Objective To pay close attention to and reverse the increasing trend about missed diagnosis and misdiagnosis of carcinoma of gallbladder and bile duct in laparoscopic cholecystectomy(LC). Methods By using retrospective analysis of 17 cases of missed diagnosis and misdiagnosis of carcinoma of gallbladder and bile duct in LC, their Clinical features and proposing protective measures were summarized. Results Seventeen patients including 14 with carcinoma of gallbladder and 3 with carcinoma of bile duct received various therapeutic measures according to their own conditions or aspirations. Conclusion Rapid intraoperative frozen section diagnosis is required for the cases with suspected carcinoma in LC and second operation is performed for those who are pathologically diagnosed with malignant tumor after the first one. No pathological diagnosis is strictly prohibited.

Objective To explore the diagnostic and therapeutic methods for male breast cancer. Methods Clinical data of 11 cases of male breast cancer treated in our hospital from 1992 were analyzed (retrospectively). Results 2 patients were diagnosed at advanced stage and survived 6 and 8 months (respectively) after biopsy. The other 9 patients received radical mastectomy. 3 were lost to follow-up, 1 was found to have pulmonary metastasis after 5 years and combined treatment of traditional Chinese medicine and western medicine was given. Nodules were found under the axillary fossa in another patient at five years after surgery and the nodules were recurrent carcinoma as confirmed by biopsy. The patient has survived for 7 years with radiotherapy and chemotherapy. The other 4 cases have survived 0.5 to 7 years respectively, and are undergoing treatment. Conclusions Early diagnosis of male breast cancer should be emphasized. Aggressive surgery combined with other auxiliary treatments are effective.

Objective To explore the emergency management and prevention of iatrogenic injury of in-ferior vena cava. Methods A retrospective study was undertaken to investigate the operative procedure and post-operative outcome of 7 patients suffering from iatrogenic injury of inferior vena cava in the course of three nephrectomy, one fight adrenal gland tumor resection, one fight surgical kidney, one right upper retro-peritoneal tumor and one pancreaticoduodenectomy. The gross hemorrhage was controlled by local pressure. Then, abdominal incision was done. Firm pressure on the inferior vena cava was performed to right side for temporary control of hemorrhage. The bleeding part could be found when the hematocele was cleaned. And continuous suture should be done with 3-0 silk or absorbable suture after the crevasse was clamped. Results In these 7 cases, 1 died of hemorrhagic shock and the other 6 had significant effect postoperatively. The asso-ciated injuries were healed well except 1 case of slight edema of lower extremity. Conclusion Iatrogenic inju-ry of inferior vena cava can be treated successfully with correct procedure. Furthermore, the injury could be avoided with exactitude intraoperative procedure.

ObjectiveTo review the management and prevention of stenosis after hepaticojejunostomy. MethodsWe retrospectively analyzed 133 patients who developed stenosis after hepaticojejunostomy carried out for iatrogenic bile duct injuries. ResultThrough our active reoperative protocol, we were able to achieve satisfactory results in 131 patients, although the results were still unsatisfactory in 2 patients. ConclusionsStenosis after hepaticojejunostomy is a severe complication which should actively be prevented. Once it happens, doctors should apply active, appropriate and effective measures to correct the stenosis.

Objective To explore methods for the treatment and prevention of residual gallbladder.Methods Clinical data of 56 patients with residual gallbladder were retrospectively analyzed.Results All 56 cases were diagnosed through clinical imaging examination and cured by selective operation of residual gallbladder resection.Conclusion The residual gallbladder can be diagnosed by repeated biliary symptoms in patients with a history of cholecystectomy and imaging examination.Residual gallbladder resection is an effective therapy for the treatment of residual gallbladder.

Aim To study relationship between expressions of apoptosis-related gene bax and bcl-x in heopatocellular carcinoma (HCC) tissues and its clinical feature. Mothods The expression of Bax and Bcl-x were determined by immunohistochemistry with EnvisionTM system. Results Bcl-x and Bax proteins were detectable in 20 and 19 out of 40 HCCs, respectively. Their expressions in HCC cells were lower than those in cirrhosis(P＜ 0.05), The expression of Bax and Bcl-x in highly or intermediatly differentiated HCC cells were highed than that in low-diffe-rehtiated HCC cells suggesting that there was significant relationship among bcl-x and bax expressions and differential degree， clinical stages of HCC cells， and AFP level. However, the expression of this proteins showed no relationship with patient's sex and age(＞ 60 or ＜ 60 years old) (＞ 0.05). Conclusion Apoptosis-related genes bcl-x and bax participate partially in apoptotic regulation of HCC cells, and show that their expressions have correlation with differential degree, clinical stage of HCC cells and AFP levels.

Objective　To investigate the relationship between canceration and primary operation mode for congenital choledochal cysts(CCC). Methods　The clinical data of 21 patients with CCC treated in the last 30 years were analysed retrospectively. Results　In this series, the incidence of carcinoma was 14.8%; the canceration rate after internal drainage operation was significantly higher than that after resection of the cyst(P<0.001); the age of canceration after internal drainage was younger than that of resection of the cyst(P<0.01) and patients without operation(P<0.01); the interval time of canceration after internal drainage operation was significantly less than that of resection of the cyst(P<0.01); the age of carcinoma would be 15.4 years younger in internal drainage operation patients than that in patients without operation. Conclusions　Internal drainage, which could accelerate the occurrence of canceration of CCC, should be abandoned; resection of the cyst is recommended as the therapy of the first choice.