Objective To study the effect of PGE_1 injection on hepatorenal syndrome.Methods 64 patients with hepatorenal syndrome were divided into two groups at random,33 cases in treatment group and 31 cases in control group.On the basis of complex treatment of the contrast group were added PGE_1 of 200?g,dissolved at 10% glucose liquid 100ml,ivgtt,qd,the course of treatment is 2 weeks.Results The improvement which treated the liver function of the group was superior to the contrast group(P

Objective To investigate the relationship between serum HBV.M.alanine transaminase(ALT) and hepatic tissue pathology in patients with chronic hepatitis B.Methods The serum HBV.M.liver function in 133 patients with chronic hepatitis B were measured,and these patients underwent percutaneous liver biopsy by colour Echo.All these patients were divided into eight groups according to HBeAg and HBV DNA positive or negative,ALT normal or not.Hepatic necrosis inflammation grade and hepatic fibrosis stage in the groups were compared.Results Hepatic histology of all these patients showed inflammation and necrosis and different degree fibrosis.In serum ALT normal patients,liver biopsy still showed different degrees inflammation and hepatic fibrosis degrees partly,even showed hepatocirrhosis.In serum ALT abnormal and HBeAg negative patients with chronic hepatitis B patients,hepatic tissue inflammation and fibrosis degrees were more serious,hepatic tissue pathology was out of proportion to the degree of serum HBV reproduction.Conclusion Judgment of disease activity doesn't only depend on the serum transaminases and the degree of serum HBV DNA replication.When clinical choosing indication of antiviral therapy,value of liver biopsy should not be substituted.Liver biopsy in chronic hepatitis B should be regarded as main basis of judgment the hepatitis activity.It also should be regarded as main basis if antiviral therapy is conducted.

Objective To explore the significance of blood coagulation disorder in acute pancreatitis(AP) of the elderly and its treatment with prostaglandin E_1.Methods Prothrombin time(PT),partially activated thromboplastin time(APTT) and fibrinogen(FIB) in cases of AP with ages over 60 were checked and compared with those in groups of AP with ages under 60 and normal control subjects.10 cases of AP of the elderly with elevated FIB were treated with prostaglandin E_1.Results Compared with groups of AP with ages under 60 and the normal subjects,FIB was significantly higher in cases of AP of the elderly with the highest in patients of SAP.8 out of 10 aged AP patients with elevated FIB was successfully treated with prostaglandin E_1.Conclusion Patients of AP may present with blood coagulation disorders especially in aged patients.Aged patients with elevated fibrinogen may predispose to SAP.Prostaglandin E_1 may be effective in this occasion.

Objective To probe into the serum blood platelet and turn into the plain(TPO) dependence that the blood platelet of level, liver cell function and periphery counts in purpose. Methods Among 106 cases of virus hepatitis patients in hsopital measuring, serum TPO level was carried on with ELISA. According to having blood platelet to reduce and divide into: A, B,C,D,E,F, G.H, group I. Results Between group A and group B,group C and group D,group E and group F,group G and group H,serum TPO level had significant differences(P

Objective To study the efficacy and superiority of laparoscopy for the treatment of urachal fistula.Methods From January 2003 to March 2007,15 patients with urachal fistula received resection of the urachus in our hospital by laparoscopy with three trocar technique.The urachus was resected by clipping both the ends with Hem-o-lok and then cutting by ultrasonic scalpel.Frozen section examination of the resected tissues were carried out during the surgery.Results All the operations were completed under a laparoscope without conversions to open surgery.The operation time ranged from 25 to 50 minutes(mean,30 minutes).The intraoperative blood loss was 10 to 20 ml.The patients were discharged form hospital 2 to 4 days after the operation(mean,3 days).Among our cases,12 achieved a mean of 25.3 months follow-up(2 to 50 months),during this period none of them developed infections,recurrence,or carcinomatous changes.Conclusions Laparoscopy is feasible for urachal fistula.The method is simple and minimal invasive with good cosmetic outcomes and results in quick recovery.

Objective To explore the feasibility and surgical techniques of laparoscopic cholecystectomy(LC) in the treatment of incarcerated cystic duct stones associated with gallbladder empyema. Methods Laparoscopic cholecystectomy was performed in 76 cases of acute cholecystitis with incarcerated cystic duct stones and gallbladder empyema.During operation the cystic duct was found wide in 37 cases and was transected with overlapped clipping(11 cases),large-sized titanium clipping(9 cases),preformed knot ligation(3 cases),or Hem-o-lok ligation(14 cases),respectively.Cystic duct stones were removed during operation in 9 cases.Gallbladder bed hemorrhage occurred and was successfully stopped in 6 cases.Partial cholecystectomy was conducted in 6 cases. Results Laparoscopic cholecystectomy was successfully accomplished in all the 76 cases.The operation time was 50~125 min(mean,65.0?32.8 min).A drainage tube was placed in all the cases and was removed at 18~36 hours postoperatively,with a drainage volume of 40~90 ml/d (mean,55.0?10.4 ml/d).Biliary leakage happened in 2 cases and was cured with indwelling abdominal drainage.No patients were complicated with postoperative hemorrhage,visceral injuries,or bile duct injuries. Conclusions Laparoscopic cholecystectomy in the management of incarcerated cystic duct stones associated with gallbladder empyema is feasible.

Objective To explore the feasibility of mastoscopic resection of benign mammary gland tumors. Methods A total of 68 cases were diagnosed as having benign mammary gland tumors(42 cases of fibroma and 26 cases of cystic adenoma) by using molybdenum target X-ray examinations.The tumor was located at lower outer quadrant in 26 cases,upper inner quadrant in 16 cases,lower inner quadrant in 14 cases,and upper outer quadrant in 12 cases,respectively.The operation was conducted via a transaxillary approach.A specially-designed flap dissector was utilized to establish a tunnel underneath the breast skin,where the air was inflated to build a surgical space.Then the tumor was resected by using an electrotome or harmonic scalpel. Frozen-section examination was routinely carried out during operation. Results The operation was successfully completed in all the 68 cases,without intraoperative complications.The operation time was 28~45 min(mean,35 min).The drainage tube was indwelled for 1~2 d.Subcutaneous effusion occurred in 1 case.Postoperative recovery was uneventful without skin necrosis or other complications.The length of postoperative hospital stay was 2~5 d(3.0?1.5 d).Follow-up checkups in the 68 cases for 3~36 months(mean,12 months) revealed good cosmetic outcomes. Conclusions Transaxillary mastoscopic resection of benign mammary gland tumors is safe and feasible,with good cosmetic results.

Objective To compare effects between laparoscopic appendectomy(LA) and open appendectomy(OA) for acute appendicitis in children.Methods A total of 95 children with acute appendicitis from July 2000 to July 2005 were given either LA(LA Group,n=50) or OA(OA Group,n=45).The surgical outcomes and curative effects were compared between the two groups.Results The operation was successfully completed in both of the groups.No bleeding,intestinal fistula,or stump appendicitis was seen.There was no difference in the operation time between the LA Group(38.8?17.4 min) and the OA Group(41.9?15.8 min)(t=-0.905,P=0.368).The time to first defecation was significantly shorter in the LA Group(26.4?7.2 h) than in the OA Group(39.7?8.8 h)(t=-8.094,P=0.000).Appendiceal perforation was found in 29 children in the LA Group and 26 children in the OA Group,without significant difference(?~2=1.633,P=0.983),but the incidence of wound infection was significantly higher in the OA Group(11 children) than in the LA Group(2 children)(?~2=8.381,P=0.004).A drainage placement was required in 3 children in the LA Group and 9 children in the OA Group,with significant difference(?~2=4.206,P=0.040).The LA Group had significantly shorter time to normal temperature(55.4?16.2 h) than the OA Group(77.8?30.6 h)(t=-4.522,P=0.000),shorter hospital stay(5.4?1.3 d) than the OA Group(13.4?6.5 d)(t=-8.520,P=0.000),but higher hospitalization costs(6 117.9?836.5 yuan) than the OA Group(4 528.6?527.1 yuan)(t=10.937,P=0.000).Conclusions Laparoscopic appendectomy is superior to open surgery for acute appendicitis in children because of its advantages of minimal invasion,little pain,early recovery,good cosmetic appearance,low complication rate,and short hospital stay.

Objective To evaluate the value and clinical efficacy of amputation of secondary structures of the spleen pedicel for laparoscopic splenectomy(LS).Methods Twenty-one cases of idiopathic thrombocytopenic purpura(ITP) and 1 case of splenic cyst were given a 4-port laparoscopic splenectomy.After the spleen was mobilized,a non-traumatic forceps was used to clip the pedicel at the site 3~5 cm from the hilus of spleen for the control of hemorrhage.The serosa on the spleen pedicel was opened by using a harmonic scalpel.Then secondary structures of the splenic arteries and veins,one by one,were disconnected from without upward,double ligated with the Hem-o-lok clips,and severed with the harmonic scalpel.The spleen was placed into an extraction bag,broken into small pieces,and removed from the extraction incision.Results The laparoscopic splenectomy was successfully completed in all the 22 cases.The operative time was 75~180 min(mean,117 min),and the estimated intraoperative blood loss was 20~280 ml(mean,87 ml).All the patients got out of bed and began to take food at 1~2 days after operation. The length of postoperative hospitalization was 5~11 d(mean,5.6 d).There were 1 case of incisional subcutaneous hematoma and 1 case of subcutaneous emphysema.Follow-up for 1.5～52 months(mean,19.3 months) in the 22 cases revealed no surgery-related complications.Conclusions The amputation of secondary structures of the spleen pedicel is a relatively safe and effective measure for completing laparoscopic splenectomy.

Objective To investigate the clinical value of two kinds of endoscopic thyroidectomy for thyroid diseases.Methods Endoscopic thyroidectomy via breast approach or axillary approach was performed in 98 cases from December 2003 to August 2005.The subcutaneous space beneath the breast area and the subplatysmal space in the neck were bluntly dissected through a 5-mm incision.The CO_2 was insufflated at the pressure of 8~10 mm Hg to create an operative space.Three trocars were inserted.The dissection of the thyroid parenchyma and vessels was performed endoscopically by using an ultrasonically activated scalpel.The recurrent laryngeal nerve,the superior laryngeal nerve,and the parathyroid glands were preserved carefully.There were 1 case of lobectomy on one side and partial thyroidectomy on the other side,18 cases of unilateral lobectomy,12 cases of bilateral subtotal thyroidectomy,46 cases of unilateral subtotal lobectomy,and 21 cases of resection of thyroid mass. Results The operation was successfully completed in all the 98 cases,without conversions to open surgery.No complications were noted.The operative time was 69.1?29.0 min,the estimated blood loss was 37.9?10.6 ml,and the postoperative hospital stay was 3.5?0.7 days.The drainage tube was removed at 24~36 hours after operation.Two cases of thyroid cancer were followed for 24 months without recurrence.The remaining 96 cases were followed for 6~28 months(mean,16 months) without recurrence.Conclusions Endoscopic thyroidectomy via breast or axillary approach is feasible and safe,giving patients satisfactory cosmetic results.