Objective To study the feasibility and safety of laparoscopically assisted hepatectomy without choledochotomy and T-tube drainage for the treatment of hepatolithiasis.Methods The study included 11 patients with hepatolithiasis in the left intrahepatic duct.Of the 11 patients,8 patients were complicated with choledocholith and 5 patients with cholecystolithiasis.After laparoscopically assisted left hepatectomy,extrahepatic bile duct stone removal and right hepatic duct exploration were carried out under video-assisted choledochoscopy through the left hepatic duct,without choledochotomy and T-tube drainage.Results The operation was successfully accomplished in all the 11 patients.Liver procedures included laparoscopically assisted left lateral lobectomy in 5 patients and left hemihepatectomy in 6 patients.The mean operation time was 128 min(range,110~150 min),and the mean blood loss was 95 ml(range,50~150 ml).No serious postoperative complications occurred.The mean postoperative hospital stay was 7 d(range,5~10 d).The 11 patients were followed for a mean of 7.6 months(range,2~16 months).The curative effects were classified as excellent in 10 patients and good in 1.No residual or recurrent stones were noted.Conclusions Laparoscopically asisted hepatectomy without T-tube drainage for the treatment of hepatolithiasis is feasible and safe for selected patients.This procedure offers advantages of simplicity of performance,short operation time,and fewer complications,being a worthwhile minimally invasive alternative.

Hepatic endometriosis is a rare form of atypical endometriosis,only 30 cases were reported worldwide.Most cases of hepatic endometriosis were misdiagnosed due to the lack of typical symptoms.One patient with space-occupying lesions in the liver diagnosed by color Doppler ultrasonography were admitted to the Fuzhou General Hospital of Nanjing Military Command on November 5,2012.The patient was preliminarily diagnosed as with hepatic echinococcosis and then received operation.The result of postoperative pathological examination confirmed hepatic endometriosis.

Objective To study the effect and safety of recombinant human brain natriuretic peptide (rhBNP)on hemodynamics in patients with refractory heart failure(RHF).Methods A total of 16 patients with RHF were enrolled in the study.We defined RHF as the symptoms and signs had not been improved with conventional intensive treatment.The patients started to receive the infusion of rhBNP with 1.5 μg/kg bolus intravenous injection followed by 0.007 5 μ4/(kg · min)for 24 hours.During 24 hours,the hemodynamic parameters,systolic blood pressure,heart rate and electrolyte were monitored.After rhBNP infused,echocardiography was used to measure the cardiac index(CI),left ventricular end diastolic diameter(LEVDD)and ejection fraction(EF)in the third day.Results After rhBNP infused,pulmonary capillary wedge pressure (PCWP),mean pulmonary artery pressure(MPAP)were significantly reduced at 15 minutes(PCWP[22.7 ±4.0]mm Hg vs[25.3 ±3.9]mm Hg;MPAP[31.9 ±3.6]mm Hg vs[34.6 ±7.8]mm Hg,P ＜0.05),the systolic blood pressure decreased remarkably at one hour([105.2 ± 11.5]mm Hg vs[119.0 ± 17.2]mm Hg,P ＜ 0.01),and the effect disappeared gradually,heart rate decreased remarkably([109.0 + 10.8]beat/min vs [82.2 ± 8.6]beat/min).blood K +,Na + and renal function remained unchanged(P ＞ 0.05).CI([3.7 ± 0.6]L/m2 vs[1.8 ±0.4]L/m2),LEVDD([63.6 ±5.7]mm vs[67.3 ±6.2]mm)and EF([43.1 ±8.3]％ vs [31.2 ± 6.4]％)were significantly improved(P ＜ 0.01).There was no symptomatic hypotension or other adverse events.Conclusion Injection of rhBNP is safe,feasible,and effective in patients with refractory heat failure for improving hemodynamics.

Objective To investigate the effective strategies to prevent and treat biliary complications after orthotopic liver transplantation.Methods The clinical data of 316 patients who received orthotopic liver transplantation at the Fuzhou General Hospital of Nanjing Military Command from November 2001 to March 2012 were retrospectively analyzed.Cold perfusion with HTK + UW solution was applied when obtaining the liver graft,and then the liver graft was preserved in the UW solution.The bile duct was perfused with UW solution thereafter.Orthotopic liver transplantation or piggyback liver transplantation were adopted in the cadaver liver transplantation.Left liver transplantation and right liver transplantation were adopted in the living donor liver transplantation.Choledochojejunal Roux-en-Y anastomosis or duct-to-duct choledochostomy were used for biliary reconstruction.Ordinary T tubes were used for drainage before 2006,and then 6 F pediatric suction catheter or epidural catheter were applied for drainage thereafter.The Ttube was pulled out 3-6 months after the operation.Enteral nutrition was applied to patients at the early phase after operation.The immunosuppressive agents used including tacrolimus + mycophenolatemofetil + adrenal cortical hormone,and for some patients,tacrolimus + mycophenolatemofetil + sirolimus + hormone were used.Patients were followed up for 2 years to learn the incidence of biliary complications and guide the medication.The difference in the incidence of bile leakage between patients who wcrc admitted before 2006 and those admitted after 2006 were compared using the chi-square test.Results The warm ischemia time was 2-6 minutes,and the cold ischemia time was 3-10 hours.For patients who received cadaver liver transplantation,orthotopic liver transplantation was carried out for 291 times and piggyback liver transplantation for 24 times; biliojejunal Roux-en-Y anastomosis was carried out for 5 times and bile duct end-to-end anastomosis for 310 times.For patients who received living donor liver transplantation,1 received left liver transplantation and 1 received right liver transplantation,and they received bile duct end-to-end anastomosis.A total of 311 patients received immunosuppressive treatment with tacrolimus + mycophenolatemofetil + adrenal cortical hormone,and 5 patients reveived tacrolimus + mycophenolatemofetil + sirolimus + hormone.Of the 316 patients who received orthotopic liver transplantation,38 had biliary complications after the operation,including bile leakage in 18 patients,intra-and extra-hepatic bile duct stricture in 6 patients,anastomotic stricture in 6 patients,biliarycomplications included cholangitis in the portal area and cholestasis in 4 patients,choledocholithiasis and cholangitis in 2 patients and biliary infection in 2 patients.The incidence of bile leakage before 2006 was 14.00％ (7/50),which was significantly higher than 4.12％ (11/267) of bile leakage after 2006 (x2-7.676,P ＜ 0.05).Of the 38 patients with biliary complications,the condition of 35 patients was improved,and 3 patients died.Of the 18 patients with bile leakage,15 was cured by conservative treatment,3 received surgical treatment (the condition of 1 patient was improved by drainage,anti-infection treatment and nutritional support,but died of peritoneal hemorrhage at postoperative 1 month; 2 patients received peritoneal drainage,1 was cured and 1 died of peritoneal infection).For the 6 patients with intra-and extra-hepatic bile duct stricture,1 was cured by liver retransplantation and 5 were cured by conservative treatment,endoscopic retrograde cholangio-pancreatography (ERCP) or balloon dilation.For the 6 patients with anastomotic stricture,the condition of 3 patients was improved by conservative treatment,balloon dilation or stent implantation,1 gave up treatment due to hepatic cancer recurrence and died thereafter,1 received anastomosis + T tube drainage,1 was cured by recurrent tumor resection and choledochojejunostomy.Four patients with cholangitis in the portal area and cholestasis were cured by conservative treatment.For the 2 patients with choledocholithiasis and cholangitis,1 was cured by stent implantation with ERCP,and 1 received conservative treatment,and the level of total bilirubin was decreased.Two patients with biliary infection were cured by anti-infection treatment.Conclusions Most of the biliary complications could be treated by non-surgical treatments.For patients with severe biliary complications or those could not be treated by non-surgical treatment,re-exploration of the bile duct is effective.Liver re-transplantation is the only choice for patients with dysfunction of liver graft caused by severe ischemic biliary injury.

Objective To investigate the effects of celastrol on the cell growth and apoptosis of human gallbladder cancer NOZ cells,and explore its potential molecular mechanism.Methods NOZ cell were cultured in vitro.And CCK-8 assay,Annexin V-FITC/PI staining method,cell cycle analysis were conducted to investigate the effects of celastrol on the growth and apoptosis of NOZ cells after being treated with drugs.The mitochondrial membrane potential and Bax and Bcl-2 protein expression level were determined by Rhodamine 123 and Western blot,respectively.Results Celastrol could inhibit NOZ cell growth,and the IC50 value was 5.3 μmol/L.Annexin-V/PI staining showed that cell apoptosis of NOZ cells were induced as the celastrol concentration increased,and the apoptosis ratio of control group was 4.4％,while the apoptosis rates of the test groups (2,5,10 p mol/L) were 7.4％,27.1％ and 43.4％,respectively.In addition,cell cycle analysis revealed that celastrol could induce G1-phase arrest.The G1-phase rate of control group was 25.6％,while the G1-phase rates of the test groups (2,5,10 μmol/L) were 36.5％,45.7％ and 92.5％,respectively.The mitochondrial membrane potential was measured after treatment with celastrol and the results indicated that the mitochondrial membrane potential was significantly decreased.Western Blot showed that the protein expression of Bax increased and Bcl-2 decreased in a time-dependent manner after treatment with celastrol.Conclusions Celastrol may inhibit cell proliferation of human gallbladder cancer NOZ cells and induce cell apoptosis partly by inducing the loss of mitochondrial membrane potential.

Objective To study the feasibility and invasiveness of hand-assisted laparoscopic hepatectomy(HALH) for liver cancer.Methods Forty patients undergoing hepatectomy for liver cancer were randomly divided into HALH group and open hepatectomy(OH) group.Data of patients of two groups,Which included operating time,intraoperative blood loss,length of incision,postoperative flatus time,hospital stay,complications and C-reactive protein(CRP) were compared.Results The mean intraoperative blood loss,length of incision,postoperative flatus time,hospital stay and CRP in HALH group were significantly less than that in OH group;but there was no significant difference in operating time,or complication and recurrence rate.Conclusions HALH for liver cancer is less traumatic,and achieves faster patient recovery.It is feasible and safe in selected patients.

Objective To lay the foundation for analyzing the mechanism of liver cell injury caused by mtDNA deletion and mutation in patients with obstructive jaundice. Methods 30 patients were randomly selected as obstructive jaundice group (case group) and 10 patients as control group according to the strict condition. Author makes use of the methods of PCR amplification of the entire human mitochondrial genome in 17 mismatch-specific overlapping fragments and gene sequencing results to Preliminary estimate the localizathion of hepatocyte mtDNA damage in patients with obstructive jaundice. Result Deletions and length of partial liver cells were 8429-9591 of about 1. 1 kb, 16024-60 of about 0. 6 kb, 1889-3031 of about 1. 1 kb and 4977bps common deletion and the high mutation rate of some bases in D-loop region. Conclusion There are multiple mtDNA deletions and multiple point mutations in patients with obstructive jaundice

Objective To study the impact of hepatic steatosis on the safety and prognosis of patients who received partial hepatectomy for liver cancer.Methods A retrospective study was conducted on 338 patients who received hepatic resection for liver carcinoma.Results There were 273,44 and 21 patients who had a normal liver,mild steatosis and moderate-to-severe steatosis respectively.There was a significantly higher body mass index in the steatosis group (P ＜ 0.05).The operative time,blood loss,transfusion rate,postoperative hospital stay and ICU stay increased in patients with moderate-severe fatty liver (P ＜ 0.05).Conclusion Mild steatosis had little impact on partial hepatectomy.Moderate-to-severe hepatic steatosis was associated with increased blood loss and perioperative morbidity.

Objective To explore the surgical management in patients with Bismuth Ⅳ hilar cholangiocarcinoma.Methods Retrospective study was used to analyze the clinical data with operative and pathologic diagnosis of Bismuth Ⅳ hilar cholangiocarcinoma in the recent five years.Results Of the 22 patients,there were 13 males and 9 females,with M∶F=1.4∶1.In the group of non-liver transplantation(NLTX),5 cases(31.3%) underwent resection(radical resection in 2 cases;palliative resection in 3 cases),and 11 cases had nonresectional internal or external drainage.In the liver transplantation group(LTX),the resection rate was 100 %(6/6).Five LTX cases survived for 28,19,17,12 and 9 months respectively,and one died from chronic rejection in 11 months after operation.In the NLTX group,the 1-and 2-yr survival rate was 32.1 % and 0% respectively.The 1-and 2-yr survival rate of LTX was 80.0 %(4/5)and 50.0 %(1/2)respectively.There was significant difference between the two groups in average survival rate(P=0.041).Conclusions Aggressive surgical treatment should be adopted for Bismuth Ⅳ hilar cholangiocarcinoma,and radical resection is crucial to enhance survival rate.LTX is a good choice for the patients with unresectable Bismuth Ⅳ hilar cholangiocarcinoma and the prognosis is satisfactory.

Objective:To compare the therapeutic characteristics of anterior hybrid decompression and posterior cervical posterior laminectomy in the treatment of multilevel cervical spondylotic myelopathy.Methods:Thirty six cases of multilevel cervical spondylotic myelopathy patients treated by anterior hybrid decompression and thirty three cases of multilevel cervical spondylotic myelopathy patients treated by posterior cervical posterior laminectomy were involved.The general information,bleeding amount,operative time,cervical curvature D value,JOA score and incidence of postoperative complications of the two groups before and after surgery were compared.Results:There was no significant difference in the general information among the two groups(P＞0.05),including age (anterior group:56.23± 7.64 years old,posterior group:55.76± 8.18 years old),sex (anterior group:22 males/14 females,posterior group:20 males/13 females),cervical curvature D value (anterior group:7.41± 3.14,posterior group:8.19± 2.74),JOA score (anterior group:9.08± 1.09 scores,posterior group:8.82± 1.26 scores),disease course (anterior group:17.24± 7.36 months,posterior group:15.75± 5.78 months) and affected segment (anterior group:3.11 ± 0.26 segments,posterior group:3.24± 0.39 segments).The the amount of bleeding in the anterior group (anterior approach:221.79± 178.02 ml,posterior group:483.07± 434.25 ml) was lower than that of the posterior group(P＜0.05).The operative time (anterior group:196.54± 51.88 mins,posterior group:175.12± 54.93 mins) was longer,but there was no significant difference (P＞0.05).The cervical curvature D value and JOA score of posterior group were increased with the extension of surgery time.However,the cervical curvature D value of posterior group was decreased,but JOA score was increased.The incidence of bone unfinished,hoarseness and cerebrospinal fluid leakage were found in the anterior group,and axial pain and C5 nerve root paralysis were found in the posterior group.But there was no significant difference in the incidence of complications between the two groups (anterior group 14.89％,posterior group:12.12％)(P＞0.05).Conclusions:Anterior hybrid decompression and posterior cervical posterior laminectomy had their own advantages in the treatment of multilevel cervical spondylotic myelopathy.,The appropriate treatment should be taken according to the condition of patients.