目的观察S100吸收性止血绫（absorbable stanching satin S100，ASS）在肝脏外科的止血效果。方法将40例择期行肝部分切除术的患者随机分成两组，应用ASS贴敷肝断面为ASS组（n=20），肝断面不用任何局部止血材料为对照组（n=20），分别于术后2 h、12 h、24 h及72 h观察腹腔引流情况，其中重点观察引流量。结果ASS组术后腹腔引流量较对照组明显减少，差异有显著性意义（P＜0.01）;ASS组术后无漏胆发生，对照组术后有2例发生漏胆; ASS组的腹腔引流管拔管时间及平均住院日均小于对照组，但差异无显著性意义（Pgt;0.05）。结论ASS在肝脏部分切除术中具有安全、有效的止血作用，特别是对于伴有凝血机能障碍的患者。
Objective To discuss the effect and prognosis of the Da Vinci surgical system assisted surgical treatment for complex hepatolithiasis. Methods The clinical data of 15 patients with complex calculus of intraheoatic duct who accepted surgical therapy at General Hospital of the Second Artillery Corps of PLA from January 2009 to August 2011 were analyzed retrospectively. Results All operations of 15 patients were performed successfully, no case of converting to laparotomy， no injury of the important blood vessels and organs in surgical procedures. Postoperative complications occurred in 4 cases （26.7%）. Among them, there were 1 case （6.7%） of hemobilia, 1 case （6.7%） of lung infection, 2 cases （13.3%） of liver surface bleeding, and no case of death and liver failure occurred during the perioperative period. All patients （100%） had follow-up visited with a median time of 11 months （ranging from 3 months to 2 years）, 12 cases （80.0%） acquired good curative effect, 3 cases （20.0%） of residual stones were found, 1 case （6.7%） of recurrence stones were found. Conclusion There are enormous potential for Da Vinci surgical system assisted surgical treatment of complex hepatolithiasis, which can be used in elderly patients，and patients with multiple surgical history, poor liver function, acute cholangitis, and so on.
【Abstract】ObjectiveTo explore a rational and effective operative procedure of fresh tissue samples preservation for biliary tract carcinoma, and to establish a tissue bank with high quality, the authors had made a plan to store up the tissue samples of cholangiocarcinoma resected during operaion in deeplow temperature (cryopreservation), which is based on the clinical preponderance in the treatment of biliary tract diseases of the department of hepatobiliary surgery of General Hospital of P.L.A., and will be a good foundation for the systemic basic research of bile duct carcinoma. MethodsCases of biliary tract tumors confirmed by pathology were selected from the inpatients of Department of Hepatobiliary Surgery in General Hospital of P.L.A. from Jan. 2000 to June 2001. Fresh tissues were taken from the excised sample, which were stored in three different disinfectant tubes labelled cancer ( or tumor ) group, peritumor group and normal group. They were stored in liguid nitrogon container temporarily, and transferred into refrigerator for longtime storage as quickly as possible. The slices divided from the sample were grouped according to the dimensional space apart from the margin of tumor. Pathological diagnosis must be made on paraffin embedded samples. A part of the tissues was used to isolate total RNA by Trizol reagent for integrality judgment of it.ResultsTwentyone excised samples were stored including 4 intrahepatic bile duct carcinoma, 6 hepatic hilar cholangiocarcinoma, 7 extrahepatic bile duct carcinoma, and 4 duodenal ampulla carcinoma. The number and size of samples stored and duration of severance were not the same for reason of the difference of tumor volume, difficulty of operation and artificial jamming. The average duration was (47.60±43.87) min. The precipitated total RNA could be seen at the bottom of Eppendorf tube, of which the rate of A260/A280 was calculated about 1.6 to 1.8. It also could be seen in the 1%agarose gel electrophoresis for the obvious two bands of 28s and 18s, in which the28s band might be twofolds lighter than the 18s. Conclusion It is an important basic work for research of genes related to human disease to built a sample bank of human genetic resource. The present program for bile duct carcinoma tissue severance and storage is feasible and could supply the goodquality sample for further study. It must be reminded that the informed consent is needed and the left sample should be sufficient for postoperative pathological examination before the performance, which should be done by a fixed and experienced researcher group. Limitted to the operation of bile duct carcinoma, the time for beginning tissue severing should be in one hour after the sample excision, and samples should be divided into slices in short time to avoid decomposition of component during the following schedule.
ObjectiveTo detect expression of FXYD6 protein in hilar cholangiocarcinoma tissues and explore its significances. MethodsThe expressions of FXYD6 protein in the 58 hilar cholangiocarcinoma tissues and 30 normal bile duct tissues adjacent to cancer were detected by strept avidin-biotin complex (SABC) immunohistochemistry. The relation between FXYD6 protein expression and biological characteristics of patient with hilar cholangiocarcinoma was analyzed. ResultsThe positive rate of FXYD6 protein expression in the hilar cholangiocarcinoma tissues was significantly higher than that in the normal bile duct tissues adjacent to cancer[75.9% (44/58) versus 33.3% (10/30), χ2=15.084, P=0.000]. Furthermore, the positive rate of FXYD6 protein expression in the well and moderately differentiated hilar cholangiocar-cinoma tissue was significantly higher than that in the poorly differentiated hilar cholangiocarcinoma [85.4% (35/41) versus 52.9% (9/17), χ2=5.243, P=0.022], which was not related to the gender (χ2=0.000, P=1.000), age (χ2=1.248, P=0.264), T stage (χ2=0.466, P=0.495), lymph node metastasis (χ2=0.357, P=0.550), pathological stage (χ2=0.005, P=0.944), and perineural invasion (χ2=3.016, P=0.082). Conclustion The positive rate of FXYD6 protein expression is associated with differentiation of hilar cholangiocarcinoma, which might be a new biomarker of it.
Objective To summarize the clinical experience of da Vinci surgical system in treatment for senile patients with severe obstructive jaundice．Methods From January 2009 to May 2011, 209 patients with hepatopancreatobiliary （HPB） diseases underwent robotic surgeries by using da Vinci surgical system. Forty-seven senile patients with severe obstructive jaundice were selected for robotic surgery （robot group） and 44 for open surgery（open group）.The distribution of disease, pro-, intra-, and post-operative data in the two groups were analyzed. Results Baseline of two groups was same. A total of 46 patients had underwent total robotic surgeries （97.87%，46/47） and 1 patient converted to hand-assisted procedure （2.13%，1/47）. Surgeries included all HPB difficult surgical procedures, also including 1 case of hilar cholangiocarcinoma patient who had high level serum bilirubin （375μmol/L）and underwent emergency resection for hilar cholangiocarcinoma and portal-jejunal Roux-en-Y anastomosis． Postoperative complications occurred in 7 cases （14.89%, 7/47） and 1 case died （2.13%, 1/47） . Three-month survival rate was 78.15%. Fifteen-day and 3-month after surgery, physical strength score was 42.87±18.61 and 58.51±23.86, respectively. The total length of abdominal incision was （6.30±1.70） cm. All the patients in the open group completed surgery, including emergency operation in 4 cases. Postoperative complications occurred in 13 cases （29.55%, 13/44） and 2 cases died （4.55%, 2/44）.Three-month survival rate was 72.36%. Fifteen-day and 3-month after surgery, physical strength score was 37.15±13.64 and 45.27±18.96, respectively. The total length of abdominal incision was （26.73±3.07） cm. There were significant differences of postoperative complications, postoperative 15-day and 3-month physical strength score, and incision length between two groups（P＜0.05）. Conclusions da Vinci surgical system is safe and effective in treatment for senile patients with severe obstructive jaundice.