Objective To study the method of combined laparoscopy and endoscopy ( duodenosco-py and choledochoscopy) in the treatment of Csendes's II, III Mirizzi Syndrome. Methods Twenty one patients with Mirizzi Syndrome were admitted for the procedures. These patients received endoscopic nasobiliary drainage first, followed by laparoscopic subtotal cholecystectomy plus common bile duct(CBD) exploration. Results Satisfactory out come was realized except conversion to open surgery occurred in 2 for failure in repairing due to the extensive adhesions of Calot's triangle and anatomical abnormalities of cystic duct. In the course of operation ,removal of incarcerated stones in neck of gallbladder was performed in 14 cases, extraction of CBD stones by intraoperative choledochoscopy in 5 cases, and all cases received primary suture on the defect of CBD. There was neither residual stones left nor serious after - effect including biliary fistula and he-mobilia. Mean postoperative stay was 9.4 days. Follow - up observations on 19 patients did not show recurrence of stones, nor bile duct stricture during 18-41 months. Conclusion The combined procedures is feasible and safe alternative but can be technically demanding. This management is able to substitute some conventional procedure of T - tube insertion, however, primary suture on the defect bile duct is especially difficult.

75 years old) with calculous acute cholangitis were endoscopically treated from May 1998 to June 2005.The endoscopic nasobiliary drainage(ENBD) was firstly performed.After patient's conditions had relieved,basket stone removal,endoscopic common bile duct exploration,or endoscopic retrograde biliary drainage(ERBD) were carried out respectively according to patient's individualized conditions.Results The ENBD was performed successfully in all the 273 patients.Three patients died before further treatment.Out of the remaining 270 patients,complete removal of common bile duct stones was achieved by single-session of emergent endoscopy in 36 patients,and by secondary duodenoscopy in 178 patients.ERBD was carried out in 31 patients.Common bile duct exploration with the combination use of duodenoscopy,laparoscopy,and choledochoscopy was conducted in 25 patients,including a conversion to open surgery in 1 patient.No serious complications were found in all the patients.Conclusions For senile patients with calculous acute cholangitis,emergent ENBD combined with duodenoscopic stone removal is safe and effective.

Objective To assess the safety and feasibility of hybrid trans-gastric endoscopic and laparoscopic cholecystectomy in a porcine model.Methods A total of 6 pigs underwent hybrid trans-gastric endoscopic and laparoscopic cholecystectomy from July to October,2010 under general anesthesia.The operation time and complications during the procedure were recorded,as well as post-operative changes of eating habits and weight.Animals underwent autopsies on post-operative days(POD)14 for evaluation of infection,abscesses and adhesion.Results All procedures were successfully performed and all dogs survived.There was no severe complication except for hemorrhage in one porcine,which was successfully managed under laparoscopy.The mean operation time was 87mins(ranging from 69-124 mins).After the operation,there was no change in eating habits or weight.At autopsy on POD 14,no abscess or hemorrhage was found.Sites of gastric closure were found to be completely healed.Conclusion The hybrid approach increases the safety of initial gastric puncture and gastric wall incision,simplifies peroral trans-gastric cholecystectomy,and decreases invasiveness of laparoscopic surgery.It is a bridge between laparoscopic and transluminal surgery.

Objective To assess the clinical outcome of massive hiatal hernia repair by mesh via laparoscopic approach. Methods A total of 31 patients with massive hiatal hernia who underwent laparoscopic repair from March 2005 to January 2009 were enrolled in the study, among which mesh was used in 20 patients. The clinical outcomes of these patients were compared with other 11 patients without mesh repair procedures. Results Surgical repair, combined with Dor fundoplication, was successful in all 31 cases.Five patients in the mesh group developed post-operative recurrent symptoms, 2 ( 10% ) of whom were confirmed by imaging study. Six patients in non-mesh group had recurrent symptoms after operation and 4 (36. 4% ) were confirmed. Conclusion Laparoscopic repair of massive hiatal hernia is technially demanding with a high post-operative recurrent rate. Administration of intro-operative mesh can reduce the difficulty of the procedure and recurrence as well.

Objective To evaluate pancreatic duct stenting for acute biliary pancreatitis with difficult endoscopic cannulation. Methods From January 2005 to December 2009, in patients with acute biliary pancreatitis who needed intervention of emergency ERCP, a total of 81 cases were found to be with difficult cannulation and were randomly divided into either treatment group (n = 35 ) to receive pancreatic duct stenting, or control group (n =46) to receive the procedure without pancreatic duct stenting. All patients were treated with same medication, and the pancreatic stents were removed after stabilization at a mean time of 11days after ERCP. All patients were followed up for 3 months after discharging from the hospital. Results There was no significant difference between two groups in regarding of mean age, the time from onset to endoscopy, Glasgow scores and relevant biochemical parameters, but the occurrence of postoperative complications was significantly higher in control group than that of the treatment group ( 17. 39% vs. 5. 71%*, P ＜0. 01 ). Conclusion Pancreatic duct stenting is a safe and bridging procedure for patients with acute billiary pancreatitis, which can also reduce complications.

Objective To observe the effects of fasudil hydrochloride injections on the levels of endothdin(ET)-1,nitric oxide(NO)in plasma and cerebrospinal fluid(CSF)in patients with subarachnoid hemorrhage(SAH),and analyze,its mechanisms in preventing cerebral vasospasm(CVS).Method Sixty SAH cases were randomly divided into fasudil group(30 cases)and control group(30 cases).On 2nd and 10th day after in hospital,the speed of cerebral blood flow was measured by transeranial Doppier(TCD),and the levels of ET-1,NO in plasma and CSF were measured by radio-immunity.Results The incidence of CVS in fasudil group were significantly less than those in control group[6.67%(2/30)vs 36.67%(11/30),P<0.05].On the 10th day,the levels of ET-1 in plasma and CSF in fasudil group were signitlcandy lower than those in control group[(118.23±14.56)ng/L vs(132.26±15.18)ng/L,(138.23±16.58)ng/L vs (156.24±17.54)ng/L ](P<0.05),the levels of NO were significantly higher than those in control group [(88.25±15.54)μmol/L vs(70.26±14.86)μmol/L,(104.27±16.52)μmol/L vs(92.43 ±12.51)±mol/L](P<0.05).But there were no significant difference on the 2nd day(P>0.05).Conclusion Fasudil can reduce CVS in patients with SAH by lowering the levels of ET-1 and increasing the levels of NO in plasma and CSF.

Objective:To optimize the extraction technology of Fufang Jinsha Lidan granule. Methods:According to the properties of traditional Chinese medicines in the formula, orthogonal experiments were used to optimize the extraction process of Fufang Jinsha Li-dan granule. The volume of water, boiling time and boiling frequency were used as the three influencing factors with three different lev-els in the orthogonal experiments. Moreover, the content of paeoniflorin and the yield of extract were chosen as the evaluation indices. The orthogonal experiments were carried out according to the L9 (34 ) orthogonal table. Results:The optimal extraction process of Fu-fang Jinsha Lidan granule was as follows:boiled twice, and one hour per time with 12-fold amount of water ( soaked for 30 min with 14-fold amount of water for the first extraction process) . Conclusion:The extraction process has such properties as high extraction rate, stability, simple operation, high yield of extract and controllable quality, which is worthy of wide application.

Objective To compare the difference of cutpoint and clinical significance of HbA1C for the diagnosis of abnormal glucose metabolism in two population groups with different ages.Methods According to oral glucose tolerance test(OGTT),the cutpoint and clinical significance of HbA1C for the diagnosis of type 2 diabetes and impaired glucose regulation(IGR)were investigated in the two population groups.Results The mean HbA1C of 1 064 young subjects in an academy and 1 671 aged subjects in a community were 5.31% ±0.41% and 5.79% ±0.71%,respectively.The cutpoints of HbA1C for diagnosis of diabetes were 5.7%(specificity 86.7%,sensitivity 66.7%)and 5.9%(specificity 73.8%,sensitivity 80.1%)in the two population groups,and 5.6% for diagnosis of IGR (specificity 82.8%,sensitivity 55.8%)and 5.7%(specificity 60.9%,sensitivity 64.3%),respectively.87.8%,78.7%,and 38.5% were diagnosed diabetes by current OGTT criteria at HbA1C levels of ≥5.7%,≥5.9%,and≥6.5%,IGR being 61.6%,39.6%,and 4.1%,and normal glucose tolerance being 24.4%,10.0%,and 0.4%.Conclusion The cutpoints of HbA1C for diagnosis of diabetes and IGR are different in populations with different ages and HbA1C levels.As one of diagnostic criteria for diabetes,HbA1C 6.5% with relatively higher specificity and lower sensitivity must be combined with fasting blood glucose,random blood glucose,and OGTT.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.