Objective To investigate short-term effects of laparoscopic liver lobectomy for the treatment of hepatocellular carcinoma. Methods A comparison was made between 17 cases of laparoscopic liver lobectomy (segmentectomy) (Laparoscopic Group) and 22 cases of open hepatectomy (Open Group) from January 2001 to June 2004. The operative time, blood loss, blood transfusion amount, liver functions and blood picture before and after the surgery, and complications between the two groups were compared respectively. Results The operative time was longer in the Laparoscopic Group (median, 300 min) than in the Open Group (median, 145 min) ( u =107.05, P =0.023). Both groups presented a similar appearance in the blood loss and the blood transfusion amount. Serum levels of bilirubin and ALT varied within narrower limits in the Laparoscopic Group than in the Open Group. No significant difference was seen in blood pictures before and after the surgery in both groups. No complications happened in the Laparoscopic Group, whereas 4 cases of complications were observed in the Open Group (1 case of incision infection, 1 case of hydrothorax, 1 case of subphrenic dropsy, and 1 case of postoperative bleeding). Conclusions Laparoscopic liver lobectomy (segmentectomy) for hepatocellular carcinoma is minimally invasive, safe and effective.

Objective To explore the feasibility, difficulties and indications of video-assisted laparoscopic pancreaticoduodenectomy. Methods Clinical records of 5 cases of laparoscopic pancreaticoduodenectomy in this hospital from November 22, 2002 to April 28, 2005 were analyzed, with respect to preoperative diagnosis, surgical methods and procedures, intraoperative blood loss, operation time, difficulties encountered and countermeasures, and postoperative recovery. Related parameters included patient's temperature, drainage volume, blood routine, liver functions, amylopsin changes, postoperative complications, bowel movement recovery, and length of hospital stay. Results All the 5 cases of operation were successfully performed, with an operation time of 360~660 min (mean, 528 min) and an intraoperative blood loss of 150~2 000 ml (mean, 770 ml). Pathological examinations revealed 3 cases of well-differentiated papillary adenocarcinoma of the duodenum, 1 case of endocrine small-cell carcinoma of the head of pancreas, and 1 case of papillary adenomatoid hyperplasia of the duodenum with malignant changes accompanying intermediated-differentiated adenocarcinoma of upper and middle intrahepatic biliary duct. Postoperatively, a small amount of pancreatic leakage occurred in case number 1 and a digestive tract stress ulcer happened in case number 2, all of which were cured by symptomatic management. In case number 4, a recurrent pancreatitis with pulmonary infection was observed, and the patient died from stress ulcer hemorrhage on the 39th postoperative day. Except for the case number 4 in which the patient's highest temperature reached 39.5 ℃ after the recurrence of pancreatitis, the highest temperatures of the other 4 patients were all

Objective To summarize the anterior trans-sternal approach endoscopic subtotal thyroidectomy. Methods Clinical data of 10 cases of endoscopic subtotal thyroidectomy were reviewed. Results All endoscopic operations in the 10 cases were successfully completed. The operation time was 140～360 min (mean, 164 min), and the postoperative hospital stay ranged 4～8 days (mean, 5 days). No injuries of nerve or parathyroid glands, or other complications occurred. Conclusions The anterior trans-sternal approach endoscopic thyroidectomy is characterized by its safety, reliability, short incision, and good cosmetic results.

Objective To investigate the laparoscopic techniques in the diagnosis and treatment of acute abdominal emergency. Methods The efficacy of laparoscopic checkups and treatment in 122 consecutive patients with surgical acute abdomen admitted from January 2001 to February 2003 were analyzed retrospectively. Results Diagnosis was clarified under laparoscope in all the patients.Operations were completed under laparoscope in 117 patients,while a conversion to open surgery was required in 5 patients because of the limitation of vision scope or dense adhesion leading to difficult exposure.Two patients expired. Conclusions Laparoscopy is valuable for the differential diagnosis of surgical acute abdomen.Laparoscopic treatment can be completed in the majority of the patients,but is not advisable in certain cases.

Objective To study the characteristics of clinical and laboratory findings in patients with adrenocorticotropic hormone(ACTH)independent macronodular adrenocortical hyperplasia(AIMAH).Methods The clinical and laboratory findings of 7 cases of AIMAH admitted between 1997 and 2005 were reviewed retrospectively.Results 5 of the 7 patients showed typical clinical features of Cushing's syndrome,including moon face,central obesity,hypertension,etc.A part of patients had hypokalemia(43%)and secondary diabetes mellitus(71%).There was lowering of plasma ACTH levels,and an increased cortisol secretion or disturbance in or circadian rhythm.In 6 patients,a low dose or high dose of dexamethasone suppression tests failed to suppress cortisol secretion.CT scan showed bilateral macronodular adrenal hyperplasia.Pituitary MR imaging for pituitary was negative in 6 patients.Unilateral total adrenalectomy was performed in 2 cases.4 cases were treated by bilateral adrenalectomy.One patient died of stroke before operation.5 cases received glucocorticoid replacement therapy after operation.Pathologic examination showed diffuse yellow or brown nodules measuring 0.3 cm～7.0 cm in diameter in all the specimems of 6 patients who undement operation.There was no recurrence in all the patients ofter surgery during the follow-up period.No Nelson syndrome occurred in these 6 patients postoperatively.Conclusion AIMAH is a rare cause of Cushing's syndrome with unique clinical,CT image and pathological findings.Bilateral adrenalectomy in one stage or in stages,or unlateral adremectomy is indicated on the basis of clinical and CT findings.

Objective To evaluate the feasibility and efficiency of laparoscopic-guided radiofrequency ablation on advanced prostate cancer.Methods From March 2003 to December 2008,a total of 6 previous prostate cancer patients who had been diagnosed with pathological results were treated by laparoscopic-guided radiofrequency ablation.All patients underwent pre-and post-operative IPSS,serum PSA,MRI and normal blood biochemistry examination.The treatment outcome,surgery-related complications were also recorded.Results All operations were successfully completed,no serious intra-and post-operative complications happened.Although there was no significant difference of IPSS between pre-operative [ ( 19.05 + 4.28 ) scores ] and 1 month after operation [ ( 19.87 + 5.72) scores ],but there were significantly decreased in 3 months [ (9.45 ± 2.03 ) scores ] and 6 months [ (6.18 + 1.79) scores ] after operation (P ＜0.05).Also being followed up to 6 months after operation,the serum PSA was significantly decreased compared with the pre-operative value [from(24.80 ± 14.56) μ g/L reduced to( 13.79 ± 7.76) μ g/L](P＜0.05).Conclusion Laparoscopic-guided radiofrequency ablation on advanced prostate cancer is safe and feasible,and can be used as an effective treatment in selective cases.

Objective To investigate the expression of pro-inflammatory cytokines in lumbar dorsal root ganglions (DRG) of rats model of high-dose fentanyl induced hyperalgesia. Methods 64 male SD rats were divided into 2 groups (n = 32), fentanyl group and normal saline (NS) group. The rats were injected with fentanyl (60 μg/kg) or NS 4 times in total subcutaneously with a 15-minute interval. Mechanical and thermal nociception were measured via the tail pressure test (tail flick thresholds, TFT) and paw withdrawal test (paw withdrawal latency, PWL) at 1 day before, at 1, 2, 3 and 4 hour and on 1 ~ 7 day after administration. 4 rats were sacrificed and the lumbar DRG were harvested to analyze the expression of PGE2 , IL-1β, IL-6 and TNF-αvia ELISA. Results There were no significant changes of TFT, PWL and the expression of pro-inflammatory cytokines in DRG compared to baseline of rats in NS group. The value of TFT , PWL in fentanyl group were above the baseline at the 1 ~ 4 hour and below the baseline at 1~3 day after fentanyl injections. PGE2 , IL-1β, TNF-α and IL-6 increased on 1,3,5,7 day after fentanyl injections significantly. Conclusions High-dose fentanyl induced significant hyperalgesia and up-regulation of pro-inflammatory cytokines in DRG. The expression pro-inflammatory cytokines peaked later and were more protracted than the change of behavior test and show no direct relationship between the two.

Objective To evaluate the effect of methylprednisolone on hepatic ischemia-reperfusion (I/R) injury in the patients undergoing hepatolobectomy.Methods Sixty ASA physical status Ⅱ or Ⅲ patients,aged 30-64 yr,weighing 45-75 kg,scheduled for elective hepatolobectomy,were randomized to control group or methylprednisolone group (n =30 each).After induction of anesthesia,methylprednisolone 500 mg (in 100 ml of normal saline) was infused intravenously at 5 ml/min before skin incision in group M.Anesthesia was induced with propofol,fentanyl and cisatracurium.The patients were endotracheally intubated and mechanically ventilated.PETCO2 was maintained at 35-45 mmHg.Anesthesia was maintained with 1％-3％ sevoflurane inhalation,remifentanil infusion,and intermittent iv boluses of fentanyl and cisatracurium.MAP was maintained at 70-100 mmHg and HR at 50-90 bpm.At 10 min before induction of anesthesia,and on postoperative day 1,3 and 5,venous blood samples were collected for determination of the plasma levels of alanine aminotransferase (ALT),aspartate amminotransferase (AST),total bilirubin (TBIL),tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).Results Compared with group C,the plasma levels of ALT,AST and TBIL were significantly decreased on postoperative day l and 3,and the plasma concentrations of TNF-α and IL-6 were decreased on postoperative day 1,3 and 5 in group M.Conclusion Methylprednisolone can reduce hepatic I/R injury in the patients undergoing hepatolobectomy and inhibition of systemic inflammatory responses is involved in the mechanism.

Objective · To investigate antiemetic effect of aprepitant for moderately chemotherapy-induced nausea and vomiting in patients with gastrointestinal cancer. Methods · From 2014 July to 2015 August, 130 cases of gastrointestinal cancer patients were collected in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, who received moderate emetogenic risk of chemotherapy for at least four courses. One hundred and nine patients were treated with aprepitant, palonosetron and dexamethasone on day 1, and aprepitant and dexamethasone on day 2 and 3. Twenty-one patients only received aprepitant and dexamethasone on day 1 and dexamethasone on day 2 and 3 in the first course of chemotherapy. During subsequent courses of chemotherapy they received aprepitant and treated in the same way as 109 patients. MASCC antiemetic tool (MAT) was used to evaluate the intensity of nausea. The primary endpoint was complete response (CR, no emesis and use of no rescue antiemetics) during the overall study phase (0-120 h after chemotherapy) at the second course. The secondary endpoint was complete protection (CP, CR plus no significant nausea) during the overall, acute (0-24 h), and delayed (24-120 h) phases at the second course. Results · The CR rates were 90.0%, 94.6% and 90.8% of patients in the overall, acute and delayed phases, respectively. The corresponding CP rates were 83.8%, 87.8% and 84.6 %, respectively. The CR rate increased from 42.9% to 57.1% during acute phase and increased from 9.5% to 90.5% during delayed phase for 21 patients after treatment with aprepitant. The main adverse reactions include constipation, anorexia and hiccups. Conclusion · Aprepitant combined with palonosetron and dexamethasone can effectively prevent moderately chemotherapy-induced nausea and vomiting in patients with gastrointestinal cancer. Aprepitant therapy can effectively maintain antiemetic effect in patients with many chemotherapy courses.

Objective To evaluate the feasibility and efficacy of laparoscopic treatment of hepatic hemangioma. Methods The clinical data of 27 patients who received laparoscopic treatment of hepatic hemangioma from November 2003 to October 2009 were retrospectively analyzed. The hepatic inflow to the liver or to a hemiliver was temporarily blocked using a Pringle manoeuvre with a self-invented laparoscopic blocker at the porta hepatis or at the pedicle to the relevant hemiliver. The Electriccautery and ultracision were used for liver transaction. Results Laparoscopic treatment of hepatic hemangioma was successfully performed in 25 patients. Conversion to laparotomy was required in two (8%) patients for uncontrollable bleeding. There were no major postoperative complications and no mortality. The mean tumor diameter was (6.34±2. 17) cm. The operating time was ( 105.21 ±72.76)min. The time of hepatic inflow block was (10. 17±12. 21)min. The blood loss was (115. 5±212.14)ml. The volume of blood transfusion was (0. 87 ± 1.45)U. The volume of postoperative drainage was (112.60±201.03)ml. The time taken to return to normal activity was (2. 0±0. 8) days.The length of postoperative hospital stay was (5.5±2.4) days. The length of total hospital stay was (12. 5 ±5.3) days. The total cost was RMB10041.6±8678. 7. Conclusion In selected patients, laparoscopic treatment of hepatic hemangioma was safe and feasible.