Objective To evaluate the safety and feasibility of totally laparoscopic cholecystolithotomy.Methods Patient baseline characteristics of all 34 totally laparoscopic cholecystolithotomy (TLC) were collected in a database.This group was compared with 34 matched patients who underwent the laparoscopic cholecystectomy (LC) in the same period.Retrospectively,intraoperative and postoperative data were added.Results Operatingtime was significantly longer in the TLC group(124.56 min vs 78.50 min,P ＜0.01).The mean hospitalization expenses of operation was significantly higher in the TLC group(10 970.85 yuan vs 8 666.72 yuan,P ＜0.01).Although not significant less patients have the symptoms of postoperative dyspepsia or diarrhea were seen in the TLC group compared with the LC group (2 vs 6,P =0.26).Intraoperative details and postoperative results such as,blood loss,hospital stay,exhaust time,abdominal bleeding,bile leakage,incision infection have no significant difference.One case of gallstone recurrence was detected in TLC group.No stone recurrence was reported in common bile duct in LC group.Conclusions TLC is effective and feasible for chronic calcular cholecystitis and is particularly favorable for thepatients with medical insurance.However,this approach is technically demanding and should be performed by experienced surgon.

ObjectiveTo investigate the application of pericardial devascularization and omental packing combined with gastric noose cerclage in the treatment of portal hypertension. MethodsThe clinical data of 59 patients who were treated in our hospital and received pericardial devascularization and omental packing combined with gastric noose cerclage from June 2007 to June 2013 were analyzed retrospectively, and the indices such as changes in portal venous pressure, portal vein diameter, and liver function after surgery, postoperative rebleeding rate, and survival rate were observed. Analysis of variance was applied for comparison between multiple groups, and paired t-test was applied for comparison between two groups. ResultsAll the 59 patients received a successful surgery, and the portal venous pressure was significantly decreased after the surgery; after the emergency operation, upper gastrointestinal bleeding was stopped, with no complications such as gastroparesis and pancreatic fistula; there was no death. The postoperative follow-up was performed for 2~5 years, and 1 case of rebleeding and 1 death occurred. ConclusionPericardial devascularization and omental packing combined with gastric noose cerclage have the advantages of both devascularization and shunt, and can achieve complete devascularization of the vessels at the lower segment of the esophagus, the cardia, and the gastric fundus, and the submucosal vessels in the gastric wall, with exact hemostasis, few postoperative complications, low rebleeding rate, and simplicity in operation, which is a reasonable, reliable, safe, and effective operation method.

Objective:To evaluate the prognostic value of sepsis-induced coagulopathy (SIC) in patients with sepsis.Methods:From January 2019 to December 2021, patients with sepsis admitted to the Intensive Care Unit of our hospital were retrospectively classified into the SIC group and non-SIC group according to SIC diagnostic criteria. The baseline clinical data, severity score, total length of hospital stay, length of ICU stay and 28-day survival were compared between the two groups. Kaplan-Meier was used to compare the 28-day survival of patients with sepsis between the two groups. Cox proportional hazard regression model was employed to analyze the risk factors of prognosis in patients with sepsis.Results:Totally 274 patients with sepsis were included in the analysis, including 139 patients in the SIC group and 135 patients in the non-SIC group. The two groups were compared in the perspectives of the Platelet count (PLT), prothrombin time (PT) , procalcitonin (PCT), D dimer, hematocrit, red blood cell distribution width, hemoglobin, acute kidney injury (AKI), the use of continuous renal replacement treatment (CRRT), the use of vasoactive drugs, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHEⅡ) score were compared between the two groups and the difference were statistically different (all P<0.05). Kaplan-Meier analysis showed that the 28-day mortality rate in the SIC group was significantly higher than that in the non-SIC group (32.4% vs. 14.1%, P<0.05). COX proportional hazard model showed that SIC score ( HR= 2.17, 95% CI: 1.15-3.91, P<0.05), APACHEⅡ score ( HR= 1.13, 95% CI: 1.09-1.17, P<0.05) and the use of vasoactive drugs ( HR=3.66, 95% CI: 1.53-8.75, P<0.05) were independent influencing factors for 28-day death in patients with sepsis. Conclusions:Patients with sepsis and SIC have more severe disease and increased mortality risk. SIC score exhibits good clinical value in predicting the prognosis of patients with sepsis.

Objective:To explore the expression of programmed death receptor ligand 2 (PD-L2) in hepatocellular carcinoma (HCC) and its relationship with clinicopathological features and prognosis of patients.Methods:The data of 344 patients with HCC who underwent surgery in the Third People's Hospital of Nantong from January 2008 to December 2016 were retrospectively analyzed. Taking HCC tissue samples to make the tissue microarray, and the expression of PD-L2 protein was detected by immunohistochemical method. The relationship between PD-L2 protein expression and clinicopathological features was analyzed. Kaplan-Meier method was used to analyze the overall survival (OS) and disease-free survival (DFS) of patients, and the prognostic factors were analyzed by univariate and multivariate Cox proportional hazards model.Results:The positive expression rate of PD-L2 protein in 344 patients with HCC was 54.4% (187/344). The positive expression of PD-L2 protein was correlated with maximum tumor diameter >3 cm ( χ2 = 8.20, P < 0.01) and high histological grade ( χ2 = 9.46, P < 0.05); OS and DFS in PD-L2 positive expression group were worse than those in PD-L2 negative expression group (OS: P = 0.001; DFS: P = 0.015). PD-L2 positive expression was not an independent adverse influencing factor for OS and DFS (OS: HR = 1.321, 95% CI 0.955-1.829, P = 0.093; DFS: HR = 1.209, 95% CI 0.990-1.624, P = 0.209). Conclusions:PD-L2 is highly expressed in HCC tissues, which may be related to the degree of malignancy. PD-L2 is not an independent risk factor for the prognosis of HCC.