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 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, 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.

[Summary] The mechanisms of gastroesophageal reflux disease ( GERD) include abnormal antireflux function and esophageal mucosa attacked by regurgitation .Gastroesophageal flap valve ( GEFV) located in the gastroesophageal junction is one mechanism of the antireflux barrier .An increased GEFV grade is associated with an increased incidence of erosive esophagitis and Barrett ’ s epithelium.With abnormal esophageal acid exposure and prevalence of a mechanically defective sphincter , patients usually have severe symptoms and lower efficiency of medication .Therefore , GEFV is valued in the diagnosis and treatment of GERD .This review summarized the relationship between GEFV and GERD .

Leech has a broken blood stasis effect and has been used to eliminate a variety of stasis diseases. With the development of modern pharmacology study, in recent years, leeches are widely used in clinical cancer patients, and its anti-tumor effects have been confirmed by numerous clinical and experimental studies. Based on the latest domestic and foreign literature analysis and summary, this article discussed the antitumor mechanisms of leech from the following aspects:inhibition of tumor growth and proliferation, induction of tumor cell apoptosis, inhibition of tumor angiogenesis, anti-platelet aggregation and anti-clotting effect, improvement of immunity, and anti-tumor multi-drug resistance. It also pointed out deficiencies and controversy in current studies, with a purpose to provide ideas for further researches and clinical applications.

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 investigate the cognition of nurse groups toward nurses' dual practice,and to analyze nurses' tendency to pursuc dual practice and its influencing factors.Methods A questionnaire survey was conducted,and 1010 registered nurses were recruited using stratified sampling method.Results Most (76.4％) nurses agreed with nurses' dual practice.The willingness about nurses' dual practice was significantly different(P=0.022,P=0.008) due to different age and length of service.The top three benefits of nurses' dual practice were to increase reasonable salary of nurses,improve quality of nursing care in community institutions for the aged and increase the utilization of health care resource.As for the disadvantages,disrupting the medical and nursing order,increasing difficulties of management and government's supervision,increasing medical risks.Nurses believed that the main obstacles for nurses' dual practice were the unclear medical risks and the unprotected nurses' interests.Conclusion The nurse groups had a positive and optimistic attitude towards nurses' dual practice.In the case that the government implements relevant laws and regulations,and the interests of nurses are well-guaranteed,nurses' dual practice is a good measure that can improve nurses' work motivation.