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 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 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.

From 1978 to 1985, 14 patients with accidental injury of extrahepatic bile ducts at cholecystecto-my were reported. The incidence was 0.12%. The injury caused suffering, severe after effects for the patients.In the analysis of the causes, half of the cases occurred due to over-confidence and negligence of operating surgeons. Other causes were as unsatisfactory anesthesia, improper operative incision, blind clamping for control of hemorrhage in the area of the bile ducts, difficult dissection of the Calot's triangle because of anatomical anomaly, fibrosis, inflammation or adhesion. The methods of the prevention were discussed.According to various types of injury, different therapy should be taken. Early intervention, Roux-Y jejunal reconstruction, judicious use of Y tube and prolonged dilatation of hilar strictures will improve the outlook. No mortality and malfunction occurred.

Objective In order to discuss the surgical treatment of iatrogenic bile duct injury.Methods 156 cases of iatrogenic bile duct injury during recent 20 years were reviewed and analyzed in this paper.Results The total re-operation rate was 85.71% (126/147), the re-operation rate of LC, OC, OC plus exploration of common bile duct were 95.24%, 87.27%, 62.50% respectively (P

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 investigate the protective influence and mechanism of Yishen Huayu Formula on the expression of connective tissue growth factor (CTGF)in the rat with renal interstitial fibrosis. Methods: 150 rats were randomly divided into sham-opration group, model group, Lotensin treatment group, Yishen Huayu high low dose treatment groups. The rat models with renal interstitial fibrosis were induced by unilateral ureteral obstruction. The expressions of CTGF in the kidneys were observed on 3rd, 7th, 14th, 21st, 28th day. The alterations of renal the expressions of CTGF in the kidneys were observed with the ?-actin as intrinsic control. Results: Compared with the control group,the expression of CTGF increased signifi cantly in model group(P

Objective To analyze the risk factors for thrombosis by investigating the incidence of central venous catheter‐related thrombosis in elderly patients .Methods Four hundred and five elderly patients who underwent central venous catheterization were divided into femoral vein group(n=46) ,internal jugular vein group (n=40) and subclavian vein group (n=319) according to their catheter position ,or into thrombosis group (n=31) and non‐thrombosis group (n=374) according to the incidence of central venous catheter‐related thrombosis .T heir gender ,age ,basic diseases ,catheter position ,retention time of catheter ,and complications of central venous catheter‐related thrombosis were retrospectively analyzed .Results The incidence of central venous cathe‐ter‐related thrombosis was significantly lower in subclavian vein group than in internal jugular vein group and femoral vein group (5 .0% vs 15 .0% ,5 .0% vs 19 .6% ,P<0 .05 ,P<0 .01) .The percentage of past venous thrombosis history was significantly higher in thrombosis group than in non‐thrombosis group (19 .4% vs 6 .4% ,P<0 .05) .Conclusions Subclavian vein catheterization can significantly reduce the incidence of central venous catheter‐related thrombosis and past ve‐nous thrombosis history can predict the incidence of central venous catheter‐related thrombosis in elderly patients .

OBJECTIVE: To establish the quality standard of Compound buwu syrup. METHODS: TLC was employed to identify Psoralea corylifolia,Angelica sinensis,Ligusticum chuanxiong and Salvia miltiorrhiza.HPLC was applied for the determination of the contents of psoralen and isopsoralen.RUSULTS:Psoralea corylifolia,Angelica sinensis,Ligusticum chuanxiong and Salvia miltiorrhiza were all well-separated with clear TLC spots.The linear ranges of psoralen and isopsoralen were 0.030 4～0.304 ?g(r=0.999 1) and 0.036 2～0.362 ?g(r=0.999 5),respectively and the average recoveries were 100.1%(RSD=2.9%) and 102.4%(RSD=2.7%),respectively.CONCLUSION:The established standard is applicable for the quality control of Compound buwu syrup.

Objective To explore the application values and the effect of myocardial preservation of right stellate ganglion block in off-pump coronary artery bypass grafting (OPCABG). Methods Sixty-two patients with ASA Ⅱ or Ⅲ,aged 50-75 years,scheduled for OPCABG were randomly divided into stellate ganglion block group (group SGB)and control group (group C)with 31 cases each.The patients in group SGB received right-lateral SGB before anesthesia induction.The medications and methods of anesthesia induction in the two groups were identical.Hemodynamics be-fore start of anethesia (T0 ),after induction (T1 ),after intubation tube (T2 ),after sternotomy (T3 ),at the beginning of bypass surgery for interrupted coronary artery (T4 ),at the end of coronary bypass grafting (T5 )were observed.Meanwhile,changes of serum cardiac troponin I (cTnI)and cre-atine phosphokinase MB (CK-MB)at T0 ,6 h (T6 ),12 h (T7 ),24 h (T8 )after operation were also observed.The operative time,the amount of drugs used and postoperative recovery were recored. Results MAP,HR of group SGB increased at T2-T5 compared with T0 ,and MAP,HR of group C significantly increased at T2-T5 comparing with T0 (P <0.05).Compared with those in group SGB, MAP,HR significantly increased at T2-T5 in group C (P <0.05 ).The Concentrations of cTnI and CK-MB of group C increased more obviously than those in group SGB at T6-T8 (P <0.05).Compared with group C,patients in group SGB needed less medication,less hospitalization time in ICU and had faster postoperative recovery.Conclusion SGB for patients during OPCABG stabilizes hemodynamy stability,further reduces myocardial injury,thus protecting myocardium.