Objective: To evaluate the effect and clinical significance of early enteral nutrition in postoperative patients with malignant obstructive jaundice. Methods: Thirty patients with malignant obstructive jaundice were randomized into postoperative early enteral nutrition (EN) group and parenteral nutrition (PN) group. Results: The body weight and level of prealbumin, albumin, transferrin decreased significantly after operation in both group, and there was no significant difference between two groups. Nitrogen balance was positive in the EN group, but it was negative in the PN group. EN had less influence on hepatic enzymes than PN. The economic consumption in EN group was less than that in PN group. Conclusions: Compared with PN, early EN support can ameliorate malnutrition state in postoperative patients with malignant obstructive jaundice more safely, effectively and economically.

Objective: To study the effect of selective portal vein embolizationon (SPVE) on the second-stage hepatectomy rate in patients with primary hepatocellular carcinoma(HCC). Methods: Eighteen patients with HCC who were not suitable for hepatectomy were treated by ultrasonic guided percutaneous transhepatic SPVE with fine needles. Success rate of SPVE, adverse reactions, successive change of the volume of each liver lobe, and hepatectomy rate after treatment were observed. Results: SPVE were successfully performed in all 18 patients. In patients with right portal vein branch embolized, the right liver volume decreased while left liver volume increased gradually. The rate of right lobe volume to total liver volume decreased from 62.9 % before SPVE to 60.6 % after l week, 57.5 % after 2 weeks and 53.0 % after 3 weeks. The adverse reactions included different degrees of pain in liver area (12 cases), lower fever (7 cases), nausea and vomiting (4 cases). After 2-4 weeks, second-stage hepatectomy for HCC were successfully performed in l0 patients (55.6 %). Conclusion: Ultrasonic guided percutaneous transhepatic SPVE is simple and effective. It can elevate the two-step hepatectomy rate of HCC and increase the safety of the operation.

Objective: To evaluate the feasibility and character of laparoscopic cholecystectomy (LC) in patients with histories of multiple upper abdominal surgeries(≥2 ). Methods: We retrospectively analyzed the results of 21 LC operations in patients who had previously accepted two or three upper abdominal surgeries . Results: LC were successfully performed in 13 of all the patients (61.9%). The success rate of LC in patients with 2 upper abdominal surgeries was 66.7%. It was only 33.3% in patients with 3 upper abdominal surgeries. Eight of the patients (38.1%) were transformed to open cholecystectomies. The mean operation time was 72.1 minutes. The transform rate was higher, and the mean operation time was longer than those without previous upper abdominal surgery at the same period in our department. Conclusion: History of multiple upper abdominal surgeries should not be regarded as the contraindication to laparoscopic cholecystectomy. But these operations were difficult with higher transform rate and longer operation time.

Objective To investigate the feasibility and technique of laparoscopic subtotal cholecystectomy(LSC).Methods Totally 168 patients were converted to LSC because of failure in laparoscopic cholecystectomy(LC).During the LSC,the Calot's triangle was separated and then the Hartmann's pouch was incised to decreased the intracystic pressure for the removal of the stones.Results Among the cases,5 patients were converted to open surgery for subtotal resection of the gallbladder.LSC was completed after clipping the cystic duct and artery in 122 patients;in the other 41 cases,the gallbladder was cut at the Hartmann's pouch to clip the bile duct and artery or suture the neck of the gallbladder,and then LSC was performed.The median operation time was(65.5?15.2)min,and the intraoperative blood loss was(71.5?15.5)ml.The time to resume the diet was(20.4?6.3)h postoperation.After the operation,7 patients developed local complications(4.2%),and the mean postoperative hospital stay was(4.2?2.6)d.Of the patients,105 were followed up for(25.5?6.5)months,during this period,5 patients had dyspepsia,3 had right shoulder pain,and 9 had right hypochondrium pain.Conclusions LSC is feasible for patients with complicated cholecystitis.It is important to control the perioperative hemorrhage and bile leakage.

Objective: To evaluate the feasibility, technical characters and benefits of laparoscopic cholecystectomy (LC) in patients with cirrhotic portal hypertension(CPH). Methods:40 CPH patients, including 21 Child A class,26 Child B class and 3 Child C class were included. Data of the patients were collected and analyzed. Results: LC was successfully performed in 37 cases, and 3 patients were converted to open cholecystectomy (OC)for uncontrollled bleeding under laparoscopy and dense adhesion of Calot’s triangle. The convertion rate was 7.5%. The time of operation was (52.6? 15.2)min. The intraoperative blood loss was (75.5? 15.5)ml. The time to resume diet was (18.3?6.5)h. Seven postoperative complications occurred in 5 patients (13.2%). All patients discharged from hospital in (4.6?2.4) d after LC. Compared with LC in non cirrhotic patients, LC in patients with CPH has longer surgical time and hospital stay after operation, higher convertion rate and postoperative complication rate, more intraoperative blood loss. Conclusion: LC in patients with CPH has the advantages of minimal invasive surgery. It is feasible and relatively safe. But it has a higher convertion rate. Intraoperative blood loss is a prominent problem. The key step for a successful operation is to pay more attention to the perioperation managements and acquaint with the technical characters of this operation.

OBJECTIVETo determine the level of neurohormonal operative stress response-reactive protein (CRP) and rest energy expenditure (REE) after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC).

METHODSTwenty-six consecutive patients with noncomplicated gallstones were randomized for LC (n = 14) and OC (n = 12). Plasma concentrations of somatotropin, insulin, cortisol and CRP were measured. The levels of REE were also measured.

RESULTSOn the third postoperative day, the insulin levels were lower than those before operation (P < 0.05). On the first postoperative day, the levels of somatotropin and cortisol were higher in OC than in LC. After operation, the parameters of somatotropin, CRP and cortisol increased compared to the preoperative period in all patients (P < 0.05). On the all-postoperative day, the CRP levels were higher in OC than in LC (P < 0.05). After operation, the REE level increased in OC and LC (P < 0.05). On the all-postoperative day, the REE levels were higher in OC than in LC (P < 0.05).

CONCLUSIONSLC results in less prominent stress response and smaller metabolic interference compared to open surgery. These benefit the restoration of stress hormones, nitrogen balance, and energy metabolism. However, LC can also induce acidemia and pulmonary hypoperfusion because of pneumoperitoneum during surgery.

Acid-Base Equilibrium ; Adrenocorticotropic Hormone ; blood ; Adult ; C-Reactive Protein ; metabolism ; Cholecystectomy ; adverse effects ; Cholecystectomy, Laparoscopic ; adverse effects ; Energy Metabolism ; Female ; Gallstones ; surgery ; Growth Hormone ; blood ; Humans ; Insulin ; blood ; Male ; Middle Aged ; Postoperative Complications ; Postoperative Period ; Stress, Physiological ; etiology ; physiopathology ; Time Factors