Objective To study variant artery and treatment under video laparoscopic cholecystectomy(LC). Methods 521 patients who received selective cholecystectomy(male 159 patients and female 362 patients, aged 11 to 76 years),were operated on with video laparoscopy. Cystic artery was anatomized under general anesthesia and carbon dioxide pneumoperitoneum. Results Variant Cystic artery presented in 140 patients(26 .9% ). Cystic artery of 60 patients originated from anterior or posterior common bile duct, single cystic artery was in 3 patients, double cys- tic artery in 51 patients, cystic artery arose from celiac artery was in 6 patients, cystic body artery existed in 17 pa- tients and cystic artery originated from variant right hepatic artery in 3 patients. Conclusion Variant cystic artery is very common. Correct recognition, dissection and safe treatment are an important to prevent hemorrhage and bile duct injuries during laparoscopic cholcystectomy.

Hemodynamic changes and regulations of indomethacin have been studied in 64 patients with obstructive jaundice and 39 patients with simple gallstones (group C) Obstructive jaundice patients were divided into non indomethacin group (group A) and indomethacin group (group B) The results showed that stroke volum,cardiac output and cardiac index were significantly higher in group A than those in group C( P

With the developments of digital medicine, Gd-EOB-DTPA enhanced magnetic resonance imaging, molecular imaging and optical/acoustic multi-modality imaging, the hepatopancreatobiliary surgery have entered the era of precise diagnosis and treatment.Bidimensional pattern of disease diagnosis and treatment is developing toward three-dimensional pattern, which make the diagnosis and treatment more comprehensive and clear.Morphological imaging is gradually developing towards molecular imaging.Ultimately, the goal of truly precise diagnosis and accurate treatment will be achieved.

Objective To study the expression of proliferating cell nuclear antigen (PCNA) in the occurrence and development of hepatocellular carcinoma. Methods Sixty SD rats were randomly divided into control group and experimental group. 3′-Me-DAB was administrated into rats to establish the experimental model of hepatocarcinoma. The expressions of PCNA of different phases were detected by immunohistochemistry and the liver pathologic changes were observed by optical microscope. Results The process of canceration was divided into three stages: inflammation, proliferative fibrosis and hepatic carcinoma. The expression of PCNA firstly presented in the oval cells that located in the portal area at the stage of inflammation, and a part of PCNA were hyper-expressed in the portal area. The expression rate of PCNA in the middle phase of inflammatory stage was higher than that of any other phases but declined later. Yet, when it came to the stage of hepatic carcinoma, the rate increased again. Conclusion Under the experimental circumstance when liver cancer is caused by the carcinogenic agent, PCNA may be firstly expressed in the oval cells, and the dynamic expression of PCNA may be an indicator for the early diagnosis of hepatocarcinogenesis.

In this study,changes in immunity were observed in 120 patients undergoing laparoscopiccholecystectomy. It was found that postoperative levels of IgG,IgM,CD3+,CD4+,and CD8+ were significantly higher than that of preoperative and postpneumoperitoneal with CO2 (P

Hepatolithiasis is a common disease in China with a high rate of residual stones up to 30％-90％ after surgery.Patients often require re-operation because the high rate of residual stones and stone recurrence.Because the calculi are deeply distributed in the liver,and the condition is often accompanied by anatomical variations,distortion and biliary strictures,traditional preoperative imaging examinations do not easily locate the lesioos precisely,making diaguosis and treatment difficult.In recent years,three-dimensional computed imaging and visual simulation have provided a novel preoperative diagnostie method for hepatolithiasis,and have offered a clearer radiologic basis for surgical planning.The value of digital medical technology in the diagnosis and treatment of hepatolithiasis is discussed in this article.

Objective To explore the clinical feasibility of hand-assisted laparoscopic surgery (HALS) through the “Lapdisc” device. Methods HALS was performed in 78 cases. After the establishment of a CO_2 pneumoperitoneum, trocars and a “Lapdisc” device were placed appropriately according to lesion’s location and operative demand. The performance of the “Lapdisc” device during the HALS was examined and clinical effects of the device were evaluated intra- and post-operatively. Results HALS through the “Lapdisc” device was successfully performed in 70 cases. The operation time was 60~240 min (mean, 140 min), the blood loss was 100~300 ml (mean, 186 ml), and the length of hospital stay, 9~15 d (mean, 10.2 d), respectively. Conversions to open surgery were required in 8 cases because of difficulties of laparoscopic performance. Conclusions The “Lapdisc” hand-assisted device has advantages of simplicity of performance, comfortable handling, excellent protection of incision, and stable pneumoperitoneum. and perfect protection to incision. The device can simplify the traditional laparoscopic surgery and be applicable to most abdominal HALS.

Objective To study blood supply by inferior phrenic artery to hepatic carcinoma and the value of interventional embolization of the artery. Methods 35 cases of primary hepatic carcinomas,with one severe biliary tract hemorrhage,underwent both hepatic and phrenic artery angiography,and chemoembolizational therapy through the hepatic arteries and the phrenic arteries that had blood suply.And those with the biliary tract hemorrhage were managed by means of gelfoam and coil embolization. Results It was found that 21 of the 35 cases had blood supply by inferior phrenic artery to hepatic carcinomas and they were mainly in mass pattern and diffuse infiltration pattern with invasion of hepatic membrane.The regions of blood supply varied from 20%to 70%.The tumors shrank 40%～50% in 14 cases,10%～30% in 18 cases,with no change in 3cases.Biliary tract hemorrhage ceased. Conclusions Among the collateral arteries that supply blood to hepatic carcinoma,inferior phrenic artery peays a main part.It seems that both the hepatic and phrenic artery should be embolized in interventional therapy to hepatic carcinoma in order to get a better therapeutic result.

Objective To evaluate the feasibility and techniques of hand-assisted laparoscopic resection using the LapDisc in patients with hepatic hemangioma. Methods A total of 8 patients with hepatic hemangioma underwent hand-assisted laparoscopic partial hepatectomy. The patients consisted of 6 men and 2 women, with the age ranging 30~72 years (mean, 47.6 years). Results The hand-assisted laparoscopic hepatectomy was successfully performed in all the patients. The average operating time was 196.3 min (range, 110～350 min), the average blood loss was 307.5 ml (range,100～750 ml), and the average postoperative hospital stay, 7.9 days (range,6～15 days). No postoperative complications such as bile leakage, intraabdominal bleeding or infection occurred. Conclusions Hand-assisted laparoscopic hepatectomy using the LapDisc is safe and feasible for patients with hepatic hemangioma with surgical indications.

Objective To investigate clinical effects of hand-assisted laparoscopic radical resection for colorectal cancers. Methods A series of 27 cases of colorectal cancer received hand-assisted laparoscopic radical surgery using the LapDisc. Results All the operations were successfully accomplished without conversions to open surgery. The operation time was 90~260 min (mean, 140 min), and the intraoperative blood loss was 50~200 ml (mean, 110 ml). No deaths or anastomotic leakages were observed after surgery. Follow-up for 6~23 months (mean, 8.6 months) found no port-site metastasis. Conclusions Hand-assisted laparoscopic radical resection for colorectal cancers gives advantages of safety, minimal invasion, quick recovery, and simplicity of performance.