Objective　To evaluate the result of unilateral ex ploration for the treatment of hyperparathyroidism caused by parathyroid adeno ma.　Methods　Clinical data of 20 case s from 1986 to 1999 were retrospectively analysed. Preoperative imaging examinat ion was suggestive of unilateral lesion and unilateral exploration was performed accordingly.Results were compared with that of bilateral exploration.　Results　In 19 out of 20 cases the result of u nilateral exploration was satisfactory making bilateral approach unnecessary exc ept for one whose symptom was later proved to be caused by bilateral lesions.Conclusions　The authors came to the c onclusi on that solitary adenoma is the most common cause of hyperparathyroidism in Chin ese patients,hence unilateral exploration is of advantages.

Objective　To investigate factors influencing the incidence of massive bleeding caused by stress ulcer in severe acute pancreatiti s (SAP) and explore the effectiveness of measures for its prevention and treatme nt.　Methods　Clinical data of 121 pat ients with SAP were reviewed retrospectively in our center between 1993 and 1998 .The incidence of massive bleeding caused by stress ulcer in SAP, its affecting factors and the results of prevention and treatment were evaluated.　Results　The incidence of stress ulcer massive b leeding in SAP was 11.6% (14/121). The risk factors included the age of patient s, the severity of the disease, concomitant bile duct lithiasis obstruction, pan creatic abscess, pseudocyst and a history of surgical debridement and drainage. Five out of 6 patients treated conservatively died, while only 1 out of 8 treate d surgically died (P＜0.01).　Conclusion　Massive bleeding stress ulcer most often occurred in elderly SAP p atients, especially those of biliogenic, with pancreatic abscess and pseudocyst. Somatostain administration effectively decreases the incidence of bleeding. E mergency operation is mandatory when conservative measures fail to stop the bl eeding.

Objective To compare the clinical application of Da Vinci robot surgical system (RSS) with traditional open surgery (TOS).Methods From Feb 2015 to Jul 2016,48 cases of upper abdominal surgical disease patients were divided into RSS group (23 cases) and TOS group (25 patients) randomly.Results The anesthesia time [(194 ±16)min vs.(181 ±11)min,t=3.262,P=0.002] and operation time [(167 ± 14) min vs.(158 ± 14) min,t =2.292,P =0.027] were much longer in the RSS,while the blood loss during operation significantly less than the TOS [(128 ± 62) ml vs.(190 ± 86) ml,t =-2.886,P =0.006].The RSS has obvious advantages in 24 h-drainage [(69 ± 27) ml vs.(114 ± 54) ml.t =-3.680,P =0.001],time to out-of-bed activity [(27.7 ± 8.0) h vs.(35.7 ± 9.9) h,t =-3.067,P =0.004],BPS,postoperative exhausting time[(27.2 ±5.9)h vs.(32.8 ±8.3)h,t =-2.690,P =0.01] and length of hospital stay [(10.4 ± 1.8) d vs.(11.8 ± 1.9) d,t =-2.600,P =0.013].But the total hospital cost was higher in RSS [(117 000 ± 10 000) yuan vs.(77 000 ± 8 000) yuan,t =15.087,P =0.000)].Conclusions The RSS is a much minimally invasive surgery,reducing blood loss and postoperative pain,promoting rapid recovery,shortening hospital stay.

Objective To explore the feasibility and safety of laparoscopic right hemihepatectomy (LRH) via anterior approach for larger tumors in the right lobe of the liver.Methods A retrospective study was conducted based on the clinical data of ten consecutive patients with large right liver cancer undergoing LRH through anterior approach and thirty-seven patients undergoing open hemihepatectomy by anterior approach in recent 6 years.Results Between the two groups there were no significant difference in gender,average age,the mean tumor size,preoperative liver reserve function,cut margin and intraoperative blood transfusion.The LRH group had less average intraoperative blood loss [(408 ± 158)ml vs.(520 ± 153)ml,t =2.047,P =0.046] and shorter postoperative hospital stay [(11.5 ±2.8)d vs.(16.2 ±4.6) d,t=3.091,P=0.003],longer operation time [(302 ±38)min vs.(251±55)min,t=2.732,P=0.009].There was no perioperative death and no significant difference in complications (20.0％ vs.35.1％,x2 =0.812,P =0.367) and similar median survival time (36 mon vs.29 mon,x2 =1.266,P =0.261).Conclusions LRH via anterior approach for larger tumors in the right lobe of the liver is safe and feasible.

Objective To investigate the expression of CD55 and its implication on prognosis for patients with gastric stromal tumors.Methods Expression of CD55 was detected by immunohistochemistry staining and the correlation between CD55 and clinicopathological features and prognosis were analyzed on 60 cases of primary gastric stromal tumors from January 2010 to October 2012.Results Of the 60 patients with gastric stromal tumors there were 33 males and 27 females.CD55 was mainly located in the cytoplasm of gastric stromal tumors.There was no statistical difference between CD55 expression and patients' gender and age (P ＞ 0.05).Moreover,the expression of CD55 was closely related to tumor size,mitotic counts,2008 NIH classifications,and distant metastasis at the first visit to the hospital (P ＜ 0.05).During a median follow-up of 58.5 (range 23-78) months,14 patients had tumor progression.Log-rank univariate survival analysis showed tumor size,mitotic counts,2008 NIH classifications,radical resection,distant metastasis at the first clinical visit and CD55 expression were related to progression-free survival (P ＜ 0.001).COX multivariate survival analysis showed that tumor size (HR 11.504,95％ CI:1.085-122.011,P =0.043) and CD55 expression (HR 11.819,95％ CI:1.827-76.477,P =0.01) were independent prognostic factors.Conclusions Up-regulated CD55 might play an important role in the development and metastasis of gastric stromal tumors.

Objective To review the experience in the management of gastric cancer with liver cirrhosis and portal hypertension.Method A retrospective analysis was made in 35 gastric cancer cases with liver cirrhosis and portal hypertension admitted into our hospital from January 2000 through June 2009.Result There were no intraoperative death in this group.Postoperative ascites occurred in 19 patients,anastomotic leakage in one case,anastomotic bleeding in 2 cases,wound bleeding in 2 cases,intraabdominal infection in 17 cases (of which combined fungal infection in 4 patients),incision infection in one patient and chylous leakage in one case.The morbidity rate was 71%.Four patients died during hospitalization including multiple organ dysfunction syndrome in 2 cases,with mortality rate of 11%. Conclusion In order to reduce the incidence of mortality and complications,we should complete preoperative evaluation,correct perioperative management,guide surgery with damage control concept,follow individualized principles and emphasize on preventive devascularization.

Objective To investigate Lovastatin's effects on proliferation and adhesion of human umbilical vein endothelial cells (HUVECs). Methods Culture medium with different concentration of Lovastatin(0.001、0.01、0.1、1.0、10μmol/L) was prepared, HUVECs was cultured in 96 well-plate with the different medium. AT the point of 24,72 and 120 h, the cell's activity and quantity was assessed by MTT. HUVECs was cultured with Lovastatin in 6 well-plate for 24 hours, then collected the cells by trypsin digestion. The cells were seeded in 24 well-plate with 2×104/ml and adhering for 30 mins. Then counting the adhered cells in different wells. Results At 24 h, Lovastatin (0.01、 0.1 μmol/L ) promoted proliferation of HUVECs ( P ＜ 0.05 ); at 72 h, Lovastatin ( 1.0μmol/L) was positive accelerating cell growth(P＜ 0.05 ). While Lovastatin ( 10μmol/L) inhibited the proliferation significantly ( P ＜0.05 ) at 120 h. As HUVECs was cultured with Lovastatin for 24 hours, Lovastatin (0.1、1μmol/L) inhanced the adhesion capability of HUVECs significantly( P＜ 0.05 ). Conclusion Lovastatin had biphasic effects on proliferation and adhesion of HUVECs dependent on the concentration. Lovastatin (0.1、1.0 μmol/L) could promote the proliferation and adhesion, while at higher concentration ( 10.0μmol/L) it inhibits cell proliferation and adhesion.

Objective To evaluate the choices and surgical skills for tension-free femoral hernia repair under local anesthesia. Methods The clinical data of 109 nonincarcerated femoral hernia patients were summarized from December 2002 to December 2009. Patients were divided into 3 groups according the time period at which the surgery was performed. 85 patients from 2002 to 2008 were divided into 2 groups,45 cases treated with preperitoneal repair ( preperitoneal group), and the other 40 cases with mesh-plug repair (plug group). The 24 cases admitted from January 2009 to December 2009 received modified preperitoneal repair. Operation time, VAS, length of hospitalization, incidence of recurrence, foreign body feelings and seroma were compared among the three groups. Results All the 109 patients were repaired under local anesthesia, and there was no perioperative death. The statistical indicator value of incidence of recurrence, foreign body sensation and seroma in preperitoneal group was lower than plug group (P ＜0.05). The modified preperitoneal repair was better in operation time, VAS, length of hospitalization than preperitoneal group (P ＜ 0.05). Conclusions Modified preperitoneal repair under local anesthesia is the choice for treating femoral hernia without incarceration. Modified preperitoneal repair is faster, more minimally invasive and faster recovery.

Objective To evaluate the safety of central lymph node dissection with total thyroidectomy for papillary thyroid carcinoma. Methods A meta-analysis on the data of suitable seven clinical researches was performed using the Mantel-Haenszel method and the risk difference was calculated.Results Seven studies with a total of 1524 patients were eligible for inclusion, 620 were with totalthyroidectomy plus central lymph node dissection and 904 with thyroidectomy alone. There was a significant increased risk of temporary hypocalcaemia ( P = 0. 03 ) and temporary vocal cord palsy ( P = 0. 01 ) when central lymph node dissection was performed in addition to a thyroidectomy. However, the risk of permanent hypocalcaemia( P = 0. 32 ) and permanent vocal cord palsy (P = 0. 75 ) has no statistical difference between the two groups. Conclusion Central neck dissection added to thyroidectomy does not increase rate of permanent morbidity in thyroid cancer patients.

Objective To evaluate the clinical characters, management and prognostic factors of patients with differentiated invasive thyroid carcinoma (DITC). Methods The data were analyzed retrospectively for 114 DITC patients treated at Department of Head and Neck Surgery of Sun Yat-sen University Cancer Center. Survival analysis was performed by Kaplan-Meier method, comparison among/between groups was performed using log-rank test, and multivariate analysis was carried out using Cox proportional hazard model. Results After surgery, 68 patients were with tumor residue. The 5-year and 10-year overall survival rate were 91.9% and 80.1% respectively in all patients, while the 10-year overall survival rate were 88.5% 、78.5% and 53.1% in no tumor residue group, micro-residue group and grossresidue group respectively. This study failed to prove that radiotherapy might improve the survival rate in patients with postoperative tumor residue. Multivariate analysis indicated that age, invasion to esophagus and recurrence predict the prognosis. Conclusion DITC may be treated mainly by surgical operation. Radical resection is the key factor in the treatment of DITC. Patients with DITC have a relatively poor prognosis.Age, esophagus invasion and status of tumor residue are the most important factors affecting the prognosis.