Objective To study the experience on a variety of hepatectomy by occluding the branches of hepatic artery and portal vein to the liver lobe,segment at hilar H fissure.Methods A total of three hun-dred and ninteen patients accepted hepatectomy in Hunan provincial people's hospital from Decemember 2006 to Decemember 2007 were involved in this study for retrospective analysis.Results There were no perioperative deaths and liver function failure in this series of patients.The average amount of blood loss was 70 15ml,and 302 (95 %)cases did not receive transfusion.Postoperative complications such as liver necro-sis,bile leaking,bleeding were not found.Subphrenic abscesses were found in 3 cases,which were cured conservatively.Conclusion Selective regional occlusion of hepatic blood flow during bepatectomy avoided the risk of ischemia-reflow injury of remnant liver,which is safe and effective to prevent massive bleeding and to reduce the incidence of liver failure.

Objective To investigate the application of selective hepatopetal blood occlusion techniques in anatomic hepatectomy.Methods We retrospectively reviewed the clinical data of 259 patients with hepatolithiasis or liver tumor undergoing anatomic hepatectomy under selective hepatopetal blood occlusion from January 2006 to December 2009.Results Totally,183 cases with hepatolithiasis and 76 cases with liver tumor underwent anatomic hepatectomy under selective hepatopetal blood occlusion.The average intra-operation blood loss was 210 mL(120-1 600 mL);post-operation incidence of complications and the rate of residual stones was 10.9% and 4.2%,respectively.Thre was no operative death in this series.The intrahepatic recurrence and metastasis rate of liver tumor was 23.6% and the median recurrence was 16.3 months.Conclusions The use of a appropriate selective hepatopetal blood occlusion during anatomic hepatectomy for hepatolithiasis and liver tumors is an effective measure to reduce surgical complications and improve outcome.

Objective To study the operative procedure for stage III and IV hilar cholangiocarcinoma. Methods A crescent shape excision on the edges of multiple hepatic segments followed by a 'skirt edge′ form hepatoenterostomy to drain the multiple hepatic ducts was used to treat unresectable stage III,IV hilar cholangiocarcinoma, . Results (1)the mean survival time was 15.65 months;(2)the patient comfortable index was 81.5%;(4)there was no operative death in the series. Conclusions The 'skirt edge' form hepatoenterostomy is a feasible and effective palliative method for unresectable stage III,IV cholangiocarcinoma.

Objective　To study the experience in prevention and treatment of iatrogenic bile duct trauma(IBDT). Methods　A retrospective study was made on the clinical data of 118 patients with iatrogenic bile　 duct trauma admitted to the Hunan Provincial People's Hospital from March 1990 to September 2000. Results　50.8%　(60/118) of patients with IBDT resulted from the wrong identification of the anatomy of the Calot' Triangle during cholecystectomy. The clinical diagnosis of IBDT depended on the clinical findings, diagnostic abdominocentesis and image examination. The diagnostic rate of ultrasonography for IBDT was 93.2%(110/118). According to the injury site of bile duct, IBDT could be divided into 6 types, the most common type of　 IBDT was resection of partical hepatic duct and part common bile duct(type Ⅲ) which occurred in 83.9%　(99/118) of the patients. The cure rate of IBCT was 100%(118/118) in this series due to the choice of operation according to the trauma type. Conclusions　The key of prevention to IBDT lies in abiding by the princible of “identifying-cut-recognazing” during cholecystectomy. The choice for surgical operative procedure should agree with the trauma type.

Objective To investigate the effect of c-myc ASODN on the proliferation and invasion of human bile duct carcinoma cell line QBC939. Methods QBC939 cells was conventionally cultured. C-myc ASODN was designed and transfected into QBC939 cell line. MTT assay and transwell experiment were used to study cell proliferation and invasion of QBC939 cells. Results MTT assay showed that cell survival rate in ASODN group was significantly lower than that in blank group(P < 0.05). Transwell experiment showed that the num-ber of cells penetrated in ASODN group was significantly lower than that in blank group(P<0.01). The cell survival rate and the number of cells penetrated in vechicle group had no difference with blank comparison group(P>0.05). Conclusions C- myc ASODN can inhibit the proliferation and invasion of QBC939 cells.

Objective To explore the expressions of cyclooxygenase-2 (COX-2), phosphatase and tensin homolog deleted on chromosome ten (PTEN) in hepatobiliary calculus associated with cholangiocarcinoma (HCWC) and their clinical significance. The relationship between the expressions of COX-2, PTEN and the onset and progression of HCWC was investigated to form an experimental base for the prevention and treatment of HCWC. Methods Thirty seven patients with tumor tissues of HCWC (group C), thirty patients with tissues of bile duct surrounding intrahepatic calculus (group B), and ten patients with normal tissues of bile duct from operations of hemangiomas of liver or liver trauma as the control (group A) were sampled and collected. A two-step immunohistochemistry (SP method) was employed to detect and statistically analyze the expressions of COX-2 and PTEN in each of the 3 groups. Results In groups A, B, C, the positive rate of the expression of COX-2 was 10%,33.3%, and 70.3%, respectively. The positive rates of expression of COX-2 in the carcinoma tissues of HCWC was significantly higher compared with the control group (P＜0. 01). In groups A, B, C the positive rates of the expression of PTEN was 90. 0%, 80. 0%, and 35.0%, respectively. The positive rate of expression of PTEN in the carcinoma tissues of HCWC was significantly lower than the control group (P＜0. 01). The expression of COX-2 was followed by a low expression of PTEN in the tissues of HCWC. Kendall's related analysis showed a strong negative correlation between the expression of COX-2 and PTEN in HCWC (r=-0. 323, P＜0. 05). Conclusions A high expression of COX-2 was related to HCWC. There was a negative correlation between the expressions of COX-2 and PTEN in HCWC. A high expression of COX-2 and a low expression of PTEN suggested a high chance of HCWC in extrahepatic or lymphatic metastasis.

Objective To summarize the experience in surgical management of bile duct injury. Methods The clinical data of 683 patients with bile duct injury who were admitted to the Hunan People's Hospital from August 1990 to December 2008 were retrospectively analyzed. Of all the patients, seven received hepatectomy +T tube drainage, two received liver repair + T tube drainage, four received external biliary drainage + hepatectomy,27 received liver repair or hepatectomy + silicone support, 233 received temporary portal triad clamping + gelatin sponge hemostasis, 72 received biliary repair + T tube drainage, 248 received hepatobiliary basin Roux-en-Y anastomosis, 22 received external biliary drainage, 61 received long arm T tube drainage, two received pancreaticoduodenectomy and five received hepatectomy + T tube drainage. The surgical outcomes were evaluated by analyzing the results of the follow-up. Results The surgical outcomes were ranked excellent, good and poor according to the condition of patients and the results of imaging examination. Six hundred and twelve patients were followed up for 8 months to 19 years, and the surgical outcomes were excellent in 337 patients (55.1%), good in 214 patients (35.0%) and poor in 61 patients ( 10.0% ). Conclusion The surgical outcome of bile duct injury could be satisfactory if the approach of the surgery is properly selected.

Objective To investigate the clinical effects of laparoscopic pancreaticoduodenectomy (LPD) for distal cholangiocarcinoma.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 37 patients who underwent LPD for distal cholangiocarcinoma in the Hunan Provincial People's Hospital between January 2013 and November 2016 were collected.LPD for distal cholangiocarcinoma was performed using the "en-block" procedure.According to the principle of "one axis,two planes and four zones",anatomy used posterior approach,anterior approach and medial approach,lymph node dissection was performed from carotid sheath outside,and en bloc specimens were resected.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination was performed to detect the patients' recurrence-free survival up to November 2017.Measurement data with normal distribution were represented as (x)±s.The survival curve and rate were drawn and calculated by the Kaplan-Meier method.Results (1) Surgical and postoperative recovery situations:all the 37 patients underwent successful LPD,without conversion to open surgery and perioperative death.The operation time,volume of blood loss and case with intraoperative blood transfusion were (326 ± 55) minutes,(176± 39)mL and 1,respectively.The time to initial exsufflation and time for diet intake were respectively (4.5± 1.6)days and (5.3±2.7)days.Of 37 patients,14 had postoperative complications,including 8 with pancreatic fistula (6 with biochemical fistula and 2 with grade B pancreatic fistula),1 with biliary fistula,3 with postoperative bleeding (2 with intra-abdominal bleeding and 1 with gastrointestinal anastomosis bleeding),2 with delayed gastric emptying (grage A),2 with intra-abdominal infection and 2 with pulmonary infection;the same patients can merge multiple complications.Three patients were in Clavien-Dindo classification ≥ Ⅲ.One patient received reoperation and other patients were improved by symptomatic treatment.Duration of hospital stay of 37 patients was 13.5 days (range,8.0-33.0 days).Eight patients underwent adjuvant chemotherapy of 4-6 cycles by taking orally tegafur or gemcitabine with cisplatin.(2) Postoperative pathological examination:tumor diameter and pancreatic duct diameter of 37 patients were (2.1±1.1)cm and (2.5±1.2) mm,respectively.Of 37 patients,9,13 and 15 were respectively detected in high-differentiated,moderate-differentiated and lowdifferentiated adenocarcinoma.Surgical margins:35 patients received R0 resection and 2 received R1 resection.Number of lymph node dissected,cases with lymph node metastasis and number of positive lymph nodes were respectively 18.5±4.9,16 and 1.7± 1.4.Analysis of lymph node metastasis location showed that the positive rates in 8a,12,13,14 and 17 groups lymph nodes were respectively 5.4％ (2/37),18.9％ (7/37),21.6％ (8/37),8.1％ (3/37) and 10.8％ (4/37);Perineural invasion (PNI),lymphovascular invasion (LVI),pancreatic invasion and duodenal invasion were identified in 14,9,16 and 6 patients,respectively.TNM stage:stage 0,Ⅰ A,Ⅰ B,ⅡA and Ⅱ B were respectively detected in 1,3,5,12 and 16 patients.(3) Follow-up situation:of 37 patients,36 were followed up for 6-45 months,with a median time of 26 months.The median recurrence-free survival time,1-and 3-year recurrence-free survival rates were respectively 28 months,80.6％ and 42.2％.Conclusion LPD is safe and effective for distal cholangiocarcinoma,and "en-block" resection not only helps to optimize the process of LPD for distal cholangiocarcinoma,but also has a significant effect on R0 resection and lymph node dissection.

Objective: To summarized the experience in laparoscopic duodenum-preserving pancreatic head resection (LDPPHR). Methods: The clinical data of four patients who underwent LDPPHR from February 2017 to June 2018 in Hunan Provincial People’s Hospital were retrospectively analyzed. The Clinical characteristics, operation time, intraoperative blood loss, biliary fistula rate, pancreatic fistula rate and follow-up data were analyzed. Results: The four patients included one patient with a solid pseudopapillary tumor and three patients with a serous cystadenoma. Two patients underwent duodenum-preserving total pancreatic head resection, and two patients underwent duodenum-preserving subtotal pancreatic head resection. The operation time of the four patients was (525.8±121.8) minutes, and the blood loss (250.0±191.5) ml. Biliary duct drainage was carried out in 2 patients: one patient developed biochemical bile leakage, while another had no postoperative complication. The two patients without biliary drainage developed grade B pancreatic leakage, delayed bile leakage, abdominal bleeding and infection. All the three patients who developed postoperative complications were treated conservatively and they recovered well. Conclusions LDPPHR was designed to better preserve the integrity and function of digestive tract. However, the perioperative complications were high. This operation should only be carried out in large pancreatic centers. Routine biliary drainage is recommended to surgeons with little experience in this operation.

Lymph node metastasis is the important survival predictor in patients with distal cholangiocarcinoma.With the application of laparoscopic pancreaticoduodenectomy in radical resection of distal cholangiocarcinoma,it is of great clinical significance to explore lymphadenectomy in laparoscopic radical resection of distal cholangiocarcinoma.The American Joint Committee on Cancer (AJCC) Cancer Staging Manual (8th ed) has became the new global guideline for cancer diagnosis and treatment since January 2018,which provides a new recommendation for lymphadenectomy of distal cholangiocarcinoma.This review provides an overview of the clinical significance of total lymph node count and number of involved lymph nodes,"en-block" procedure in lymphadenectomy,membrane anatomy for lymphadenectomy,experience and skills in lymph node dissection,lymph node sorting after surgery,adjuvant therapy in the treatment of distal cholangiocarcinoma.