Objective To investigate the management of large cystic duct during laparoscopic cholecystectomy(LC). Methods 24 out of 1052 patients, whose cystic duct size in diameter are larger than 0.4cm, were reviewed retrospectively from March 1995 to December 2001. The diameter of cystic duct is 0 4cm～0 6 cm in 12 cases, 0 6cm～0 8cm in 8 ones, 0 8cm～1 0cm in 2 ones and larger than 1cm in 2 ones. Different methods were adopted. Two-clip method was used in 10 cases, three-clip method in 5 ones, ladder clip method in 6 ones and rotation clip method in 3 ones. Results LC was completed successfully in 21 cases. 3 cases were converted to open cholecystectomy due to blood loss. No complications such as bile leakage and subphrenic abscess occurred. Conclusions Large cystic duct during LC can be managed successfully by different methods.

0.05).Conclusion Selective hepatic vascular occlusion is superior to complete hepatic vascular occlusion,and is worth being widely used.

Objective:To study the expression of extracellular matrix metalloproteinase (MMP-9) inducer CD147 and MMP-9 protein in hepatocellular carcinoma (HCC) and explore their correlation with invasion, metastasis, and prognosis of HCC.Methods:SP immunohistochemistry was used to evaluate the expression of CD147 and MMP-9 in 83 HCC tissues and 15 normal liver tissues. Results:The positive rate was 73.5% for MMP-9 and 68.7% for CD147, significantly higher than normal tissues (MMP-9: 6.7%;CD147: 0%, P<0.05). Expressions of CD147 and MMP-9 were positively correlated with the tumor size, pTNM stages, differentiation degree, the portal vein cancer embolism, and postoperative recurrence (P<0.05), but not with the patient's age, gender, the serum level of alpha-fetal protein (AFP), and the Child-Pugh grades. Patients with positive expression of CD147 and MMP-9 had shorter survival time than those with negative expression of CD147 and MMP-9. Expression of CD147 was positively related with expression of MMP-9 in HCC tissues.Conclusion:CD147 and MMP-9 had positive correlation with tumor size, pTNM stages, differentiation degree, portal vein cancer embolism, and postoperative recurrence. Detection of the expression of CD147 and MMP-9 may be helpful to make a comprehensive prediction of the prognosis of HCC.

Objective To evaluate the feasibility of laparoscopic hepatectomy.Methods A total of 27 patients received laparoscopic hepatectomy by using laparoscopic Peng's multifunctional operative dissector(LPMOD).Among the patients,13 underwent anatomic hepatectomy(resection of the Ⅱ and Ⅲ segments in 3,Ⅴ segment in 1,Ⅵ in 7,Ⅴ and Ⅵ in 1,and Ⅴ,Ⅵ,Ⅶ,and Ⅷ segments in 1),and 14 received partial hepatectomy.Results The laparoscopic hepatectomy was accomplished successfully in all the patients without converting to open surgery.The mean operation time was 35-360 min [mean,(178.0?78.4) min];intraoperative blood loss was 35-1200 ml [mean,(451.7?332.6) ml];and the postoperative hospital stay was 2-14 d [mean,(8.4?3.0) d].No severe complication occurred after the operation.The postoperative pathological examinations showed hepatic hemangioma in 15,focal hyperplasia of the liver in 2,hepatocelluar carcinoma complicated with liver cirrhosis in 6,intrahepatic bile duct stone complicated with hyperplasia of the bile duct in 2,liver(hematoma) fibrosis in 1,and hepatic angiomyolipoma in 1.The patients were followed up for 1-26 months [mean,(7.9?7.4) months] by using B-ultrasonography or CT.No recurrence of hemangioma or carcinoma,tumor implantation at the puncture site,or residual stones in the intrahepatic bile duct was found in this series.Conclusion By using LPMOD,laparoscopic hepatectomy is safe and feasible for selected patients.

Objective To explore the method and clinical effect of laparoscopic anatomical right liver resections. Method The candidates for laparoscopic right hepatic lobectomys were 4 cases including 3 cases of liver hemangioma and 1 case of hepatorrhexis. Results The laparoscopic right hepatic lobectomy we performed saccess bully in all the 4 patients, operation time was (470±42.7)min. The blood loss in operation was ( 1950± 881.3) ml. The postoperative hospital stay was ( 15 ± 2.9) days.There was not complcation. Conclusions Laparoscopic right hepatic libectomy is feasible and safe.For the patients with benign liver disease, it is an operation with less operation wound.

Objective To investigate the expression of human leukocyte antigen F (HLA-F) in hepatocellular carcinoma (HCC) tissues and to evaluate its relation to clinicopathological features and prognosis of HCC.Methods HLA-F expression of tumor lesions and their adjacent normal liver tissues from 115 HCC patients were analyzed by immunohistochemistry,and its relationship between HLA-F expression and the clinicopathological features and prognosis of HCC patients was also analyzed.Results HLA-F expression was positive in 47.0％ (54/115) of the HCC lesions and in 10.6％ (7/66) of the normal liver tissues (x2 =24.799,P ＜ 0.05).HLA-F expression in HCC lesions was significantly correlated with portal vein invasions (x2 =7.644,P =0.006),tumor number (x2 =4.210,P =0.040) and patient sex (x2 =6.759,P =0.009).The mean survival time of the HLA-F positive HCC patients was 34.0 months(95％ CI:27.5-40.5 months),which was significantly shorter than that of HLA-F negative HCC patients(44.6 months,95％ CI:38.3-50.9months) (x2 =5.148,P =0.023).HLA-F expression was an independent predictor of overall survival of HCC patients.Conclusions Positive HLA-F expression is negatively correlated with the prognosis of HCC patients.

Objective To study the safety and feasibility of laparoscopic left lateral sectionectomy using the Glissonian pedicel approach.Methods The root of the round ligament of the liver was exposed and the Glissonian pedicel of the left lateral section was dissected,starting from left and using the lapa roscopic Peng's multifunctional operative dissector (LPMOD).After the Glissonian pedicel of segment Ⅱ and Ⅲ was dissected,clipped and cut,the ischemic boundary showed up.The liver was transected at the boundary of the ischemic liver,and the left hepatic vein and its branches were cut. Resutts The surgery was successtully performed in 8 patients.There was no conversion to open operation.The operative time was 110- 190 (151.0±35.4) min.The time of Glissonian pedicel dissection and liver resection was 70- 135 (101.0±24.1) min.Operative blood loss was 100-300(210.0± 89.4) ml.The ALT increased by 35- 102 (75.4± 26.5) U/L after operation and decreased to a normal level in 2-6 (3.0± 1.7) d.The postoperative hospital stay was 6-10 (8.2± 1.6) d.There was no major complication.Conclusion Laparoscopic left lateral sectionectomy using the Glissonian pedicel approach is safe and feasible.

Objective To investigate the expression characteristics of PAK5,CyclinD1 in HCC and its relationship with clinicopathological factors and prognosis.Methods The immunohistochemical method was used to detect the expression of PAK5 and CyclinDl in 76 cases of HCC tissue and 31 cases of adjacent liver tissue.The correlation between the abnormal expression of PAK5 and CyclinD1 and clinicopathological factors and prognosis was also analyzed.Results The PAK5 expression in tumor lesions and adjacent tissue was 86.8％ (66/76) and 54.8％ (17/31) (x2 =12.962,P ＜ 0.05).Meanwhile,the CyclinD1 was positive in 73.7％ (56/76) of the HCC tissue and in 41.9％ (13/31) of the adjacent tissue (x2 =9.691,P ＜0.05).The expression of PAK5 was significantly correlated with sex (x2 =5.063,P =0.024),tumor diameter(x2 =9.159,P =0.002) and portal vein-emboli (x2 =4.469,P =0.035).CyclinD1 expression was correlated with portal vein-emboli (x2 =4.842,P =0.028),TNM (x2 =7.930,P =0.005).PAK5 expression was positively correlated with CylinD1 (γ =0.284,P =0.033).The mean survival time of PAK5positive patients after operation was shorter than the PAK5 negative patients(x2 =7.104,P =0.008).By Cox multiple factors analysis,the PAK5 expression was independent impact factors affecting the prognosis of HCC patients (RR =0.186,P =0.012).Conclusion In HCC patients positive PAK5 expression predicts poor postoperative survival.

Objective To evaluate the efficacy of laparoscopic Habib 4X (Habib 4X,Angio Dynamics US),a new bipolar radiofrequency (RF) device,in laparoscopic liver resection.Methods Thirty one patients who underwent laparoscopic liver resection using the laparoscopic Habib 4X from Sept 2009 to Apr 2012 were studied retrospectively.Results The laparoscopic Habib 4X was success fully used in 30 patients (malignant,n=18; benign,n=12).The procedures performed included left lateral sectionectomy (n=12),left hemi-hepatectomy (n=1),Ⅴ or Ⅵ segmentectomy (n=9),Ⅴ and Ⅵ bi-segmentectomy (n=2) and wedge exclusion (n=6).The time required for precoagulation and resection was 10～68 min (median 24 min).The mean intraoperative blood loss was 145±75ml (range 8-370 ml).Mild abnormal liver function which returned to normal in 3 to 5 days was detected postoperatively.The mean hospital stay was 7.8±2.6 d (range 3～12 days).There was no patient who developed postoperative bleeding,bile leakage or abdominal abscess.For cancer patients,there was no local recurrence on follow-up.Conclusion Laparoscopic Habib 4X,a device when used in laparoscopic liver resection,resulted in minimal blood loss and quick recovery.It had only mild effect on liver function and it had low morbidity.In addition,it might reduce the risk of local recurrence in malignant tumours.

Objective: To investigate the effect of hepatitis B virus (HBV) X gene integration on expression of zinc finger protein ZBTB20 in chronic hepatitis B (CHB) patients complicated with hepatocellular carcinoma (HCC). Methods: Eighteen CHB patients complicated with HCC who underwent surgical treatment in Taizhou Enze Medical Center Enze Hospital and Taizhou Central Hospital from July 2015 to June 2017 were enrolled. Samples of carcinoma tissue, para-carcinoma tissue and corresponding normal liver tissue were collected from each case. DNA was extracted from three kinds of tissue samples. HBV-Alu-polymerase chain reaction (PCR) was used to amplify the integrated HBVX fragments and their bilateral flanking sequences in human genomic DNA. The integrated HBV fragments were determined by PCR products sequencing. Protein was extracted from three kinds of tissue samples.The level of expression of ZBTB20 was detected by protein imprinting. Statistical analysis was performed using t test, analysis of variance, and χ² test. Results: Among the 18 CHB patients complicated with HCC, integration of HBVX gene was found in 13 carcinoma tissue samples, 16 para-carcinoma tissue samples and 9 corresponding normal liver tissue samples. The difference was statistically significant (χ²=6.353, P=0.037). Of the 18 patients, the protein expressions of ZBTB20 in carcinoma tissue, para-carcinoma tissue and corresponding normal tissue were (50.14±11.25)%, (40.71±7.17)% and (39.06±5.17)%, respectively, which was statistically different (F=9.420, P<0.01). HBVX gene integration was detected at ZBTB20 locus in five patients. The expression levels of ZBTB20 in patients with HBVX gene integration at this locus in carcinoma tissue, para-carcinoma tissue and corresponding, normal liver tissue were all significantly lower than those in patients without HBVX gene integration (carcinoma tissue (37.37±10.30)% vs (55.06±7.06)%, para-carcinoma tissue (32.06±2.61)% vs (44.04±5.24)%, corresponding normal tissue (34.66±5.59)% vs (40.76±4.04)%, t=4.205, 4.821 and 2.589, respectively, all P<0.05). Conclusions Incidence of HBVX integration in para-carcinoma tissue is higher than that in carcinoma tissue in CHB patients complicated with HCC.The expression level of ZBTB20 in carcinoma tissue is higher than that in para-carcinoma tissue. Integration of HBVX gene at ZBTB20 locus may decreases the expression of ZBTB20.