Objective To improve the diagnosis and treatment of hepatolithiasis associated with cholangio-caminoma.Methods Data of 28 cases of hepatolithiasis associated with intrahepatic cholangiocarcinoma from 2005 to 2008 in Li Huili Hospital of Ningbo University Medical School were collected and analysed.Results The diagnosis was established preoperatively in 8(28.6%)cases.Twenty-one(75.0%)patients were radically resected,5(17.9%)patients received palliative operation,and other 2(7.1%)patients received exploratory surgery.In the 24 patients followed-up closely,the median survival time was 30 months in radical surgery group,8 months in palliative operation group,whereas 2 exploratory surgery cases only survived 2 months and 4 months respectively.Conclusions Cholangiocarcinoma may be related to hepatolithiasis.Early diagnosis rate is low and prognosis is poor in the cholangiocarcinoma associated with hepatolithiasis.Early radical therapy for hepatolithiasis plays an important role in preventing cholangiocarcinoma occurrence.Palliative operation for cholangiocarcinoma may improve quality of live.

Pancreaticogastrostomy appears as a method of pancreatic digestive tract reconstruction after pancreaticoduodenectomy.Its research mainly includes incidences of pancreatic-fistula,pancreatic exocrine and endocrine function and methods of pancreaticogastrostomy,which is frequently compared with pancreaticojejunostomy.In this review.The author will discuss these problem and review.The history of pancreaticogastrostomy.

Liver volume can reflect the change of parenchyma volume and functional reserve of liver.Liver volumetry is commonly achieved by imaging methods such as ultrasound,CT and MRI,while CT volumetry is most commonly used in clinical practice.This article discussed the decision making among different liver volumetry methods and associated applications in hepatectomy.

Maintaining organ viability after donation until transplantation is critically important for optimal graft function and survival. To date, static cold storage is the moot widely used form of liver preservation in clinical practice. Although simple and effective, it is questionable whether this method is able to prevent deterioration of organ quality in the present with increasing numbers of organs retrieved from older, more marginal, and even non-heart-beating donors. This review describes the history and progress of liver preservation and preservation solution, including hypothermic machine perfusion. Despite the fact that hypothermic machine perfusion might be superior to static cold storage preservation, liver are still exposed to hypothermia induced damage. Therefore, recently some groups have pointed at the beneficial effects of normothermic machine perfusion as a new perspective in liver preservation and transplantation.

Objective The retrograde isolated hepatic perfusion (RIHP) model was used to compare with the isolated hepatic perfusion (IHP) model in reducing the rate of normal hepatic tissue toxicity and peripheral drug leakage during chemotherapy in rat liver. Methods A total of 90 male Sprague-Dawley rats weighing 300-350 g were randomized into 3 groups with 30 rats in each. Group A: perfusion with Lactated Ringer'S Solution through arteria hepatica (RA) and portal vein (PV),the inferior vena cava was used as an outflow tract of perfusate. Group B: For isolated hepatic perfusion (IHP), Fluorouracil (5-FU) was added into the perfusate at a dose of 350mg/kg and introduced in to the liver through arteria hepatica, portal vein was perfused by Lactated Ringer'S Solution, and the inferior vena cava was used as an outflow tract of perfusate. Group C: by using retrograde isolated hepatic perfusion (RIHP), the solution which contains 350 mg/kg Fluorouracil (5-FU) was also introduced through arteria hepatica, the inferior vena cava was introduced with Lactated Ringer'S Solution;the portal vein was used as an outflow tract of the perfusate. On day 1, 3, 5 and 7 after the perfusion in all groups, blood serum ALT test and liver histopathology test were performed. The peripheral blood drug levels were measured with high performance liquid chromatographic(HPLC) system in group B and group C. Results The survival rate was 90%, 86.7% and 90% in group A, B and C,respectively. No statistically significant difference was observed in the survival rate among the 3groups. In all the three groups, serum ALT levels were the highest on the first day after IHP: (481.6±207.6)μmol/LingroupA;(1641. 6±658.0) μmol/LingroupBand( 913. 0±353. 5)μmol/Lin group C. Significant higher serum ALT levels were observed by comparing group B and C with A(P＜0. 05). Meanwhile, the serum ALT levels were significantly higher in group B than in group C (P＜0.05). The peaks of peripheral blood drug concentration during the perfusion were 131.2±29.4μg/ml in group B and 65.3±28. 4μg/ml in group C. Significant difference was observed (P＜0. 05). Liver biopsies of group A showed mild changes on the first day after IHP and returned to normal after 7 days. Group B showed severe changes on the first day after IHP and local necrosis still existed after 7 days. Group C showed moderate changes as compared with group B on the first day after IHP and also returned to normal after 7 days. Conclusion Retrograde isolated hepatic perfusion (RIHP) can reduce the liver toxicity compared to isolated hepatic perfusion (IHP). Hopefully, RIHP will be considered as a safer way in regional chemotherapy in liver cancer.

Objective To discuss the harm and the rectification procedures for patients who have received nonstandard cholangioenterostomy and improper endoscopic retrograde biliary drainage.Method The clinical data of 55 patients who had received nonstandard cholangioenterostomy and improper endoscopic retrograde biliary drainage seen at the Ningbo LiHuiLi Hospital between 2004.6 to2011.12 were retrospectively analyzed.Results There were 23 patients who had stones located intrahepatically which had not been dealt with in the previous operation; 16 patients received choledochoduodenostomy; 5 patients received side-to-side or side-to-end cholangiojejunostomy (with no division of the common bile duct) ; 2 patients developed anastomotic stricture after nonstandard cholangioenterostomy; 3 patients had a short efferent loop of jejunum; and 6 patients had improper endoscopic retrograde biliary drainage.Through reoperative rectification,all patients had satisfactory therapeutic outcomes.Conclusions For hepatolithiasis patients,nonstandard cholangioenterostomy and improper endoscopic retrograde biliary drainage not only cause harm to the patients,but also force patients to have a reoperation.Thus,following strict operative indications,choosing the right operation and improving on the operative skills are the keys to prevent a reoperation.

Objective:To study the influencing factors in predicting conversion of laparoscopic liver tumor resection to open surgery to provide references for selection of patients for laparoscopic hepatectomy.Methods:The clinical data of 222 patients who were planned to undergo laparoscopic liver tumor resection at Ningbo Medical Center Lihuili Hospital from December 2015 to November 2018 were analyzed retrospectively. There were 146 males and 76 females, with an average age of 58.1 years. These patients were divided into the conversion group ( n=24) and the laparscopic group ( n=198) according to whether intraoperative conversion to open surgery was carried out. Chi-square test was used to evaluate relevant factors of conversion. Logistic regression analysis was used for multivariate analysis and to find out independent risk factors of conversion. Results:The conversion rate was 10.8% (24/222). Univariate analysis showed that hypertension, history of abdominal surgery, liver cirrhosis, tumors located at posterosuperior segments and major liver resection were significantly associated with conversion (all P<0.05). Multivariate analysis showed that the risk factors which were independently associated with conversion were liver cirrhosis ( OR=2.611, 95% CI: 1.018-6.701), tumors located at posterosuperior segments ( OR=6.115, 95% CI: 2.207-16.941), and major liver resection ( OR=3.361, 95% CI: 1.150-9.825)(all P<0.05). Conclusion:Patients who were planned for laparoscopic liver tumor resection with liver cirrhosis, tumors at posterosuperior segments or major liver resection were at higher risks of conversion to open surgery.

Objective To measure plasma microRNAs dysregulated in patients with pancreatic cancer and to assess the potential of these miRNAs as biomarkers for pancreatic cancer.Methods Thirty-seven patients with pancreatic cancer who underwent pancreatic resection between June 2010 to July 2011 were enrolled in the Lihuili Hospital,and ten healthy volunteers were used as control in this study.The expression levels of miR-190,miR-196a,miR-221 and miR-222 were analyzed using quantitative real time polymerase chain reaction (qRT-PCR).U6 was used as an internal control.The relationships between clinicopathoiogic characteristics of pancreatic cancer and microRNA expression levels were analyzed.Results The relative abundances of plasma microRNAs were significantly higher in pancreatic cancer patients than in the control group.The highly expressed plasma miR-190,miR-196a,miR-221,miR-222 levels did not correlate with clinicopathologic characteristics of patients such as sex,age,tumor maximal diameter,and level of serum CA199.The plasma miR-196a levels showed a positive correlation with TNM stage in pancreatic cancer patients.Conclusions The plasma levels ofmiR-190,miR-196a,miR-221 and miR-222 were highly upregulated in pancreatic cancer patients.These microRNAs in plasma may provide a new method in the early diagnosis of pancreatic cancer.

Objective To study the clinical outcomes of 28 pancreatic cancer patients who underwent total pancreaticoduodenectomy.Method The clinical data of 28 patients with pancreatic cancer who underwent total pancreaticoduodenectomy from January 2009 to March 2015 were retrospectively analyzed.Results Among the 28 patients,complications occurred in 11 (39.2％) after the operation.There were 7 patient having Grade Ⅱ,4 Grade] complications.No patient died within 30 days after the operation.Fol low-up of 25 patients showed a median survival of 13.5 months.There were 24 patients with pancreatic ductal adenocarcinoma,and the median survival was 13 months.Conclusions Total pancreaticoduodenectomy could not improve long-term survival but it decreased postoperative complications and improved postoperative quality of life.In selected patients,total pancreaticoduodenectomy could be a rational option.

Objective To compare laparoscopic hepatectomy to open surgery in recurrent hepatolithiasis.Methods From Jan 2014 to Feb 2016,106 cases of recurrent hepatolithiasis eligible for hepatectomy were prospectively randomized into laparoscopic group (53cases) and open group (53 cases).The perioperative variables,postoperative morbidity and outcomes were analyzed and compared between the 2 groups.Results The statistical results show that the laparoscopic group and open group had similar intraoperative rate of blood loss ＞400 ml,wound infection,abdominal infection,Grade B bile leakage,score of Clavien classification system,stone clearance rate and hospitalization cost (P ＞ 0.05).The laparoscopy group had longer operation time (P ＜ 0.05),and shorter postoperative hospital stay (P ＜0.05).Binary logistic analysis showed that decreased preoperative platelet count,longer operation time,and hepatectomy in difficult places are risk factors for intraoperative blood loss ＞ 400 ml (OR ＞ 1,P ＜0.05);type of past biliary tract operation,positive bile culture during surgery and residual stones are risk factors for grade B bile leakage (OR ＞ 1,P ＜ 0.05).Conclusions Laparoscopic hepatectomy for recurrent hepatolithiasis is safe and feasible.