3 d in 16)were converted to open surgery because of massive adhesion at the Calot's triangle(13 cases),severe wound hemorrhage(4),common bile duct stones(4),gallbladder-duodenum fistula(2),gallbladder-colon fistula(1),or Mirizzi syndrome(1).During the operation,no bile duct injury occurred.None of the patients had intra-abdominal haemorrhage,biliary leak,or subhepatic abscess after the operation.The 279 patients were followed up for 5 to 24 months with a mean of 12 months,during which no patients complained of abdominal pain or jaundice.Conclusions The success of LC depends on early treatment and strict selection of patients.Intraoperative hemorrhage and bile duct injury can be avoided by sufficiently exposing the Calot's triangle and using the technique of flush-suction blunt dissection.Conversion to open surgery is necessary when LC is difficult.

Objective To observe the liver function changes in patients after enteral nutrition through nasal jejunal tube.Methods Altogether 74 inpatients requiring enteral nutrition were collected for this study from September 2011 to August 2014 in the Intensive Care Unit of Zhengzhou People's Hospital and divided into 2 groups with random number table:the nasal jejunal tube group (n =36) and the nasogastric tube group (n ＝38),with nasal jejunal tube and nasogastric tube inserted,respectively,for early enteral nutrition.We observed the two groups of patients in terms of liver function indexes on day 7 and day 14 after starting enteral nutrition.Results In the nasal jejunal tube group,31 patients (86.11％) showed abnormality in at least 1 liver function index,while that number was 23 in the nasogastric tube group (60.53％),with significant inter-group difference (x2 =6.136,P =0.013).On day 7 after enteral nutrition,there were no significant differences in alanine transaminase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),γ-glutamyl transpeptidase (γ-GGT) and albumin (ALB) between the two groups [(39.1 ± 8.6) U/L vs.(42.3 ±8.9) U/L,t=-1.475,P=0.145;(36.2±6.8) U/Lvs.(38.0±7.1) U/L,t=-1.237,P=0.220;(61.8±11.5) U/Lvs.(63.1 ±13.2) U/L,t=-0.696,P=0.489;(47.3±8.2) U/Lvs.(50.5±7.5) U/L,t=-1.640,P=0.106;(35.2±6.7) g/Lvs.(36.2±7.4) g/L,t=-0.610,P=0.543];but on day 14,the nasal jejunal tube group had significantly higher levels of ALP,γ-GGT,and ALB compared with the nasogastric tube group [(201.2 ± 15.2) U/L vs.(116.5 ± 13.6) U/L,t =-25.380,P =0.000;(109.4±7.2) U/Lvs.(49.2±6.5) U/L,t=-37.665,P=0.000;(37.2±7.1) g/Lvs.(30.1±6.5) g/L,t =-4.490,P =0.000].On day 7 and day 14,there were no statistically significant differences in totalbilirubin [(4.6±0.9) μmol/L vs.(4.8 ± 1.0) μmol/L,t =-0.905,P=0.368;(4.8±12) μmol/Lvs.(5.2±1.1) μmol/L,t=-1.492,P=0.140],indirect bilirubin [(6.1 ±0.8) μmol/Lvs.(6.3±0.9) μmol/L,t=-1.012,P=0.315;(6.9±0.9) μmol/L vs.(7.3±1.0) μmol/L,t=-1.811,P =0.074],and direct bilirubin [(4.0 ± 0.6) μmol/L vs.(3.9 ± 0.5) μmol/L,t =0.777,P =0.440;(5.1 ±0.8) μmol/L vs.(5.4±0.9) μmol/L,t=-1.517,P=0.134] between the nasogastric tube and the nasal jejunal tube groups.The incidence of pulmonary infection in the nasal jejunal tube group was significantly lower than that in the nasogastric tube group (30.56％ vs.55.26％,x2 =4.598,P =0.032).Conclusion Compared with enteral nutrition through nasogastric tube,enteral nutrition through nasal jejunal tube may be more likely to lead to abnormal liver function.

OBJECTIVE To explore the possibility of no recurrent laryngeal nerve injury in thyroid surgery. METHODS A total of 659 consecutive patients with thyroid disease undergoing thyroidectomy byotolaryngologists from March 2001 to March 2005 were retrospectively analyzed. The operative mode and incidence of complications, particularly postoperative RLN palsy, hypoparathyroidism and postoperative recurrence were evaluated. Routine dissection and identification of the RLN was performed during all operative procedures and parathyroid with the blood supply was preserved. RESULTS Unilateral total thyroidectomy with contralateral partial lobectomy was performed in 376 cases, unilateral total thyroidectomy with isthmectomy in 87, bilateral subtotal thyroidectomy with the remnant left at the upper pole in 76, total thyroidectomy in 73. The operations on 47 patients with substernal goiter have been successfully performed via cervical collar incision. None of our patients incurred unilateral or bilateral vocal cord paralysis and permanent hypocalcaemia. Of these patients, the incidence of temporary postoperative hypocalcemia was 1.67 %(11/659). Postoperative hemorrhage requiring reoperation occurred in 4 cases (0.60 %) and 5 patients developed wound haematomas (0.76 %).Postoperative hypothyroidism was found in 3 patients(0.45 %).The incidence of postoperative recurrence was 0.15 %(1/659). No patients had incision infection. CONCLUSION With knowledge of the anatomy of the RLN and routinely complete identification the RLN in performing capsular dissection high on the surface of the thyroid gland, RLN injury may be avoided in thyroid surgery. [

Objective To summarize our experience in the prevention and treatment of right accessory hepatic duct and right hepatic duct injury during laparoscopic cholecystectomy. Methods The clinical data of 21 cases with right accessory hepatic duct or right hepatic duct during laparoscopic cholecystectomy were reviewed retrospectively. Result According to anatomy identified by preoperative work-up and selective cholangiography during the operation, 18 cases had the right accessory hepatic duct,eleven of them were confirmed intraoperatively. The accessory hepatic ducts were conserved in 3 cases and clipped without biliary leaks postoperativly in 7 cases; One case had biliary leaks postoperatively with the duct sutured intraoperatively, and recovered well conservative therapy. Accessory hepatic ducts were accidentally injuried in 7 cases, two patients were transferred to open surgery; three cases were confirmed to be injuried and clipped by second laparoscopic exploration because of biliary leaks postoperatively. Three cases had a low confluence of the right and left hepatic duct with the gallbladder duct joining the right bile duct, the ducts were conserved in 2 cases and injuried in one. Postoperatively all these 21 cases were followed up for 2 years, without jaundice or liver dysfunction. Conclusions To prevent injury of right accessory hepatic duct and right hepatic duct. High vigilance and familiarity with the anatomic variants of the biliary tree and intraoperative cholangiography in selective cases are fundmental.

Objective To analyze the diagnosis and treatment of pancreatic pseudocyst. Method This study included 46 pancreatic pseudocyst cases, 7 received conservative therapy, 12 received internal drainage, 9 received external drainage, 5 received sequential internal and external drainage and 13 received partial pancreatectomy. Result Cases receiving conservative therapy recovered well without recurrence, one case receiving internal drainage suffered from postoperative pancreatic fistula, one receiving external drainage was complicated with pancreatic fistula and recurrence developed in another 2 cases, one case undergoing partial pancreatectomy was complicated with postoperative pancreatic fistula. Conclusion Pancreatic pseudocyst should be managed individually according the course and patients' clinical condition.

Objective To evaluate the feasibility and efficacy of laparoscopic splenectomy(LS). Methods In this study 41 cases were enrolled including 10 cirrhotic splenomegaly cases and 17 idiopathic thrombocytopenic purpura cases. The clinical data of 41 cases undergoing LS was retrospectively reviewed. KG2Result Two cases were shifted to open surgery, LS was successful in 39 cases with average operating time of 238 min, the average spleen weight was 389 g, blood loss 318 ml, postoperative GI movement started from 12 to 24 hrs. The average postoperative hospital stay was 4 days. Postoperative complications occurred in 3 cases including intraabdominal bleeding, subcutaneous emphysema, and stabbing-caused abdominal wall bleeding in one each. Conclusion LS is safe and less traumatic in selected patients indicated for splenectomy, especially for those suffering from haemotologic diseases.

ObjectiveTo evaluate the effect of laparoscopic cholecystectomy (LC) combined with intraoperative cholangiography (IOC) and intraoperative endoscopic sphincterotomy (IOEST) for the diagnosis and treatment of choledocolithiasis. Methods Statistical analysis was carried out for 106 patients with cholecystocholedocolithiasis diagnosed and treated by LC-IOC-IOEST. Results Sixty-four (60.4%, 64/106 ) patients with preoperative diagnosis of simple gall stone were found with complicated choledocholithisis; LC-IOC -IOEST was successfully performed in 99(93.4%, 99/106) cases. Six cases (6.1%) suffered from mild postoperative acute pancreatitis. Duodenal perforation, bile leakage, peumothorax (0.9%) developed in one each. Duodenal adenocarcinoma was overlooked in one case, and 2 cases (1.8%) suffered from gastric paralysis. Conclusion LC combined with IOC and IOEST was a safe, effective approach to the diagnosis and minimally invasive treatment of choledocholithiasis.

Objective To analyze risk factor of bile duct injury (BDI) during laparoscopic cholecystectomy (LC). Methods A retrospective population-based cohort study was carried out on 13878 patients undergoing LC from Apr 1994 to Dec 2003. Patients were divided into BDI group and non-BDI group. Factors with statistically significant differences between groups in anivariable analysis were selected to construct a multivariate logistic regression mode. Result Among 13878 LC procedures 38 BDI (0.27%) were identified. Factors which were of significant differences between groups in anivariable analysis includ diameter of common bile duct(?~2=5.92, P

0.05). CONCLUSION The sound localization apparatus can test the localization ability of person, and it can be used in simply and reasonably.

BACKGROUNDTo investigate the diagnostic significance of detection of telomerase activity of bronchoalveolar lavage liquid (BALF) in primary lung cancer.

METHODSBALF of 63 patients with lung cancer and 31 patients with non-cancerous pulmonary disease was collected, and telomerase activity was detected with silver-stained TRAP. Brush cytology and BALF cytology were carried out simultaneously.

RESULTSThe positive rate of telomerase was 76.2% (48/63) in lung cancer group, which was higher than 6.5% (2/31) in control group (Chi-square=40.6, P < 0.01). The positive rate was also higher than that of brush cytology (58.7%, 37/63) (Chi-square =3.6, P > 0.05), and higher than that of BALF cytology (14.3%, 9/63) (Chi-square=46.3, P < 0.01). In central type lung cancer group, the positive rate of telomerase was 71.4% (35/49), and higher than that of BALF cytology (12.2%, 6/49) (Chi-square= 35.3 , P < 0.01), but had no significant difference compared to that of brush cytology (61.2%, 30/49) (Chi-square=1.1, P > 0.05). In peripheral-type lung cancer group, the positive rate of telomerase in BALF was 92.9% (13/14), and higher than that of brush cytology (50.0%, 7/14) and that of BALF cytology (21.4%, 3/14).

CONCLUSIONSThe telomerase activity could be detected in the BALF of the primary lung cancer. Hence, detection of telomerase in the BALF of patients may be helpful to diagnose lung cancer.