Objective To investigate the advantages and indications of combined laparoscopic surgery(CLS). Method 488 casesof laparoscopic procedures were given from May 1992 to February 2002.Among them 21 were CLS.Laparoscopic common bile duct exploration (LCBDE)+Laparoscopic cholecystectomy(LC)(7);Laparoscopic fenestration of liver syst+LC(4),LC+Laparoscopic appendectomy(4);LC+hand-assisted laparoscopic splenectomy(2);laparoscopic cystectomy for pancreatic pseudocyst+LC (1);LCBD+LC+Laparoscopic fenestration of right renal cyst(1)and LC+laparoscopic partial hepatectomy for small liver cancer(1). Results The combined procedures were succesful in all the 21 cases with no complications. Conclusions CLS has expanded the field of laparoscopy and advantages of minimally invasive nature and indications should be strictly choosen for the procedure.

Objective To investigate the feasibility and clinical value of laparoscope combined with choledochoscope in the treatment of intra- and/or extrahepatic bile duct cholelithiasis. Methods 10 patients with intra- and/or extrahepatic bile duct stones underwent common bile duct incision exploration to remove stones under laparoscope combined with fiber-choledochoscope from September 2000 to March 2002. Common bile duct was directly sutured or T-tube drainage was performed. Results All cases were operated on successfully without conversion to open operation. There was no serious complication except 1 case of postoperative bile leakage cured by conservative treatment. The residual stones of 2 cases were removed by choledochoscope. Conclusions Laparoscope combined with choledochoscope in the management of intra- and/or extrahepatic bile duct stones is a safe, reliable and minimally invasive procedure. However, it is important to choose indications.

Objective To study the safety and efficacy of intraoperative implanting slow-released 5-Fu after hepatectomy in patients with hepatocellular carcinoma (HCC). Methods 59 HCC patients undergoing hepatectomy from January 2008 to January 2009 were divided into two groups:to receive slowrelaesed 5-Fu in treatment group and nothing in control group.Postoperatively no patients in both group took chemotherapy.The serous value of WBC,ALT,AST,TBIL and AFP were measured in all cases on 1 day before and 3 weeks after the operation.During the first six months,AFP was measured and imaging studies were done one month after discharge,and every 3 months since then.CT-guided biopsy was used to confirm the recurrence of HCC. Disease-free survival rate and overall survival rate in two groups calculated respectively 6-,12-,18- and 24-months after the operation. Results The serous value of WBC,ALT,AST,TBIL was not different between treatment group and control group 3 weeks after the operation (separately t =0.801,- 0.854,- 1.948,- 0.503,all P ＞ 0.05).AFP was (361.58 ± 431.06) μg/L,( 17.02 ± 15.55 ) μg/L,(43.61 ± 58.03 ) μg/L in treatment group and (495.50 ± 441.63 ) μg/L,(26.82 ±60.46) μg/L,(127.48 ±229.79) μg/L in control group preoperatively,3 weeks and 6 months after the operation.AFP was lower in treatment group than that in control group ( t =- 2.065,P ＜ 0.05 ).The disease-free survival rate in treatment group was 95.8％,91.7％,79.2％,75.0％ at 6-,12-,18- and 24-months after the operation,in control group it was 94.3％,71.4％,60.0％,48.6％ ( x2 =4.035,P ＜0.05).The overall survival rate was respectively 100％,95.8％,91.7％,83.3％ in treatment group and was 100％,94.3％,77.1％,60.0％ in control group( x2 =3.931,P ＜0.05).Conclusions Intraoperativeimplanting slow-released 5-Fu during the hepatectomy was safe and effective method to reduce the recurrence rate of hepatocellular carcinoma and prolongs postoperative disease free and overall survival in HCC patients undergoing hepatectomy.