Hepatocellular carcinoma (HCC) is the most common malignant cancer in China. The size of HCC can be categorized into 4 grades: (1) micro-HCC, the diameter of the HCC is ≤2 cm; (2) small HCC, the diameter of the HCC is between 2 and 5 cm; (3) large HCC, the diameter of the HCC is between 5 and 10 cm; (4) giant HCC, the diameter of the HCC is > 10 era. The new classification helps to choose the appropriate methods and to analyze the curative effect for various kinds of HCC respectively. The resection of large and giant HCC is safe and feasible. During the past 20 years, we have modified and innovated some techniques of HCC surgery, including hepatectomy without dissecting the hepatic hilus, increasing the safety time limit of portal pedicle occlusion from 15-20 minutes to 20-60 minutes, in situ bepatectomy with occlusion of hepatoduodenal ligament and infrahepatic vena cava, and double hanging maneuver techniques. The techniques mentioned above improved the bleeding control of hepatectomy, and enhanced the long-term survival rate of HCC patients.

China ; General Surgery ; history ; History, 20th Century

Objective To investigate the role and expression of serum substance P (SP) in the patients with breast cancer.Methods The quantity of serum SP by using ELISA in 21 patients with breast cancer (breast cancer group) and 10 healthy women (control group) were detected,the data were analyzed according to AJCC guide line.Results The positive rate of serum SP in breast cancer group was significantly higher than that in control group [57.1％ (12/21) vs.0] (P ＜ 0.01).The level of serum SP in breast cancer group was significantly higher than that in control group [(240.14 ± 435.04) ng/L vs.(16.80 ± 11.74) ng/L](t =2.9852,P ＜ 0.01).There was no relationship between serum SP and estrogen receptor in the patients with breast cancer (t =0.1856,P ＞ 0.05).The level of serum SP showed significantly difference according to AJCC stages respectively (F =3.24,P ＜ 0.05).Conclusion The level of serum SP in the patients with breast cancer increase and may play a role in the progress of breast cancer.

China ; Surgery/*history

Objective To study the diagnosis and treatment of iatrogenic bile duct injury(IBDI).Methods The clinical data of 92 patients with IBDI who had been admitted to our hospital from January 1994 to December 2007 were retrospectively analyzed.Results The diagnosis of IBDI was based on the clinical findings,diagnostic abdominocentesis and imaging examination.Sixteen patients gave up treatment because of economic reasons,and 2 patients who were complicated with sepsis and multiple organ dysfunction syndrome died shortly after being transferred to our hospital.Forty-eight patients were treated by Roux-en-Y choledochojejunostomy,14 by endoscopic treatment.2 by bile duet repair+T tube drainage,3 by percutaneous catheter drainage,1 by choledochoduodenostomy,4 by percutaneous transhepatic cholangiodrainage,and 2 by ultrasound guided percutaneous puncture drainage.Sixty-two patients were followed up for 4 month to 10 years(mean,3.6 years),and satisfactory results were obtained.Conclusions Detection of IBDI during operation and prompt repair yield favorable outcome.Roux-en-Y choledochojejunostomy is the best choice for bile duct injury complicated with biliary stricture.Endoscopic and interventional treatments are important auxiliary measures in the treatment of bile duct injury.

Objective　To improve the treatment effect of primary hepatic cancer (PHC). Methods　Analysis of the influential factors on treatment effect of PHC in China, and propose the countermeasure. Results and Conclusions　The main factors influencing the treatment effect of PHC in China are the followings: (1) Most patients with PHC of subclinical type failed to be diagnosed and treatment in time. (2) As a wrong idea PHC has been considered an “uncurable disease", so the treatment strategy is nagative. (3) Unsuitable choice of treatment resulted in some PHC unable to be resected. (4) Intraoperative massive bleeding due to unskill-operative techniques, increase the postoperative morbidity and mortality. (5) The manner of treatment is not positive for PHC patients with portal cancer thrombosis, bile duct cancer hteombosis and portal hyperlension. (6) Combined therapy can not be used or unsuitably used. The following things should be done in order to improve the treatment effect of PHC: (1) Strengthening improving the health-protective consciousness of people and regular examinaton of “high risk" population. (2) Renewing the professional knowledge in time to improve the level of diagnosis, treatment and operative techniques of medical personnel. (3) strengthening the basic medical research to make a break through in PHC treatment.

Objective　To study the expression of 5 multidrug-resistant genes in hepatocellular carcinoma (HCC) and establish the criteria for genetic diagnosis of multidrug resistance (MDR). Methods　The expression of mRNA and proteins of the multidrug-resistant genes were detected with reverse transcriptase polymerase chain reaction (RT-PCR) and flow cytometry (FC) respectively. IC50 of the original HCC cells was determined with MTT method. Results　MDR in HCC was associated with the genes of mdr1, MRP, LRP, Topo II α and GSTTP1. mdr1 mRNA ≥0.5, MRP mRNA ≥0.6, LRP mRNA ≥0.8, GSTP1 ≥0.7 and Topo II α mRNA ≤0.4 could be used as the criteria for genetic diagnosis of MDR in HCC. Conclusion　The complex MDR is the main form of drug resistance of HCC. Using RT-PCR to detect the mRNA expression of 5 multidrug-resistant genes is necessary and feasible for predicting sensitivity of chemotherapy for HCC.

Intravascular large B cell lymphoma is a rare subtype of diffuse large B cell lymphoma. Abnormal proliferation of intravascular lymphoma cells is its pathological feature with aggressive clinical behavior such as easy invasive feature, rapid disease progression, poor prognosis and low survival rate. We review the progress in recent research on classification, diagnosis, treatment and prognosis of intravascular large B cell lymphoma.

Objective To observe the effects of octreotide combined with enzyme supplementation in treatment of pain in chronic pancreatitis. Methods Fifty-six patients were divided into two groups. Thirty-six patients in the treatment group were treated with octreotide combined with enzyme supplementation,and twenty patients in the control group were treated with enzyme supplementation alone. The pain relief rate,analgesic requirement per day and average days in hospital were analyzed between the two groups. Results Compared with the control group,the treatment group presented better improvement of abdominal pain(P〈0. 05),less requirement of analgesics(P〈0. 05),and shorter duration in hospital(P〈0. 05). Conclusion Octreotide combined with enzyme supplementation is effective in alleviating pain and improving quality of life in patients with chronic pancreatitis.

Mental Health Law has specify the mental disorder patients’ informed consent right,but in practice, the problems,the mental health status of patients, namely the families’ right of subrogation exercise,“loss of self-control or deny having mental disorder”, have prevented the exercising of informed consent right. Therefore,it is necessary to effectively solve this plight of rebuilding a harmonious relationship between doctors and patients,estab-lishing mentally disordered patients’ right to advance directives, especially choosing the instrument of assessing the individual’ s capacity to consent.