With almost 10 years of basic and clinical research,robotic surgery has entered the phase of commercial introduction and wide clinical application.Upon successful accomplishment of 100 cases of robotic assisted surgery,along with a systematic and retrospective study on Da Vinci surgical system-assisted complex hepatobiliary and pancreatic surgery,we summarized the main advantages of Da Vinci surgical system as follows:(1)the optimized three-dimensional and high-definition view provide surgeons with more stability and confidence during complex and delicate snrgical procedures;(2)the extremely agile multi-functional robotic arms have overcome the limitation of human hands,which makes complex surgery possible;(3)the totally new surgery modality helps to integrate various disciplines into a collaborative team,thus bringing revolutionary changes to minimally invasive surgery.Da Vinci surgical system marks a milestone in the development of minimally invasive surgery.

Oligodeoxynucleotides containing CpG motifs have shown powerful immunoregulation effects, which are able to activate a variety of immune cells such as natural killer (NK) cells, monocytes,macrophages, dendritic cells(DC), B and T lymphocytes. CpG oligodeoxynucleotides (CpG ODN) can not only induce and enhance nonspecific and specific immune responses, but also regulate the type of immune responses through inducing Th1-type immune response and suppressing Th2-type immune response. DC are known to be the most powerful special antigen-presenting cells (APC) at present. It plays an important role in antigen recognition,antigen processing presenting, and T cell activation, and can kill various kinds of tumor cells. Recently, the immunotherapy based on tumor vaccines of dendritic cell has become more and more important. The research progress on dendritic cells for cancer treatment is reviewed in this article.

Objective To explore the etiology and clinical prevention regime for hepatitis B virus reinfection in patients after orthotopic liver transplantation. Methods One hundred and twenty eight orthotopic liver transplantation recipients with hepatitis B virus related end-stage liver diseases were analyzed retrospectively. The patients' primary diseases included chronic fulminant hepatitis B, end-stage liver cirrhosis and liver carcinoma. All the patients were given lamivudine pre-transplantation to prevent hepatitis B virus reinfection. Single lamivudine was administered post-transplantation in 3 cases; lamivudine combined with hepatitis B immunoglobulin were given in 125 cases. Adefovir dipivoxil was administered to the patients with hepatitis B virus reinfection. All the patients were followed-up for 3～48 months. Results Two out of the three patients who received single lamivudine developed hepatitis B virus reinfection. The reinfection occurred in one patient 6 months after orthotopic liver transplantation, and the other patient was found to be reinfected 9 months after transplantation. Five out of the 125 patients who received lamivudine and hepatitis B immunoglobulin (small dosage) developed hepatitis B virus reinfection. To 3 patients with hepatitis B virus reinfection adefovir dipivoxil was given, and hepatitis B virus-DNA negative conversion was observed after three months of treatment. Conclusions Treatment with lamivudine and low dose of hepatitis B immunoglobulin post-transplantation may offer an effective prevention against hepatitis B virus reinfection. Adefovir dipivoxil is effective for patients with reinfection of hepatitis B virus by suppressing its variant replication.

Objective To investigate the diagnosis and treatment of pseudotumorous pancreatitis. Methods A retrospective clinical analysis was made on 20 cases with pseudotumorous pancreatitis in one stage from 1983.7 to 2004.5. Resulds There were 14 males and 6 females. Jaundice and abdominal pain were the major complaints. 17 cases underwent surgery, including cholangiojejunum Roux-en-Y anastomosis in 11cases, pancreatoduodenectomy in 3 cases, laparotomy and biopay in 3 cases . 3 cases underwent US-guided needle biopsy. All the 15 cases who were followed up had no jaundice at all after operation and abdominal pain relief was achieved to various degree. Conclusion It's difficult to diagnose pseudotumorous pancreatitis before operation. Hepatojejunal Roux-en-Y anastomosis was suitable for the patients with obstructive jaundice. When refractory abdominal pain was encountered or intraoperative pathologic diagnose was diffcult, pancreaticoduodenectomy should be recommended.

Objective To investigate the changes of CD cells in splenic tissue in patients with portal hypertension(PHT) accompanied by hypersplenism to explore the features of immunological function in patients with PHT.Methods The resected splenic tissue was made into paraffin sections for the detection of number and distribution of CD_3~+,CD_8~+,CD_(20)~+ and CD_(68)~+ cells,with the control of those in healthy individuals.Results The numbers of CD_3~+,CD_8~+,CD_(20)~+ and CD_(68)~+ cells remarkably decreased in patients with PHT accompanied by hypersplenism compared with those in normal controls.In normal controls,the CD_(68)~+ cells mainly existed in splenic lymphocyte nodules and red pulp(RP),and in patients with PHT,they existed in splenic lymphocyte nodules and periarterial lymphatic sheath(PALS).Compared with the normal controls,the numbers of CD_(68)~+ in splenic lymphocyte nodules,red pulp and marginal zone(MZ) decreased in patients with PHT.Conclusion The number and distribution of CD cells are changed in patients with PHT accompanied by hypersplenism.With splenectomy,the immunological function may be improved and the abnormalities in routine blood parameters and liver function be corrected.However,the immunological indexes detected in the study can not completely show the systematic immunological function of the patients with PHT accompanied by hypersplenism.Thus we should conduct a long-term follow-up study on immunological function in these patients.

Objective This study was to investigate correlations between the expression of oncogene c erbB 2 , p16 and nm23H1 and the development of the carcinoma. Methods Immunohistochemical S P method was used to examine the expression of oncogenes in 46 cholangiocarcinoma cases and 13 cases of benign bile duct lesions. The relationship between the expression and clinical pathology was analyzed. Results The positive rate of C erbB 2 in cholangiocarcinoma increased significantly ( P

Objective To evaluate the anatomical basis and techniques in laparoscopic liver resections. Methods Entered the study there were 16 patients with both their lesions located at liver margin, or the surface of the right liver, or left liver and their liver functions classified as Child B or above, including 8 cases of primary liver cancer, 3 cases of liver hemangioma, 1 case of cholangiocarcinama, 1 case of hepatic adenoma, 1 case of focal nodular hyperplasia, 1 case of liver abscess and 1 case of infected liver cyst. The procedures were performed, via 4～6 epigastric ports, by using electriccautery, ultracision or endo-cutter for transecting liver and by titanic clip or medical albumin glue for dealing with the cut surface. Results Laparoscopic liver resection was completed under pneumoperitoneum in 16 cases (18 lesions), including 8 cases of local liver resection and 8 cases of anatomical left liver resection. The operation time was (206?75) min and the blood loss was (354?282) ml. An intraoperative blood transfusion of 800 ml was required in 2 cases because of a blood loss of 1000 ml. The abdominal drains were left for (2～4) days and no bile leakage, bleeding or other complications happened. The postoperative hospital stay was (5.8?1.6) days. Conclusions Proper dealing with hepatic portal vessels is the key to the laparoscopic liver resection. In order to effectively control the bleeding during the partial hepatectomy or left hemihepatectomy, it is crucial to fully dissect the sub-grade hepatic portal vessels.

Objective To evaluate the feasibility of laparoscopic liver resection. Methods Total laparoscopic liver resections were carried out in 44 candidates between July 2002 and February 2004, including 22 cases of primary hepatocellular carcinoma, 10 cases of liver hemangioma, 3 cases of liver abscess, 1 case of infected liver cyst, 3 cases of liver focal nodular hyperplasia, 1 case of hepatic adenoma, 1 case of bile duct cystadenoma, 1 case of liver inflammatory granuloma, 1 case of hilar bile duct carcinoma and 1 case of highly specialized biliary cellular carcinoma. According to the Child-Pugh classification, 38 cases fell into “Class A” and 6 cases (all of which were hepatic carcinoma), “Class B”. Results Laparoscopic procedures were completed smoothly, including liver partial resections in 17 cases, left liver anatomical resections in 14 cases and right liver anatomical resections in 13 cases. The operation time was 15～450 min(mean,195 min). The blood loss was 50～1 500 ml (mean, 405 ml). The amount of blood transfusion was 0～1 000 ml(mean,175 ml). Postoperative convalescence was uneventfully, with a hospital stay of 2～9 d(mean,5 6 d). Conclusions Laparoscopic liver resection is a safe and feasible procedure. It may be reserved for both benign and malignant tumors in selected cases.

Objective To explore a new way to drain a postoperative abdominal abscess. Method Drainage catheter and sinography were employed to locate the site of the abscess, and a 10.2F~16F catheter with single or double lumen was inserted into the abscess by interventional technique. Result A 100% success was obtained for the 15 patients with 18 abscesses by inserting the drainage catheters, and all the abscesses were cured 7~65 days after drainage. Conclusions Compared with the surgical or percutaneous drainage, the present method is less traumatic, safer, more economical and effective, and it could be applies to all kinds of postoperative intraperitoneal abscesses which could not been drained adequately or with formation of sinus because of displacement of drainage tube.

Objective To summarize the experience of diagnosis and management of regional portal hypertension. Methods The clinical manifestations, diagnostic methods and therapeutic modalities of 16 cases of regional portal hypertension were analyzed retrospectively. Results Among 16 patients with ~regional portal hypertension, 12 cases resulted from pancreatic diseases, and 4 cases were complicated with non-pancreatic diseases. The main clinical findings were splenomegaly in 16(100%), abdominal pain ~in 10(63%) , gastrointestinal bleeding in 7(44%) and abdominal masses in 3(19%). All had normal liver function test. The main diagnostic methods were ultrasonography(US), computerized tomography (CT) and endoscopy. Splenic vein thrombosis could be detected by color Doppler ultrasonography (7/7). ~Enhanced CT could demonstrate enlarged and tortuous short gastric veins, gastroepiploic veins, and ~coll- ~ateral vessels around splenic hilum(16/16). Isolated gastric varices (4/5) were revealed mainly by ~gastro- ~scopy . Splenectomy was effective for controlling gastrointestinal bleeding, and its complication of portal vein thrombosis occurred in 1 case. Conclusions It is not difficult to diagnose regional portal ~hyper- ~tension based on findings of US and CT, together with special clinical characteristics. Therapeutic options should be ~individualized according to underlying diseases, however, splenectomy should be performed in the ~patients with gastrointestinal bleeding.