Abstract:Objective:To study the methods and effect of the surgical treatment for intrahepaticolithiasis(IHL). Methods:In recent 12 years, in our hospital,230 cases of IHL were treated by different operations companied with biliary fibrescopy to remove the residnal stones of biliary tract. Results:(1)Hepatolobectomy combined with Ytype hepatocholangiojejunostomy was done in 103 cases,the success rate was 91.8%.(2)Ytype hepatocholangiojejunostomy was performed on 45 cases,the success rate was 81.2%.(3)Hepaticolithotomy combined with Ttube drainage was done in 72 cases,the success rate was 69.3%. Conclusions: For intrahepaticolithiasis,combination of hepatolobectomy with other operation and with biliary fibrescopy during or after the operation shoul be done, which can effectively improve the curative effect.

Abstract:Objective:To study the perioperative treatment of intraand extrahepatic cholelithinsis in patients with liver cirrhosis . Methods : The clinical data of intraand extrahepatic cholelithinsis in patients with liver cirrhosis in our hospital in resent 10 years was retrospectively analyzed. Results :According to the preoperative examation, improving hepatic function（turn child class C to A or B）, correcting the coagulation disturbance,decreasing portal vein pressure preoperatively,and proforming operation carefully to reduce bleeding,and giving support treatment and liver care treatment to improve the liver function further postoperatively etc were made.Fifteen cases remained stones, 5 cases appearred chronic liver failure,2 cases appearred kidney failure ,the other 69 cases recovered well. Conclusions :If optimizing perioperative treatment is given, favorable effect might be obtained in intraand extrahepatic cholelithinsis in patients with liver cirrhosis.

Abstract:Objective:To investigate the effect of endoscope assisted microincision cholelithotomy(EMC) in the treatment of gallstone. Methods: The clinical data of 86 patients with gallbladder stone treated by EMC were analyzed retrospectively.Of them, 63 cases were follwedup and studied. Results :All eightysix patients were successfully operated on and discharged, no operative complications occurred. Among 63 patient being followed up for 1~3 years,the recurrence rate of gallbladder stones was 3.2%(2/63). No recurrence was noted in 46 patients with single gallstone. In the other seventeen patients with multiple stones, gallstone recurrence was found in 2 patients, the recurrence rate was 11.8%(2/17). Conclusions :If selection of the operation idications are strict, endoscope assisted microincision cholelithotomy for treatment of gallstone is simple, safe, effective and less trauma, and can preserves the function of gallbladder, but it can not replace the cholecystectomy.

Abstract:Objective:To study the prevalence of cholelithiasis among spinal cord injured （SCI）male patients, and the correlation of cholelithiasis with the SCI patients′ age, weight,and the level of injury, severity and duration of the SCI. Methods:One hundred male SCI patients including 58 patients with ASIA class A and B and 42 with ASIA class C and D,with aged 20-65 years old(average 46.5 years) were followed up.They suffered from a spinal cord injury more than one year. The control group consisted of 100 male volunteers without both SCI and biliary diseases, with aged 20-68 year old(average 42.6 years). All patients in the two groups underwent ultrasonographic imaging to evaluate the gallbladder and the biliary tract. Results:The prevalence of cholelithiasis was 26.0%
in the SCI group patients and 10.0% in the control group,the difference was statistical difference (P<0.01). But the the incidence of cholelithasis was not significant difference between the patients′ age ， weight ,SCI level, duration and severity（P>0.05）. Conclusions:SCI represents a major risk factor for the development of cholelithiasis . There are no correlation of cholelithiasis with the SCI patients′ age , weight,SCI level,severity and duration of SCI.

Abstract:Objective: To explore the value of application of choledochofiberscopy in the diagnosis and treatment of the extrahepatic bile duct disease, and the effect on reducing the incidence of the postoperative residual stone in biliary ducts. Methods:According to the case history and ultrasonography,if the common bile duct(CBD) diseases suspected,the CBD was explored by intraoperative choledochofiberscope(IOCF). During the procedure,a biliary passage mirror inducer apparatus and biliary tract probe which were manufactured by ourselves were used. Results :During LC,IOCF was performed on 385 cases of the 10 396 LC cases,and possitive findings were dicovered in 102 cases(26.49%). Among those positive patients, 67 cases belonged to stricture of the lower biliary tract; 5 cases were Mirizzi syndrome; 2 cases were carcinoma of the periampulla; 1 case was primarily carcinoma of the bile duct; 1case was ascarisis of the biliary system. Conclusions:IOCF is a good inspect technique with high success rate and clear image of bile duct, it can discover the common duct diseases which are difficult to be diagnosed through the routine examination.At the same time, it can provide the locative and qualitive diagnosis, determine reasonable methods of operation,and effectively provent postoperative complications.

Abstract:Objective: To investigate the expression of antiapoptosis gene bag1 and its relation to the differentiation of intrahepatic cholangiocarcinoma (ICC). Methods : Immunohistochemical techniques were adopted to study the expression of bag1 in ICC tissue ( n＝48) and parahepatocarcinoma bile duct (control group, n＝25). Results: Expression of bag1 in the ICC group was significantly higher than that in the control group. In the ICC group （P＜0.01）, the expression of bag1 in 21 cases of well differentiated ICC was significantly lower than that in 27 cases of middle and poor differentiated ICC （P＜0.01）. Conclusions: The expression of bag1 gene increases in the middle or poor differentiated ICC tissue suggests that bag1 gene might relate to the differentiation of ICC.

Abstract:Objective: To investigate the effect of genetic alteration(homozygous deletion and point mutation)and expression of p16 gene and p16 protein on hilar cholangiocarcinoma(HCGC) . Methods:Genetic alteration and expression of p16 protein were detected by polymerase chain reaction single strand comformation polymorphism (PCRSSCP) and immunohistochemical method in 36 HCGC tissues. Results:p16 gene revealed alteration in 21 of 36 HCGC tissues (58.3%),among which 8 had homozygous deletion and 13 had point mutation. In HCGC tissues, 8 revealed no p16 protein expression and 10 showed low level expression of p16 protein. Conclusions :The alteration of p16 gene and abnormal expression of p16 protein are significantly correlated with the biological behavior and clinical staging of HCGC,and may be helpful to evalute the malignant degree of HCGC and the patients prognosis.

Abstract:Objective: To investigate the relationship between the expression of tumor suppressor gene PTEN and p16 protein and the biologcal behaviors of cholangiocarcinomas.Methods: The expression of PTEN and p16 protein in 43 of cholangiocarcinoma tissues and 10 chronic cholangitis tissues were investigated by immunohistochemical technique.The relationship between expression of PTEN and p16 protein and the clinicopathological parameters of cholangiocarcinoma was analyzed. Results :The positive expression rate of PTEN and p16 protein in cholangiocarcinoma was 39.5％ and 44.2％,respectively.The expression of PTEN and p16 protein were positively relatad with the TNM staging,differentiation degree and metastasis of cholangiocarcinoma (P<0.05).Moreover,there was a positive correlation between the PTEN and p16 protein expression in cholangiocarcinoma(r=0.49,P<0.005).Conclusions: Expression of tumor suppressor gene PTEN and p16 could be helpful in predicting the biological behavior and prognosis of cholangiocarcinoma.

Abstract:Objective: To study the expression and effect of macrophage inflammatory protein2(MIP2) in liver injury induced by ischemia/reperfusion(I/R). Methods: Thirtytwo rats were randomly divided into 4 groups(8 rats in each group):false operation (control) group and 3, 9, 24 hours reperfusion group.The expression of MIP2 mRNA in hepatic tissue, MIP2 protein in plasma, the neutrophil infiltration in liver tissue and serum ALT were measured. Results: The expression of MIP2 mRNA in the ischemic tissue was significantly higher than that in nonischemic tissue (P<0.01), and was significantly higher in 9 hours reperfusion group than that in 3 hours reperfusion group (P<0.01); significantly higher in 24 hours reperfusion group than that in 9 hours reperfusion group (P<0.01). The level of plasma MIP2 protein, the neutrophil infiltration in liver, the degree of liver injury had the similar changs of MIP2 mRNA.The expression of MIP2 mRNA in liver ischemia tissue and the level of plasma MIP2 protein had positive correlation with neutrophil infiltration in liver tissue(P<0.01) . Conclusions :The results suggeste that MIP2, one of the neutrophil chemotactic factors, plays an important role in the liver injury induced by I/R in rats.

Abstract:Objective: To investigate the effect of nitric oxide synthase（NOS） inhibitors and Larginine（LArg） on the prognosis of traumatic shock in rats. Methods:Traumatic shock models of SpragueDaulay rats were made and randomly devided into control group (n=24)，LNAME treatment group (n=24)，AG treatment group (n=24) and LArg treatment group (n=24). Serum nitric oxide(NO) levels and oxygen partial pressure in tissues include skeletal muscles，liver and small intestine were detected at 1h，3h，5h after resuscitation. Meanwhile，hemodynamic data of the rats and their survival rates of 12h and 24h were monitored and recorded. Results:Serum NO concentration was statistically lower after resuscitation in LNAME group than that in control group, while there were no statistical significance of tissues oxygen partial pressure and survival rate in 12、24h between the two groups. AG could decrease serum NO levels only at late stage of traumatic shock，but no effect on the synthesis and relase of NO at early stage of traumati shock.AG could improve tissues oxygen partial pressure of the liver and small intestine, and prolonged the mean survival time. LArg could increase serum NO levels, and improve oxygen partial pressure of intestine and significantly increase the survival rate at 12h and 24h in rats with traumatic shock. Conclusions:Treatment with AG and LArg can improve the prognosis of traumatic shock rats much better than that with LNAME.

Abstract:Objective:To investigate the clinical and pathological charasteristic, and the operative indications of polypoid lesions of gallbladder (PLG). Methods: The clinical date of 297 patients with PLG comfirmed by pathologic examination were analyzed retrospectively.Results:In nonneoplasm lesions, 80.1% were less than 10mm in diameter, and 71.6% were multiple.However,most of tumorous polyps were single and more than 10mm in diameter. Conclusions:If PLG companied with following conditions,an operation should be considered:(1)Neoplastic polyps.(2)The patients age are over 50 years old, the PLG diameter ＞10mm, the PLG lie in the neck of gallbladder.(3)PLG complicated with clinical symptoms.(4)The PLG diameter increases or complicated with stones.But surgical treatment should be prudent for nonneoplasm PLG, especially cholesterol polys.

Abstract:Objective:To investigate the diagnosis and treatment of refluxing cholangitis.Methods:Clinical data of 60 patients with refluxing cholangitis treated by surgery in recent 7 years in our hospital were reviewed retrospectively.Of the 60 patients,spontaneous refluxing cholangitis and iaotrogenic refluxing cholangitis ocurred in 42 and 18 patients respectively.Results:Postoperactive complications occurred in 13 cases,including biliary fistula in 6 cases,incision infection in 2,intestinal obstruction in 2,subphrenic abscess in 2, all the complications were cured by various treatment.There was no perioperative mortality in this series.Fiftyfive patients were followedup for 2-11 years,42 were excellent,9 good and 2 poor;2 patients died of cerebral haemorrhage and myocardial infarction respectively during the followup period.Conclusions:An appropriate operation should be chosen for patients with refluxing cholangitis according to the basic disorder and the extent of biliary duct wall deficit.

Abstract:Objective:To detect the relationship between the pathological degrees of chronic cholecystitis and coincident diseases. Method:The pathological degree was divided into mild,moderate and severe degree according to the pathological changes in 442 cases of chronic cholecystitis,and the proliferation of mucosa cell was detected by SP immunohistochemical staining in 105 cases. Results : The coincident calculus, polyp, adenoma in the mild chronic cholecystitis were 65.0%,17.1% and 0.5%, respectively. The coincident calculus, polyp, adenoma and malignant neoplasms in the moderate chronic cholecystitis were 70.1%, 19.4%, 3.7% and 2.2%. The coincident calculus, polyp, adenoma and malignant neoplasms in the severe chronic cholecystitis were 88.0%, 26.4%, 24.2% and 9.9%. The positive expression rates of PCNA in mild, moderate and severe chronic cholecystitis were 12.3%, 17.5% and 38.7%, respectively. The results showed that the pathological degree of chronic cholecystitis was obviously related to the coincidence of calculus, polyp, adenoma, malignant neoplasms. Conclusions:Severe chronic cholecystitis is a highrisk lesion of gallbladder carcinoma,it should be removed surgically.

Abstract:Objective:To study the treatment of hepatocellular carcinoma(HCC) complicated with bile duct thrombus.Methods:Restrospective study was performed on the treatment of 34 cases of HCC complicated with bile duct tumor thrombus from January 1995 to December 2002 admitted to our hospital.Results:Among the 34 cases, one patient had no treatment,6 cases received PTCD and 27 cases received operation.In surgical treatment patients,the postoperative 30 days mortality was 22.2%(6/27),the morbidity was 55.6%(15/27).In 16 patients who received hepatectomy with thrombectomy and biliary duct drainage, the survival time was 1～27 months with a median survival time of 16.5 months.Conclusion:The prognosis of HCC complicated with bile duct tumor thrombus is poor. Early diagnosis and aggressive operative are the key points to improving the survival time of patients.

Abstract:Objective:To summarize the experience in major vessels reconstruction after resection of retroperitoneal neoplasm invided major vessel. Methods:Sixteen patients with retroperitoneal neoplarsm invading major vessels underwent resection of the tumor companying with the inviding major vessels, and the resected vessels were reconstructed.Of them, 13 artificial vessels were placed for the vascular reconstruction,and 3 underwent inferior vena cava partial resection and repair with or without PTFE patch;combined reconstruction of arteries and veins were performed on 6 patients，and combined resection and reconstruction of vessels and other invaded organs were performed on 3 patients. Results:There was no operative mortality in this series. Fourteen patients were followed up for 371 months(averaged 30 months) .Five patients died,in which 3 patients died within 12 months, 1died at 64 months and 1died at 71 months after surgery,respectively.There were no obstruction of the reconstructed vessels during follow up. Conclusions:Combined resection of retroperitoneal neoplasm with invided major vessel and vascular reconstruction is a safe, effective operation for retroperitoneal neoplasm companying with inviding major vessel.

Abstract:Objective:To investegate the influencing factors of intraabdominal infectious complications after pancreatoduodenectomy(PD). Methods: The postoperative intraabdominal infectious complications occurrence rate and the influencing factors after PD in 196 patients in recent 7 years were retrospectively analyzed.Results:After PD,the rate of postoperative intraabdominal infections was significantly higher than the rate of other complications. The rate of intraabdominal infections in patients with near normal pancreatic remnent and with pulmonary infections were significantly higher than those in with harder pancreatic remnant and without pulmonary infections(P<0.01). Conclusions:The pancreatic remnant texture and pulmonary infections are the significant influencing factors of intraabdominal infections after PD.So attention should be paid to consider the condition of pancreatic parenchyma,and prevent and cure pulmonary infections to avoid the occurrence of intraabdominal infections as possible.