrospective analysis was conducted on clinical data from 86 cases whose uterus were bigger than twelve gestational age uterus and therefore treated with laparoscopic hysterectomy from February 1998 to December 2005.Among the 86 cases,12 received total laparoscopic hysterectomy(TLH),59 received laparoscopic supracervical hysterectomy(LSH),and 15 received laparoscopic-assisted vaginal hysterectomy(LAVH).The location of laparoscopy was determined to be at least 3-5 cm above the fundus of uterus.The most crucial step was the treatment of adnexa and uterine blood vessels.After blocking the uterine blood vessels,most of uterine bodies were rotarily cut in TLH and LAVH.Results All operations(86 cases)were performed successfully under laparoscopy and no severe operative complications were noticed except for 1 case of subcutaneous emphysema.The average operation time and the intra-operative blood loss were(92.3 ?33.5)min and(113 ?31)ml respectively.The average postoperative hospital stay was(4.1?0.3)days.No postoperative complication was found in all cases during the 6-month follow-up.Conclusions Laparoscopic hysterectomy of large uterus is safe and feasible,and does not increase operative risk and incidence of complications,when suitable laparoscopic location is selected and treatments of adnexa and uterine vessel are well performed.

Objective To observe the effect of glutamine-enriched early enteral nutrition on intestinal mucosal barrier injury after orthotopic liver transplantation in rats.Method Male Wistar rats,the recipients were randomly divided into three groups:control group (control group,n =10),orthotopic liver transplantation group (OLT group,n =30) and glutamine-enriched early enteral nutrition group (EEN group,n =30).Only dissecting hepatoduodenal ligament was performed in control group,and OLT was performed from Wistar to Wistar rats by modified two-cuff method in OLT group and EEN group.For EEN group,recipients were supplied with Nutrison Fiber (125 ml/kg every day) plus Gln (0.3 g/kg every day) for 3 days before and 3 h after surgery by gastric perfusion.For OLT group,the same volume of normal saline was administered instead of the Nutrison in the same time.No special treatment was given in control group.The levels of plasma endotoxin,D-lactic acid,and TNF-α were determined at different time points in the three groups.The ultrastructural changes of ileal mucosa were observed under the transmission electron microscopy.At the same time,the remaining 5 rats per group were used for observing the lifetime.Result As compared with control group at 12,24 and 72 h,the levels of plasma endotoxin,D-lactic acid,and TNF-α were significantly increased in OLT group and EEN group (P＜0.01),and as compared with OLT group,the above-mentioned indexes were obviously decreased in EEN group at 24 and 72 h (P＜ 0.01).The ileal mucosal epithelial clearance in control was normal,and microvilli arranged neatly under the electron microscope.the ultrastructure damage in OLT group was more serious than in EEN group at 12,24,and 72 h.As compared with control group at 12,24,and 72 h,the expression levels of TNF-α mRNA were significantly increased in OLT group and EEN group (P＜0.01),and as compared with OLT group,the expression levels of TNF-α mRNA were obviously decreased in EEN group (P＜0.01).The survival time in cntrol group was significantly longer than in OLT group and EEN group (P＜0.05),and as compared with OLT group,the survival time in EEN group was obviously extended (P＜0.05).Conclusion OLT can lead to the damage of intestinal mucosal barrier,and glutamine-enriched early enteral nutrition is a potent protection against intestinal mucosal barrier injury and prolongs the survival time of rats after OLT.

Objective To explore the value of laparoscopic operations for early-stage cervix cancer. Methods Eighteen patients with Ⅰ b～Ⅱ a astage cervix cancer underwent extensive total uterectomy combined with pelvic lymphadenectomy under laparoscope (17Ⅰ b cases, 1Ⅱ a case). Concurrently, another 19 patients with the same diagnosis and approximately the same clinical features as the abovementioned 18 cases, as the control group, were treated by open extensive total uterectomy combined with pelvic lymphadenectomy. The operation time, intraoperative blood loss, postoperative recovery and complications of two groups were compared. Results No statistically significant differences were found on mean operation time between the laparoscopy group (272.8 min?80.3min) and open group (226.5 min?66.8min) (t=1.921,P=0.063). The number of removed lymph nodes was 15.6?5.1 in laparoscopy group and 16.8?5.7 in open group, without statistically significant differences (t=0.674,P=0.505). The recovery time of intestine functions in laparoscopy group (34.2 hours) was obviously shorter than that of open group (60.7 hours) (P

Objective To evaluate the feasibility of laparoscopic radical trachelectomy combined with laparoscopic pelvic lymphadenectomy in the treatment of early-stage cervical carcinoma.Methods Six women with early-stage cervical carcinoma demanding the preservation of child-bearing potentials were treated from April 2003 to April 2005.Laparoscopic pelvic lymphadenectomy was carried out for frozen-section examinations.Once a negative finding was established,the ureter was divided and the cardinal ligament was severed,with the uterine arteries and the round ligament preserved.Then transvaginal procedures of amputation of cervix,resection of superior vagina 2 cm in length,and corpus-vagina anastomosis were performed.Results The operation time was 75~150 min(mean,120 min),and the estimated blood loss was 100~250 ml(mean,150 ml).No complications were found.Normal menses was recorded 1 month after operation.Follow-up for 5~24 months(mean,14.6 months) found no recurrence in all the 6 patients.Conclusions Laparoscopic radical trachelectomy combined with pelvic lymphadenectomy is a feasible method for early-stage cervical carcinoma in patients with child-bearing demands.

Objective To explore the feasibility of laparoscopic operation as treatment for early malignant uterine tumors Method Six patients with endometrial carcinoma underwent laparoscopic extensive total hysterectomy and bilateral adnexectomy, and 2 with cervical cancer underwent additional pelvic lymphadenectomy Results The mean operating time of the 6 laparoscopic extensive total hysterectomy and bilateral adnexectomy was 220 min, and mean blood loss was 200 ml The mean operating time of 2 cases underwent additional pelvic lymphadenectomy was 240 min No organ trauma occurred, and the average post operative hospital stay was 8 days Conclusion These results suggest that laparoscopic operation is safe and feasible in treating early stage malignant uterine tumors

0.05).Follow-up was available for(14.2?3.6) months(range,7-19 months) in the laparoscopic group and for(13.1?4.2) months(range,7-19 months) in the laparotomy group.No recurrence was detected in both the groups during the follow-up.ConclusionLaparoscopic surgery do not affect the expression levels of the factors,including E-cadherin,MMP-2,VEGF-C,and CD44v6,that influence the metastasis and implantation of tumor cells in patients with endometrial cancer.

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Objective To evaluate the clinical efficacy of four different operative patterns of laparoscopic hysterectomy: laparoscopically assisted vaginal hysterectomy (LAVH), laparoscopically introfasial subtotal hysterectomy (LISH), laparoscopically subtotal hysterectomy (LSH) and laparoscopically total hysterectomy (LTH). Methods A retrospective analysis on 2272 cases of laparoscopic hysterectomy was carried out, including operating time, blood loss, complication and postoperative recovery. Results For the two groups which preserved cervix, LISH was performed in 1323 cases. The operating time was (91?21) min, blood loss (93?23) ml, complication rate 4.1%. LSH was conducted in 229 cases, with an operating time (70?18) min, blood loss (69?17) ml, complication rate 0. The difference between the two groups was significant (all P0.05). All patients recovered well postoperatively. Conclusions The four operative patterns are ideal for hysterectomy. Young patients should be operated with laparoscopic hysterectomy with preservation of cervix, old patients or patients with CIN should be operated with excision of cervix.

BACKGROUND: Multipotency of hepatic stem cells is of important value in liver transplantation. Stem cells have been successfully identified and isolated from the animal livers. However, reports on whether stem cells exist in human hepatic tissue and how to isolate and identify them ars few.OBJECTIVE: This study was in attempt to isolate hepatic stem cells from human para-cancerous tissues of hepatoma and in vitro culture them, also to identify the stem cell surface marker, in order to find a new source of heptatic stem cells.DESIGN: Cell observation experiment.SETTING: Department of Common Surgery, First Hospital, Jilin University; Department of Common Surgery,Dongfeng Hospital of Traditional Chinese Medicine.PARTICIPANTS: Samples were harvested from 10 patients with hepatoma admitted to Department of hepatobiliary surgery, First Clinical College, Jilin University between October 2005 and June 2006, with age of 45 to 58 years.Hepatic tissue 2 cm away from cancer nest was cut when patients underwent hepatectomy, and it was pathologically confirmed as carcinoma-free tissue. Written informed consents were obtained from each patient. DMEM/F12 dry powder used for cell culture was provided by Hyclone Company, USA. Fresh fetal bovine serum was prepared by Lianxing Biotech Co.,Ltd, Tianjin. Various cell growth factors were the products of Cytolay Company, USA.METHODS: Para-cancerous tissues of hepatoma was cut into pieces, rinsed with Hank's solution and digested with type Ⅳ collagenase. Then the isolated cells were re-suspended in the DMEM/F12 medium supplemented with 0.1 volume fraction of fetal bovine serum, and hepatocyte growth factors, epidermal growth factors and α- fibroblast growth factors of 25 μg/L each were added in the above medium. When the cultured cells covered 2/3 of bottom,they were digested with trypsinase for passage and inoculated at 2×107 L-1. When cells propagated to the 3rd and 4th generations, 2.60×109 L-1 cell suspension prepared with trypsinase was added, and subsequently, anti-human C-kit antibody, immunomagnetic beads and Buffer solution were added in order. C-kit+ cells were preliminarily isolated by immunomagnetic bead separation. Haematoxylin-eosin staining and immunofluorescent histochemical double-staining were used for detecting the hepatic stem cells in para-cancerous tissues.MAIN OUTCOME MEASURES: ① Observation of cell morphology. ② Identification of hepatic stem cells from para-cancerous tissues. ③ Identification of C-kit+ cells by immunofluorescent histochemical double-staining.RESULTS :① After primarily cultured for 2 weeks, the adherent cells grew in colony. After one half of culture medium was renewed, mature hepatocytes were gradually broken and disappeared. Small round cells propagated, and most of them were located in the center and arranged in cluster. Most cells were found with one big nucleus in each, less cytoplasm and clear cell boundary. When cells propagated to the 1st and 2nd generations, they still grew in colony, but fast. Each C-kit+ cell isolated by immunomagnetic bead separation presented a spherical cell body with a very big nucleus and less cytoplasm. After in vitro cultured for 1 week, it presented broken pieces and apoptotic symptoms.② After para-cancerous tissue was stained by haematoxylin-eosin, atypically proliferated biliary tracts with small round cells could be seen in the portal area. After para-cancerous tissue was stained by immunofluorescent histochemical double-staining, small round cells in the biliary tracts proliferated in the portal arsa co-expressed red fluorescence AFP and green fluorescence cytokeratin (CK) 19 with yellow superposition arsa. ③ After C-kit+ cells were stained by fluorescence immunocytochemisty, cytoplasm expressed alpha-fetoprotein (AFP) red granules and CK19 green granules. The superposition area of both presented yellow fluorescence of AFP+/CK19+-positive cells.CONCLUSION: Hepatic stem cells exist in human para-cancerous tissues of hepatoma. Therefore, expressions of C-kit+/AFP+/CK19+, the surface markers of hepatic stem cells, can be used for identifying and isolating hepatic stem cells. Small round cells obtained by in vitro isolation and culture, i.e. hepatic oval cells possess bipotential differentiation of hepatocyte and hepatobiliary epithelial cells.

Objective To investigate the clinical effectiveness of dynamic hip screw (DHS) internal fixation and proximal femoral nail (PFN) internal fixation for intertrochanteric femoral fractures.Methods One hundred and sixty-five patients with intertrochanteric femoral fractures were randomly divided into 2 groups,85 patients were in DHS group and 80 patients were in PFN group.The clinical effectiveness,index in operative procedure and complications were compared between two groups.Results The fine rate of DHS group and PFN group was 75.3％(64/85 ) and 83.8％( 67/80 ) (P ＞ 0.05 ).The indexes of function recover time,fracture healing time,amount of bleeding in operation,operation time in PFN group were significant lower than those in DHS group [(54.3 ± 11.7 ) d vs.(92.6 ± 10.5 ) d,(63.8 ± 12.2) d vs.(71.3 ± 10.6) d,(453.3 ± 50.7) ml vs.(627.5 ± 46.8) ml,(77.9 ± 25.2) min vs.( 115.7 ± 32.8) min](P＜0.05 ).The rate of short-term complications was 16.2％ (13/80) in PFN group,and 12.9 ％ ( 11/85 ) in DHS group(P ＞ 0.05 ).The rate of long-term complications was 1.2％( 1/80 ) in PEN group and 4.7％(4/85 ) in plts group (P ＜ 0.05).Conclusions As the treatment of intertrochanteric femoral fractures,PFN internal fixation has less bleeding and better efficacy,and can improve function recovery.PFN internal fixation is a better method for unstable femoral fracture.