Objective To evaluate the effect of atorvastatin on patients with hepatolithiasis and obstructive jaundice after partial hepatectomy.Methods We retrospectively analyzed the data of 51 patients with hepatolithiasis and obstructive jaundice who were treated with partial hepatectomy from July 2006 to August 2015 at Xishan People's Hospital of Wuxi.Based on whether atorvastatin was used or not,the patients were divided into the treatment group (25 patients) and the control group (26 patients).Liver function tests were determined regularly after operation.The serum liver function on postoperative day 3 (P3d) and postoperative day 5 (P5d),complications (incisional infection,abdominal infection,pleural effusion,peritoneal effusion and bile leakage) and duration of hospital stay in the two groups of patients were compared.Results There was no perioperative death in the two groups.When compared with the control group,liver function data suggested an improvement in the treatment group,as ALT and AST in the treatment group were significantly lower than in the control group on P3d and P5d [ALT (252.6 ± 87.0) U/L vs (385.0 ± 152.9)U/L,(89.9 ±28.2) U/L vs (116.9 ±29.3) U/L;AST(130.7 ±66.9) U/L vs (212.7 ±80.0) U/L,(47.5 ± 16.1) vs (69.2 ± 12.2) U/L,all P ＜ 0.05].When compared with the control group,the serum cholesterol level was lower on P3d and P5d [TC:(6.7 ± 0.3) mmol/L vs (6.2 ± 0.3) mmol/L;(6.1 ± 0.4) mmol/L vs (7.0 ± 0.4) mmol/L,P ＜ 0.05],the serum CRP level was also lower in the treatment group [(56.8 ± 15.7) mg/L vs (98.9 ± 40.3) rg/L,P ＜ 0.05];the duration of hospital stay was (10 ± 1) days in the treatment group,which was significantly different from the control group (12 ± 1) days.Conclusion The use of atorvastatin in patients with hepatolithiasis and obstructive jaundice who were treated with partial hepatectomy improved postoperative liver function and shortened postoperative hospital stay.

Objective To clarify the association of pre-existing choledocholithiasis or cholecystolithiasis and the development of intrahepatic cholangiocarcinoma(ICC).Methods A computerized literature search was performed in Pubmed,EmBase and CBM.Cohort and case control studies on the risk of choledocholithiasis or cholecystolithiasis developing ICC was included.Meta-analysis was performed using STATA version 12.0.Either a fix or random effect model was used according to heterogeneity among studies.Egger's test was performed to assess publication bias.Results A total of 6 case control studies fulfilled our inclusion criteria including 123,713 patients,4,753 for ICC and 118,960 for tumor free controls.Bile duct stone contributed to the development of ICC (OR:15.64,95％ CI 9.33-26.23).Apart from hepatolithiasis,there was still a high risk of ICC development for choledocholithiasis (OR:11.05,95 ％ CI:4.02 ～ 30.37).Cholecystolithiasis is also a risk factor for ICC (OR:2.35,95 ％ CI:1.28 ～ 4.31).Conclusion Both choledocholithiasis and cholecystolithiasis are important prognostic factors for ICC.

Objective To investigate the clinical efficacy and safety of laparoscopic common bile duct exploration and primary common bile duct closure in the treatment of extrahepatic bile duct calculi.Methods The clinical data of 215 patients undergoing laparoscopic common bile duct exploration from October 2010 to December 2016 in Wuxi Xishan People' s Hospital were retrospectively analyzed.According to the different surgical methods,patients were divided into two groups:laparoscopic common bile duct exploration and primary common bile duct closure group(primary duct closure group,n =122) and laparoscopic common bile duct exploration group(T-tube drainage group,n =93).Operation time,intraoperative blood loss,recovery time of gastrointestinal tract,liver function in postoperative 1 week and hospitalization expenses,postoperative hospital stay(t test) and postoperative complications (x2 test) were compared.All patients were follow-up by clinic and telephone for 6 months.Measurement data were represented as ((x) ± s),and t test was used between the two groups,while count data using x2 or Fisher test.Results The postoperative hospital stay in primary duct closure group and T-tube drainage group was(8.5 ± 1.9) days and (12.5 ±2.4) days respectively,the difference between the two groups was statistically significant(P ＜ 0.05).The hospitalization costs in primary duct closure group and T-tube drainage group were (1 200 ± 300) yuan and (1 400 ± 500) yuan,the difference was statistically significant (P ＜ 0.05).Postoperative analgesia in primary duct closure group and T-tube drainage group was 11 cases and 32 cases statistically,and the difference was statistically significant (P ＜ 0.01).There were no significant difference in the operation time,intraoperative blood loss,recovery time of gastrointestinal tract,liver function 1 week after operation and postoperative bile leakage between the two groups (all P ＞ 0.05).There was no long-term complications in both groups after 6 follow-up months.Conclusion Under favorable operation technology and strictly grasp the surgical indications,laparoscopic common bile duct exploration and primary common bile duct closure has good clinical application value,and can embody minimally invasive and enhance recovery.

Objective:To investigate the clinical effect of vascular pressurisation and super reflux on free anterolateral thigh flap (ALTF).Methods:From January 2017 to September 2021, the Department of Hand and Foot Microsurgery, the Second Affiliated Hospital of Hainan Medical College had treated 31 cases of soft tissue defects of the limbs. The patients were 23 males and 8 females, aged 4-76 years old at 40 years old in average. All the patients received transfer of free ALTFs carrying 2 groups of blood vessels of the descending and oblique branches of lateral circumflex femoral artery (LCFA). The vascular pressurisation and super-reflux techniques were applied in wound repair. Soft tissue defect area 7 cm × 5 cm-22 cm × 10 cm. The sizes of flaps were 8 cm×6 cm-23 cm×11 cm. All the donor sites were sutured directly. Fifteen patients had inner flap pressurisation (or super-reflux) and the rest of 16 patients had external flap pressurisation (or super-reflux). After surgery, scheduled follow-ups were conducted through outpatient clinic, telephone and WeChat reviews or home visits to evaluate the efficacy of wound repair.Results:All the 31 flaps survived, except 2 flaps that had mild infection after surgery. The wounds of donor and recipient sites healed completely. The time of follow-up was 3-55 months. The skin of flaps achieved good texture, colour, lustre and appearance. TPD of the flaps ranged 7-12 mm.Conclusion:Vascular pressurisation and super reflux technique are stable and reliable in the clinical application of free ALTF to repair soft tissue defects of limbs.