Objective To explore the application value of layered suture technique in laparoscopic common bile duct exploration with primary suture. Methods A total of 216 patients received laparoscopic common bile duct exploration with primary suture in our hospital from March 2007 to March 2013.Of these cases, layered suture technique was utilized in 89 patients and single-layer suture was used in 127 patients.The operation time, postoperative hospital stay, and postoperative complications were compared between the two groups. Results Two groups of patients were operated smoothly, with no conversions to laparotomy.Postoperative recovery was smooth.The operative time was not significantly different between the two groups of patients (t=-0.931, P=0.353). The postoperative hospital stay and incidence of postoperative bile leakage were significantly lower in layered suture group than those in single-layer suture group [(5.9 ±1.7) d vs.(7.7 ±1.8) d,t =7.400, P=0.000;3.4%(3/89) vs.20.5%(26/127), χ2 =13.167, P=0.000].In the single-layer suture group, the incidence of postoperative bile leakage was significantly higher in patients complicated with acute cholangitis [45.4%(10/22) vs.15.2%(16/105),χ2 =8.429, P=0.004], whereas in the layered suture group, the incidence of postoperative bile leakage was insignificantly different among patients with and without acute cholangitis [7.1%(1/14) vs.2.7%(2/75),χ2 =0.002, P=0.964]. Conclusion Application of layered suture technique in laparoscopic common bile duct exploration with primary suture is feasible and safe, with advantages of less bile leakage and shorter hospital stay.

Objective To evaluate the safety and feasibility of laparoscopic right hemi-hepatectomy for hepatolithiasis.Methods The clinical data of 3 patients who underwent laparoscopic right hemi-hepatectomy were analyzed retrospectively.Results In 2 patients the operation was performed successfully.The operative time was 340 min and 300 min,and the intraoperative blood loss was 800 ml and 400 ml.There was no need for blood transfusion.There was a small amount of bile leakage (30-60 ml/day) in these 2 patients.The postoperative hospital stay was 9 d and 11 d.The third patient was converted to open surgery because of profuse bleeding.All the 3 patients recovered well from surgery.Conclusions Total laparoscopic right hemi-hepatectomy for hepatolithiasis was safe and feasible.

Objective To study the feasibility and results of laparoscopic anatomical liver resection for hepatolithiasis.Methods A retrospective study was conducted based on the clinical data of 103 patients who underwent laparoscopic anatomical liver resection from June 2007 to July 2013.Results Total laparoscopic anatomical liver resection was successfully carried out in 97 patients.The mean operation time was 225.5 minutes,the blood loss was 50 ～ 1 000 ml and the mean postoperative hospital stay was 11.4 days.Postoperative complications included bile leakage (n =18),abdominal cavity infection (n =3),pulmonary infection (n =4),wound seroma (n =3),right hepatic duct injury (n =1).There was no perioperative death.Conclusion Laparoscopic anatomical liver resection for hepatolithiasis is a feasible,practical,and minimally invasive procedure.

Objective To apply Nutritional Risk Screening-2002(NRS-2002) to perform primary screening for nutritional risk in patients with esophageal cancer who undergo radiotherapy, and assess their nutritional status, and to investigate the value of NRS-2002 in such patients.Methods A total of 97 patients who were diagnosed with esophageal cancer and underwent radiotherapy in Zhejiang Cancer Hospital from January 2010 to April 2014 were analyzed retrospectively.The Kaplan-Meier method was applied to analyze the difference in survival, and the chi-square test and the Pearson correlation analysis were applied to analyze the correlation between NRS-2002 score and blood parameters.Results Of all patients, 26.8%had nutritional risk before radiotherapy, which gradually increased with the progress of radiotherapy.The 1-year overall survival rates of the patients with NRS-2002scores of ≤3 and ≥4 on admission were 91.1%and 61.9%, respectively (P=0.010).As for the patients with the highest NRS-2002 scores of ≤2 and ≥3 during treatment, the 1-year overall survival rates were 94.2% and 77.5%, respectively (P=0.012).As for the patients with the lowest NRS-2002 scores of ≤3 and ≥4 during treatment, the 1-year overall survival rates were 91.3% and 54.5%, respectively ( P=0.018).The NRS-2002 score was correlated with prealbumin on admission and at week 1 of radiotherapy (P=0.000 and 0.002), and the NRS-2002 score was correlated with albumin at week 3 of radiotherapy (P=0.036).The multivariate analysis showed that the TNM stage of esophageal cancer and the highest NRS-2002 score during treatment were the independent prognostic factors in esophageal cancer (P=0.001 and 0.005).Conclusions The patients with esophageal cancer undergoing radiotherapy have high nutritional risk, and NRS-2002 score is the independent prognostic factor in these patients and can be used as a tool for primary screening for nutritional risk.

Objective To study the feasibility and results of laparoscopic surgery for cholelithiasis in elderly patients over 80 years old.Methods A retrospective study was conducted on 53 patients over 80 years old who underwent laparoscopic surgery for cholelithiasis from January 2015 to April 2017.Results The operation was successfully carried out on 53 patients.The intraoperative blood loss was 5 ～ 300 ml.The operation time was (93.5 ±41.2) minutes and the postoperative hospital stay was (11.0 ± 3.7) days.Postperative complications included bile leakage (n =5),intra-abdominal infection (n =1),pulmonary infection (n =5),wound seroma (n =2).There were no perioperative deaths.Conclusion Laparoscopic surgery for cholelithiasis was safe and efficacious in elderly patients over 80 years old.