Objective To evaluate the clinical applications and surgical methods of combined laparoscopic common bile duct (CBD) exploration with choledochoscopy. Methods From 2006 to 2009,clinical data of 42 patients with choledocholithiasis undergoing laparoscopic common bile duct exploration were retrospectively analyzed. We applied a step-by-step electric coagulating incision technique on the CBD,the step-by-step suturing technique, and the step-by-step clamping technique with alligator forceps, and soft tube irrigating technique with suctioning by selecting the proper exploration route, improving the common bile duct incision technique and calculus removing techniques. Results Procedures were successful in all the cases. There was no conversions to open surgery, no postoperative bleeding and no operative mortality. The mean operating time was 120 minutes (ranging, 90 to 150 minutes) with minimal intraoperative blood loss ( ranging, 20 to 40 ml). Ductal stone clearance was successful in 41 out of 42 patients ( 93% ). The largest number of the common bile duct stones was 16. With the diameter of stones larger than 15 mm in 18 cases in which the biggest was 30 mm. Bile leak developed in 1 patient, retained stones found in 3 patients,including intrahepatic cholelithiasis in one case. As a result, 38 out of 42 patients underwent common bile duct exploration. 35 patients were placed on T-tubes. Four patients underwent cystic duct exploration in which 3 had primary suture of the cystic duct and 1 had drainage. There was no infection and stenosis of biliary tract in the 42 followed-up cases. Conclusions Laparoscopic common bile duct exploration with stone extraction can be performed with high efficiency, minimal morbidity and without mortality. Improving the way of operation and selecting suitable exploration can result in better clinical outcomes.

Objective To analyze the clinical characteristics and relevant factors of 88 cases of cirrhotic portal hyper-tension complicated with gallstone. Methods A total of 366 patients with cirrhotic portal hypertension complicated with gallstone were selected. 88 patients were assigned to a gallstone group and 278 patients were assigned to a control group on the basis of clinical diagnosis. Retrospective analysis was carried out for clinical data and auxiliary examina-tion data of the two groups, and single-factor and multi-factor analyses were applied for the risk factors of cirrhotic portal hypertension complicated with gallstone. Results Child-Pugh grade ≥B, ascites, peak systolic flow velocity of hepatic artery, portal thrombosis, peripancreatic varicose veins, and varicose veins of gallbladder were independent risk factors of cirrhotic portal hypertension complicated with gallstone (P<0.05). Conclusion Cirrhotic portal hypertension complicated with gallstone is related to hepatic functions, ascites, hemodynamics of hepatic artery, and collateral circu-lation of portal vein, and Child-Pugh grade≥B, ascites, peak systolic flow velocity of hepatic artery, portal thrombosis, peripancreatic varicose veins, and varicose veins of gallbladder are independent risk factors.

Objective To evaluate the prognostic significance of the candidate selection Hangzhou criteria for liver transplantation of HCC patients undergoing hepatectomy.Methods 199 HCC patients undergoing hepatectomy between 2009 and 2011 were enrolled retrospectively.Predictors of survival were identified using the Kaplan-Meier method.The disease state was staged by the Hangzhou criteria (HC) and Milan staging systems.Calculating the area under the receiver operating characteristic (ROC) curve (AUC) evaluates the discriminatory ability for the prediction of survival of both staging system.Results Portal vein thrombosis,poor differentiation,and tumor size (＞ 8 cm) were independent risk factors for survival after hepatectomy.Milan criteria and Hangzhou criteria functioned well in predicting tumor-recurrence.For 1-year AUROC,the AUROC for Milan criteria and Hangzhou criteria are 0.602 and 0.741,respectively.For 3-year AUROC,the AUROC for Milan criteria and Hangzhou criteria are 0.643 and 0.733,respectively.Conclusions The HC were shown to be a promising survival predictor in a Chinese cohort of HCC patients after hepatectomy.