Objective To compare the perioperative safety and curative effects oflaparoscopic adrenal sparing surgery (ASS) with laparoscopic total adrenalectomy (TA) for aldosterone producing adenoma (APA).Methods An online systematical retrieval was performed with Pubmed,ScienceDirect,Springerlink,the Cochrane library,CNKI and China Biology Medicine disc for clinical comparative studies published before May 2016,these studies reported the treatment of ASS/partial adrenalectomy (PA) versus TA for APA.The selected studies were applied to Revman 5.3 software for meta-analysis.The main contents were perioperative outcomes (operative time,intra-operative blood loss,and length of hospital stay) and postoperative efficacy (cure rate,partial response rate,inefficiency rate).Results A total of 9 clinical studies (3 English documents and 6 Chinese documents) with 1036 patients were included into the final analysis,among which 544 patients were assigned to ASS group and 492 in TA group.The analyzed results demonstrated no statistical significance between ASS group and TA group on operative time (WMD:-2.09min,95％CI:-9.86-5.67,P=0.60),length of hospital stay (WMD:-0.10d,95％CI:-0.32-0.12,P=0.36),intra-operative blood loss (WMD:1.13ml,95％CI:-8.86-11.12,P=0.82),cure rate (OR=l.07,95％CI:0.73-1.58,P=0.72),partial response rate (OR=0.85,95％CI:0.57-1.27,P=0.43) and inefficiency rate (OR=2.15,95％CI:0.32-14.34,P=0.43).Conclusion For surgical treatment of APA,ASS is technically safe,can achieve reliable postoperative efficacy and a similar therapeutic effect compared with TA,so deserves further application in clinical practice.

Objective To investigate the pathogen distribution and drug resistance of biliary tract infection in patients with cholelithiasis, and to summarize the clinical experience.Methods160 patients with cholelithiasis were analyzed.The proportion of patients with biliary tract infection was counted.The bile and venous blood were collected and the distribution of pathogens was detected.The patients were also analyzed for the drug resistance.ResultsThe incidence of biliary tract infection was 62.5%, the positive rate of bile culture was 62.5%, and the positive rate of blood test was 37.5% for 160 patients with cholelithiasis.Gram-positive bacteria include Escherichia coli, Enterococcus faecium, Staphylococcus, Gram-negative bacteria, including Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, etc.;Gram-positive bacteria for the large Methicillin and erythromycin resistance is higher, Gram-negative bacteria for ampicillin and levofloxacin higher resistance.ConclusionThe pathogen distribution and drug resistance of biliary tract infection in patients with cholelithiasis are analyzed.The clinical pathogens are widely distributed.At the same time, the pathogens have different resistance to different antimicrobial agents.Therefore, clinical use should be reasonable choice when using antimicrobial agents, With a view to give full play to drug effects.

Objective To evaluate the effect of the empowerment theory-based health education on anxiety, depression and self-efficacy in the major caregivers for patient with leukemia. Methods Eighty patients with leukemia and their caregivers were enrolled during November 2013 to November 2014 and were divided into the intervention group (n=40) and the control group (n=40). The caregivers of the intervention group received empowerment theory-based education , while those of the control group received general health education. The two groups were compared in terms of anxiety, depression and self-efficacy. Results Before intervention, there were no significant differences in the three items between the groups (P>0.05). After intervention, the level of self efficacy in the intervention group was better than that in the control group (P<0.05) and the scores in the intervention group were significantly lower than those of the control group. Conclusion The empowerment theory-based education can relieve anxiety and depression and improve the self efficacy of the caregivers of patients with leukemia.

Objective To evaluate the length of hospital stay and the incidences of complications after omentoplasty with non-omentoplasty for the patients with esophageal cancer.Methods The databases including Pubmed,Embase,The Cochrane Library,Web of Science,CBM,CNKI,VIP and Wanfang data were searched for collecting randomized controlled trials on the omentoplasty.According to the inclusive and exclusive criteria,the datas were extracted.Two reviewers independently screened literatures and assessed the qualities of the included studies and extracted data.Meta-analysis was performed by using of RevMan 5.2 software.Results A total of 6 RCTs including 2 167 patients from 206 original articles were included in this analysis.In terms of the anastomotic leakage after esophagectomy and the hospital stays,the incidence of anastomotic leakage (OR =0.19,95％ CI:0.09 ～ 0.39,Z =4.55,P ＜ 0.000 01) and hospital stays (MD =-1.91,95％ CI:-2.26--1.57,Z =10.87,P ＜ 0.000 01) with omentoplasty was significantly lower than those of the non-omentoplasty,with significant differences.However,in terms of anastomotic stricture (OR =0.76,95％ CI:0.29-2.01,Z=0.55,P=0.58) and mortality rate (OR =0.72,95％ CI:0.24-2.21,Z=0.57,P=0.57),there wrer no significant differences.Conclusion Comparing with non-omentoplasty,the use of omentoplasty has beneficial effects for the postoperative complication such as anastomotic leakage and hospital stays,and does not increase the incidence of anastomotic stricture and mortality rate.

Objective:To examine the inhibitory effect and mechanism of niclosamide combined with low-dose cisplatin on adrenocor-tical carcinoma xenografts in nude mice. Methods:A SW-13 cell transplanted tumor model was first established in nude mice. The nude mice were then divided into the control group, niclosamide group, cisplatin group, and combined drug group. The groups were compared in terms of tumor body volume, tumor weight, and biochemical index. The cell apoptosis rate of the transplanted tumor tis-sue was detected by TUNEL assay, while Bcl-2 and caspase-3 protein expression in the transplanted tumor tissue was detected by im-munohistochemistry and Western blot. Results:The terminal tumor volume and weight of the combined drug group were lower than those of the niclosamide and cisplatin groups (all P<0.001). The white blood cell count of the cisplatin and combined drug groups were lower than that of the control group (all P<0.001). Meanwhile, no difference was observed between the cisplatin and combined drug groups (P=0.29). The creatinine and glutamic pyruvic transaminase of the cisplatin and combined drug groups were higher than those of the control group (all P<0.001), whereas no significant difference was observed in the levels of creatinine and alanine aminotransfer-ase between cisplatin and combined drug groups (all P>0.05). TUNEL test results showed that the cell apoptotic rate of the combined drug group was higher than that of the niclosamide group (P=0.004) and cisplatin group (P=0.005). Immunohistochemistry and West-ern blot test results showed that Bcl-2 expression in the combined drug group was lower than those of the niclosamide and cisplatin groups (all P<0.001), while caspase-3 expression in the combined drug group was the highest among those of other groups (all P<0.001). Conclusion:Niclosamide can enhance the inhibitory effect of low-dose cisplatin on the growth of adrenocortical carcinoma and has no additional side effects. This enhancement is probably related to the influence of niclosamide on Bcl-2 and caspase-3 expres-sion levels. Niclosamide promotes the apoptosis of the tumor cells by influencing Bcl-2 and caspase-3 expression.

Objective To explore the feasibility and safety of total laparoscopic radical resection for a patient of Bismuth type Ⅲ a hilar cholangiocarcinoma.Methods This patient underwent right hemihepatectomy combined caudate lobectomy,radical regional lymphadenectomy and Roux-en-Y hepaticojejunostomy under total laparoscopic techniques.Preoperatively the volume of future liver remnant estimated by CT scan was 46％,and indocyanine green retention rate at 15 min (ICG R15) was 6.0％.Results The total laparoscopic surgery was carried out successfully with operation time of 540 min and intraoperative blood loss 300 ml,without blood transfusion.The results of pathological examination showed well-differentiated adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis(0/13).The postoperative recovery was uneventful with hospital stay time of 10 days and without any complications.Conclusion At experienced hands,total laparoscopic radical resection of Bismuth type Ⅲ a hilar cholangiocarcinoma is feasible and safe for selected patients.

Objective To explore the feasibility and safety of laparoscopic right hemihepatectomy (LRH) via anterior approach for larger tumors in the right lobe of the liver.Methods A retrospective study was conducted based on the clinical data of ten consecutive patients with large right liver cancer undergoing LRH through anterior approach and thirty-seven patients undergoing open hemihepatectomy by anterior approach in recent 6 years.Results Between the two groups there were no significant difference in gender,average age,the mean tumor size,preoperative liver reserve function,cut margin and intraoperative blood transfusion.The LRH group had less average intraoperative blood loss [(408 ± 158)ml vs.(520 ± 153)ml,t =2.047,P =0.046] and shorter postoperative hospital stay [(11.5 ±2.8)d vs.(16.2 ±4.6) d,t=3.091,P=0.003],longer operation time [(302 ±38)min vs.(251±55)min,t=2.732,P=0.009].There was no perioperative death and no significant difference in complications (20.0％ vs.35.1％,x2 =0.812,P =0.367) and similar median survival time (36 mon vs.29 mon,x2 =1.266,P =0.261).Conclusions LRH via anterior approach for larger tumors in the right lobe of the liver is safe and feasible.

Objective To evaluate hepatic vein exclusion (HVE) outside the liver in the resection of giant hepatic hemangioma near the second hepatic hilum. Methods From January 2003 to December 2009, giant hepatic hemangiomas near the second hepatic hilum were resected in 19 cases. Preoperatively 19 cases were divided into two groups: HVE group (9 cases) and IVE group ( 10 cases). Data regarding the intra-operative and postoperative courses of the patients were analyzed. Results There was no difference between the 2 groups regarding the age, sex and tumor size. No damage of hepatic vein was happened in HVE group. Resection of the hemangioma was applied in all cases of HVE group, and 1 case in IVE group had right hemi-hepatectomy. Hepatic veins rupture occurred in 4 cases in IVE group and 2 cases of them had massive bleeding, while in HVE group hepatic veins rupture occurred in 5 cases but no massive bleeding occurred. Intra-operative blood loss was significantly less in HVE group than IVE group. The serum ALT value in postoperative day 1 and total bilirubin in postoperative day 3 in HVE group was significantly lower than that of the IVE group. The mean drainage volume in HVE group was significantly less than that of the IVE group on postoperative day 1 and day 2. The total cost of patient in HVE group were significant less than in IVE group. Conclusions The use of hepatic vein exclusion reduces the risk in the resection of giant hepatic hemangioma near the second hepatic hilum.

Objective To evaluate the result of multiple segmentectomy under selective occlusion of hepatic inflow for complicated intrahepatic cholangiolithiasis. Methods In this study 12 cases of complicated intrahepatic cholangiolithiasis receiving multiple segmentectomy under selective occlusion of hepatic inflow during 2004. 1 - 2010. 10 were reviewed retrospectively. The short-term and long-term outcomes of the patients were analyzed. Results There was no surgical mortality in this group. The segmentectomy performed were Ⅱ + Ⅲ + Ⅴ in 1 case; Ⅱ + Ⅲ + Ⅵ in 2 cases; Ⅱ + Ⅲ + Ⅴ + Ⅵ in 1 case;Ⅱ +Ⅲ+Ⅵ +Ⅶ in4 cases; Ⅱ +Ⅲ +Ⅳ +Ⅵ in 3 cases and Ⅱ + Ⅲ +Ⅳ +Ⅵ +Ⅶ in 1 case. The average intraoperative blood loss was 560 ± 291 ml. Postoperative complications were wound infection in 2 cases, bile leakage in 1 case, abdominal infection in 1 case. There were no liver failure, intrabdominal hemorrhage or hemobilia; stone clearance rate at 10 days after operation was 83% (10/12) and 92%(11/12) at 6 weeks after operation following postoperative choledochoscopic lithotripsy. 92% (11/12) cases were followed-up with the median follow-up period of 31 months. The result was excellent or good in 92% (11/12) cases. Conclusions Multiple segmentectomy was the choice for complicated intrahepatic cholangiolithasis, and the procedure could be safely performed under selective occlusion of the hepatic inflow.

Objective To investigate the clinical significance of the serum sialic acid (SA) detection for the diagnosis and therapy monitoring in liver cancer patients.Methods Patients and healthy people of Chinese academy of medical science cancer hospital from January 2011 to October 2012,were enrolled,including 221 liver cancer patients (183 primary hepatic carcinoma patients and 38 metastatic hepatic carcinoma patients),117 benign liver disease patients and 150 healthy people.The concentration of serum SA were tested by ROCHE P800.The intra-assay and inter-assay coefficient of variation (CV) of SA kit were evaluated by use of low and high concentration samples,measured for 5 days and 4 times each day.Receiver operating characteristic (ROC) curve were used to determine the cut-off of SA using data of 183 cases of primary liver cancer and 150 healthy controls.The area under the curve (ROC-AUC) were used to evaluate the diagnostic value of SA.The changes of serum SA level in 103 cases of primary hepatic carcinoma patients were monitored before therapy and at the 1 st day,7 th day,14 th day,1 st month,3rd month,6 th month and 9 th month after treatment.SPSS16.0 was used to analyse the results.Results The intra and inter-day CVs for low level sample were 2.4％ and 3.2％ respectively,and for high level sample were 2.2％ and 3.1％.The cut-off value of the serum SA was 659 mg/L for liver cancer,the sensitivity and specificity was 63.4％ (1 16/183) and 94.7％ (142/150) respectively.The serum SA level of liver cancer group [(726 ± 173) mg/L] was higher than that of liver benign disease patients group [(552 ± 128) mg/ L] and healthy controls group [(599 ± 62) mg/L,U values were 1832.52 and 887.00,P ＜ 0.01].The serum SA level were tracked in 103 cases of primary hepatic carcinoma patients during therapy period.The serum level of SA elevated to [(817 ± 193) mg/L,t =-3.272,P ＜ 0.05] at I st week after treatment and kept at high level until late in 1st month after treatment [(782 ±173) mg/L,t =-2.694,P＜0.05].In the 3rd month,the SA level decreased to that of pretreatment [(662 ± 138) mg/L,t =1.225,P ＞ 0.05].In the 6th months,the SA level declined to [(615 ± 144) mg/L,t =1.999,P ＜0.05],as well as the level of healthy control group.There were 85 cases of hepatic carcinoma patients with decreased SA level compared with that of pretreatment,and the coincidence rate was 82.5％ (85/103),the Kappa value was 0.79.There were 5 cases of patients with hepatic carcinoma relapse after treatment in 9 th months and the SA levels increased significantly to (939 ± 175) mg/L.Conclusion The serum SA has significant values possibly in the diagnosis and therapy monitoring in liver cancer patients.