Objective To discuss the clinical value of modified laparoscopic lithotomy of common bile duct.Methods Clinical data of 78 patients over the age of 60 with gallstone and choledocholithiasis who underwent modified laparoscopic lithotomy of common bile duct in the past four years were analysed.Results All operations were successful.T-tubes were withdrawn 4 weeks after operation.Of the 78 cases,77 cases hat no complications and only one case had a small incision infection.All patients recovered without complications after with drawal of T-tube.Conclusions Modified laparoscopic lithotomy of common bile duct can allow incision and suture of common bile duct and placement of T-tube under direct vision,and achieves excellent therapeatic results in the treatment of common duct stones,especially in elderly patients who cannot tolerate a long period of pneumoperitoneum.

A common pathophysiological changes caused by liver cirrhosis indudes damage of liver function and portal hypertension,and upper gastrointestinal hemorrhage caused by portal hypertension is the main cause of death in patients with liver cirrhosis.Therefore,the main purpose of portal hypertension treatment should be prevention and control of esophagus and fundus of stomach variceal bleeding.However,upper gastrointestinal bleeding can not be completely cured no matter by medication or endoscopic treatment,devascularization or shunt.Although liver transplantation is the best treatment method for portal hypertension,the application of liver transplantation is limited by the source of donor and medical condition.Devascularization is effective to treat upper gastrointestinal hemorrhage caused by portal hypertension,while disputes exist on the surgical indications,timing and procedure selection.

Objective To study the feasibility and safety of hand-assisted laparoscopic hepatectomy combined with splenectomy. Methods Hand-assisted laparoscopic hepatectomy combined with splenectomy was performed in 3 patients. A midline epigastric or right subcostal incision was made for hand-assisted port. The attachments of the spleen were dissected with a harmonic scalpel and the pedicle of the spleen was severed with the Endo-GIA. The transection of the liver was conducted using the harmonic scalpel dissection and nonabsorbable polymer clipping. The cut surface of the liver was closed by interrupted sutures. Results The operation was successfully completed in all the 3 patients. The surgical time was 130 min, 115 min, and 145 min, and the blood loss was 350 ml, 50 ml, and 150 ml, respectively. No serious postoperative complications occurred. The postoperative hospital stay was 9, 7, and 11 days, respectively. Follow-up observations for 6, 23, and 5 months showed no recurrence. Conclusions Hand-assisted laparoscopic hepatectomy combined with splenectomy is feasible and safe in selected patients .

Objective To study the feasibility and safety of laparoscopically assisted hepatectomy without choledochotomy and T-tube drainage for the treatment of hepatolithiasis.Methods The study included 11 patients with hepatolithiasis in the left intrahepatic duct.Of the 11 patients,8 patients were complicated with choledocholith and 5 patients with cholecystolithiasis.After laparoscopically assisted left hepatectomy,extrahepatic bile duct stone removal and right hepatic duct exploration were carried out under video-assisted choledochoscopy through the left hepatic duct,without choledochotomy and T-tube drainage.Results The operation was successfully accomplished in all the 11 patients.Liver procedures included laparoscopically assisted left lateral lobectomy in 5 patients and left hemihepatectomy in 6 patients.The mean operation time was 128 min(range,110~150 min),and the mean blood loss was 95 ml(range,50~150 ml).No serious postoperative complications occurred.The mean postoperative hospital stay was 7 d(range,5~10 d).The 11 patients were followed for a mean of 7.6 months(range,2~16 months).The curative effects were classified as excellent in 10 patients and good in 1.No residual or recurrent stones were noted.Conclusions Laparoscopically asisted hepatectomy without T-tube drainage for the treatment of hepatolithiasis is feasible and safe for selected patients.This procedure offers advantages of simplicity of performance,short operation time,and fewer complications,being a worthwhile minimally invasive alternative.

Objective To study the clinical features and prognostic risk factors of patients with autoimmune hepatitis-related hepatocellular carcinoma (AIH-HCC).Methods We reviewed the clinical data of 40 patients with AIH-HCC who were treated at the 302 Hospital between May 1,2008 and April 30,2013,and analyzed the clinical characteristics and prognostic risk factors of these patients.Results These patients were diagnosed to have HCC at a mean ± SD of 55.1 ± 13.5 years (range 28-76 years).The median duration from the time of confirmed cirrhosis to a diagnosis of HCC was 49.2 ± 44.5 months (range 3-194 months).The median survival of the AIH-HCC patients was 16.0 ±4.0 months (range 1-44 months),and the 1-year survival rate was 54.0％.Univariate analysis showed AFP,tumor size,tumor number were related to prognosis (P ＜ 0.05) ; while gender,age,IAIHG score,category,history of blood transfusion,alcohol-drinking and smoking did not significantly affect the patients' survival (P ＞ 0.05).Multivariate regression analysis showed AFP and tumor number were independent prognostic factors.Most of these patients received transcatheter arterial chemoembolization(TACE),however the survival rate of those patients who received hepatectomy was significantly higher than those who received TACE or accepted conservative treatment.Conclusion Liver cirrhosis in AIH is the sine qua non for HCC development,which subsequently occurs at a rate of 1.65％ per year.Patients who had AFP-negativity or a single tumor had a better prognosis.Surgical treatment prolonged survival.

Objective To study the feasibility and invasiveness of hand-assisted laparoscopic hepatectomy(HALH) for liver cancer.Methods Forty patients undergoing hepatectomy for liver cancer were randomly divided into HALH group and open hepatectomy(OH) group.Data of patients of two groups,Which included operating time,intraoperative blood loss,length of incision,postoperative flatus time,hospital stay,complications and C-reactive protein(CRP) were compared.Results The mean intraoperative blood loss,length of incision,postoperative flatus time,hospital stay and CRP in HALH group were significantly less than that in OH group;but there was no significant difference in operating time,or complication and recurrence rate.Conclusions HALH for liver cancer is less traumatic,and achieves faster patient recovery.It is feasible and safe in selected patients.

Objective To evaluate the safety and feasibility of hepatic resection for huge primary liver carcinoma (PLC). Methods 216 cases of huge PLCs(mean diameter of 14.2cm) were resected. The hepatectomies were performed under intermittent occlusion of hepatic inflow. Results All 216 cases were successfully resected. The mean time of occlusion of hepatic inflow was 19min, the mean blood loss was 743 ml. No serious complications occurred, and only seven patients died of hepatic failure and upper gastrointestinal haemorrhage postoperatively in this series. Conclusions Although resection of huge PLC is quite difficult, but if suitable surgical techique and perioperative management are adopted ,it is safe and feasible .

Objective To explore the prevention and treatment of early pulmonary infection after liver(transplant).Methods A retrospective analysis was carried out on the clinical data of 34 cases suffered from post-transplant pulmonary infection among 62 cases of liver transplant.Results Among the 34 cases,27 cases recovered and 7 cases died.The sputum of 27 cases was cultured positive for bacteria and fungus(including) Gram-negative bacteria(51.9%),Gram-positive bacteria(29.6%) and fungus(18.5%),cytomegalovirus 1 case,EB virus in 1 case,and pathogens unknown in 5 cases.Conclusions (Gram-negative) bacteria are the main pathogens of pulmonary infection after liver transplant.The critical stage of pulmonary infection is the first week after operation.The perioperative management of respiratory tract and rational use of antibiotics are important for prevention and treatment of post-transplant pulmonary infection.

Objective To study the feasibility and safety of hand-assisted laparoscopic modified Sugiura procedure for portal hypertension. Methods Ten patients with cirrhotic portal hypertension and splenomegaly underwent hand-assisted laparoscopic modified Sugiura procedure. Results The operation was successful in all 10 patients. Mean surgical time was 189.5 minutes, Mean blood loss was 141 ml. There was no mortality nor serious postoperative complications. The mean postoperative hospital stay was 10. 5 days. Conclusions Hand-assisted laparoscopic modified Sugiura procedure is feasible and safe. It helps to reduce operative difficulty and control intraoperative bleeding for patients with portal hypertension.

Objective To explore the surgical management in patients with Bismuth Ⅳ hilar cholangiocarcinoma.Methods Retrospective study was used to analyze the clinical data with operative and pathologic diagnosis of Bismuth Ⅳ hilar cholangiocarcinoma in the recent five years.Results Of the 22 patients,there were 13 males and 9 females,with M∶F=1.4∶1.In the group of non-liver transplantation(NLTX),5 cases(31.3%) underwent resection(radical resection in 2 cases;palliative resection in 3 cases),and 11 cases had nonresectional internal or external drainage.In the liver transplantation group(LTX),the resection rate was 100 %(6/6).Five LTX cases survived for 28,19,17,12 and 9 months respectively,and one died from chronic rejection in 11 months after operation.In the NLTX group,the 1-and 2-yr survival rate was 32.1 % and 0% respectively.The 1-and 2-yr survival rate of LTX was 80.0 %(4/5)and 50.0 %(1/2)respectively.There was significant difference between the two groups in average survival rate(P=0.041).Conclusions Aggressive surgical treatment should be adopted for Bismuth Ⅳ hilar cholangiocarcinoma,and radical resection is crucial to enhance survival rate.LTX is a good choice for the patients with unresectable Bismuth Ⅳ hilar cholangiocarcinoma and the prognosis is satisfactory.