0.05).Conclusions Epidural anesthesia and lower pneumoperitoneum pressure(8 mm Hg) can completely meet with demands of most LC operations,and have the advantages of safety,economy and minimal invasion.

Objective To investigate the influence of propofol on the induction of inducible nitric oxide synthase (iNOS) expression in spinal cord after spinal cord injury (SCI) in rats. Methods SCI model was reproduced according to Allen′s method with modification. Seventy-four SD rats were randomly divided into three groups: normal group (n=4), SCI with propofol treatment group (n=35), and SCI with saline treatment group (n=35). Immunohistochemistry and Western blot were employed to detect iNOS expression in spinal cord at different time (1h, 3h, 8h, 1d, 3d, 7d, 14d). Results The results showed that iNOS expression in spinal cord of propofol treatment group was significantly decreased compared with that of saline treatment group (P

Objective To evaluate the effect of clonidine as an adjuvant of PCEA with morphine and ropivacaine in patients with essential hypertension and it' s effects on hemodynamics and plasma concentrations of endothelin-1 ( ET-1) and calcium gene-related peptide ( CGRP) . Methods Sixty ASAⅠ - Ⅱ patients of both sexes (24 males, 36 females) with a history of essential hypertension for 1-2 years were included in this study. The patients ranged in age from 45-72 yrs and in body weight 55-70 kg and were scheduled for elective pelvic surgery under combined general-epidural anesthesia. An epidural catheter was placed at T12-L1 or L1-2 interspace before induction of general anesthesia. Anesthesia was induced with fentanyl 4 ?g ? kg-1 , propofol 2 mg?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with isoflurane and epidural analgesia. The patients received PCEA after operation. The PCEA regimen included a loading dose of 5 ml followed by background infusion at 2 ml?h-1 with an 1 ml bolus dose and a 15 min lockout interval. The PCEA solution contained morphine 2 mg + ropivacaine 75 mg in group A (n = 20); clonidine 150 ?g + morphine 2 mg + ropivacaine 75 mg in group B ( n = 20) ; clonidine 300 ?g + morphine 2 mg + ropivacaine 75 mg in group C ( n = 20) in 60 ml of normal saline. BP, HR, VAS pain score (0 = no pain, 10 worst pain) and Ramsay sedation score (1 = wide awake, 5-6 over sedated) were recorded one day before operation (T0), before induction of anesthesia (T1 ), 0, 5, 15, 30, 60 min, 2, 4, 8, 20, 24 h (T2-11 ) after PCEA was commenced. Blood samples were taken before induction of anesthesia (baseline) and 6 and 24 h after operation for determination of plasma concentrations of ET-1 and CGRP. The total number of button pressing (D1) and the number of actual delivery of bolus dose (D2) and the consumption of PCEA solution were also recorded. Results VAS pain score was significantly higher in group A than that in group B and C ( P

Objective To compare the effects of laparoscopic hepatectomy (LH) versus conventional laparotomy hepatectomy (CLH) on cellular immunity. Methods Fifteen ASA Ⅱ-Ⅲ patients aged 34-61 yrs, weighing 48-75 kg undergoing laparoscopic hepatectomy (LH) were studied. Another 15 patients aged 33-64 yrs, weighing 46-73 kg undergoing conventional laparotomy hepatectomy (CLH) served as control. The preoperative liver function was rated as Child classification A in both groups. The patients were premedicated with phenobarbital 0.1 g and atropine 0.5 mg i.m. . Anesthesia was induced with fenlanyl 4 ?g?kg-1, propofol 1.5 mg?kg-1 and succinylcholine 2 mg?kg-1. After tracheal intubation the patients were mechanically ventilated and PETCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with inhalation of isoflurane (MAC 1.0?0.31) and 60% N2O in O2 and intermittent i.v. boluses of vecuronium. The patients received after operation patient-controlled epidural analgesia (PCEA) with 0.125% ropivacaine and morphine 0.05 ?g?kg-1?min-1. Radial artery and right internal jugular vein were cannulated for BP and CVP monitoring. Peripheral venous blood samples were taken before operation and on the 1 st and 3rd postoperative day for determination of CD3+ , CD4+ , CD8+ T cells (by flow cytometry) and IL-6, TNF-?concentrations (ELBA) . Results CD3+ , CD4+ and CD8+ counts were significantly decreased while IL-6 and TNF-?levels were significantly increased on the 1st postoperative day compared with the baseline values before operation in both groups but there was no significant difference between the two groups. On the 3rd postoperative day CD3+ , CD4+ and CD8+ counts and IL-6, TNF-?levels returned to preoperative level in group LH while in group CLH CD3+ , CD4+ , CD8+ remained low and IL-6, TNF-?levels remained high.Conclusion The results suggest that LH exerts less effects on immune function than conventional laparotomy technique.

Objective To study the relationship ofiliac vein, portal vein(PV) and superior mesenteric vein (SMV), explore the feasibility on application of iliac vein in extended pancreatoduodenoctomy, and observe the clinical results. Methods Portal system and iliac venous system were dissected in 20 adult corpses. The caliber, thickness and branches of iliac vein, PV and SMV were observed and compared. The application of iliac vein in extended pancreateduodenoctomy were studied in 2 patients. Results There were no branch in 30 mm near lilac vein, 1 branch in 30--50 nun and 2-3 branches in 51-70 ram. The thickness and caliber of iliac vein matched with PV's and SMV's, there was no significant difference. Only proper pro-longed operative incisions were needed and the operation time was 5-7 hours. Postoperative vascular throm-bosis, necrosis of intestine, liver failure and so on were not occurred. No evidence of vascular embolism and recurrence happened within 6-16 months' follow-up. Conclusion Uiac vein, as a choice, can be used for vasotransplantation in the pancreatoduodenectomy.

Objective To investigate the safety of laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively.Methods Forty patients who received laparoscopic common bile duct exploration and lithotomy at the Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from January 2011 to June 2013 were prospectively analyzed.All the patients were randomly divided into 2 groups according to the random number table.Twenty patients in the experimental group did not received drainage tube placement,and the other 20 patients in the control group had subhepatic drainage after operation.The operation time,duration of hospital stay and incidence of postoperative complications were compared between the 2 groups.Patients received computed tomography and B sonography at postoperative month 1 and 3,and then patients were reexamined every 6 months till postoperative year 3.The follow-up was ended on July 31,2013.The measurement data and the count data were analyzed using the independent sample t test and the Fisher exact probability,respectively.Results Patients in the 2 groups were cured after the operation.The operation time and duration of hospital stay were (117 ± 11) minutes and (5.6 ± 0.6) days in the experimental group,and (108 ± 12)minutes and (7.9 ± 0.7)days in the control group,with significant difference between the 2 groups (t =2.453,-ll.388,P ＜ 0.05).No complications including bile leakage,residual stones,obstructive jaundice,abdominal bleeding and subphrenic infection were detected after the operation.Thirty-one patients were followed up for 1 month to 2 years,no bile duct stone recurrence or biliary stricture were detected during the follow-up.Conclusion Laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively is safe and feasible.

AIM: To explore mechanism by which sodium butyrate induces mouse embryonic stem cells(ES) to differentiate into hepatocytes in vitro.METHODS: E14 mouse ES cells were cultivated in a routine way,and then cultivated in suspension to form embryonic bodies(EBs).EBs were transferred into 6-well culture dishes and 3 mmol/L sodium butyrate was added into the culture medium.Morphological changes were investigated by phase contrast microscopy.?-fetoprotein(AFP),albumin(ALB) and cytokeratin 18(CK18) were examined by immunofluorescence staining.AFP,ALB,?_1-antitrypsin(AAT) and TTR mRNA were assayed by RT-PCR.Proportion of ALB positive cells was analyzed by flow cytometry.Periodic acid Schiff(PAS) reaction and indocyanine green(ICG) uptake assay were performed to assess the characteristic hepatocyte function of the differentiated cells.RESULTS: In the presence of sodium butyrate,parts of ES cells differentiated into a population with epithelial morphology similar to mouse hepatocytes.AFP and TTR mRNA expression were observed at 7 d,and ALB and AAT mRNA expressed at 14 d.Hepatocytes specific markers,ALB,AFP and CK18 were positive expression in immunofluorescence staining at 14 d.PAS reaction and ICG uptake were positive for the hepatocyte-like cells.CONCLUSION: Mouse ES cells can be induced into hepatocyte-like cells by sodium butyrate efficiently,and these ES cells-derived hepatocytes possess characteristic hepatocytic function.

Objective To compare the effect of pericardial devascularization with that of the modified Sugiura procedure in management of portal hypertension. Methods From 1990 to 2008, 236patients with portal hypertension underwent operations including pericardial devascularization in 147and modified Sugiura in 89 in our hospital. Results There were 12 perioperative deaths (8.2 % ), and 2 rebleedings (2 % ) in the pericardial devascularization group, and 7 perioperative deaths (7.9 % ) and 2 rebleedings(3.4 % ) in the modified Sugiura group. The follow-up rate was 91.9 % in the pericardial devascularization group and 87.8% in the modified Sugiura group respectively, in a period from 6 months to 19 years. The 1-, 3-and 5-year rebleeding rates were 5.7%,15.2% and 25.5% in the pericardial devascularization group and 6.9%, 16.3%, 29.5 % in the modified Sugiura group, respectively. The 1-, 3- and 5-year survival rates were 87.8% ,79.1% and 69.7% in the pericardial devascularization group and 95.8 %,85.0%, 76.9 % in the modified Sugiura group, respectively. Conclusion Modified Sugiura procedure and pericardial devascularization have differences in perioperative mortality as well as rebleeding and survival rates.

Gallbladder cancer is a biliary malignant disease with difficulty in early diagnosis, high malignancy and poor prognosis. Radical resection is the most effective approach to improve the prognosis of patients. With the update of minimally invasive devices and the accumulation of surgeon experience, laparoscopic surgery has achieved satisfactory results in the treatment of malignant tumors of the digestive tract, but there is still controversy in its application in gallbladder cancer treatment, mainly due to lack of reliable evidence for improved survival outcomes. The current studies indicated that laparoscopic surgery could benefit some patients with early gallbladder cancer in perioperative period and survival. For advanced gallbladder cancer, although there is still no consensus on the resection extent, laparoscopic staging can prevent patients from unnecessary expanded resection. The minimally invasive process of radical cholecystectomy needs to be promoted through a high-quality diagnosis and treatment process. Only in this way can there be practical clinical evidence to guide the best clinical practice.

Objective To investigate the value of three dimensional (3D) laparoscopic anatomical hepatectomy for liver tumors. Methods Clinical data of 10 patients with liver tumors who underwent 3D laparoscopic anatomical hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from September to November 2013 were analyzed retrospectively. There were 7 males and 3 females with age ranging from 36 to 62 years old and the median age of 49 years old. The primary disease were primary liver cancer (n=8), hepatic hemangioma(n=2). The informed consents of all patients were obstained and the ethical committee approval was received. All the patients underwent 3D laparoscopic anatomical hepatectomy through endotracheal general anesthesia. The operators and assistants wore special 3D glasses. After the 3D laparoscope was inserted through the navel incision, operation channels were established by putting 3 to 4 trocars (5 mm or 10 mm) at different positions of upper abdomen respectively, and then anatomical hepatectomy was performed according to the diseased region. The operaton procedures, intraoperative blood loss, length of hospital stay and postoperative complications of patients were observed. Results All the 10 patients underwent anatomical hepatectomy through 3D laparoscope, and no case converted to open surgery during the operation. Three cases received right hemihepatectomy, 3 cases received segment Ⅴ+Ⅵ hepatectomy, 2 cases received hepatic left lateral lobectomy, 1 case received mesohepatectomy, and 1 case received segment Ⅴ hepatectomy. The average operation duration of patients who underwent right hemihepatectomy was (270±26)min, segment Ⅴ+Ⅵ hepatectomy was (122±8)min, hepatic left lateral lobectomy was (90±7)min, mesohepatectomy was 245 min, and segment Ⅴ hepatectomy was 95 min. The intraoperative blood loss was (483±104), (233±29), (125±35), 450, 180 ml, and the length of hospital stay was (17±5), (11±1), (9±1), 13, 10 d accordingly. Liver disfunction was observed in 1 case out of the patients after right hemihepatectomy. Right lower lung infection was observed in the patient after mesohepatectomy. No complication was observed in the other 8 patients after operations. Conclusions The 3D laparoscope has a certain advantage in dissecting the intrahepatic ductal structures precisely, and can help to control the intraoperative blood loss. It is applicable to anatomical hepatectomy for liver tumors, especially to hemihepatectomy.