Vascular disconnection around the gastroesophageal junction in 100 patients with portal hypertension and gastroesophageal varices resulted in such complications as ascites,peritoneal infection,recurrent gastrointestinal bleeding,gastric perforation,ischemic gastric necrosis,hepatic failure,multiple organ failure,etc in 41 patients (with a operative morbility of 41%).9 cases out of the 41 died because of peritoneal sepsis,massive bleeding and hepatic or multiple organ failure.Multiple organ failure was the most common cause of death.Grade III liver function and improper perioperative management were the associated factors responsible for the operative complications and death in these patients.

Objective To evaluate the long term results of regular hepatic resection for hepatolithiasis.Methods Five hundred and fourteen patients with hepatolithiasis underwent hepatic resection from Jan. 1975 to Dec. 1998 in Southwest Hospital. The indications included stones confined to one segment or one lobe of the liver, significant atrophy of the portion of the liver harboring the stones from repeated episodes of obstruction and infection, multiple strictures of the ducts in the affected portion of the liver. Resection of S 2 and S 3 was performed in 284 patients, S 2, S 3 and S 4 in 98 patients, S 6 and S 7 in 26 patients, S 5, S 6, S 7 and S 8 in 37 patients; both of the left and right hepatic lobes were partially resected in 23 patients. Additional biliary procedures including choledochojejunostomy and common bile duct exploration were performed in 296 patients.Results The operative mortality was 2 1%, and the morbidity rate was 8 4%. The majority of complications were biliary fistulas (2 9%), subphrenic infection (4 5%), peritoneal abscesses (0 4%) and liver failure (0 6%). Long term follow up on 436 patients at a median of 9 1 years showed that 75 9% were symptom free, 14 5% had occassional mild attacks of cholangitis, 9 6% had severe cholangitis requiring further surgical intervention.Conclusion Anatomic hepatic resection is the most effective treatment and the therapy of choise to eradicate intrahapatic stone foci in cases of hepatolithiasis .

Objective To investigate the clinical value of lasting methylene blue staining in precise hepatectomy.Methods The clinical data of 21 patients with liver cancer who received precise hepatectomy after methylene blue staining at General Hospital of PLA from February to August in 2009 were retrospectively analyzed.After the hepatic pedicle Was dissected,methylene blue WaS injected into the portal vein,and then the hepatic pedicle was ligated.Parenchymal division is initiated along the line of devascularization demarcated on Glisson capsule.Results The success rate of methylene blue staining Was 100%.Methylene blue retained in the parenchyma for(80±23)minutes.Right hepatectomy was performed on 2 patients,left hepatectomy on 1,right posterior lobectomy on 2,right anterior lobectomy on 3,left lateral lobectomy on 1,segmentectomy of segment Ⅷon 2,segmentectomy of segment Ⅶ on 3,segmentectomy of segment Ⅵ on 1,segmentectomy of segment Ⅳ on 2 and combined segmentectomy on 4.The mean volume of blood loss,incidence of postoperative complications and postoperative hospital stay were(236±6)ml,14%(3/21)and(12±3)days.Conclusions Ligation of hepatic pedicle after methylene blue injection has the advantages of high success rate and lasting staining of parenchyma of liver.Especially,this staining method contributes to improve the precision of hepatectomy by guiding the segment selection during parenchyma transection.

Objective To study the influence of furosemide on the currents of the delayed rectification potassium channel and sodium channel of mice's spiral ganglion neurons.Methods Postnatal mice(P1～P6) spiral ganglion neurons were obtained by mechanical dissociation and enzymolysis.Delayed rectification potassium channels' currents and sodium channels' currents were recorded with whole-cell patch clamp techniques.Observed was the influence of furosemide on potassium channels and sodium channels.Results When furosemide was added around the spiral ganglion neurons,the delayed rectification potassium currents were inhibited to around +200～+300 pA,and sodium currents were inhibited to about 30% of peak current.Furosemide was washed away after working steadily for 1 minute,5 and 10 minutes.The delayed rectification potassium currents could recover to 98%,64%,and 25% of the peak currents before and sodium currents could recover to 96%,76% and 54% of the peak currents accordingly.Conclusion The currents of delayed rectification potassium channels and sodium channels could be inhibited by furosemide to different degrees.The longer furosemide was used,the greater damage could occur in the ion channels.

Objective To investigate the causes, diagnosis and treatment of gastrolienal portal hypertension. Methods During recent 10 years, 32 cases of gastrolienal portal hypertension were admitted. Clinicopathological features were analyzed. Results The main causes of this entity was chronic pancreatitis or pseudocyst of the pancreas (14 cases), tuberculosis of lymph nodes in retroperitoneum (7 cases) , retroperitoneal malignant lymphoma (3 cases) and pancreatic tumors (8 cases). Definite diagnosis was made in all 32 cases during the hospitalization. Twenty cases underwent surgery including splenectomy (11 cases) , splenectomy plus portal-azygous disconnection (5 cases) , splenectomy plus distal pancreatectomy (4 cases) , endoscopic varicose vein ligation combined with partial splenic embolization (2 cases), and endoscopic varicose vein ligation ( 5 cases). Conclusion A definite diagnosis of gastrolienal portal hypertension lies in the surgeon's recognition of this entity. Splenectomy is the most effective symptomatic treatment.

In 1989, Fitz defined and classified severe acute pancreatitis (SAP) and he thought that surgical treatment of SAP is feasible. Since then, the strategy of treating SAP was a controversial issue over past decades. Currently, relevant literatures reported that medical or minimally invasive treatments are superior to surgical treatment, while it is too early to make the final conclusion because of the complexity of SAP. From 1989 to 2008, 1852 patients with acute pancreatitis were treated at the General Hospital of PLA, and the clinical data of 18 patients who died of SAP were retrospectively analyzed. Based on the analysis, we concluded that medical conservative therapy and surgical operative therapy should not be opposed to each other. Selecting ideal timing and appropriate operation on the basis of pathological changes of retroperitoneum and pancreatitis should be considered seriously, and the new concept of "miniaturization of trauma" should also be introduced in treating SAP.

Objective To understand the regional distribution and drug resistance of clinical isolates of bacteria flora ,in order to provide the basis for the diagnosis and treatment of bacterial infection .Methods According to the national clinical test proce‐dures operation separation strains ,HX‐21 bacteria identification/susceptibility analyzer bacteria identification and drug sensitive test .Results Among 1 705 strains of isolated bacteria ,Gram‐positive cocci accounted for 39 .8% ,Gram‐negative bacteria accounted for 60 .2% ;separation rate from high to low were:benzene azole resistance westwood 13 .3% coagulase negative staphylococcus , pseudomonas aeruginosa ,12 .0% benzene azole resistance westwood staphylococcus aureus 11 .3% ,did not produce the ultra broad spectrum beta lactamase 10 .7% ,e .coli to produce ultra broad spectrum beta‐lactamase e .coli 9 .9% ,acinetobacter was 7 .1% ,pro‐ducing ultra broad spectrum beta‐lactamase pneumonia klebsiella bacteria 5 .9% ,did not produce the ultra broad spectrum beta‐lac‐tamase pneumonia klebsiella bacteria 5 .7% ,benzene azole westwood sensitive coagulase negative staphylococcus 4 .8% ,enterococ‐cus was 4 .8% ,benzene azole westwood sensitive staphylococcus aureus 4 .5% ,etc .Conclusion The common pathogenic bacteria is gram‐negative bacilli in the common pathogenic bacteria .In negative bacilli infection ,acinetobacter ,pseudomonas aeruginosa ,e .coli , klebsiella pneumoniae ,etc were more common .In staphylococcus aureus strains ,benzene azole westwood drug‐resistant strain ratio is higher than benzene azole westwood sensitive strain rate for 3 times .In addition to the vancomycin and teicoplanin sensitive ,other commonly used antibiotics shows different degrees of resistance .

Objective To investigate the effects of structured triglyceride (STG) and physical mixed medium chain/long chain triglycerides (MCT/LCT) on hepatic and renal function and lipometabolism of patients with acute necrotizing pancreatitis (ANP).Methods The clinical data of 30 patients with ANP who were admitted to the PLA General Hospital between January 2012 and June 2014 were prospectively analyzed.A double-blind,randomized,controlled study was performed in 30 patients who were allocated into the experimental group (15 patients received STG) and the control group (15 patients received physical mixed MCT/LCT).All the patients received isometrical nitrogen and isocaloric parenteral nutrition more than 5 days.The levels of alanine transaminase (ALT),aspartate transaminase (AST),glutamyl-transpeptidase (GGT),alkaline phosphatase (ALP),creatinine (Cr),blood urea nitrogen (BUN),triglyceride (TG) and total cholesterol (TC) were assayed before nutritional support treatment and at day 1,3 and 5 after nutritional support therapy.The measurement data with normal distribution was presented as (x) ± s.The skew distribution data were described as M (range).The comparison between groups were evaluated with an independent sample t test or one-way ANOVA.The count data were analyzed using the chi-square test.Results A total of 30 patients were screened for eligibility.The levels of ALT,AST,GGT,ALP,Cr,BUN,TG and TC were changed within a certain range at day 1,3 and 5 after nutritional support treatment.The levels of ALT,AST,GGT,ALP,Cr,BUN and TC before treatment and at day 5after treatment were changed from 29.0 U/L,25.4 U/L,83.2 U/L,(193 ± 115) U/L,(124 ± 97) μmol/L,(8±6)mmol/L and (2.4±1.1)mmol/L to 29.4 U/L,33.0 U/L,77.7 U/L,(172±74)U/L,(117 ±103)μmol/L,(8 ± 5) mmol/L and (2.3 ± 1.0) mmol/L in the experimental group,and from 23.8 U/L,22.9 U/L,96.2 U/L,(148 ± 108) U/L,(82 ± 57) μmol/L,(9 ± 7) mmol/L and (2.5 ± 0.7) mmol/L to 21.3 U/L,24.5 U/L,127.4 U/L,(179 ± 126) U/L,(80 ± 54) μmol/L,(10 ± 6) mmol/L and (2.4 ±0.8) mmol/L in the control group,respectively.There were no significant differences in the changing trends of the levels of ALT,AST,GGT,ALP,Cr,BUN and TC between the 2 groups (F =0.647,1.186,0.282,0.553,0.862,0.182,0.369,P＞0.05).The level of TG in the experimental group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (1.5 ± 0.7) mmol/L,with increasing trend from pre-treatment to day 1 after treatment and reaching the normal level at day 3 and 5 after treatment.The level of TG in the control group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (2.4 ± 0.6) mmol/L,with increasing trend from pre-treatment to day 1,3 and 5 after treatments.There were significant differences in the changing trends of TG before and after nutritional support therapy between the 2 groups (F =7.940,P ＜ 0.05).Conclusion STG and physical mixed MCT/LCT don't influence the hepatic and renal function of patients with ANP undergoing parenteral nutritional support therapy,while STG has a better effect of lipometabolism compared with physical mixed MCT/LCT.Registry This study was registered with the UMIN Clinical Trial Registry with the registry number of UMIN000016958

Objective To evaluate three-dimentional (3D) reconstruction technique and methylene blue staining in precise anatomic hepatectomy.Methods The clinical data of 12 patients with hepatocellular carcinoma who were admitted to the Chinese PLA General Hospital from February 2009 to August 2011 were retrospectively analyzed.The 3D reconstruction of the liver tumor and intrahepatic vessels were done based on the computed tomography data and magnetic resonance imaging data.The portal vein supplying the tumor and its anatomic relationship with adjacent vessels were evaluated.Precise anatomic hepatectomy was performed guided by sustained methylene blue staining.Results The accurate rate of 3D model of the portal triad was 12/12.The shape of target segments observed after methylene blue staining was consistent with the results of 3D evaluation.Two patients received hemihepatectomy,3 received lobectomy,5 received monosegmentectomy or subsegmentectomy,2 received multisegmentectomy.The mean tumor diameter,operation time,blood loss,postoperative hospital stay and complication rate were 5.6cm (2.5-16.0 cm),(150±24)minutes,(236±25)ml,(10±3)days and 2/12,respectively.After a median follow-up of 14 months,tumor recurrence was found in 2 patients,and 1 of them died of tumor progression.Conclusions The 3D reconstruction may contribute to precise evaluation of the anatomic relationship between the tumor and its adjacent vessels.The 3D technique combined with sustained methylene blue staining may significantly improve the accuracy of anatomic hepatectomy.

Objective To investigate the diagnosis and treatment of traumatic pancreatic injury.Method The clinical data of 35 patients with traumatic pancreatic injury treated between January 1998and July 2010 at the General Hospital of Chinese PLA were retrospectively analyzed.Results There were 9 patients with Grade Ⅰ injury,7 with Grade Ⅱ injury,7 with Grade Ⅲ,7 with Grade Ⅳ,and 5 with Grade V injury,respectively.The diagnostic rate using CT before operation was 75.8％.8 patients with mild traumatic pancreatic injury received nonoperative treatment. 27 patients underwent open operation which included 15 simple external drainage of the pancreas area,2 distal pancreatectomy,5 Roux-en-Y pancraticojejunostomy,3 duodenal diverticulisation procedure,and 2 pancreaticoduodenectomy.After operation,there were 14 patients with pancreatic leakage,9 with intraabdominal infection,and 6 with intrabdominal bleeding.There were 3 patients with Grade Ⅳ and Grade V injuries who died of multiple organ failure or uncontrolled massive intraabdominal bleeding.Conclusions It was difficult to diagnose pancreatic injury before operation.CT was a suitable method to accurately diagnose severe traumatic pancreatic injury.Most minor pancreatic injury could be treated nonoperatively or by external drainage.The appropriate operation should be selected according to the extent and degree of the injuries basing on the principle of damage control in patients with major injuries.Pancreatic fistula,intraabdominal infection and bleeding were conrmon complications after operation.Multiple organ failure and massive bleeding were the main causes for mortality.