Objective To study the clinical application oflaparoscopic-assisted operation to colorectal neoplasms. Methods 28 cases of colorectal neoplasms underwent laparoscopic surgery from July 1997 to November 2000. The mean age was 65.3 years old(33～89)years.3 cases underwent right hemicolectomy.1 case of sigmoid colon adenoma was given partial colectomy. Sigmoid-rectal anterior resection was conducted in 21 cases. 3 cases underwent abdominal peritonieal resection. Results 5 cases were converted to open laparotomy.The mean operative time was 178(150～300)min for 23 cases given laparoscopic surgery with 135(30～1000)ml of average intraoperative bleeding. Neither postoperative complications nor intraoperative deaths occurred.1 case of low portion rectal cancer showed abdominal metastasis 12 months after surgery.Neither port site nor incision metastasis happened. Conclusions Laparoscopic assisted surgery has the advantages of less surgical trauma,less gastrointestinal interference and quicker recovery. Under the circumstances of radical resection and selected candidate,laparoscopic assisted surgery can be applied to colorectal neoplasms.

Objective To evaluate laparoscopic hepatectomy for the treatment of primary liver cancer. Methods Nine patients with primary liver cancers at segment Ⅱ, Ⅲ, Ⅴ, Ⅵ and at the edge of the liver underwent laparoscopic partial hepatectomy with hand-assist devices, harmonic scalpel, and Endo-GIA. Results All operations were successful including resection of tumors involving both Ⅱ and Ⅲ segments, and irregular segmentectomy, and 2 cases with additional laparoscopic splenectomy. Surgery lasted for 80～145 min. Intraoperative bleeding was 150～700 ml, with no postoperative complications. Patients were followed-up for 5～25 months with intrahepatic tumor recurrence on 3rd, 4th and 13rd month in one each respectively. Conclusion Hand-assisted laparoscopic partial hepatectomy is a safe and feasible approach for primary liver cancer in clinically selected patients.

Objectives:To study the clinical significance of prealbumin and retinol binding protein in parenteral nutrition assessment. Methods:Serum prealbumin,retinol binding protein,transferrin and albumin were determined respectively before and a week after total parenteral nutrition(TPN) support in 40 cases with gastrointestinal diseases. Results:A week after TPN,plasma prealbumin and retinol binding protein concentrations increased significantly( P

53 cases who underwent major and moderate abdominal surgery were administered total paraenteral nutrition(TPN) by double energy resources and "all in one" irffusion way since December 1998. Non-protein energy was 105～150KJ/kg·d. Nitrogen was 0.16 ～0.35g/kg·d, Fat was 30%～40% of total energy. Serum protein of the cases were approximately or exceeded preoperative level. Body weight remained stable or increased (0.5～3kg). Positive nitrogen equilibrium was achieved 5～7d postoperatively. TPN improved the patients nutritional status, facilitated postoperative recovery and reduced the occurence of complications. We have the experience: (1) Appropriate nutrition support helps the critical patients of abdominal surgery tide over the long critical course and enhance curative rate. (2) It is necessary for the patients of obvious malnutrition and poor tolerance for operation to receive nutritional support for 5～7d. Postoperative TPN support should not be less than 1 week. (3)Infusion of nutritional ingredients should follow the principle of "metabolic support". (4)TPN can improve not only nutritional condition and immunity,but anticaneerous function of patients with gastrointestinal tract tumor combined with chemotherapy. (5)TPN support can reduce intestinal fluid leakage, facilitae fistua healing and prevent infection for patients with intestinal fistula. (6)TPN support can supply appropriately body needed nutrition and reduce exocrine secretion of pancreas for patients with severe pancreatitis.

Objective To explore the value of percutaneous radiofrequency ablation (PRFA) with or without transcatheter hepatic artery and portal vein chemoembolization in the treatment of primary and recurrent small hepatocellular carcinoma. Methods Ultrasound-guided percutaneous radiofrequency ablation was adopted in the treatment of 11 cases of primary small hepatocellular carcinoma (≤5 cm) and 13 cases of recurrent small hepatocellular carcinoma (≤3 cm) from September 2001 to September 2004. Among them, a combined use of transcatheter hepatic artery and portal vein chemoembolization was conducted in 4 cases of primary hepatocellular carcinoma and 8 cases of recurrent hepatocellular carcinoma. Results Out of the 11 cases of primary small hepatocellular carcinoma, CT or MRI results showed a complete coagulation necrosis of lesion in all 6 cases in which tumors were not more than 3 cm in diameter and in 4 out of 5 cases in which tumors were between 3 cm and 5 cm in diameter, the 1-, 1.5- and 2-year cumulative survival rates being 100%, 85 71% and 68 57%, respectively. Out of the 13 cases of recurrent small hepatocellular carcinoma, CT or MRI results showed a complete coagulation necrosis in all 7 lesions in cases of solitary tumor and in 12 out of 15 lesions in 6 cases of multiple tumors, the 1-, 1.5- and 2-year cumulative survival rates being 88.89%, 77 78% and 64 81%, respectively. Conclusions Percutaneous radiofrequency ablation provides a new alternative for the treatment of primary and recurrent small hepatocellular carcinoma. For patients with tumor more than 3 cm in diameter or with recurrent hepatocellular carcinoma, a combined use of transcatheter hepatic artery and portal vein chemoembolization conduces to a high tumor necrosis rate, a decrease of recurrence and an elevation of survival rate.

Objective To discuss the value of ultrasonography in the evaluation of efficacy of radiofrequency (RF) thermal ablation for hepatic carcinoma. Methods A total of 49 patients with 66 lesions of hepatic carcinoma underwent ultrasound-guided multipolar radiofrequency ablation. Ultrasound examinations were carried out on tumor sizes, echo signals, vascular flows and frequency spectrums before and after the treatment. Moreover, AFP or CEA levels before and after the procedure were observed. And the CT scanning results were regarded as the control. Results Ultrasound examinations 1 month after the ablation found that “claw-like” heterogeneous hyperechoic changes covered the whole tumors without vascular flows inside in 42 patients with 59 lesions (89 4%). Afterwards, the tumors gradually reduced or remained unchanged in size, with a homogeneous echo texture. The serum levels of AFP or CEA markedly reduced or dropped down to normal. All of these were suggestive of an excellent curative effect. In the remaining 7 patients with 7 lesions (10 6%), intratumoral echo pattern kept unchanged, with arterial flow signals inside and unremarkable decrease of AFP or CEA levels, all of which were suggestive of an unsatisfactory outcome of the first radiofrequency treatment and a requirement of an additional radiofrequency treatment. CT examinations 1 month after the ablation revealed an enhancement of lesions in 9 patients with 9 lesions, among which the CT results were in agreement with the ultrasound outcomes in 7 patients with 7 lesions. Compared with the enhanced CT scans, ultrasonography in the detection of intratumoral vascular flows had a sensitivity of 55 6% (5/9), a specificity of 96 5% (55/57) and an accuracy of 90 9% (60/66). Conclusions Ultrasonography is an effective alternative for the evaluation of efficacy of radiofrequency thermal ablation in the treatment of hepatic carcinoma.

Objective To explore the feasibility of hand-assisted laparoscopic splenectomy and azygos-portal disconnection. Methods Hand-assisted laparoscopy was performed in 12 patients with hypersplenia secondary to post-hepatitic hepatocirrhosis and a history of rupture and bleeding of esophago-gastric varicose vein.An ultrasound knife was used to dissect the ligaments of the spleen.The Endo-Cutter was used to cut off the pedicle of the spleen.Then the spleen was removed in a plastic bag.All of the varicose vessels around the fundus and the lower segment of the esophagus(6~8 cm in length) were dissected and disconnected according to the criteria of open surgery.Results The operation was successfully completed in 10 patients,while conversions to open surgery were required in 2 patients because of massive hemorrhage during the operation.The operating time was 2.5~5 h(mean,3.4 h) and the hemorrhagic volume was 100~500 ml(mean,250 ml).Postoperatively,1 patient experienced an intraperitoneal hemorrhage and received open surgery for hemostasis while the remaining patients had an uneventful recovery without complications.A total of 10 patients were followed for 0.5~2 years(mean,1.5 years).Four patients died of liver failure.Six patients presented small volumes of relapsed upper gastrointestinal bleeding around 1 year after operation.Gastroscopy showed portal hypertensive gastropathy in 3 patients,gastric ulcer in 1 patient,and ruptured varicose esophageal veins in 2 patients.All the 6 patients were cured by conservative medical treatment.Conclusions Hand-assisted laparoscopic splenectomy and azygos-portal disconnection is a feasible,effective,and safe surgical procedure.

Objective To investigate the feasibility of laparoscopic splenectomy(LS).Methods Laparoscopic splenectomy was performed in 32 cases from June 1999 to December 2005 in this hospital.The splenic ligaments were disconnected using a harmonic scalpel and the pedicle of spleen was cut using the Endo-GIA system.After the spleen was mobilized,it was placed into an extraction bag,broken into small pieces,and removed from the extraction incision.Results The operation was successfully completed in 29 cases.The operation time was 60~270 min(mean,100 min),the amount of intraoperative blood loss was 30~1 000 ml(mean,230 ml),and the length of postoperative hospital stay,3~7 d(mean,5 d).No postoperative complications occurred.Conversions to open surgery were needed in 3 cases because of hemorrhage of the splenic pedicle,hemorrhage of the short gastric vessels,and extensive adhesion,respectively.Of the 22 cases of idiopathic thrombocytopenic purpura(ITP),the platelet count recovered to normal levels in 18 cases and kept unchanged in 4 cases.Of the 2 cases of hemolytic anemia,the hemoglobin levels were elevated after operation.Of the 4 cases of hypersplenism accompanying posthepatitic cirrhosis,the platelet count recovered to normal levels.Conclusions Laparoscopic splenectomy is a safe and feasible,especially for patients with hematologic diseases.

Objective To evaluate prospectively the preoperative use of 16-multidetector computed tomography (MDCT) with cholangiography and angiography in determining the resectability of hilar cholangiocarcinoma.Methods From January 2002 to January 2009,75 consecutive patients with hilar cholangiocarcinoma underwent preoperative MDCT with cholangiography and angiography.3D images of the portal vein,hepatic artery,and bile ducts were created and viewed simultaneously.The accuracy of MDCT with cholangiography and angiography was determined by comparison with intraoperative and pathologic findings.Results All patients tolerated the CT imaging well.The sensitivity,specificity,and accuracy rates were 92.9%,100%,and 96%for portal invasion and 83.3%,100 %,and 93.3%for hepatic arterialinvasion.The accuracy rate of longitudinal tumor extension,using the Bismuth-Corlette classification system,was 96 %.The sensitivity,specificity,and accuracy of prediction of resectability were 95.7%,82.1%,and 90.7%,respectively.Conclusion Preoperative MDCT with cholangiography and angiography gave a good assessment of the degree of biliary and vascular involvement of hilar cholangiocarcinoma.It also accurately predicted resectability in patients with hilar cholangiocarcinoma.

Objective To investigate the practicability and safety of laparoscopic anatomical hepatectomy.Method 40 patients with space occupying lesions in the liver underwent laparoscopic anatomical hepatectomy between Jan.2008 and Mar.2012.The diagnoses were hepatocellular carcinoma (HCC) (n=13),recurrent HCC (n =1 ),cholangiocarcinoma ( n =1 ),metastatic cancer ( n=6),hepatolithiasis (n=10),hemangioma (n=7),FNH (n=1) and liver cell adenoma (n =1).Intraoperative ultrasound was routinely performed to locate lesions and intrahepatic structures.Selective hemihepatic vascular occlusion was applied during resection. High frequency cautery,CUSA and Ligasure were used to transect liver parenchyma. Hemolocks were applied when large blood vessels and bile ducts were encountered.Endo-GIA was used if necessary.The operations included right hemihepatectomy (n =3),left hemihepatectomy (n =10),resections of segment Ⅴ and Ⅵ (n=5),segment Ⅴ (n=3),segment Ⅵ (n =4),and segment Ⅳb (n =1).Result34 hepatectomics were performed laparoscopically.6 patients were converted to open surgery.There was no perioperative death. The operating time was 250.21±50.94 min,and intraoperative blood loss was 420.20± 120.10 ml.Bile leakage was diagnosed in 2 patients after operation.Conclusion With careful patient selection,and improvement in surgical technique and apparatus,laparoscopic anatomical hepatectomy has become safe and practicable.The operation has the advantages of minimal invasion and rapid recovery. It can be regarded as a standard procedure for selected benign and malignant lesions.