Objective: To evaluate the effect and clinical significance of early enteral nutrition in postoperative patients with malignant obstructive jaundice. Methods: Thirty patients with malignant obstructive jaundice were randomized into postoperative early enteral nutrition (EN) group and parenteral nutrition (PN) group. Results: The body weight and level of prealbumin, albumin, transferrin decreased significantly after operation in both group, and there was no significant difference between two groups. Nitrogen balance was positive in the EN group, but it was negative in the PN group. EN had less influence on hepatic enzymes than PN. The economic consumption in EN group was less than that in PN group. Conclusions: Compared with PN, early EN support can ameliorate malnutrition state in postoperative patients with malignant obstructive jaundice more safely, effectively and economically.

Minimally invasive approach points toward one of the directions of the development of surgery in the new century.Based on endoscopy,laparoscopy and interventional technique,minimally invasive techniques have been more and more widely applied to abdominal surgery.Some have already replaced conventional open surgery and become the first option for the treatment of some diseases.Nevertheless,some problems and mistaken ideas do exist in the development of minimally invasive techniques,which call for our attention and proper solution.Combined use of different minimally invasive techniques represents the trend of the development of minimally invasive surgery,while virtual reality techniques,robotic techniques and remote minimally invasive techniques will be playing a leading role in the future.

Objective: To study the effect of selective portal vein embolizationon (SPVE) on the second-stage hepatectomy rate in patients with primary hepatocellular carcinoma(HCC). Methods: Eighteen patients with HCC who were not suitable for hepatectomy were treated by ultrasonic guided percutaneous transhepatic SPVE with fine needles. Success rate of SPVE, adverse reactions, successive change of the volume of each liver lobe, and hepatectomy rate after treatment were observed. Results: SPVE were successfully performed in all 18 patients. In patients with right portal vein branch embolized, the right liver volume decreased while left liver volume increased gradually. The rate of right lobe volume to total liver volume decreased from 62.9 % before SPVE to 60.6 % after l week, 57.5 % after 2 weeks and 53.0 % after 3 weeks. The adverse reactions included different degrees of pain in liver area (12 cases), lower fever (7 cases), nausea and vomiting (4 cases). After 2-4 weeks, second-stage hepatectomy for HCC were successfully performed in l0 patients (55.6 %). Conclusion: Ultrasonic guided percutaneous transhepatic SPVE is simple and effective. It can elevate the two-step hepatectomy rate of HCC and increase the safety of the operation.

Objective: To evaluate the feasibility and character of laparoscopic cholecystectomy (LC) in patients with histories of multiple upper abdominal surgeries(≥2 ). Methods: We retrospectively analyzed the results of 21 LC operations in patients who had previously accepted two or three upper abdominal surgeries . Results: LC were successfully performed in 13 of all the patients (61.9%). The success rate of LC in patients with 2 upper abdominal surgeries was 66.7%. It was only 33.3% in patients with 3 upper abdominal surgeries. Eight of the patients (38.1%) were transformed to open cholecystectomies. The mean operation time was 72.1 minutes. The transform rate was higher, and the mean operation time was longer than those without previous upper abdominal surgery at the same period in our department. Conclusion: History of multiple upper abdominal surgeries should not be regarded as the contraindication to laparoscopic cholecystectomy. But these operations were difficult with higher transform rate and longer operation time.

Objective: To evaluate the feasibility, technical characters and benefits of laparoscopic cholecystectomy (LC) in patients with cirrhotic portal hypertension(CPH). Methods:40 CPH patients, including 21 Child A class,26 Child B class and 3 Child C class were included. Data of the patients were collected and analyzed. Results: LC was successfully performed in 37 cases, and 3 patients were converted to open cholecystectomy (OC)for uncontrollled bleeding under laparoscopy and dense adhesion of Calot’s triangle. The convertion rate was 7.5%. The time of operation was (52.6? 15.2)min. The intraoperative blood loss was (75.5? 15.5)ml. The time to resume diet was (18.3?6.5)h. Seven postoperative complications occurred in 5 patients (13.2%). All patients discharged from hospital in (4.6?2.4) d after LC. Compared with LC in non cirrhotic patients, LC in patients with CPH has longer surgical time and hospital stay after operation, higher convertion rate and postoperative complication rate, more intraoperative blood loss. Conclusion: LC in patients with CPH has the advantages of minimal invasive surgery. It is feasible and relatively safe. But it has a higher convertion rate. Intraoperative blood loss is a prominent problem. The key step for a successful operation is to pay more attention to the perioperation managements and acquaint with the technical characters of this operation.

A 48-year-old female presented with a one-week history of painful and enlarged lymph nodes in the left neck.One-week systemic treatment with antibiotics resulted in no obvious improvement.Skin examination revealed palpable lymph nodes between the left lateral cervical papillae and clavicle,which appeared as a string of beads with a little mobility and obvious tenderness.The largest diameter of enlarged lymph nodes was about 2 cm.No enlarged lymph nodes were palpable in the other body sites.Histopathologically,histiocytes of various shapes,immunoblasts and plasmacytoid monocytes markedly proliferated with different degrees of karyorrhexis.Immunohistochemistry revealed that the lesions were positive for CD3,CDS,CD68,mouse macrophage inflammatory protein,and CD20.A diagnosis of histiocytic necrotizing lymphadenitis was made.

Objective: To explore the protections of GLP-Ⅱ pretreatment on mouse intestinal mucosal immunity after ischemia/reperfusion insult. Methods: Thirty ICR mice were randomly divided into three groups: namely normal control (N), control (C) and GLP-Ⅱ pretreatment (P). Group C and group P were inflicted with ligation of superior mesenteric artery for twenty minutes. The morphology of distal ileum mucosa, the rate of intestinal bacteria translocation, the level of plasma endotoxin and intestinal IgA were determined. Results: After ischemia/reperfusion insult, there were obvious damage at distal ileum mucosa in group C and obvious proliferation in group P.The rate of intestinal bacteria translocation and the level of plasma endotoxin were significantly increased (P

Objective To explore the application of hysteroscopy in assisted reproduction. Methods A retrospective analysis was made on results of routine hysteroscopy in 150 cases of infertile women scheduled for assisted reproduction.Results Among the 150 cases,abnormal hysteroscopic findings were identified in 47 cases(31%),including endometrial polyps in 18 cases(12%),endometrial hyperplasia in 17 cases(11%),uterine deformity in 7 cases(5%),uterine adhesion and stenosis in 3 cases(2%),endometrial tuberculosis in 1 case(0.7%),and submucous myoma or adenomyoma in 1 case(0.7%).To think of hysteroscopic findings as the standard,the sensitivity,specificity,positive predicted rate,negative predicted rate,and accuracy were 66%(31/47),98%(101/103),94%(31/33),86%(101/117),and 88%(132/150) for transvaginal ultrasonography,respectively,and were 26%(12/47),100%(95/95),100%(12/12),73%(95/130),and 75%(107/142) for uterophotography,respectively.Conclusions Hysteroscopy is a simple and reliable way to explore the uterine cavity.It may be selected as a routine examination before assisted reproduction.

Objective To investigate the feasibility and technique of laparoscopic subtotal cholecystectomy(LSC).Methods Totally 168 patients were converted to LSC because of failure in laparoscopic cholecystectomy(LC).During the LSC,the Calot's triangle was separated and then the Hartmann's pouch was incised to decreased the intracystic pressure for the removal of the stones.Results Among the cases,5 patients were converted to open surgery for subtotal resection of the gallbladder.LSC was completed after clipping the cystic duct and artery in 122 patients;in the other 41 cases,the gallbladder was cut at the Hartmann's pouch to clip the bile duct and artery or suture the neck of the gallbladder,and then LSC was performed.The median operation time was(65.5?15.2)min,and the intraoperative blood loss was(71.5?15.5)ml.The time to resume the diet was(20.4?6.3)h postoperation.After the operation,7 patients developed local complications(4.2%),and the mean postoperative hospital stay was(4.2?2.6)d.Of the patients,105 were followed up for(25.5?6.5)months,during this period,5 patients had dyspepsia,3 had right shoulder pain,and 9 had right hypochondrium pain.Conclusions LSC is feasible for patients with complicated cholecystitis.It is important to control the perioperative hemorrhage and bile leakage.

Objective To study the effect of glucagon-like peptide 2 (GLP-2) on the absorption- related genes [ sodium dependent glucose transporter 1 (SGLT1) and dipeptide transporter 1 (PEPT1)] mRNA expressions of residual small bowel in a rat model of short bowel syndrome. Methods Rats undertaken 75% small bowel resection were randomly assigned into 3 groups: short bowel control (SBC) group, growth hormone (GH) group and GLP-2 group. Another weight-matched normal rats with normal diet was used as normal (NC) group. All rats were given normal chow on the 1st postoperative day (POD). On the 6th POD, partial segment of terminal ileum was harvested to evaluate the mRNA expressions of SGLT1 and PEPT1 by semiquantified reverse transcription polymerase chain reaction. Results The mRNA expressions of both SGLT1 and PEPT1 in SBC group were significantly higher than that of NC group(P0.05). Conclusions A short term GLP-2 adiministration in early postoperative days may has no significant effect on mRNA expressions of SGLT1 and PEPT1 in residual ileum in rats with short bowel syndrome.