Objective:To observe the ability of abdominal ultrasonography (hereinafter referred to as water-injection ultrasonography) after injection of 0.9% sodium chloride solution via endoscopic nasobiliary drainage tube in the detection of residual stones in bile duct after stone extraction by endoscopic retrograde cholangiopancreatography (ERCP).Methods:From January 2015 to June 2023, at the Second Department of General Surgery, Shengjing Hospital, China Medical University, 342 patients, who were diagnosed with choledochal stones and received stone extraction by ERCP and at the same time placed endoscopic nasobiliary drainage tube, were enrolled.After stone extraction by ERCP, all the patients underwent cholangiography, conventional abdominal ultrasound, and water-injection ultrasonography. The patients with stones removed by the secondary ERCP were positive. The ability to detect residual stones in bile duct by cholangiography, conventional abdominal ultrasound and water-injection ultrasonography were compared. Chi-square test was performed for statistical analysis.Results:The results of cholangiography showed that 35 patients were suspected with residual stones in bile duct, among them 28 were confirmed to be true-positive, the sensitivity was 50.9% and specificity was 97.6%; the results of conventional abdominal ultrasound showed that 15 patients were suspected with residual stones in bile duct, among them 13 were confirmed to be true positive with a sensitivity of 23.6% and a specificity of 99.3%; and the results of water-injection ultrasonography showed that 56 patients were suspected with residual stones in bile duct, among them 50 were confirmed as true positive, with a sensitivity of 90.9% and a specificity of 97.9%. The number of true-positive patients detected by water-injection ultrasonography was greater than those determined by cholangiography and conventional abdominal ultrasonography, and the sensitivity was higher than that of cholangiography and conventional abdominal ultrasonography, and the differences were statistically significant ( χ2=21.33, 50.85, 38.77 and 92.53, all P<0.001). There was no statistically significant difference in the specificity among water-injection ultrasonography, cholangiography and conventional abdominal ultrasonography (both P>0.05). Conclusion:Water-injection ultrasonography can effectively improve the detection rate of residual stones in bile duct after ERCP.

The etiology of congenital biliary dilatation(CBD)is still unclear.Currently,abnormal pancreatico-bile duct confluence is the mainstream theory.In terms of classification,Todani classification is the most widely used.On the other hand,Dong′s classification which proposed by Dong Jiahong and his colleagues has guiding significance for the selection of surgical methods.CBD is difficult to detect and diagnose because of the poor specificity of clinical symptoms,and it is often necessary to make a preliminary diagnosis based on the medical history,and it is also quite dependent on the assistance of imaging.Serological examination also plays a key role in the diagnosis of CBD because of its convenience and high acceptance.This article reviewed the etiology,classification and diagnosis of CBD.

Intrahepatic bile duct stone is a type of biliary system disease characterized by complex conditions and frequent recurrence,and traditional surgical treatment methods tend to cause various complications and have high requirements for surgical standards.Percutaneous transhepatic cholangioscopy(PTCS)is highly efficient in removing stones and is widely used in clinical practice,but there are also other medical techniques for the treatment of cholelithiasis.This article mainly discusses the constant development of PTCS and compares the efficacy of PTCS and other techniques in the treatment of cholelithiasis.

Objective:To evaluate the safety and reliability of percutaneous management of benign extrahepatic biliary strictures with biliary duct dilatation and large-bore catheter placement .Methods:The clinical data of 17 patients at Shengjing Hospital from Mar 2017 to Mar 2020 was retrospectively analyzed.Results:There were 7 cases of bilioenteric anastomotic strictures and 10 cases of iatrogenic biliary tract injury strictures (6 cases of Bismuth type Ⅰ and 4 cases of Bismuth type Ⅱ). Fourteen of the 17 patients completed the treatment with a success rate of 82.3%.The catheter was gradually upsized to 22-24Fr.Catheters were left in place for 6-9 months (median time 7.6 months). Patients were followed up for 6-28 months (median follow-up time was 19 months), no recurrent stricture occurred.Conculsion:Percutaneous management of benign extrahepatic biliary strictures with bile duct dilatation and placement of large-bore catheter is a safe and effective minimally invasive treatment method.

Objective:To analyze the optimal preoperative timing of indocyanine green administration to do the fluorescence imaging during laparoscopic cholecystectomy.Methods:A total of 102 patients with laparoscopic cholecystectomy from January 2019 to November 2019 were retrospectively analyzed in this study, including 42 male patients and 60 female patients with an average age of 49(15-87) years old. The preoperative timing of indocyanine green (2.5 mg/ml, 1 ml) administration was set at 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12 h before surgery, 12, 7, 8, 6, 6, 7, 8, 10, 8, 8, 8, 7, 7 patients, respectively. The intraoperative fluorescence imaging and signal contrast were compared.Results:Comparing with 0.5h group, the liver fluorescence intensities in 5, 6, 7, 8, 9, 10, 11 and12 h groups were significantly decreased (all P<0.05). There were no differences in the fluorescence intensities of the gallbladder, gallbladder duct, common bile duct and common liver duct between those groups with different injection timepoints (all P>0.05), and signal contrast was significantly lower in 0.5 h group than patients in 6, 7, 8, 9, 10, 11 and 12 h groups (all P<0.05). When preoperative timing of indocyanine green administration was 7 h, the fluorescence signal contrast reached the highest values of 0.29. Conclusions:The optimal preoperative timing of indocyanine green intravenous administration for laparoscopic cholecystectomy under fluorescence navigation was 7 h at dose 2.5 mg.

Objective The aim of this study is to analyze the clinical characteristics,diagnosis,treatment and prognosis factors of primary retroperitoneal liposarcoma.Methods We retrospectively analyzed 44 patients diagnosed with primary retroperitoneal liposarcoma that confirmed by pathology from Jan 2008 to Jun 2018 at the Department of General Surgery,Shengjing Hospital,China Medical University.Results The 44 patients consist of 19 males and 25 females.the clinical manifestations were abdominal mass,abdominal distension and abdominal pain.Asymptomatic patients were mainly found through physical examination.The main preoperative examination method was CT,and its accuracy rate was 75％.The most common pathological type was well-differentiated liposarcoma.The recurrence rate is 82％,and 24 (55％) patients died from tumor recurrence,2 patients died of other unrelated diseases.Conclusions Primary retroperitoneal liposarcoma is difficult to be diagnosed at early stage.CT is the main examination method.Complete surgical resection is the main treatment for primary or recurrent patients.This disease is prone to relapse and the prognosis is poor.

Objective To study the relationship between juxtapapillary duodenal diverticulum (JPDD) and pancreaticobiliary diseases, and the effect of JPDD on the diagnosis and treatment of ERCP. Methods A retrospective analysis was performed on data of 1230 patients who had received ERCP in general surgery departments of Shengjing Hospital of China Medical University from January 2012 to January 2017. The patients were divided into JPDD group ( n=360) and non-JPDD group ( n=870) according to whether JPDD was found. Patients with JPDD were divided into intradiverticular papilla group ( n=41) and non-intradiverticular papilla group ( n=319) according to whether the papilla located in diverticulum. The incidence of pancreaticobiliary diseases, success rate of cannulation, success rate of stones removal, and incidence of postoperative complications among each group were compared by using chi-square test or Fisher's exact probability. P < 0. 05 was statistically significant. Results The incidence of choledocholithiasis, primary choledocholithiasis and recurrent choledocholithiasis were 87. 78％ (316/360), 31. 11％ (112/360), and 6. 67％ (24/360), respectively, in the JPDD group, and 75. 52％ (657/870),19. 08％ (166/870), and 4. 02％ (35/870), respectively, in the non-JPDD group. There were significant differences between the two groups (χ2=23. 158, P<0. 001; χ2=21. 068, P<0. 001; χ2=3. 897, P=0. 048) . No significant differences were observed in the success rate of cannulation and complete stones removal during the first ERCP session, as well as the incidence of postoperative hemorrhage, pancreatitis and hyperamylasemia between the two groups ( all P>0. 05) . The incidence of recurrent choledocholithiasis in the intradiverticular papilla group and the non-intradiverticular papilla group were 14. 63％ ( 6/41) and 5. 64％ (18/319), respectively, with significant difference (χ2 =4. 721, P=0. 030). There were no significant differences between the two groups in the incidence of choledocholithiasis and primary choledocholithiasis, the success rate of cannulation and complete stones removal during the first ERCP session, as well as the incidence of postoperative hemorrhage, pancreatitis and hyperamylasemia ( all P>0. 05) . Conclusion JPDD is associated with the occurrence of primary choledocholithiasis. JPDD patients, especially the patients with intradiverticular papilla, are more likely to have recurrent choledocholithiasis after ERCP treatment.

Objective To investigate the application value of the adhesive suspension of left lateral lobe of liver in transumbilical single-port laparoscopic left upper abdominal surgery.Methods The retrospective crosssectional study was conducted.The clinical data of 112 patients who underwent single-port laparoscopic left upper abdominal surgery in the Shengjing Hospital of China Medical University between January 2010 and October 2016 were collected.Patients underwent single-port laparoscopic left upper abdominal surgery,and intraoperative surgical fields were exposed through adhesive suspension of left lateral lobe of liver.Observation indicators:(1)intraoperative situations:surgical completion,surgical procedures,time of liver adhesive suspension,total operation time and intraoperative liver adhesive suspension-related complications;(2) postoperative situations:pre-and post-operative alanine transaminase (ALT) and aspartate transaminase (AST) levels,hospital expenses and duration of hospital stay;(3) follow-up:number of patients with follow-up,follow-up time,complications during follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to June 2017.Measurement data with normal distribution were represented as (x)+s.Repeated measurement data were analyzed using the repeated measures ANOVA.Results (1) Intraoperative situations:112 patients underwent successfully single-port laparoscopic left upper abdominal surgery,without conversion to multi-port surgery or open surgery.Of 112 patients,30,23,13,11,11,10,3,3,3,3,1 and 1 underwent radical resection of gastric cancer,partial gastrectomy,esophageal Heller myotomy + Dor fundoplication,subtotal gastrectomy,resection of body and tail of pancreas,paraoesophageal hiatal hernia repair + fundoplication,total gastrectomy,splenectomy,splenectomy + devascularization,pancreatic tail resection,simple fundoplication and splenic artery aneurysm resection,respectively.Time of liver adhesive suspension and total operation time in 112 patients were respectively (1.4±0.4)minutes and (192.0±91.3) minutes.There was no hepatic laceration,hepatic subcapsular hematoma and other complications.(2) Postoperative situations:of 112 patients,preoperative ALT and AST levels of 6 patients were mildly elevated,postoperative ALT and AST levels in 2 of 6 patients returned to normal,that in 1 of 6 patients were elevated at day 1 postoperatively and returned to normal at day 3 postoperatively,and that in 2 of 6 patients remained mildly elevated at week 1 postoperatively;preoperative ALT and AST levels of 106 patients were normal,ALT and AST levels in 31 of 106 patients were elevated at day 1 postoperatively (that in 28 patients returned to normal within week 1 postoperatively,and that in 3 patients remained mildly elevated),and that in 75 of 106 patients returned to normal.ALT and AST levels of 112 patients were (16± 11) U/L,(18±7) U/L before operation and (31 ±21) U/L,(34±26) U/L at day 1 postoperatively and (19 ± 17) U/L,(19 ± 12) U/L at week 1 postoperatively,respectively,with statistically significant differences in ALT and AST levels before operation and at day 1 postoperatively (F=36.353,29.792,P＜ 0.05),and no statistically significant difference in ALT and AST levels before operation and at week 1 postoperatively (F=2.905,1.284,P＞0.05).Hospital expenses,surgery-related expenses and duration of hospital stay were (45 231±20 440)yuan,(23 511±9 609)yuan and (6.0±l.9)days,respectively.(3) Follow-up:112 patients were followed up for 1.0-3.0 months,with a median time of 1.6 months.During the follow-up,there were no obvious complications.Conclusion Adhesive suspension of left lateral lobe of liver is simple and safe,with satisfactory exposure effects,and it is suitable for the better operative field exposure in single-port laparoscopic left upper abdominal surgery.

Objective To study the application of the cold cutting technique in transumbilical sin gle-incision laparoscopic liver resection (TUSI-LLR),and to evaluate its feasibility and treatment results.Methods The clinical data of 35 patients with liver lesions treated by transumbilical single-incision laparoscopic liver resection from 2013 to 2017 were retrospectively analyzed in Shengjing Hospital of China Medical University.In all these patients,the liver parenchyma was transected with the cold cutting technique.The operation time,intraoperative blood loss,postoperative complications,time to remove abdominal drain,and total hospital stay in the patients were analyzed.Results 11 of the 35 patients were male.The average age was (49.9 ± 10.8) years.The average body weight was (63.2 ± 11.1) kg.The diagnoses were hemangiomas in 18 patients,hepatolithiasis in 5 patients,malignant hepatocellular tumors in 5 patients,focal nodular hyperplasia in 3 patients,and others in 4 patients.There were 22 left lateral sectionectomies,2 left hemihepatectomies,11 wedge resections (8 in the left and 3 in the right).The operations were all successfully performed,with no conversion to conventional laparoscopic hepatectomy or open surgery.The average operation time was (112.2 ±51.0) minutes,and the intraoperative blood loss was (105.4 ±70.1) ml.No patients required intraoperative blood transfusion.The average surgery cost was (36 336.7 ± 5 938.2) yuan.All patients recovered well,with no postoperative hemorrhage,bile leakage,or incisional wound infection.The average time periods for removal of the abdominal drain,and hospital stay were (4.5 ± 1.2) days and (5.2 ± 1.4) days,respectively.All the 35 patients were followed up (1 ～ 3 months),with no patients complaining of abdominal distension or abdominal pain.Conclusions The cold cutting technique in transumbilical single-incision laparoscopic liver resection was safe and feasible.Its benefits included the operative speed,the small amount of intraoperative blood loss and the rapid postoperative recovery of the patients.