Energy-based surgical instrumentation (ESI) are surgical devices ablating or cutting tissues via the application of electrical,luminous,acoustic or other energy.High frequency electrotomes are widely used due to the low price,but they produce smoke in the process of surgery and incisions heal slowly.Ultrasonically activated scalpels' cutting performance is satisfying with easily healing incisions while its coagulating capability is poor.Laser scalpels are qualified for both cutting and coagulating in spite of the need of novel technology to overcome the characteristic that tissues absorb laser wavelength selectively.

Objective To analysis effect of compound amino acid 15 peptide 2 on levels of tumor markers in serum of postoperative patients with liver cancer.Methods 42 postoperative patients who were diagnosed with liver cancer were collected.All patients were randomly divided into experimental group and control group, 21 cases in each group.The two groups of patients were given the corresponding parenteral nutrition therapy, after treatment, the serum tumor markers, T lymphocytes, liver function and nitrogen balance related indicators in all patients were detected.Results After treatment, compared with control group, the serum alpha fetal protein(AFP),carbohydrate antigen 19-9(CA19-9) and carcino embryonie antigen(CEA) levels were lower in the experimental group (P<0.05); the serum CD3 +T cells, CD4 +T cells and CD4 +/CD8 + ratio levels were lower in the experimental group (P<0.05); the serum alanine amino transferase (ALT), aspartate aminotransferase (AST) and total bilirubin(TBIL) levels were lower in the experimental group (P<0.05); the patients in the experimental group changed to positive nitrogen balance(P<0.05).Conclusion The diluted compound amino acid 15-2 injection for intravenous injection,can significantly reduce the level of serum tumor markers in patients with liver cancer, improve the immune function of patients, correct negative nitrogen balance, protect liver function.

Objective To compare the clinical efficacy of primary closure versus T-tube drainage after laparoscopic common bile duct exploration in acute cholangitis cases.Methods The clinical data of 100 patients with acute cholangitis undergoing laparoscopic common bile duct exploration from January 2012 to December 2014 were reviewed.54patients received primary closure of the common bile duct and 46 patients were subjected to T-tube drainage after choledochotomy.Results One hundred patients underwent the surgery successfully.Compared with the T-tube group,the operation time(96.72 min vs 123.00 min,P =0.001),intraoperative blood loss(27.13 ml vs 38.48 ml,P =0.009),postoperative gastrointestinal function recovery time(1.57 d vs 2.33 d,P=0.003) and postoperative hospital stay(6.19 d vs 9.20 d,P=0.000) were significantly less in the primary closure group.There were no statistical differences in the incidence of postoperative drainage (309.22 ml vs 212.46 ml,P =0.070),drainage time (3.96 d vs 4.02 d,P =0.875),incidence of bile leakage(9.3％ vs 0,P =0.060) and postoperative bleeding rate(5.1％ vs 2.2％,P =0.622) between these two groups.Conclusion Laparoscopic common bile duct exploration with primary closure of the common bile duct is an effective and safe procedure in acute cholangitis cases compared with T-tube drainage.

Objective To observe changes of plain MR T1WI signal intensity of dentate nucleus in nasopharyngeal carcinoma patients after radiotherapy and multiple times of intravenous injection of gadolinium-based contrast agent(GBCA).Methods Fifty patients with pathologically confirmed nasopharyngeal carcinoma and received intensity-modulated radiotherapy were retrospectively enrolled as the nasopharyngeal carcinoma group,and 50 patients with other malignant tumors and without history of brain radiotherapy were retrospectively enrolled as the control group.All patients received yearly GBCA enhanced MR examinations for the nasopharynx or the head.T1WI signal intensities of the dentate nucleus and the pons on same plane were measured based on images in the year of confirmed diagnosis(recorded as the first year)and in the second to the fifth years.T1WI signal intensity ratio of year i(ranging from 1 to 5)was calculated with values of dentate nucleus divided by values of the pons(△SIi),while the percentage of relative changes of year j(ranging from 2 to 51 was calculated with △SIj compared to △SIi(Rchangej).The values of these two parameters were compared,and the correlation of △SI and GBCA injection year-time was evaluated within each group.Results No significant difference of gender,age nor △SI1 was found between groups(all P＞0.05).The second to the fifth year △SI and Rchange in nasopharyngeal carcinoma group were all higher than those in control group(all P＜0.05).Within both groups,△SI was positively correlated with GBCA injection year-time(both P＜0.05).Conclusion Patients with nasopharyngeal carcinoma who underwent radiotherapy and multiple times of intravenous injection of GBCA tended to be found with gradually worsening GBCA deposition in dentate nucleus,for which radiotherapy might be a risk factor.

Objective:To investigate the causes and prognosis of salvage cholecystectomy for relapsing cholecystolithiasis after gallbladder-preserving gall stones removal surgery.Methods:From Jul 2015 to Dec 2019, 24 referral patients with gallstone recurrence after gallbladder-preserving cholelithotomy surgery received salvage cholecystectomy. The clinical data was analyzed to explore the causes for re-operation and the prognosis.Results:Twenty-two cases had definite gallstone recurrence, among them 19 cases were symptomatic, 2 cases were operated on suspected gallbladder tumor and common bile duct stones induced acute cholangitis. Laparoscopic cholecystectomy was successfully performed in 23 cases and 1 case was converted to open surgery. No severe complication were observed in all the patients.Conclusions:Symptomatic gallstone recurrence is the most common causes of salvage cholecystectomy after gallbladder-preserving cholelithotomy. Laparoscopic surgery procedure is still highly successful.

OBJECTIVE To evaluate the safety and clinical efficacy of cefoperazone/sulbactam in the treatment of biliary tract infections.METHODS In this prospective multicenter study,159 hospitalized patients with biliary tract infections received cefoperazone/sulbactam,and the clinical and bacteriological efficacy as well as the side effects were evaluated.RESULTS The clinical effective rate of cefoperazone/sulbactam in the treatment of biliary tract infections was 86.78%.After treatment,the body temperature reduced to normal rapidly,the average time of defervescence was 3.09?1.81 days.Pathogen eradication rate was 85.71%.No adverse reactions were reported during the study period.CONCLUSIONS Cefoperazone/sulbactam can be used as one of antibiotics of choice in the initial empirical therapy for biliary tract infections.

Lung micropapillary adenocarcinoma is characterized by frequent metastasis, lymph node infiltration, high recurrence rate and low overall survival rate as a high-grade lung adenocarcinoma. Special oncogenic pathway is activated and immune microenvironment is established in this subtype of tumor. This article reviews the Pathological phenomena and molecular features of micropapillary adenocarcinoma studied in recent years, aiming to deepen the understanding of micropapillary lesions and lay the foundation for formulating specific treatment strategies.
.