Objective To evaluate the safety and clinical efficacy of laparoscopic hepatectomy in the treatment of hepatic hemangioma.Methods Clinical data of 58 patients with hepatic hemangioma who underwent laparoscopic hepatectomy in Hai'an People's Hospital Affiliated to Nantong University from January 2010 to January 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among 58 patients,22 cases were male and 36 female,aged from 33 to 68 years with a median age of 48 years.5 patients were diagnosed with multiple hepatic hemangiomas and 53 cases with single hepatic hemangioma.The diameter of hemangioma was 6-19 cm,and located at liver segments Ⅱ-Ⅵ.Laparoscopic non-anatomical or anatomical hepatectomy were performed in the patients.The intraoperative status and prognosis were analyzed.Results One case was converted to open surgery,and the remaining 57 cases underwent laparoscopic hepatectomy successfully.Anatomical hepatectomy was performed in 24 cases including 15 cases left lateral lobectomy,3 left hemihepatectomy,2 right hemihepatectomy and 4 segmental hepatectomy.Non-anatomical hepatectomy was performed in 33 cases.The median operation time was 176 (107-244) min and the intraoperative blood loss was 372 (190-553) ml.No perioperative death,postoperative complication,such as massive intra-abdominal hemorrhage,bile leakage and liver failure,was observed.The average postoperative length of hospital stay was (7.1±2.3) d.Hepatic cavernous hemangioma was confirmed by postoperative pathological examination.No hemangioma recurrence was observed during the follow-up.Conclusions Laparoscopic hepatectomy is a safe,feasible and efficacious treatment for hepatic hemangioma,which possesses the advantages of rapid recovery and small incision,etc.

OBJECTIVE:To provide reference for improving the efficiency of medicine supply in primary health care institutions. METHODS:By stratified random sampling,6 counties of Dabie Mountains in Anhui province were selected as sample areas. Medicine purchase data of 143 primary health care institutions in 2015 were collected from Anhui provincial centralized purchase platform. Those data were analyzed in respects of purchase and distribution of National Essential Medicine,medicines of Anhui Province Essential Medicine List and cheap medicines. By stratified random sampling,12 primary health care institutions were selected for on-site interview. The reasons for medicine distribution and insufficient distribution were investigated. RESULTS:The rate of medicine distribution in the sample areas was 82.27%,and the rate of essential medicine distribution was more than 80%. Ratio of purchase amount for national essential medicines and medicines of Anhui Province Essential Medicine List were all up to standard in different types of primary health care institutions. The rate of cheap medicine distribution was in low level(only 80%). The distribution rate had great difference in the primary health care institutions and different areas;the highest rate of medicine distribution reached 99.86%,and the lowest was only 46.18%. The results of on-site investigation showed that main reasons for insufficient distribution were the divided area distribution model had a certain influence on the market competitiveness of the distribution enterprises,and distribution enterprises strength had huge differences. CONCLUSIONS:The primary health care institutions have high awareness of National Essential Medicine System in Dabie Mountains of Anhui Province;purchase rate and overall distribution rate of essential medicine are also high. There are great differences in distribution efficiency among different areas and health care institutions,and some health care institutions cannot distribute medicine in time with full capacity. It is suggested to conduct"two-receipt system"of medicine distribution,perfect medicine distribution enterprise supervision system, establish medicine circulation information platform and lead cheap medicine supply guarantee by government,etc. Those measures can guarantee the accessibility and selectivity of the masses to essential medicines in grass-roots areas.