As an essential technique involved in complicated liver surgery,portal vein reconstruction results in eradication of macro- or microscopic tumor residual on surgical margins when combined with precise hepatectomy,improving both the living quality and the survival rate of patients.The application of this reconstruction technique needs precise evaluation of pre-operational image data,clearly dissection of portal vessels and tremendous amount of collaborative effort by the surgery team. Other techniques performed during the surgical procedure include intra-operative ultrasound scan,revitalizing the cryopreserved vessels,and angioplasty.

Objective To explore the optimal surgical treatment strategy of advanced gallbladder carcinoma (Nevin Ⅲ - Ⅴ ), with an aim to prolong patients' overall survival. Methods 17 patients with advanced gallbladder carcinoma were reviewed. Their preoperative diagnosis, surgical treatment, complications and survival time were studied. Results The diagnosis of advanced gallbladder carcinoma was done using different medical imaging techniques, but incorrect diagnosis still happened. There is a wide range of surgical treatment for advanced gallbladder carcinoma. Controversy still exists as whether lymph node resection should be done. In our patients, 35.3% of the 13a lymph nodes and 23. 5% of the 8 lymph nodes were positive for metastasis, which showed that lymph node resection should be carried out. Extended surgery was sometime required to ensure a R0 resection.The main complications of surgery were intraabdominal infection, bile leakage and paralytic ileus.Conclusion An aggressive surgical approach for advanced gallbladder carcinoma is required to ensure a R0 resection, which contributed to better overall survival.

Objective To evaluate the therapeutic effect and safety of precise hepatectomy for primary liver cancer.nethods A total of 103 liver cancer patients who had been admitted to Drum Tower Hospital from July 2007 to October 2009 were divided into precise hepatectomy group(n=54)and routine hepatectomy group (n=49).Peri-and postoperative conditions and the results of follow-up of patients in the 2 groups were compared.All data were analyzed via t test or Fisher exact test.Results No perioperative mortality was observed in the 2 groups.Mean blood loss was(635±608)ml in precise hepatectomy group and(929±1044)ml in routine hepatectomy group,with no significant difference between the 2 groups(t=1.722,P>0.05).Intraoperative blood transfusion volume,postoperative level of aspartate transaminase,positive rate of resection margin and incidence of postoperative complications were(222±381)ml,(158±121)U/L,2%(1/54)and 7%(4/54)in precise hepatectomy group,and were(542±785)ml,(292±347)U/L,18%(9/49)and 24%(12/49)in routine hepatectomy group,with significant difference between the 2 groups(t=2.590,2.558,P<0.05).The 1-year tumor recurrence rate and 1-year survival were 24%(8/33)and 85%(28/33)in precise hepatectomy group,42%(20/48)and 77%(37/48)in routine hepatectomy group,with no significant difference(P>0.05).Conclusion Precise hepatectomy is safe and effective in the treatment of liver caner without much injury to patients.

Objective To investigate the efficacy of amoxicillin,clavulanate potassium and cefotaxime in the treatment of neonatal pneumonia and its influence on intestinal microflora.Methods 310 cases of neonatal pneumonia diagnosed in the hospital from June 2014 to June 2016 were selected as the subjects.They were divided into three groups according to random number table.The group A (100 cases) was treated with amoxicillin and clavulanate potassium,group B(105 cases) was treated with cefotaxime,group C(105 cases) was treated with amoxicillin,clavulanate potassium and cefotaxime.The effect and the difference of intestinal microecology were compared among the three groups.Results There were no statistically significant differences among the three groups in effect and the cure time [(5.2 ± 1.3) d vs.(5.4 ± 1.5) d vs.(5.3 ± 1.4) d] (P ＞ 0.05).There were statistically significant differences in intestinal microecology among the group A,group B,group C and control group (x2 =11.741,7.066,6.163,8.752,22.851,all P ＜ 0.05).The lactobacillus,Bifidobacterium,Enterococcus and true Bacillus of group A,group B,group C were less than those of the control group,which in group C were significantly less than group A and group B,there were statistically significant differences (t =10.453,6.843,5.974,17.654,all P ＜ 0.05).The Enterobacteriaceae of group A,group B and group C was significantly more than that of the control group,and the Enterobacteriaceae of group C was significantly more than that in group A and group B,there were statistically significant differences (t =6.574,4.634,3.968,9.893,all P ＜ 0.05).Conclusion Amoxicillin,clavulanate potassium and cefotaxime are effective in the treatment of neonatal pneumonia,the combined use of drugs has great influence on intestinal microflora.