Objective To investigate the management of large cystic duct during laparoscopic cholecystectomy(LC). Methods 24 out of 1052 patients, whose cystic duct size in diameter are larger than 0.4cm, were reviewed retrospectively from March 1995 to December 2001. The diameter of cystic duct is 0 4cm～0 6 cm in 12 cases, 0 6cm～0 8cm in 8 ones, 0 8cm～1 0cm in 2 ones and larger than 1cm in 2 ones. Different methods were adopted. Two-clip method was used in 10 cases, three-clip method in 5 ones, ladder clip method in 6 ones and rotation clip method in 3 ones. Results LC was completed successfully in 21 cases. 3 cases were converted to open cholecystectomy due to blood loss. No complications such as bile leakage and subphrenic abscess occurred. Conclusions Large cystic duct during LC can be managed successfully by different methods.

Objective To review the diagnosis and treatment of hepatic veno-occlusive disease(HVOD)induced by sedum aizoon in HBsAg positive patients. Methods Clinical data of 35 HBsAg positive cases who took sedum aizoon decoction and developed HVOD were collected, the clinical manifestation, imaging examination, histological examination of liver puncture biopsy, and the outcomes of patients were reviewed. Results Hepatomegaly, liver dysfunction, abdominal effusion and map-like density changes in liver CT scan were observed in 35 patients. Liver biopsy wag performed in 17 patients. In histopathological examination, the swelling and point-like necrosis of liver cells, expansion and congestion of sinus, endothelial swelling, wall thickening, incomplete lumen occlusion of small liver vascular were observed. Map-like density changes in liver CT scan were found in all 17 patients who were diagnosed by histological examination. Fifteen patients presented small amount of ascites within 4 weeks of onset, 13 of whom recovered or improved after treated with low-molecular weight heparin and albumin; while among the remaining 20 patients. only half of them were benefited from the same treatments. Conclusion HVOD can be diagnosed by liver CT scan instead of histological examination; treatment of patients in early stage may improve the outcome.