Application of lymphatic tracer has greatly facilitated lymphadenectomy of tumor resection.As a novel lymphatic tracer,activated carbon nanoparticles suspension has high lymph taxis and can stain lymph nodes black as indicators.Thus,carbon nanoparticles can help to track tumor lymphadenectomy,modify the efficiency of lymphadenectomy and improve the prognosis of patients.Now it has been widely applied in the area of surgical treatment of tumors,such as gallbladder cancer,pancreatic cancer,liver cancer,etc.

Objective To evaluate carbon lymph tracer (CH40) in pancreatic cancer surgery.Method 61cases of pancreas head carcinoma undergoing whipple procedure from June 2011 to December 2013 were divided into intraoperative nano carbon group (group A,36 cases),in which resection range was adjusted according to lymph node staining including 13 standard resection cases (group A1),and 23 modified extended radical resection cases (group A2).Standard group (group B,n =17),and extended radical operation group (group C,n =8),respectively.Results The average lymph nodes harvested in group A1 were 25.08 ± 2.72,with positive lymph nodes of 7.92 ± 2.22,significantly more than group B (19.47±1.55,2.68 ±5.24),P＜0.05.In group A2,the average lymph node was 29.91 ±2.68,positive lymph node was 11.04 ± 2.38,significantly more than group C (25.13 ± 2.85,8.49 ± 3.32),P ＜0.05.The mean survival time and overall survival time of group A1 were 43.80 ±4.09 months,51.44 ±1.64 months,significantly more than group B (27.11 ±3.36,41.74 ±3.28 months),P ＜0.05.In group A2,the average tumor free survival time,and overall survival time was 31.58 ±2.99 months,45.02 ±2.54 months,not statistically different with group C (29.13±4.76 month,43.67 ±3.33 months),P ＞0.05.Conclusions Intraoperative lymphatic tracer technology significantly increases lymph node harvest,improving the survival time and tumor free prognosis.

Objective To investigate the influence of diameter of liver outflow vein on portal hypertension and artificial blood vessel (ABV) patency rate in Budd-Chiari syndrome (BCS) patients undergoing atrial caval shunting (ACS).Methods We recruited 209 patients,who had undergone ACS for Ⅱ type of BCS.Those patients with unobstructed liver outflow vein were included into group A and the patients with stenosed liver outflow vein into group B.Free portal pressure (FPP) was measured before and after ABV opening.Portal vein velocity (Vpv),liver function,spleen volume and function,esophagogastric varices and ABV patency were evaluated postoperatively.Results After ABV opening,FPP decreased significantly in group A than group B (t =10.45,P ＜ 0.05).Vpv accelerated significantly in group A 2 weeks after operation than group B (t =12.81,P ＜ 0.05).Apparent improvement of liver function,spleen function and esophagogastric varices and reduction of spleen volume were observed in group A patients than group B patients (P ＜ 0.05).Reduction of esophagogastric varices in group A was better than in group B (x2 =44.73,P ＜ 0.05).By postoperative follow up,ABV patency of group A was higher than group B (P ＜ 0.05).Conclusions Patency status of liver outflow vein significantly influences postoperative portal vein pressure and closely correlats to ABV patency rate after ACS.

Objective To study carbon nanoparticles lymphatic tracer to guide surgery for gallbladder cancer.Methods 120 patients with gallbladder cancer were randomized into two groups:the experimental group (n =60) and the control group (n =60).For the experimental group,0.1 ml carbon nanoparticles was injected at 4 ～ 6 locations subserosally around the cancerous site intraoperatively.Stained lymph nodes were used as markers to guide lymphadenectomy.The resected specimens were carefully dissected,and then the lymph nodes were studied according to their positions by histopathological examinations.Results Various degrees of stained lymph nodes were seen in the specimens.In the experimental group,the number of lymph nodes (12.0 ± 3.8),and metastatic lymph nodes (6.3 ± 3.3) per patient were obviously higher than those in the control group (9.2 ± 3.6、4.4 ± 2.8),respectively,(P ＜ 0.05).There were significant differences (P ＜ 0.05) in postoperative disease-free survival and overall survival.Conclusions Intraoperative injection of carbon nanoparticles enhanced lymph node clearance and increased the number of lymph nodes and metastatic lymph nodes dissected,which helped to guide pathological staging.There were significant improvements in disease-free survival and overall survival of these patients with gallbladder cancer after surgery.

Objective To investigate the change of inferior vena cava pressure (IVCP) in type Ⅱ Budd-Chiari syndrome patients undergoing atrial caval shunting and its relationship with postoperative artificial blood vessel (ABV) patency rate.Methods We recruited 209 patients who had undergone atrial caval shunting for type Ⅱ Budd-Chiari syndrome and evaluated IVCP,right atrial pressure (RAP) and free portal vein pressure (PFP) before and after ABV opening.Presure changes were compared by t-test.These patients were followed up by color Doppler ultrasonograthy for ABV patency.The correlation between IVCP and postoperative ABV patency were analyzed By Kaplan-Meier test.Results IVCP (t =0.56,P ＜ 0.05)and PFP (t =0.72,P ＜ 0.05) decreased and RAP increased significantly after ABV opening (t =0.52,P ＜ 0.05).Follow up result showed that ABV patency rate was lower in patients with IVCP descent ＜ 1 kPa than those with IVCP descent ＞ 1 kPa (P ＜ 0.05).Conclusions Significant IVCP descent correlates with high ABV patency rate after atrial caval shunting in type Ⅱ Budd-Chiari syndrome patients.

Objective To investigate the influence of different pancreaticojejunostomy on the incidence of postoperative pancreatic (PF) fistula in pancreaticoduodenectomy (PD).Methods The clinical data of 343 patients undergoing radical PD from January 2011 to December 2015 were collected.343 patients were divided into 3 groups,including 124 cases of continuous lamellar duct-to-mucosa pancreaticojejunostomy (CL-DMP) (group A),111 cases of invaginated pancreaticojejunostomy (group B) and 108 cases of binding pancreaticojejunostomy (group C).The rates of postoperative PF and related complications,length of postoperative hospital stay,perioperative mortality and hospitalization costs were compared between the 3 groups.Results There was no statistical difference in the size of pancreatic duct between the 3 groups (P ＞ 0.05).The postoperative PF incidence of group A was 4.84％,significantly lower than 13.51％ in group B and 15.74％ in group C,respectively (P ＜0.05).The anastomosis took less time and postoperative hospital stay was shorter in group A than that in the other 2 groups (P ＜0.05).Conclusion CL-DMP is time-saving,safe and effective method of pancreaticojejunostomy during the process of pancreaticoduodenectomy.

Objective To evaluate fusion indocyanine green fluorescence imaging in laparoscopic anatomical hepatectomy.Methods The clinical data of 75 liver cancer patients undergoing laparoscopic anatomic hepatectomy (LAH) at the Department of Hepatobiliary and Pancreatic Surgery,Henan Provincial People's Hospital from Apr 2017 to Sep 2018 were retrospectively analyzed.Patients were divided into the indocyanine green fluorescence fusion imaging technique (FIGFI-LAH) group (35 cases) and laparoscopic anatomical hepatectomy (LAH) group (40 cases).Results Pathologically positive margin was found in 1 case in FIGFI-LAH group and 9 cases in LAH group (x2 =4.649,P =0.031).There were no significant differences in the mean operative time,intraoperative blood loss,blood transfusion rate,and rate of conversion to open surgery (P ＞ 0.05).Conclusion The use of FIGFI technique in laparoscopic anatomical hepatectomy for liver cancer effectively reduces the positive rate of surgical margin.

Objective: To study the use of different techniques of pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD) for patients with slim pancreatic ducts. Methods: The clinical data of 45 patients with slim pancreatic ducts (<3 mm) who underwent LPD in People's Hospital of Zhengzhou University from May 2017 to March 2019 were studied. These patients were divided into 2 groups: Chen's suturing technique (group A, n=31), and the imbedding pancreaticojejunostomy (group B, n=14). The postoperative pancreatic fistula (PF) rates, complication rate, pancreaticojejunostomy time, and length of postoperative hospital stay were compared between the 2 groups. Results: There was no significant difference in the general data between the two groups (P>0.05). The incidence of postoperative pancreatic fistula in group A (4 cases) was significantly lower than that in group B (6 cases) (12.9% vs. 42.9%, P<0.05). The operation time of pancreaticojejunostomy in group A was significantly shorter than that in group B [(26.5±0.8) min vs. (28.0±2.4) min, P<0.05]. There was no significant difference in the length of postoperative hospital stay between the 2 groups (P>0.05). Conclusion Chen's suturing technique was a safe and effective pancreaticojejunostomy technique in LPD carried out in patients with slim pancreatic duct patients.

Objective To evaluate enhanced recovery after surgery (ERAS) in the treatment of cholecystolithiasis complicated with extra hepaticbile duct stones by laparoscopy and choledochoscopy.Methods Patients were divided into ERAS and control groups according to the inclusion and exclusion criteria.Patients in ERAS group received perioperative management according to enhanced recovery rehabilitation program.Clinical and laboratory results were compared between the two groups.Results 46 patients were enrolled into ERAS group and 40 patients into control group.The ERAS group had shorter time of first postoperative exhaust,first postoperative oral intake,getting out of bed,removal of abdominal drainage tube,postoperative hospital stay (respectively t =-3.658,-15.552,-8.864,-6.673,-6.036,all P ＜ 0.05),less pain in 6,12,24 and 48 hours after operation (F =8.284,P =0.000),and lower complication rate (x2 =4.172,P =0.043),lower C-reactive protein (CRP) level from pre-operation to postoperative day 1,3 and 5 (F =6.692,P =0.013),higher level of prealbumin (PA) from preoperation to postoperative day 1,3 and 5 (F =21.191,P =0.000),lower hospitalization costs (t =-0.592,P =0.004).Conclusion The application of ERAS in the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones by laparoscopy combined with choledochoscopy is conducive to rapid postoperative recovery of patients.

Objective To explore the application value of nano carbon lymph tracing technique in the radical resection of gallbladder cancer.Methods The prospective study was conducted.The clinical data of 120 patients with gallbladder cancer who were admitted to the Henan Provincial People's Hospital between January 2010 and December 2014 were collected.All the patients were allocated into the experimental group and control group by random number table.For the experimental group,a total of 0.1 mL carbon nanoparticles were injected at 4-6 locations subserously around the cancerous site,radical resection of gallbladder cancer were performed at 15 minutes after injection,and intraoperative stained lymph nodes were used as markers to guide lymphadenectomy.Patients in the control group underwent regular radical resection of gallbladder cancer.Observation indicators:(1) intra-and post-operative situations;(2) number of lymph node sorting;(3) follow-up situations.Follow-up using telephone interview was performed to detect survival of patients up to January 2016.Measurement data with normal distribution were represented as x-±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M(P25,P75),and comparison between groups was analyzed by the Mann-whitney rank-sum test.Comparisons of count data were analyzed using the chi-square test.Comparison of ordinal data were analyzed by the nonparametric test.The survival curve was drawn by the Kaplan-Meier method.Survival analysis was done using the Log-rank test.Results One hundred and twenty patients were screened for eligibility,and were allocated into the experimental group and control group,60 in each group.(1) Intra-and postoperative situations:operation time,volume of intraoperative blood loss and duration of postoperative hospital stay were respectively (164± 51) minutes,(200 ± 98) mL,(13 ± 4) days in the experimental group and (178± 52) minutes,(225±98)mL,(14±5)days in the control group,with no statistically significant difference between groups (t=-l.50,-1.42,-1.03,P＞0.05).(2) Comparison of lymph node sorting:overall number of lymph node sorting,overall number of positive lymph node sorting,number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 13.0 (12.0,15.0),8.0 (5.0,9.0),7.0 (5.0,8.0),3.0 (2.0,4.0) in the experimental group and 10.0 (8.0,12.0),5.0 (4.0,6.0),5.0 (3.0,5.0),1.0 (1.0,2.0) in the control group,with statistically significant differences between groups (Z =-5.51,-4.37,-6.24,-6.18,P＜0.05).Number of N1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 6.0 (5.0,6.0),4.0 (3.0,5.0) in the experimental group and 6.0 (4.0,7.0),4.0 (2,0,5.0) in the control group,with no statistically significant difference between groups (Z =-0.82,-1.34,P＞0.05).Overall number of lymph node sorting,overall number of positive lymph node sorting,number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 5.0 (4.8,6.3),0(0,0.8),2.0 (1.0,3.3),0(0,0.5) in patients with stage Ⅱ of the experimental group and 3.0 (2.0,4.3),0 (0,0),0 (0,1.3),0(0,0) in patients with stage Ⅱ of the control group,with statistically significant differences between groups (Z=-2.96,-2.02,-2.38,-2.01,P＜0.05).Number of N 1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 3.0 (3.0,3.3),0 (0,0.3) in patients with stage [[of the experimental group and 3.0 (2.0,3.0),0 (0,0) in patients with stage Ⅱ of the control group,with no statistically significant difference between groups (Z=-1.18,-1.81,P＞0.05).Overall number of lymph node sorting,overall number of positive lymph node sorting,number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 13.0 (12.0,15.0),7.0 (5.0,8.0),7.0 (5.0,8.0),3.0 (2.0,4.0) in patients with stage Ⅲ of the experimental group and 10.0 (9.0,12.0),5.0 (4.0,6.0),5.0 (4.0,5.0),2.0 (1.0,2.0) in patients with stage Ⅲ of the control group,with statistically significant differences between groups (Z =-4.80,-3.43,-5.25,-4.76,P＜ 0.05).Number of N1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 6.0 (6.0,8.0),4.0 (3.0,5.0) in patients with stage Ⅲ of the experimental group and 6.0 (5.0,7.0),4.0 (3.0,4.5) in patients with stage Ⅲ of the control group,with no statistically significant difference between groups (Z=-1.52,-1.16,P＞0.05).Overall number of lymph node sorting,overall number of positive lymph node sorting,number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 14.0 (13.0,15.0),9.0 (8.0,10.0),8.0 (7.5,8.0),4.0 (4.0,5.0) in patients with stage Ⅳa of the experimental group and 11.0 (10.0,13.0),6.0 (4.0,8.0),5.0 (5.0,6.0),2.0 (1.0,2.0) in patients with stage Ⅳ a of the control group,with statistically significant differences between groups (Z =-3.47,-3.25,-4.02,-3.92,P＜0.05).Number of N1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 6.0 (5.5,6.0),5.0 (4.0,5.0) in patients with stage Ⅳa of the experimental group and 6.0 (5.0,7.0),4.0 (3.0,6.0) in patients with stage Ⅳa of the control group,with no statistically significant difference between groups (Z=-0.14,-0.45,P＞0.05).(3) Follow-up situations:120 patients were followed up for 12-60 months,with a median time of 28 months.The postoperative overall survival time was (45.7 ± 2.3) months in the experimental group and (36.5 ± 2.4) months in the control group,with a statistically significant difference between groups (x2 =8.32,P＜ 0.05).The postoperative overall survival time was (54.5±3.0) months in patients with stage Ⅱ of the experimental group and (39.6±0.9)months in patients with stage Ⅱ of the control group,with no statistically significant difference between groups (x2 =3.77,P＞0.05).The postoperative overall survival time was (42.2±2.7)months in patients with stage Ⅲ of the experimental group and (35.0±3.0)months in patients with stage]Ⅲ of the control group,with a statistically significant difference between groups (x2=4.12,P＜0.05).The postoperative overall survival time was (37.7±2.5)months in patients with stage Ⅳa of the experimental group and (27.0±3.1)months in patients with stage Ⅳa of the control group,with a statistically significant difference between groups (x2 =4.14,P＜0.05).Conclusion The nano carbon lymph tracing technique in the radical resection of gallbladder cancer can guide precise operation,increase the numbers of overall and positive lymph nodes sorting,and extend postoperative overall survival time.