Minimally invasive biliary surgery developed rapidly and laparoscopic cholecystectomy has become the"gold standard"for the treatment of benign gallbladder disease.Combined application of endoscopic and ultrasonic technology improved the diagnosis of biliary diseases.Endoscopic balloon dilation or sphincterotomy of duodenal papilla to remove connon bile duct stones and internal biliary stent placement under ERCP for obstructive jaundice caused by biliary tumors provided safe and satisfactory therapeutic effect.However,in the laparoscopic era,minimally invasive techniques should still be used in conjunction with traditional biliary surgery.Meanwhile,strict indication should be emphasized to avoid the occurrence of complications.

Hepatolithiasis is a benign disease but seriously threatening human health.The academician Huang Zhiqiang came up with the therapeutic principle ofRelieve obstruction,Remove lesions,Build unobstructed drainage for the disease.He kept emphasizing that removal of lesions is the key link in the treatment of hepatolithiasis,and advocating to earlier diagnosis,earlier surgical resection,less bilioenteric anastomosis.Until today,numerous hepatobiliary surgeons treat hepatolithiasis following his principle.We could get a better understanding and comprehension to the academician Huang's outstanding contribution for biliary surgery through reading his discussion of therapeutic principle for hepatolithiasis.The academician Huang deserves the title of the Father of Chinese Biliary Surgery.

The reoperation for biliary diseases is usually unplanned, and the major reasons leading to this situation include:(1) The initial operation was performed under emergency situation and radical procedure could not be carried out.(2) The surgical procedure was inadequate.( 3 ) The operator was unqualified for the operation. In order to avoid repeated operations,the following principles must be obeyed strictly.Firstly,once the initial operation was failed,the patients must be transferred to large medical center and the reoperation must be performed by hepatobiliary specialists.Secondly,the operator must realize that most of the patients were in poor condition because of the previous operation,and they needed careful evaluation of organ function and adequate supportive treatment before reoperation.Thirdly,various measures must be taken to avoid unplanned operation and ensure the successful implement of radical operation at a time:( 1 ) Operator must learn all the details of previous operation,which include operation procedure,findings during operation and postoperative complications.( 2 ) Cholangiogram of the whole biliary tree is important for surgical planning,ultrasonography,computed tomography (CT),endoscopic retrograde cholangiopancreatography,magnetic resonance cholangiopancreatography, percutaneous transhepatic cholangiography (PTC),or PTC-CT should be performed solely or comprehensively to determine the nature and location of lesions.For bile duct injury,additional examination including CT angiography,magnetic resonance angiography or digital subtraction angiography is necessary to ascertain the accompanied vessel injury.(3) Making individual surgical procedure according to patien's condition and distribution of lesions.

Gallbladder cancer is a disease associated with high mortality. Improvement of early diagnosis is of great significance to prolong the survival. Risk factors for gallbladder cancer include gallstones, cholelithiasis, anomalous pancreaticobiliary junction, focal mucosal microcalcifications, and et al.Advances in endoscopic ultrasonography, magnetic resonance cholangiopancreatogram and helical computed tomography have enhanced preoperative diagnosis of gallbladder cancer. Understanding the characteristics of gallbladder cancer with the help of multiple imaging modalities can facilitate accurate diagnosis and may also help in sorting patients to undergo extended resection or an alternative therapy. Resection is currently the most effective and only potentially curative treatment for gallbladder cancer.However, owing to its non-specific symptoms, gallbladder cancer patients often suffer from late diagnosis, and few patients are suitable for surgery. Other treatment strategies such as chemotherapy, radiotherapy, percutaneous biliary drainage, palliative surgery are used in patients with advanced gallbladder cancer.For jaundiced gallbladder cancer patients, preoperative biliary drainage is still under debate. Since biliary inflammation adversely affects the prognosis of gallbladder cancer patients,antibiotics with high concentration in bile is recommended for selected patients. Palliative treatment and molecular target therapy are promising for patients with inoperable gallbladder cancer.

Objectives　To investigate the effect of nitric oxide(NO) on hepatic steatosis caused by total parenteral nutrition(TPN) in rats.Methods　Thirty Wistar rats were randomly divided into five groups: Group A,normal control; Group B,TPN group;Group C,TPN plus L-arginine; Group D,TPN plus NG-nitrio-L-arginine methyl ester(L-NAME，NOS inhibitor); Group E,TPN plus L-arginine and L-NAME.At the seventh day,liver function tests were performed and the livers were resected to test the lipid and nitric oxide content,and nitric oxide synthase activity.Results　The hepatic lipid content 〔triglycerid(μmol/g),cholesterol(μmol/g)〕in group B significantly increased compared with group A （39.3±2.4、13.1±1.1 vs.6.9±0.8、5.6±0.6）(P＜0.05).That was higher in group D（49.7±6.2、14.1±1.7）than in group B(P＜0.05),whereas that was lower in group C（18.2±4.4、7.3±3.1）than in group B(P＜0.05).The activity and distribution of NOS in the liver were associated with the content and distribution of hepatic lipid.Conclusions　NO produced by the liver may protect hepatic steatosis caused by total parenteral nutrition in rats.

Objectives To investigate the effect of nitric oxide(NO) on hepatic steatosis caused by total parenteral nutrition(TPN) in ratsMethods Thirty Wistar rats were randomly divided into five groups: Group A, normal control; Group B, TPN group;Group C, TPN plus L arginine; Group D, TPN plus N G nitrio L arginine methyl ester(L NAME,NOS inhibitor); Group E, TPN plus L arginine and L NAME. At the seventh day, liver function tests were performed and the livers were resected to test the lipid and nitric oxide content, and nitric oxide synthase activity.[WT5”HZ] Results [WT5”BZ] The hepatic lipid content 〔triglycerid(?mol/g), cholesterol(?mol/g)〕in group B significantly increased compared with group A (39 3?2 4、13 1?1 1 vs. 6 9?0 8、5 6?0 6)( P

Objectives To study the liver protective effect of L arginine for postoperative cirrhotic patients with primary liver cancer (PLC) receiving total parenteral nutrition (TPN). Methods Thirty preoperative cases were divided into two groups:Group A,TPN only( n =14);Group B,TPN+arginine( n =16). Liver function, serum lipid, immune function and serum nitric oxide were observed on preoperative phase, postoperative day 1 (POD 1) and day 7 (POD7) respectively. Liver biopsy was taken for histological study intraoperatively and on POD 7. Results Compared with group A on POD7,AST and TBIL level were near preoperative level, ALB level signiflcanly decreased, TG was lower than preoperative level, CD4 + and NO increased signiflcanly,and the degree of liver steatosis showed a signiflcant decrease in group B. Conclusions Supplement of appropriate amounts of L arginine increases hepatic NO level, reduces serverity of hepatic steatosis associated with TPN, promotes postoperative recovery of transaminase activity, ameliorates cell mediated immunity and anti infection capacity in postoperative PLC patients.

Objective To evaluate therapeutic effects of portal azygous devascularization on patients with portal hypertension. Methods In this study, data of 212 patients with portal hypertension who underwent devascularization were analyzed retrospectively. Among them 52% patients had a history of variceal bleeding. Preoperative Child A accounted for 15% patients, B for 57% and C for 27%. Emergent operation and selective operation were performed in 11% and 89% cases, respectively. Hassab procedure was performed in 176 cases (83%), whereas modified Sugiura procedure in 36 cases (17%). Results Portal vein pressure decreased from (40?6) cm?H 2O to (36?7) cm?H 2O. The re-bleeding rate of 3, 5,10 years were 2%, 6%, 11%, and the survival rates of 3, 5, 10 years were 97%, 92% and 89%, respectively. Conclusions Devascularization is an effective procedure in controlling bleeding with low incidence of liver failure, operation mortality and encephalopathy. Emergent operation should be avoided as it causes high morbidity and mortality. The decreased portal pressure following devascularization may result in a reduced blood supply to the liver. Persistent exasperation of the liver function caused by chronic hepatitis and the development of hepatocellular carcinoma are the two major factors endangering long-term survival.

Objective To investigate the effects of angiopioetins and tyrosine kinase receptor Tie-2 ,vascular endothelial growth factor (VEGF)on the angiogenesis and progression of hepatocellular carcinoma(HCC). Methods With the methods of RT-PCR and immunohistochemistry, the specimens from 28 HCC patients, 10 cirrhotics, and 10 normal livers were analysed, and the relationship between angiopioetins, VEGF (expression) and the clinical pathological characteristics of HCC was studied. Results Ang/Tie-2 and VEGF were significantly up-regulated in HCC compared to cirrhotic tissue and normal liver tissue. (Immunohistochemical) staining also showed increased expression of Ang-2,VEGF,Tie-2 protein in HCC. A high Ang-2/Ang-1mRNA ratio and high VEGF in HCC were closely associated with tumor vascular invasion and microvascular density level which assesssed by CD34. Conclusions Ang /Tie-2 and VEGF may play critical roles in promoting tumor angiogenesis and progression in human HCC.

Objective To investigate whether protease inhibitor (ulinastatin, UTI) can protect liver from ischemia-reperfusion injury in hepatocellular carcinoma (HCC) patients undergoing hepatectomy after hepatic inflow occlusion. Methods A prospective randomized control study was designed. Thirty-one HCC patients undergoing hepatectomy after hepatic inflow blood occlusion were randomly divided into the following two groups. UTI group (n=16), 1?105 units of ulinastatin was given intravenously in operation, then the dosage was continuously used twice a day up to 5 days postoperatively. Control group (n=15), the patients received other liver protective drugs. Liver function, plasma C-reactive protein (CRP) and cortisol level were compared between these two groups. Results The postoperative liver function of the UTI group was significantly improved compared with the control group. For example, on the third postoperative day the aspartate transaminase (AST), alanine transaminase (ALT) and total bilirubin level in the UTI group were significantly lower than those in the control group, respectively (P