Objective　To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods　CEPP experiences of 1046 patients in 6600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results　Of the 1046 patients, 1028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions　CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.

Objective To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods CEPP experiences of 1?046 patients in 6?600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO 2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results Of the 1?046 patients, 1?028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.

Objective To investigate the cause of and management for bile leakage after laparoscopic cholecystectomy (LC). Method Thirty-four bile leakage cases out of 12 000 LC procedure performed in our department were retrospectively analyzed. Results Common bile duct (CBD) transection injury in 6 cases was retrieved by Roux-en -Y choledochojunostomy. Bile leakage caused by clip exfoliation in 3 cases necessitated a reexploration. Injury on CBD lateral wall or right hepatic duct in 7 cases was successfully treated by repair and T-tube stenting. Twenty-one cases of aberrant duct or accessory duct injury were cured by conservative therapy. Subdiaphragmetic abscess developed in 3 cases were cured by puncture and aspiration. Anastomotic stricture in one case after Roux-en-Y choledochojunostomy was cured by redoing Roux-en-Y choledochojunostomy. Conclusions Bile duct injury is the most common cause of bile leakage after LC. Patent drainage, bile duct repair and T tube stenting or choledochojejunostomy are the main method in treating bile leakage after LC.

Objective To report a randomized trial in comparing the clinical outcomes of three-port LC versus standard four-port LC. Methods From March 2001 to August 2004, four hundred consecutive patients who underwent elective LC were randomized to receive either the three-port or the four-port technique. All patients were blinded to the type of operation they underwent. Postoperative overall pain and incisional pain at different sites were assessed on the first day after surgery using the Prince-Henry scale. Other outcome measures included length and success of the operation, analgesia requirements, postoperative complications, postoperative stay, and the cosmetic results. Results There was no difference between the two groups in age, sex, weight or other diseases. In terms of outcome, patients in the three-port group had less pain at individual subcostal port sites and better cosmetic results. Success rate, mean operative time, complications, subxiphoid port and overall pain score, analgesia requirements, and postoperative hospital stay were similar between these two groups. Conclusion Three-port LC resulted in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port LC. The three-port technique is as safe as the standard four-port procedure for LC. Thus, it can be recommended as a routine procedure in elective LC.

To combine more than 20 years of experience in clinical practice skills teaching of laboratory medicine, with the characteristics of laboratory medicine, the theory system of formative assessment has been constructed, to guide the clinical practice of the students.Based on the construction of network question bank, students make use of the network question bank self testing, to know whether they had got the stage goal, existing problems and future plan through self testing, so as to mobilize their enthusiasm and initiative to enhance their self-confidence.Under the formative assessment teaching system, students establish internship file information, including practice notes, weekly practice, group discussion, self testing results, the teacher and peer assessment information.Teachers set up QQ group, WeChat group with their students, the timely to get the question from students and to take appropriate measures improve teaching.Teachers had established and improved the long-term after graduation feedback mechanism, and formative assessment improved the teaching quality of the whole practice teaching benefits teachers as well as students.

The concentrations and distributions of trace metals and rare earth elements (REE) in sediment and mussel samples collected from the India Ocean hydrothermal area were analyzed.The metal correlation between organisms and sediments was investigated, and the ecological and chemical characteristics of REE were also explored.The results showed that, the trace metals in sediments were mainly Fe (96.6 mg/kg), Mn (1.14 mg/kg) and Zn (322.6 μg/kg), and Fe had high ratio of 98.15% by normalized calculation, which indicated that the available sediments in this studying hydrothermal area mainly consisted of iron ore substances.Trace metals and REE distributions all had good correlation between deep-sea sediments and deep-sea mussels, and the correlation coefficients were 0.991 for trace metals and 0.996 for REE.The contents and distributions of metal elements in deep-sea mussels were different from those in offshore mussels.The REE distributions in sediments and mussels showed obvious fractionation phenomenon, and the enrichment of LREE in mussels was significant.Through the REE patterns, Eu and Gd in sediments and mussels all showed anomalies, and Eu had a significant abnormal phenomenon in deep-sea sediments and deep-sea mussels.Besides, δEu values were 9.50, 10.68 and 0.23 in deep-sea sediments, deep-sea mussels and offshore mussels, respectively, and δCe were 2.21, 2.71 and 4.38, which showed that the enrichment sources of REE in offshore mussels and deep-sea mussels were different, and the REE in sediments and mussels from the India Ocean were homologous.

Objective To probe the prevention and management of complications after laparoscopic cholecystectomy (LC). Methods Retrospective study was performed on 13 000 patients, who underwent LCs from September 1991 to February 2005 at our department. Results The complication rate was 1. 66% (216 patients) including intraabdominal hemorrhage in 21 patients (0. 16%),bile duct injury in 11 (0. 08% ),gastrointestinal perforation in 7(0. 05% ) , bile leakage in 26(0. 20% ) , retained abdominal tumor in 10(0. 08% ) , retained common bile duct stones in 47(0. 36% ) , intraabdominal abscess in 4(0. 03% ) , upper gastrointestinal hemorrhage in 2(0. 02% ) , extensive subcutaneous emphysema in 32 (0. 25% ) , port wound infection in 46(0. 35% ) , incisional hernia in 1 (0. 01% ) and deep vein thrombosis in 9 (0.07%). Six patients died postoperatively. Conclusions LC is a safe technique when up-to-date equipment and meticulous dissection techniques are employed. With the routine procedure, LC can be performed more safely.

OBJECTIVETo evaluate the role of laparoscopic ultrasonography(LUS) in prevention of bile duct injury(BDI) and residual common bile duct (CBD) calculi during complicated laparoscopic cholecystectomy (LC).

METHODSOne hundred and four cases of LC were defined complicated because of anatomic aberrance of the extrahepatic biliary system, unconfirmed exposed cystic duct, suspected CBD calculi or BDI, adhesion or inflammation in the Calot's triangle, acute cholecystitis, and atrophic gallbladder. LUS was performed to scan the extrahepatic bile duct. LC was carried out with assistance of the LUS.

RESULTSAssisted with the LUS demonstrated anatomic relationship between the extrahepatic bile duct and cystic infundibulum or cystic duct, 85 cases of LC were accomplished successfully. 19 were converted to open cholecystectomy because of LUS-indicated potential risk of BDI, CBD calculi, and suspected BDI.

CONCLUSIONSWith the extrahepatic bile duct visualized by LUS and contrast of the cystic infundibulum and cystic duct, operators can precisely identify the anatomic relationships between the cystic infundibulum, cystic duct and extrahepatic bile duct. Preoperatively unpredicted choledocholithiasis may be recognized.

Adult ; Aged ; Aged, 80 and over ; Bile Ducts, Extrahepatic ; diagnostic imaging ; Cholecystectomy, Laparoscopic ; adverse effects ; methods ; Cystic Duct ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Ultrasonography

In order to understand the actual needs and influencing factors of cancer patients to participate in medical decision-making, 29 cancer patients were selected for semi-structured interviews by purpose sampling from September 2020 to February 2021, and the data were analyzed by substantive coding step by step according to interview method. The results showed that the quality of patient-clinician interaction was an important factor influencing the decision quality. The elements for cancer patients to participate in medical decision-making include: patients’ disease knowledge, awareness of choice, communication duration, support from family members and doctors, and mutual trust between doctors and patients. Medical staff should respect patients’ preference to participate in medical decision-making, break the medical-centered system arrangement, help patients obtain services matching their preferences for participating in decision-making, and achieve a pattern that is beneficial to both patients and the medical system.

Heme/metabolism* ; Cryoelectron Microscopy ; Membrane Transport Proteins ; Escherichia coli Proteins/metabolism*