Objective To explore a convenient and safety way for surgical treatment of juxtra-papillary duodenal diverticulum.Methods A total of eighteen patients with juxtra-papillary duodenal diverticulum admitted to Hunan Provincial People's Hospital from May 2011 to May 2013 were involved in this study for retrospective analysis.Results Most of patients were old people and the average age was (55.5 ± 11.2) years in this group.All 18 patients accepted diverticulectomy without operation-mortality.No postoperative complications such as bleeding,duodenal fistula,biliary fistula and traumatic pancreatitis were happened.The average operation time was (2.5 ±0.6) hours.The average blood loss was (35.1 ± 14.2)ml.A total of 16 patients had been accepted follow-up survey.Mean length of follow-up was (10.5 ±2.0)months.Good result rate was 100％.Conclusions Do-not-open the duodenum diverticulectomy is the ideal surgical treatment of juxtra-papillary duodenal diverticulum.

Cholelithiasis has still been a common and endemic disease damaging people's health in our country.Management modes and prognosis of this disease have been changed and improved greatly in the past fifty years.Based on our own clinical practice and experience in the People's Hospital of Hunan Province,we reviewed aspects concerning on diagnosis,principles and technical considerations of surgical treatment,summarized background and changes in the past almost half century,which reflected our unremitting efforts and distinctive contributions in management of cholelithiasis.Our experience demonstrated that cholelithiasis should not be considered as a gradually disappearing disease,difficulties and perplexities in dealing with such disease would still be arduous challenges for surgeons,although rates of stone residue and reoperation decreased dramatically.

Objective To describe a modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy and explore its clinical application.Methods We retrospectively reviewed clinical data on 57 patients receiving modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy in the Department of Hepatobiliary Surgery,People's Hospital of Hunan Province during the period from February 2016 to August 2016.Results Among 57 cases,38 cases previously underwent conventional basinforming hepatic duct-jejunum Roux-en-Y choledochojejunostomy for the reasons such as hepatolithiasis,iatrogenic proximal bile duct injury,congenital choledochal cyst (Todani type Ⅰ),etc.The mean number of operation was 1-4(1.8 ± 1.3).Errors during reoperation can be classified relevant to cholangiojejunostomy anastomosis,bridging jejunal loop and jejunum-bridging jejunal loop anastomosis.Among 57 cases,bile intestinal anastomotic leakage occurred in one patient,incision fat liquefaction in 3 patients,2 patients experienced stress gastritis,all postoperative complications recovered under conservative management.No postoperative mortality happened.During mean (4.07 ± 3.27) months follow-up period,only 4 patients complained of reflux cholangitis,which could be easily managed by antibiotics use.Conclusions By correcting errors in application of conventional Roux-en-Y choledochojejunostomy,a modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy proposed in this study demonstrated preliminary better results.

Objective To review the diagnosis and causes of iatrogenic injury to the distal choledochus at operation. Method The case notes of the patients with bile duct injuries that were treated in my Department from 1990.2-2005.2 were reviewed. Results To detect distal bile duct injuries, a sound in the bile duct had an accuracy rate of 95 % while injection of water into the bile duct to detect leakage had an accuracy rate of 100%. Using a long arm T tube in the common bile duct was an effective method to treat the injury. In 18 patients with an average follow-up time of 20. 8 months, the results were satisfactory. Conclusions Injecting water into the bile duct to diagnose distal common bile duct injury at operation was an effective way to detect distal bile duct injury. Adequate exposure of the opeative field is the best method to prevent bile duct injury.

Objective To investgate the methods of preoperative diagnosis and management of Mirizzi syndrome.Methods 31 cases of Mirizzi syndrome confirmed by operation were retrospectively analysed.Results The rate of preoperative diagnosis was low (38 71%).All patients were cured by different operation without complication. Conclusions We consider that the key criteria of the diagnosis of Mirizzi syndrome is gallstones cholecystitis with manifested charcot's syndrome occurrence,it could strongly suggest Mirizzi syndrome. The operative method should be selected by the typing of Mirizzi syndrome and the degree of pathological injury .

9scores). Results Fifty-five of fifty-seven cases with CT between 0～6 scores,which considered to be resected,underwent tumor resection . The accuracy of prediction of CT was 96.5%. Conclusions Preoperative CT scord could accurately predict the resectability and difficulty of pancreatic cancer.

Objective To investigate the effect of c-myc ASODN on the proliferation and invasion of human bile duct carcinoma cell line QBC939. Methods QBC939 cells was conventionally cultured. C-myc ASODN was designed and transfected into QBC939 cell line. MTT assay and transwell experiment were used to study cell proliferation and invasion of QBC939 cells. Results MTT assay showed that cell survival rate in ASODN group was significantly lower than that in blank group(P < 0.05). Transwell experiment showed that the num-ber of cells penetrated in ASODN group was significantly lower than that in blank group(P<0.01). The cell survival rate and the number of cells penetrated in vechicle group had no difference with blank comparison group(P>0.05). Conclusions C- myc ASODN can inhibit the proliferation and invasion of QBC939 cells.

Objective To explore the surgical treatment of bile duct necrosis.Methods Clinical data of 94 cases of bile duct necrosis treated in this hospital from May1990 to December 2008 were retrospectively analyzed.Results There were no death or severe complications such as biliary fistula and massive hemorrhage in these patients.Conclusion Bile duct necrosis should be treated with a proper surgical approach based on its features.

Objective　To study the experience in prevention and treatment of iatrogenic bile duct trauma(IBDT). Methods　A retrospective study was made on the clinical data of 118 patients with iatrogenic bile　 duct trauma admitted to the Hunan Provincial People's Hospital from March 1990 to September 2000. Results　50.8%　(60/118) of patients with IBDT resulted from the wrong identification of the anatomy of the Calot' Triangle during cholecystectomy. The clinical diagnosis of IBDT depended on the clinical findings, diagnostic abdominocentesis and image examination. The diagnostic rate of ultrasonography for IBDT was 93.2%(110/118). According to the injury site of bile duct, IBDT could be divided into 6 types, the most common type of　 IBDT was resection of partical hepatic duct and part common bile duct(type Ⅲ) which occurred in 83.9%　(99/118) of the patients. The cure rate of IBCT was 100%(118/118) in this series due to the choice of operation according to the trauma type. Conclusions　The key of prevention to IBDT lies in abiding by the princible of “identifying-cut-recognazing” during cholecystectomy. The choice for surgical operative procedure should agree with the trauma type.

Objective To investigate the diagnosis and treatment of hepatolithiasis complicated by bronchobiliary fistula.Method The data of 35 patients with hepatolithiasis and bronchobiliary fistula treated in our department in the last 10 years were retrospectively studied.Results The operations were:-repair of fistula in the diaphragm (n=35),hepatic segmentectomy (n=22) biliary stricturoplasty (n=13),T-tube drainage of common bile duct (n=19),hepaticojejunostomy (n=3) and bilateral hepatojejunostomy with a Roux-en-Y loop of jejunum (n=13).Residual stones were left in 4 patients.There was no recurrence of the bronchobiliary fistula on follow-up.Conclusions Expectoration of bitter and purulent yellow sputum was an important clinical feature of bronchobiliary fistula.The key steps in a successful operation were reliefing the obstructed bile duct and re-establishment of adequate biliary drainage.