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 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.

This paper was aimed to study effects of diosgenin on expressions of activator protein-1 (AP-1) and vascular endothelial growth factor (VEGF) in synovial tissues of collagen-induced arthritis (CIA) rats induced by bovine type II collagen, in order to investigate the possible mechanism of herbal medicine diosgenin in the treatment of rheumatoid arthritis (RA). After the CIA rats models were successfully established, rats were randomly divided into the blank control group, CIA model group, diosgenin group, and positive medicine control (tripterygium) group. The in situ hybridization was used to detect the expressions of AP-1 (c-fos and c-jun) in synovial tissues of the knee joint. The real-time PCR was used to detect the VEGF mRNA expression in synovial tissues of rats’ knee joints. The results showed that c-jun and c-fos, VEGF mRNA expressions in synovial tissues of rats’ knee joints were obviously higher than that of the blank control group (P<0.01). After treatment of diosgenin and tripterygium, the expressions of c-jun and c-fos, VEGF mRNA were significantly reduced (P<0.01). It was concluded that diosgenin may regulate the expression of VEGF in synovial tissues through c-jun and c-fos of AP-1 in order to inhibit synovial angiogenesis for the treatment of RA.

Objective To investigate the expression and clinical significance of mammalian sterile 20-like kinase 1 (MST1) in cervical cancer. Methods Immunohistochemical method was applied to detect the expression level of MST1 protein in specimens of cervical cancer tissues (n=139) and pericarcinomatous tissues (n=20, with≥4 cm distance from the primary tumor's edge). Western blot assay and qPCR were used to detect the protein and mRNA transcription expression levels of MST1 in 20 pairs of cervical cancer tissues and pericarcinomatous tissues, respectively. The correlation between MST1 expression, clinic pathological features and the prognosis were analyzed. Results MST1 was mainly expressed in cytoplasm. The positive expression rate of MST1 was significantly lower in cervical cancer tissues (27%, 38/139) than that in pericarcinomatous tissues (80%, 16/20,χ2=21.62, P<0.01). The expressions levels of MST1 protein and mRNA were both lower in the cervical cancer tissues (P<0.01). In cervical cancer, the positive expression rate of MST1 inⅠb+Ⅱa stage was higher than that ofⅡb+Ⅳstage (P<0.05), the positive expression rate of MST1 in lymph node metastasis was lower than that of without lymph node metastasis (P < 0.05). Values of age, tumor size, histological type and differentiation degree showed no significant difference to positive expression rate of MST1. Moreover, the negative expression of MST1 displayed a significantly poorer overall survival time than that of positive expression of MST1 (Log-rank χ2=28.35, P < 0.01). Conclusion MST1 shows a lower expression in cervical cancer, which may be a new target for clinical treatment and prognosis of cervical cancer.

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

Objective To study the relationship between angiogenesis and pathology and prognosis of cholangiocarcinoma. Methods Immunohistochemistry was used to determine micro-vessel density (MVD) and the expression of vascular endothelial growth factor(VEGF) and its receptor Flk-1/KDR in 50 cholangiocarcinoma cases. Results were compared with pathological and follow-up parameters. Results MVD in cholangiocarcinoma tissues and para-tumor tissues (34.04 ? 11.08, 32.80 ?9.28) were higher than normal bile duct tissues ( 11. 67 ? 4. 64) ( P

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.

Objective To investigate the occurrence of postoperative healthcare-associated infection(HAI)in pa-tients with hepatobiliary malignant tumor,explore the related risk factors,so as to provide the basis for taking ef-fective prevention and control measures.Methods The occurrence of postoperative HAI in patients with hepatobili-ary malignant tumor in a hospital from January 2012 to December 2014 were retrospectively analyzed,risk factors for postoperative HAI were analyzed through reviewing and collecting patients’medical data.Results A total of 302 patients were investigated,42 (13.91 %)developed postoperative HAI,no multiple site infection occurred,the main infection site was deep surgical site (n=10,23.81 %),followed by lower respiratory tract (n=9,21 .43%) and digestive system (n=7,16.67%).Of 42 infection cases,38(90.48%)were sent specimens for pathogenic cul-ture,36 pathogenic strains were isolated,31 (86.11 %)of which were gram-negative bacteria,and 5 (13.89%) were gram-positive bacteria.Multivariate logistic analysis showed that operation duration≥2 hours (OR =1 .48), overweight (or obesity)(OR=1 .40),and preoperative radiotherapy (OR=2.98)were independent risk factors for postoperative HAI in patients with hepatobiliary malignant tumor (all P <0.05).Conclusion Incidence of postoper-ative HAI is high in patients with hepatobiliary malignant tumor,risk factors are long length of operation,over-weight (or obesity),and preoperative radiotherapy,effective prevention and control measures against risk factors should be taken.

Objective To investigate the clinical efficacy and experiences of laparoscopic hepatectomy (LH) for segment Ⅶ and Ⅷ liver tumors.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 94 patients who underwent LH for segment lⅦ or Ⅷ liver tumors in the Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from June 2010 to August 2016 were collected.The operating space for operation was built under laparoscopy.According to liver cirrhosis grading,tumor size,adjacent relationship with major blood vessels and residual liver volume,non-anatomical and anatomical hepatectomies were selected by patients.During the operation,tumors were precisely pinpointed and plane of liver resection was determined,and then proper instruments of liver partition and techniques of hepatic inflow occlusion were selected.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situation.Follow-up using outpatient examination and telephone interview was performed to detect the patients' survival up to July 2017.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (interquartile range).Survival rate was caculated by the Kaplan-Meier method.Results (1) Surgical and postoperative recovery situations:all 94 patients received successful operations,without perioperative death,including 73undergoing non-anatomical hepatectomy and 21 undergoing anatomical hepatectomy.Fourteen patients had conversion to open surgery and 27 received hepatic inflow occlusion.The median operation time,median volume of intraoperative blood loss and cases with intraoperative blood transfusion were respectively 187.5 minutes (75.0minutes),200 mL (200 mL) and 15.Eighteen patients had postoperative complications,including 6 with pleural effusion,6 with abdominal effusion,1 with wound infection,1 with abdominal infection,1 with venous thrombosis,1 with bleeding,1 with coagulation disorders and 1 with hepatic insufficiency.Clavien-Dindo classification of complications:11,1,5 and 1 patients were detected in grade Ⅰ,lⅡ,Ⅲ and Ⅳ,respectively.All complications were improved by symptomatic treatment.The median duration of hospital stay was 7 days (6 days).(2) Postoperative pathological examination:results of tumor pathological examination showed that 45,5,9 and 35 patients were respectively confirmed as hepatocellular carcinoma,cholangiocarcinoma,metastatic hepatic carcinoma and benign liver tumor.(3) Follow-up and survival situation:59 patients with malignant tumors were followed up for 6.0-52.0 months,with a median time of 42.6 months.Postoperative 1-and 3-year overall survival rates of 59 patients with malignant tumors were 98.3％ and 84.7％,respectively.Conclusions LH for segment Ⅶ and Ⅷ liver tumors which is conducted in experienced medical center is safe and feasible,with definite effects.Building operating space for operation under laparoscopy,determining precise positioning of the tumor and plane of liver resection,and selecting proper instruments of liver partition and techniques of hepatic inflow occlusion are the key points of successful operation.

Objective To evaluate the maneuvre of curettage and aspiration(LTCA) in laparoscopic hepatectomy. MethodsWe used Peng′s multifunctional operative dissector(PMOD) to perform laparoscopic liver transection by maneuvre of curettage and aspiration in 20 cases undergoing laparoscopic hepatectomy. Results Procedures were all successful. The recovery was uneventful without any complications. Mean operative time was 105 minutes, the average bleeding volume was 420 ml, the largest excised sample size was 10 cm?9 cm?7 cm. All patients were discharged within one week. ConclusionsThe new technique-LTCA can be used in laparoscopic hepatectomy, it has the advantages of clear anatomy, good exposure of canal construction, rapid liver transection, satisfactory hemostasis and clear operative field.