Objective To study the expression of inducible nitric oxide synthase (iNOS)，endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) in human gastric cancer and their relationship with tumor angiogenesis and to investigate the interaction of NOS and VEGF in gastric cancer. Methods The expression and distribution of VEGF, iNOS and eNOS in 34 gastric cancer specimens were detected with immunohistochemistry. Microvessel density (MVD) was counted with FⅧRAg immune specific staining. Results The expression rates of iNOS, eNOS and VEGF in 34 gastric cancers were 73.5%, 82.4% and 91.2% respectively. The expression of VEGF had a significant positive relation with iNOS, but not with eNOS. The MVDs of VEGF or iNOS positive gastric cancers were obviously higher than those of VEGF or iNOS negative gastric cancers. There was no significant difference between the MVDs of eNOS positive gastric cancers and eNOS negative ones. Conclusion MVD increases with increase of expression of VEGF and iNOS in gastric cancer. It is indicated that VEGF and iNOS can promote gastric cancer angiogenesis. VEGF and iNOS have a significant positive correlation, which suggests that in human gastric cancer, iNOS plays an important role in the production and action of VEGF.
Objective To study whether carbon dioxide used to establish pneumoperitoneum has an influence on port-site and intraperitoneal implantation and metastasis of tumor cells. Methods R15 hepatic cancer cells were injected into 30 Wistar rats’ peritoneal cavities 1 hour before operation, then the 30 Wistar rats were randomly divided into 3 groups: gasless group, helium group and carbon dioxide group. The suspension was exposed to the gas environment for 2 hours, all animals were killed after 28 days and the port-site and intraperitoneal implantation and metastasis of tumor cells were examined. Results On port-site, intestinal serous coat, mesentery, greater omentum and diaphragm, the weights of tumor cells, in carbon dioxide group were (326.7±230.3) mg， （626.2±215.9） mg，（476.2±204.8） mg，（2 536.5±906.7） mg and （384.5±149.9） mg respectively； in helium group were (235.6±107.3) mg， （414.2±148.4） mg, （261.8±92.6） mg, （1 633.4±247.3） mg and（220.0±57.9） mg； in gasless group were (145.0±42.4) mg， （221.5±108.2） mg， （212.5±109.6） mg, （797.5±335.9） mg and 113.0 mg.The weights of carbon dioxide group showed a significant increase, compared with helium group and gasless group (P＜0.05). The weights of helium group were greater than gasless group，but there was no significance in statistics (Pgt;0.05). Conclusion The insufflation of carbon dioxide promotes intraperitoneal tumor implantation and growth compared with helium and gaslessness in a rat model.
Objective To investigate the preventive measures for bleeding in laparoscopic hepatectomy. Methods The candidates for laparoscopic hepatectomy were 22 patients with live lesions， including 5 patients with primary liver cancer， 16 patients with liver hemangioma， and 1 patient with metastatic liver cancer. The tumors locatedthe left lateral lobe in 15 cases， caudate lobe in 1 case， segmentⅣin 2 cases， and segmentⅥ in 4 cases. The meandiameter of tumors was 4cm （2-10cm）. The surgical approaches included the left lateral lobectomy （15 cases）， leftlateral lobectomy of caudate （1 case）， and nonanatomic and wedge resection were performed in 6 cases. Results Twenty-two cases underwent laparoscopic liver resection， there were no conversion to open and operative death. The mean operative time was 115min （65-142min）， the mean blood loss was 450mL （270-780mL）， the mean length of hospital stay after operation was 6.5 days （3-11 days）. Conclusion Control liver section hemorrhage is a key technique in laparoscopic hepatectomy.
目的 探讨胆道术后肝内、外胆管狭窄的治疗方法。方法 回顾性分析吉林大学第一医院自2003年1月至2007年12月期间应用胆道镜对37例胆道术后肝内、外胆管狭窄患者行气囊扩张治疗的结果。结果 本组37例患者42处肝内、外胆管狭窄均行胆道镜下气囊导管扩张，29例（78.4%）系胆管狭窄伴肝内胆管结石，经气囊扩张后，胆道镜通过狭窄部位，取净远端胆管结石； 另8例（21.6%）系单纯胆管狭窄无结石,仅行导管扩张。本组成功率达97.3%（36/37）； 1例因胆汁性肝硬变伴弥漫性胆管狭窄扩张失败后行肝叶切除手术。27例狭窄仅需一次性扩张,9例因胆管多处严重狭窄而行多次扩张。全部患者均获随访，随访时间6~24个月,平均12个月，未见结石复发。结论 胆道镜下气囊导管扩张治疗胆管狭窄微创、直观、安全、简便易行且疗效可靠,是治疗胆管狭窄并取净结石的理想方法。但需注意操作方法及技巧，防止并发症的发生。
Objective To approach the indications， techniques features， and efficacy of laparoscopic hepatectomy for liver tumor. Methods The clinical data and follow-up results of 61 patients who received laparoscopic hepatectomy at our institute from January， 2007 to December， 2012 were retrospectively analyzed. Results Of the 61 patients， 16 cases were with primary liver cancer， 1 case with liver adenocarcinoma， 2 cases with metastatic liver cancer， 31 cases with hepatic hemangioma， and 11 cases with other benign liver diseases （including hepatocellular adenoma， focal nodular hyperplasia， hepatic cysts， and mucinous cystadenoma）. The average tumor diameter was 5.6 cm （2-15 cm）. The surgical approaches includes laparoscopic hepatic left lateral lobectomy （42 cases）， right posterior lobectomy （2 cases）， hepatectomy of segmentⅥ （3 cases）， hepatectomy of segmentsⅦ/Ⅷ， Ⅳa， and caudate lobe （one respectively）. Non-anntomic and wedge resection were performed on 11 patients. The mean operating time， blood loss， postoperative hospital stay， and postoperative complication rate were （124±65） min （50-200min）， （251±145） mL （50-1 000mL），（7.3±3.6） d （4-11d）， and 16.3% （10/61）， respectively. In 19 cases with malignant liver lesions， 15 cases were followed up mean for 26 months （1-48 months）. One of them died in 1 year after operation for multiple organ dysfunction， others were survival. Conclusions Experienced laparoscopic surgery doctors selected appropriate cases， used proper blood inflow oclussion and liver resction methods， and cared for tumor-free principle， the laparoscopic hepatectomy for malignant and benign tumors of liver could be safe and effective to carry out.