Gallstone ileus is a rare mechanical ileus,which was caused by discharge of giant gall bladder stone to the intestine.Understanding the causes of ileus is the key factor for treatment,and surgical treatment is the treatment of choice.An old patient with gallstone ileus was admitted to the Second Affiliated Hospital of Soochow University in April 2013.Preoperative X ray detection and computed tomography showed gallbladder wall thickening,formation of a sinus tract between the gall bladder and the duodenum,and intestinal ileus in the left iliac region (the diameter of the stone was about 4 cm).The patient received medical treatment for 3 days and then exploratory laparotomy + lithotomy.Gall bladder stones were not detected during the operation,so the gall bladder was preserved.The patient was followed up till December 2013,the sinus tract was disappeared under B sonography,and the cholecystitis was cured.

Objective To reveal the relationship between a certain ratio of the length to width of a slender narrow pedicle and random flap in survival area with an experimental study. Methods 25 pigs were randomly divided into 5 groups. The ratio of length to width of slender narrow pedicle in 5 groups was different and every ratio's slender narrow pedicle was carrying 5 different sizes of random flaps. In each group, these 5 flaps were created randomly in each pigs' bilateral back. The flaps were evaluated with the general observation, fluorescence examination, blood flow ECT test, and computerized analysis of survival area. Results When the ratio of the length to width of the slender narrow pedicle was constant, along with the flap area increased, the flap survival area also increased, but when the flap reached a certain area, the distal flap would develop necrosis, the flap survival area would not reduce; when the flap size remained unchanged, along with the ratio of the length to width of the slender narrow pedicle increased, the flap survival area was not affected, but, when the ratio of the length to width of the slender narrow pedicle increased to a certain limit, distal flap would lead to necrosis, and the flap survival area would reduce. Conclusion The slender narrow pedicle flap is a new and practical random flap. The pedicle of random flap can be designed as slender shape, and the ratio of pedicle width to flap length is far less than traditional ratio. Increasing the flap size or ratio of the length to width of a slender narrow pedicle in a certain extent will not lead to flap necrosis.

Objective To introduce a new and practical method of treating blepharoptosis with direct suspension of the frontal muscle-fascia improvement. Methods 22 cases of blepharoptosis were corrected by direct suspension of the frontal muscle-fascia in which the dynamia still came from frontal muscle.Through double-fold eyelid incision, the frontal muscle-fascia was dissected from the subcutaneous tissue and a 1.5 cm length incision of the frontal muscle-fascia was cut under the supraorbital margin. And through the incision, the frontal muscle-fascia on the superficies of periosteum was dissected 1.5 cm to the upper margin of orbital, and then the frontal muscle-fascia was pulled down and fixed to the levator muscle aponeurosis directly by mattress sutures, with the tension being adjusted to a moderate degree. Results 22 cases of blepharoptosis were cured by primary healing with this method. The patients were followed up for 3 to 6 months with satisfactory results and no recurrence. Conclusion Compared with the traditional methods,this one may decrease the damage to the upper lid and frontalis area, leaving no risk of damaging the vessels or nerves. The technique is simple and the curative effect is affirmed. It can be used to treat any blepharoptosis patient with normal frontal muscle function.

Objective This study aimed to investigate the impact of Xuebijing injection on postoperative inflammatory response and liver function in patients who underwent liver resection for hepatocellular carcinoma,and to evaluate its safety and clinical value.Methods The clinical data of 426 HCC patients who underwent partial hepatectomy at the Nanfang Hospital,Southern Medical University from January 2015 to June 2017 were retrospectively studied.These patients were divided into the treatment group and the control group based on whether they were treated with Xuebijing injection or not.After propensity score matching,each group included 101 patients.The preoperative and postoperative WBC,NE％,C-reactive protein (CRP),body temperature,ALT,AST and TBil levels,as well as the occurrence of adverse drug reactions and the days and costs of hospitalization were compared between the two groups.Results There were no significant differences in ALT,AST,TBil,WBC,NE％ before surgery between the two groups (P＞0.05).When compared with the control group,the WBC,NE％,and CRP in the treatment group were significantly lower than those in the control group on day 3 and 5 after surgery:(11.5±3.2)×109/L vs (10.2±4.0) × 109/L,(8.1± 2.4)×109/L vs (7.3±2.8)×109/L;(78.3±11.6)％ vs (73.3±6.4)％,(69.3±12.1)％ vs (64.7±7.7)％;(81.2±51.8) mg/L vs (64.2±43.7) mg/L,(51.9±26.3) mg/L vs (44.4±24.0) mg/L,respectively.The differences were significantly difference (P＜0.05).There were 76 patients with fever in the control group within 5 days after operation,and 60 patients in the treatment group,75.2％ vs 59.4％.The difference was significantly difference (P＜0.05).The WBC,NE％ of the two groups showed a gradual decline after surgery.The levels of ALT,AST and TBil on day 1,3,5 after operation were not significantly different between the two groups (all P＞0.05).The total incidence of adverse drug reactions,postoperative hospital stay and hospitalization costs were not significantly different between the two groups (all P＞ 0.05).Conclusion Xuebijing injection showed a good anti-inflammatory effect with no obvious liver toxicity in patients who underwent liver resection.It demonstrated good safety and could be applied to prevent and treat patients with excessive inflammatory reaction after liver resection.

Objective To compare the discriminatory power of the Albumin-bilirubin score (ALBI) and the Child-Pugh score (CP) in predicting post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) after curative liver resection,and to explore the clinical value of ALBI score.Methods The clinical data of HCC patients who underwent curative hepatectomy in Nanfang Hospital,Southern Medical University from January 2011 to December 2016 were retrospectively reviewed.The risk factors of PHLF were identified through logistic regression.The areas under the receiver operating characteristic (ROC) curve were calculated to measure the ALBI and CP scores in the prediction of PHLF.Results A total of 1 013 patients were enrolled.The incidence of PHLF was 17.7％ (179/1013).Both CP score (OR =1.94,P ＜ 0.05) and ALBI score (OR =3.85,P ＜ 0.05) were identified as independent predictors of PHLF on multivariable analysis.The incidence of PHLF in patients with CP grade A was significantly lower than those with CP grade B(16.4％,158/963 vs.42％,21/50;P ＜ 0.05).The incidences of PHLF in patients with AIBI 1,2 and 3 were 9.9％ (50/504),24.8％ (124/501) and 62.5％ (5/8),respectively (P ＜0.05),indicating that the incidences of PHLF increased significantly with increasing ALBI grades.Moreover,when the ALBI score further classified patients of the CP grade A into the ALBI 1-A and ALBI 2-A subgroups,the incidence of PHLF in patients with ALBI 1-A was significantly lower than that with ALBI 2-A (9.9％,50/504 vs.23.5％,108/459;P ＜0.05).The area under the ROC curve for the ALBI score in predicting PHLF was greater than that of the CP score (0.705 vs.0.630;P ＜ 0.05).Conclusions The prognostic power of the ALBI score was greater than that of the CP score in predicting PHLF.Even in patients with CP grade A,the ALBI score was more sensitive in identifying patients with a high risk of PHLF.The ALBI score is a useful tool to predict PHLF after hepatectomy in HCC patients.

Objective To compare the safety and short-term efficacy of laparoscopic repeat hepatectomy (LRH) with open repeat hepatectomy (ORH) for recurrent hepatocellular carcinoma (rHCC).Methods The clinical data of 33 patients with rHCC who underwent hepatectomy at Nanfang Hospital,Southern Medical University from August 2015 to November 2017 were retrospectively analyzed.There were 24 males and 9 females.The patients were divided into LRH group (n=15) and ORH group (n=18).The preoperative clinical data,operative and postoperative data of the two groups were compared.Results No significant differences were observed in the preoperative clinical data of the two groups,including the extent of the previous hepatectomy,the interval between the two surgeries,the number of tumors,and the maximum diameter of tumors.No significant differences were observed in the liver resection method,portal occlusion time and operation duration between the two groups.Blood loss was significantly lower in the LRH group [(66.7±86.1) ml vs.(251.1±75.6) ml,P＜0.05].The total hospitalization expenses,first postoperative white blood cell count,and hepatic insufficiency in the two groups were not significantly different (P＞0.05).The postoperative diet recovery was significantly shorter (1.2±0.4) days vs.(2.9± 1.4) days,the inflammation indicator NEU％ was significantly decreased (83.6±4.8)％ vs.(88.2±3.7)％,and the length of postoperative hospital stay (6.3±2.9) days vs.(9.8± 3.7)days was significantly shorter in the LRH group (P＜0.05).Conclusions LRH was safe and effective in the treatment of rHCC,LRH was superior in reducing intraoperative blood loss,promoting postoperative recovery and shortening hospital stay when compared to ORH.

Objective To analyze the effect of Xuebijing injection on inflammatory response in patients after hepatobiliary and pancreatic surgeries, and to evaluate its safety and clinical value. Methods A retrospective cohort study was conducted. 708 patients received hepatobiliary and pancreatic surgeries of Nanfang Hospital, Southern Medical University from January 2015 to September 2017 were enrolled and divided into Xuebijing treatment group and conventional treatment group according to whether they were treated with Xuebijing injection or not. The inflammatory response indexes included white blood cell count (WBC), neutrophil (NE), C-reactive protein (CRP), body temperature, which were compared between the two groups at 1, 3, and 5 days after operation. The incidence of adverse reactions, the length of postoperative hospital stays and hospitalization costs were compared. Results A total of 209 patients were prescribed with Xuebijing injection, and 499 patients were allocated into conventional treatment group. The two groups were stratified by liver, biliary and pancreatic surgery types, and further 1:1 propensity score matching was performed. After propensity score match, 189 patients were included in each group, with 101, 46, and 42 patients undergoing liver, biliary, and pancreas surgery, respectively. There were no significant differences in baseline data such as gender, age and inflammatory response indexes before surgery between the two groups. In both groups, the WBC and NE showed a gradual decline after operation, CRP were increased gradually and then decreased after 3 days. Compared with the conventional treatment group, Xuebijing treatment group showed obvious anti-inflammatory effect from 3 days after operation [WBC (×109/L): 10.1±4.0 vs. 11.0±3.5, NE: 0.71±0.10 vs. 0.76±0.12, CRP (mg/L): 73.1±38.7 vs. 82.2±41.8, all P < 0.05]. On the 5th day, it still showed a strong anti-inflammatory trend [WBC (×109/L): 7.0±2.8 vs. 7.9±2.6, NE: 0.62±0.10 vs. 0.68±0.12, CRP (mg/L): 43.4±31.0 vs. 50.9±25.3, all P < 0.05]. The cases of postoperative fever in the Xuebijing treatment group were significantly less than that in the conventional treatment group (cases:98 vs. 119, χ2＝4.711, P＝0.029). There was no significant different in the total incidence of adverse drug reactions such as rash, nausea and vomiting (5.0% vs. 3.2%), the length of postoperative hospital stays [days: 9.3 (6.1, 13.5) vs. 9.1 (5.5, 13.3)] and hospitalization costs [wanyuan: 5.8 (3.6, 9.5) vs. 5.7 (3.5, 9.8)] between Xuebijing treatment group and conventional treatment group (all P > 0.05). Conclusions Xuebijing injection has a good anti-inflammatory effect on patients undergoing hepatobiliary and pancreatic surgeries. Xuebijing injection has good safety and can be applied to the prevention and treatment of excessive inflammatory reaction after hepatobiliary and pancreatic surgeries.