Objective To investigate the diagnosis and treatment of injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 6 patients with injury in choledocho-pancreatico-duodenal junction who had been admitted to Beijing Hospital from January 2000 to January 2008 were retrospectively analyzed. Results Of the 6 patients, 4 were diagnosed according to the intraoperative findings, cholangiography and fiber cholangioscopy. The 4 patients were cured after suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage. Two patients developed severe abdominal and retroperitoneal infection and other complications after operation, and were diagnosed by cholangiography and fiber cholangioscopy. Of the 2 patients, 1 was cured and 1 died after multiple drainage procedures and debridement. Conclusions Diagnosis and treatment in the early stage are crucial for the curative purpose. Cholangingraphy and fiber cholangioscopy are effective in the diagnosis of injury in choledocho-pancreatico-duodenal junction. The suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage should be chosen for patients who are diagnosed during primary operation. For patients with abdominal and retroperitoneal abscess and cellulitis, drainage and debridement should be performed, and biliopancreatic diversion and duodenal diverticularizatian are applied to patients when necessary.

Objective To evaluate the efficacy and safety of the damage-controlling surgery for the elderly patients with obstructive biliary diseases. Methods 278 elderly patients with obstructive biliary diseases were divided into the damage-controlling surgery group and definite surgery group.The obstructive biliary diseases were divided into the benign obstructive group and the malignant obstructive group. The complication rate and mortality between the 2 groups were analyzed and compared. Results One hundred and eighteen elderly patients were treated by damage-contolling surgery, its complication rate was 9.32 % and the mortality was 0 %. One hundred and sixty elderly patients,were treated by definite surgery, its complication rate was 24.38%, the mortality was 6.88%. There were significant differences in complication rate and mortality between the damage-controlling surgery group and the definite surgery group (all P＜0.01). The complication rate of the benign obstructive diseases group treated by damage-controlling surgery was 17.3%, the mortality was 0%. The complication rate of the benign obstructive diseases group treated by definite surgery was 16.3%, the mortality was 4.34%. There was no significant difference in the complication rate and mortality between the 2 groups (all P＞0.05). The complication rate and mortality of the malignant obstructive biliary diseases group treated by damage-controlling surgery were 4.45% and 0% respectively, and were 35.29% and 10.29% by definite surgery, there were significant differences in the complication rate and mortality between the 2 groups (P＜0.01 and P＜0.05). Conclusions Damage-controlling surgery may decrease the complication rate and mortality of the elderly patients with obstructive biliary diseases, and improve the operation safety of the elderly patients.

Objective To investigate the management of pseudomyxoma peritonei originated in the appendix.Methods The clinical data of 51 patients with pseudomyxoma peritonei originated in the appendix who were admitted to the Beijing Hospital from 1970 to 2010 were retrospectively analyzed.The results of operation,reoperation,adjuvant treatment and follow-up were analyzed.The time from pseudomyxoma peritonei recurrence to the reoperation between patients who did or did not receive chemotherapy was compared by two tailed t test.Results Of the 51 patients,48 received operation,and the operation time was (135 ± 72 )minutes.Tumor recurrence was observed in 34 patients,and 16 of them received cytoreduction procedure,and 33 cytoreduction procedures were performed in total.The median time of follow-up was 49.7 months (range,3-132 months).The disease-specific survival was observed in 25 patients and disease-free survival in 16 patients.Four patients died of tumor recurrence or progression.The results of postoperative pathological examination confirmed that 19 patients were with benign disseminated peritoneal adenomucinosis (DPAM),26 were with malignant peritoneal mucinous carcinomatosis (PMCA) and 6 were with intermediate subtype (PMCA-1).The 3-,5- and 10-year survival rates were 75％ (38/51),55％ (28/51) and 22％ ( 11/51 ),respectively.The survival time and reoperation time interval for patients who received postoperative chemotherapy were ( 21 ± 4) months and ( 10 ± 6 ) months,which were longer than (19 ±7 )months and (7 ±4)months of those who did not receive postoperative chemotherapy (t =1.027,0.361,P ＞ 0.05).The median survival time of patients with benign DPAM,PMCA-1 and malignant PMCA were 96,63,23 months,respectively.The tumor recurrence interval for patients with benign DPAM and those with malignant PMCA were ( 15 ± 5 ) months and (7 ± 4) months,with significant difference ( t =2.193,P ＜ 0.05 ).Conclusions An active cytoreduction surgery is feasible for patients with pseudomyxoma peritonei originated in the appendix in improving survival.Repeated cytoreduction is a treatment of strategy to prolong the recurrence time and improve the prognosis of selected patients.

Objective To investigate bile leakage prevention in laparoscopic common bile duct (CBD) choledochoscopic exploration through micro-incision approach at the cystic duct-CBD junction.Methods From August 2007 to February 2015,a total of 147 cases undergoing laparoscopic CBD choledochoscopic exploration through micro-incision approach at the cystic duct-CBD junction were included in this study.From August 2007 to November 2012,57 patients were treated with laparoseopic CBD exploration (control group).From November 2012 to February 2015,90 patients were with optimized suture method of CBD (study group).The outcomes of patients in two groups were compared,including procedure time (PT),postoperative hospitalization time (PHT),and postoperative complications.Results In control group,the bile leakage rate was 5.3％,compared to 1.1％ in study group.There were significant differences in postoperative hospitalization time(t =1.98,P =0.0007) and hile leakage rate (x2 =139.5,P =0.04)between the two groups.Conclusions The prophylaxis measurements during operation are important to prevent bile leakage in laparoscopic CBD choledochoscopic exploration through micro-incision approach,including strict indications for micro-incision operation,proper expertise for laparoscopic cholecystectomy and laparoscopic suturing,choledochoscopic exploration,and suturing the whole layer of CBD wall,and carefully checking the suturing spot in case of bile leakage.T-tube placement is recommended while bile leakage is suspected.

Objective To evaluate the intraoperative advantage and postoperative outcomes of threedimensional laparoscopic common bile duct (CBD) choledochoscopic exploration by micro-incision made at the cystic duct-CBD junction (LCBDEM) for gall stones and choledocholithiasis.Methods From January 2014 to December 2015,31 patients were operated under 3D LCBDEM (study group) and 37 patients under 2D LCBDEM (control group).The outcomes of patients in two groups were compared,including total procedure time (TPT),modified procedure time(MPT),suturing time(ST) and the wrong grasping per 100grasps(WG)of the LCBDEM.8 surgeons experienced in 3D LCBDEM were asked to fill in a subjective questionnaire.Results In control group,the TPT,MPT,ST and WG were (148 ± 47) min,(108 ± 42)min,(20 ±3)min and (19 ±4)per 100 grasps,respectively.In study group,the TPT,MPT,ST and WG were (148 ± 46) min,(9 1 ± 25) min,(1 8 ± 3) min and (8 ± 2) per 100 grasps,respectively.There were significant differences in MPT (t =-2.026,P ＜ 0.05),ST (t =-2.239,P ＜ 0.05) and WG (Z=-7.062,P ＜ 0.001).In subjective questionnaire survey,3D laparoscopy has advantages over 2D laparoscopy in visual and operation experience.But 3D laparoscopy made eyes more easily tired and dizzy.31 aparoscopy was inferior to 2D laparoscopy in spinning the camera around to get optimal field of vision.Conclusions 3D LCBDEM shortens procedure time and suturing time,increases operating accuracy and safety by providing high definition stereovision.

Object To provide the theoretical basis for the artificial planting of Hypericum perforatum L., the effects of light, gibberellin and ethephon on the germination of H. perforatum seeds were studied. Methods The method of direct germination was used. Results The seeds germinated to 79% in the light, while didn't germinate in the dark. Gibberellin and ethephon not only promoted the germination in the light, but also induced the germination in the dark. But ethephon inhibited the growth of seedling radicals severely. Conclusion The seed of H. perforatum is light-dependent seed, its light-dependence is related to gibberellin and ethephon.

Objective To study the influence of long-term home noninvasive positive pressure ventilation (HNPPV) on respiratory muscle strength in patients with stable severe chronic obstructive pulmonary disease (COPD).Methods Sixty-four patients with stable severe COPD discharged from Huabei Oil-field Hospital,Renqiu,Hebei were divided into two groups,one (n=24) with HNPPV plus conventional therapy,and the other (n=40) with conventional therapy plus long-term oxygen therapy as controls.All parameters were followed-up for one-year and compared for the two groups,including maximal iuspiratory pressure (MIP),transdiaphragmatic pressure (Pdi),maximal transdiaphragmatic pressure (Pdimax),ratio of Pdi/Pdimax,arterial partial pressure of carbon dioxide (PaCO2),forced expiratory volume in one second (FEV1),6-min walking distance (6MWD),mortality and re-hospitalization rate.Results Age,gender,course of the disease,body mass index (BMI),arterial PaCO2,PaO2,MIP,Pdi,Pdiraax,ratio of Pdi/ Pdimax,FEV1,ratio of FEV1/FVC%,6MWD and re-hospitalization rate of the patients between the two groups were all comparable (P>0.05).In one-year follow-up,PaCO2averaged (52±8)mm Hg,MIP (64±7) cm H2O,Pdi (33±5) cm H2O,Pdimax (101±9) cm H2O,Pdi/Pdimax (0.31±0.04),FEV1 (35±4) %,FEV1/FVC% (44±4) %,6MWD (272±26) m and (2.6 ± 0.8) admissions per year in the HNPPV group,significantly different from those in the control group [ (57 ± 6) mm Hg,(59 ± 6) cm H2O,(31±4) cm H2O,(84±7) cm H2O,(0.35±0.05),(33±3)%,(41±4)%,(212±28) m,and (3.7±0.8) admissions per year] (P<0.05).One death was observed in the HNPPV group (1/24) and three in the control group (3/4 0) in one - year follow - up,with no statistically significant difference (X2=0.00,P>0.05).Conclusions Long-term use of HNPPV for patients with stable severe COPD could efficiently improve their respiratory muscle strength and endurance,thus improving their pulmonary ventilation and treatment efficcacy.

Objective To investigate the effect of octreotide on inhibition of growth of subcutaneously implantedtumor with human gall bladder cancer cells in nude mice,and to explore the mechanisms.Methods We established subcutaneous implanted tumor model in nude mice by using human gallbladder carcinomacell line GBC-SD.A total of 18 male nude mice bearing xenografts of the cell line were randomly divided into therapy and control groups,with 9 in each group.Octreotide was administered intraperitoneally at a dose of 100 ?g/(kg?d) to the therapy group and isovolumic normal saline was administered to the controlgroup for 6 weeks.All mice were put to death,and the weight and volume of the tumors were assayed.Flow cytometry was used to examine apoptosis of tumor cells.Immunohistochemical staining was used to examin the expression of p53,bcl-2,and Ki-67.Results The weight of implanted tumors in nude mice in the therapy group[(0.99?0.54)g] was lower than that in control group [(1.58?0.51)g,P

ObjectiveTo evaluate the hemostatic effect of human thrombin in surgery.Methods A prospective, randomized, controlled and multicenter study was designed to evaluate the hemostatic effect of human thrombin on abdominal operation incision (96 cases) and liver wound (40 cases). Human thrombin was insufflated topically in study group, with 0 9% NS as control. Results The average hemostatic time of abdominal incision in study group was (104?70) s, hemorrhagic volume per square unit was (0 4?0 3)g/cm 2, in liver wound the average hemostatic time was (106?78) s, the hemorrhagic volume per square unit was (1 0?0 7) g/cm 2, the difference was all statistically significant ( P

ObjectiveTo study the feasibility and technique in liver transplantation (LT) in an adult with situs inversus (SI) and reviewed the medical literature on this subject.MethodsA 45-year-old male with complete SI,suffered from progressive hepatic failure secondary to hepatolithiasis,obstructive jaundice,portal hypertension and liver cirrhosis.He underwent liver transplantation in July 2004.His anatomy was studied by preoperative CT scan and three-dimensional liver reconstruction imaging and angiography.LT was performed using the modified piggyback technique.The donor right liver was rotated 45 degree to the left,making the donor left liver pointing to the left paracolic sulcus and the donor right liver was in the recipient hepatic fossa.The donor suprahepatic vena cava was anastomosed end-to-side to the recipient vena cava,and the infrahepatic vena cava was closed by oversewing.ResultThe patient recovered uneventfully.His liver function was stable during a follow-up of 75 months.ConclusionLT in patients with SI is safe and feasible.Exact determination of the anatomy,comprehensive preoperative planning,and good technique in liver transplantation play important roles in LT for patients with SI.