Volume 90  ·   Issue 28  ·  2010

The anatomical structure of the liver is complex and the physiological function is important. There is often a contradiction between completely removing the diseased tissue and keeping the remaining liver structure intact and functional compensation during hepatectomy. This contradiction is the main cause of determining the surgical risk, and it is also the main problem to be solved in preoperative planning.

Objective To study the value and feasibility of a novel method of urethrovesical anastomosis during radical laparoscopic prostatectomy.Methods From 2008 to 2009, 10 patients with local prostate cancer (LPC) underwent radical laparoscopic prostatectomy through the placement of two separate needles for running urethrovesical anastomosis.The first step comprised the first stitch placed in the posterior wall of anastomosis (at 4 o'clock) and then clockwise running suture from 4 to 12 o'clock position.The next steps entailed another needle, stitching at 3 o'clock position and counterclockwise running suture.Two sutures would meet at 12 o'clock position for the third and final knot.When the position of urinary leak was observed, an additional suture would be performed.Results This technique was performed in 10 patients with a mean anastomosis duration of 30 minutes ( range : 25 - 45 ) and a mean operative duration of 220 minutes (range: 200-300).The Foley catheter was implanted for 14 days.Neither bladder neck stricture nor urinary leak was observed with a follow-up period of 3-24 months.Conclusions The described technique is a feasible and safe method for urethrovesical anastomosis with a low rate of complications.And it may be quickly mastered so as to lower the learning curve of a novice.

Objective To report our initial experiences of laparoseopic partial nephrectomy (LPN)for small renal tumors.Methods From July 2005 to December 2008, 59 patients with small renal tumors were resected by laparoscopic partial nephreetomy.Results All operations were successfully accomplished.Twenty-seven patients were treated via a transperitoneal approach and the other 32 cases a retroperitoneal approach.The average operative duration was 72 minutes ( range: 60-95 ) and the average kidney ischemia time 19 minutes (range: 15-32).The estimated blood loss was from 20-50 ml and no patient needed transfusion.The collecting system closure was performed by suture in 2 patients, and no complication of hemorrhage or urine leak was found.Thirteen cases used Hemo-lok to clamp the suture instead of traditional ligature.And the mean time of renal warm ischemia was 13 minutes (range: 10 - 18).These patients included 55 with clear cell renal carcinoma, 3 with granule cell renal carcinoma and 1 with oxyphil cell renal carcinoma.All renal tumors were completely removed with a negative surgical margin.The mean postoperative hospital stay was 6.2 days (range: 5 - 10).The postoperative ECT and creatinine were normal and there was no significant difference as compared with the preoperative findings(P <0.05).None patient had any local recurrence during a mean follow-up period of 24.6 months ( range: 3 - 42).Conclusions LPN for pT1 stage renal tumor is both safe and feasible.Mastering the skilled laparoscopic techniques may facilitate operation.Employing Hemo-lok instead of traditional ligature to clamp the suture while sewing renal wound shortens the warm ischemia time.

Objective To summarize the experiences of laparoscopic pancreatectomy and to discuss its clinical indications and operative techniques.Methods From March 2003 to February 2010, 49 patients with pancreatic diseases, including 18 males and 31 females with a mean age of (42 ± 14) years old (range:21 -77), underwent laparoscopy at our department.The preoperative diagnoses included insulinoma (n =38 ) , cystadenoma ( n = 4), cystadenocarcinoma ( n = 1 ), nonfunctional islet cell tumor ( n = 5 ) and solidpseudopapillary tumor (n = 1 ).Results Thirty-nine cases underwent total laparoscopic surgery and 8 cases converted to open surgery.The operative duration was (245 ± 146) minutes (range: 90-960).The mean intraoperative blood loss was (191±306) ml (range: 20-1500).Secondary operations were needed in 3 cases and pancreatic fistula occurred in 7 cases.The postoperative hospital stay was ( 10 ±7) days (range:4 -31 ).Conclusion Laparoscopic pancreatectomy is safe and feasible in the treatment of most benign pancreatic diseases and some malignant tumors.

Objective To discuss the risk factors of recurrent non-muscle-invasive bladder cancer and elucidate its clinical significance.Methods The retrospective survival analysis of 161 patients with nonmuscle-invasive bladder cancer was performed by Kaplan-Meier method, Log-rank test and COX proportional hazard model.Results On univariate analysis, the parameters of tumor stage, tumor grade, number of tumors and previous recurrence were significant for tumor recurrence ( all P < 0.05 ).On multivariate analysis of COX proportional hazard model, all the above risk factors remained significant for tumor recurrence.The hazard ratios were as follows : tumor stage ( RR = 3.810, P = 0.001 ), tumor gade ( RR =2.416, P = 0.009), number of tumors (RR = 1.736, P = 0.036)and previous recurrence (RR = 1.810, P =0.010).Conclusion Tumor stage and tumor grade plays the most important role in tumor recurrence.

Objective To discuss the relationship between high sensitive C-reactive protein (hs-CRP), lipoprotein (Lp)(a), blood uric acid (BUA) and severity of coronary artery disease (CHD).Methods A total of 813 cases of suspected or established coronary atherosclerotic heart disease patients were recruited.The patients received selective coronary arteriography and they were divided into normal and CHD groups according to the result of selective coronary arteriography.The dividing mark was coronary artery stenosis more than 50% by selective coronary arteriography.Patients in CHD group were further divided into 1-4 vessel disease.Blood glucose, cholesterol, triglyceride, LDL-ch, hs-CRP and BUA were detected by automatic biochemical analyzer.Results Among them, 754 cases ( CHD group, 92.7% ) were confirmed as coronary heart disease while 59 cases( control group, 7.3% )confirmed as non-coronary heart disease.There were significantly difference between two groups ( P < 0.05 ) : hs-CRP ( 7.12 ± 4.48 vs1.71 ± 1.42) mg/L, Lp (a) (0.45 ± 0.42 vs 0.18 ± 0.03 ) mmol/L and BUA (402 ± 103 vs 327 ± 88 )μmol/L.The levels of hs-CRP, Lp (a) and BUA in different number of diseased coronary vessels significantly differed from each other ( P < 0.05 ).A comparison of 1-vessel disease group versus 4 vessel disease group was as follows: hs-CRP (3.59 ± 2.93 vs 13.11 ± 3.00) mg/L, Lp(a) (0.37 ± 0.25 vs0.58 ±0.17) mmol/L and BUA (384 ± 126 vs 444 ±91 ) μmoL/L.Logistic regression analysis showed that hs-CRP, Lp(a) and BUA were independent risk factors of coronary artery disease.Conclusions The elevations of hs-CRP, LP (a) and BUA promote the establishment and development of coronary artery disease.A joint detection of hs-CRP, Lp(a) and BUA shows a comparatively great value in evaluating highrisk groups and the patient's condition.And it provides references for an active intervention of clinical coronary heart disease.

Objective To evaluate the efficacy and safety of a 24-hour continuous infusion of paclitaxel in combination with oxaliplatin in the treatment of advanced esophageal cancer.Methods A total of 43 subjects with Ⅲ -Ⅳ stage advanced esophageal cancer were enrolled from March 2008 to June 2009.There were squamous cell carcinoma (n=32) and adenocarcinoma (n = 11 ).Among them, 36 patients had no prior chemotherapy, 7 patients received adjuvant chemotherapy and 4 accepted taxane-based regiments.The median age was 56 years old.All patients were treated with paclitaxel 175 mg/m2 by a 24-hour continuous infusion, oxaliplatin 130 mg/m2 at Day 2, 3 weeks as one cycle.Results Forty-three patients completed 130 cycles ( median: 3 ) .And the efficacy and safety of 41 patients could be evaluated.According to the WHO standard, there were complete response (CR) (n=4), partial response (PR) (n=16), stable disease (SD) (n=9), progressive disease (PD) (n=12) and response rate (RR) 48.7%.Thirty eases of squamous cell carcinoma could be evaluated, CR 4, PR 14, SD 4, PD 8, RR 60.0%;Adenoearcinoma CR 0, PR 2, SD 5, PD 4, RR 18.2%.Statistical test show that RR of squamous was higher than that of adenoearcinoma (P < 0.05).The most common toxicity was hematological.Grade Ⅲ -Ⅳ neutropenia was seen in 16 patients (41.4%), alopocia 60.9%, vomiting 26.8%, neuropathy 22% and myalgia 19.5%.Most of them were of Grade Ⅰ - Ⅱ.Conclusions The efficacy of a 24-hour continuous infusion of paclitaxel plus oxaliplatin in the treatment of advanced esophageal cancer is excellent.All toxicities are well tolerated.So this protocol may be considered a main regimen in the treatment of advanced esophageal cancer.

Objective To observe the changes of serum vascular endothelial growth factor (VEGF)in newborns at different gestational ages and infants with retinopathy of prematurity (ROP) and explore the relationship with ROP.Methods A total of 184 newborns admitted into our hospital were enrolled.They were divided into three groups as < 32 weeks, 32-36 weeks and term neonates based on gestational age.Each group was further divided into two subgroups of non-oxygen and oxygen.The ROP group was diagnosed by ophthalmologist in infants whose birth weights were less than 2000 grams.Serum VEGF was measured by ELISA every other week from birth until discharge.Results In three non-oxygen subgroups, the serum VEGF was declining with postnatal age in prematurities and stable in term neonates.Serum VEGF (ng/L)in 32 - 36 week premature group was much higher than those of term group at Weeks 1 and 3 (522 ± 224 vs247 ± 123, P = 0.000; 393 ± 220 vs 247 ± 177, P = 0.022) ; Serum VEGF in < 32 week premature group was slightly higher than that of term group at Week 1 (P = 0.071 ).Serum VEGF (ng/L) in oxygen subgroup at Weeks 1 and 3 was significantly lower than that of non-oxygen subgroup (324 ± 148 vs 522 ±224, P = 0.000; 264 ± 106 vs 393 ± 220, P = 0.005 ) only in 32 - 36 week premature group.Serum VEGF (ng/L) in ROP group abnormally increased at Week 5 and it was significantly higher than that of prematurities without ROP at 31 weeks of corrected gestational age (515 ± 154 vs 347 ± 161, P =0.047).Conclusions Abnormally elevated serum VEGF in prematurities may be related to ROP.Monitoring serum VEGF in prematurities could help to predict ROP.

Objective To explore whether the analyses of urine sediment spectrum contribute to the diagnosis of crescentic nephritis and whether special cells in urine could be a biomarker for the early stage crescentic nephritis. Methods Thirty-five patients diagnosed as crescentic nephritis with renal biopsy were recruited. The phase-contrast microscope was used to observe the early morning urine and offer comprehensive descriptions of urine sediment spectrum. And podocalyxin antibody was utilized to detect podocytes in urine and renal specimens by immunohistochemistry. Results Marked hematuria and casts were present in the urine of crescentic nephritis and "special cells" appeared in over 50% subjects. The detection rates of "special cells" were 75% , 41% and 0 respectively in early, middle and later stages of crescentic nephritis. Podocytes were identified in the urine of 8/9 subjects. Conclusions The urine sediment spectrum contributes to the diagnosis of crescentic nephritis. And special cells in urine are helpful to gauge the stage of crescentic nephritis.

Objective To explore the effect of early statin therapy(atorvastatin and simvastatin) on mortality in patients with non-ischemic dilated cardiomyopathy.Methods A retrospective study was conducted at a single center.A total of 315 patients with non-ischemic dilated cardiomyopathy, admitted into our hospital from January 2002 to December 2008, were enrolled.The association of statin therapy at the initial hospitalization with all-cause mortality was evaluated.The median follow-up period was 45.1 months.Results By the single-factor analysis, we found that the follow-up mortality was 17.2% in statin group and it was significantly lower than 37.4% of non-statin users ( P = 0.003 ) ; in patients with worsening cardiac function NYHA Ⅲ-Ⅳ, the mortality of statin group was 17.2% while a much higher mortality of 47.4% was found in non-statin users(P=0.003) ; in patients with NYHA Ⅰ-Ⅱ, no significant difference was found in mortality between two groups.By the multi-factor analysis adjusting for age, gender, history of hypertension, diabetes mellitus, current cigarette smoking, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, left ventricular ejection fraction, NYHA functional class, use of angiotensin-converting enzyme inhibitor, β blocker, aldosterone, other diuretics, digoxin and calcium channel blocker, we found the relative risk (RR) of death in statin use was 0.352 (95% CI 0.135-0.920, P=0.033 ).In patients with NYHA Ⅲ-Ⅳ, the relative death risk of statin therapy was 0.250 (95% CI 0.081-0.778, P = 0.017 ).Conclusions Early treatment of atorvastatin or simvastatin is closely correlated with the reduction of mortality in non-ischemic dilated cardiomyopathy patients, especially in those with severe heart failure.And the correlation is independent of the lipid-lowering effects of statins, ACEI and β-blocker therapy.

Objective To investigate the role of bacteria in the etiology of chronic prostatitis.Methods Complete prostate specimens were obtained at autopsy from 192 organ donors (aged 20 - 38 years old) during 2002 to 2008 who died of non-prostatic diseases.One tissue taken from the peripheral prostatic zone according to McNeal was divided into two pieces.One piece of tissue was taken for routine pathological examinations and immunohistochemical studies of interleukin (IL) -1β, tumor necrosis factor-α (TNF-α)and IgA.Another one was taken for PCR assay to detect the bacterial 16S rRNA genes ( 16S rDNA ).Results Of 192 prostate specimens, 64 (33.3%) had pathological changes of chronic prostatitis and 38 ( 19.8% ) specimens was positive for bacterial 16S rDNA.Positive rates of 16S rDNA in chronic prostatitis and non-prostatitis specimens were 50.0% (32/64) and 4.6% (6/128) respectively ( X2 = 55.185, P <0.001 ).Expressions of IL-1 β, TNF-α and IgA in specimens of chronic prostatitis were significantly higher than those in non-prostatitis specimens ( P < 0.001 ).A positive correlation could be found among three immunohistochemical indicators (P < 0.01 ).In 64 specimens with chronic prostatitis, a significant expression of IL-1β, TNF-α and IgA was more often demonstrated in 16S rDNA positive group than in 16S rDNA negative group (P <0.001 ).Conclusions The up-regulations of bacterial 16S rDNA, cytokines and immunoglobulin A are involved in inflammatory response of chronic prostatitis.Bacterial infection may be an important cause of chronic prostatitis.

Objective To investigate the clinical significance of radical pancreatoduodenectomy plus retroperitoneal nerve, lymph node and soft tissue dissection in carcinoma of pancreatic head.Methods Forty-six patients with carcinoma of pancreatic head were treated at our hospital from 1995 to 2005.They were divided into two groups: radical pancreatoduodenectomy plus retroperitoneal nerve, lymph node and soft tissue dissection (Group A, n=25) and routine Whipple's operation (Group B, n=21).Two groups had no significant difference in age, gender and pre-operative risk factors.And the peri-operative conditions,pathological data and survival rates were compared and analyzed.Results There was no difference in tumor size, intra-operative findings, post-operative complications and length of hospitalization.But the number and positive rate of resected lymph node in Group A were significantly higher than those in Group B (P<0.05 ).The survival rates of 1, 3-year in Group A were 80% and 52.9% respectively.And they were higher than those in Group B (P < 0.05 ).There was significant difference in the survival rates between patients with nerve infiltration and those without in Group A (P < 0.05 ) .Conclusion The radical pancreatoduodenectomy plus retroperitoneal nerve, lymph node and soft tissue dissection can effectively remove the lymph node and nerve tissues with tumor infiltration and reduce the local recurrent rate so as to improve the long-term survival rate.

Objective To explore the T cell-mediated immunopathogenesis of latent autoimmune diabetes in adults (LADA).Methods Seventeen LADA patients, 28 T2DM (type 2 diabetes mellitus) patients and 16 healthy controls were recruited.GAD-Ab, IA-2Ab and CPH-Ab were determined by radioligand assays.Human peripheral blood mononuelear cells were isolated by Ficoll-Hypaque density gradients.And the spot numbers of IFN-γ-secreting T cells ( IFN-γ-Th1 ) and IL-4-secreting T cells ( IL-4-Th2) were detected by enzyme linked immunospot (ELISPOT) assay.One spot-forming represented a GAD65-reaetive IFN-γ/IL-4-secreting T cell.The ratio (balance) of Th1/Th2 was defined as IFN-γ-Th1/IL-4-Th2.Results ( 1 ) The spot numbers of IFN-γ-Th1 (median) were 4.0, 2.0 and 1.0 in LADA,T2DM and control while those of IL-4-Th2 2.0, 3.3 and 1.0 and Th1/Th2 3.0, 0.4 and 0.3 respectively;(2) As compared to T2DM or cntrol group, significant increases of Th1 (P<0.01 ) and Th1/Th2(P<0.05 ) were observed in LADA group.But the spot numbers of Th2 showed no significant differences among three groups (P>0.05).And there were no differences of Th1 and Th1/Th2 between T2DM and control group ( P > 0.05 ) ; (3) No significant difference of Th1 or Th2 was observed for phytohemagglutinin (PHA) stimulation in three groups (P > 0.05).Conclusions Significantly enhanced IFN-γ-Th1 cells and a shift of Th1/Th2 towards Th1 are present in LADA patients.They may contribute to the T-cell mediated immunopathogenesis of LADA.

Objective To investigate the expressions of BJ-TSA-9, CK19 and Pre-preGRP mRNA in peripheral blood from the patients with non-small cell lung cancer and analyze their correlations with nonsmall cell lung cancer.Methods The expressions of BJ-TSA-9, CK19 and Pre-proGRP mRNA were detected by nested reverse transcription-PCR assay in peripheral blood from the patients with non-small cell lung cancer(n=120 ), benign pulmonary disease ( n = 106 ) and from healthy subjects ( n = 80 ) so as to further investigate their relationship with clinicopathological features and prognosis.Meantime we also examined the sensitivity, specificity and accuracy of combination detection.Results The expressions of BJTSA-9, CK19 and Pre-proGRP mRNA in non-small cell lung cancer patients were 56.7% ,57.5% ,35.0%,higher than that of benign pulmonary disease ( 0.9%, 6.6%, 5.7% ) and healthy groups (0,3.8%, 0, all P <0.05).The ROC curves indicated the sensitivity of combined detection was 84.3% and the specificity of combined detection was 94.6%.Univariate analysis revealed that the clinical stage, the ECOG score and the number of positive marker had significant association with overall survival (OS) ( x2 = 67.928, 95.981,60.285, all P=0.000).Multivariate analysis indicated that the clinical stage, ECOG score and the number of positive marker was an independent prognostic factor each ( HR=2.866,4.251,1.845, all P=0.000 ).Conclusion BJ-TSA-9, CK19 and Pre-proGRP mRNA may be the specific and sensitive markers to detect circulating tumor cells in the peripheral blood of non-small cell lung cancer patients.

Objective To investigate the effect of n-3 polyunsaturated fatty acids (n-3PUFAs)on the hemorheology and coagulation function of high-fat induced atherosclerotie rots and understand the underlying mechanism.Methods Twenty-four Wistar rats were assigned randomly into 3 groups: normal control, model and n-3PUFAs treatment ( n = 8 in each).The rats in model and treatment groups were injected with a single dose of vitamin D3 (600 000 U/kg) and fed with a high-fat diet.Basic chow was provided for normal control group.After a 6-week high-fat diet, the rats in treatment group were treated with hemorheology, coagulation, nitric oxide (NO), total antioxidant capacity (T-AOC) and malonaldehyde (MDA) were detected after a 6-week n-3PUFAs diet.Results Compared with control group, model group rat total cholesterol (TC), low density cholesterol (LDL-C), plasma viscosity, whole blood viscosity,fibrinogen (FIB) and MDA concentrations were higher (all P <0.05), but activated partial thromboplastintime ( APTT), prothrombin time ( PT), thrombin time (TT), erythrocyte deformation index ( DI), plasma NO and T-AOC were lower (all P < 0.05).Compared with model group, n-3PUFAs could reduce blood FIB [ (2.45 ±0.12)g/L vs (2.65 ±0.13) g/L], lower MDA content[ (10.1 ±0.7) μmol/ml vs (11.2 ±0.6) μmol/ml] , prolong APTT,PT and TT [ (29.04 ±0.49)s vs (26.46 ±0.25)s,(13.86 ±0.55)s vs ( 10.71 ± 0.34) s, ( 23.05 ± 0.24 ) s vs ( 20.90 ± 0.68 ) s ], increase erythrocyte DI (0.35 ± 0.01 vs 0.31 ±0.02), plasma NO [ (3.9 ±0.7 ) nmol/ml vs (2.8 ± 0.7 ) nmol/ml ] and T-AOC levels [ ( 8.0 ± 0.6 )U/ml vs (6.7 ±0.6) U/ml] of atherosclerotie rats( all P <0.05).Conclusion n-3PUFAs may improve hemorheology and coagulation of atherosclerotic rats, reduce oxidative stress, improve endothelial function and inhibit atherosclerotic plaque formation.

Objective To determine whether urinary connective tissue growth factor (CTGF) can be a molecular marker for chronic allograft nephropathy (CAN) in a rat model.Methods F344 rat renal grafts were orthotopically transplanted into Lewis rats (n= 24) .Lewis rats underwent sham operation as control group (n = 12).Kidney grafts were harvested at Weeks 4, 8, 12 and 16 respectively.Serum creatinine (SCr) was measured.The CAN grades were evaluated according to the Banff 97 schema.The expressions of CTGF in kidney, serum and urine were determined by Western blot and competitive indirect ELISA.Spearman correlation analysis was used to compare CTGF expression and the development of CAN.Results The expression of CTGF in the graft group was markedly elevated in comparison with the control group.Statistics analysis of CTGF protein in kidney detected by Western blot showed significant differences between these five groups (0.33 ± 0.05 for control, 0.55 ± 0.02 for Week 4, 0.80 ± 0.03 for Week 8,0.90 ±0.03 for Week 12 and 1.14 ±0.11 for Week 16, P <0.01 ).Both urine and serum CTGF increased by Week 4 and maintained a high level up to Week 16.The urinary CTGF of renal allografts was (2.9 ±0.7), (12.9±3.6), (32.3 ± 11.4) and (31.0 ±8.9) ng/mg creatinine for Weeks 4, 8, 12 and 16 respectively.The urinary levels were positively correlated with SCr, Banff scores and expression of CTGF in the graft kidney ( r = 0.848,0.874,0.747, all P < 0.01 ).Conclusions CTGF plays a significant role in the pathological changes of CAN after kidney transplantation.Urinary CTGF has the potential as a biomarker for predicating the chnical course of CAN.

Objective To investigate the effect of allitridin on murine cytomegalovirus (MCMV) induced regulatory T cells (Treg) amplification in vitro.Methods A co-culture system of T cells and MCMV infected mouse embryo fibroblasts (MEF) was established.A maximum tolerance concentration (MTC) of allitridin was added into the co-culture system.After 3 days, the change of Foxp3 mRNA was measured by real-time PCR.And the percentages of Tc1 ( CD3 + CD8 + IFN-γ+ ), Tc2 (CD3 + CD8 + IL-4 + ), Th1 ( CD3 +CD8 - IFN-γ+ ) and Th2 ( CD3 + CD8 - IL-4 + ) were analyzed by flow cytometry.The production of IL-10 and TGF-β in supernatants was detected with double-antibody sandwich ELISA while the viral load of culture quantified by plaque assay.All results were compared with those of the placebo group.Results The MTC of allitridin was 9.83 μg/ml in MEF.The treatment of 9.83 μg/ml allitridin could partly block the MCMV induction of Foxp3 mRNA expression [ (87 ± 5 ) vs ( 114 ± 8), P < 0.01 ].The percentages of Tc1, Tc2 and Th1 significantly increased to the levels of (12.42 ± 1.23)%, (4.28 ±0.56)% and (13.25 ±0.68)%respectively.They showed statistic differences with those of placebo controls [ (6.85 ± 0.92) %, (2.34 ±0.42)% and (9.32 ±0.86)% ; all P <0.01 ].Meanwhile, the levels of IL-10 and TGF-β1 in supernatants also significantly decreased to ( 29.98 ± 3.15 ) pg/ml and ( 3.48 ± 0.23 ) ng/ml by allitridin treatment as compared with placebo controls [(38.21±4.02) pg/ml and (5.31 ±0.59) ng/ml, all P <0.05].In addition, the MCMV plaque assays showed that allitridin significantly suppressed the viral loads by one order of magnitude.Conclusion Allitridin can partly retrieve MCMV-induced Treg expansion and Treg-mediatad anti-MCMV immunosuppression so as to enhance the specific cellular immune responses against CMV.

A 48-year-old male was admitted to the hospital on November 20, 2009 due to abdominal pain and blood in the stool for 1 month. The patient suddenly developed severe diffuse colic around the umbilical cord without inducement 1 month ago, and the abdominal pain persisted without relief. About 2 hours later, he defecated fresh and bloody stool for more than 10 times, about 100~200 ml each time, without fever or vomiting. He went to the emergency department of another hospital, and the physical examination showed soft abdomen, no tenderness, and peritoneal irritation sign (-). 　　

A 47-year-old male was admitted to the Department of Gastroenterology of Peking Union Medical College Hospital on October 19, 2009 due to abdominal pain for 6 years and diarrhea for 2 years. In the past 6 years, he suffered from recurrent middle and upper abdominal pain, accompanied by acid reflux, and multiple gastric ulcers were revealed by gastroscopy in an outside hospital, which improved after taking omeprazole. He started watery diarrhea 2 years ago, which worsened after eating, and lost 9 kg in weight.

The patient was an 18-year-old male who had repeated gingival bleeding 6 years ago and was treated with vitamin C and vitamin B complex intermittently. The symptoms were mild and severe. In the past month, the symptoms of gingival bleeding were aggravated and the fatigue was obvious, and she came to our hospital on September 18, 2009. The patient was the first fetus delivered naturally at full term, and her parents were not close relatives. Her mother was 21 years old when she was pregnant, and she had no history of taking medication during pregnancy. Denial of mumps and history of special medication.

Laparoscopic surgery has many advantages such as light surgical trauma and quick postoperative recovery. It has developed rapidly in recent years, and some surgeries have become the standard surgical methods. Laparoscopic hepatectomy has always been one of the most difficult and risky surgeries in the whole abdominal surgery. Laparoscopic hepatectomy was first reported by American gynecologist Reich et al. [1] in 1991. A total of 3 cases were reported. The surgical method was local resection of superficial small liver tumors; Laparoscopic left hepatectomy was reported in China by Zhou Weiping [2] in 1994.

A 43-year-old female was admitted to hospital on December 30, 2008 because she found an abdominal mass for half a year with an enlargement of one month. Six months ago, the patient inadvertently palpated a mass about 7 cm ×8 cm in the right lower abdomen, but it was not paid attention to it. One month ago, she found that the mass gradually enlarged and the right lower abdomen swelled.