Objective To summarize the clinical experience of laparoscopic cholecystectomy (LC) for acute cholecystitis. Methods Clinical records of 79 cases of acute cholecystitis treated by LC from September 2002 to August 2003 were respectively reviewed. Results Intraoperative cholangiography (IOC) was successfully conducted in 75 cases, 6 of which were found common bile duct stones. Of the 6 cases, 4 underwent LC combined with intraoperative endoscopic sphincterotomy and 2 underwent a conversion to open choledochotomy with T-tube drainage. The rest of 73 cases were diagnosed as simple gallbladder stones: LC was successfully accomplished in 70 cases and a conversion to open surgery was required in 3 cases because of serious inflammatory adhesion. In the study no severe complications occurred. Conclusions LC can be performed safely in the majority of cases of acute cholecystitis.

Compared to portal vein embolization and traditional two-stage hepatectomy,associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can induce the proliferation of liver rapidly,concomitantly with high incidence of complications and mortality in the perioperative period.The feasibility and safety have been improved gradually as the improvement of technology and the accumulation of experience.But it is still controversial on its efficacy for malignant tumors,especially with insufficiency of medium-and long-term out-comes.The mechanism of rapid proliferation induced by ALPPS needs more studies with further steps.

Objective:Establishing the hepatic stem cell(WB-F344)line that expresses human interleukin-2 stably and effectively.Methods: We constructed the retroviral vector Plpcx-il-2 containing human interleukin-2 gene, and transfected it into PT67 packaging cells.The infectious viruses were used to infect the hepatic stem cell WB-F344,then the puromycin resistant clones were acquired after puromycin selection.The expression of IL-2 was detected using RT-PCR,immunocytochemistry, Western blot and indirect immunofluorescence, respectively.Results: The retroviral vector containing human IL-2 gene was constructed.The titer of virus in the supernatant reached 10~5 CFU/ml after transfecting PT67 packeting cells.The puromycin resistant clones were acquired after infection of WB-F344 and the cell line WB-F344/Plpcx-IL-2 expressing human interleukin-2 stably was established.Conclusion: By retroviral-mediated transfecting human interleukin-2 gene, the hepatic stem cell stably and effectively expressing interleukin-2 are obtained.This provides a good basis for further research on immuno-gene therapy of liver cancer.

Objective To evaluate the effect of a biodegradable paclitaxel-eluting biliary stent on bile duct scar formation and biliary stricture by observing the healing process after stent placement in a porcine billiary model.Methods A novel biodegradable paclitaxel-eluting biliary polylactide stent was manufactured by immersion method.The efficacy of drug release for paclitaxel-eluting biliary stent was investigated by HPLC.Paclitaxel-eluting stent were surgically inserted in the bile duct of fifteen swines in experimental group while stent without paclitaxel were placed in other fifteen swines in control group.Animals were sacrificed after 1,3,6 months.The anastomic healing of the common bile duct was observed.The size of anastomosis was measured and compared between the two groups.Result A novel biodegradable paclitaxel-eluting biliary stent was manufactured.The total amount of paclitaxel released was about 281 pg (30.4％) over a month as determined with HPLC methods.There was no death,no leakage.The diameter of anastomosis in the experimental group was significantly larger than that in control group.Cholangiography did not show obvious bile duct dilatation in experimental group.Histologic examination showed less hyperplasia of the bile duct wall in the experimental group than that in control group.Conclusion Release of paclitaxel via a biodegradable stent relieves billiary stricture in porcine model and have no obvious negative influence on wound healing of the common bile duct.

Objective To determine the quantitative indices of conservative treatment for perforation of peptic ulcer. Methods The clinical data of 321 patients admitted from 1990 to1999 were analyzed retrospectively. Score was obtained according to patients' age, extension of abdominal pain, time of perforation, fever,abdominal paracentisis,free air of abdominal cavity, etc.Results Conservative treatment was given to 85 patients who scored ≤ 2, of whom 81 (95.2%) recovered.In 22 patients who scored 3, 16 (72.7%) recovered.In 8 patients who scored 4, 2 (25.0%) recovered.Conclusions If the perforating ulcer patients scored less than 2, conservative treatment should be given.For those who scored 3, conservative treatment can be given for the first 24h,and then whether to continue conservative treatment or change to operation should be considered according to patients' condition.For patients scored ≥ 4 , an operation should be performed as soon as possible.

Objective To discuss the mechanism and prevention of bile duct injury in laparoscopic cholecystectomy (LC). Methods Twenty-six cases with bile duct injuries in this study were evaluated retrospectively regarding their location, mechanism, time of detection, repairment and outcome, and the role of intraoperative cholangiography (IOC) in preventing bile duct injury. Results Among a total of 26 cases there are duct injury due to misidentification 15 cases,( IOC detected the misidentification of bile duct injuries intraoperatively 10 cases, clipping the common duct 3 cases, duct thermal injuries 4 cases and duct lacerations 4 cases, Conclusion Duct injury due to misidentification was the main type of bile duct injury in LC, Correct interpretation of IOC will detect the duct injury intraoperatively and prevent the severe consequence. Meticulous dissection and exposure of the junction of distal common hepatic duct, proximal common bile duct, and proximal cystic duct, and safe hemostasis in Calot triangle are the important measures to prevent bile duct injury in LC.

Objective To study the effects of different operation time of laparoscopic cholecystectomy(LC) on systemic stress response.Methods A total of 40 patients conducted by LC were divided into the Group A(

Objective To investigate the feasibility a nd the clinical significance of modified laparoscopic transabdomimal preperitoneal (TAPP) mesh and suture inguinal herniorrhaphy. Methods Clinic al records of 13 patients with inguinal hernia treated by laparoscopic TAPP mesh plug combined with suture fixation from June 2002 to October 2004 in this hospi tal were retrospectively reviewed. Out of the 13 patients, there were 9 patients with indirect inguinal hernia and 4 patients with direct hernia, including 1 re current patient. The hernia was right-sided in 8 patients, left-sided in 4, and bilateral in 1. Results All the operations were completed succ essfully. The unilateral operation time was 35~85 min (mean, 50 min). No convers ions to open surgery were required and no postoperative complications were noted . The mean duration of postoperative hospital stay was 2 days. Follow-up observa tions for 1~28 months (mean, 12 months) in the 13 patients found no recurrence. Conclusions Laparoscopic TAPP mesh plug combined with suture fixation, characterized by advantages of simplicity of performance, minimal inva sion, little postoperative pain, and quick recovery, is a safe, reliable and eff ective alternative of inguinal herniorrhaphy. This technique can replace the ope n surgery and is recommended for wide application.

ObjectiveTo assess the value of intraoperative cholangiography(IOC) for detecting bile duct injury during laparoscopic cholecystectomy.Methods31 cases of bile duct injuries were reviewed regarding the site of injury,mechanism,time of diagnosis,and the place of IOC was evaluated.ResultsBile duct injuries resulted from misidentification in 19 cases.In 12 of these 19 cases,the diagnosis was made by IOC.Primary laparoscopic repair or open repair and T-tube drainage solved the problem without postoperative complications.However,in 3 of the above 19 cases the result of IOC was misinterpreted and in 4 of the above 19 cases IOC was not performed.Two of the 7 patients had aberrant bile duct injuries, in all of them the diagnoses were delayed.There were two cases in which bile duct injury developed after an IOC.ConclusionsCorrect interpretation of IOC enables detecting bile duct injury caused by intraoperatively misidentification and consequent morbidity.

Objective To evaluate the feasibility,safety and therapeutic efficacy of laparoscopic radical resection for gastric carcinoma. Method In this study,15 patients with gastric carcinoma underwent laparoscopic radical resection from May 2005 to Aug 2006,clinical parameters including surgical procedures,operation time,blood loss,time for passage of flatus,complications and pathological findings were recorded. Result All operations were successful.Five cases received laparoscopic radical distal gastrectomy,5 cases received hand-assisted laparoscopic radical distal gastrectomy,laparoscopic total gastrectomy was performed in 4 cases,laparoscopic proximal gastrectomy was performed in 1 case.The operation time ranged from 195 to 350 min,the blood loss was 100 to 600 ml.The average time of intestinal function recovery was(2.9 ± 0.8)days.The average number of lymph nodes dissected were(28±6).There was no major postoperative complications.Postoperative follow-up were 24 months in 15 cases,there were no metastasis and tumor recurrence.Conclusion Laparoscopie radical gastrectomy is a feasible and safe surgical procedure for patients of gastric carcinoma.