Objective:To analyze the effect of rapid division of left Glisson pedicle and Arantius tube plane in laparoscopic anatomical left hemihepatectomy (LALH).Methods:Clinical data of 25 patients (15 with intrahepatic bile duct calculus and 10 with liver tumor) undergoing LALH in the Department of Hepatobiliary and Pancreatic Surgery, Jiangyin Hospital Affiliated to Nantong University from June 2020 to November 2024 were retrospectively analyzed, including 14 males and 11 females, aged (66.6±11.9) years. Among the patients, 15 received LALH with rapid division of left Glisson pedicle and Arantius tube plane in " one-clamp" fashion, and the others received LALH after traditional dissection of left Glisson pedicle. Age, sex, body mass index, time of left Glisson pedicle dissection, whether the MHV exposure, the time of liver transection, whether MHV and its important branches or bile duct injury occurred, intraoperative blood loss, the incidence of postoperative biliary leakage, the time of abdominal drainage remove, the hospital stay, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, albumin 3 days after postoperative were compared between the groups.Results:The times of left Glisson pedicle dissection in the new-fasion and traditional group were (6.1±1.6) min and (13.8±3.0) min, and the time of liver transection was (24.9±3.5) min and (33.4±3.3) min, respectively ( t=-8.34, 6.08, P<0.001 for both). After division of left Glisson pedicle, the MHV was well exposed in 14 cases of new-fashion group and none of traditional group ( P<0.001). All the patients successfully completed the operation without conversion to laparotomy. Intraoperative blood loss, incidence of postoperative bile leakage, time of peritoneal drainage tube removal, postoperative hospital stay, AST, ALT, total bilirubin and albumin 3 days after surgery between the two groups were no significant differences (all P>0.05). Conclusion:LALH using the rapid division of left Glisson pedicle and Arantius tube plane in " one-clamp" fashion could be safe and feasible, the time of left Glisson pedicle and liver transection was short.

Objective:To analyze the effect of rapid division of left Glisson pedicle and Arantius tube plane in laparoscopic anatomical left hemihepatectomy (LALH).Methods:Clinical data of 25 patients (15 with intrahepatic bile duct calculus and 10 with liver tumor) undergoing LALH in the Department of Hepatobiliary and Pancreatic Surgery, Jiangyin Hospital Affiliated to Nantong University from June 2020 to November 2024 were retrospectively analyzed, including 14 males and 11 females, aged (66.6±11.9) years. Among the patients, 15 received LALH with rapid division of left Glisson pedicle and Arantius tube plane in " one-clamp" fashion, and the others received LALH after traditional dissection of left Glisson pedicle. Age, sex, body mass index, time of left Glisson pedicle dissection, whether the MHV exposure, the time of liver transection, whether MHV and its important branches or bile duct injury occurred, intraoperative blood loss, the incidence of postoperative biliary leakage, the time of abdominal drainage remove, the hospital stay, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, albumin 3 days after postoperative were compared between the groups.Results:The times of left Glisson pedicle dissection in the new-fasion and traditional group were (6.1±1.6) min and (13.8±3.0) min, and the time of liver transection was (24.9±3.5) min and (33.4±3.3) min, respectively ( t=-8.34, 6.08, P<0.001 for both). After division of left Glisson pedicle, the MHV was well exposed in 14 cases of new-fashion group and none of traditional group ( P<0.001). All the patients successfully completed the operation without conversion to laparotomy. Intraoperative blood loss, incidence of postoperative bile leakage, time of peritoneal drainage tube removal, postoperative hospital stay, AST, ALT, total bilirubin and albumin 3 days after surgery between the two groups were no significant differences (all P>0.05). Conclusion:LALH using the rapid division of left Glisson pedicle and Arantius tube plane in " one-clamp" fashion could be safe and feasible, the time of left Glisson pedicle and liver transection was short.

Objective:To analyze the clinical characteristics of acute pancreatitis (AP) in Wuxi city based on multi center data from four tertiary hospitals.Methods:A retrospective analysis was conducted on the clinical data of 1 254 AP patients treated at Affiliated Hospital of Jiangnan University, Yixing People's Hospital, Jiangyin Hospital of Traditional Chinese Medicine, and Jiangyin People's Hospital from January 1, 2006 to December 30, 2009 and January 1, 2020 to December 30, 2023, including 743 males and 511 females, aged 53 (40, 67) years. The patients were divided into two groups based on the time period of inclusion: the 2006-2009 group ( n=456) and the 2020-2023 group ( n=798). Clinical data such as general clinical characteristics, etiology, laboratory parameters, imaging parameters, complications and prognosis were collected. Results:Compared with the 2006-2009 group, the 2020-2023 group had an increased proportion of biliary AP [60.6%(484/798) vs. 46.5%(212/456)], hyperlipidemic AP [11.2%(89/798) vs. 4.2%(19/456)], comorbid diabetes mellitus [22.1%(176/798) vs. 7.2%(33/456)], and hypertension [32.1% (256/798) vs. 13.6%(62/456)], all of which were statistically significant (all P<0.05). Compared with the 2006-2009 group, the interval between symptom onset and admission to the hospital became longer in the 2020-2023 group [2.0(1.0, 4.0)d vs. 1.0(0.5, 3.0)d], the length of hospitalization was shorter [10(8, 13)d vs.13(8, 19)d], and the proportion of the number of people who got better was increased [85.6%(683/798) vs. 56.4%(257/456)] but the proportion of the number of people who were cured was decreased [12.2%(97/798) vs. 39.7%(181/456)], and the proportion of patients with postoperative complications of ketoacidosis increased [1.90%(15/798) vs. 0.22%(1/456)], with the differences statistically significant (all P<0.05). In both groups, the season with the highest number of AP cases was spring. Conclusion:The incidence of biliary AP in Wuxi City is on the rise, hypertension, meanwhile diabetes mellitus and hyperlipidemia emerge as the predominant etiologic factors, and spring is the high incidence season of AP.

Objective To evaluate the efficacy and safety of eravacycline in the treatment of complicated intra-abdominal infection(cIAI)in Chinese adult patients.Methods In this multicenter,randomized,double-blind phase Ⅲ study,cIAI patients were randomly assigned to receive either eravacycline(1.0 mg/kg,q12h)or ertapenem(1 g,q24h)by intravenous infusion for 5 to 14 days.The primary and secondary efficacy endpoints included the clinical efficacy and microbiological efficacy in different populations,including modified intention-to-treat(MITT)population,clinically evaluable(CE)population,and microbiologically evaluable(ME)population,at different time points after treatment.Clinical cure rates at specific visits were summarized and compared between treatment groups in different populations.The microbial eradication rate was calculated for the patients with baseline pathogens.The incidence of adverse events(AE)and drug-related treatment emergent adverse event(TEAE)was analyzed by treatment group.Results A total of 144 patients with cIAI who received at least one dose of the study drug were included in the MITT population.The clinical cure rate was 77.8％(56/72)in eravacycline-treated patients and 90.3％(65/72)in ertapenem-treated patients at 25-31 days after the first dose(TOC visit).When the patients who received insufficient treatment(＜72 hours)were excluded,the clinical cure rate was 83.6％(56/67)in eravacycline group and 90.3％(65/72)in ertapenem.For CE and ME patients,the clinical cure rate at TOC visit was 91.1％(51/56)and 83.3％(25/30)in eravacycline group,95.3％(61/64)and 90.9％(30/33)in ertapenem group.Eravacycline treatment achieved microbiological eradication rate of 91.3％(21/23)against Escherichia coli at TOC visit in micro-MITT population while ertapenem treatment resulted in a microbiological eradication rate of 96.2％(25/26).The microbiological efficacy of eravacycline and ertapenem against Klebsiella pneumoniae was 4/5 and 3/3,respectively.The incidence of TEAE was similar in eravacycline and ertapenem groups(75.0％vs.70.8％),most of which were mild or moderate.The AEs associated with eravacycline were mainly infusion site phlebitis(9.7％,7/72)and infusion site pain(8.3％,6/72).Conclusions Similar to ertapenem,eravacycline has good clinical and microbiological efficacy in treating cIAI.It is also safe and well-tolerated in the patients.

Objective:To analyze the clinical characteristics of acute pancreatitis (AP) in Wuxi city based on multi center data from four tertiary hospitals.Methods:A retrospective analysis was conducted on the clinical data of 1 254 AP patients treated at Affiliated Hospital of Jiangnan University, Yixing People's Hospital, Jiangyin Hospital of Traditional Chinese Medicine, and Jiangyin People's Hospital from January 1, 2006 to December 30, 2009 and January 1, 2020 to December 30, 2023, including 743 males and 511 females, aged 53 (40, 67) years. The patients were divided into two groups based on the time period of inclusion: the 2006-2009 group ( n=456) and the 2020-2023 group ( n=798). Clinical data such as general clinical characteristics, etiology, laboratory parameters, imaging parameters, complications and prognosis were collected. Results:Compared with the 2006-2009 group, the 2020-2023 group had an increased proportion of biliary AP [60.6%(484/798) vs. 46.5%(212/456)], hyperlipidemic AP [11.2%(89/798) vs. 4.2%(19/456)], comorbid diabetes mellitus [22.1%(176/798) vs. 7.2%(33/456)], and hypertension [32.1% (256/798) vs. 13.6%(62/456)], all of which were statistically significant (all P<0.05). Compared with the 2006-2009 group, the interval between symptom onset and admission to the hospital became longer in the 2020-2023 group [2.0(1.0, 4.0)d vs. 1.0(0.5, 3.0)d], the length of hospitalization was shorter [10(8, 13)d vs.13(8, 19)d], and the proportion of the number of people who got better was increased [85.6%(683/798) vs. 56.4%(257/456)] but the proportion of the number of people who were cured was decreased [12.2%(97/798) vs. 39.7%(181/456)], and the proportion of patients with postoperative complications of ketoacidosis increased [1.90%(15/798) vs. 0.22%(1/456)], with the differences statistically significant (all P<0.05). In both groups, the season with the highest number of AP cases was spring. Conclusion:The incidence of biliary AP in Wuxi City is on the rise, hypertension, meanwhile diabetes mellitus and hyperlipidemia emerge as the predominant etiologic factors, and spring is the high incidence season of AP.

Objective To evaluate the feasibility and clinical value of laparoscopic partial splenectomy to treat benign splenic diseases.Methods The clinical data of 13 patients who underwent laparoscopic partial splenectomy carried out by a single operating surgeon from June 2010 to January 2016 in our hospital were analyzed retrospectively.The enrolled patients included 6 with a splenic epidermoid cyst,4 with a splenic pseudocyst and 3 with splenic hemangioma.The lesion diameters ranged from 5.1 to 12.4 cm,with an average of (7.2 ± 2.3) cm.Results The operations were all successful.There was no conversion to laparotomy and there was no perioperative death.The operations included 4 upper pole splenic resection,5 lower pole resection,2 middle and upper pole resection and 2 middle and lower pole resection.The operative time ranged from 95 to 155 min,with an average of (119 ± 17) min.The volume of intra-operative blood loss ranged from 100 to 350 ml,with an average of (187 ± 78) ml.There was no postoperative bleeding,pancreatic fistula,digestive fistula,intra-abdominal infection,splenic vein thrombosis and other complications after the operation.The average postoperative hospitalization stay was (5 ± 1) d.Conclusions In carefully selected patients,laparoscopic partial splenectomy carried out by experienced surgeons to treat benign splenic diseases is safe and feasible.

Objective To evaluate the feasibihty and clinical value of laparoscopic hepatectomy for liver tumors.Methods Laparoscopic hepatectomy from May 2010 to Oct 2013 was summarized including 27 cases of primary hepatocellular carcinoma,5 cases of liver hemangioma,3 cases of hepatic nodular hyperplasia,2 cases of liver metastases of colorectal cancer,2 cases of liver cystadenoma and 1 case of liver cyst.The diameter averaged at (4 ± 4) cm.Results All patients were successfully operated,no perioperative death.Irregular hepatectomy was performed in 21cases,hepatic left lateral lobectomy in 12 cases,segment VI resection in 4 cases and left hepatectomy in 3 cases.Operative time averaged (166 ± 109) min.Average blood loss was (480 ± 233) ml.Tumor margin was positive in two HCC cases.Bile leakage and ascites developed in one each patient,who were then cured by conservative treatment.Conclusions Laparoscopic hepatectomy for liver tumors is safe and feasible.

Objective To observe the efficacy of extensive decompression through transforaminal lumbar interbody fusion (TLIF) pathway combined with pedicle screw fixation on treating degenerative lumbar stenosis in the dderly.Methods Seventy-five elderly patients (28 males and 47 females) with degenerative lumbar stenosis were treated with extensive decompression through transforaminal pathway at our hospital from Jan.2007 to Aug.2010.The operation is through the TLIF pathway to resect part of the articular facet,and expose unilaterally the intervertebral vertebral foramen.Decompression of the vertebral canal was conducted by removing the disc.In the end,we performed posterolateral fixation with pedicle screw and placement of bone graft in posterolateral part of the lumbar or did the interbody fusion.JOA scores were obtained before and 1 day after operation and in 3 month follow-up consultation.The intervertebral height and bone fusion were observed by X ray.Results The follow-up period of the 75 patients was 6-36 months with an average of 12 months.There was significant difference (t =20.79,P ＜ 0.05 ;t =25.89,P ＜ 20.05) in JOA score between 3 month follow-up (21.08 ± 3.60) and preoperation (10.91 ± 2.23),between 1 d follow-up (22.72 ± 3.26) and preoperation (10.91 ±2.23),respectively.The rate of improvement was (88.6 ± 10.8)％,with 98％ of excellent or good in 3-month follow-up.Lumbar plane films showed neither instability or internal fixation loosening,breakage or distortion in follow-up consultation.There were 2 cases in whom Cage dislocation occurred without any neurological symptoms.Conclusion Extensive decompression through TLIF pathway combined with pedicle screw fixation is an efficacious method of treating degenerative lumbar stenosis in elderly patients.This method can retain the structure of lumbar posterior complex,reduce the risk of low back pain.It is a safe choice for treatment of degenerative lumbar stenosis in the elderly.

Objective To compare the efficacy and safety of three different methods of laparoscopic common bile duct exploration (LCBDE).Methods The clinical data of patients with LCBDE treated in our hospital by the same surgeon from January 2010 to December 2012 were retrospectively analyzed.These patients were divided into three groups according to the 3 surgical methods:Group A:15 patients were treated with laparoscopic transcystic common bile duct exploration (LTCBDE).Group B:85 patients were treated with laparoscopic common bile duct exploration followed by primary duct closure (LCBDEPDC).Group C:20 patients were treated with laparoscopic common bile duct exploration and T tube drainage (LCBDE-TD).The study measured the TBIL,inner diameter of common bile duct,costs,length of operation,postoperative hospital stay,peritoneal drainage time,and operation-related complications.Results The operations were successfully carried out in the 3 groups of patients.When compared with group C,group A and group B had significantly shorter operative time,shorter postoperative hospital stay,shorter peritoneal drainage time,lower hospital costs,and earlier return to work (P＜0.05).The only significant difference between group A and group B was the peritoneal drainage time.There was no significant difference in the incidences of postoperative complications between the 3 groups (P＞0.05).Conclusions The three different methods of LCBDE had their own indications.LTCBDE was better than primary suture,and LCBDEPDC was better than T-tube drainage after laparoscopic common bile duct exploration.