Objective To summarize the experience of laparoscopic cholecystectomhy(LC) in the treatment of acute cholecystitis in senile patients. Methods A retrospective review was made on 279 cases of LC in senile patients,involving 263 cases of acute calculous cholecystitis,8 cases of gallbladder adenoma,5 cases of polypoid gallbladder lesions,and 3 cases of acute cholecystitis with unknown causes.Out of the 279 cases,there were 25 cases of gallbladder hydrops accompanying stones impacted in the neck and 23 cases of atrophic cholecystitis. Results The success rate of LC was 87.5%(244/279),and LC was converted to open surgery in 35 cases.No serious complications or fatal cases happened. Conclusions For senile patients,acute cholecystitis is often complicated with other diseases,which increases peri-operative risks.To prevent and minimize the occurrence of complications,strict adherence to surgical indications,proper management of co-morbidities,and broadening indications of conversions to open surgery are all considered essential.

Objective To explore the surgical procedures and effects for recurrent scalp dermatofibrosarcoma protuberans (DFSP).Methods Retrospective review was conducted in 7 scalp recurrent DFSP cases in the past 3 years.Intraoperative frozen section analysis of surgical margins was performed.Wide local excision with margins of 3 cm or more was applied,and excision of the skull external lamina or the entire layer of the cranial bones was performed once the skulls under the tumors were invaded.Frozen section analysis was again performed on all the margins.Secondary wound was repaired with local skin flap or fascial pedicled flaps.Surgically removed tumor was paraffin-embedded for HE-staining and immunohistochemical analysis.Results All of 7 tumor specimens were proved recurrent DFSP with histologic findings of intraoperation or postoperation.7 patients were all performed with wide local excision with margins of 3 cm or more,also with skull excision (5 cases with excision of skull external lamina and 2 cases with excision of the entire layer of skull).Negative margins were confirmed with intraoperative frozen sections or postoperative paraffin-embedded sections analysis were confirmed.Immunohistochemical analysis demonstrated that Ki-67 was all positive and CD34 was partially positive in 7 cases.No tumor recurrence or metastasis had been observed in any of our patients after a median follow-up duration of 17 months (range 15-41).Conclusions Wide local excision together with the skull invaded by tumors completely is effective surgical treatments for recurrent scalp DFSP; Use of scalp transferring technique could improve wound repair after complete tumor excision.

ObjectiveTo study the efficacy of adjuvant percutaneous transhepatic portal vein chemoembolization (PVCE) in the prevention of tumor recurrence after partial hepatectomy for hepatocellular carcinoma.MethodsThe clinical data of 89 patients who received liver resection for hepatocellular carcinoma in our hospital from January 2007 to January 2010 were studied retrospectively.41patients received PVCE (the treatment group) while 48 patients received no PVCE (the control group).Postoperative recurrence and cumulative disease free survivals were compared using the Kaplan-Meier method.ResultsOn follow-up which ranged from 6-42 months,the 1- and 2-year disease free survivals were 76.5％ and 48.0％ in the treatment group,and 53.8％ and 25.8％ respectively in the control group (P＜0.05).The mean disease free survivals were 19.91 (95％ CI,16.09-23.73)and 13.8 months (95 ％ CI,10.95-16.65),respectively.The cumulative disease free survivals in the PVCE group were significantly higher than the control group (P=0.01).Cox multivariate analysis showed that adjuvant PVCE,tumor size,portal vein thrombosis,and postoperative transcatheter arterial chemoembolization (TACE) were independent factors of disease free survival.ConclusionAdjuvant PVCE was effective in preventing postoperative recurrence of hepatocellular carcinoma after partial hepatectomy.

Objective To explore the effect of supplemental parenteral nutrition (SPN) combined with early enteral nutrition (EN) for enhanced recovery in postoperative liver cancer patients.Methods From June 2015 to June 2018,liver cancer patients admitted to our hospital were randomly divided into two groups with 47 patients receiving SPN combined with early EN in the study group and 45 patients receiving early EN in the control group.Results There were no significant difference in bilirubin recovery,liver enzyme recovery,postoperative exhaust and defecation time and complication rate between the two groups (P ＞ 0.05).In study group prealbumin (PAB) synthesis recovered faster (F =7.89,P =0.006),albumin use was significantly lower (t =-2.29,P =0.0024),and postoperative hospital stay was shorter (t =2.46,P =0.016).Conclusion In ERAS patients with liver cancer,the combination of SPN and early EN provide reasonable energy support to improve nutritional status and accelerate patient recovery.