Laparoscopic associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) is an innovative surgical procedure with technical challenges and the risk of surgery,its use in the treatment of hepatocellular carcinoma with cirrhosis is still at an early and exploratory stage.Based on the clinical data and follow-up results of 11 cases of laparoscopic ALPPS for the treatment of hepatocellular carcinoma with cirrhosis,the author summarized the indications,techniques,complications,perioperative and oncology results of the procedure preliminarily.This study has provided technical experience and implementation plan in clinical practice of laparoscopic ALPPS for the treatment of hepatocellular carcinoma with cirrhosis.

Minimally invasive surgery is the trend of development of modern surgery.As the representative of minimally invasive surgery,laparoscopy has widely been used in surgeries for visceral diseases.Liver is the biggest solid organ in the abdominal cavity,with complicated anatomical structure and important biological functions.Laparoscopic hepatic surgeries were thought to be difficult and with high risk.In recent years,laparoscopic surgery has been widely applied in the hepatic surgery as the improvement of laparoscopic techniques and instruments.The application of laparoscopy has been extended from marginal and local resection for hepatic benign diseases to major hepatectomy,resection of liver graft,hepatectomy at special location and anatomical segmentectomy.In China,patients with liver cancer or hepatolithiasis have high recurrence rate,and part of the patients had to receive reoperation.Furthermore,patients with hepatic cancer were usually complicated with hepatic cirrhosis,and patients with hepatolithiasis were easily complicated with hepatic atrophy,hepatic cirrhosis or cavoportal transposition,which hinder the application of laparoscopy for the treatment of liver cancer and hepatolithiasis.In this article,we investigate the application and update of laparoscopic techniques in anatomical hepatectomy and re-hepatectomy based on the experiences of 800 cases of laparoscopic hepatectomy.

Liver transplantation is the only effective way to save the lives of patients with end-stage liver disease and acute liver failure, but the shortage of donor liver limits the clinical application of liver transplantation. There is few report on living donor liver transplantation using the otherwise discarded partial liver after laparoscopic hepatectomy for benign liver tumor, and there are no corresponding standards and specifications for donor selection, surgical indications, preoperative evaluation, surgical planning, operation process and technical points. Based on the clinical practice of laparoscopic hepatectomy, and combined with relevant literature, the author discusses the feasibility and problems of using the otherwise discarded partial liver after laparoscopic hepatectomy for living donor liver transplantation.

Objective To investigate the protective effect of pentoxifylline (PTX) on bile duct in grafts against ischemia-reperfusion (IR) injury and its potential mechanisms in the animal model of OLTx in miniature swines. Methods After PTX was added to the preservation solution and administrated through hepatic artery, changes of blood flow, activity of ATPase, apoptosis of epithelial cells, and pathomorphology of the bile duct were investigated in the animal model of OLTx in miniature swines. The animals were divided into IR, IR+NS, and IR + PTX groups. Results The results showed that the incidence of biliary necrosis was significantly lower in IR+PTX group than that in IR and IR +NS groups. When compared with those in IR and IR +NS groups, GGT and ALP levels, numbers of apoptosis cells, and scores of pathomorphology were significantly decreased in IR+PTX group, while blood flow, activity of Na +-K +ATPase, Ca 2+ -ATPase of bile duct in grafts were significantly elevated. Conclusion These results suggest that PTX has multiple antagonistic effects against IR injuries of the bile duct. The effects of PTX on bile duct of grafts against IR injuries are possibly correlated with the improvement of the microcirculation, preservation of the ATPase activity of the bile duct, and suppression of the apoptosis of the bile duct cells.

Objective To provide a reliable model of orthotopic liver transplantation in rats and study surgical techniques for improving the quality of the operation. Methods The model was established by modified Kamada’s cuff technique. The time of cold preservation was 60 min. The successful rate of the method and one-week survival rate were observed. Results In 135 cases undergoing orthotopic liver transplantation, one-week survival rate was 89.2% . The successful rate of the model was 95.6% . Conclusions The key for success in rat liver transplantation is the shortened anhepatic period and delicate and skillful surgical manipulation. Also some detailed modified techniques should be used.

Objective:To explore the factors influencing colonization of Mutans streptococci (MS) on teeth of children.Methods:Dental colonization of MS was investigated in 123 children aged from 7 to 42 months in Beijing. Oral examination was performed. Information of nursing habits, diet history etc. was obtained from parent questionnaires.Results:Logistic regression analysis showed that the number of erupted teeth and the intake of sugar-containing food were positively related with MS colonization, their WALD values were 17.411(P=0.000) and 5.637(P=0.018) respectively,OR values were 3.287 and 2.739 respectively.Conclusion:The main factors influencing the colonization of MS were the number of erupted teeth and the intake of sugar-containing food.

Objective To explore the effects of selective external biliary drainage (SEBD) on the liver function of rats with obstructive jaundice. Methods The rates of right hepatic lobe weight against body weight of SD rats in SEBD group and total external biliary drainage (TEBD) group were calculated at day 0, 1, 4, 7, 10 after external biliary drainage. The mRNA and protein expressions of multidrug resistance-associated protein 2 (MRP2) and bile salt export pump (BSEP) were detected by RT-PCR and Western blot. Results Compared with TEBD group, the rate of right hepatic lobe weight against body weight and mRNA and protein expression of MRP2 and BSEP were significantly higher in SEBD group (t=15.569, P <0.05 ; t =4.485, 7.143, 9.169, 5.178, P <0.05). Conclusions SEBD improves the liver function of rats with obstructive jaundice, which may be related to the compensatory increase of remnant liver volume and elevation of expression per volume of membrane transport proteins.

Objective　To investigate factors influencing the incidence of massive bleeding caused by stress ulcer in severe acute pancreatiti s (SAP) and explore the effectiveness of measures for its prevention and treatme nt.　Methods　Clinical data of 121 pat ients with SAP were reviewed retrospectively in our center between 1993 and 1998 .The incidence of massive bleeding caused by stress ulcer in SAP, its affecting factors and the results of prevention and treatment were evaluated.　Results　The incidence of stress ulcer massive b leeding in SAP was 11.6% (14/121). The risk factors included the age of patient s, the severity of the disease, concomitant bile duct lithiasis obstruction, pan creatic abscess, pseudocyst and a history of surgical debridement and drainage. Five out of 6 patients treated conservatively died, while only 1 out of 8 treate d surgically died (P＜0.01).　Conclusion　Massive bleeding stress ulcer most often occurred in elderly SAP p atients, especially those of biliogenic, with pancreatic abscess and pseudocyst. Somatostain administration effectively decreases the incidence of bleeding. E mergency operation is mandatory when conservative measures fail to stop the bl eeding.

Robotic surgery is a major trend of mini-invasive surgery,which is still in its infancy in China.The training and education of robotic surgeons is a problem to be solved imperatively.In our clinical practice,we explored the new strategy of training and education for hepatobiliary robotic surgeons by assimilating the essence of traditional surgery education and by drawing lessons from the successful training of robotic surgery in foreign countries.Satisfactory teaching effect was obtaincd.

Objective To explore the application value of Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with portal vein (PV) resection and artificial vascular graft and reconstruction.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with cancer of pancreatic head combined with biliary and duodenal obstructions who was admitted to the Southwest Hospital of the Third Military Medical University in November 2015 were collected.Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with PV resection and artificial vascular graft and reconstruction were applied to the patient due to intraoperative tumor extensive invasion to the PV and angiogenesis around the tumor.The operation time,volume of intraoperative blood loss and transfusion,time of postoperative drainage-tube removal,postoperative complications,result of postoperative pathological examination,duration of postoperative hospital stay and results of follow-up were observed.The follow-up of outpatient examination and telephone interview was performed to detect the survival of the patient up to February 2016.Results The patient underwent successful Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with PV resection and artificial vascular graft and reconstruction.The length of intraoperative excisional PV,operation time,volume of intraoperative blood loss,volume of red blood cell suspension and blood plasma infusions were 3 cm,670 minutes,600 mL,400 mL and 200 mL,respectively.The patient got out-off-bed activity at postoperative day 1 and fluid diet intake after gastric-tube removal at postoperative day 3,and drainage-tube was removed at postoperative day 8.No postoperative complication was detected.The patient had unblocked main PV without obvious stenosis and filling defect by computer tomography rescanning.Adenosquamous carcinoma of the pancreatic head was confirmed by postoperative pathological examination.There were negative resection margins from the proximal and distal duodenum to the pancreas.The patient was discharged from hospital at postoperative day 12 and followed up for 3 months,with a good survival.Conclusions Da Vinci robot-assisted laparoscopic pancreaticoduodenectomy combined with PV resection and artificial vascular graft and reconstruction are safe and feasible in the treatment of the cancer of pancreatic head combined with biliary and duodenal obstructions,with a good short-term outcome.