Objective To explore the feasibility and the selection of laparoscopic cholecystectomy(LC) for the treatment of acute gallstone pancreatitis(AGP) without jaundice.Methods Laparoscopic cholecystectomy had been performed in 95 patients with AGP accompanying no jaundice from July 1996 to July 2004 in this hospital.All of the patients had a history of conservative treatment.Selective LC was performed in 79 patients after their symptoms were relieved,while emergent LC was required in 16 patients because of failure of response to conservative treatment.Results All the operations were successfully completed.The operation time was 40~328 min(mean,103 min),and the intraoperative blood loss was 0~210 ml(mean,35 ml). Intraoperative cholangiography was carried out in all the 95 patients and succeeded in 92.Thirteen patients were found having lower common bile duct stones and then were cured with endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic spincterotomy(EST).No conversion to open operation was required.No postoperative biliary hemorrhage or leakage occurred.No fatal case was seen.Pathological examinations following operation revealed multiple small or sand-like stones in the gallbladder.Follow-up in 39 patients for 1 months ~ 5 years found no recurrence of pancreatitis or cholelithiasis.Conclusions Laparoscopic cholecystectomy should be performed as early as possible in the treatment of AGP without jaundice.Use of intraoperative cholangiography and postoperative EST should be emphasized in proper cases.

Aim To investigate the relationship between spinal cord noradrenergic neurons ? 1 adrenoceptors and the spinal analgesia of ketamine. Methods Kunming mice were used. Analgesia tests were investigated with warm water tail flick test. The effects of intrathecal injection (ith) of ketamine (50,100,200 ?g)on tail flick latency of animals were observed. And the effect of pretreatment with intrathecal 6 hydrodoapa(6 OHDA, 6?g ) and ? 1 adrenoceptor antagonist prazosin (5, 15 ?g) or terazosin (5, 15 ?g) , respectively on the spinal analgesia of ketamine (100 ?g,ith) was studied. Results Dose dependent analgesia was observed following ith ketamine (100,200 ?g, P

Objective To evaluate the safety and efficacy of mesohepatectomy for large and centrally located hepatocellular carcinoma.Methods A retrospective study was carried out on 136 pa tients who underwent mesohepatectomy for large and centrally located hepatocellular carcinoma at Xiangya Hospital,Central South University,from 2001 to 2007.Intraoperative/post operative data and long-term survivals were analyzed.Results Vascular occlusion time,operative time,intraoperative blood loss,intraoperative blood transfusion and hospital stay were (13.3 ± 9.1) min,(173.1 ±41.1)min,(548.7±320.5)ml,(511.4±231.7)ml and (18.6±8.8)d,respectively.Four patients developed major complications.There was no in-hospital death.The 1-,3-,and 5-year overall survival rates and disease-free survival rates were 71％,46％,29％ and 65％,40％,24％,respectively.Conclusions Mesohepatectomy for large and centrally located hepatocellular carcinoma preserved the maximum amount of functional liver parenchyma.It is safe and reliable and may be used as the treatment of choice.

Objective To investigate the impact of preoperative portal vein thrombosis (PPVT) on living donor liver transplantation (LDLT).Methods In this study,99 patients who underwent LDLT by the same surgical team of Tianjin First Centre Hospital from 2007 to 2011 were retrospectively analyzed.According to whether there was a PPVT,all the patients were divided into PPVT group (26 cases) and non-PPVT group (73 cases).The preoperative risk factors and the impact of PPVT on LDLT and outcomes were analyzed.Results Among 26 PPVT patients there were 23 cases in grade Ⅰ and 3 cases in grade Ⅱ.Splenectomy was found to be an independent risk factor for PPVT (x2 =10.211,P =0.001).PPVT prolonged the anhepatic phase (Z =-2.430,P =0.015),but the incidence of surical complications and mortality were no statistical differences between the PVT group and the non-PVT groups.Meanwhile,there was no statistical difference of 1-and 3-year survival rate between the two groups(x2 =0.505,P =0.477).Conclusions With proper intraoperative treatment and postoperative prevention,PPVT does not affect the outcomes of patients suffering from grade Ⅰ or Ⅱ PPVT.However,PPVT added to difficulties of operation,so the detailed preoperative evaluation and careful intraoperative operation is necessary.

Objective To investigate the relationships between the severity of non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS).Methods One hundred and twenty-seven cases of NAFLD patients were selected from March 2011 to August 2012 in the First Hospital Affiliated to Fujian Medical University,of them,61 patients with mild NAFLD,45 patients with moderate and 21 patients with severe.And 21 cases without NAFLD were selected as control group during the same hospitalized period.All objects received the measures of height,body weight,waist circumference (WC),blood pressure; Liver ultrasonic examination,the examination of fasting plasma glucose,blood fat and hepatic function detections were also handed by special people.Results The proportion of overweight in the control group and the three NAFLD subgroups were 57.1％ (12/21),88.5％ (54/61),95.6％ (43/45) and 100％ (21/21) respectively (x2 =18.376,P ＜0.001) ;The proportion of the obesity in control group and the three NAFLD subgroups were 19.0％ (4/21),44.3％ (27/61),64.4％ (29/45) and 71.4％ (15/21) respectively(x2 =16.440,P =0.001).The proportion of the metabolic syndrome of the control group and the three NAFLD subgroups were 14.3％ (3/21),45.9％(28/61),71.1％ (32/45) and 71.4％ (15/21) respectively (x2 =22.637,P ＜ 0.05).All three subgroups of NAFLD were higher than the control group (x2 =6.641,P ＜ 0.05 ; x2 =18.562,P ＜ 0.05 ; x2 =14.000,P ＜0.05,respectively).The severity of NAFLD was positively correlated with BMI,WC,TG,FBG,SBP,and DBP (r =0.467,0.503,0.386,0.369,0.279,0.295,P ＜ 0.01),and negatively correlated with HDL-C (r =-0.209,P ＜0.05).Conclusion The severity of NAFLD had significant correlations with metabolic syndrome's components.

Objective To observe the biomechanical effect of sacroiliac screw fixation with dif-ferent needling points in treatment of extorsion pelvic instabihty so as to provide experimental basis for clinical application. Methods Ten fresh adult pelvis specimens were fixated by sacroiliac screw with needling points B (2.5 cm anterior to posteroinferior iliac spine and 40. cm posterior to greater sciatic notch), A (0.1 cm anterior to the same horizontal plane of point B) and C ( 1.0 cm posterior to the same horinzontal plane of point B). The shifting of the pubic symphysis diastasis and the sacroiliac joint crack under the same extorsion force was measured in integrity ligament group, point A group, point B group and point C group to compare the stability of different needling points. Results In confronting extor-sion force, integrity ligament group and point C group were obviously inferior to point A group and point B group (P<0.05 ) but there was no statistical difference between point B group and point A group (P > 0.05). As for the stability of the sacroiliac joint, there was statistical difference among all groups ( P < 0.05 ), while there was no statistical difference between integrity ligament group and point B group ( P > 0.05). Conclusion Point B is the most stable, safe and effective needling point.

OBJECTIVE:To optimize the matrix formula of Lanlian ertong qingre cataplasm. METHODS:Taking adhesion force,peel strength and sensory description as index,the ratio of matrix framework material(sodium polyacrylate-gan hydroxyl alu-minum-tartaric acid-glycerin) was optimized with orthogonal test. The single factor test was adopted to select adhesive and filler;the amount of penetrating agent azone was screened using the in vitro penetration amount of phillyrin. RESULTS:The best matrix ratio of Lanlian ertong qingre cataplasm was sodium polyacrylate-gan hydroxyl aluminum-tartaric acid-glycerin(4.0:0.8:0.4:15);PVP K-90 was used as adhesive,and bolus alba as filler;penetration enhancers azone accounted for 2.0%. Validation test showed, prepared cataplasm had good appearance,could stick on the 5th or the 6th ball;it's peel strength was 7.5 N;all RSDs of score were lower than 4%(n=3). CONCLUSIONS:The optimized matrix formula of Lanlian ertong qingre cataplasm is simple,stable and good in molding.

Objective:To follow up the hepatitis B recurrence post liver transplantation using the combination of lamivu dine and high-dose intravenous/intramuscular hepatitis B immunoglobulin.Methods:Fifty-two consecutive patients who underwent liver transplantation were included in this analysis.All patients were administered lamivudine combined with hepatitis B immunoglobulin intravenous(V group)or intramuscular(M group)injection prophylaxis.Dosages of hepatitis B immunoglobulin were 4 000 U during anhepatic phase,2 000 U/d during the first six days after operation,2 000 U/week at 2-4 weeks after operation and 2 000 U/month at 2-6 months after operation.The dosages of hepatitis B immunoglobulin were decided by blood concentrations at 6 months after transplantation in both groups(HBsAb titer≥200 U/L during the 6-12 months after operation;100-200 U/L one year after operation).The negative-conversion rates of serum HBsAg,serum HBsAb levels and hepatitis B recurrence rate at the 6th month,1 year after transplantation and at the end of this study were investigated.Results:The daily average negative-conversion rate of serum HBsAg was significantly faster in V group than that of M group within the first 4 postoperative days(P ＜ 0.05).The 100% of serum HBsAg negative-conversion rate was obtained in two groups after one week of operation.No recurrence was found in two groups.And the ease of death was independent on HBV recurrent during the follow-up.Conclusion:Lamivudine combined with hepatitis B immunoglobulin intravenous/intramuscular injection prophylaxis was effective protocol for the hepatitis B recurrence after the liver transplantation.

ObjectiveTo investigate prophylaxis and treatment of bile leakage from hepatic duct anomalies after liver transplantation.MethodsWe retrospectively analyzed 3 patients with bile leakage from hepatic duct anomalies after liver transplantation in our institute.The graft procurements were combined liver-kidney harvesting.The reconstruction of the bile ducts was end-to-end anastomoses.ResultsIn the first patient with a right accessory duct joining the cystic duct,leakage of bile came from the stump of the cystic duct after anastomosis of the bile ducts.The original anastomosis was taken down,and reanastomosis was performed after plasty of the bile ducts.The patient recovered uneventfully.In the second patient with a Luschka bile duct,the biliary fistula closed spontaneously after percutaneous drainage.However,re-transplantation was performed for severe infection 7 month after the primary transplantation.In the third patient with an accessory hepatic duct from the right posterior sector joining the common bile duct,the bile duct stump which we missed leaked bile.Re-transplantation was performed because of severe complications.Conclusion Understanding the anatomy of intra- and extra-hepatic bile ducts and their common anomalies identifying the structures in the porta hepatis during preparation of the liver grafts,and looking for possible accessory hepatic ducts and aberrant bile ducts are important steps to prevent bile leakage in liver transplantation.

ObjectiveTo study the impact of allocation of organ arteries and their reconstruction for donor livers on arterial complications after liver transplantation from organ clusters obtained by combined liver,kidney,pancreas and duodenum harvesting.The aim is to guide future use of donor organs more safely and rationally with a decrease in postoperative complications.MethodWe studied 11 patients.ResultsThere was no hepatic artery anomaly.A Carrol artery patch was obtained at the bifurcation of the proper hepatic artery and the gastroduodenal artery in these donor livers.In one patient,an arterial graft was used because of inadequate arterial length,and arterial thrombosis developed which required re-transplantation.The hepatic arterial reconstruction was successful for the remaining 10 patients.One patient died of pulmonary infection 5 months post transplantation.ConclusionWhen combined liver,kidney,pancreas and duodenum harvesting was used,enough arterial length of the recipient must be preserved.There should be adequate and prompt communication between the teams carrying out the donor operation and the recipient operation.A Carrol arterial patch of the proper hepatic artery and the gastroduodenal artery for the donor liver,and the use of microsurgical vascular anastomosis in the operation are the keys to prevent hepatic arterial complications after liver transplantation.Multi-organ harvesting can be used for obtaining donor livers in liver transplantation.