Objective To observe the clinical results of laparoscopic cholecystectomy(LC) combined with endoscopic Oddi sphincterotomy(EST) in treating cholecystolithiasis and choledocholithiasis.Methods The preoperative and postoperative clinical data of 20 cases that received LC & EST combined therapy for cholecystolithiasis and choledocholithiasis were analyzed retrospectively.Results The success rate was 95.0% ,with all the calculi removed completely;no complications occurred.The average hositpal stay was 7.5 days.Conclusions Combined LC & EST procedure is a safe and effective method to treat patients suffering from cholecystolithiasis and choledocholithiasis.

Objective To explore selective criteria of sphincter preservation operation(SPO) for middle to low third rectal cancer,and analyze clinicopathologic parameters resulting in the selective criteria.Methods Two hundred and seventy-nine cases of middle to low third rectal cancer who accepted operative treatment from 1996 to 2004 were analyzed retrospectively.One hundred and eighty-seven rectal tumours were located in 5-10 cm from anus,92 rectal tumours in below 5 cm from anus.Among them 127 cases were treated by abdominal-perineal resection(APR),and 152 cases were treated by SPO in which there were 130 Dixon operations,12 Bacon operations,and 10 Parks operations.Clinicopathologic parameters and survival rate in APR and SPO groups were compared statistically.Results Gender,age,size,tumor types,site of tumor,degree of differentiation,infiltrated circumference of intestine,and lymph node metastasis,depth of invasion and Dukes stages were not significantly different between APR and SPO groups.SPO performed rate was 54.48% in all.SPO was performed in 48 lower third rectal cancer cases(52.17%,48/92).Regional recurrence rate was 6.81%(19/279).Middle survival time was((65.00?6.87))months and 5-year survival rate was 63.51% in SPO group.Middle survival time was((52.23?5.63)) months and 5-year survival rate was 52.50% in APR group.Chi-Suqare was 18.14 by Log-rank test(P=0.054 1).Conclusion There is no statistically difference in survival rate between APR and SPO groups.

Objective　To summarize the methods of diagnosis and operation of carcinoma of the extrahepatic bile ducts. Methods　The clinical data of 100 cases of carcinoma of the extrahepatic bile ducts which were treated in our hospital from 1972 to 1999 were retrospectively analysed. In this series, there were 68 cases of the cancer located in the upper portion of exlrahepatic duct(proximal cancer), 12 in midder portion(midder cancer), 18 in lower portion(distal cancer), and 2 in whole bile duct. Results　The initial symptom was upper abdominal discomfort or vague pain, abdominal distension, weakness, weight loss and progressive jaundice. BUS, CT and MRI were scatheless. If the intrahepatic bile duct dilatation or extrahepatic cholestatic jaundice were revealed, PTC(13 cases in this series) or ERCP(42 cases in this series) were to further determine the location of tumor. According to the position and type of the tumor, the different operations were selected. Twenty-five cases(36.8%) of the proximal cancer were resected, including 15 cases of type Ⅰ treated with localresection or “skeletonization” resection, 9 cases of type Ⅱ treated with resection of the tumor and caudate lobe, 1 case of type Ⅲb treated with resection of the tumor, caudate lobe and left hepatic trisegmentectomy. Nine cases(75%) of midder cancer were resected. After resected the proximal and midder cancer, bile duct reconstruction by Roux-en-Y hepaticojejunostomy was performed on all the cases. Fourteen cases(77.8%) of distal cancer were treated by pancreatoduodenectomy. The total resection rate in this series was 48%. Of the cancer resected cases, 35 were followed up, the five-year survival rate was 58%. 32 of the 52 cases without cancer resection were followed up, and all of them died one to one and half year after operation. Conclusions　BUS, CT and MRI are the first selective methods for early diagnosis of the carcinomas of extrahepatic bile duct. If needed, PTC or ERCP should be done because of these methods have more accurate diagnostic value. Surgical resection of the tumor is the only likelihood for effective treatment.

BACKGROUND: Transplantation of bone marrow mesenchymal stem cells (MSCs) has been used in the field of repair of nerve injury. Brain stereotactic transplantation and transvascular transplantation are two transplantation methods. OBJECTIVE: We infused MSCs into rat peripheral cerebral infarct focus, in order to investigate the improvement of rat neurological dysfunction by forelimb use asymmetry test and postural reflex test.DESIGN: A randomized controlled animal experiment. SETTING: Department of Neurology, First Hospital of Jilin University.MATERIALS: This study was performed at the Key Laboratory of Zoonosis, Ministry of Education, Institute of Zoonosis, Jilin University between October 2006 and April 2007. Healthy male Wistar rats of clean grade, weighing 250-280 g, were provided by the Laboratory Animal Center of Jilin University. The protocol was performed in accordance with ethical guidelines for the use and care of animals.METHODS: MSCs from healthy adult volunteers were in vitro cultured and proliferated by density gradient separation and adherence screening method. Their immunophenotypes were identified by a flow cytometer. The Wistar rats were randomized into 5 groups with 10 rats in each: normal control group, sham-operated group, model group, serum-free DMEM-treated group (DMEM group) and MSCs -treated group (MSCs group). Rat models of cerebral ischemia/reperfusion were developed by occluding rat right middle cerebral artery following suture occlusion method modified by Longa et al. Rats in the normal control group were untouched. In the sham-operated group, operation was not ended till cervical interior and exterior arteries were exposed and sutured, and the other disposals were the same as those in the model group. At ischemia 90 minutes reperfusion 1 hour, a stereotaxic apparatus was used to take rat right peripheral cerebral ischemic region as transplantation site: 3 mm lateral to, 1mm caudal to and 4 mm posterior to Bregma. Rats in the MSCs group were slowly injected 5 μL BrdU-labeled MSCs (4×1011 L-1) serum-free medium. Rats in the DMEM group were injected 5 μL serum-free medium. After perfusion, inserted needle was retained for 5 minutes and then slowly withdrawn in order to avoid the back flow of liquid from needle pole. The survival of MSCs in rats was detected by immunohistochemical technique, and rat behavioral changes of observed on days1, 3, 7 and 28 after transplantation by forelimb use asymmetry test and postural reflex test.MAIN OUTCOME MEASURES: ① The immunophenotype of MSCs were identified by a flow cytometer. ② The survival of transplanted MSCs in the rat brain. ③ Rat behavioral changes. RESULTS: All the 50 rats were included in the final analysis. ① High purity of MSCs were harvested in the experiment. Flow cytometer detection showed that both CD44 and CD29 were positive, while CD34, CD45 and CD31 were negative. ② MSCs transplanted into the brains of rats in the MSCs group gathered in the peripheral cerebral ischemic region and survived. ③ Behavioral scores of rats in the MSCs group were significantly lower than those in the other groups (P < 0.05). They were gradually decreased with time after transplantation, and reached the valley value on day 7 after transplantation (P < 0.01). CONCLUSION: Neurological function of rats recovers in all the groups except normal control group. But the recovery differs in different groups, and neurological function of rats in the MSCs group recovers better than that in other groups.