Objective To explore the application of laparoscopy in non-traumatic acute abdominal emergency. Methods The authors retrospectively analyzed 201 cases of emergency laparoscopy between March 1999 and May 2002. Results All the 201 patients were unequivocally diagnosed during operation. Laparoscopic operations were successfully completed in 190 cases (139 cases of acute appendicitis, 21 cases of acute cholecystitis, 19 cases of upper gastrointestinal tract perforation, 10 cases of intestinal obstruction and 1 case of common bile duct stones accompanied with acute cholecystitis), with a success rate of 94.5% (190/201). The remaining 11 patients underwent a conversion to open surgery. Conclusions Emergency laparoscopic exploration can not only clarify a diagnosis for acute abdominal emergency with unknown causes but also simultaneously offer a therapeutic method in at least 90% of cases.

Objective To evaluate laparoscopic hepatectomy for the treatment of primary liver cancer. Methods Nine patients with primary liver cancers at segment Ⅱ, Ⅲ, Ⅴ, Ⅵ and at the edge of the liver underwent laparoscopic partial hepatectomy with hand-assist devices, harmonic scalpel, and Endo-GIA. Results All operations were successful including resection of tumors involving both Ⅱ and Ⅲ segments, and irregular segmentectomy, and 2 cases with additional laparoscopic splenectomy. Surgery lasted for 80～145 min. Intraoperative bleeding was 150～700 ml, with no postoperative complications. Patients were followed-up for 5～25 months with intrahepatic tumor recurrence on 3rd, 4th and 13rd month in one each respectively. Conclusion Hand-assisted laparoscopic partial hepatectomy is a safe and feasible approach for primary liver cancer in clinically selected patients.

Objective To explore the effectiveness of using middle-latency somatosensory evoked potentials (MLSEP) to predict the prognosis in patients with acute severe stroke. Methods MLSEP, shortlatency somatosensory evoked potentials (SLSEP), and Glasgow Coma Scale (GCS) were recorded in 70 acute severe supratentorial stroke patients within 1 week after onset. All patients were evaluated with modified Rankin Scale (mRS) and follow-up in 6 months after onset. SLSEP and MLSEP were recorded in 20 normal controls. The consistency between MLSEP, SLSEP, GCS and prognosis, as well as the prognostic authenticity of MLSEP, SLSEP, and GCS were analyzed. Results Bilateral N20, N35, and N60 exited in all normal controls. Some waves of MLSEP were absent in stroke patients, and the proportion of absent waves in ipsilateral MLSEP was higher than in contralateral MLSEP. The consistency between bilateral absence of N60 and unfavorable outcome ( Kappa = 0.828, P ＜ 0.01 ), and between bilateral absence of N60 and death ( Kappa = 0.686, P ＜ 0.01 ) was satisfactory. By using the prognostic authenticity analysis of predictors, the ipsilateral absence of N60 showed the highest sensitivity ( 100% ) for unfavorable outcome and death, which added 14.3% compared with the sensitivity of ipsilateral absence of N20 ( 85.7% ). Bilateral absence of N60 showed a high specificity of 100% for unfavorable outcome, which equaled bilateral absence of N20.However, it showed a lower specificity ( 82.9% ) for death, than bilateral absence of N20 (97.1% ).Conclusions MLSEP was able to reflect the degree of brain injury and showed higher sensitivity than SLSEP for predicting unfavorable outcomes. Therefore combined use of MLSEP and SLSEP in evaluating and predicting the outcomes in brain injuries is suggested.

Objective To investigate the feasibility of laparoscopic splenectomy(LS).Methods Laparoscopic splenectomy was performed in 32 cases from June 1999 to December 2005 in this hospital.The splenic ligaments were disconnected using a harmonic scalpel and the pedicle of spleen was cut using the Endo-GIA system.After the spleen was mobilized,it was placed into an extraction bag,broken into small pieces,and removed from the extraction incision.Results The operation was successfully completed in 29 cases.The operation time was 60~270 min(mean,100 min),the amount of intraoperative blood loss was 30~1 000 ml(mean,230 ml),and the length of postoperative hospital stay,3~7 d(mean,5 d).No postoperative complications occurred.Conversions to open surgery were needed in 3 cases because of hemorrhage of the splenic pedicle,hemorrhage of the short gastric vessels,and extensive adhesion,respectively.Of the 22 cases of idiopathic thrombocytopenic purpura(ITP),the platelet count recovered to normal levels in 18 cases and kept unchanged in 4 cases.Of the 2 cases of hemolytic anemia,the hemoglobin levels were elevated after operation.Of the 4 cases of hypersplenism accompanying posthepatitic cirrhosis,the platelet count recovered to normal levels.Conclusions Laparoscopic splenectomy is a safe and feasible,especially for patients with hematologic diseases.

Objective To investigate the clinical applicative of short 5 Fr pancreatic duct (PD) stents in difficult biliary cannulation of ERCP. Methods 131 patients who underwent difficult biliary cannulation during routine ERCP were randomized to receive prophylactic short 5 Fr PD stents (stent group, 66 patients) and not (control group, 65 patients) from January 2012 to October 2015. The success rate of biliary cannulation for the first ERCP, scores of abdominal pain, the incidence of post-ERCP pancreatitis (PEP) and hyperamylasemia and severe post-ERCP pancreatitis were analyzed. Results The success rate of biliary cannulation for the first ERCP was significantly higher with the stent group than the control group. The scores of abdominal pain of the stent group was significantly lower than the control group. The postoperative serum amylase value at 3 h and 24 h were obviously lower in PD stents group than those in control group. The incidence of hyperamylasemia, post-ERCP pancreatitis, severe post-ERCP pancreatitis were also significantly lower with PD stents group than the control group. 3 cm long 5 Fr PD stents has high success rate of placement, high spontaneous migration rate, low complications, decreases the need for endoscopic removal. Conclusion In difficult biliary cannulation during ERCP, placement of short 5 Fr PD stent is safe and effective, enhance the success rate of biliary cannulation, relieve the abdominal pain, reduces the rate of post-ERCP pancreatitis efficiently.

Objective To study the clinical application oflaparoscopic-assisted operation to colorectal neoplasms. Methods 28 cases of colorectal neoplasms underwent laparoscopic surgery from July 1997 to November 2000. The mean age was 65.3 years old(33～89)years.3 cases underwent right hemicolectomy.1 case of sigmoid colon adenoma was given partial colectomy. Sigmoid-rectal anterior resection was conducted in 21 cases. 3 cases underwent abdominal peritonieal resection. Results 5 cases were converted to open laparotomy.The mean operative time was 178(150～300)min for 23 cases given laparoscopic surgery with 135(30～1000)ml of average intraoperative bleeding. Neither postoperative complications nor intraoperative deaths occurred.1 case of low portion rectal cancer showed abdominal metastasis 12 months after surgery.Neither port site nor incision metastasis happened. Conclusions Laparoscopic assisted surgery has the advantages of less surgical trauma,less gastrointestinal interference and quicker recovery. Under the circumstances of radical resection and selected candidate,laparoscopic assisted surgery can be applied to colorectal neoplasms.

Objective To explore the application of plastic pancreatic stents and/or nasal biliary drainage for choledocholithiasis patients having DSBC during Endoscopic Retrograde Cholangiopancreatography (ERCP).Methods Retrospective analysis on clinical data of 57 ERCP cases aiming at choledocholithiasis patients having DSBC from January 2010 to December 2015 has been carried out. According to the guide wire cannulation in an operation, patients are divided into three groups, i.e. plastic pancreatic stents group, nasal biliary drainage group, and plastic pancreatic stents + nasal biliary drainage group, so as to observe the success rate of operation and the occurrence rate of postoperative complications, such as pancreatitis or hyperamylasemia, as well as to compare the differences between the three groups.Results Out of the 57 patients receiving ERCP, 13 patients are in the plastic pancreatic stents group, with two successful operations (15.4%), one case of hyperamylasemia (7.7%), two cases of postoperative pancreatitis (15.4%), one case of fever (7.7%) and one case of hemorrhage (7.7%); 20 patients are in the nasal biliary drainage group, with 20 successful operations (100.0%), no occurrence of hyperamylasemia or postoperative pancreatitis or other complications including hemorrhage and fever; 24 patients are in the plastic pancreatic stents + nasal biliary drainage group, with 19 ERCP operations succeeded at the first attempt (79.2%) and 5 ERCP operations succeeded at the second try (20.8%), as well as 4 cases of hyperamylasemia (16.7%), 2 cases of hemorrhage (8.3%) , no occurrence of fever cases and postoperative pancreatitis. In comparison between the three groups, the occurrence of postoperative pancreatitis and successful rate of operation show a significant difference.Conclusion By adopting plastic pancreatic stents and/or nasal biliary drainage for patients having a dififcult selective biliary cannulation during ERCP, the success rate of operation can be improved, and the occurrence of pancreatitis can also be reduced.

Objective To evaluate the effect of laparoscopic herniorrhaphy(LHR)for inguinal hernia. Methods From December,1998 to December,2001, 176 patients with inguinal hernia were treated by LHR using laparoscopic purse string to ligate the neck of hernia sac and to place the intraperitoneal mesh.There were 160 patients with indirect inguinal hernia, 15 patients with direct inguinal hernia and 1 with indirect and direct hernia in this series. Results In this series,the mean operation time was 30 minutes, and was no intraoperative or postoperative complications; the hospital stay was 2～3 days. All the patients were followed-up for 10～36 months, only 2 recurrences(1.2%) were found. Conclusions LHR is a new herniorrhaphy which is safe and effective.The advantages of LHR are simple procedure, low complication rate, faster postoperative recovery, low recurrence rate.This operation should be widely adopted.

Objective To explore the variations of regeneration hormones after hepatectomy for liver cancer,and evaluate the relationship between the liver regeneration hormones and cancer recurrence.Methods The clinical data of 129 patients with primary hepatic carcinoma in our hospital from Dec 2004 to Dec 2005 were collected.The patients were divided into three groups according to their recurrent times,which were one-month recurrence group,6 months recurrence group and one-year recurrence group.And at the same time,40 cases of liver cancer that received TAE treatment were as contrast group.Serum HGF value was detected before operation and 1,3,7,10 and 14 days after operation.c-met,which is the receptor of HGF,was also detected as c-met mRNA and protein expression in cancer tissue and near-carcinoma liver tissue by semi-quantitative RT-PCR and Western Blot.The differences between the level of expression and the time of recurrence were compared,and the results were also compared with pathological indexes.Results Serum HGF value elevated after hepatectomy,the crest time appeared at about 10 days after the operation,and decreased after 14 days.The elevated values of HGF in large HCC tumors were markedly higher than those in small HCC tumors.The change of c-met mRNA and protein levels,revealed that the earlier the recurrence in both large and small HCC,the higher the c-met levels,and the higher the rate of vascular cancer emboli.Conclusions There is marked elevation of HGF level after hepatectomy in patients with liver carcinoma,and the over expression of c-met of the tumor may be related to its early postoperative recurrence.

Objective To explore the clinical effects of unilateral placement of plastic stents by ERCP for nonresectable Bismuth type IV hilar cholangiocarcinoma.Methods A prospective study was conducted in 42 patients with nonresectable Bismuth type IV hilar cholangiocarcinoma,who had unilateral insertion of plastic stents in the recent 4 years,All of the patients had successful insertion of single plastic stent by ERCP manipulation.Early results (less than 30 days) of procedure-related complications,mortality,long-term results (greater than 30 days) and survival were observed.Results All of the 42 patients had successful drainage.Mean total bilirubin value decreased from (332.3?163.4)?mol/L to (30.6?18.5)?mol/L,and complete resolution of jaundice was achieved in 61.9% (26/42)of the patients.Early comlications included papilla bleeding due to EST in 4 of 42 patients (9.5%) and acute cholangitis in 10 of 42 patients (23.8%).No procedure-related death occurred.All of the patients needed to have their stents replaced periodically,and the median duration up to the first stent replacement was 65 d,and without significant differences between the two groups in stent insertion to the left and right hepatic duct.Median duration of stent patency was 5.15 months,and median patient survival was 6.5 months,but also no significant differences were found between the two groups.Conclusions Unilateral plastic stent insertion is safe and feasible,can achieve adequate drainage for relatively long time,and can improve life quality and survival for patients with nonresectable hilar cholangiocarcinoma.