Objective To evaluate the clinical effectiveness of laparoscopic cholecystectomy ( LC) combined with endoscopic sphincter-otomy ( EST) for treatment of gallstones with common bile duct stones. Methods Clinical data of 652 patients who were treated by LCs and ESTs were retrospectively analyzed. Results ESTs were successfully accomplished in 634 patients (97. 2%), and LCs were successfully ac-complished in 621 among the 634 patients (97. 9%) after ESTs. The mean length of hospitalization after LCs was 4 days (2~15 days). In all 652 patients, there were 233 cases of acute pancreatitis, including 171 cases before ESTs and 62 cases (13. 1%) after ESTs, and they were all cured after ESTs. In 621 patients after LCs, bile leakages occurred in 8 patients (1. 2%) and they were cured with intraoperative drainages. Local fluid accumulations occurred in 120 patients (19. 0%), and 118 cases of them healed without management, and the other 2 cases were cured with percutaneous tube-placement drainages guided by ultrasonography because of abscesses. Conclusion It is safe and effective to treat gallstones with common bile duct stones by LC combined with EST because of its high success rate, short hospital stay and mild complications.

Objective: To explore the major factors which influence the hospitalization expense of fibroid operation,provide references for the effective control of the increasing medical expense and ease the burden of patients. Methods: From January 2011 to December 2012, 1 837 cases of fibroids in our hospital were investigated, and pathway analysis method was used to analyze the factors which influence the hospitalization expense. Results: Operation method, whether use hysterectomy, the year of medical treatment, complication, medical group and nosocomial infection are the critical influencing factors which can directly effect on the hospitalization expense, and these factors not only have direct effects but also have indirect effects on hospitalization expense. Conclusion:Government and medical institutions should take comprehensive measures to decraease hospitalization expense, including the reasonable treatment options, rational drug use, active treatment and prevention of infection.

Objective To observe whether coagulation zones can be produced by intraductal radiofrequency ablation (RFA) in vivo and investigate the effect of portal blood flow on the sizes of coagulation zones. Methods Fourteen bile duct targets in hepatic hilar from 6 swines were equally divided into non-Pringle manoeuvre group and Pringle manoeuvre group. A 13mm segment of non-insulated mono-electrode was inserted into the bile duct, then RFA was performed under the condition of 5 W power output for 4 minutes. The pathological changes of bile duct and adjacent hepatic tissues were observed. Results Semi-oval offwhite coagulation zones in the sections were observed in both groups, with obvious dark-red rims around them. Necrosis and denaturation of mucosal and submucosal layers of bile duct and denaturation of adjacent hepatic tissue in coagulation zones were observed under optical microscope. The dark-red rims revealed hepatic hemorrhage. The mean long axial diameter of coagulation zones in the non-Pringle manoeuvre group and Pringle manoeuvre group was (13.29±1.38)mm and (13.29±1.1 1)mm, respectively, with no statistical difference (t=0.000, P>0.05). The mean short axial diameter of coagulation zones in the non-Pringle manoeuvre group and Pringle manoeuvre group was (3.14±1.07)mm and (4.57±0.98)mm, respectively, with statistical difference (t=2.611, P<0.05). Conclusions Intraductal RFA can produce a typical ablation zone. The portal blood flow affects the short axial diameter of coagulation zone but does not affect the long axial diameter.

Objective:To observe the complications caused by radiofrequency ablation (RFA) after RFA via the lumen of bile duct in hilum hepatis and the pathological progress of the tissue in ablation zones. Methods: Fourteen healthy dogs were randomly divided into 2 groups with 7 dogs each group. RFA by inserting a 13 mm non-insulated mono-electrode into the lumen of bile duct was performed under general anesthesia on 10 W power output, 4 min ablation duration in group Ⅰand on 5 W power output, 8 min ablation duration in group Ⅱ. After RFA, 2 dogs were sacrificed in 3 days and 1 dog in 9 days and 4 dogs in 14 days respectively in each group. The complications concerning RFA such as bile leakage, cholelithiasis, hepatic artery thrombosis, portal vein thrombosis, hepatic vein thrombosis1 and vena cava thrombosis were observed. Results: Portal vein thrombosis, hepatic vein thrombosis and vena cava thrombosis occurred in one dog. Cholelithisis occurred in one dos. No hepatic artery thrombosis occurred in all dogs. No bile leakage caused by RFA occurred in all dogs. Obvious necrosis of the mucosal and submucosal layers of the wall of bile duct and hepatic tissue in coagulation zones occurred in 3 days after RFA. The infiltration of inflammatory cells and partial fibrosis of the mucosal and submucosal layers of bile duct and hepatic tissue occurred in 9 days after RFA. Obvious fibrosis of the wall of bile duct and hepatic tissue occurred in 14 days after RFA. Conclusions: The complications caused by RFA occur seldom after RFA via the lumen of bile duct. The necrosis, the infiltration of inflammatory cells and gradual fibrosis of the mucosal and submucosal layers of bile duct and hepatic tissue occur in ablation zone.

objective To evaluate endoscopic surgery for high risk patients over 70 years old with severe acute cholangitis. Methods From October 1991 to October 2003, 84 high risk patients over 70 years old suffering from severe acute cholangitis were included and divided into laparotomy surgery (ST) and endoscopic surgery (ET) group. Results 80 patients were cured. The care rate was 81.2% in ST group and 91.6% in ET group. The mortality rate was lower in ET compared with ST (9.1% vs 18.8%). The rate of complication was reduced from 37.5% in ST group to 13.9% in ET group. The average duration of drainage was reduced from 49.4 days in ST group to 18.6 days in ET group. The total treatment days were shortened from 46.2 days to 22.8 days comparing ST with ET. Conclusions Endoscopic surgery should be the first choice for the senile and high risk patients with severe acute cholangitis. Endoscopic surgery was convenient, with mininal injury, safe and effective, and period of treatment was shortened, especially for elderly or critically ill patients, as well as those with MODS or previous billiary operations.

Glenohumeral subluxation is one of the most frequent complications in patients with post-stroke hemiplegia. This paper reviewed the recent advances in research on post-stroke Glenohumeral subluxation from the epidemiology, pathogenesis and related factors, diagnosis,treatment and so on.

Objective:To explore the effect of L-glutamine(Gln) on liver Bcl-2mRNA expres sion and apoptosis after total hepatic inflow occlusion in rats.Methods:Male Wistar rats were assigned randomly to three groups(n=40):Group A sham-operation group,group B control group,rats were pretreated with 4 ml 0.9% saline intraperitonally twice per day on 5 consecutive days,group C,rats were pretreated with Gln dissolved in 4 ml 0.9% saline intraperitoneally twice per day on 5 consecutive days.The rats from group B and C underwent total hepatic inflow occlusion for 35min by the pringle's manoeuvre.Ten rats from each group were randomly chosen and killed before the initiation of occlusion at 2 h,4 h,24 h after reperfusion respectively.The levels of MDA,GSH in liver tissue were measured.The serum concentrations of ALT,AST,LDH were assayed on a standard biochemistry autoanalyser.The expression levels of Bcl-2 mRNA in liver were assessed by RT-PCR.The apoptosis of liver were observed by DUTP method.The percentage of apoptosis was analyzed.Results:Compared with group B,the levels of GSH in group C increased after reperfusion(P

Objectives:To explore the effect of L-glutamine(Gln) on intestinal injury following total hepatic inflow occlusion.Methods:Male Wistar rats were assigned randomly to three groups(n=40) :Group A,sham-operation;Group B,control group,rats were pretreated with 4 ml 0.9% saline intraperitonally twice per day on 5 consecutive days;Group C,rats were pretreated with Gln dissolved in 4 ml 0.9% saline intraperitoneally twice per day on 5 consecutive days.The rats in group B and C underwent total hepatic inflow occlusion for 35min by the pringle' s manoeuvre.Ten rats from each group were randomly sacrificed before occlusion and at 2,4,24h after reperfusion respectively.The levels of MDA,SOD,GSH in intestine tissue were measured.The levels of serum TNF-? and portal vein endotoxin were detected.Results:Compared with group A,the levels of GSH and SOD decreased after reperfusion(P

Objective To evaluate the endoscopic managements of acute cholangitis of severe type (ACST) accompanied with multiple organ dysfunction syndrome (MODS). Methods A total of 122 ACST patients accompanied with MODS from January 2000 to October 2008 underwent endoscopic treatment in two time periods. In critical phase, emergent endoscopic retrograde cholangiopancreatography (ERCP) plus en-doscopic naso-biliary drainage (ENBD) were performed to correct critical situation of the patients. After sta-bilization, endoscopic sphincterotomy (EST) plus stone removal, EST plus stent placement, or laparoscopy was performed according to the causes of ACST. Results Emergent endoscopic managements succeeded in all patients of critical phase. At third day post-operation, a reduction in white blood cell count, serum total bilirubin, body temperature, and rate of patients with shock, mental symptoms and purulent bile juice was a-chieved. Recovery rate of dysfunction organs was 60.2% at one week after emergent procedure, and 82. 6% at 2 weeks post-operation. Selective EST plus stone removal was performed in 36 patients with a success rate n one session at 91.7%. Laparoscopic cholecystectomy was performed in 85 patients with a success rate of 95.3%. Stent was placed in 16 patients with an effective rate of 81.3% at 3 months post the procedure. No severe complication or death occurred during the whole therapeutic course. The 6-month survival rate of 10 cancer cases was 70%. Conclusion Therapeutic ERCP plus ENBD is the first choice for acute severe cholangitis accompanied with MODS, while EST plus biliary lithotomy, or EST plus stent placement, or com-bined laparoscopy are ideal methods for subsequent treatment.

This study was aimed to discuss possible problems in the data collection process of traditional Chinese medicine (TCM) clinical medicine and to propose appropriate solutions. Based on analysis of clinical data features and data collection demands among 20 TCM clinical research bases, reference were made on key technologies of the Electronic Medical Records' integration and sharing, to propose the solution of TCM clinical data collection. The re-sults showed that proposing the metadata and data entities synchronized intersecting strategy, analyzing key points on this strategy, and proposing appropriate solutions, found the technical processes of the TCM clinical data collec-tion. It was concluded that the analysis and solution on key points of TCM clinical data collection provided the basis and the reference to data collection issues of TCM clinical research base.