Objective To investigate the significance and surgical skill for lymphadenectomy around common hepatic artery in gastric cancer.Methods Two hundred and fifty-seven cases with undergoing lymphadenectomy around common hepatic artery in gastric cancer between January 2001 and December 2006 were retrospectively reviewed.Experiences and understanding of dealing with this procedure in curative gastrectomy for gastric cancer were concluded.Results The number of dissected No.8 lymph node was 2.2?1.7,and the positive rate of No.8 lymph node was 30.35%.There were no lymphadenectomy related complications,such as anastomotic leakage,lymphatic fistula and postoperative hemorrhage in this series.Dissection around common hepatic artery lymph nodes along artery intrathecal space,division and ligation of left gastric vein at its root,and sufficient exposure of anatomic structures were important to dissection lymph nodes around the common hepatic artery.The exposure of anatomic structures included liberation of common hepatic artery by traction with the band,and the exposure of posterior side of pancreas by Kocher incision.Conclusion Being familiar with the anatomy around common hepatic artery,careful dissection,and attention to the surgical skill of lymphadenectomy are very important to improve the effectiveness of lymphadenectomy around common hepatic artery in gastric cancer.

Objective:To investigate the expression and clinical significance of Nusap1 in hepatical carcinoma. Methods:The expression of Nusap1 protein in 61 specimens of hepatical carcinoma was examined by immunohistochemistry. Based on the levels of Nusap1 expression, the 61 specimens were divided into a high Nusap1 expression group and a low Nusap1 expression group. The correlation between Nusap1 expression with clinicopathologic features and prognosis of hepatical carcinoma was analyzed. Results:TherateofhighNusap1expressionwas54.1%inhepaticalcarcinoma.TherateofhighNusap1 expression was 21.3%in noncarcinoma, with signiifcant difference between the 2 groups (P<0.01).Nusap1 overexpression had signiifcant correlation with histological differentiation, tumor size, liver cirrhosis,lymphaticmetastasis,tumorthrombiandearlyrecurrence(P<0.05),butnotwithsex,age,AFP level,tumornumber,TNMclassificationandtumorencapsulation(P>0.05).Survivalanalysissuggested thatthe6monthand12monthnoncarcinomasurvivalratewassignificantlylowerinthehighNusap1 expression group [33.3%(11/33), 17.9%(5/33)] than that in the low Nusap1 expression group [89.3%(25/28), 53.6%(15/28);P<0.005]. Conclusion:Nusap1 is overexpressed in hepatical carcinoma and is a valuable prognostic factor for hepatical carcinoma.

OBJECTIVE: To figure out the etiological factors and overall mortality of the patients with acute intestinal obstruction, and to explore the rational period of conservative therapy before operation. METHODS: Medical records of all the patients with acute intestinal obstruction admitted to West China Hospital from 1995 to 2002 were retrospectively reviewed. The etiology of the obstruction was categorized, and the correlation of mortality and time interval between conservative therapy and operation was analyzed. RESULTS: There were 705 patients with acute intestinal obstruction included. There were 71.1% of the obstruction lesions located on the small bowel, and 82.6% of the patients experienced simple obstruction. The most frequent cause was adhesions (62.0%), and next was neoplasms (23.7%). There were 57.6% of the patients underwent the surgical treatment. The overall mortality rate was 1.6%, and the mortality rates in conservative therapy and surgical intervention groups were 1.3% and 1.7% respectively. The intestinal necrosis rate was increased gradually with the prolongation of time interval between conservative therapy and operation, and the death might occur 24 hours after strangulation. CONCLUSION: The epidemiological transition to adhesive obstruction still exists in China, and it is similar to that in Western countries. In our experience, near half of the patients with simple obstruction may achieve palliation by conservative therapy. Surgical intervention is indicated for the patients with prolonged and non-palliated simple obstruction, or strangulation disease within the first 24 hours.

The incidence of esophagogastric junction cancer (EGJC) is rising dramatically both in western countries and in China.For type Ⅱ EGJC,controversies over the optimal surgical approach still remain.More and more studies support the abdominal transhiatial extended gastrectomy to be superior to the abdominothoracic combined approach.The aim of this report is to evaluate the feasibility and safety of laparoscopic transabdominal hiatal extended gastrectomy for surgical treatment of type Ⅱ and Ⅲ esophagogastric junction cancer.Based on clinical experience of 95 patients who underwent laparoscopic tansabdominal hiatal extended gastrectomy,we conclude that laparoscopic transabdominal hiatal extended gastrectomy is feasible and safe,offering a safer and simpler way of intramediastinal dissection and digestive tract reconstruction at experienced hands as compared with open surgery.This procedure also offers the merit of longer esophageal resection length without entering the pleural cavity.

Objective To investigate the expression of nucleolar spindle-associated protein 1(NuSAP1) in hepatocellular carcinoma (HCC) and in non-cancerous tissues,and to study the correlation between NuSAP1 and early recurrence and prognosis of HCC.Methods The expression of NuSAP1 in 61 cases of HCC and non-cancerous tissues were assessed by RT-PCR,quantitative PCR and immunohistochemistry.The relationship between the expression and the clinicopathological features was studied.Results The levels of mRNA and protein in HCC were higher than the non-cancerous tissues (P＜0.05).On univariate analysis,the expression levels of NuSAP1,mRNA and protein in HCC were significantly associated with TNM classification,lymphatic metastasis,early recurrence,tumor thrombosis and histological differentiation (P＜0.05).Multivariate analysis showed early recurrence was associated with the expression of NuSAP1 protein in HCC (P＜0.05).Overexpression of NuSAP1 protein was correlated with poor outcome of the patients with HCC (x2=15.846,P＜0.001).Conclusions NuSAP1 was overexpressed in hepatocellular carcinoma.Overexpression of NuSAP1 was associated with early postoperative HCC recurrence and bad prognosis.

Objective:To discussed the diagnostic value of magnetic resonance cholangiopancreatography (MRCP), and the use of laparoscopic surgery in management of patients with choledochal cyst with extrahepatic bile duct anomaly.Methods:Of 330 consecutive patients who underwent laparoscopic choledochectomy at Guangzhou Women and Children's Medical Center from January 2010 to September 2018, there were 23 patients with extrahepatic bile duct anomaly. The data of these patients were retrospectively analyzed. There were 4 males and 19 females, with an average age of 3.2 (range 0.3~9.0) years. According to whether the extrahepatic bile duct anomaly was diagnosed by preoperative MRCP, these patients were divided into the preoperative MRCP diagnosis group and the preoperative MRCP undiagnosed group. The impact of MRCP in diagnosing bile duct anomaly to prevent bile duct injury, on operation time, hospital stay and the types of extrahepatic bile duct anomaly on outcomes of laparoscopic treatment were analyzed.Results:All the 23 patients with choledochal cysts complicated by extrahepatic bile duct anomaly were confirmed at surgery. The incidence of extrahepatic bile duct anomaly was 6.97% (23/330). There were 47.8% of type II AHD (11/23); 36.8% of type III AHD (7/23); 4.3% of type IV AHD (1/23); 17.4% (4/23) of the type with communication with accessory bile duct (CABD). The preoperative MRCP diagnosis group consisted of 14 patients, while the preoperative MRCP non-diagnosis group consisted of 9 patients, including 2 patients without MRCP. The diagnostic rate of MRCP in preoperative diagnosis of extrahepatic bile duct anomaly was 66.7%(14/21). The preoperative MRCP undiagnosed group, when compared with the preoperatives MRCP undiagnosed group, had a significantly higher bile duct injury rate [preoperative MRCP diagnosis group 7.1%(1/14), preoperative MRCP non-diagnosis group 55.6%(5/9)], and a significantly longer operation time [preoperative MRCP diagnosis group(232.6±10.0) min, preoperative MRCP undiagnosed group (278.9±22.45)min], (all P<0.05). Laparoscopic surgery was completed in 22 of 23 patients. One patient was converted to open surgery. AHD reconstruction was needed in 11 patients with type II AHD and 1 patient with type IV AHD. Seven patients with type III AHD did not require any surgical intervention for the anomaly. The 4 patients with CABD underwent simple ligation. Postoperative chyloperitoneum developed in 1 patient, who successfully responded to conservative treatment. Postoperative recovery was uneventful in the remaining patients. At a median follow-up of 2 years (range 1 to 5 years), no further complications, including intrahepatic bile duct dilatation and hepatic atrophy were detected. Conclusions:MRCP was effective in preoperative diagnosis of choledochal cysts with extrahepatic bile duct anomaly. It helped to decrease intraoperation injuries to bile duct anomalies. MRCP was also useful in classifying patients with extrahepatic bile duct anomaly to better preoperatively planning of surgical treatment strategies. Laparoscopic surgery could be completed in the majority of these patients with good postoperative results.

Objective: To compare the effect of scalp acupuncture and scalp acupuncture plus acupuncture exercise therapy (AET) on walking ability in children with spastic cerebral palsy (CP). Methods: A total of 60 spastic CP children with gross motor function classification system (GMFCS) grades Ⅰ-Ⅲ were divided into a control group and an observation group by the random number table method, with 30 cases in each group. Both groups were treated with the same conventional rehabilitation and scalp acupuncture therapy for CP. The control group received conventional rehabilitation first and then scalp acupuncture. The observation group received AET, which was to receive the conventional rehabilitation and scalp acupuncture simultaneously. Before and after treatment, the clinical efficacy was evaluated by the modified Ashworth scale (MAS) score, scores of dimensions D and E of the gross motor function measure (GMFM) scale, walking speed, and walking distance. Results: During treatment, there were 2 dropouts in the observation group. After 3 courses of treatment, the MAS scores in both the control group and observation group decreased compared with the same group before treatment (P<0.05), and the scores of dimensions D and E of the GMFM, walking speed, and walking distance were increased (P<0.05); the between-group comparison showed that the MAS score in the observation group was lower than that in the control group (P<0.05), and the scores of dimensions D and E of the GMFM, walking speed, and walking distance in the observation group were higher or longer than those in the control group (P<0.05). Conclusion: W ith the same treatments, scalp acupuncture combined with AET is superior to the conventional scalp acupuncture method in reducing lower-limb muscle tone, improving standing balance ability, and walking stability in children with spastic CP.

Objective To discuss the association of allele polymorphisms SNP-rs1799724(C>T)in the TNF-αand SNP-rs11559013(G>A)in the ALCAM with HCV chronic infection in Han population in Yunnan province. Methods 434 HCV chronic infectious patients and 444 healthy individuals of Han Chinese population in Yunnan province were recruited. Two single nucleotide polymorphisms(SNPs)in the SNP-rs1799724(C>T) of TNF-αgene and SNP-rs11559013(G>A)of ALCAM gene were determined by real-time TaqMan polymerase chain reaction. We evaluated the associations of the two SNPs with HCV chronic infection. Results The distributions of allele and genotype of SNP-rs1799724(C>T)in the TNF-αand SNP-rs11559013(G>A)in the ALCAM between hepatitis C virus(HCV)chronic infectious patients and the healthy controls were not statistically significant(P > 0.05). Conclusion SNP-rs1799724(C>T)in the TNF-αand SNP-rs11559013(G>A) in the ALCAM have no association with HCV chronic infection in the Han population in Yunnan province.

0.05). Conclusions There is no difference in immune responses to rectal cancer patients undergoing laparoscopic total mesorectal excision with anal sphincter preservation and those having open surgery.