Fluid therapy plays a quite important role in peri-operation period,however,conventional measurements are not sensitive to hypovolemia.Goal directed fluid therapy( GDT),which is based on balance of oxygen delivery and consumption,can achieve the aim of fluid therapy more efficiently.Many RCTs have proven that GDT could reduce morbidity,shorten hospital time of high risk surgical patients,therefore,it is a beneficial work.

Although natural orifice transluminal endoscopic surgery provides excellent cosmesis,it is not being widely accepted because of the restriction in aspects of technology,instruments and ethics.As a bridge,laparoendoscopic single site surgery(LESS)has been widely applied in digestive surgery,including bariatric,gastric,hepatobiliary and colorectal surgery.Although LESS provides excellent cosmetic results,and its safety and feasibility seems similar to conventional laparoscopy in most procedures,its effectiveness in the treatment of malignant tumors still needs to be proved. Compared with conventional laparoscopy,LESS has the drawbacks of longer operation time and higher demand in experience.Besides,because digestive tract reconstruction is often needed after resection,more convenient and applicable instruments need to be invented for the development of LESS.

In recent years, the concept of minimally invasive surgery has become accepted by the surgical community, though there are limitations in locating small gastrointestinal tumors when laparoscopy is used alone. Meanwhile, endoscopy is an excellent tool for locating these small tumors, though one must take extreme care to avoid hollow viscus perforation. Combination of laparoscopy and gastroduodenoscopy has extensive application in the resection of gastrointestinal stromal tumors, sessile gastric polyps and early gastrointestinal carcinoma. During laparoscopic operation, the endoscopist can help to locate the tumor or polyp. Endoscopy can also help to determine whether or not the tumor or polyp has been resected completely. In performing traditional laparoscopic colectomy for left-sided colonic tumors, specimen retrieval necessitates a mini-incision which is often the cause of postoperative pain, wound infection, and other pain-related complications. The combination of laparoscopy with transanal endoscopic microsurgery is feasible for selected patients with left-sided colonic tumors, and complications related to mini-incision can be avoided completely. Combination of laparoscopy and gastrointestinal endoscopy also benefits patients with acute bowel obstruction prior surgical operation. With the help of perineum-bowel tube, sigmoidoscopic technique can relieve acute bowel obstruction, so that these patients may have chance for laparoscopic operation. In summary, this hybrid approach can not only decrease surgical incisions, but also avoid some of the surgical risks of emergent operations.

Objective To explore the surgical indexes, therapeutic efficacy and prevention of complications in treatment of some blood diseases by splenectomy (including laparoscopic splenecto- my). Methods The clinical data of 27 patients with blood diseases receiving splenectomy in our hospi-tal were retrospectively analyzed. Results The effective rate of splenectomy was 100% in 4 cases of hereditary spherocytosis, 76.47% in 17 cases of ITP and low in 6 cases of Non-Hodgkin's lymphoma.The postoperative incidence of complications was 7.41% (2/27). Conclusion Splenectomy is of the first choice for treatment of hereditary spherocytosis. Meanwhile, it is effective for most of the patients with ITP. It is an important approach for comprehensive of malignant lymphoma. Proper choice of indications and perioperative management are helpful for decreasing incidence of postoperative complications.

The current treatment of chronic pancreatitis(CP) includes medicine, endoscopy, extracorporeal shock wave lithotripsy (ESWL) and surgical methods. In this paper, a variety of treatments of chronic pancreatitis, mainly progress in surgical methods are reviewed.

Objective To evaluate the preoperative diagnostic procedures and treatment choice of primary tumor of the duodenum (PTD).Method The clinical data of 52 cases with PTD in the last 10 years was analyzed retrospectively.Results The correct diagnostic rate of auxiliary examination was:duodenal endoscopy of 90.5%,air barium double radiography of 80%.Six primary benign tumors of duodenum (PBTD)were resected completely with a 5 year's survival of 100%.Among the 46 cases of primary malignant tumors of duodenum (PMTD),28 cases underwent pancreatoduodenectomy,4 cases received segmental duodenectomy,the remaining 13 cases in which the tumors were unresectable were treated bypass.The resection rate was 69.6% and the 5 years' survival rate was 32.6%.Conclusions Duodenal endoscopy and air barium double radiography are mainstays for the diagnosis of PTD.Segmental duodenectomy and simple tumor resection are curable for PBTD; while for PMTD,the therapy of choice should be pancreatoduodenectomy.

ObjectiveTo investigate the effect of IL-1? on primary cultured rat hepatocytes (PCRH).MethodsUsing PCRH of Wistar rats, the cytotoxicity of IL-1? (LDH release), the influence of IL-1? on cell proliferation and cellular energy metabolism (intracellular ATP content and KBR) were observed.ResultsIL-1? significantly increased LDH release on all 6 culture conditions with LDH activities of 22?2,25?4,18?5,12?4,15?5 and 11?4, in individual controls compared with 36?3,43?5,34?6,31?4,31?5 and 22?3,in individual IL-1? treated groups, all P

Purpose To explore the commonality and disparity between 64-slice CT coronary artery imaging and coronary angiography (CAG) for the diagnosis of coronary heart disease, and to provide evidence for clinical diagnosis.Materials and Methods Forty-nine patients with suspected coronary heart disease (CHD) underwent both 64-slice CT coronary artery imaging and conventional coronary artery angiography, all available coronary segments were evaluated using a 15-segment modified AHA classification, and the results of both methods were compared and analyzed.Results 493 segments of coronary artery were evaluated, results of 29 segments were incongruent between 64-slice CT coronary artery imaging and CAG. With CAG as the gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of CT coronary artery imaging for the diagnosis of coronary artery stenosis were 91.6%, 95.4%, 91.0% and 95.7% respectively.Conclusion There is a high consistency between 64-slice CT coronary artery imaging and CAG for diagnosing CHD, 64-slice CT coronary artery imaging can be used to evaluate the nature of artery plaque, but it is inferior to CAG in diagnosing small angiostenosis.

Chronic pancreatitis (CP) with mass and pancreatic cancer are difficult to identify from the Clinical performance. Imaging methods in the diagnosis of the CP with mass play an important role, which is very helpful for the indications for surgery of the hands, of resectable pancreatic head tumor, and surgical options, as well as estimates of the difficulty of the surgery. At present, we have taken the CP with mass as a precancerous lesion of pancreatic cancer. Surgical strategy in CP with mass has been directed at the pancreatic head with a variety of tactics including pancreatoduodenectomy ( Whipple procedure with or without pylorus preservation) and partial resection of the pancreatic duct drainage( Frey operation, Beger operation ). Once the diagnosis of the CP with mass was confirmed surgical treatment should be performed by pancreatoduodenectomy, which by not only the pancreatic head mass was resected, the bile ducts and pancreatic ducts and obstruction of the duodenum were lifted, but also the potential causes of pancreatic cancer were ruled out. Pancreatoduodenectomy has great risk for the big mass of pancreatic head, but the partial head resection can be accomplished with relative safety.

ObjectiveTo compare the efficacy and health economics between open choledocholithotomy and endoscopic sphincterotomy (EST) these two operations on patients with choledocholithiasis. Methods177 patients (aged 20-75 yrs, with simple choledocholithiasis on medical imaging,who had not been treated with either biliary tract surgery or EST, and had no severe complications)were treated electively at the Beijing Friendly Hospital and Beijing Jishuitan Hospital from 2002 to 2009. These patients were divided into two groups according to the treatment they received: open operation (n=62), or EST (n=115). There was no significant difference in sex, age, ASA class,symptoms before operation, and complications before operation between the 2 groups. The following data were compared: operation time, blood loss, size and number of stone, duration of postoperative ileus, duration of abdominal pain, incidence of postoperative complications, duration of hospitalization, cost of hospitalization and operation, and incidence of residual stones. ResultsFor the open operation group, the operation time was 50-300 min (M=110), the blood loss was 10-300 ml (M=60), the duration of post-operative ileus was 24-96 h(M=48), the duration of abdominal pain was 0-96 h(M=48), the duration of hospitalization was 8-70 d(M=21), the duration of hyperamylasemia after operation was 8.1％ and the cost for operation was 546-2498 yuan (M=1503. 2). For the EST group, the operation time was 10-120 min (M=25), the blood loss was 2-40 ml (M=10),the duration of post-operative ileus was 1-48 h (M=3), the duration of abdominal pain was 0-144 h (M-0), the period of hospitalization was 5-56 d (M=17), the duration of hyperamylasemia after operation was 40％ and the cost for operation was 2028-5728 yuan (M=2028). There were significant differences in every aspect between these 2 groups of patients. Conclusions EST has a significantly shorter operation time, less blood loss, shorter duration of postoperative ileus, shorter duration of abdominal pain, shorter duration of hospitalization. However, EST had a significantly higher incidence of hyperamylasemia after operation and the cost was higher than open operation.