With the development of minimally invasive management,laparoscopic operation has become more and more prevalent.As a surgical procedure,a serial of events,such as psychological damage,fasting,bleeding,hypothermia,pain,introduce of cathartic,gastric tube,urinary catheter and aggressive resuscitation of crystal fluid,can produce stress and delay the rehabilitation. Evidence-based medicine has demonstrated that during the laparoscopic surgery,alleviating these events is associated with milder stress reaction and fast recovery.The focus of minimally invasive surgery should be shifted from the local injury to the stress of the whole body,from the wound size to the psychological,physiological and pathological changes of the whole body,from the technique of operation to the comprehensive management during perioperative period.In summary,the minimally invasive surgery focuses more and more on minimizing the stress influence on the whole body rather than merely on the minimal incision.It is reasonable to conclude that this kind of research will bring significant innovation in minimally invasive surgery in the future.

It is still contradictory whether PGI_2 and TXA_2 can influence hepatic is-chemic damage. Rats were divided into three groups at random. Group 1 and 2 were givensaline; group 3 were pretreated with indomethacin. 30 min before the induction of liverischemia drugs were injected into peritoneal cavity. After 2 h of ischemia and 2 hof reperfusion, the results showed that the TXB_2 content of ischemia group was higherand the P/T ratio was lower than that of the indomethacin group. The control groupshowed no change. Massive necrosis was observed in the ischemia group, but only focalnecrosis was seen in the indomethacin group. There was no hepatic necrosis in the controlgroup. The results suggested: 1. TXA_2 was an important cell injury agent; 2. Indomethacinhave protective effect on the reperfusion liver cell injury.

Objective To determine the value of detection of micrometastasis in peripheral blood to hepatocellular carcinoma (HCC) metastasis or recurrence. Methods Reviewed the related literatures, the methods and significances of the detection of HCC micrometastasis in peripheral blood were analyzed. Results Currently, there are mainly two methods, hematogenous dissemination cell detection and HCC specific mRNA biomarker detection, for detection of HCC micrometastasis in peripheral blood. Theoretically, although they are considered as early detections of HCC metastasis or recurrence, researches still not have a abroad agreeable conclusion from different studies. After adjusting and improving the methods and detection time, different studies also have not gotten a quite consistent conclusion. Conclusion There is a great significance in detection of HCC micrometastasis in peripheral blood to understanding the mechanisms of HCC metatasis and recurrence, and also to improving the clinical therapy. Theoretically and practically, the method should be improved for facilitating the mechanism research of HCC metastasis and recurrence, and the application of detection.

Objective To evaluate the long-term clinical outcomes between laparoscopic gastrectomy and open gastrectomy with D2 lymph dissection for advanced gastric cancer.Methods Clinical studies that compared clinical outcomes of laparoscopic gastrectomy and open gastrectomy for advanced gastric cancer were searched from PubMed,EMBASE,Medline,Cochrane Library,WanFang,CNKI,CMCC and VIP database with the Gastric neoplasms Laparoscopy Gastrectomy Long-term outcomes Meta-analysis between Jan.2002 and Oct.2016.Data of long-term survival and recurrence were analyzed by using of RevMan 5.2 software.Survival data were present by the odds ratio(OR) and 95％ CI.The heterogeneity of the data was analyzed using the I2 test.Results Fifteen studies including 4,053 cases were enrolled.There were 2,091 patients in LG group and 1,962 patients in the open gastrectomy group.There was no significant difference in the 3-year overall survival rate(OR =1.00,95％ CI:0.83-1.20,P =0.98),5-year overall survival rate (OR =1.14,95％ CI:0.95-1.36,P =0.15),5-year disease-free survival rate(OR =1.13,95％ CI:0.93 ～ 1.39,P =0.22)and cancer recurrence rate (OR =0.96,95％ CI:0.79 ～ 1.18,P =0.71)between the patients treated with laparoscopic gastrectomy,or open gastrectomy (P ＞ 0.05).Conclusion Laparoscopic gastrectomy with D2 lymph dissection for advanced gastric cancer has similar long-term outcomes as compared to open gastrectomy.

Objective To investigate the role of Rho/Rho kinase -associated cell migration of hepatic carcinoma cell line and inhibition of tumor cell invasion by Rho kinase inhibitor Y-27632. Methods Western blot was used to estimate the expression of Rho protein in the cells. After treatment of SMMC7721 cell with Y-27632, cell biological behaviors such as colony-forming efficiency, adhesiveness, cell motility, in vitro invasiveness, metastatic potential were observed. Results The ability of Y-27632 treated SMMC7721 cells to invade the reconstituted basement membrane decreased significantly ( P

Objective To study the surgical technique of right hemihepatectomy in adult-to-adult living donor liver transplantation . Methods Eight donors underwent right hemihepatectomy in adult-to-adult living donor liver transplantation . Among these donors operation, there were 5 right hemihepatectomy and 3 extended right hemihepatectomy . If the diameter of the auxiliary right hepatic vein more than 0.8cm, it should be reserved. The dissection line of right hemihepatectomy was at the 0.5cm～1.0cm to the right side of middle hepatic vein, and the dissection line of extended right hemihepatectomy was at 0.5cm～1.0cm to the left side of middle hepatic vein. Intraoperative cholangiogram was performed, and without inflow vascular occlusion was done during the operation.Results The donor average operation time was 448 min (ranged from 353 min to 510 min). The average blood loss of operation was 384 ml (ranged from 170ml to 900ml). The grafts average weight was 669.4g (ranged from 445g to 900g), the right hemihepatic grafts weighted 667.0g averagely and the extended right hemihepatectic grafts weighted 673.3g averagely.The average graft-to-recipient body weight was 1.16% (ranged from 0.76% to 1.50% ). There were 2 donors occurred complications including biliary leak in 1, and dysfunction of liver and kidney in 1, all the 2 complications were cured. There was no donor mortality and all donors well recovered,All the donors were discharged within three weeks after operation.All of the 8 grafts and 8 recipients survived one year. Conclusions The right hemihepatectomy and extended right hemihepatectomy in adult-to-adult living donor liver transplantation can be performed safely,if the liver resection techmqne is proformed exactly and successfully.

Objective To investigate the clinical value of preventive analgesia in patients with radical gastrectomy for gastric cancer.Methods The clinical data of 161 patients undergoing radical gastrectomy for gastric cancer at the Xijing Hospital from July 2012 to June 2013 were prospectively analyzed.A single-blind,randomized,controlled study was performed in the eligibe patients who were randomly divided into the preventive analgesia group and the control group based on a random number table.All the patients received major gastrectomy + Billroth Ⅱ anastomy or total gastrectomy + esophagojejunastomy,and then they received vein combined anesthesia and tracheal intubation.In the preventive analgesia group,10 mg dexamethasone and 200 mg parecoxib were administered by intravenous infusion before operation,7-8 mL ropivacaine (0.5％) were injected at the incisional site and transversus abdominis infiltration at open and close surgery and celecoxib was taken orally for 3 days.In the control group,vein analgesia pump was used after operation.The visual analogue scale (VAS),proportion of patients with postoperative out-off-bed activity time ＞ 8 hours,time of flatus,time of defecation and duration of hospital stay were recorded between the 2 groups.The measurement data with normal distribution were presented as x ± s.The comparison between groups was evaluated with the t test and repeated measures ANOVA.The data with skew distrubution and ordinal data were analyzed by the analysis of variance,and the count data were analyzed using the chi-square test.Results All the 161 patients who were screened for eligibility were randomly divided into the preventive analgesia group (87 patients) and the control group (74 patients).The scores of the VAS at postoperative day 1,2 and 3 were 2.8 ± 0.6,2.6 ± 0.4 and 1.8 ± 0.4 in the preventive analgesia group,and 5.3 ± 0.5,4.2 ± 0.6 and 2.4 ± 0.3 in the control group,with a significant difference between the 2 groups (F =4.25,P ＜ 0.05).The proportion of patients with postoperative first abmulation time ＞ 8 hours at postoperative day 1,2 and 3 were 8,17 and 20 in the preventive analgesia group,and 0,3 and 11 in the control group,with a significant difference between the 2 groups (x2 =7.60,10.26,3.16,P ＜ 0.05).The time of flatus,time of defecation and duration of hospital stay were (51 ± 24) hours,(61 ± 24) hours and (5.5 ± 3.0) days in the preventive analgesia group,compared with (71 ± 23) hours,(83 ± 30) hours and (6.3 ± 2.1) days in the control group,showing a significant difference between the 2 groups (t =5.32,5.04,0.17,P ＜ 0.05).All the patients in the 2 groups normally survived after surgery without respiratory depression,incision infection and adverse drug reaction.Conclusions Preventive analgesia in the perioperative treatment of patients with radical gastrectomy for gastric cancer could relieve the postoperative pain of patients,improve the bowel function and enhance the recovery of patients.Registry This study was registered with the Chinese Clinical Trial Registry with the registry number of ChiCTRTRC-11001440.

Objective To investigate the expression of RhoA gene in human hepatocellular carcinoma (HCC) and to discuss its significance during hepatocellular carcinogenesis. Methods Intratumor RhoA expression level was determined and compared with that in adjacent nontumorous hepatic tissues using quantitative real time reverse transcription polymerase chain reaction and Western blot in 64 HCC patients. Results The mRNA levels of RhoA were significantly higher in tumor tissues than that in the unaffected portions (t =3.445 ,P =0.0006). The expression of RhoA mRNA in the primary lesion was higher in patients with venous invasion (t = 2.667, P = 0.009), microscopic satellite lesions (t=2.172,P =0.038), and advanced pTNM stage (stage Ⅱ/Ⅳ; t=2.551,P=0.013) than in those without. There was a significant difference between high RhoA protein levels in the tumor tissues and noncancerous liver tissues in HCC patients (t = 3.532, P = 0.0002), and there was a significant association between high tumor RhoA protein levels and the presence of venous invasion (t = 2.087, P = 0.042), microscopic satellite lesions (t = 2.254, P = 0.031), and advanced pTNM stage (t = 2.812, P = 0.007). Conclusions There is a significant correlation between RhoA expression, tumor stage, and intrahepatic metastasis. The expression of RhoA could be used as a good tumor marker for invasive and advanced carcinoma as well as a prognosis predictor.

Objectives To compare total laparoscopic gastrectomy with intracorporeal hand-sewn Gl reconstruction and laparoscopy-assisted gastrectomy for gastric cancer. Methods Between July 2009 and July 2010, 21 patients of gastric cancer underwent total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn reconstruction and 28 did laparoscopy-assisted D2 radical gastrectomy in Xijing Hospital of Digestive Diseases. All patients were operated on by an experienced surgeon. Patient demographics, TNM stage, location of tumor, the intraoperative and postoperative details of the two groups were compared. Results In the 21 patients undergoing total laparoscopic gastrectomy, there were 15 of distal gastrectomy and 6 of total gastrectomy, compared with 21 and 7 in laparoscopy-assisted group. In total laparoscopic group, intracorporeal hand-sewn technique was used for gastro-jejunal and jejuno-jejunal (J-J)anastomosis, and 25 mm circular stapler was used for esophago-jejunal anastomosis. The operation time was significant longer in total laparoscopic group than in laparoscopy-assisted group of (279 ± 65 ) min vs.(232 ±40) min (P ＜ 0.05 ). No significant difference was observed between the two groups in proximal margin [(5.7 ± 1.5 )cm vs. (5.1 ± 1.4) cm, P ＞ 0.05] and distal margin [( 3.1 ± 0.9 )cm vs. ( 2.9 ±0.9) cm,P ＞0.05]. The iv narcotic use in laparoscopy-assisted group was 1.8 d but it was not used in total laparoscopic group. The first passing flatus was on day 3 in total laparoscopic group compared with 4.8 d in laparoscopy-assisted group. Both groups had 2 postoperative early complications, one intra-abdominal infection and one lung infection in total laparoscopic group compared with one wound infection and one lung infection in laparoscopy-assisted group. There was no anastomosis-related complications after 4 months of follow-up. Conclusions The operation time and postoperative early complication was acceptable for selected patients treated by total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn GI tract reconstruction in hands of experienced laparoscopic surgeon.

Objective To investigate the expression and the early diagnostic significance of heat shock protein 70 in acute allograft rejection of liver-transplamed rats. Methods The model of rat orthotopic liver transplantation was made by using a modified "two-cuff technique". The rats were randomly divided into 3 groups. For each group, donors and receptors all included 15 rats respectively. The control group: Wistar to Wistar liver transplantation; The untreated group: SD to Wistar liver transplantation, not receiving any immunosuppressant after liver transplantation; The treatment group: SD to Wistar liver transplantation, receiving intramuscular injection of tacrolimus (FKS06, 2mg kg-1. day-1) after operation. Five rats were executed randomly in every group on the post-transplantation day 3, 5 and 7 and the graft samples were obtained for optical microscopic observation. The expression of HSPT0 in grafts was detected by using immunohistochemical method and RT-PCR. The correlation between acute rejection following liver transplantation and the expression of HSP70 in grafted liver was studied. Results There was no acute rejection examined in the control group. The untreated group showed typical allograft rejection and the rejection activity index (RIA) went up gradually after the operation (P<0.01). The treatment group showed no rejection or borderline allograft rejection. The level of HSP70 was increased transiently after operation, then reduced in the control group (P<0.05). The level of HSP70 in the untreated group was higher than in the control groupand gradually increased with the prolongation of time after transplantation (P<0.01). A significant correlation was found between HSP70 and pathological score in the untreated group (P<0.01). The treatment group showed low levels of HSP70 of all the time. Conclusions The expression of HSP70 in grafts is closely related to the occurrence and development of the acute rejection and can be useful for early diagnosis of acute allograft rejection following liver transplantation.