Hepatocellular carcinoma(HCC) is one of the most common malignant tumors with the highest cause of death and increasing incidence worldwide, and the annual incidence rate is rising. The early diagnosis of HCC is very essential to its prognosis. At present, AFP has been widely used in the survey of HCC diagnosis, therapeutic effect and predict recurrence. However, the sensitivity and specificity of AFP is not satisfactory. In recent years a variety of new serum tumor markers have emerged one after another. A new serum marker-Golgi glycoprotein-73(GP-73) in early diagnosis of HCC is expected to become the new target maker,its sensitivity and specificity are better than AFP.

Objective To investigate the feasibility and ways of closed establishment of pneumoperitoneum for laparoscopic procedures in patients with a history of abdominal surgery. [WT5”HZ]Methods[WT5”BZ] Between September 1991 and December 1998, 963 patients with a history of abdominal surgery received closed establishment of pneumoperitoneum. The difficulties with closed establishment were classified as false and real types. Veress needle penetrating into falciform ligament, mesentery, great omentum or retroperitoneal fat tissue caused false difficulty, while the difficulty due to Veress needle penetrating into abdominal viscera or because of extensive adhesion was known as real difficulty.[WT5”HZ] Results[WT5”BZ] 18 cases for false and real difficulty were transfered to open surgery.Two cases suffered visceral injuries for laparoscopic cholecystectomy, including jejunum and ileum injuries in one each case. The occurrence rate of visceral injuries accounted for 0 2% in this group.[WT5”HZ] Conclusion[WT5”BZ] This result demonstrates that closed establishment of pneumoperitoneum is safe and feasible in most patients with abdominal operative history. Abiding by the rule of closed establishment pneumoperitoneum and conversion to laparotomy in time in real difficulty is important to avoid visceral injuries.

Objective To evaluate the effect of TILs treatment on postoperative patients with hepatocellular carcinoma (HCC) and the in vitro and in vivo hepatic targeting tendency of a compound of Galactosyl-Anti-CD_3McAb-TILs.Methods Thirty postoperative HCC patients were treated with TILs plus rIL-2. A hepatic targeting carrier, Galactosyl-Anti-mouse-CD_3-monoclonal antibody (Gal-Anti-CD_3-McAb), was synthesized.Result It was found that the peripheral blood level of IL-2 and T cell subset increased in all the 30 patients treated by TILs.24 HCC cases undergoing hepatectomy were treated by TILs therapy, and follow-up of 6 to 48 months found no recurrence. In an murine experiment a combination of TIL & Galactosyl-Anti-CD_3McAb-TIL tended to aggregate in lung while infused from peripheral vein. Its hepatic targeting tendency was unremarkable. Conclusion Postoperative use of TILs increased patients’ antitumor immunity, prolongs the survival, while galactosyl-anti-CD_3McAb-TIL does not show a satisfactory hepatic target tendency.

Objective To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods CEPP experiences of 1?046 patients in 6?600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO 2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results Of the 1?046 patients, 1?028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.

Objective To investigate the cause of and management for bile leakage after laparoscopic cholecystectomy (LC). Method Thirty-four bile leakage cases out of 12 000 LC procedure performed in our department were retrospectively analyzed. Results Common bile duct (CBD) transection injury in 6 cases was retrieved by Roux-en -Y choledochojunostomy. Bile leakage caused by clip exfoliation in 3 cases necessitated a reexploration. Injury on CBD lateral wall or right hepatic duct in 7 cases was successfully treated by repair and T-tube stenting. Twenty-one cases of aberrant duct or accessory duct injury were cured by conservative therapy. Subdiaphragmetic abscess developed in 3 cases were cured by puncture and aspiration. Anastomotic stricture in one case after Roux-en-Y choledochojunostomy was cured by redoing Roux-en-Y choledochojunostomy. Conclusions Bile duct injury is the most common cause of bile leakage after LC. Patent drainage, bile duct repair and T tube stenting or choledochojejunostomy are the main method in treating bile leakage after LC.

Objective To investigate the clinical manifestations, histopathological patterns, and methods of diagnosis and treatment of primary malignant duodenal tumors. Methods The data of 82 patients with primary malignant duodenal tumors confirmed by pathology and admitted to our hospital over a 10-year period were analyzed retrospectively. Results Tumor location:Tumors were located in the peripapilla region in 64 cases, at the descending portion of the duodenum in 11 cases, at other regions of the duodenum in 7 cases. The common presenting symptoms and signs were abdominal pain in 57 cases, jaundice 53 cases, and gastrointestinal bleeding in 41 cases. In these patients, radical resection of tumor was performed in 36 cases, palliative resection of tumor in 31cases,and operative intervention was not done in 15 cases.The 5-year survival rate of followed-up patients in this group was 2.4%. Conclusions The common presenting symptoms and signs of patients with primary malignant duodenal tumors were abdominal pain, jaundice and GI bleeding, but these patients usually lack specific symptoms and signs. The chief pathologic type is adenocarcinoma and the predisposed site of occurrence is the duodenal papillary region and the descending duodenum . CT, B ultrasonography and gastroduodenoscopy are the chief measures for the diagnosis of primary duodenal malignant tumors, and surgical resection is the main modality of treatment of this disease. The prognosis of primary duodenal malignant tumors is very poor.

Objective　To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods　CEPP experiences of 1046 patients in 6600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results　Of the 1046 patients, 1028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions　CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.

Objective To investigate the clinical efficacy and safety of hyperthermic intraperitoneal perfusion chemotherapy (HIPC) in treatment of advanced colorectal cancer.Methods The Meta-analysis was applied to analyze 8 randomized controlled quantitative studies published at domestic and abroad.These patients treated by HIPC after radical operation with colorectal cancer were included for the treatment group,and those treated only by radical operation with colorectal cancer for the control group.Relative risk (RR) of outcome variable of 3-year and 5-year survival rate and safety between the two groups were compared.Results There were 8 selected literatures,including 1 501 cases,in which 765 cases for treatment group,and 736 cases for control group.RR of 5-year survival rate of the total patients was 2.39 (95% CI:1.66-3.45).RR of 3-year survival rate of the total patients was 2.13 (95% CI:1.45-3.13).The results demonstrated that HIPC could improve 5-year and 3-year survival rate,and sensitivity analysis confirmed the conclusions more reliable.The security was described in 5 literatures,the available information showed smaller potential security issue.Conclusions HIPC after radical operation of advanced colorectal cancer can increase 5-year and 3-year survival rate of patients,improve the prognosis of patients.Whether patients with increased incidence of postoperative complications related to the HIPC is no clear-cut conclusions for lack of related research.

ObjectiveTo investigate the misdiagnostic reason and treatment of the syndrom of splenic flexure of colon(SSFC). MethodsThe clonical data of 21 patients with SSFC admitted from May 1993 to May 2001 were retrospectively analysed. ResultsThese patients aged from 51 to 88 years old with a median age of 67.8years.Clinical manifestalion was repetitive stomach pain, abdominal distension, constipation, etc. Double contrast radiology of colon demonstrated that too high fixation site of colon of splenic flexure, volvulus of colon of splenic flexure, and displacement of colon usually occurred together with transverse or sigmoid colon redundant.All of them were cured by cololysis of colon of splenic flexure, redundant partial colectomy and managing other companying diseases.Postoperative pathological diagnoses were chronic colitis.Followed up was done for 6 months to 6 years, all of them released from primary symptoms. ConclusionsThe main misdiagnostic reason of SSFC is less understanding of SSFC and did not take double contrast radiology of colon. By way of cololysis of splenic flexure, redundant colon resection and managment other companying abdominal diseases, most patients with SSFC may expect satisfactory treatment effects.

Objective To investigate the measurement , feasibility and clinic effect of hyperthermic intraperitoneal chemotherapy (HIPEC) guided by B ultrasound in the treatment of malignant ascites from peritoneal carcinomatosis. Methods From July 2011 to June 2013, B ultrasound-guided approach was used to perform HIPEC on 36 patients affected by malignant ascites secondary to peritoneal carcinomatosis. Every patient underwent HIPEC for three times , by way of continuous circulatory perfusion into peritoneal cavity with saline at 400 ~ 600 mL/min and intraperitoneal perfusion with 5-FU mitomycin-C and cisplatin for 90 minutes with an inflow temperature of (43 ± 0.2)℃. These patients were followed up for a long term. Results Intraoperative course was uneventful in all cases. Complete clinical regression of ascites and related symptoms was achieved in all the 26 patients, partial regression achieved in 8 patients, and no curative effect achieved in 2 cases. The acquired total clinic effectiveness was 94.44%. No postoperative deaths and complication related to the procedure occurred in this study. The KPS grades of patients rose (P < 0.001), the level of tumor markers decreased, including CA199 (P < 0.001), CEA (P < 0.001), CA125 (P = 0.003). Conclusion HIPEC guided by B ultrasound appears to be a safe, feasible and effective procedure for the treatment of debilitating malignant ascites from unresectable peritoneal carcinomatosis , which would have a clinic good perspective in future.